Tag Archives: eating disorder

We Have Met The Enemy and S/he is Us

Moana’s Archetypal Message Offers Hope and Healing… Lava Monster and All

I was very excited to see the movie Moana. But it took a long time. Life got in the way…my little one and I went to the theater twice and it was sold out…and then, finally, we saw it. I entered expecting it to be good, but by the end I was sobbing. Like many archetypal stories, this one reaches right onto your heart. And with this one, the hero is a girl. A girl who has nothing but a canoe, a friend in the ocean, and a grandmother who believed in her.

 

Everybody has a canoe, whatever your “canoe” is: the vehicle that carries you on your journey to awakening. For some it is writing, or art. For some it is meditation, 12 step, or yoga. And everyone has someone who believed or believes in him or her. (More on that later). And every one of us, no matter how far gone, disconnected, unworthy, or unforgivable we think we are, knows the truth about themselves deep down. Not the Demigod complex of trying-to-rule-the-world-because-he-feels-unworthy-so-he-is-constantly-trying-to-make-up-for-it-by-acting-bigger-than-he-is. Not that part. (Although Heaven knows there is a lot of that energy going around, and that part definitely needs both compassion and fierce confrontation). But I’m not talking about that part here. I’m talking about the deeply-humble, but most powerful intuition-heart-knowing.

In Moana, the Goddess Te Fiti is the one who held the “greatest power ever known,” who creates Life. And she shared it with the world! And yet, without her heart she began to crumble, and a terrible darkness was born.

What is thArt-HighRez-3918-3157178725-Ois power of creation?

Women have long-held the power of creation in their bodies. It’s not an accident that women with disordered eating hate or try to starve away parts of themselves that reflect this power of fertility: their hips, their stomachs (wombs), their butts. The power of fertility is profound but, in the current culture, relationship with this power is ambivalent at best. This fertile power is not just literal, it is symbolic. Archetypally, the feminine includes the Great Mother, the Earth Mother that holds the power of creation. Long ago the Venus De Willendorf embodied fertility. Hindu goddesses such as Aditi and Aitimmavaru are the mothers of the deities and laid the egg that hatched the gods Brahma, Siva, and Vishnu. In the Wiccan tradition, the Mother Goddess is sometimes identified as the Triple Goddess, composed of Maiden, Mother, and Crone. Another name for the mother goddess is Gaia, Earth Mother.

The feminine goddess archetype also holds the power of destruction, as seen in the Hindu goddesses Durga and Kali dancing on her dead consort, Siva. In Moana, this destructive force is embodied in Te Ka, the lava monster. A similar goddess in Hawaii is Pele, the goddess of the volcanoes. She is also the creator of the Hawaiian islands. This points to how interrelated these forces of creation and destruction can be.

Creation or Destruction?

Any woman with disordered eating knows, in her body, when this force of feeding life turns into a force of destroying or hurting. When eating an enjoyable bowl of ice-cream turns into frantically stuffing the entire carton in, shoveling it down so quickly so it can be violently thIMG_1539 copyrown back up, that is the destroyer. That is where feeding your own life-body turns against the self. There are many reasons for this: trauma and abuse, a family or larger culture that tells women “nice girls don’t get angry,” ambivalence and fear of becoming a women in a culture that does not celebrate the power of the feminine, and many more. We do not have rituals to celebrate becoming a woman in American culture, and so it is a time when many girls start to implode. Mary Pipher, author of Reviving Ophelia: Saving the Selves of Adolescent Girls writes: “Adolescent girls discover that it is impossible to be both feminine and adult.” And so menstruation, having a woman’s body, and speaking from the place of your inner truth become submerged, hidden, hated, and cut off.

Back To Moana

So Moana, from her childhood has this connection with herself and the world. She connects with the ocean; it “calls her.” She connects with the turtles; she connects her Grandmother’s sense of knowing something bigger than what her family and culture are telling her to be the truth. And, like many women struggling with disordered eating, wanting to be good girls, and finding their voice, she wrestles with it. She sings:

“See the light where the sky meets the sea/ It calls me/ No one knows how far it goes”*

And later

“The voice inside is a different song/ What’s wrong with me?” *

This questioning part, this part that doesn’t match up with cultural expectations needs mirroring and validation. Without it, self-destruction (disordered eating, depression, anxiety, etc) runs rampant. We all have, if we look far and deep enough, this person or Being that mirrors our inner truth in our life. It may be a teacher who “got” your art. Or it may have been an aunt who had travelled her own healing journey and was in recovery from alcoholism. If you are lucky, it was a parent. For many of us, we find this mirroring understanding in a therapist. For Moana, this was her Grandmother. Her Grandmother is the self-described “village crazy,” who doesn’t have to answer to Moana’s father (the Village Chief).

“I’m his mother – I don’t have to tell him anything!” *

This Grandmother is what Clarissa Pinkola Estes would call a “Wild Woman,” one who has power in her body. In the Hopi tradition there is a butterfly dancer. As Clarissa Pinkola Estes, PhD writes in Women Who Run With The Wolves, (Ballentine Books: New York, 1992)

The butterfly dancer must be old because she represents the soul that is old. She is wide of thigh and broad of rump because she carries much. Her gray hair certifies…IMG_1860 copy[that] the Butterfly Woman can touch everyone…This is her power. Hers is the body of La Mariposa, the butterfly.

It is not about what her body looks like – it is about listening to her feeling within:

The wilder woman will not be easily swayed…For her the questions are not how to form, but how to feel. The breast in all its shapes has the function of feeling and feeding…Does it feel? It is a good breast.

The hips, they are wide for a reason…they are portals, the handholds for love, a place for children to hide behind…

There is no “supposed to be” in bodies. The question is not size of shape or years of age, or even having two of everything, for some do not. But the wild issue is, does this body feel, does it have right connection to pleasure, to heart to soul, to the wild?…Can it in its own way move, dance, jiggle, sway? Nothing else matters.

Her “Wild Woman” Grandmother mirrors and nurtures listening-to-her-inner voice inside her body for Moana. She sings:

“You may hear a voice inside/ And if the voice starts to whisper/ To follow the farthest star/ Moana, that voice inside is/ Who you are” *

And this is the truth that guides Moana on the hero’s journey that every recovering woman must travel: Who are you?

Who You Really Are

This is the work that I engage with my clients every week: Who are you? How can you listen to your values? What does your inner Wise self have to say? How can I help you separate enough from the critical voices telling you “Stay small” or “Art is not for grown ups” or “You should do something more practical” rather than follow your dream of becoming a Nutritionist/Healer/Artist/Yoga Teacher/Environmental Educator/Women’s Advocate. This process involves separating enough from the cultural dictates and negative messages enough to hear the quiet voice inside. It is the moment when Moana, abandoned by Maui on the boat and despairing, is visited by her Grandmother’s spirit. And her Grandmother asks the question: Moana, Who are you? This is the point at which she discovers “the call isn’t out there at all – it’s inside me.”

You might be thinking “But how is this going to help in my recovery and in the world we are living right now?” Well, there certainly are a lot of “lava monsters” whose hearts have been stolen in the world right now. Where do we start? Where do I start? Where can you start? We start with ourselves. I start with myself. You start with yourself.

OLYMPUS DIGITAL CAMERAThe cartoonist Walt Kelly stated, “We have met the enemy and he is us.” Moana, in looking for the place to return the heart of Te Fiti suddenly realizes it is in her worst fear. The heart of Te Fit is inside the lava monster. But she is not afraid. Because she knows that fear, that addiction/eating disorder/lava monster/war/global warming/misogyny (as just a few examples J) are not outside her: They are inside her. And the call to awaken was always inside her as well. The call to find her true self. There is nothing to fear.

One of my favorite quotes from A Course In Miracles, A Self-Study in Spiritual Thought says:

The course does not aim at teaching the meaning of love, for that is beyond what can be taught. It does aim, however, at removing the blocks to the awareness of love’s presence, which is your natural inheritance. The opposite of love is fear, but what is all-encompassing can have no opposite.

In Moana, the, still voice of never-ending, powerful, and all-encompassing love emerges as she sings to the Lava Monster Te Ka:

“I have crossed the horizon to find you, I know your name / They have stolen the heart from inside you, but this is not who you are / You know who you are, who you truly are.” *

*Lyrics from Soundtrack to Moana (2016)

All original art work copyright Linda Shanti Mccabe

 

Feminism and Eating Disorders

Any woman who chooses to behave like a full human being should be warned that the armies of the status quo will treat her as something of a dirty joke. That’s their natural and first weapon. She will need her sisterhood. –Gloria Steinem

goddess

In honor of Eating Disorder Awareness Week, I am writing a series on Eating Disorders and Feminism. The first is a guest blog, “Full Women Have Full Feelings,” published on Psyched in San Francisco magazine. 

Have you ever been afraid of being called “The B word” (something that rhymes with
witch)? I know I have. As someone who is attuned to relational dynamics, asserting my own voice, when…

To continue reading Full Women Have Full Feelings, click HERE

 

Part two continues the topic of sexual assault followed by an exploration of how eating disorders do not only affect straight, white adolescent women. Stay tuned!

 

2 Ways to Take Care of Your Self During the Holiday Season

The holidays can be hard. They can be especially difficult for people recovering from disordered eating, alcoholism, depression, or anxiety. The intention of this blog is to help you be a bit more fierce with your own self-care and a bit more compassionate with yourself and others. This is not a list to use to beat up on yourself for not doing enough or being imperfect! May it be helpful, useful, and ease some of your suffering during this time.

  1. HALT

Try not to let yourself get too Hungry, Angry, Lonely, or Tired. Getting too tired, hungry/hypoglycemic, resentful, or isolating is a recipe for addictive behaviors and/or haltdepression. Imagine yourself to be a little one (this will not be hard for you parents to imagine) who needs regular meals and snacks, regular emotional understanding, and regular sleep. If little ones get too tired/hungry/emotionally not heard, there will be meltdowns. Be a kind parent to yourself. Pack a self-care bag with protein snacks, water, get to bed on time, make plans with friends and/or providers that “get” you so you can feel nourished and grounded. Practice what a friend of mine calls “aggressive self-care.”

2. Keep 1 Thing Constant

Choose one thing – morning meditation, weekly support group, your meal plan, sobriety, journaling, daily inspirational reading. Whatever it is, just keep coming back to this.

A Word About Kindness and Self-Compassion

The intention here is to help you be a bit more fierce with your own self-care and a bit more compassionate with yourself and others… not to beat up on yourself for not doing enough or being imperfect. So if you HAVEN’T kept one thing constant, just restart it. And when you notice you haven’t kept your thing – whatever your thing is that keeps you grounded and sane – constant (We all fall off the wagon on this. It is part of being included in humanity.), notice with kindness and compassion. Imagine you are a puppy. Gently pick yourself up from the place where you are being unkind to yourself and bring yourself back to the place where you are being kind. Gently bring yourself back to the thing that helps you. Just keep coming back.

 

What You Need to Know About Pregnancy and Eating Disorders: A Podcast

In introducing this month’s Butterfy Effect theme of CONNECTING, I am honored to share an interview by the founder of Recovery Warriors, Jessica Raymond, MS. Recovery Warriors is a multimedia resource hub for hope and healing from an eating disorder. Here is a link to the podcast: RecoverywarriorsPodcast

An overview

The desire to become a mom can be a motivating factor in eating disorder recovery. However,the challenges of pregnancy and the postpartum period mirror the early stages of recovery. Both pregnant and new mothers and women recovering from eating disorders experience anxiety, body image distress, difficulty sleeping, hormonal changes, appetite changes, and ambivalence/excitement/distress around cultivating a new identity. In this episode of The Recovery Warrior Show, expert Dr. Linda Shanti shares personal and professional stories of recovering from an eating disorder and entering into motherhood. Listen in regardless of where you are at in the biological cycle because there is much to learn.

What You’ll Learn

  • Why people don’t talk about miscarriages
  • How pregnancy is similar to early stages of recovery
  • Why you need to be proactive in seeking professional help before having a baby?
  • Why how a mother eats affects her child
  • Is there a right time to have a kid

 Favorite Quote

The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new. -Bhagwan Shree Rajneesh

Advice to Former Self

You’ll get through this honey, you will. It’s going to change you and it is changing you and that’s ok; that’s the way it’s supposed to be. There’s no parallel life that you’re supposed to be leading; this is it, this is not a detour. Just because you’re suffering doesn’t mean you’re on the wrong path; you’re absolutely on the right path. Keep going.

Definition of Recovery

Taking care of yourself physically, emotionally, psychologically, and spiritually. Not engaging in behaviors that hurt me. Moving toward growth edges. Accepting my body as it is. Allowing and inviting all feelings. Lowering the bar on perfectionism. Thinking in the rainbow between black and white. Listening to my heart and connecting with a larger purpose.

FullSizeRender-4 copy

 

5 Things Moms Can Do to Prevent Eating Disorders

I recently gave a talk for parents on Eating Disorders and what parents wanted to know most was: How do I prevent my child from developing an eating disorder?

Here are five things you can do (and some you can be conscious of NOT doing) to assist with preventing your child from developing an eating disorder:

  • 1. DON’T Diet. 

Diets don’t work. This has been proven again and again. Here are a few scary statistics:

*95% of all dieters will regain their lost weight in 1-5 years (Grodstein, Levine, Spencer, Colditz, & Stampfer, 1996; Neumark-Sztainer, Haines, Wall, & Eisenberg, 2007).

*80% of 10-year-old girls in America have dieted to lose weight. (Bates, 2016)

And yet

Women who were put on diets as young girls are more likely to struggle with obesity, alcohol abuse and disordered eating as adults. (Keel, 2014).

*35% of “normal dieters” progress to pathological dieting. (Shisslak, Crago, & Estes, 1995).

  • 2. DO eat intuitively.

Intuitive eating can be summarized by: relying on internal cues for hunger and satiety, eating for physiological rather than emotional reasons, having no dietary restrictions/unconditional permission to eat, and body size acceptance (Tribole, and Resche, Intuitive Eating A Revolutionary program that Works, 1995, 2012). Listen to your own hunger and don’t restrict. Give yourself permission to enjoy eating!

  • 3. Take care of your own body image.
body ruffle.jpg

The Onion, Aug 25,2014

Be mindful that you are your child’s mirror. You may be tempted, as I saw in a humourous newspaper wear a “Mom’s Bathing Suit as One Giant, Body-Ecclipsing Ruffle.” You many gaze disgustedly in the mirror at your postpartum muffin top.  Postpartum body image and ageing can be brutal. However, don’t allow yourself to buy into the culture’s message around self-worth being tied to “getting your postbaby body back in shape.”

A) Your postpartum body will never be the same shape. You grew a baby in there.

B) Your worth is bigger now. You have been changed by life. Try and embrace and radically accept that. Be proud of your tummy like your child is proud of theirs. You are beautiful because of the life you have lived and your body reflects that: all the scars, stretches, and wrinkles. A wizened tree does not Botox itself to look like a skinny leaf-sprout. Be the tree that you are proudly (or, on a bad day, good-enough).

  • 4. Follow the “Division of Responsibility” when feeding your child.

FullSizeRender-4 copy 3Briefly, the division of responsibility is: The parent is responsible for What, When, and Where you eat. The child is responsible for How much and Whether they eat. This is based on Ellen Sattyr’s work. To see a handout on this, click here

I know it can be hard to trust that your child WILL choose to eat vegetables. But it CAN and DOES happen. See this amazing transformation in my own little one, who used to only eat anything soft and white. Notice how one carrot and two bits of pepper have grown into a plate almost entirely filled with vegetables!

FullSizeRender-4(By the way, DO respect sensory sensitivities. If your child prefers soft texture, make soft texture food and gradually without a fight and making it fun introduce other textures.) And, remember: there are no bad foods. Kids need carbs and fat, and so do you. They help you have enough energy, they feed your brain.

  • 5. Allow all feelings in your family (especially uncomfortable ones like anger, fear, and shame).

Low tolerance for negative affect has been shown to be one of the factors contributing to eating disorders. What does this mean? It means, in order to create an environment where your child willFullSizeRender-4 copy not feel they have to hide or stuff parts of themselves in order to be loved, you have to allow discomfort. Anger is a tough one. Most people error in one direction (rage at others) or the other (blame self and stuff into depression). Work on expressing anger at the level of irritation before it gets too overwhelmingly big. Have weekly family meetings. If you get in a fight with your partner, make up and show your child you have made up so they can see people re-unite after being mad at each other. When your child is mad, don’t withdraw your affection. Notice: “I see you are mad. I’m going to help you. I love you even when you are mad. You can hit the pillow, but not me. I’m going to stay with you until we work this out.” Allow fear. Allow insecurity, embrace imperfection. When someone makes a mistake in our house, we say “Yay! I made a mistake!” This is not my natural inclination. The natural inclination with shame is to hide it. Sweep it under the rug quickly! Pretend-like-you-know-what-you-are-doing-before-you-get-in-trouble-or-someone-sees-that-you-are-a-fraud! Don’t do this. Turn toward your own and your child’s imperfections and growth edges. Growing requires failing, and failing, and failing before succeeding. Support your child in practicing new skills. When your little one is learning to walk and falls down, you say “Hooray! Try again!” Continue to do this with yourself and your little one. Again and again.

It is possible to prevent eating disorders. And it is also possible to build a strong protective factors so that if your child develops one, they can recover with more ease. Do what you can. Eating Disorders are complex and develop from a unique and individual interplay of many factors. Eating disorders are no-one’s fault, but everyone’s responsibility. Prevention and recovery are possible.

 

Trapped faces and family Roles

Are you a salsa dancer? Free form? Do you watch from the side and “don’t do dancing”? All family systems have a dance and all family members play a role. There is nothing wrong with this, unless you find yourself square dancing when you prefer salsa or if you are being called to lead a partner dance with your parent and you are 5-years-old.

My preschooler recently was at the “small manipulatives” table at preschool and made this:

Trapped Faces and Family Roles

He called it “Trapped faces.” Though I am 95% sure this was not his intent or interpretation, it did remind me of what can happen in family systems when individual members carry certain emotions, roles, or characteristics for the family. When everyone is not allowed to have all aspects of their human experience, certain aspects of being human can become trapped in individuals. Some of these may include being: the responsible-one, the one-who-is-depressed, the angry-raging-one, the one-who-takes-care-of-everyone–else, the-one-who-is-creative, or the one-who-achieves or-looks-good-for-the-family.

Below is a list of family roles that children often adopt (based on the work of clinicians Virginia Satir, Claudia Black and Sharon Wegscheider) summarized beautifully by Laura Doughty, LMHC:[i]

The Hero

The hero is the responsible, accomplished one. She gets good grades in school, is goal oriented and self-disciplined. Externally, she appears successful and together; internally, however, she bears the burden of making the family look good. She holds the belief that if she is perfect enough, the family problems will go away or be solved.

The People Pleaser

The people pleaser tries to ease and prevent any trouble in the family. She is caring, compassionate and sensitive. She also denies her own needs, and, as a result is anxious and hypervigilant.

The Scapegoat

The scapegoat is the family member who is blamed for the trouble in the family. She acts out her anger at any family dysfunction and rebels by drawing negative attention to herself. While she is more in touch with her feelings than the other roles and is often creative, in school she gets poor grades and is often in trouble.

The Mascot

The Mascot is the class clown with the uncanny ability to relieve stress and pain for others. But there’s something missing that he won’t find until he looks beneath the humor façade and faces his own pain.

The Lost Child

The Lost Child is quiet, withdrawn, lonely and depressed. She doesn’t draw attention to herself because she doesn’t want to be a burden. But what she wants most is to be seen and loved, and to be healthy, she must allow herself to be visible.

Many family systems “roles” also include the Alcoholic/Addict and the Caretaker/Codependent. The Codependent often tries to prevent the alcoholic from experiencing consequences of their behavior and cares for others at the expense of themselves.

New Roles

In my clinical practice, I often see aspects of all of these family roles and “trapped faces” in adults. Many recovering anorexics identify with the hero child or the people pleaser, many bulimics or alcoholics can see the mascot or the scapegoat in themselves. Adult children of alcoholics may see the lost child in themselves. In the process of recovering from an eating disorder, depression, anxiety, codependence, or alcoholism, there needs to be room to include allowing ALL aspects of yourself. That doesn’t mean you have to act it out all of these roles. If you’ve never expressed anger, it doesn’t mean you need to start raging. However, it does mean that you allow yourself to own parts of yourself that may not have been able to develop in the “trapped-ness” of your family system.

If you were the scapegoat as a child, you can now see, embrace and practice as an adult that you have hero responsible, leadership qualities as well. You have skills that are valuable and you are not the problem. If you played the role of the hero as a child, you can consider getting a B+ or even failing a class as an adult, just to practice imperfection and seeing the world doesn’t fall apart if you don’t get an A. It means you allow yourself to have aspects of being angry, sad, happy, carefree, irresponsible, responsible, pleasing, rebellious, and creative.

The Past and the Present

My clients often ask me: “But what if my mother/father/family member boss/husband doesn’t change? How can I?” The answer is that YOU can embrace all of your human experience, whether or not your mother/father/other family member does or does not. That can be challenging and difficult, especially if they want to trap you into staying in the role that is most comfortable for them to be playing within the family system. As a child, you didn’t have much of a choice. Your survival depended on fitting into your family system to have your needs get met. As an adult you have other choices. That is where recovery is simple but not easy. Emotionally, it feels like you don’t have choices and you need to continue being the Hero/Scapegoat/People Pleaser/Mascot/Lost Child. Time does not exist in the emotional world, so your inner child will feel as if it needs to keep playing that role.

That is where you can bring your newly growing conscious adult self in and practice differently. You may need to risk shaking up the family system in practicing a new dance. If your family system is used to a precise salsa or ballet dance and you start practicing a chaotic free form dance, it may not be welcomed. Nobody in your family knows the steps to that dance. Do not be surprised if you encounter resistance.

The Gift of Resistance

I recently heard a Zen teaching about a master and a bird. The master was holding the bird on his finger and the bird was learning how to fly. If the master dropped his finger down quickly, the bird would fall, and need to be caught. If the master held his finger still, the bird could practice jumping off his finger and flapping its wings in order to develop strength. This allowed the bird to fly.

Externalizing Parts of Yourself to get free of them

One way to release feeling trapped/stuck in playing only one role regardless of whether members of your family system change is to externalize them through art, writing, or drama and see what wisdom they have to share. These parts of yourself are often “protecting” vulnerabilities that were too scary to be seen as a child but can now offer wisdom as an adult. They also hold strengths that can offer you help in your life currently. The “Lost Child” part of myself is the one that makes art and studied to become an expressive arts therapist. Here are some examples of my own and some of my clients’ soulcollage® card collaged images (shared with permission). Soulcollage® is a process of making a whole deck of collaged cards, each card representing one aspect of your multifaceted Self.IMG_1564

Addiction

I am your addiction. No matter what it is: food, pills, worry, it will never be enough. Feed me and I will want more.
Listen to me; believe me and I will take over. Listen to me, but know that there is fear underneath that needs tending, and I will get smaller and not run your life.

Body image stomach in knots.

I am one who has pain internally and believes all others can see it. The wisdom I have to offer you is that this pain is not something you can avoid or run away from. There will always be pressure. If you aIMG_1423ccept that I am here, I can offer you ways to own your power and listen to your gut.

Postpartum Depression

I look like I have it, all but there is part of me lying on the couch hiding all the time. I want to go to sleep. I can’t be perfect. Not even going to try.

The wisdom I have to offer is that you can no longer overachieve. This is the ultimate experience of practicing imperfection and asking for help. Let someone see me and you may find you are not alone.

Creating Recovery Families

Last but not least, many recovering people find they need to create a “recovery family” to help them practice new roles. This can be a collection of recovering friends, your therapist/treatment team, a 12-step sponsor or other people who embrace and welcome all the parts of you and themselves. These are people who want to help you practice new roles, want to help you learn how to practice imperfection if you are recovering from perfectionism or playing the hero or practice taking leadership steps if you are more familiar with being a scapegoat or lost child.

Where in your personal relationships, work life, home life currently are you playing the same role over and over? Where can you embrace the strengths that some of your more familiar roles offer? Where can you risk bringing in another part of you?

[i] “The Effect of Family Roles on Life’s Choices” Laura Doughty, LMHC, Thriving, A Journal of Well being, Spring 2010.

What causes an Eating Disorder or Depression and if I have it, is my child doomed to have it, too?

IMG_1691

The short answer? “It’s complicated.”

The longer answer: Genetics and temperament both play a strong role in the possibility of Depression or an Eating Disorder developing, but do not determine it.

The hopeful answer: Even if your child develops an Eating Disorder or Depression, it is possible to recover.

In this post, I will look at some of the risk factors that can lead to an Eating Disorder or Depression.

Eating Disorders: Are they inherited?

Eating Disorders develop as a combination of genetic vulnerability combined with temperamental traits and a facilitating environment. Some (but not all) risk factors named in Carolyn Costin and Gwen Schubert Grabb’s book 8 Keys to recovery from an Eating Disorder (W.W. Norton, 2012) that can contribute to developing an eating disorder include:

  • being overweight or dieting as a child
  • having a mother who diets or has an eating disorder
  • early menstruation
  • being bullied or teased
  • engaging in sports or activities with a focus on appearance or weight (for example ballet, cheerleading, ice skating, wrestling, gymnastics, modeling)
  • a history of childhood abuse

In a 2000 study in the American Journal of Psychiatry, results showed that anorexia nervosa has a heritability of 58%, but the authors were unable to rule out the contribution of environment. However, they did conclude that genetic factors influence anorexia and contribute to comorbidity of anorexia and depression.

Along with genetic links being discovered with both anorexia and binge eating, certain temperamental traits tend to foster the birth of an Eating Disorder. Ovidio Bermudez, in presenting at Eating Disorder Recovery Services conference* this past year discussed the following temperament traits as those at risk of developing an Eating Disorder:

  1. Anxiety, Depression, or OCD
  2. Low stress tolerance
  3. Low distress tolerance
  4. Sensitivity to real or perceived injury

So in other words, if you have a sensitive child who struggles with tolerating “distressing” feelings such as sadness, anger, or shame and you (or a family member) struggle with Depression, Anxiety or OCD, the ground is fertile for the seed of an Eating Disorder to sprout.

What about Depression?

At least 10% of people in the U.S. will experience Major Depressive Disorder at some point in their lives. According to statistics, two times as many women as men experience major depression. (There is a lot to be said there in terms of mis-diagnosis of symptoms, gender bias, and who reaches out for support to mental health professionals, that can affect these statistics, but that is for another blog.)

According to two Stanford doctors writing about genetics and brain function, genetics play a strong role in causing Major Depression (Levinson, Douglas F. M.D. and Nichols, Walter E. M.D., Professor in the School of Medicine Department of Psychiatry and Behavioral Sciences, Stanford, 2015). They write:

  • The heritability (or percentage of the cause due to genes) is probably 40-50%, and might be higher for severe depression.
  • The situation is a little different if the parent or sibling has had depression more than once (“recurrent depression”), and if the depression started relatively early in life… the siblings and children of people with this form of depression probably develop it at a rate that is 4 or 5 times greater than the average person.

What else contributes to Depression? And what about Postpartum Depression?

Stressful life events (trauma, loss of a loved one, moving/loss of support, having a baby) can lead to depression in and of themselves. When combined with a genetic risk, there is a stronger possibility of developing depression. And having one (or more) episode of depression increases the risk of having future episodes. (Kendler, Thornton, and Gardner, 2001)

While many women experience some mild mood change or “the blues” during or after the birth of a child, 1 in 7 women (and some recent research says 1 in 5) experience more significant symptoms of depression or anxiety. 1 in 10 Dads become depressed during the first year. (Postpartum Support International)

Risk factors for Postpartum Depression

Some women are more likely than others to develop Postpartum depression. The following factors put you at an increased risk:

  • Previous history of depression
  • History of severe PMS or premenstrual dysphoric disorder
  • Medical complications for you or your baby
  • Lack of support from family or friends
  • A family history of depression or another mental illness
  • Anxiety or negative feelings about the pregnancy
  • Problems with a previous pregnancy or birth
  • Marriage, Relationship, or money problems
  • Stressful life events
  • Substance abuse

How does Postpartum Depression impact children?

Postpartum Depression and other Perinatal Disorders (Anxiety, OCD, Psychosis) can affect children in the following ways:

  • Behavioral Problems
  • Delays in Cognitive Development
  • Emotional Problems and/or Depression

 According to Zero To Three, a research-based resource for federal and state policymakers and advocates on the unique developmental needs of infants and toddlers, untreated Depression can have detrimental effects on children’s functioning and future outcomes (2009).

The mental health of parents can affect young children… infants of clinically depressed mothers often withdraw from caregivers, which ultimately affects their language skills, as well as their physical and cognitive development. Older children of depressed mothers show poor self-control, aggression, poor peer relationships, and difficulty in school.

and

Unlike adults, babies and toddlers have a fairly limited repertoire of responses to stress and trauma. Mental health disorders in infants and toddlers might be reflected in physical symptoms (poor weight gain, slow growth, and constipation), overall delayed development, inconsolable crying, sleep problems, or aggressive or impulsive behavior and paralyzing fears. Early attachment disorders predict subsequent aggressive behavior. Some early mental health disorders have lasting effects and may appear to be precursors of mental health problems in later life, including withdrawal, sleeplessness, or lack of appetite due to depression, anxiety, and traumatic stress reactions.

So, if you have had or are currently suffering with and through (because it is possible to recover and get through it) an Eating Disorder or Depression, your child does have risk. But that does not mean they are doomed. It means, even more important than ever, that you get treatment and recovery yourself! When I attended Postpartum Support International’s training on Perinatal Mood Disorders, the message that they gave was: There is Hope and You are not alone. It is possible to recover and in recovering yourself, you help build a more protected base from which your child can thrive and grow. 

References/Resources:

Wade, Tracey D, Ph.D., Cynthia M. Bulik, Ph.D., Michael Neale, Ph.D., and Kenneth S. Kendler, M.D., “Genetic and Environmental Risk Factors Anorexia Nervosa and Major Depression: Shared Risk Factors,” Am J Psychiatry 2000; 157:469–471.

Eating Disorder Recovery Services The mission of EDRS (Eating Disorder Recovery Support), Inc. is to promote recovery and wellness for those impacted by eating disorders by providing support, information, and education to individuals, families, professionals, and the community at large regarding eating disorders and recovery resources. EDRS.net

Ovidio Bermudez, MD Dr. Bermudez has lectured nationally and internationally on eating pathology across the lifespan, obesity and other topics related to pediatric and adult healthcare, and has been repeatedly recognized for his dedication and advocacy in the field of eating disorders.  eatingrecoverycenter.com

“Major Depression and Genetics” Douglas F. Levinson, M.D. and Walter E. Nichols, M.D., Professor in the School of Medicine
Department of Psychiatry and Behavioral Sciences (2015) Depression and Genetics

Zero To Three The Zero To Three policy Center is a nonpartisan, research-based resource for federal and state policymakers and advocates on the unique developmental needs of infants and toddlers. zerotothree.org

Link to Depression during and after Pregnancy Fact Sheet

Perinatal Depression Fact sheet

Link to study on teaching sleep with infants to prevent Postpartum Depression:

postpartum+depression+sleep

Link to study on effects of Lexipro on treatment of Postpartum Depression:

clinical trials postpartum+depression

Using Soulcollage to Re-find Wisdom in Your Body

The body has been made so problematic… that it has often seemed easier to shrug it off and travel as a disembodied spirit.

Adrienne Rich, Of Woman Born

Who among us in this culture of busy-ness to get-things-done, has not consciously or unconsciously thought life would be so much easier  if we didn’t need to tend to this human body with all of its needs, desires, and dis/comforts?

A Mother’s Body, The Earth’s Body

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I am the small, furry animal in your heart. Please slow down and listen to me. Get down on my level. Listen to the drumbeat that I follow.

Yet the body, our human bodies, the earth body on which we live, are what give us life and sustain us. We all come from, grew in, a body, a mother’s body and we all return to a body, this planet’s body, when we die. Coming back to this body, these bodies, are essential to fully living the original duality of life: we are all born, we will all die. The body remembers the past and creates the future. The body, every person’s body, your body, is actually made from the stars of the cosmos, starts that collapsed in the past:

Every single cell in our bodies contains elements created in the burning center of a collapsing star — from the iron in our blood to every bit of calcium in our bones and keratin in our hair. That’s because in the very early days of the universe that followed the Big Bang, only the simplest elements existed, like hydrogen.

In the words of the celebrated astrophysicist Neil deGrasse Tyson  “We are not just figuratively but literally made of star dust.” 1

And yet so many of us walk around thinking of our bodies as a slow burden to carry our minds around. As a Psychologist, I have compassionate awareness for people who have experienced trauma have a tendency to avoid felt-sense in their bodies. There is good reason for this: trauma is painful, we are not meant to experience that much pain, and to survive we often leave our bodies during the pain. Learning to re-enter the body and feel safe there is a journey that requires fiercely compassionate attention, often with a safe (therapist) guide assisting the process. Women and men recovering from eating disorders often have sensitive dispositions that, if not “leaving” or numbing feelings in the body through eating disorder behaviors, require building up the capacity to tolerate distress in the body. People who find themselves “living in their heads” can also find that re-entering the body actually brings a sense of peace that accomplishing “more” can never provide.

Finding Animals in Your Body

What? No, I’m not talking about parasites. I’m talking about a fun way to return to, explore and invite what your body has to say to you, without judgement. That is the beauty of expressive arts work- it uses the right brain to invite the body back in while bypassing the left brain’s “gatekeeping.” Expressive art can be a vehicle for you to come back to your body in a fun, playful and safe way.

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I am your headache in your third eye. I wan to fly away. Release me.

Soulcollage(R) is an expressive arts process developed by Seena Frost, MFT, in which you make a deck of collage-d cards, each card representing an aspect of your multifaceted self.  Finding an animal, in the soulcollage process, includes being guided in a meditation through the different energy centers in your body to see what animal being lives in each of them.

When doing the process of finding an animal in each of the chakras in the body, it is not a literal, but an imaginal process. Because of this, it can be a fun and inviting way to curiously explore wisdom in the body.

When I work with women recovering from disordered eating, who often hate their stomachs, they find wisdom and joy again when they find an animal in their solar plexus. “I hate my stomach,” after discovering a tiger, becomes “I own my power, hunt for what feeds me, and am  fiercely clear about my intentions.

I am a snake in your belly. If you listen to me, you will own your power. If you don't, you may destroy yourself.

I am a snake in your belly. If you listen to me, you will own your power. If you don’t, you may destroy yourself.

But what if I don’t find an animal, find more than one or find one that I don’t like?

There are no wrong ways to find or not find an animal. Because this is an imaginal process, it is in Rumi’s mystical field “beyond right doing and wrong doing.”  When I was guided through this meditation in the soulcollage facilitator training, we were directed to find an animal in our fifth chakra, the center of expression located in the throat. I found a horse in my throat. First there was a hummingbird, then it flew away, then a horse appeared. Now, I don’t have anything against horses per say, but I really didn’t WANT  to find a horse. I would have preferred the hummingbird. Hummingbirds are beautiful magical gems flying through the air and humming! Horses are clunky, big, and snort. But because this was an imaginal process that was fun, I was able to let go of baggage/judgement about a horse vs a hummingbird. I got curious and asked what the horse had to offer and why it appeared. Turns out that it had a wealth of wisdom to offer me about letting my intuition lead the way in my life. This horse told my anxiety-mind that was obsessing over a particular Psychological licensing obstacle at the time: “Let go and trust that I can get you there quicker.” It basically told my mind to get back onto and into the “horse” of my body and relax.

In my training as an Imaginal Psychologist, we learned that “psyche” comes from the Greek word meaning soul. And so psychology is actually about the soul, bringing the soul back. The soul lives in the body, as well as the mind. There is no mind-body split from this perspective. There is an invitation to return to the place where your mind, body and soul are aspects of a unified YOU. I love this quote from Clarissa Pinkola Estes in her wisdom of what returning to your body can bring:

I saw again what I had been taught to ignore, the power in the body. The cultural power of the body is its beauty, but power in the body is rare, for most have chased it away with their torture of or embarrassment by the flesh… the wildish woman can inquire into the luminosity of her own body and understand it not as a dumbbell that we are sentenced to carry for life, not as a beast of burden, pampered or otherwise… but a series of doors and dreams and poems through which we can learn and know all manner of things. In the wild psyche, body is understood as a being in its own right, one who loves us, depends on us, one to whom we are sometimes mother and who sometimes is mother to us.                                             

-Clarissa Pinkola Estes, PhD, Women Who Run with the Wolves

References:

1 “Every cell in your body is infused with the collapse of a star,”   May 21, 2014.

2  “The Seven Chakras for Beginners” Mind Body Green, October 28, 2009.

Resources:

Soulcollage.com

DrLindaShanti.com or email Linda@DrLindaShanti.com (for soulcollage workshops!)

When is it Emotional Eating and when is it Disordered?

I once heard the anecdote that if you eat something and eating more of it makes you even more hungry, it is probably mouth hunger. In eating disorder recovery, the terms “mouth” vs “stomach” hunger are often used, mouth hunger referring to hunger that is more about emotions and stomach hunger referring to hunger that is more about physical hunger. I remember in my eating disorder 16 years ago, I would eat an entire pint of ice-cream and be even more hungry afterward. In clinical research and practice, emotional eating is often defined as eating is response to negative affect (depression, anger, anxiety) and gets correlated with binge eating. For those of us recovered, recovering, or wanting to recover from disordered eating, we know all to well what emotional eating is. Or do we? Emotional eating is not necessarily a pathological symptom to “get rid of,” nor is it limited to those struggling with eating disorder recovery. I tell my recovering clients if eating were devoid of emotional connections, then people would eat food pellets at every meal. Almost all eating has an emotional component to it. Ellyn Satter, Registered Dietitian, Family Therapist, and internationally recognized authority on eating and feeding writes:

“Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good…It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.”  1

What is the difference between normal eating, emotional eating, and disordered eating?

That is the 10 million dollar question! I remember early in my eating disorder recovery, I needed to have some guidelines around meals in order to know what “normal” eating was- I had been so dis-connected from normal eating and it had been so long since I had felt able to trust myself. A “meal” in my eating disorder could be ice-cream with a bag of cookies or a bowl of broth. Neither of those took into account my stomach hunger, my body, or frankly, my emotions. I was either bingeing or starving not only my body but my emotions. It was like I was letting the fearful, angry toddler inside of me prepare all of my meals. In my recovery, I needed to have some guidelines around eating that helped me include my physical and emotional needs. These included guidelines such as: eating every 4-5 hours, eating a variety (at least 3 food groups) of foods at each meal, not eating the same thing every day (variety), and allowing dessert. It also helped me to establish some food recovery “bottom lines” that included: no bingeing, no restricting (skipping meals, avoiding food groups), no isolating while eating, and no purging.

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Being a mom of a toddler myself now, I can see firsthand how toddler food preferences don’t necessarily veer toward vegetables and prefer sweet tastes such as cookies or ice-cream. There is a reason for this! As one Nurse Health-educator points out, “newborns are born with innate taste preference for sweet, rich, and fatty flavors and naturally reject sour or bitter flavors. This is mother nature’s way of ensuring that a newborn will accept the sweet and rich flavor of breast milk.” 2 So how does a parent deal with a toddler wanting to eat only cookies? Interestingly, guidelines to eating disorder recovery are similar to those presented to parents feeding picky childhood eaters: eat together, serve three foods, don’t force cleaning one’s plate or eating vegetables in order to get dessert, allow choice while pairing trying new foods with familiar foods. 2

But what about the emotions that I’ve been starving or bingeing?

That is where the good news and the bad news is it’s not about food. That is where no food can attend to the anger, sadness or fear that is crying for your attention. As Geneen Roth’s sign on her refrigerator states “It’s not in there.” That is where moving toward rather than away from those feelings, with tenderness rather than avoidance or aggression, is the only way out. That is where I call in the principle of what in yoga is called “ahimsa,” or non-violence toward the self. In medicine and therapy, it is referred to the principle of do no harm. It is what being a good parent, one that is emotionally aware, does with grace. Geneen Roth, asks the following questions:

“Can you imagine how your life would have been different if each time you were feeling sad or angry as a kid, an adult said to you, ‘Come here, sweetheart, tell me all about it?’ If when you were overcome with grief at your best friend’s rejection, someone said to you, ‘Oh, darling, tell me more. Tell me where you feel those feelings. Tell me how your belly feels, your chest. I want to know every little thing. I’m here to listen to you, hold you, be with you.’  All any feeling wants is to be welcomed with tenderness. It wants room to unfold. It wants to relax and tell its story. It wants to dissolve like a thousand writhing snakes that with a flick of kindness become harmless strands of rope.” 3

     As you are considering emotional eating or disordered eating, I invite you to go deeper with these questions. What would it be like to bring even a tiny bit of kindness and some fiercely advocating compassion to yourself? Even for a moment? Even one moment of kindness can make a timeless amount of difference…Before my very last binge 16 years ago, I stopped before I went into the corner store to buy ice-cream. I thought of all the women struggling with the same feelings of sadness, overwhelm, and fear that I was struggling with in that very moment. I had the visceral experience of compassion. I held my own hand and I said “Honey, it’s not in there.” The tears started flowing, and I finally turned a corner.

Resource references:

1. http://ellynsatterinstitute.org/hte/whatisnormaleating.php

2. http://www.healthy-start.net/

3.  http://www.oprah.com/health/An-Excerpt-from-Geneen-Roths-Women-Food-And-God

 

 

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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