Merry Binge-mas: Why I Wrote A Dark Comedy About My Eating Disorder

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By: Angela Gulner

Some may find it odd, insensitive, or tasteless, even, (pun intended) that I (and my teammates at HLG Studios) chose to launch our crowdfunding campaign ( to fund Binge, a dark comedy inspired by my decade-long struggle with bulimia, the Monday after Thanksgiving. Thanksgiving. The day you’re basically required to have an eating disorder.

Um, no thanks, two pieces of pie were eno–WHAT!!!! What is wrong with you?! It’s Thanksgiving! Why do you hate Thanksgiving? Do you hate America, Angela, is that it? Do you? Do you? No, I don’t hate America, Uncle Pete, I’ll have another piece of pie.

If you don’t feel like vomiting after Thanksgiving Dinner (and dessert, and second dinner, and second dessert) then according to society, you’re just not doing it right. So, by that measure, Thanksgiving should be a great day to be bulimic, right? The entire country is bingeing. Your behaviors, on this day, are normal, glorified, and insisted upon (minus the purging part, that’s still considered ‘effing gross’). But for me, Thanksgiving was one of the most painful days of the year.

I think what so many outsiders don’t understand is that we don’t want to be bulimic. At least, I didn’t want to be bulimic. Bulimia isn’t fun. It’s ugly. It’s embarrassing. It’s animalistic. And bulimia doesn’t usually cause weight loss, so we don’t get the positive social benefits that anorexics get (wow, that’s hella fucked up – anorexia is rough, too). We hate ourselves and we hate our bulimia, even while we’re addicted to it. Like many bulimics, I’d often go into a trance-like frenzy where I couldn’t see clearly. My heart would pound, time would blur, and then a few hours later, I’d realized I’d just consumed my entire kitchen pantry. But I didn’t want to. What I wanted – what so many bulimics want – was to eat nothing at all.

For me, the days leading up to Thanksgiving were filled with crippling anxiety, constant dread, and obsessive planning. Weeks in advice, I’d map the entire day out for myself– what I’d eat, and when, and how slowly. How would I manage to: 1. Eat as little as possible while still 2. Appear totally normal and happy without 3. Triggering a binge so I wouldn’t need to 4. Puke my fucking guts out in the basement toilet. But every year of the ten I struggled, when Thanksgiving day arrived, my well-crafted plan backfired. I’d be 15 minutes in, with a respectable vegetable medley resting on my tiny plate, take a sharp left turn at the cookie tray, and be hunched over the toilet before Halftime.

Bulimia is a vicious cycle. And regardless of how it appears, bulimics are not choosing to partake in it. Now, I’m not a dietician, or a doctor, or a therapist. But I spent ten years, a shit ton of therapy, and two rounds of treatment in that cycle and I have learned a lot. Eating disorders change your brain chemistry and your body’s physiology. With bulimia, despite the massive quantity of food consumed during a binge, purging and frequent starvation between episodes means one is generally malnourished. And when you’re malnourished, you’re depressed. You just are. Your brain doesn’t have what it needs to fire correctly. When you’re malnourished, your body kicks into “survival mode”. It tries to save itself…by eating. By eating a lot, as quickly as it can. Because it doesn’t know when it will next be fed, and it doesn’t know how long it will have that food once it gets it. But when the binge ends, those survival instincts disappear. The bulimic is left alone, physically ill and emotionally devastated. I can’t believe it happened again. I said it would never happen again. I’m a failure. I’m an idiot. I’m a pig. I suck.

The shame and fear is too much. We purge. And the cycle begins again.

Bulimia – and eating disorders in general – are so often thought of, by the general public and by those who suffer, as emotional afflictions. Deficiencies. Vanity gone too far. Maladaptive behavior patterns caused by some trauma, or ineffective coping mechanism. And while that’s definitely (sometimes) part of it, it’s not the whole story. Our bodies are at work here, too. And the longer we’re in the bulimic cycle, the harder it is, emotional and psychologically, to break out of it. Ending the cycle, for many, is beyond what we are capable of without outside interference. Only when the body and brain get steady, uninterrupted nourishment can the cycle be broken (and can the underlying emotional traumas be worked through).

This whole tangent is all to say — there were a shit ton of mechanisms at work for me during my bulimic Thanksgivings. And the self-hate, the shame, and the failure I felt wasn’t fair. My bulimia was beyond my control. I wasn’t weak. I wasn’t selfish. I wasn’t a pig. I was trapped. And it really fucking sucked.

…so if it was all so terrible (honey, it was), then why? Why make BINGE, a webseries about the pain and strife that comes with these afflictions? Why ask for donations to create a show about this illness? Because 30 million people in the US alone suffer from eating disorders. Because in many countries around the world, there is no talk of eating disorders at all, so thousands suffer in silence. Because eating disorders have the highest mortality rates of all mental illnesses, and yet there is very little representation of them in the media. Because this community shouldn’t have to feel alone.

We released BINGE ( a year ago, and over half a million people have seen it, all over the word. We have received thousands of emails from men and women who have been moved by the show, who have learned something about their friends or their loved ones, and who want to fight the stigma surrounded these illnesses. I hopes that the show helps you get you through your struggle.

You’re not alone. You’re not a freak. You’re not a pig. You’re a badass. You’re going to get help, and you’re going to kick this thing. For those of you who don’t struggle in this way, I hope BINGE gives you some understanding of what is going on with those who do. Even if you don’t know it, you know someone who’s hurting in this way. And your compassion can make a shit season a little less shitty.

Keep fighting!

( If you’d like to get involved with our crowdfunding campaign, click here: )


Angela Gulner is a writer, actor, producer, and recovering bulimic. She co-created the dark comedy BINGE, inspired by her decade-long struggle with bulimia. She also co-hosts the feminist comedy podcast Welcome to the Clambake. Follow her on Instagram, @gulnatron and Twitter, @angelagulner.

Open Letter to my Eating Disorder

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By: Anonymous

An open letter to my eating disorder:

Dear Eating Disorder,

I know we have a love-hate relationship. I know that since we met four years ago we’ve had our share of ups and downs. We’ve had seasons of being the best of friends, and seasons of being frustrated and angry with each other.

It started out well, our friendship- it started out with you promising me that if I listened to your “requests” that my life would be better for it. I believed you wholeheartedly, and now? Now I regret it.

Friendships are not supposed to cost me time with my family, enjoyment of holidays and birthdays, happy memories, being able to work and live on my own. Friendships are not supposed to send someone to the hospital because their “friend” is slowly killing them. Friendships are not supposed to be one person giving in to endless cruel demands of the other. But that is what was happening.

Eating disorder, you are a liar. You feed me lies and convince me not to feed myself, and for a long time it has worked.

I am writing to you today to say that I am done. I am done listening to you, even though I know you won’t stop speaking to me, and likely that you will be trying to sneak back into my life persistently. I am done listening.

Dear eating disorder, you’ve had control over me for far too long. That ends now.


Someone who is no longer, and never again, your friend.

The Evidence Base: Eating Disorders and DBT

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By: Melissa Gerson, LCSW

There is a growing base of evidence supporting the effectiveness of dialectical behavior therapy (DBT) with certain eating disorder patients.

DBT has its roots in treating borderline personality disorder (BPD); in fact, the American Psychological Association lists DBT as one of the best empirically supported treatments for BPD1.  At its core, DBT teaches patients skills to help them better manage their emotions.   Because many patients with eating disorders experience this kind of emotion dysregulation, DBT has been studied as a treatment for anorexia, bulimia, and binge eating disorder.

A recent paper in the American Journal of Psychotherapy2 reviewed the research on DBT for eating disorders.

Here are my key takeaways:

  1. There is good evidence to support the use of DBT skills training with bulimia and binge eating patients. The evidence on anorexia is less compelling, but encouraging.
  2. There is promising evidence to support the use of DBT with any eating disorder patient who also has BPD. According to one study, about 20% of eating disorders patients have comorbid BPD3; given the effectiveness of DBT with BPD, it makes sense that DBT would be effective for this subpopulation.

These findings mirror what I see in practice as the Clinical Director of an eating disorder treatment center.  We generally start our co-morbid BPD patients with DBT early on; improved emotion regulation makes treatment more effective for these patients.  We also turn to DBT when patients treated with cognitive behavioral therapy (CBT-E) get stuck because of significant mood-intolerance component.

If you are seeking a DBT resource for an eating disorder patient, there are key components to look for:

  • Skills Training Group. These group sessions are where the core skills of mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance are taught.
  • Individual Therapy. These one-on-one sessions help patients apply skills to their personal situation.
  • Telephone Consultation. These brief phone calls are designed to help patients deploy skills in-the-moment, when they’re experiencing distress and/or facing obstacles. At Columbus Park we find this component particularly helpful; over the phone, the therapist identifies the problem, evaluates the skills the client used already, and then offers additional skill options for managing the struggle.  This intervention helps clients replace emotion-driven, impulsive behaviors with active, competent self-directed skill use.
  • DBT Consultation Team. In a comprehensive DBT practice, providers meet weekly for DBT consultation. These team meetings are a critical component of effective DBT practice as they are designed to support each therapist in his/her work while encouraging constant growth and learning for the group as a whole.  Patients benefit in turn from a strong, committed and motivated team of providers.


1Oldham JM: Guideline Watch: Practice Guideline for the Treatment of Patients with Borderline Personality Disorder. Arlington, VA: American Psychiatric Association, 2005

2Wisniewski, L & Ben-Porath, D. D. (2015).  Dialectical Behavior Therapy and Eating Disorders:  The Use of Contingency Management Procedures to Manage Dialectical Dilemmas. American Journal of Psychotherapy, Vol 69, No. 2, 129-140

3Milos, G. F., Spindler, A. M., Buddeberg, C., & Crameri, A. (2003). Axes I and II comorbidity and treatment experiences in eating disorder subjects. Psychotherapy and Psychosomatics, 72, 276-285



Hospital vs. Outpatient Setting: Learning to Sit with Less Control, Rewarded by the Full Story

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By: Jennifer L. Gaudiani, MD, CEDS, FAED

I entered this field and worked for eight years in a medical hospital setting, caring for highly medically compromised adults with anorexia nervosa. In retrospect, practically every interaction I had with patients took place in a totally controlled environment. They were patients who, for their clinical teams at home and loved ones, were in fearsome danger of death. Their vital signs, laboratory values, nutritional intake, and bodies were all as unsafe as could be imagined. And yet, once they were admitted to the program I had helped run on a daily basis for so long, I knew they would be okay. Enveloped by expert professionals, introduced to carefully designed clinical care pathways, guaranteed to be monitored and nourished, my hospital patients were safe. Can’t get out of bed on her own due to weakness? There’s a nurse’s aide by her side all night long so she doesn’t fall. Overcome by anxiety? Their psychologist who sees them daily will be here this afternoon.

In the hospital setting, I could go home every night content in the knowledge that every one of my patients was in good hands, eating, getting electrolytes tuned up, taking medicines. As a result, I don’t remember spending a lot of time on the age-old clinician-patient duel: “You need to eat.” “I won’t eat.” I could, instead, sit and share favorite passages from poems with patients, to help soothe the anguish of their eating disorder voices. I was an English major in college, and poems are a part of who I am. “My own heart let me more have pity on…Maybe at last, being but a broken man,/ I must be satisfied with my heart,” counseled Gerard Manley Hopkins. “It is always a matter, my darling,/ Of life or death, as I had forgotten. I wish/ What I wished you before, but harder,” marveled Richard Wilbur. I sat with my patients and, yes, talked medicine. But I also indulged in developing metaphors to clarify their physical and emotional experiences. In listening to their stories, I learned some of the archetypal narratives that can culminate in an eating disorder. I connected with that depleted, brilliant, sensitive, exhausted, and captive audience of my hospital program, in the luxury of knowing they were getting exactly what they needed.

Now I’m an outpatient doctor and founder of a medical clinic dedicated exclusively to people with eating disorders and disordered eating. I now serve a less medically compromised patient population, but I have far less control over my patients’ lives. My patients might see me for a half an hour a week, and their therapist and dietitian another hour a week apiece, and the rest of the week they are on their own. The rest of the week, their eating disorder gets to have full access to their extraordinary minds. No one is making sure they eat enough, or don’t purge, or don’t use their substance of choice, or get enough sleep, or take their meds, or avoid triggering interactions.

And while they are less medically ill than my former patients were, my patients now clearly still experience significant challenges. The patient who has lost a bunch of weight after leaving residential, is binge drinking, and refuses to step back up to a higher level of care. The patient who has abdominal distention and pain that does not improve no matter what workup I arrange, no matter what evidence-based treatments I prescribe. The patient whose borderline tempests simultaneously pull me into the tumult of need even as they reject and revile me. They’re all my outpatients.

I used to have thirty minutes a day, every day, for a week or so, with terribly ill patients in an almost perfectly controlled setting. And now I have thirty minutes maybe once a week, for as long as they’ll keep me as their doctor, with patients who are both physically ill and struggling with concurrent mental illness, in a relative wilderness of a setting. Sure, we talk in comfort of my office, but in a medical catch-and-release, I then have to let these fragile, tenacious individuals back into their lives for the rest of the week. I have sat, looking into the stormy eyes of a furious young man whose team has set boundaries that trigger his abandonment fears, thinking to myself, “Stay in scope of practice. He has a mental health provider. You’re his internist.” I have learned to say, “I hold space for this emotion. It feels like something you need to discuss with your therapist.” At times, I’ve reflected with heartsick disappointment on the somatic suffering I was not able to ameliorate, or even diagnose. I’m supposed to be an expert. That’s why they came to me. I wanted to give them answers and instead could only bear witness to their suffering.

And yet. One of the top reasons I left my hospital program to found this clinic was to help keep patients from ever getting that sick. To put my energies and efforts behind the theory that getting better in the context of one’s life, interests, and pursuits might make recovery more sustainable. So, I have enjoyed a telemedicine session with the smiling college freshman, whose matriculation formed the backbone of why she worked so hard over the summer to restore weight, as she glowingly tells me all the incredible people she’s now meeting, and the pizza she ate with her roommates last night at midnight. I have watched in astonishment as the fourteen-year-old shrugs and says, “I can look in the mirror again. I don’t even really think about food anymore,” remembering when she first sat in my office, miserably obsessed with each calorie, four months ago. I have rejoiced with the patient in a larger body who took her first hike in five years, shyly glowing as she relates how good it felt to get out in nature. “I felt like myself again, Dr. G.”

This is what I didn’t get in the hospital setting. Because when patients left for residential programming, I didn’t get to hear the rest of their stories. The narrative arc, different for each patient, always started with near-death starvation and ended with one chapter of recovery done, the rest of the novel to come. Now, despite the lack of control, the trepidation I feel as I say farewell till next week, the utter uncertainty of it all, I get to read the whole book as they write it.

I founded my clinic because I have the privilege of venturing into the unknown. I deliberately left a secure position to create something novel, both for patients and for the remarkable people I work with. For the former, a greater opportunity to work on recovery while experiencing daily life, with its triggers and unique motivations. For the latter, a workplace founded on feminist principles and good boundaries. We can throw ourselves into work with a fierce joy and passion, and then at the end of the day fully engage with partner, family, and interests. Robert Frost wrote that he would not relinquish to time “The things forbidden that while the Customs slept/ I have crossed to Safety with. For I am There,/ And what I would not part with I have kept.” As I wrote this I realized: it turns out that there is more safety in this less safe setting than I could have imagined.

Specialist Supportive Clinical Management Treatment

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By: Melissa Gerson, LCSW

In my work as the Clinical Director of a specialized eating disorder treatment center, on occasion I will meet individuals who continue to struggle with severe anorexia after having received multiple treatments over the span of years. Severe and enduring anorexia, also known as Longstanding Anorexia Nervosa (L-AN), is often associated with poor quality of life, resistance to treatment and treatment failures. Often, individuals suffering from L-AN will report that they feel disheartened by their failed treatment attempts, report negative treatment experiences and a sense of skepticism about services and recovery, altogether. Specialist Supportive Clinical Management (SSCM) is a novel treatment approach that has been gaining ground within the field. It has now been reviewed by professionals and compared to alternative interventions such as CBT. Specialist Supportive Clinical Management is well-suited to clients with L-AN as it is developed around a central principle of aligning with a client’s goals and supporting them as willingness and resistance ebbs and flows. As defined in an article published to International Journal of Eating Disorders, SSCM “is an outpatient treatment that could be offered to individuals with anorexia nervosa in usual clinical practice by a provider trained in the treatment of eating disorders. It combines features of clinical management and supportive psychotherapy.”

Researchers of SSCM found it limiting that in most studies, traditional interventions such as CBT, group therapies, nutritional treatments (e.g. dietary counseling, nutritional advice) and family therapy are evaluated. Beyond these studies, little is known about the effectiveness of psychotherapy treatment for L-AN and there have been few attempts to identify or develop novel treatment methods. It was here in this small space that a manual for SSCM was developed. SSCM is composed of two major components; Clinical Management and Supportive Psychotherapy.

Clinical Management

This term has been conceptualized by researchers as “good-quality care, delivered by a competent clinician with our without the addition of any specific treatment regimen.” The lack of specific treatment regimen is supported as the article claims “There is mixed evidence about whether more specialized psychotherapies or treatments confer added benefit to good clinical management. Differences in outcome between known effective treatments and good clinical management may be small or negligible.” Clinical management includes education (symptoms and diagnosis, etiology, warning signs of illness recurrence, prevention strategies and what will happen if it is left untreated), care, and support, and fosters a therapeutic relationship that promotes adherence to treatment. For individuals with anorexia nervosa, treatment emphasizes the resumption of normal eating and the restoration of weight. A main goal of the clinical management component is to establish a stable rapport and therapeutic relationship with a client as that relationship promotes adherence to the treatment regimen and compliance in taking medications. An important factor that will enhance the effectiveness of clinical management is an open discussion about fears or prejudices on the part of the client as they relate to mental health care. It will also be important for the client to present their ideas as they differ from those of the clinician. Sharing the diagnosis with the patient in this way enables the clinical to provide, and the patient to receive, ongoing care and treatment.

Supportive Psychotherapy

The delivery of information and psychotherapy within SSCM must be done in a supportive manner. Supportive Psychotherapy is best defined by L. Luborsky (1984) as “demonstration of support, acceptance, and affection toward the patient; emphasis on working together with the patient to achieve results; communication of a hopeful attitude that the goals will be achieved; respect of the patient’s defenses; and focus on the patient’s strengths and acknowledgment of the growing ability of the patient to accomplish results without the therapist’s help.” Supportive psychotherapy has a conversational style, using techniques such as active listening, verbal and nonverbal attending, open questioning, reflection, praise, reassurance, advice, and therapist self-disclosure.

Phases of Treatment:

SSCM is divided into three phases. Phase one includes a patient orientation to SSCM, identification of target symptoms and goals for weight gain and normal eating. The features are agreed upon by both parties. Middle phase includes the ongoing monitoring of target symptoms and support/encouragement. The final phase involves discussion of issues related to termination and planning for the future. In this particular clinical trial, sessions were scheduled 1x per week for 20 weeks. It is important to note that the time frame for SCM is flexible, and therapy contracts are re-negotiable.

Throughout the course of treatment the provider maintains that the client must stay medically stable throughout but otherwise, is largely responsive to the client. While a main focus of treatment is weight restoration, it is not the primary focus. Instead, the focus is on improving quality of life and in doing so, invariably eating, food and overall health are addressed in a way that may be experienced as far less threatening for the client. Physical status is evaluated throughout via weigh-in’s and blood test monitoring in addition to the delivery of nutritional education and advice.

How does this differ from other therapeutic interventions?

SSCM was specifically designed so as not to overlap with the key features of CBT or IPT. As practiced in this clinical trial, supportive therapy allows discussion of personal concerns and issues on a session by session basis and as identified by clients as opposed to challenging irrational beliefs (CBT) or focusing on interpersonal issues as facilitated by the therapist (IPT).

While further research of this promising therapy is warranted to evaluate the effectiveness of SSCM, it is an important tool for clinicians to evaluate as it may impact their clinical treatment of L-AN.


McIntosh, V., Jordan, J., Carter, F., McKenzie, J., Bulick, C., Joyce, P., (2006) Specialist Supportive Clinical Management for Anorexia Nervosa. International Journal of Eating Disorders, 39:8 625–632.

Luborsky L. Principles of psychoanalytic psychotherapy. New York: Basic Books; 1984.

About the Author: Melissa Gerson, LCSW is the Founder and Clinical Director of Columbus Park, Manhattan’s leading outpatient center for the treatment of eating disorders. As a comprehensive outpatient resource for individuals of all ages, they offer individual therapy, targeted groups, daily supported meals and an Intensive Outpatient Program (IOP). Columbus Park uses the most effective, evidence-based treatments like Enhanced CBT and Dialectical Behavior Therapy (DBT) to treat binge eating, emotional eating, bulimia, anorexia and other food or weight-related struggles. They track patient outcomes closely so they can speak concretely about their success in guiding our patients to recovery.

Opening Myself to Recovery

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By: Alysa Cristadoro

About a month ago, I finished my yoga teacher training. At the end of the month, we were gifted with mala beads: beads that are used for prayer and meditation. We all infused these beads with the mantra “I open myself to you.” This could hold so many different meanings for each individual. For me, I think about how I can open myself to others, how I can open myself to the challenges that life throws my way, and how I can open myself to the higher power I believe in. But I also thought about how much I have opened myself to this journey of recovery.

What do I mean by that?

For so many years I was trapped in my eating disorder because I would never open my heart to the true beauty that recovery is. I was so close minded in my belief that my story was different than others. Unlike the countless individuals that were living a life of food and exercise freedom, I convinced myself that I wasn’t capable of that. My heart was closed to the thought of recovery, my mind was held in the chains of my disordered mind – I did not open myself to anything but my eating disorder.

When people asked how I recovered, I don’t really have a straight forward answer. I strayed off the path several times. I tripped and epically messed up, I felt like I didn’t know what the heck I was doing at times. But the thing that ultimately led me to a life of freedom was opening my heart and mind to this life of recovery. Instead of convincing myself that I was different, that I was incurable; I let go of self-limiting beliefs and dove head first into this crazy messy journey that is eating disorder recovery. I released my mind from the chains of the disorder thoughts that controlled me so long and dug deep into my heart to find strength to change. Open your heart to love – love for yourself and for your journey. When you invite love and openness into your heart, you can truly let go of fear. Opening myself to recovery and letting go of my eating disorder was single-handedly the best thing I have done in my life thus far. See what happens when you actually stop closing yourself off to recovery. I promise you wonderful things will come your way.

About the Author: My name is Alyssa but you can call me Lyss. I am a college student, a certified yoga teacher, a nature lover, and I talk a lot about recovery because it is SO possible. I love spreading hope and light to others and inspiring people along their journey towards freedom.

Sometimes Recovery Is Taking a Leap of Faith

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By: Kaity J

The night sky was full of stars, but no moon. Oh how I missed the moonlight as it shone through my window and cradled me in its light. Looking up at the star I wonder who else is seeing the same thing. My dad always said whenever we were apart; to remember we look at the same stars. He said that he thought of me whenever he looked into the sky. I did too. In science class, I learned that we are made of stars, which I can understand because the God that placed the stars in the sky also made us. I’ve been gone a lot, jumping from place to place, never really staying, and never settling. Sometimes I like it, I’m like a shooting star, you see me for a glimpse and then I’m gone. Sometimes I compare that with being my true self. I’m so obsessed with other people liking me, you cant see the real Kaity, but then, maybe like a star or maybe like a moon, I appear, sometimes as fast as lighting and sometimes as slowly as a waxing moon. Like peeling off wet clothes, one by one, the layers fall. I am scared to be a moon. It’s so much easier to just be a star, almost invisible at times, shining light from years ago.

A moon is visible and its light is present, from within. What if I don’t have enough light? What if I’m as dark as a moonless night? My family told me that they would hold onto my hope when I had none, is hope light? My hop is waning, flickering, almost out. I’m tired of being a star, yet I’m too afraid to become a moon. Because once I fully become a moon, I will never go back to being a star. While pondering all of this, a tear slips down my cheek. Running from my real self is exhausting. Looking up at the starts I start to see a moon creep over the horizon. Here is my chance and in that moment, I decide to leap in and take it.

About the Author: In recovery, figure skater, lover of animals and movie watcher!

You Don’t REALLY Believe That?

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By: Erin Parks, PhD

Having appreciated the humor that comedians have poked at“awareness” campaigns, I wanted to be very intentional about what, exactly, I wanted to make people aware of during Eating Disorder Awareness Week (#EDAW). And then the answer hit me in the face.  I was interviewing a clinician—she was kind, funny, had an excellent resume—and I was telling her about the culture and theoretical orientation of our center.  I told her that our research uses neuroimaging and genetics to look at the neurobiological underpinnings of eating disorders and that our three clinics take an agnostic approach, consistent with Family Based/Maudsley therapy, in that we truly believe that parents do not cause eating disorders and they are not to be blamed.  The applicant smiled, met my gaze, raised her eyebrows, and leaned in as though we were about to share a secret…

“I understand why you tell the parents that, but surely you don’t really believe that.”

really do believe that parents do NOT cause eating disorders.  I share that belief with our directors, our researchers, our clinicians, our office managers, our dietitians, our cooks, and every last member of our staff.  We believe, that like cancer and epilepsy and schizophrenia and autism, there are neurobiological and genetic causes to eating disorders.  But it is easy for US to believe this—we spend our days working with wonderful parents. These parents remind us of ourselves; they’ve been trying their very best to raise happy and caring children. These parents are shocked that their child has become so ill, because similar to the interviewing clinician, they too had previously believed that poor parenting caused eating disorders.

I wish I could say that was the first time in an interview that someone had asked me if I secretly blamed the parents, but there are many intelligent and caring people—clinicians, teachers, neighbors, friends—who believe the common myth that parents cause eating disorders.  This myth of parental causation has existed for many illnesses and most mental health disorders: schizophrenia, ADHD, autism, depression.  But it feels particularly pervasive for eating disorders—why is that?

Eating disorders have the highest mortality of any mental illness—rates that many studies suggest may be comparable to common pediatric cancers.  And yet, when we hear of a child getting diagnosed with cancer, friends and neighbors spend very little time wondering what caused the cancer and instead energy is focused on treating the cancer and supporting the family. The same is not true when a child is diagnosed with an eating disorder. When I asked a group of caring, intelligent parents what thoughts came into their minds when hearing of a 13-year-old being hospitalized for an eating disorder, they confided that they wondered about the parents: did they diet in front of their children, did they pressure them to succeed, what messages did they give about body image? There is this cultural sense that there is a right way and a wrong way to raise a child, and doing it incorrectly can cause problems—including eating disorders.  So what is the right way?

There is a prolific stream of (conflicting) parenting articles offering the latest opinion/theory/research on how to approach feeding your family.

Don’t feed your kids sugar: they’ll become addicted.  Feed your kids sugar: depriving them will make them binge later.  Make your kids try new foods: if not, they’ll never develop a healthy pallet.  Don’t worry if your kids are picky eaters: they will have disordered eating if you make food a battle.  Don’t bribe your kids with food: food shouldn’t be a reward. You can bribe your kids with food if it helps them eat their vegetables.  Hide vegetables in your kids’ foods. Don’t lie to your kids about what’s in their food.  Let your kids eat as much or as little as they want: follow their lead so they become intuitive eaters.  Your kids should be on a schedule, including meals: structure is good for kids. Gluten is bad.  All food is good.  Kids have to eat meat.  No kids should eat meat.  Dieting is bad: teach kids to love their bodies at all shapes.  Model healthy eating: we have an obesity epidemic.  If you put your kid on a diet they will develop an eating disorder.  If you don’t put your kid on a diet they will become obese and get diabetes.  Confused yet?

The conflicting advice continues when the parenting articles discuss achievement.  Parents should teach their children art and music and sports and STEM skills and foreign languages.  Parents enroll their children in way too many activities.  Parents should let their children choose their activities. Tiger Moms vs Free Range Kids. Kumon vs Montesorri.  It’s your fault if your children get hurt—you should have been watching them.  Don’t be a helicopter parent and let your children play unsupervised.  Challenge your kids, they need frustration and failure—they need grit.  Don’t push your kids—they’ll develop eating disorders.

Parenting is an unyielding stream of decisions, creating infinite iterations of parenting.

Our clinic has worked with hundreds of families and while their home cultures slightly differ, most are just typical families, trying to find moderation amid the sea of conflicting internet advice when it comes to feeding and raising their kids.  No matter what food and parenting choices they made for their families, somewhere there is an expert saying that they made the wrong choice and that is why their child has disordered eating.

A confession: I have two toddlers and I consume the endless stream of conflicting parenting articles that fill my Facebook feed and the Huffington Post. Sometimes I WANT parents to be the cause of language delays and college dropouts and cancer and bullying and ADHD and eating disorders. Then I could just parent correctly and guarantee that nothing bad will ever happen to the two children I love most in this world.  But that is not our reality.  In reality there are pros and cons to all decisions and there are complex causes to complex issues.  The reality is that parents everywhere are trying their very best, doing a very good job, and are parenting in ways that may look very similar to how each of us parent—and their children are struggling with difficult and scary things—including eating disorders.

Many articles this week will talk about hypothesized causes of eating disorders—food culture, focus on achievement, the media—and while it can be important to think about the negative consequences of some aspects of our culture, this search for a singular cause can feed into the culture of blaming the parents.  The majority of parents will diet, the majority of women will feel bad about their bodies, the majority of teens will feel pressure to succeed, and the majority of images of women in the media will be distorted and unhealthy—and yet the majority of children will NOT get eating disorders.

I hope we can turn the conversation to the successful evidence-based treatments that now exist for eating disorders and how we can improve upon them so that they are effective, accessible, and affordable for everyone.  I hope we can discuss how parents know their children best and can be the most wonderful treatment allies in helping their children fully recover from an eating disorder.  I hope everyone can now believe that parents are truly, really, not to blame.

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About the Author: Dr. Erin Parks is a clinical psychologist and the Director of Outreach and Admissions for the UC San Diego Eating Disorders Center for Treatment & Research . She is passionate about educating clinicians, parents, and the community about the neurobiological basis of eating disorders and the evidence-based treatments that are now available. Dr. Parks wants to help society view mental illness as brain illness–narrowing the funding and resource gap between physical and mental disorders.

Physical, Biological and Psychological Effects of Food Restriction and Chronic Dieting

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By: Megan J. Driscoll LPC, RD, CD

We all can agree that the dieting industry in the United States is a forever booming and profitable industry (to be exact, an alarming 60 billion dollars annually according to Washington Monthly) however we also know that dieting does not produce long term results and is also a significant risk factor in the development of an eating disorder. “Getting healthier and losing some weight” are often a main reason for going on a diet. However, what is often less talked about and even ignored are the harmful physical, biological and psychological effects of dieting or food restriction.


Physical (to name a few) –

  • Use of muscle tissue for energy (why would we want to decrease our muscle if we are dieting to be “healthier?”)
  • Reduced metabolic rate
  • Cold intolerance (I am from Wisconsin, why would anyone want to have this?)
  • Constipation and delayed gastric emptying (meaning food stays in your GI system longer, resulting in discomfort and bloating – constipation is literally the worst, we all know it.)
  • Cardiac arrhythmias
  • Edema & other skin changes – these changes may actually influence our negative body image even more
  • Osteoporosis


Biological –

  • Increases your appetite by reducing the amount of leptin you produce (leptin is our fullness or “satiety” hormone and is released to tell you to stop eating and increase your metabolic rate to start burning the calories you just ate – why would we want to mess with this?)
  • Lowers your core body temperature
  • Reduces your effectiveness at recognizing hunger and fullness cues


Psychological –

  • Induces powerful urges to binge on food (think about survival)
  • More specifically, powerful cravings for energy dense foods such as ice cream, chips, chocolate (sugar is the quickest way for our body to get energy in a deprived state). Remember the brain does not function without carbohydrates
  • Food obsession and preoccupation – why would we want to spend our lives only thinking about food when there are so many more important things to think about, like our goals, dreams and vacations we want to go on?
  • Depression
  • Anxiety
  • Social isolation
  • Apathy
  • Fatigue
  • Irritability
  • Poor concentration (our brain’s neurotransmitter’s rely on fat to make the myelin sheath which essentially helps them talk to one another and perform)
  • Mood swings
  • Drop in levels of serotonin
  • Binging causes the release of “feel good” chemicals like serotonin and endorphins so it begins to act like a self-soothing/stress relief mechanism to cope with the stress of dieting. Therefore, the body begins to crave the binge behavior to simply feel better.
  • Last but NOT LEAST, when we “fail” at our diet because our body is trying to save us, it induces feelings of shame, guilt, failure and that we did something “wrong”


Overall, “getting healthier and losing some weight” is not as simple as “eat less calories” and see the number on the scale go down. We know many factors influence our health and weight such as our age, genetics, medical and other underlying conditions, and dieting/weight history. What if instead of promoting dieting and scale-dependent self-esteem, what if we begin practicing body acceptance and intuitive eating? Life is too short to only order salads.


Source: Health at Every Size by Linda Bacon & Keyes Starvation Study

About the Author: Megan J. Driscoll LPC, RD, CD is a registered dietitian and psychotherapist. Megan Driscoll specializes in research based weight management, chronic disease prevention and health promotion using a health at every size and non-diet approach. Megan Driscoll graduated from the University of Wisconsin-Madison in 2008 with undergraduate degrees in Dietetics and Psychology. Megan completed her Dietetic Internship at Mount Mary College in Wauwatosa, Wisconsin. Megan then went on to complete her Master’s degree in Educational Psychology, with an emphasis on community counseling, at the University of Wisconsin-Milwaukee in 2011. She currently works as a registered dietitian and program psychotherapist at Aurora Psychiatric Hospital on the inpatient and partial hospital eating disorder unit. She is also the primary dietitian for their Eating Disorder Lorton Outpatient Clinic and provides outpatient nutrition counseling through Affiliated Wellness Group in Glendale and Delafield, WI. She lives with her husband, their 3-year-old son, Henry and their big dog, Riley. She enjoys shopping, reading and being outside in her free time!

The In-Between

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By: Krystal Cook

I’ve found myself in a difficult place lately. A place I’ve come to reference as the In-Between. No one talks much about this place, but I have a hard time believing I’m the only one who has found themselves here. I’m in-between the old me and the future me. The sick me and the whole me. The addicted, disordered me and the real me.

You see, I dropped out of life at 13 when I began starving myself, self-harming, and living with depression. I retreated into a giant shell that was my armor for over 12 years. I dropped out of school, out of relationships, out of my family, and out of growing up. I didn’t know how to handle the pain, the chaos and all the feelings in the world around me so I did everything in my power to stop feeling anything. If you know me at all you know that when I get passionate about something I get very, very passionate about that thing. I give everything 110%. I feel everything to the extreme. This would be great if the world only dealt out love, joy and happiness, but we all know that is not the case. So I decided that even the intense love and joy I felt at times were not worth the intense pain, rejection, and sadness I also felt.

Fast forward through a dozen years of therapy, treatment centers, recovery attempts and relapses…and here I am today with over a year of true recovery behind me, and only traces of the sick me that surface in my brain every once in a while. Don’t get me wrong, to be where I am is a miracle and I am so grateful to be out of the dark hole I crawled into so long ago. I am no longer obsessed with food, my weight or the scale. I don’t have to fight the urge to hurt myself anymore, and I get out of bed most days so thankful for my life. But at the same time I often feel like I woke up out of a dream and I am that 13 year old girl in a 27 year old body. I am married, self-employed and by all outward appearances handling myself pretty well as an adult. I’ve gotten really good at the “I’m fine” persona who has all her ducks in a row and is “just living and enjoying life!” But under the surface I find myself in low grade panic mode in many situations. Especially when it comes to relationships and interacting with other people.

As an introvert to begin with, and one who never learned how to make healthy relationships in my formative years, I find myself retreating into a different shell of isolation. So while I am not struggling with the behaviors of my sick self, I am also not what I would consider a whole self either. I even find myself struggling in my marriage because I was a different person three years ago when I said “I do” to the man who had won my heart and who (I thought) knew the best and worst about me. The truth is, I still put the “I’m fine” wall up with him more often than not. He says it is like pulling teeth to get me to open up and be honest about how I really feel. In many ways I feel like we’ve had to start completely over again in getting to know each other, and I know that is a process that will continue for the rest of our lives. But it is hard, frustrating, and has left me feeling confused and misunderstood many times.

I say all this to say that recovery from any addiction, disorder or mental illness is so much harder and more complex than I think people realize or want to admit. Just because the behaviors change or stop does not mean the work is done. Just because life is a million times better than it was with the addiction (I absolutely promise you it is!!) does not mean it is easy. Just because you are out of treatment and can call yourself recovered or in recovery, does not mean you no longer need help. When your entire identity was wrapped up in this thing for over a decade you emerge without a sense of who you are and where you belong now. And if you are not careful you will gravitate to defining yourself by mere labels and what your current role in life is (wife, mother, sister, friend, career woman, etc). You can feel like a ship without a rudder suddenly trying to navigate life, and all the emotions you stuffed down for years come at you like a hurricane. It can be incredibly overwhelming and it explains why relapse happens so often.

I realize the blessing in this is that I know where I am. I see that I am not where I want to stay, that I have so much more growing to do. I tell people I want to live a life of authenticity and yet I watch myself put up a front more often than not. I long for real connection that goes beyond the surface and yet I keep people at arm’s length. I tend to use my ‘introvertedness’ (if that’s not a word it is now) as another shell to hide under. I’ve spent enough years of my life feeling stuck and out of control. I’m ready to move on and move forward. I want to do the hard things (ok, I don’t really want to but I know I need to) and reach out and truly connect with others. I want to find out what it’s like to be whole me.

Brene Brown defines whole hearted living this way, “Whole hearted living is about engaging in our lives from a place of worthiness. It means cultivating the courage, compassion and connection to wake up in the morning and think, no matter what gets done and how much is left undone, I am enough. It’s going to bed at night thinking, yes I am imperfect and vulnerable and sometimes afraid but that doesn’t change the truth that I am worthy of love and belonging.” I think this is such a good place to start. Addicts have so much shame to fight through even after they break free from the behaviors. Shame that the past ever happened, and fear that it might repeat itself in the future. That shame keeps us from believing we are worthy. And only until we believe that truth and begin to live out of it will we start to fully live and move out of the In-Between. So this is just to say, I’ll be working on that and here is a good list to start with if you are too.

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