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.

This post originally appeared on ucsdeatingdisorders.tumblr.com


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.


This post originally appeared on krystalkaye.blogspot.com

What Your Therapist Wants You to Know

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By: Dr. Michelle Mannia, PsyD, HSPP

Asking for help in recovery is difficult. Some people hide their struggles from friends and family or hesitate to meet with a therapist because of anxiety or shame. Fears about being judged, not being understood, or not gaining anything useful can prevent people from getting valuable guidance with managing disordered thoughts and behaviors. Therapists serve many different roles and can provide support and direction to help manage challenges at any stage of recovery. As a psychologist specializing in the treatment of eating disorders, I have encountered many fears, concerns, and beliefs that people have about therapists.

So here are 5 things that your therapist wants you to know about eating disorder recovery:

We believe you can recover. We are working with you because we know you can make positive changes and have a more fulfilling life. Even when it’s hard for you to believe, trust us that recovery is possible. We are not angry when you have a setback in recovery. Lapses are a normal part of recovery. We view them as opportunities to learn about yourself and become stronger. What you do after a setback is important, and we want to help you get back on track. Honesty is important. Shame and secrecy can be barriers to making progress in recovery. It is easier to help address your concerns and struggles when we know what they are. It’s okay if you’re not sure you want to recover. Making changes is difficult! We are happy to help you better understand your ambivalence and figure out what to do next. You don’t have to be motivated all of the time. Recovery is worth it. We know that recovery is hard and that the things we ask you to do may be difficult or painful. But the chance to live a fulfilling life free from your eating disorder is worth the effort. Recommit to recovery each day and each meal, and you will not regret it.


About the Author: Michelle Mannia, PsyD, HSPP is a clinical psychologist specializing in the treatment of eating disorders in South Bend, Indiana. For more information, visit drmichellemannia.com

Beauty

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“Beauty”

By: Molly Kirschner

Most women should lose weight, he said,

in Boston Market, over a large plate of brownies

he was the only one eating. I don’t know

about the other girls, but I didn’t say fuck you

because I didn’t know he was wrong. It made sense

that smaller people would have smaller problems,

not the kind of sadness that threatens to make itself

pregnant with you.

So I went home and told my roses they would look better as rulers.

I dumped them out and went to Staples,

bought a flower pot’s worth of rulers.

They sit politely on my windowsill.

Perfect identical erect rectangles. Well-mannered. Measured.

Need no water. You can come see them if you like,

gathering light to no purpose. Beautiful isn’t it?

Beauty is a shapeless dress of a word,

one I can’t afford.


About the Author: Molly Kirschner is a poet and playwright. Kirschner’s first book of poems, Hard Proof, was released in July of 2015 from Red Mountain Press. Her second collection, Notes For Further Research, is forthcoming from Fly By Night Press, a subsidiary of A Gathering of the Tribes. Kirschner’s poems have appeared in numerous journals, as well as in Italian translation. Her new play L’appel du Vide premiered this summer at Under St Marks Theater.

To the Eating Disorder Who Promised to Look Out For Me

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By: Anonymous

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 to long. That ends now.

Sincerely,

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

My Wish for My Girls: Radical Self-Love & Acceptance…and Anger, Placed Appropriately

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By: Lisa Tieglman-Koepp, M.S.Ed., LPC, NCC

I wish for you the courage to see the world, the fashion industry and magazines, health food stores and weight loss companies, network marketers and independent distributors of nutritional products, as entities dependent upon your hatred of yourself.

I wish for you the trust to see this diet industry as predatory, with ill-intent to prey on your insecurities, hoping you’ll buy into a product or service, which fails 95% of the time. I wish these industries would simply leave you alone, but they won’t. And I won’t give up on you.

I wish for you the ability to celebrate your beauty just the way you are, your entire being, the whole of you! I wish you would have trusted that if you’d have eaten normally, intuitively and enjoyably, your weight and size would not be an issue. It’s not too late! I want you to move for the health of it and the simple enjoyment of being alive. I wish you would trust that if you do these things, you’ll be just fine.

I want to teach you to be “informed consumers”, so that you do not waste another single penny on products and services that fail 95% of the time. I wish you accepted that these companies do not care about you! They care about your money, period! I wish I could help you bust through the pressure to look like models in fashion magazines and the media and teach you to trust your bodies, to live fully in them and most of all, to befriend and trust your hunger.

I wish that you’d believe that you are already programmed to be a certain size, shape and weight by your ancestry genetics and DNA, so you could take a deep breath and start accepting yourself and allow your body to do what it will. I wish you the beauty in seeing the lineage in which you come from.

I wish you the ability to salvage your metabolism. History misunderstood repeats itself, which is why the weight loss industry is so successful as you continue to fail time and time again. I hope that after years of yo-yo dieting, when your metabolism decreases and your gastrointestinal system slows down, and your body goes into starvation mode in order to protect you, you will understand that the problem all along was your attempt to lose weight, not your willpower or motivation.

I wish more people were mad enough to raise more hell about this. I wish for you the chance to celebrate the diversity of your body and love the vehicle that carries your soul, instead of trying to manipulate your weight and size. The answer to improved self-esteem is not found in this route. I wish that you take the leap of faith and love and live to the fullest potential, and start redirecting your energy towards making your unique thumb-print on the world!


About the Author: Lisa A. Tieglman-Koepp, M.S.Ed., LPC, NCC, is a therapist in private practice and the Lead IOP Therapist in the Eating Disorder Services at Aurora Psychiatric Hospital. She is the proud mom of three amazing girls.

About Bulimia

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By: Melissa Gerson, LCSW

Alex starts her day with the intention to “be good.” As she navigates through her day, burdened by negative body thoughts, she feels down but hopeful that she will eat “clean” and with control. By mid-afternoon she’s starving and preoccupied with thoughts about food. When a co-worker puts out a tray of desserts for everyone to partake, Alex tries to resist but then can’t get the treats out of her mind. So she has one. Then another.   She’s on autopilot, out-of-body.   After too many cookies to count she’s despondent, miserable, stuffed.   She purges in the office bathroom since the full feeling is intolerable… and of course, the threat of absorbing all the calories is equally terrifying. Alex is resolved to make this her last binge/purge.   She’s “back on track.” But before you know, a food “mistake” or unexpected temptation gets in the way and the rest is history.

The pattern I just described is the classic bulimic cycle. There is restriction, deprivation, rules about what is on or off limits… Then a temptation, giving in, a food “mistake…” The binge means freedom from the exhausting control – at least for a short while. But then remorse, self-hatred. The purge is supposed to “undo” the binge but at the same time, without realizing it, the purge forgives the binge, actually opening the door for more binges in the future.

Most individuals with bulimia, will relate to some element – if not every element – of this cycle.*   The problem is that intuitively, it seems like more control and restraint are needed. The reality is that the exact opposite is true: over-control, deprivation, rigid rules are to blame. Because of this misguided effort to increase control, many who struggle with bulimia try and try again to end the cyclical pattern but find themselves frustrated in the process – and left with more shame, self-loathing, isolation.

What you should know about bulimia:

  1. Frequent purging – either by self-induced vomiting or laxatives – can lead to dangerous medical complications. The most common concern relates to cardiac health since minerals essential for proper cardiac function like sodium, magnesium, phosphorous get depleted through fluid loss. The only way to know if you have imbalance of these minerals is through a blood test. Your health status can change quickly so frequent labs are essential if purging is happening regularly. You could absolutely be at risk for a serious cardiac event but physically, feel no indication that anything is wrong.
  2. It is so important to consider a behavioral therapy like CBT-E, a treatment designed – and proven – to treat bulimia nervosa. CBT-E is so successful because of its laser focus on the factors that are keeping the cycle going – things like chronic dieting or restriction, rigid food rules (i.e. good and bad foods)… and also factors like intense focus on weight/shape, harsh comparisons to others and body checking like frequent weighing or body checking (mirror, pinching etc).
  3. CBT-E focuses on guiding you to a pattern of regular, consistent and flexible eating – an eating style that tends to reduce one’s vulnerability to binge eating and purging.   The treatment works to change your relationship with food (and thus your control!) by integrating:
    1. Flexibility: encouraging an approach to eating that allows for last minute changes, social eating, managing with the food available to you.
    2. Variety: balanced, satisfying meals. Moving away from having “off limit” foods since those tend to be the very things people consume in excess later.
    3. Adequacy: under-eating, delaying eating for long periods makes you more vulnerable to over-eating. If you’re starving, it’s harder to stay in control.
    4. Awareness: being present, aware of what is happening in the moment is key to maintaining control over eating behavior.
    5. Planning: you mustn’t under-estimate the power of being prepared. For many who struggle with BN, decisions on the fly lead to trouble. We want to move away from impulsive decision-making.
  4. Treatment must also address your current coping strategies since binge eating and purging for many are actually methods for relieving stress, numbing out, escaping….   To recover, you will likely need to establish alternative methods of coping – skills and strategies so you can care for yourself and manage feelings without defaulting to food-related behaviors.

Bulimia: The Bottom Line

There are many factors that contribute to the development of bulimia – biological/genetic, cultural/social, emotional…. But often what caused the problem in the first place is less important to focus on that the factors that are keeping the problem going now.

Bulimia is highly treatable. With the right intervention, people are able to make significant changes very early on in treatment. It is so important to seek help if you’re stuck in a destructive cycle with your eating.

* Please note that every individual is different. The pattern described in this post is among the more common presentations but there are many who have a very different “clinical picture.” Regardless, it’s essential to understand your pattern so that you can target the factors that are keeping it going.


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.

Being Okay With Not Being Okay With My Third Trimester Body

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By: Danielle Sherman-Lazar

Okay, so I hate to admit it, but lately I have been a total hypocrite of everything I stand for in my post-recovery life.

I hit third trimester and I am having an extremely hard time accepting my body. And no, not in an “I am starving my baby” kind of way, because no matter what I would never get to that point, but a “wow I am uncomfortable, and may kind of resemble a baby pot belly pig and am hating my body more than usual” way.

I am about to be more honest than I have ever been, so brace-yourself.

This week has been hard and there have definitely been some factors that made it that way. First let me get the humor items out of the way:

It’s Hot AF:

The New York heat defined in one word: brutal. It makes you feel like you are on the verge of losing your mind. Heat hitting you SMACK, hard in the face. Salty sweat, falling down your nose and into your mouth. Mmm-hm. Lovely.

I am walking my daughter to classes and the hot humid air (if you could call that air…) makes my shirt press tightly against my pregnant belly. I am not only hating myself with each stare down at the “buddha” (my belly), but feel wet, maybe even swamp-monster-like from the amount of perspiration exiting my body.

I picture the belly bouncing in slow motion, because the heat takes me to a desert-cacti-zone where the speed would be sloth-like.

Constipation: 

The baby is officially the size of a pineapple. Therefore everything feels smothered. I swear I can feel my organs shriveled up in a corner.

Taking a dump has become even more of a controversial topic now that it is not only something I have to worry about for my daughter, but also for myself. Because of said “smooshed organs” and with the baby taking up the anterior of my stomach, it has been harder to make everything move along, causing major discomfort in my belly zone.

I lie in bed at night picturing the days’ items I’ve eaten, stuck and arranged in different organs since they are all blended together at this point–at least that’s how I picture them.

Transformation: 

In all seriousness, I forgot how hard it is being pregnant in terms of having your body change so drastically, especially while being in recovery from ED. First and second trimesters were easy, but third trimester is where the changes are getting more rapid and noticeable.

It’s strange to think, within the past five years of recovery (official rock-bottom date December 5th 2012), I have gone through weight restoration, followed by two pregnancies. That’s a lot of body evolutions in a short period of time.

As much as I hate to admit it, it hasn’t been easy for me. I can preach all day about self-love and the new respect I have for my body since creating my amazing girls (one coming in October), which I do, but I don’t feel body confidence at every second. In fact, I think it’s important to say that I do struggle a lot so others know it’s okay to not feel perfect about your baby bump all the time. I don’t even believe in perfection as a realistic expectation. First thing you learn in recovery from anorexia is about this awesome gray-area, where flaws are accepted and embraced and nothing is black or white (What? Yes, really ED—no one is perfect). In fact, the other day, I was moody and snappier than a snapping turtle on steroids (that’s one angry AF turtle) because I felt so shitty about my body, plus everything hurt! And you know what? That’s okay.

When I complain about my size, I am met with “but you are pregnant and so lucky so don’t complain.” I know I am, but just because I am pregnant and lucky doesn’t mean I can’t express my normal rational body fears.

I would like to make a clear differentiation too. I struggle with how I look, but I do practice total self-love in the way I nourish and care for my body. I am not self-destructing because I am thinking of the beautiful child I am fortunate enough to bear (and the one that is outside my belly looking at me as a role model); and in addition to the above, I would never go there again. I am way too happy in my ED free life to ever look back. I just don’t think I look hot, or even kind of good, but I know I am much more than my body, plus my ED was more about coping and control than actual size and weight loss, as most peoples are.

Bottom line, I am healthy and how I feel about my body is never going to stop me from growing my family—or being the best version of me for them. Also, it is not about acceptance, because I accept every part of me wholeheartedly right now, because it is giving me the best gift in the world—another daughter. But third trimester mamas-to-be I want to make something crystal clear–we are allowed to bitch!

Let’s Talk About Society 

It is ironic that our need to be skinny is dictated by the media and society, but then if we have a fear of getting “fat” when we are pregnant, it is considered blasphemous and we are thought of as superficial. Addressing any downsides of being pregnant is frowned upon and seen as taboo, but it shouldn’t be. I bet you most mothers-to-be have insecure days and these so-called “irrational fears.” We have to start supporting, rather than judging, one another so we can talk about these normal fears and make one another feel better, instead of holding the feelings in (https://themighty.com/2017/05/advice-for-a-new-mother-in-eating-disorder-recovery/). In fact, these fears are okay and should be expressed. Holding feelings in is how we find ourselves thinking we are the only ones having these thoughts and we must be messed up– when really a lot of people are feeling similar.

So let’s support each other as women and mothers, and the amazing human beings we are. Let’s promote each other and pick each other up when we are feeling down. You know what? Sometimes it’s okay to bitch even if they are lucky problems. So please bitch away. I will be happy to hear it.

Why We All Need To Read Carolyn Costin’s Review of To The Bone

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Below you can read Carolyn Costin’s official review of To the Bone:

“I was hesitant to see the new Netflix eating disorder movie, To The Bone. As someone recovered from anorexia and an eating disorder therapist, author, educator and spokesperson I generally do NOT like eating disorder movies, documentaries, TV specials, “reality shows” or even autobiographical books about eating disorders and tell my patients to steer clear of them. However, when asked by Project Heal to attend the screening and moderate a panel discussion afterward, I agreed.

The film stirred up controversy even before its release and because of its significance as the first major film on eating disorders with the potential to be seen in 100 million homes, I wanted to ascertain the situation for myself. Did To The Bone have something of value or was it going to end up on the “do not watch” list with so many others.

To The Bone is based on a true story about a young woman with anorexia nervosa, and brings viewers into the eating disorder world, including interactions her family, her doctor, and a variety of other patients in a treatment center. The patients are portrayed realistically, without showing gratuitous scenes of behaviors such as wretching into a toilet while at the same time not glamorizing the illness by avoiding anything that could be potentially controversial or disturbing.

This is a film based on what happened in the life of one individual, not a movie about understanding, preventing or treating eating disorders. It’s not meant to educate the public on the causes of the illness, or how best to treat it. It is writer/director Marti Noxon’s autobiographical story (with some artistic license thrown in). Marti felt her story was important to tell in order to raise awareness about a misunderstood subject.

To The Bone will, for sure, raise more questions than provide answers, and that is exactly what Marti had in mind. Her hope is to promote a conversation about an illness that is still not well understood by the public and does not get appropriate coverage or concern.

The film’s main character, Ellen, has anorexia nervosa, from which more people die than any other mental illness, yet no one has taken it seriously enough until now to put resources into a major film. Marti felt compelled to make a film and make a difference and faced many obstacles along the way. For example, several people whom she tried to get interested in the project told her they did not think the eating disorder topic was a big enough issue. She knew, and many of us know, better.

Are there things I dislike about the movie? Yes. Do I think there were unrealistic parts? Yes. Would I have done things differently? Yes. As an eating disorder treatment provider, educator and activist, I wish there ha been more explanations given about the disorder and that the movie had shown more about how treatment helps people recover. I would have included much more and much different therapeutic dialogue and I would not have depicted the eating scenes at the treatment center in the same way.

Much of the controversy surrounding the film comes from the fact that Lily Collins, who played the part of Ellen, also suffered from anorexia as a teen and yet she lost weight to authentically play the role.

I too was concerned and unsettled upon hearing the leading actress had suffered from anorexia in the past yet lost weight to play the part. As a therapist I certainly would not recommend any of my clients do this. But after meeting and talking to the real person, Lily, her mom and Marti, I learned about the care and thinking that went into her decision including the medical and nutritional monitoring that took place. But even that is not the most important thing here. What is far more important is that Lily is fine. Not only did she not relapse, she found the entire experience “insightful” and “therapeutic” learning many things she did not know or understand when she was 16 and suffering from her eating disorder.

To those who express their anger and boycott the film, I wonder what would they suggest as an alternative? As far as I know, no one has yet offered a better solution for Ellen’s character. Should Marti have found an actress currently suffering from anorexia to play the part? Should some other actress have lost weight for the part? Should she have hired a normal weight actress to play the part of someone with severe anorexia nervosa? All of these alternatives would have brought their own problems, concerns and controversies. To avoid all potential problems or criticism, no movie could be made at all.

You can’t make a film about a troubling topic without troubling people. There is no way to deal with a sensitive, disturbing, and difficult subject, such as eating disorders, without upsetting or “triggering” a sub set of individuals most closely associated with the issue, whether professionals, patients or their families. If no one was disturbed by this film, there would indeed be something terribly wrong. Eating disorders are disturbing, confounding illnesses. Would I advise patients to go, no, they don’t need to see it, they already know what the movie is trying to reveal.

The other controversy has so far sprung from those who have seen the trailer and complain that showing a white skinny girl is not fully representative of the spectrum of eating disorders and the scenes might be triggering for those who are vulnerable or already suffer from the illness.

They are right. However, the trailer is not representative of the movie. The movie portrays 7 patients with varying diagnoses, body shapes, gender and color. Particularly arresting is Alex Sharp’s portrayal of the male patient, Luke.

Will the trailer and the film trigger some people, yes, but I found this film less potentially triggering than most. The trailer shows perhaps one of the most triggering scenes of the film. But you can’t make a film about eating disorders without upsetting or triggering some people. During my own eating disorder just watching someone in a movie eat, get on a scale, go on a diet, or work out at a gym was triggering. Any program, of any kind, about eating disorders will trigger some and that will be the case withTo The Bone, but not such that is loses all value which will be as diverse as the people who go to see it.

With my 40 year history in the eating disorder field, I am passionate about anything that can be done to help understand, prevent and treat these illnesses and even though To The Bone has weaknesses and is not the movie I would make, it is still an important step in bringing eating disorders front ancenter. I can put aside my own biases both as someone who recovered and as a current expert in the field and see this movie for what it is, one woman’s story that is authentic, sad, realistic, disturbing, scary, and true. And as for hopeful, let me just say that the real Ellen, Marti Noxon, is recovered and here to say it is possible and that speaks volumes.” – Carolyn Costin, July 14, 2017


Carolyn+Costin+-+Angie+VietsCarolyn Costin, MA, MEd., MFT, CEDS, FAED, is a world renowned, highly sought-after eating disorder clinician, author, and international speaker. In her twenties, Carolyn recovered from anorexia and became a teacher and a psychotherapist. After successfully treating her first eating disorder client in 1979, she recognized her calling. In 1996, she created Monte Nido, the first licensed, residential eating disorder treatment facility in a home setting. Having left Monte Nido in 2016, Carolyn maintains her private practice and remains very active in the eating disorder field lecturing, training, teaching, writing and supervising. In 2017, Carolyn founded The Carolyn Costin Institute, which offers Eating Disorder Mentor and Coach Training, online and in-person Continuing Education for clinicians, and other specialized trainings.Carolyn Costin, MA, MEd., MFT, CEDS, FAED, is a world renowned, highly sought-after eating disorder clinician, author, and international speaker. In her twenties, Carolyn recovered from anorexia and became a teacher and a psychotherapist. After successfully treating her first eating disorder client in 1979, she recognized her calling. In 1996, she created Monte Nido, the first licensed, residential eating disorder treatment facility in a home setting. Having left Monte Nido in 2016, Carolyn maintains her private practice and remains very active in the eating disorder field lecturing, training, teaching, writing and supervising. In 2017, Carolyn founded The Carolyn Costin Institute, which offers Eating Disorder Mentor and Coach Training, online and in-person Continuing Education for clinicians, and other specialized trainings.