What Saved Me From the Shame of My Eating Disorder

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By: Lydia Hubbard

Shame is suffocating.

I wanted to take off the bread like I wanted to rip the layers of my skin and ask my bones to carry the burden. I was desperate to reach the ultimate emptiness and rid myself of the pain. I grew the anger beneath my fragility by refusing nourishment.

30 days in a treatment center to uncover years of hiding. Searching for every reason to leave, signing a 72 but erasing the ink. Staying taught me how to breathe, even when I wanted to give up on my lungs. My mother called the facility on the first day to make sure they watched her suicidal daughter; I told her they were always watching.

I played the game: eat the meal, dismiss the unforgivable pain, move up into the next dining hall and get out. 30 days later, on discharge day, I lost when I thought I had finally won. I agreed to enter outpatient treatment the next day with the full intent of never showing up. I was lying to myself out of the desperation to be done. Done being told what to do, done talking about food, done talking about myself. The plastic trays lay heavy and the weight drowned my consciousness; the longing for emptiness never disappeared. I was let off the chain, but I no longer had the energy to run.

I wanted to prove I was ready to leave, but I did not know how to prove something I did not believe. Treatment was not a cure. The complexities of anorexia were so innate that I could not separate the disorder from myself. I hated the process because of the fears it forced me to confront, the anger I had pushed away for so long. I was disregarding negative emotions and shaming my ability to feel, a gift I labeled as a curse. Avoiding emotion with my use of restriction and control kept me from myself. I was told, “the purpose is not to feel better, but to get better at feeling.” Vulnerability saved me.

The day of my admittance, I vowed to get better for my parents when my father’s tears fell on my raw shoulder. I am unable to fully explain those 30 days — they were my own. Finding the internal motivation to heal was what began my recovery. I encountered intelligent and genuinely beautiful human beings with such significant empathy. I am not sure there is an adequate way to truly recognize the individuals who keep your heart beating until you learn to do so yourself. So I will fight to bring my shame into the light and advocate for others as a thank you — it does not have to be suffocating.

This post was originally published here

About the Author: Lydia Hubbard resides in Philadelphia, Pennsylvania. She is a College Coach who works with College Possible for a year of service through AmeriCorps. At Project HEAL, Lydia is dedicated to sharing words of hope after her recovery from anorexia. She is passionate about mental health, suicide awareness, and the power of meditation.

A Different Type of Scale

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By: Eva Romanoff

When I was nine years old, I asked my mother if I could buy a new sweatshirt. They were this new brand that were super soft, and each one was unique with a special design and color. My parents gave it to me for my birthday, but as my mom placed in my excited hands, she said that, while it was a very cute sweatshirt, she didn’t think it was like my style had been in the past. The next day at school, my friends and I all obsessed over our new sweatshirts, until a week later when a girl bought a new type of backpack. Then I wanted that. I didn’t particularly like the bag, but I began to think, if my friends all liked it, then they wouldn’t like my bag if it was different, and therefore wouldn’t like me. A perpetual system of self-doubt and comparison began to form. At twelve years old, my friends began to diet. I had worried about eating certain foods in the past, but I had never followed a strict meal plan. When my friend group at school began to diet together, I assumed I should join in, because what if they resented me for eating “junk” food in front of them while they were eating “healthy” food? At thirteen, when my friends began to work out intensely, my actions immediately followed theirs. What if their bodies began to change and mine didn’t, what if I stood out too much? My eating disorder, the loudest voice in my head, was shouting that I should follow the other people in my life.

For me, my anorexia focused my thoughts on my general body shape and appearance rather than specific weight and numbers. Instead of counting calories or weighing myself, I placed my life on a different scale, those of my peers. If my friend dressed a certain way, I mimicked her style. If my sister cut her hair, I scheduled an appointment at the salon immediately. If my friend talked to a boy with a certain attitude, I needed to talk to a boy and use the same attitude. I needed to be the best, the first, the most accurate. I placed myself on a metaphorical scale of self-worth and comparison rather than pounds. I was able to deceive myself, convincing my brain that these weren’t connected to my eating disorder, that these thoughts were normal and consistent with teenage life. Unfortunately, I was very wrong. Without realizing, my eating disorder voice crawled into my common sense, and they morphed together to sway me against my values. My goal had always been to be my individual self and to hold true to my values, yet my brain was telling me that acting and looking exactly like my friends were my values. The scale that my eating disorder forced me onto wasn’t just about weight or appearance, but included weighing my intelligence, my emotions, my athleticism, and my personality against the people around me.

When I went into residential treatment at fourteen, we did a group activity about two months into my stay. We gathered around a scale, wrote the cruel things that our eating disorder told us on the plastic in a big sharpie, and then took hammers and smashed the scale until it was screws and broken pieces. My therapist called it “scale bashing” and it was a way for us to visibly take power away from our eating disorders and the pressure to be a certain weight. I had a difficult time with this exercise though, because what if my central problem wasn’t my weight? What if it was the weight of my values? How did I bash that scale? I grappled with this for months, even after I was discharged at a much healthier place, and especially when I was reintegrated into school and my social life. My eating disorder voice and my healthy voice were separated, and my healthy voice was winning each daily battle. Yet the squeaks of my eating disorder that I still heard were centered around comparison. It wasn’t about being the funniest in the world, but simply the funniest in my friend group. It wasn’t about being the smartest girl in the school, but just in my grade. My obsessiveness around food was gone, yet here lingered these thoughts of comparison. After dealing with these ideas for the better part of my freshman year of high school, I realized that my eating disorder hadn’t morphed into a new disorder, but rather the core of it remained. It was like an apple; the skin and flesh of the fruit were about food, weight, and appearance, but the core was based on my position within a larger group of people. This isn’t how everyone experiences their eating disorder, but for me, the revelation that it hadn’t been about food was life changing. I didn’t need to bash a real scale, as much as a needed to bash the scale of my self worth. What I began to understand was a simple concept that I had never previously grasped; respect for oneself cannot and should not be based on other people’s life and actions. It should be based on your own perspectives of the world and your own opinions. My experiences are what should shape my values, not my friends experiences. This shift in thinking was my first step to understanding the personal scale I had built for myself. I didn’t need to ‘fix’ myself, I needed to change my focus from my friend’s opinions to my own.

When I realized this was the root of my eating disorder, I began to look at the larger picture. Throughout my life, I was raised with the same set of children surrounding me. My best friends, my sister, my classmates and my acquaintances. I had spent the last fourteen years of my life with these people, and we had essentially raised each other. How was I supposed to find my own voice when the people I loved seemed to be expressing kind and helpful things as well? Why did I need to have my own values when my friends believed in kindness and acceptance too? I grew to understand that my friends and family could have good values that I related to, and they could guide me in my own journey, but the end result had to be discovered on my own. I couldn’t blindly follow others opinions just because, I had to analyze the purpose of my perspectives before I could connect them to myself. Through discovering my own thoughts independent of others, I am able to engage more fully in vibrant discussions, and hold true to my own personality, something that was previously hidden beneath the scales of my eating disorder.

About the Author:  Eva resides in New York City. Eva is a high school student who works with other teenagers to instill a sense of hope regarding the possibility of full recovery, as well as what that means and what that looks like in a teenager’s life.  At Project HEAL, Eva is dedicated to providing others with a sense of community and security throughout the process of recovery, spread education and awareness to fellow high school students, rand to promote a healthy lifestyle that allows everyone to discover their true selves and purpose.  She is passionate about horse back riding, learning about history, and spending time with friends and family. Eva’s favorite ice cream flavor is coffee ice cream with chocolate chips and caramel sauce.


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 BPD 1 . 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 Psychotherapy 2 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 BPD 3 ; given the effectiveness of DBT with BPD, it makes sense that DBT would be effective for this subpopulation.

These findings mirror what we see at Columbus Park which is an outpatient 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
         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.

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

3 Milos, 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

About the Author: Melissa Gerson, LCSW is the Founder and Clinical Director of Columbus Park, the leading outpatient eating disorder treatment center in New York City. Melissa is a native New Yorker whose “first career” was as a professional ballet dancer with the Miami City Ballet in Florida. After seven years, touring with the MCB company, Melissa retired from ballet and returned to her NYC roots to attend Columbia University as a Psychology major. She went on to earn a master’s degree in social work at New York University. Melissa has over a decade of training and experience in treating eating disorders. She completed post-graduate training at some of the most reputable NYC institutions like NYU’s Psychoanalytic Institute, the William Alanson White Institute and NY State Psychiatric Institute. Melissa is a true leader in the eating disorder treatment community with a particular focus on using the most current and efficient evidence-based treatments like CBT-E, DBT and Family-Based Treatment for Children and Adolescents.

Technology for Eating Disorders: The Major Players

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By: Melissa Gerson, LCSW

Over the past 10 years, various universities, researchers and clinical teams have worked to evaluate the efficacy and efficiency of eating disorder treatments delivered via technology. In this time, a wide range of technologies (e.g., televideo, e-mail, CD-ROM, Internet, text message) have been utilized with the intention of either delivering a treatment modality entirely, or serving as a compliment to a specific level of care (e.g., therapy, guided self-help, treatment adjunct). These studies were typically based off cognitive behavioral principles and interventions (CBT) and utilized a sample size of at least 10. While the studies demonstrated an overall positive result, caveats remain and are worth evaluating prior to implementing such services in any practice. The predominant concern that was shared between researchers and clients was a desire for more personal and face-to-face interaction. Despite this desire, technology continues to grow at an extremely fast rate and it is necessary to evaluate this rich area for growth and development within the field of mental health. Let’s review a few of the identified ‘major players’ within this pool of research.

Those seeking to attain the highest degree of integration between psychotherapy practice and technology would utilize devices such as the telephone, e-mail, and videoconferencing. These devices are the most direct, meaning they administer actual psychotherapy. Studies surrounding these devices posed questions that would evaluate the acceptability of these formats for both the administrator and the recipient. A number of factors must be considered when utilizing an email or internet based format such as access to a computer and internet-based education.

Email Format:

The first technology-based innovation in a large scale trial was to contact a large number of potential patients by email through mass mailings. The therapists used e-mail to elicit history, encourage food monitoring, and identify and change maladaptive ED cognitions and behaviors.

The e-mail treatment lasted three months and averaged two e-mails per week. Researchers stated “At the end of treatment, significantly fewer individuals met criteria for an ED in the e-mail condition (~22%) compared with the wait-list control group, of which all members were still diagnosed with an ED at follow-up.”

The email format demonstrated a new means to reach a large group of people who may not otherwise seek treatment or have access to an ED clinic in their geographic region.

Internet Format:

A second internet-based format utilized an internet-based therapy called “Set Your Body Free,” (Gollings & Paxton, 2006). Regardless of designated format, each participant received the treatment manual that provided focused psychoeducation, change-based strategies and a treatment topic guide. Participants in the Internet-based condition involved synchronous (scheduled, real-time, two-person) communication were paired with a therapist in an online chat-room with discussion board (“chats” included a patient’s motivation to change, self-monitoring skills, degree of body dissatisfaction and more). At the end of the study, subjects in both conditions reported reduced ED symptoms (e.g., self-reported body image concerns, dietary restraint, and bulimic symptoms). While there were stronger initial effects in the face-to-face condition, participants in the Internet group continued to make gains, reaching similar levels of symptom reduction at 6 months follow-up.

It is important that researchers fully explored limitations of this study, and factors that may have impacted patient experience and results. These were identified as “participants’ keyboard skills, which may have reduced some individuals’ participation, difficulties in relaying the same amount of information as in traditional talk therapy, and computer problems that resulted in four participants’ premature termination.”

Video-conferencing (Telehealth)

A fourth study evaluated face-to-face intervention as compared to the use of video-conferencing. This technology-supported therapy condition attempted to replicate the experience of traditional psychotherapy more closely. Results indicated similar levels of ED symptom reduction in the two groups and equivalent therapist alliance in both conditions. Interestingly, therapists reported a subjective preference for the FTF format. Reasons cited included that therapists valued the experience of sharing a room with a client as the communication results in greater feelings of closeness between individuals and traditionally, psychiatrists and psychologists consider face-to-face contact necessary to fully assess the general mental (and physical) state of the patient’s heath. Additional barriers included a difficulty scheduling sessions at distal sites and technical difficulties.

Guided Self Help:

In a research study that utilized internet-based guided self-help sites/manuals/CD-Roms, “more than one-third of the BED sample reported abstaining from binge eating post-intervention and showed significant improvements in related ED symptoms such as shape concerns and body dissatisfaction.” While outcomes suggest that Internet-based guided self-help holds promise to benefit patients who have difficulty accessing face-to-face psychotherapy, issues with treatment completion and with suboptimal response require additional attention. To remedy this, a set of research studies investigating guided self-help programs have also included additional contact between counselors and participants, with the aim of boosting the therapeutic alliance, promoting retention, and increasing effect.

While generally, technology-delivered therapies have yielded positive results, interventions with the greatest level of therapist interaction resulted in higher abstinence rates. These findings suggest that there may be an ‘optimal level’ of therapist-client interaction that results in the highest rate of long-term symptom reduction. Researchers will continue to dive further into this field to identify what that necessary level of support is, and how to promote substantial and permanent behavioral change via the promise of technology.



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Moving Forward: My Story

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By: Samantha Havens 

 I’ve never been bullied by a classmate, friend, or family member. However, I lived with a bully in my head for years. That bully was my eating disorder. He gave me orders to eat less, count my calories, and cut out certain foods. If I didn’t listen to him, I was a failure. He tormented me. I let my eating disorder consume me. I was 11 years old when his voice crept into my mind. I never thought anything of it. I simply thought it was my insecurities getting to me. I always saw myself as overweight when I looked into the mirror. I never realized that I looked malnourished and underweight in reality. My eating disorder never let me think I looked good. One day my best friend told me she was worried about my weight, that a lot of people thought I was too skinny. When I looked up anorexia online, there were a lot of symptoms I related to. As I read the complications of having this mental illness, I got worried.

I decided to tell my family. After I told them I felt relieved; I thought it would all go away now. However, it got a lot worse before getting better for me. I was hospitalized at an eating disorder inpatient unit. The hospital was intense and frightening. I was only 14 years old when I got admitted. There were strict rules, my eating disorder was stripped away from me. I felt as if the hospital had all the control, and I craved to have that control back.

However, the second time in the hospital changed my life. I listened to my treatment team, ate according to my meal plan, and tried to push my eating disorder out of my life. As I was opening up in therapy and getting to the roots of my problems, I felt less drawn to restricting. When I wasn’t restricting and consumed with worrying how fat I looked, I began to live in the moment and enjoy life. I may have still been in the hospital, but I felt true happiness and genuine laughter once I started to let go of my eating disorder.

Recovery is not easy, it is a tremendous amount of self talk all the time. You have to fight the voices everyday. However, it is all worth it. I believe that suffering is a gift. It gives us the chance to embody courage, to learn, and to grow. My eating disorder was a gift because I learned a lesson not many people actually learn: I may not have control over what happens in my life, but I can control the way I react to it. Being anorexic is not having control, it is being controlled. All along I had the control to put an end to it and chose real happiness. I came out stronger than I ever could have imaged from my struggles. I will forever use that strength in times of any struggles and obstacles I encounter.

You have one life to live. You have one body that is given to you. Your body has amazing abilities to keep you alive and to do everyday functions. Why waste your life away hating yourself? I promise you, you will get so much more out of life if you can try and start to love yourself, and live the happy life you deserve. Everyone’s story is unique. Don’t be afraid to share yours. Eating disorders are nothing to be ashamed of. It’s a disease that no one chooses to have. Nobody wakes up wanting to become anorexic or bulimic. However, you do get to choose to fight and get your life back. The more people open up and share their stories, the less stigma there will be surrounding eating disorders. Not only that, but sharing your story can motivate someone silently struggling to open up.

About the Author: Samantha is a past volunteer for the central New Jersey chapter.

Finding Self-Worth and Self-Compassion in Recovery

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By: Leilani McIntosh

In honor of my official discharge from my (almost) 4 year journey of being in all different levels of treatment, I want to repost an article I wrote for an awesome online magazine, “Be Wise”, started by my beautiful friend and role model, Ceciley Hallman.

I spent the majority of my high school experience in treatment for my eating disorder. Strong people fight cancer. Brave people fight in war. Educated people fight within a justice system. I fight with myself. I fight a battle inside my head every day. It is not easy, nor enjoyable, and it is certainly not a choice. A common phrase one might here is, “You are your own worst critic.” Analyzing the world around us, why shouldn’t we be harsh on ourselves?

Women and men are bombarded with guidelines the world has laid out for us. For example, a common expectation is to look like we always have everything together. Mothers are supposed to be holding the world on their shoulders, smiling, without breaking a sweat. Men are coached to show no sign of weakness. One’s manhood is threatened when they choose to open up to someone. The world has also given men and women guidelines on what the ideal body looks like. Men are supposed to be built and muscular, when women need to be skinny yet curvy. Women are taught they need make up to look beautiful… the list goes on and on. So how does that impact our lives?

Step back and ask yourself: What do I see when I look in the mirror? Am I happy? Am I comfortable in my own skin? Do I immediately find a quality that I wish I could change about myself?

I started nitpicking about myself in the fourth grade. People started commenting on my body and I became very self-conscious at a very young age. I started talking about diets and was worried about exercising. As I got older, those thoughts turned into my reality. Through my high school years, I went through many trials which I didn’t know how to handle. Some people cope by drugs or drinking, which turns into an addiction. I coped through eating disorder behaviors, and it became my addiction. It took me going to treatment to realize how unhappy I was.

Often I listen to the seconds of the clock ticking away… physically I think I am alone until I listen extra closely. I hear a voice. A clear voice who knows exactly what I am thinking. It is a voice who I am so familiar with that I don’t even notice that it is around. It is a voice whom I can find being my best friend and advocate, but it is also a voice who is my worst nightmare. My frenemy is the voice in my head.

When I went away to residential treatment, I felt stuck for a long time. I was just sitting there, following the rules, not speaking to anyone, and keeping to myself. When I had therapy appointments, the first little while, I kept things very vague; until my therapist asked me, “Do you love yourself?” The question brought me speechless. I ended up just shaking my head, no. She continued on, “Do you believe you have self-worth?” To be honest, I had no idea what she meant. The dictionary defines self-worth as “the sense of one’s own value or worth as a person.” Your self-worth is commonly used as a synonym for self-esteem; but I have found it goes much deeper than that. Self-esteem is usually measured through one’s actions, when self-worth is valuing your own inherit worth as a person. It is about who you are, not what you do. My therapist told me that I needed to find what makes me worth it as a person, before I could love myself; so the journey of finding my worth began.

The first step to building self-worth is to stop comparing ourselves to the world and being overly critical about every move we make.  Easier said than done, I know. To be able to conquer the challenge of caring what everyone thinks, we need to challenge our “critical inner voice”. With these internalized conversations of thoughts, or “inner voices”, it undermines our self-worth and may cause destructive behaviors and may make you feel worst about yourself. Dr. Lisa Firestone explained in her article “7 Reasons Most People Are Afraid of Love:” We all have a “critical inner voice,” which acts like a cruel coach inside our heads that tells us we are worthless or undeserving of happiness. This coach is shaped from painful childhood experiences and critical attitudes we were exposed to early in life as well as feelings our parents had about themselves. While these attitudes can be hurtful, over time, they have become engrained in us. As adults, we may fail to see them as an enemy, instead accepting their destructive point of view as our own. As we challenge these critical thoughts, we will be able to see who we are and what we are capable of.

Find self-compassion for yourself. Self-compassion is the practice of treating yourself with the same kindness and compassion as you would treat a friend. I often resisted having self-compassion because I didn’t want to be conceded. WRONG. That was just an excuse my critical inner voice told me. Having self-compassion is a form of self-care. I learned three steps that helped me to have self-compassion.

1) Acknowledge and notice your suffering.

2) Be kind and caring in response to suffering.

3) Remember that imperfection is part of being human and something we all share.

By challenging your inner voice and stopping to compare yourself to others, you can begin the process of recognizing your own self-worth. You can push the way you see yourself from just an average, or below average, to a worthwhile person in the world. Developing my self-worth is something I work on every day.

This is my battle, and it is not easy, nor does it happen overnight; but it has truly changed my life. You do not know how your subconscious or present thoughts about yourself, truly affect your and your everyday choices and lifestyle. You can’t control many things in your life, but you can surly control your thoughts. It is hard to dig up uncomfortable feelings about yourself, and it may bring up a lot of emotions; but I promise you, it will change your life, because it has changed mine. Don’t let that inner voice stop you from becoming the best person that you can be. Don’t let others bring you down, because my friend, you are worth it.

About the Author: Blogger – NYC Based – Trying My Best In Recovery, Project HEAL volunteer. Follow her journey @leilani_mcintosh

5 Answers to Common Questions From Those Struggling with Anorexia

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By: Melissa Gerson, LCSW

Although every client is different, here are the five most frequent things we hear from anorexia patients at Columbus Park, together with our response:

1. “Why can’t I stop thinking about food?”

That’s what happens when your body is starving.

Chronic food deprivation and loss of body weight results in heightened interest in food.   When your body weight drops below a comfortable set point range, the brain switches into starvation mode—metabolism slows and hunger signals pick up.  This focus of the starved mind on food may lead to increased interest in food preparation (often for others, not oneself), obsessive planning of meals, extending eating experiences for long periods, reading about recipes, and/or looking at photos of food.  Many describe this fixation on food as persistent and profoundly distressing.  Weight restoration helps reverse these effects.

2. “My weight isn’t low enough; how can I be starving?”

Your body feels starved long before you look emaciated.

The popular image of anorexia and under-eating is that of someone emaciated. While some people do get to this point, most enter starvation mode at higher weights.  Each of our bodies has a set point range (usually about a 5-7 pound range) it works to maintain.  Set points vary by individual—based on genetics, lifestyle, height and weight as a child, and where the body was prior to the start of the eating disorder.  Once weight falls below your set point, your body enters starvation mode.

3.  “Why can’t I keep exercising a lot? It makes me feel calmer.”

Yes, exercise can be relaxing, but too much can impede your recovery.

Mammals who are in areas of famine show remarkable strength and single-minded focus to migrate to areas where food is more plentiful.  There is some evidence to suggest a similar effect in those with anorexia; a kind of hyper energy even in the absence of adequate food.   Exercise also stimulates the production of neurochemicals which serve as natural soothers.

4.  “Why can’t I limit my diet to just healthy, clean foods?”

Is it really about health?

I’m all for healthy eating – but “healthy and clean” eating often gets taken to unhealthy extremes.  When clients with anorexia frame healthy, clean eating as in the service of health, I remind them that this extreme restriction and rigidity has actually had the opposite impact; it has taken them to a dangerously unhealthy place (hair loss, poor circulation in extremities, slowed heart rate, loss of periods in women, and more).   These clients typically require intensive medical oversight due to their compromised health – hardly a “healthy” place.  It’s not really about a pursuit of health; it’s about taking eating habits that might be considered ideal or even virtuous to an extreme.

5.  “Why can’t I get better without gaining weight?”

It’s not possible.  Your body and mind simply cannot recover if you remain underweight and malnourished.

The consequences of maintaining a low weight include constant thoughts about food, low energy, avoidance of social situations, isolation, poor sleep, inability to focus, and obsessing about the number on the scale. Clients sometimes want to shed those un-pleasantries without actually gaining weight.  It can’t be done; they are inseparable.  Achieving a full and balanced life means restoring health and balance to your body.  Most of our clients with anorexia notice that as they restore weight they feel better, not worse.  Depression and anxiety symptoms remit along with obsessive food and body thoughts.  They develop the kind of flexibility required to re-engage socially.  Physically, they feel stronger, more energetic, and better able to concentrate.


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.

To learn more about treatments offered at Columbus Park head to www.ColumbusPark.com

A Thank You Letter to My Therapist

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By: Ericka Christina

To my therapist,

After almost eight years of working with you, I can say we have established a pretty solid relationship. We’ve worked through so much more than just my eating disorder symptoms, and we have uncovered layers of trauma to reveal a strength I never imagined I could possess. There have been highs and lows, and I’ve lost count of how many times I think you have saved my life.

Today, during my session, we talked about my progress, and the option of coming to therapy less frequently or even stopping all together. While I consider myself stable right now, stopping is not an option. I value the time I have with you, and it is the highest form of self-care for me. As I reflect on the years of work we have done together, I am in awe of the progress and changes in myself. Last year, I didn’t have to schedule an emergency session to figure out how I would cope with a Thanksgiving meal, and I didn’t need to have my phone with me at the dinner table in case I needed to send an SOS text. For this, and so much more, I’d like to say thank you.

Thank you for all of the hard work and dedication you have shown me through the years. There are countless examples that come to mind, but some stick out more. You listened with support when I blamed you for taking away the thing that meant the most to me, and then, you let me grieve that loss (over and over again) before helping me to see that I no longer had a need for the eating disorder. Thank you for having me set a phone alarm to text you daily when I needed encouragement to complete meals. I labeled the alarm as a “reminder that someone cares,” and though it is no longer an active alarm, I’ve kept it on my phone.

Thank you for signing into Recovery Record, reading my food logs and leaving feedback. It made me try harder to “do the next right thing” because I knew there was accountability. Thank you for collecting my scales (yes, plural!), storing them safely away from me and for showing a genuine happiness whenever I had meal victories. For what may seem like little things (but to me, made a world of difference), thank you.

From writing encouraging letters for me to save to read when I needed a boost to preemptively supporting me during holidays and transitional periods by sending a quick text, I appreciate every bit of it. You were never afraid to promise me that I would be OK and because I trusted you more than I trusted myself, I chose to believe that. It became a reality. You relentlessly worked to help me discover my self-worth and reminded me of reasons to recover. Most of all, thank you for giving me the constant reassurance that no matter what, at the end of the day, I have a person in my corner and I’m never alone in this recovery journey. Even though I don’t see you as often right now, you will continue to be the voice in my head that helps me to choose recovery every day. For this, I am forever grateful.

About the Author: Yogini. Social Worker. Avid napper. Recovery Warrior.

I Didn’t Think Recovery Was For Me

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By: Anonymous

I never thought I would recover. I wasn’t sure if recovery from an eating disorder was even a real thing. Let alone possible for me. I never thought I would want to recover even if it were a possibility. I remember leaving a clinic that I didn’t want to go to in the first place; I was supposed to go get my things and come back in the morning to start inpatient therapy. I wasn’t ready. Are we ever really ready? I guess that the answer must be yes, or at least that we must kind of want to try, anyway. But not yet. I had to get worse before I got “ready.” Because eventually, I had to decide — did I want to die or not? I wasn’t really sure if I cared anymore. That’s the decision that it ultimately comes down to if you let it. Or it did in my case anyway. I’ve never felt more alone or more ashamed. And I’ve never liked myself less. And my family was worried about me, and I hated myself for making them worry.

Eventually, I started to worry about me too. “Do I have electrolyte imbalance(s)? Am I going to lose consciousness and wake up in a hospital? Do I have osteoporosis? Am I infertile? Does it even matter? I can’t even take care of myself; how could I ever even think about taking care of a child?” I didn’t know what to do. But it seemed I had learned exactly what not to do. For a while, I actually I thought I was in control. I thought had such great willpower. And I guess it did start out that way. If you can deny yourself a basic human need, what can you not do?

But somewhere along the way, I lost that control. I remember seeing a photo of a note on the inside of a toilet lid that said “who’s in control now?” It really stuck with me. Looking back now, I feel confident I will never go back because I see now that there is no winning. No end goal. No staying in control. No being perfect. I would never be “good enough.” I remember setting and reaching weight goals, and I never felt even a little better. Not once.

I never thought I’d be here today. Here, drinking coffee that’s not black, studying so that I can try to figure out how to help others like me (or unlike me). I never would have considered that my thoughts or my story may be worth sharing. I never thought I’d talk or write about this. But what have I got to lose? If it helps anyone, it was worth it. And I like to think it couldn’t have all been just for me. Now I even have a recovery tattoo, for myself, and for anyone else who may need it. To remind myself how far I’ve come. And that there is hope. And to know that I am not alone. None of us are alone. Asking for help is not a sign of weakness; it is a sign of strength. Recovery is possible. You are more than enough.

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.