Right Time, Right Place, Right Therapist

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By: Frances Coleman-Williams

Having suffered from anorexia for over half my life, I had come to the conclusion life wasn’t worth fighting for. My belief that I was fundamentally flawed was confirmed every time I failed to get better. Restricting food and purging even the tiniest amounts sapped all my energy and I couldn’t think straight. I was exhausted, slowly killing myself and I didn’t care. The voice in my head was getting her way. She told me not to eat and told me she cared for me and wanted what was best for me. I believed her for many years. I’d failed at therapy after therapy and I couldn’t see even a chink of light in the darkness. No one seemed to understand me, they claimed they did but why then did they make ridiculous comments and talk so patronisingly to me?! I know I need to eat more but I CAN’T. I know I need to stop exercising but I CAN’T. I do not need educating, I need understanding.

I was dragging my sorry body down the road during one of the numerous walks I made myself do when I received a phone call from the dreaded Day Care offering me an appointment for an assessment. My heart was beating so hard I thought I was going to faint. I held it together and agreed to go in. The voice inside my head told me this was futile, ridiculous and that they would just make me fat. But something else within my shouted out that I could no longer live like this and something had to change, I needed help and this was worth a go. Of course, I feared I’d be turned away for being too well as I was convinced I was too fat to need intense support but they advised me to join the day program immediately. Again, the voice told me I should run away, they would make me fat and they’d not care for me as much as she did. Although lacking in energy and spirit, I was determined to make this time work. I decided I wasn’t going to throw this opportunity away. I decided I’d be completely honest and put a stop to my living hell once and for all. While at Day Care I was referred to a new therapist. I was skeptical to start with, I didn’t think he’d see me because he was a family therapist and usually saw sufferers with family members. But he saw me on my own. For the first time he was not doing therapy to me – previously experiences were of someone trying to do DBT, CBT etc to me, as though I was an illness that needed irradiating. For the first time he was open to who I was not what I was. For the first time I was with someone who would let me cry, scream or be silent and he wouldn’t judge me, try to stop me or talk about a finite number of sessions in which we had to ‘complete’ therapy. I saw this therapist for a few years, initially weekly, eventually monthly and I grew into the person I’m proud to be now. Yes, I gained weight, I had to to survive. But (equally importantly), I discovered who I was, what was important to me and I moved my eating disorder out of the centre of my life. I started working and got married and while these may not be the most important things in life, they are symbolic of my stability. There are still things I struggle with but I would say I’m recovered because these small things do not rule my life, nor do they stop me doing what I want.


About the Author:

Frances Coleman-Williams is a writer using personal and professional experience to fight stigma and discrimination faced by people with mental health problems.

When The Dietician at the Hospital Doesn’t Understand Eating Disorders

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By: Elizabeth Janiello

“You are in good health, Elizabeth.” These are the words my dietician at the psychiatric hospital spoke to me. When she called me back to talk with her, I felt relieved. Finally, I can talk to someone in this hospital who understands eating disorders. Someone that can help me navigate the hospital while having an eating disorder. She sits me down, tells me my weight, and I instantly know that she has no clue how to work with patients with eating disorders. She didn’t ask what I’ve been eating since entering the hospital. She didn’t ask what I was eating before getting to the hospital. She simply said my height and weight and declared that I am in “great shape” and “very healthy”. She said, in broken English, “You are happy with your weight, yes?” Honestly, I respond no. I am not happy with my weight. She says, “You could lose a little, maybe a few pounds.” She asks, “Do you have a goal weight?” I respond with the weight I would like to weigh, one that I know is unhealthy, one that I know is meant for middle schoolers. But this is the weight I would like to be at. She responds, “Okay, that is fine.” She walks away.

Talk about a medical professional who knows nothing about eating disorders. I don’t know why I even expect anyone to understand eating disorders at this point. This is another reason I am so thankful for Project HEAL. I am fortunate enough to work with an entire team of specialists who SPECIALIZE in eating disorders. I am so very lucky.

I’d like to say that being here is helping me get better. But right now, I’m not so sure. I still feel stuck and defeated. And I know I’m letting my depression and anxiety get the best of me. Writing this has helped put me on a better path- a recovery-focused path.

Sitting in front of me is a banana, what I took for lunch from the cafeteria. To all those who are struggling and reading this, I am going to do something for you. I am going to eat this banana for you. It is literally the last thing I want to do. I am already in “restrictor mode” as I call it. But my outpatient dietician says that everyday we are given hundreds of opportunities to make decisions. For any given choice, one will be comfortable and safe, and one will be uncomfortable and scary. She told me to always chose the scary and uncomfortable choice. For me, restricting is safe and comfortable. I restrict when I’m scared, anxious, sad, angry, lonely, defeated, etc. Any emotion I’m feeling- I restrict. So, in this moment, I’m going to do the hard, scary, uncomfortable thing. I’m going to eat my banana. Right now, I’m doing it for you, for anyone who is reading this blog. But maybe one day soon, I’ll want to do it for me.


Lizzie studied Psychology at Hillsdale College, a small liberal arts school in Michigan. She currently works as a research assistant in Washington, D.C. She is in recovery and hopes to one day use her experiences to help others struggling with eating disorders. Lots of love and please stay strong! You’ve got this. 

Cultivating Joy in the Kitchen: A Caregiver’s Take on Meal Prep in Eating Disorder Recovery

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As the primary caregiver of an adult with an eating disorder, I often find myself navigating multiple roles as I support my partner in her recovery. On days when her eating disorder is particularly strong, I play the “parent”. I prepare and plate her food for her according to her meal plan, regardless of any excuse her eating disorder might have. One might think that at 29 years old my partner should be able to feed herself, but recovery in a sense, is about starting over. It’s about learning to feed oneself without their eating disorder controlling food decisions.

I’d be lying if I said I didn’t get frustrated at times when I have to take on this role, but it helps when I remind myself that food is thy medicine. I have to remind myself to stay present and that right now food for her is her prescription. She can’t miss a dose.

This is not always an easy task. If only a “spoon full of sugar” would help this medicine go down. As I help her complete her snacks and meals, I recognize and subsequently attempt to work through the internalized stigma and shame that I have recently become aware of that I hold. As someone who thankfully has had a “normal” relationship with food my entire life, I sometimes struggle to be understanding and compassionate.

Preparing dinner in our kitchen is part comical, part loving, part gratitude, part frustrating, and part sad. Food prep involves constant inquiries from my partner because she actually doesn’t know how to make something or she feels like she’s not cooking something “right” or she’s anxious and her mind is racing (it’s probably a combination of the three). As an observer to this, it’s interesting to see the eating disorder’s black and white way of thinking continually play out, even in moments of recovery. The dish she is helping me prepare has to be either correct or incorrect, which often leaves her slicing up vegetables or preparing sides dishes, while I cook the main dish.

This amazes me because this is the exact opposite as to why I love cooking and find it therapeutic. I too, like my partner, have a tendency to lean towards perfectionism, but in the kitchen I find that I can be haphazard and playful and the dish will still turn out great. I prefer cooking over baking because I don’t have to measure anything. I know that this lack of methodology and measuring cups is difficult for her, as it leaves much about the dish “unknown”. I know that sometimes it’s easier for her to not be in the kitchen while I’m cooking so she doesn’t see what’s going into a dish.

While I accept this struggle as where we’re at in recovery right now, I’m looking forward to see her move past the side dishes and be able to truly cook meals together that we are both excited to enjoy. Cooking is a past time for me. It’s a way for me to evoke and maintain joy and memories and I want to show my partner that experience with food is possible.

in love and support,

CJ


Jamie Dannenberg (CJ) is the primary carer of her partner, also named Jamie but referred to as OJ, who is in recovery from an eating disorder. As the partner of someone with an eating disorder and a registered dietitian, CJ has had to learn to navigate various roles in their relationship. With OJ, Jamie has become involved in global advocacy work and together they share their experience as a queer couple in recovery on their blog thirdwheelED. Follow them on Facebook, Twitter & Instagram.

Why Comparisons In Recovery Aren’t Helpful

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By: Melena Steffes

We’ve all done it. Whether it was comparing our own personal mountains, or milestones, comparison has snuck into our brains somewhere along the line. Eating disorders play games with your thought processes and when you’re sick it’s harder to see reality, so comparisons can make finding the truth that much more difficult.

Everybody’s recovery is so individualized, we’ve all experienced things differently and cope with things in our own ways. So when we take something as personal as our recovery, and compare it to those around us, it can be really damaging. The only truth we really have, is our own. We can’t really tell where those around us are in recovery, someone else’s middle won’t look the same as ours, especially if we’re still working on our beginning stages.

It’s really easy to find ways to compare ourselves. Sometimes, for example, seeing people’s posts online can become problematic when we perceive others as being further ahead in recovery than we are. I remember when I was pretty new to recovery, and I followed other people’s blogs who were also documenting their journeys, I felt like I was doing everything wrong. When my body changed differently, I felt inadequate and even more self-conscious, especially when I saw “progress pictures.” When my coping skills didn’t work similarly, I felt like I was some kind of poser, or like I wasn’t trying hard enough. I had a Tumblr that I kept through the start of my recovery and it kept me stuck in my thoughts. Once I realized that, I deleted it, even though I didn’t completely want to. But it helped allow me to heal, so now I am able to look at things like that with a new perspective, with a healthier brain.

The same things happened once I entered treatment for the first time, and the second, etc. The comparisons occurred continuously and it was really hard to teach myself that they weren’t doing me any favors.

It was really hard sit at the table during lunch when I looked at my meal plan and then looked around at those surrounding me. It was hard to pick my afternoon snack without looking to see what other people were choosing. I did this with pretty much everything. It happened partially because I felt like I wasn’t worthy of being in treatment, and because I couldn’t always take my eating disorder seriously. I can’t even count how many times I’ve told providers that I felt like I was taking up a bed that was more deserved by somebody else.

Whether comparison was to positive aspects of my recovery, or to eating disorder behaviors, it always chipped away at my recovery, regardless. But, with a lot of hard work, I have made doing so a non-option. I started to, whether this phrase has become cliché or not, take it day by day. I had to redirect myself when I found myself choosing a snack based on somebody else’s selections, or when I caught myself checking out others’ plates at lunch.

Even outside of recovery friends, I would still check myself against friends from other places or my family. I would look at people I saw on commercials, etc., and just think to myself that I needed desperately to change something about myself to be “better.” None of this ever helped or made me happier.

Reminders that my recovery may mean doing different things than others to progress was a realization that was really important. It started with me trying to forgive myself daily for things that I considered to be mistakes. It meant forgiving myself for not being the same as those around me. I had to let myself start over, daily. I needed to let myself try again and stop letting one missed exchange, allow my entire day to snowball out of control. I had to stop beating myself up for not doing my meal plan perfectly. Forgiveness of myself is an ongoing fight, but allowing myself to recover in my own way, and at my own pace, released me into climbing my mountains in the ways I needed.

Recovery, to me, has a variety of ‘mountains’. And comparisons are one of them. Climbing my way to the top, to conquer it, was challenging. Sometimes I still find myself slipping back into it, but I always remind myself that it always hurt more than it helped.

My recovery is mine. My path is mine, and won’t always look like the ones I see online, or in others around me. My life won’t always match the one that I think I’m supposed to have. And that’s okay.

It’s important to remind yourself that you didn’t fall down the rabbit hole of becoming sick just as somebody else, so you won’t climb your own mountains just as they do either.

 

 

 

 

Eating Disorder Treatment: The Least Restrictive Setting

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By, Melissa Gerson, LCSW

In a 2016 exhaustive review of the research on eating disorders there was a consistent finding across all diagnoses (anorexia, bulimia and binge eating):

“Treatment should be offered in the setting that is least restrictive and best suited to the individual’s needs and preferences.”[i]

The outpatient setting (treatment in your real life environment) is the least restrictive treatment setting and the ideal course for the majority of patients. More intensive, highly controlled settings are necessary primarily if there are immediate medical complications or co-occurring issues like suicidality that require a high level of oversight and intervention.

If you think about it, treating in a “real life” setting makes sense:  

  1. The Leading Evidence-Based Treatments Are Designed for Outpatient

The gold standard treatments for eating disorders are designed for outpatient application. They can be adapted somewhat for Day Programs or Residential settings, but they were designed for and tested in the outpatient practice setting.

  1. Work, School, Family Obligations

For most people, participation in work, school or family/social life is an important factor and “taking a break” from these responsibilities for treatment may be impossible. Outpatient treatment reduces disruption dramatically; in outpatient, you’re encouraged to engage, particularly in activities and pursuits that enrich your life, breed a sense of efficacy and boost self-esteem.

  1. Opportunity to Address Stressors Head On

While it’s not easy, working through treatment in the context of daily life challenges allows you to fully address them – with support – and gives you the opportunity to practice new, more effective ways of coping.

  1. Cost

Outpatient treatment is the most affordable level of care. It is said to be approximately 10% of the cost of inpatient.[ii] Since most of us rely on insurance for major medical expenses, the “higher levels of care” like Residential, Partial Hospital and Day Treatment, may be out of the question; insurance companies are becoming increasingly reticent to cover these higher levels care and if they do, the treatment stays are shorter than ever. Unless there is immediate medical risk, most managed care companies require that patients receive an outpatient trial of treatment first.

What’s Right For You

There are certainly situations where a highly structured and restricted setting is necessary but it is important not to jump the gun and assume that this kind of intensity is needed. There are short-term, time-limited outpatient treatments that are effective even for the more severe eating disorders. For example, using CBT-E, patients with severe bulimia can see full results in 20 sessions. And MOST of the change actually happens in the first 8 weeks. In fact, early change is the single most potent predictor of a good outcome.

Inpatient vs. Outpatient Criteria

The first step is a thorough assessment with a provider who is committed to using the research to guide practice. A recommendation will then be made for you based on very specific criteria.

At Columbus Park, we have clear criteria based on guidelines established by the American Psychiatric Association. Below is a sneak peak at the chart that our team uses to establish the proper level of care for those seeking our guidance:

 

Standard Outpatient CriteriaIntensive Outpatient Program CriteriaPartial Hospital/Residential/Inpatient Criteria
Medically stable/cleared by Medical DoctorMedically stable/cleared by MD/ frequent follow up requiredMedical instability
With guidance, pt is capable of creating one’s own meal structureExternal structure needed to eat or gain weightSupervision required during/after meals
Fair to good motivation to recoverAt least fair motivation to recoverPoor motivation to recover
Co-morbidities (i.e. depression, anxiety) may have some limited impact on functioningCo-morbidities (i.e. depression, anxiety) have high impact on functioningPsychiatric condition requiring hospitalization
Suicidality, if present, is passive (no active plan or intent to take one’s life) 

Suicidality, if present, is active and more structure/points of contact needed. Possible suicide attempts in past.

 

Suicidality is active w/intent and plan and unable to contract for safety
Some ability to control exerciseSome ability to modulate exerciseStructure needed to prevent compulsive exercise
Some social supportLimited social supportNo support available to add structure outside of treatment

[i] Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, Touyz S, Ward W. Australian & New Zealand Journal of Psychiatry 2014, Vol. 48(11) 977–1008

 

[ii] Katzman DK, Golden NH, Neumark-Sztainer D, et al. (2000) From prevention to prognosis: Clinical research update on adolescent eating disorders. Pediatric Research 47: 709–712.


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.

5 Things I Wish I Knew When I Started Treatment For My Anorexia

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This isn’t my first time recovering from anorexia. I had relapsed and recovered before, but this relapse was the worst, and it was the first time I ever sought treatment. I have done “recovery” on my own, but this time was different. Here are some things I wish I knew when I started treatment:

  • Your body needs time to heal. Your ED didn’t develop overnight, so your body won’t recover overnight either. You’ve put your body through hell, and now it needs time to heal. I have been in recovery for 16 months after a relapse that lasted only 3 months. My body is still not finished healing. It’s not even close. There’s no telling how long it will take, but I do know that it takes time, and you cannot rush it. And yes, it sucks. My body is struggling to recover, and I know that’s only because I put it through so much for so long. It thinks that at any moment it could starve again, and therefore it’s reacting as if there’s a famine, even though I continue to follow my meal plan and eat 3 meals and 2 snacks a day. It’s hard, and to be honest, I avoid mirrors and wear baggy clothes, and try to hide. It’s hard. Your body needs time. A lot of time.
  • Inpatient/ residential is the easy part. The hard part is transitioning into the real world. The hard work comes when you step down to PHP (partial hospitalization), IOP (intensive outpatient), and outpatient. That’s when you take all the skills you learned in treatment and apply it to your life. It’s hard. And it only gets harder. I know you’ve heard this before, but recovery isn’t linear. And some days you will want to give up. But I’m here to tell you that recovery is worth it. When things get easy, it only means that you aren’t challenging yourself and your ED voice. ED recovery is hard- it’s supposed to be. If you find you are comfortable in treatment, and if you think it’s easy, then you’re doing something wrong. Challenge yourself and challenge your ED voice every chance you get. 
  • You will meet amazing people during your journey to recovery. You will meet compassionate, intelligent, and loving souls and the bonds that you make in treatment can last a lifetime. My ED always tried to isolate me from my friends and family. In treatment, my ED told me to keep to myself because I thought that everyone was struggling more than I was. I didn’t want to burden others who were also on their path to recovery. But once I learned to open up to a few people, I saw that friendship is far more important that my ED and that isolation would only lead me deeper into my depression. Reach out to others you meet in treatment. They get it. 
  • Weight stabilization is hard, but necessary. You will be able to think clearer, love with your whole heart, and regain strength with every pound you gain. It’s hard. It’s hard looking in the mirror and seeing someone that you don’t recognize. But see point one: your body needs time to heal. Re-feeding is so challenging, and even though it’s necessary, it doesn’t mean it’s easy. I understand. I’ve been there. The thing is, I knew that when I entered treatment, I would inevitably gain back all the weight that I lost. I hated it. I didn’t want to gain any weight. But I knew that I would get close, if not reach, the weight I was at before my relapse. What I didn’t know was that I would gain much more than I lost- I would actually gain three times what I lost. I don’t say this to scare you or to convince not to seek treatment for your ED. I’m telling you this because it happens. It happened to me and I had no clue. I didn’t know what to expect. So if this happens to you, it is okay. You are okay. You are beautiful and brave and it will get better. I promise. 
  • Even when it feels like too much, don’t turn back. It will only reset the clock and take your body and mind even longer to recover. Your ED has probably made you a lot of promises. “People will like you if you are thin.” “People won’t be annoyed with you if you starve yourself.” “You can finally be pretty if you only lose 10 more pounds.” “You will finally be happy if you just reach your goal weight.” I’m here to tell you that no matter what size you are at, if you are living with your eating disorder, you aren’t living at all. You cannot have your ED and be happy. It’s impossible. What I wish I knew was that even after starting recovery, I wasn’t going to be instantly happy. Just like your body cannot heal overnight, neither can your mind. You’ve put your brain through a lot, and it needs time to heal. You might even be more miserable after starting your journey to recovery. You may gain the weight (and it might go all to your stomach at first- I know, the worst) and your ED voice will get even louder. It doesn’t stop. It keeps telling you that you are a failure, that you are fat, and that you will only be happy if you listen to it. Fight through this. It will get easier, but only after time. Lots of time. So if you are committed to recovery, and still find yourself unhappy, keep fighting. It takes your mind time to catch up with your body. Sometimes our bodies even heal faster than our minds. And my body is taking forever, so who knows how long it will take for my mind to heal itself. But whatever you do, don’t turn back. If you’ve started your journey, keep fighting. Stay strong and fight every day. It gets harder before it gets easier, but if you keep pushing through, you will find happiness and contentment. 

I guess, overall what I wish I knew was that recovery is one of the hardest thing I will go through. And it gets harder before it gets easier. But that doesn’t mean you stop fighting. It only means that you need to devote more and more energy into your recovery. I know there’s no turning back now because I am so far into my journey. I don’t want to reset the clock and start all over. I want to keep pushing. I want to keep fighting. I want to recover. I hope you that you do too. 


Lizzie studied Psychology at Hillsdale College, a small liberal arts school in Michigan. She currently works as a research assistant in Washington, D.C. She is in recovery and hopes to one day use her experiences to help others struggling with eating disorders. Lots of love and please stay strong! You’ve got this.

Two Pathways to Over-Eating or Binge-Eating: Change Your Course

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As I field inquiries from individuals seeking treatment for conditions like binge eating disorder and bulimia, I almost always provide some basic education in that very first call about the two most two most common “pathways” to over-eating or binge-eating (and ultimately purging cases of bulimia).

Almost every caller will identify with at least one of the common pathways or patterns:

  1. Chronic restriction, restraint or long-term weight control efforts

Many who struggle with over-eating report varying degrees of effort to limit or restrict eating with the objective of controlling or losing weight. Or alternatively, there can be restricted or controlled eating with the goal of eating “clean,” being “healthy.” I hear a lot of people talk about ongoing efforts to “be good” or stick to some kind of eating rule[s] and then the experience of guilt and self-condemnation should they break that rule. Invariably, judgments about good/bad, ok/not ok, lead to preoccupation and tremendous investment of time thinking and worrying about food.

Whether restrictive behaviors leave you so ravenous that you can’t help but over-eat or alternatively, they just leave you frustrated, conflicted, deprived — the result is over-eating or bingeing, feeling lousy and then trying to “get back on track” by jumping right back into a restrictive pattern.

  1. Mood or event-related eating

Feelings. We all have them but don’t always manage them effectively. Food is a means of escape, numbing, relaxing, pleasure, relief… Unfortunately, these are short-term “benefits” but long-term, using food to cope leads to all sorts of problems. Some people find that certain settings or events can be triggering and can lead to over-eating or binge eating episodes. Again, the food can act as a means of self-soothing, which can feel helpful, calming in the short-term – but clearly not beneficial in the bigger picture.

Effective Treatment for Over-Eating

Effective treatment for binge eating or over-eating (and purging) needs to address the aforementioned patterns head on. Enhance Cognitive Behavioral Therapy in many cases, is the ideal intervention. A benefit of course, is that it is relatively short-term (20 weeks) and thus, extremely efficient and cost effective. We expect to see at least a 50% reduction in symptoms in the first 6-8 weeks.   If we do not, then we will be serious about figuring out what is getting in the way of change. The vast majority of patients (at least two thirds) do respond with this kind of symptom reduction in the first stage of treatment. So that’s some potentially very serious change, which comes as a tremendous relief to anyone suffering from binge eating/over-eating.

CBT-E provides strategies to support a stable, pattern of flexible eating. You will identify the emotions that get you in trouble and learn alternative skills for coping. You will be given strategies for increasing your awareness of what’s happening with your food and alternatives (skills) when tempted to eat when you’re not actually hungry.

More standard talk therapies or open-ended exploratory, insight-oriented therapies are very helpful for many, but they tend not to be highly impactful if you are trying to change your eating.  We require behavioral interventions for behavioral struggles. So CBT-E – proven through research as the most effective course for binge eating disorder and bulimia – is in most cases, the way to go.

When seeking treatment, be sure to ask about therapist training and treatment orientation. Standard CBT is different from CBT-E, which was designed specifically for eating disorders, so be sure that the provider knows and practices the Enhanced CBT version of CBT. And make sure that the therapist plans to adhere fully to the CBT-E treatment.  “Using techniques” from CBT-E is not enough.   For more information on Enhanced CBT click here.


About the Author:

Melissa Gerson, LCSW is the Founder and Clinical Director of Colombus Park, the leading outpatient eating disorder treatment center in New York City.

Melissa is a native New Yorker whose original career path landed her as a professional ballet dancer with the Miami City Ballet Company in Florida. But after seven years on her toes, Melissa retired 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 fifteen plus years of experience both on the front line of eating disorder treatment as a therapist, but also behind the scenes in program development and clinical supervision. Melissa 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. Having completed years of intensive training through the Training Institute for Childhood and Adolescent Eating Disorders, Melissa is a Certified Family-Based Treatment Therapist; thus she is one of a handful of providers in NY State, fully certified to provide Family-Based Treatment (Maudsley) for children and teens.

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.

MG

Eating Disorders Are Not A Choice

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    “Why can’t you just eat?”  Such a simple question with such a complex answer.

Trust me, when I was struggling with anorexia, I knew I looked sickly. I just couldn’t get myself to eat. It wasn’t that easy. That is the biggest misconception about anorexia; that if you just eat, you will get better. Great, if it was just that easy!

            Similarly, when I was trying to recover through the Maudsley approach, family based treatment; I couldn’t help but slip a couple of times.  It was like a force was pulling me towards them like I was in some kind of magical trance. My parents didn’t understand. One time it got really bad. I didn’t respond well—we all didn’t respond well.3f3b9c7167ac6de9b6a01d75725d2cb5

            I was about halfway through my Maudsley refeeding at twenty-six—I know, it was rough-when my mom found natural laxatives I’d bought in one of the drawers in the computer room at my parents house. I was staying there for a couple of months to avoid inpatient treatment, while working with an eating disorder therapist and other experts. I had compartmentalized the laxatives as not being a problem. I mean I was gaining weight, eating, doing everything else right. Can’t I be getting better but still abusing laxatives at the same time? I wondered. I know the answer to that now, but just humor me for a moment.

            I had tried to justify them to myself when I sneakily bought them because they were “natural” laxatives. Natural meant they were acceptable in my mind—wrong! My mom called my dad when we were on the way home from work and angrily told him what she discovered. He yelled at me for being deceitful.

            “All you do is lie to me. I can’t trust you! How could you lie to me?” he roared, his lower teeth overtaking his upper lip like a shih tzu, which was intimidating as fuck—not like the cute little teacup shih tzus I was familiar with.

            “I am so sorry, I didn’t mean to—” I said biting my lip hard, tears forming in my shameful eyes.

            “You mean, you didn’t mean to get caught! Your mother and I have been busting our asses\s trying to get you better, and this is how you repay us. You are so ungrateful.”

            I swear he had such force in his voice that the car shook with its booming vibrato. He never knew how to handle his emotions, especially over things he couldn’t control. He wanted to scare the shit out of me, scare the anorexia and bulimia out of me, so I wouldn’t do it again. Though that wasn’t going to help. He didn’t understand how powerful this addiction was. He didn’t understand that the last thing I wanted to do was lie to him, to my mom. It wasn’t about trust. I had a problem. I was an addict.

            I cried all the way home as he expressed his disappointment in me as a person, even more hurtful, as his daughter. We got home, and as we pulled in, I saw the outline of my mom at the door peering out: her long brown locks, medium-height lanky body, and long skinny arms. How would I get around her without talking to her? My dad’s screams were all blending together as the intensity seemed to decrease, and all I could hear were the same words over and over again “disappointment” and “unappreciative.”

            I opened the car door and slithered out like a rattlesnake making its escape, slammed the door shut behind me, and ran past my mom up the back stairs and hid. Yes, you read that correctly, I hid. I didn’t want them to belittle me anymore. I couldn’t take it. Through the vents, I could hear them talking, but only in murmurs. Then they shouted for me: “Dani! Dani!” I stayed in my hiding spot, paralyzed. I felt like a little girl hiding from her spanking.

            I hid in a closet in my room under hanging clothes, squishing old shoes with my butt and legs for what seemed like a long time. I whimpered but tried to stay as quiet as possible. It was hot and dark with a little light peeking through the bottom. I saw the backs of dresses from when I was younger. One was dark maroon. I recognized it as the dress I wore to my bat mitzvah. I placed my fingers on it and felt the texture; it felt hard, almost stale. I looked at a suitcase above me where I used to hide laxatives, now I was hiding for them. I was hiding because I was so addicted to them, to my habits, that I couldn’t stop myself from using them. I’d reached a new low. I was sitting in my childhood closet hiding from the world.

            I heard my mom calling in echoes. “Dani, Dani! Is this a joke? Where are you?” I heard her faint footsteps far away.

            My dad chiming in: “Did she leave the house?”

            I heard the front door open and slam close.

            Tucked quietly away, I let them panic for a bit. I let them squirm the way I had been squirming these past couple of months, tiptoeing around them, trying everything to please them, following their every order so I wouldn’t be hospitalized. Somehow, in this moment, this felt so much worse than the worst punishment I could think of. I wanted to get even with them in a way. I resented my dad’s reaction; I resented my mom for busting me the way she did. She could have just waited until we both got home, instead of making me get stuck in a car with someone who saw this as the ultimate betrayal.

            “You are going to be in big trouble whenever you come out!” I heard my dad scream. Not exactly motivation for me to move. I closed my eyes and tried to slow my breathing, hoping the walls from the closet would close in and suffocate me, end it all right now, right here . . .

            “Dani, please, we are not mad at you,” my mom countered his lunacy. Her panicked voice made me feel a little bad.

            About ten minutes in hiding, I opened the closet door from the inside, revealing myself. I picked myself up slowly, gaining balance on my two feet and feeling weak and defeated as I shouted, “I’m here, I’m here.” I realized that my voice was in a whisper and not the shout I intended it to be. “I’m here. I am coming!” I screamed again, and this time it was actually louder.

            I walked down the front stairs and found them both in the kitchen.

            When I saw their faces, I apologized through broken whimpers and tears. My parents both embraced me. I snuggled into my dad’s chest, hiding my face and tears in the warmth of his body. I cried for my parents. I cried for myself. I cried because I didn’t think I could do this anymore. I just cried.

             I wish all of us had responded differently. There were a lot of emotions. It was one of the hardest times in all of our lives. My dad didn’t know anything from eating disorders. He thought I chose not to eat. He never heard of anyone being addicted to something like laxatives. But now every year at the NEDA (National Eating Disorders Association) walk, my dad stands right by my side listening to the speakers; his unblinking eyes release tears that roll along the contour of his chin and down his neck. Now, he is my biggest advocate and understands how difficult this illness is. He is proud of me, of all the people that beat this. He knows this is not a choice.


About the Author:

10891898_823190404388849_6718222877376591849_nDani Sherman-Lazar is four years in recovery from anorexia and bulimia, Vice President of a transportation company, and a mother to an eleven month old. Hobbies (when she has a minute to breathe!) include reading, writing or blogging, anything on Bravo (she is not afraid to admit her reality-tv/Real Housewives of Anywhere addiction) and the occasional workout. She has been published on Bluntmoms, The Mighty, Project Heal, Beating Eating Disorders, Sammiches and Psych Meds, Kveller.com and Humorwriters.org. Follow her on her blog Living a Full Life After ED and like it on Facebook.

Making Friends With Other Girls with Eating Disorders

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I can say probably the best part of being in treatment is the people you meet. I’ve not only made incredible friends with staff, but also with the other girls I’ve been in treatment with. Meeting these people from all around the country, with similar issues felt a little less lonesome. At home, this isn’t an easily discussed topic. Now, here I was in a room full of people that understood what it was like. My biggest secret was known by every single person here, and it’s such a relieving feeling. These girls ended up being my biggest supports, I lived with them, ate with them, shared living spaces with them.. they not only became friends, they became family. So, you can imagine one of the worst parts of leaving treatment is when you have to say goodbye, it’s extra hard if they live half way across the country. Keeping in touch is often hard, because of a few things.
Defend Your BoundariesI wanted to talk about this topic, not only because I wanted to shout out my lovely Renfrew, 5West, CFD and OPC girls, but also because I wanted to talk about the sad possibility of distancing yourself for your own protection. I want to say that I’ve been on both sides of this conflict. I’ve had to distance myself and others had to distance themselves from me. Well not me exactly, but from my disorder which was in control at the time.
When someone with an eating disorder is struggling, it’s a possibility that it’s obvious. (Not all the time, but sometimes its apparent.) The sad truth is that recovery is hard, probably the hardest thing I’ve ever had to keep up with. Possibly the hardest thing I will ever have to do. But, while someone is struggling and asking for your help.. there is only so much you can do for them without putting your own recovery in jeopardy. I’ve had to learn how to put up healthy boundaries.
  1. Keeping in contact but not going into details about behaviors/numbers/etc. It’s going to be different when one friend is more in their eating disorder than the other. Someone who is malnourished and actively listening to the “ED voice” will try and sneak in those topics. Shut it down, instead tell them how much you care about them and want to see them healthy and happy. Remind them of the beautiful life they’re missing out on.
  2. Temporarily “unfollow” them on social media. Validation of our sickness is a huge trigger, we might seek for it. I’ve been the one to body check and post pictures of myself because sometimes I felt “not sick enough.” Getting that text message from a concerned friend asking, “Hey, are you okay? I saw the picture you just posted..” Was a validation that I indeed was looking ill. When you’re trying to recover yourself, seeing these pictures of emaciation is sadly a trigger. It may remind you of when others would seem to care more, or when you had a sick body. It may remind you of treatment and make you miss the constant support or the safety, it may bring up a lot of things for you. Well, it does for me and that is why distancing yourself from those images is crucial.
  3. Tune out jealousy and competition, in replacement for compassion and gratefulness. It’s hard giving up your eating disorder, and I’m sure a piece of your identity too. When I hate the way I look, I seem to focus on what I did look like or what others look like. (Usually something emotional is causing that, by the way.) Eating disorders are competitive, “Why does she get to look like that?” or “She’s already lost so much weight and I’ve maintained?” It’s easy to get caught up in comparison of ones eating disorder to someone else’s, which is dangerous. You may begin to lash out on your friend or even slip up in your own recovery. I often romanticize what it was like to be in my eating disorder, I forget the nasty details and focus on the appearance part. What is helpful for me is to remember what I was doing, how I felt physically and mentally when I was at that place. What it took me to get to that place and how it affected others that I loved. Feel bad for them, because you’re in such a better place. Wish for them a better life and be thankful you’re no longer there.

About The Author:

unnamed-1My name is Kristina, I’m 23 and I’m from New York. I’ve suffered with an eating disorder for quite some time and in that time I’ve learnt so much from treatment. I’m trying to use my experiences to help others, give tips and helpful advice that I have had to learn the hard way. Aside from blogging, I enjoy singing, playing the ukulele, and spending time with my amazing boyfriend. I’m a big believer that humor is the best medicine, so I always try and have fun and crack a joke. I’m inspired by others, and I hope others will be inspired by me one day! I truly thank project heal for letting me share a blog entry, its an incredible organization!

 

From Noise to Nutrition: Part 1

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By: Melissa Gerson, LCSW

Developing an increased awareness of the neuroscience behind eating disorders can help empower family members to intervene more effectively with their loved ones. As discussed in “Inside The Anorexic Brain,” research demonstrates that eating disorders are a biologically and brain-based illness.  

Studies now show that “noise” in the brain, as a result of faulty neural pathways, can be deafening to individuals, causing distorted thinking and rituals surrounding food. Subsequently, brain “noise” functions as a key barrier to recovery. This improved understanding of the neuroscience behind eating disorders, helps us understand the physical, mental and emotional experiences of eating disorders and informs best practices within the field.

Brain Pathways in an Individual With Anorexia Nervosa

When an individual struggling with anorexia nervosa expresses that he or she is not feeling hungry, family members, out of concern, question their claims or express frustration. There is often the implication that the decision not to eat is a choice. In reality, when an individual with AN begins to eat, signals from the brain and body are wildly misinterpreted. 

When food enters the stomach of someone with anorexia, neurochemical messages are sent from the body to the brain. First, signals are sent from the “Sensory Relay Station” called the thalamus, to the insula, the “Taste/Hunger Station” where taste and hunger are registered.  Individuals with “healthy” pathways will experience sensations such as flavor and fullness at this point in the pathway.  For an individual with AN, however, signals within this pathway may fire a weak response, or not fire at all, contributing to a dulled sense of flavor in food. There may be little to no feeling of hunger present at all. This lack of taste, along with reduced hunger messages are relayed to the amygdala, the “Panic Station.” The amygdala sends out a warning as it becomes confused by the lack of clear food-related messages. When these alarms begin to go off in the panic station, there are no signals to suggest to the individual’s body and brain that food is safe. It’s easy to see how this pathway would reinforce anxiety around mealtime. 

table-1956498_640With this information, we may now react quite differently to the expressed anxiety of a loved one who is sitting down for a meal or snack. Normalizing their experience, offering support, providing psychoeducation, or consulting a treatment team member are the best options for helping alleviate their very real anxieties.

To learn more about how neuroscience has influenced eating disorder treatment and best practices, head over to “From Noise to Nutrition-Part 2”


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

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