Food for us comes from our relatives, whether they have wings or fins or roots. That is how we consider food. Food has a culture. It has a history. It has a story. It has relationships. –– Winona Laduke
Food is about more than sustenance. It is about pleasure and joy and connection. Food is one of the ways we connect with our cultural traditions and our ancestors. This is one of the reasons I am so passionate about my work to help people with eating disorders. When someone has an eating disorder and they are fearful of eating or of eating certain foods, they miss out on the pleasures of food and they miss out on the opportunities to connect with others through food. They also miss out on their own connection with their relatives and their cultural heritage.
In my own family, my 103-year-old Nana has always been known for her piano playing and her delicious poundcake. While her prized Steinway piano now stands in my home, I did not inherit her piano-playing her abilities. I did, however, learn her poundcake recipe.
From the time I was a young girl, I have memories of “Nana’s poundcake.” Simple to make with only 5 ingredients, buttery and yummy. During visits to Kansas City, I looked forward to making it with her. And when she visited us in New York we would make it together. And, occasionally my mom and I would make it without Nana. My kids have had the experience of making poundcake with my Nana, their great grandmother. And they have made it with me. After she eventually passes, we will retain this connection to my Nana and my kids will hopefully continue to make and share her recipe with future generations.
Photos of my daughters making poundcake with Nana back in 2012 at her apartment (she was 96)
I am glad to have this connection to Nana and to be able to fully enjoy making and eating poundcake with all its rich butter and sugar. What joy and connection I would be missing out on if I were afraid of eating it. To be able to make it and eat it with enjoyment enriches my life and allows me to have a shared experience through four generations of my family. I will always have joyful memories of baking and eating poundcake with the different generations in my family.
Bonus Feature — Nana’s Poundcake Recipe
1/2 pound salted butter (2 sticks) – softened
1 3/4 cup sugar
2 cups sifted flour
2 T vanilla
Cream butter and sugar
Add eggs one at a time while beating constantly
Add flour and flavoring
Pour into well-greased loaf pan (or bundt pan)
Bake at 350° for 90 minutes
Photos from a poundcake I made with my daughter in 2019.
When parents are renourishing a child with an eating disorder and that child gets sick, parents often don’t know what to do. Some families may back off on feeding every time a child gets any illness, which can be a risky practice. Especially during Phase 1 of FBT, ensuring eating is a priority. To help parents, I’ve asked Jennifer Johnson, MD, a medical doctor who specializes in treating patients with eating disorders, to share some advice.
First, let me say that in general, minor illness should not cause a kid with an eating disorder to lose weight. Parents who are refeeding their child know that even missing a meal or a snack makes a difference in their progress. Don’t let illness throw you off course. As you know, failure to gain as expected may occur if nutrition is even a bit compromised. It is absolutely not a given that illness or surgical procedure must cause weight loss. When I hear that someone has lost 3 pounds “because they had a cold” the previous week, I ask a lot of questions – that should not have happened.
Second, plan ahead. After you’ve read through my answers and looked at other parents’ recommendations, be proactive. Make a plan with your child and treatment team about what you will do if they get sick (which they inevitably WILL at some point during recovery). They should know that they WILL still be eating. But talk about what foods they tend to like when they are ill, and think about how to plug maximum nutrition into them. Buy any non-perishable supplies and stock up on over the counter medications for colds, coughs, and fever. (And please have a thermometer on hand! A $10 digital one is plenty good to give us doctors valuable information.)
What should parents do in terms of feeding when a child with an eating disorder has a head cold or sore throat and loses their appetite? Is it necessary to avoid dairy?
If your child is listless and feeling unwell, they will often not be very hungry for a couple of days. A sick child needs care and comfort. Caring for a sick child who has an eating disorder includes keeping up the nutritional intake. You don’t want the eating disorder to think that illness is a good way to sneak through the back door. And, there are other times when your child is not hungry, just from refeeding itself, and they have to eat anyway. So, push ahead, but gently. Present nutrition dense food and beverages that will be particularly appealing to your child. Does a milkshake sound appetizing? You can add a packet of Benecalorie. (There’s nothing wrong with dairy, by the way.) Chicken noodle soup? Maybe add some extra pasta. There are lots of helpful posts from parents on the Around the Dinner Table Parent Forum.
What about if they have a fever?
Having a significant fever (101 or above) increases fluid needs as well as metabolic rate (more calories are burned). Your child will feel better if you control the fever with regular doses of acetaminophen or ibuprofen. Giving the medication at regular intervals, say every 6 hours for acetaminophen, may prevent the fever from getting as high as it otherwise might. This also helps with the headaches that usually accompany fever. Keeping your child hydrated, particularly with something like Gatorade, will also help them feel better – and thus more likely to have some appetite. Some kids maintain their appetite when they have a fever and of course, it’s fine to continue refeeding. Otherwise, know that keeping up nutrition during an illness helps your child feel better sooner, and push on. Again, it’s helpful to adjust what you give them based on their preferences.
What about when kids in recovery have the stomach flu?
What do you do if they’re vomiting?
Generally, vomiting is worst at the onset of an episode of stomach flu and becomes less frequent over the next 24 hours. A parent’s main goal when a kid is vomiting is to keep them hydrated. I recommend not giving anything by mouth for 2 hours after they’ve thrown up. Then you can give them ice chips or a couple of teaspoons of water. This liquid will get absorbed from the mouth. Do this every 5 minutes or so for half an hour. If they haven’t vomited again, you can have them try slightly larger amounts of liquids at less frequent intervals. They should be able to keep down about 2/3 of a cup of liquid, and be hungry, before you try a very small amount of food. Slowly increase the amount you give them. Kids may become ravenous and eat a huge meal, but then throw up everything they’ve just eaten. A kid who throws up a day or two into recuperation may have just overdone it. In that case, you’ll need to let up a bit before pushing back into refeeding.
What about diarrhea?
For kids with diarrhea, we don’t generally recommend giving any medications that are designed to decrease the number of stools (bowel movements). No major food restrictions are needed. There is nothing magical or beneficial about the so-called BRAT diet (bananas, rice, applesauce, toast), which is of low nutritional density. Studies have shown that having diarrhea for a few days does not make someone lactose intolerant. We know that eating when you have a “stomach bug” with diarrhea will generally increase the number of diarrheal stools. But we also know that at the end of the illness, people who have continued to eat will end up better nourished (= digested more calories). And that, of course, is the ultimate goal.
One thought: you may want to speak with your child’s doctor about a proactive prescription for a small number of anti-emetic tablets (that dissolve in the mouth) to have on hand in case your child gets stomach flu. I don’t normally recommend this but refeeding is an exception. We want to minimize the duration of nausea and vomiting to make it easier for your child to eat. Also, many of my patients who have eating disorders are afraid of truly fearful of vomiting (a condition called emetophobia), which only makes stomach flu worse for everyone. If your doctor is willing to do this, they undoubtedly want you to call before you give the medication.
What if your child has no appetite (due to illness)
Biology is on our side. When a kid (or another human being) eats less due to a minor illness, appetite typically returns with a vengeance and we make up for what we’ve missed. For a kid in the early refeeding phase, of course, it is normal to not feel hungry. So you may not know whether your child is not hungry because they’re not feeling well or because they’re refeeding. In either case, your eating disordered child needs you to continue to push forward. Refeeding is the mainstay of treatment and you’re the team leader. Go for it!
Please note that none of the above should be construed as medical advice. If you have concerns about your child’s health, contact their doctor. Some examples of when you should call the doctor are: Bloody diarrhea, high fever (102 or above), vomiting that continues more than 24 hours, weakness, severe dizziness or fainting, or very little urine.
About Jennifer Johnson, M.D., MS, FAAP
Dr. Johnson is a medical doctor. She has more than 20 years’ experience as a pediatrician and adolescent medicine specialist. She practices in Newport Beach (Orange County), California.
Dr. Johnson is certified by the American Board of Pediatrics in Adolescent Medicine as well as in Pediatrics. Dr. Johnson also has an advanced degree in public health. She has been a professor in the Department of Pediatrics at the University of California, Irvine School of Medicine, where she served as director of the adolescent medicine program. Dr. Johnson has taught medical students, residents, faculty, and community physicians, for whom she continues to present educational programs. She has presented at national meetings of many organizations, including the American Academy of Pediatrics and the American Academy of Family Practice. Dr. Johnson has written many research articles and book chapters related to adolescent and young adult medicine.
Dr. Johnson is an advocate for adolescents and young adults. She is a Fellow of the American Academy of Pediatrics (AAP). She has led many activities in the Academy’s Section on Adolescent Health and served as its chairperson. Dr. Johnson is active in the Orange County chapter of the AAP, as well. Current projects include the Teen Safe Driving Initiative and healthcare for GLBTQ teens.
Dr. Johnson has also been active in the Society for Adolescent Medicine. As a member of the medical advisory board for Teengrowth, Dr. Johnson wrote many articles and answers to reader questions. Articles and webcasts by Dr. Johnson are posted at Healthology.com, medbroadcast.com, and the New York Daily News.
Dr. Johnson is on the medical staff of Hoag Hospital in Newport Beach.
Mayo Clinic researchers are conducting a study examining parents’ perspectives on eating disorder recovery. We believe that parents have valuable information about their children that can help us better understand eating disorder recovery and improve treatment outcomes. If you are a parent of a child or a teen with an active or past eating disorder, we would appreciate your input by taking an online survey. If you are interested in participating, please click on this link:
You may share this message and link with anyone else or any group that you think might be interested in participating.
This survey is for parents who:
Have a child or a teen who was diagnosed with an eating disorder before the age of 18
Have access to some data about their child’s heights and weights prior to diagnosis, at diagnosis, and after diagnosis (any measurement system is fine!)
We will be asking you questions about your child’s illness and aspects of recovery, including weights and heights if you have them. If you have growth records, it would be helpful to gather them before taking the online survey. The survey should take about 30 minutes to complete and will be anonymous.
Understanding Carers’ Experience in Treatment for Their Child’s Eating Disorder
You are being asked to participate in a research study to understand carers’ experience in treatment for your child’s eating disorder. This invitation is being posted on blogs, social media groups and sent to listservs for parents of children or adolescents who have had/ currently suffer from an eating disorder. If you agree to participate, you will be asked to spend approximately 30 minutes completing an online survey. We will ask you questions about your experiences during your child’s treatment and your personal definition of “recovery” for your child. The survey is anonymous, so your answers cannot be identified or traced back to you. The risks and burden associated with this research study are minimal. While there is no direct benefit to you if you choose to take this survey, we believe that this research study will provide a better understanding of carers’ perspectives of their children’s treatment and recovery, with the goal of improving treatment and outcome assessment. Please understand that this is a voluntary study and your current and future medical care at Mayo Clinic will not be affected by whether or not you participate. Contact the Mayo Clinic Institutional Review Board (IRB) to speak to someone independent of the research team at 507-266-4000 or toll-free at 866-273-4681 if you have questions about rights of a research participant. Thank you for sharing your time and expertise.
by Elisha Carcieri, Ph.D., a former associate therapist at EDTLA
One of the hallmark features of eating disorders is placing a high value on body weight and shape in determining one’s self-worth. In addition, people with eating disorders often believe that body shape and weight can be controlled through diet, exercise, or, in the case of bulimia nervosa, purging. Individuals with bulimia nervosa purge in an attempt to eliminate calories consumed (which is actually ineffective), empty or flatten the stomach, modulate mood, or as a self-imposed negative consequence for binging. Bulimia carries serious mental and medical health risks. The road to recovery from bulimia usually involves (at least) outpatient therapy with a qualified mental health professional such as a psychologist.
Cognitive behavioral therapy (CBT) is the most well-researched and effective treatment for bulimia. Therapy begins with an initial goal to immediately stop purging, monitoring weight and food intake and implementing regular eating, which usually looks like three meals and two snacks spread out over the course of the day. Over the course of therapy, the patient and therapist address the various factors that keep the eating disorder going including the over-evaluation of weight, shape, and one’s ability to control these factors, dietary restraint and restricting food intake, and mood and anxiety-related factors associated with the eating problem.
Most patients with bulimia nervosa present to treatment at a weight that is in a “normal” range for their height. This is in contrast to those with anorexia nervosa, who are typically underweight. Despite being at a normal weight, the characteristic weight and body dissatisfaction associated with bulimia is strong at the beginning of treatment, and patients believe that they are controlling their weight via their purging behaviors. People with bulimia often restrict food intake in various ways, only to eventually binge and purge. Because treatment involves eating meals at regular intervals without purging, a common fear at the outset of treatment is whether changing eating patterns will result in weight gain. The answer is…maybe.
For most patients with bulimia nervosa, treatment will not result in a significant change in weight. However, some patients may gain weight and a small percentage of patients will lose weight as a result of eliminating binge eating. It is not advisable for patients in recovery from an eating disorder (or anyone, for that matter) to have a specific goal weight in mind. Focusing on weight loss is incompatible with CBT strategies to eat balanced and sustaining meals at regular intervals. Weight may fluctuate over the course of treatment, and, when a person is eating normally, the body naturally gravitates toward a biologically determined weight that is largely out of our control. Indeed, learning to focus less on body weight as a determinant of achievement or self-worth is a valuable treatment goal.
What is Weight Suppression?
Some patients with bulimia may start treatment at a weight that is in the normal range for their height or even on the high side but low in the context of their adult weight history. Weight suppression is maintaining a body weight that is lower than an individual’s highest adult weight. Recent research has begun to shed light on the effects of weight suppression on eating disorders, especially bulimia. Bulimia is often kick-started with a desire to lose weight and attempt at weight loss through dieting. Research has demonstrated that living at a suppressed weight has a significant impact on bulimic behaviors, increasing the likelihood of binge eating (potentially through a brain-based biobehavioral self-preservation mechanism), and subsequently purging. Relatedly, and counterintuitive to what people with bulimia believe about their ability to control their weight, weight suppression is associated with weight gain over time, which further promotes dieting and purging given the strong aversion to weight gain that most sufferers experience.
Will I Gain Weight?
So, what does this mean for treatment and recovery? For patients seeking treatment, this means that yes, you may gain weight, especially if your weight is lower than a previous higher adult weight. This may feel scary, especially at first. Clinicians may even feel uncomfortable having this discussion and feel tempted to reassure patients that they will not gain weight. However, this message is inconsistent with what we now know about weight suppression and reinforces the idea that gaining weight is to be feared and avoided at all costs. Gaining some weight may actually be the key to breaking the cycle of binging and purging, which is much more valuable than maintaining a lower weight.
Greater weight suppression is associated with persistent bulimia symptoms and relapse, so gaining some weight may actually increase the likelihood of recovery from bulimia and also serve as protection against future eating disorder relapse. Weight gain may not just be a side effect of treatment, but it may be an appropriate treatment goal if you have bulimia and are living at a suppressed weight, just as it is an important goal for someone recovering from anorexia.
If you have had previous treatment, but are still binging and/or purging, it is important to explore whether weight suppression might be a contributing factor. You can discuss whether gaining some weight might be appropriate with your clinician. Understanding the role of weight suppression on maintenance of the eating disorder should serve as motivation to continue treatment and work toward managing negative feelings related to weight gain. Indeed, it is helpful to explore the motivation behind the importance of thinness or maintaining a certain weight and challenging fears associated with gaining weight. You may find that living at a slightly higher weight, once acceptance is achieved, can be much less stressful and time-consuming than forcing your body to weigh less than it is biologically programmed to.
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY: Guilford.
Juarascio, A., Lantz, E. L., Muratore, A. F., & Lowe, M. R. (2018). Addressing weight suppression to improve treatment outcome for bulimia nervosa. Cognitive and behavioral practice, 25(3), 391-401.
Lowe, M. R., Piers, A. D., & Benson, L. (2018). Weight suppression in eating disorders: a research and conceptual update. Current psychiatry reports, 20(10), 80.
Elisha Carcieri, Ph.D., is a licensed clinical psychologist (PSY #26716). Dr. Carcieri earned her bachelors degree in psychology from The University of New Mexico and completed her doctoral degree in clinical psychology at Saint Louis University. During her graduate training, she conducted research focused on eating disorders and obesity and was trained in using cognitive behavioral therapy (CBT) for eating disorders and other mental health disorders such as anxiety and depression. Dr. Carcieri completed her postdoctoral fellowship at the Long Beach VA Medical Center, where she worked with Veterans coping with mental illness, disability, significant acute or chronic health concerns, and chronic pain. In addition to cognitive behavioral strategies, she is also a proponent of alternative evidence-based approaches such as mindfulness, and acceptance and commitment-based strategies, depending on the needs of each client. Dr. Carcieri has experience working with culturally diverse clients representing various aspects of diversity including race/ethnicity, gender, age, disability, and size. She is currently living in Charleston and working as a full-time mom to her two sons, ages 3 and 1. Dr. Carcieri is a member of the Academy for Eating Disorders (AED). She can be reached via email at email@example.com.
In today’s digital age, photos of ourselves are everywhere. For many people with eating disorders and body image issues, they can be a source of distress.
Do you avoid photos? Do you refuse to let people take or post photos of you? Do you hide in the back when asked to be in a group photo? Do you agree to be in them but then feel awful when you see them because you can’t stop critiquing your body? Do you spend hours looking at old photos and longing to look like you used to?
If you relate to any of these scenarios, you are like many of my patients who feel uncomfortable with their bodies and either avoid photos altogether or obsess over them. I’m going to suggest some strategies that have been helpful for my patients.
The first thing to understand is your anxiety is almost always increased by the avoidance of something that is distressing but not dangerous. When a situation makes you anxious, the only way to get over it is to face it. With time, your brain learns to tolerate it—we call this habituation. This means that avoiding photos entirely will just increase your distress.
Next, consider how sad it is to not be photographed. As Alison Slater Tate wrote in her widely-shared article “This Mom Stays in the Picture”, “I’m everywhere in their young lives, and yet I have very few pictures of me with them.” I’ve worked with patients that have so avoided photos there was almost no record of their lives. How sad for the people that love them!
On the other hand, it is also unproductive to take photos and then scrutinize the results for each of your flaws. This kind of obsessive focusing is destructive and only makes people feel worse. It also defeats the purpose of having taken the photo.
Photo Exposure Strategies for Body Image
Here’s what I suggest:
When you look at a photo, resist the urge to zero in on your areas of body concern with an eye to criticize. Instead, look at the image of your entire body more holistically. Try to be nonjudgemental and curious.
Remember that what you are looking at is not actually your body, but a representation of your body. Many factors influence this representation—the lighting, the angles, the quality of the camera, the capability of the photographer. (How many times have you taken a number of photos in a row and the people look different and better or worse from one to another?). If you take enough photos, it’s an inevitability that some will be good and some will be bad.
Think about the purpose of taking the photo. Set aside social media bragging rights—the authentic purpose of a photo is to capture a moment in time, to remind you of a feeling you have experienced, to recall a place that is special to you, or to celebrate a relationship.
Take, for example, a woman who attended her sister’s wedding. When she looked at the photos, she could choose to focus on how unmuscular her arms were, the imperfections in her hair, or how she was bigger than certain other guests. Alternatively, she could focus on why they took the photo: the joy she felt in sharing this special occasion and her love for her sister.
Also, keep in mind that your perception of the same photo can differ over time. How many times have you hated a photo when it was taken but looked back on it later and loved it?
So this is my challenge to you: when given the opportunity to pose for a photo, seize it. When you look at the photo, practice not critiquing your appearance or comparing yourself to others or to past versions of yourself. Instead, ask yourself what is important about the photo—why you took it and what you wanted to remember about the moment it captures.
In the spring of 2018 major league baseball player, Mike Marjama abruptly retired from the sport to focus on being an ambassador for the National Eating Disorders Association. He struggled with an eating disorder growing up and his move to working with NEDA was only to help save lives but to give men who are struggling a voice to hear that they aren’t alone. Mike Marjama is a reminder that eating disorders can affect anyone of any gender.
According to the National Eating Disorders Association, about one in three people with an eating disorder in the United States are male. That’s roughly about 10 million males. There is a long-standing myth that men do not have eating disorders. A common misconception is that eating disorders are a women’s issue. As a result, many men are ashamed or may not even recognize that they have an eating disorder.
Eating disorders are complex mental illnesses with both genetic and environmental contributing factors. It is also important to be aware that just because someone has poor self image does not necessarily mean they have an eating disorder and vice versa.
Although eating disorders are about much more than body image, it’s hard to ignore the societal impact of cultural ideals of beauty and gender. Women are not the only ones impacted by gender ideals. The ideal male body includes large muscles and little to no body fat. Next to the Cosmopolitan magazines are the men’s magazines with models showing off their six-pack abs. I recall a time shopping with my fiance when we came across the packages for men’s underwear. There, staring me in the face, was a man with a Spartan-like body, doing his best to sell this product. I could see how men could feel intimidated, just like when women are walking through a Victoria’s Secret store. Many males they are taught at a young age to be ‘tough” and “not to cry.” Expressing feelings is often frowned upon.
According to the National Eating Disorders Association, “25% of normal weight males perceive themselves to be underweight and 90% of teenage boys exercised with the goal of bulking up.” Male athletes can become hypersensitive to their bodies when sports such as running, gymnastics, or wrestling has them paying close attention to their weight. Many males are loathe to ask for help because it may make them appear weak or too feminine The fear might be “I am not man enough.” Unfortunately, health professionals may also not recognize eating disorders in males who are usually diagnosed later in their illness, which can lead to a worse outcome.
A few years ago there was a reaction to the athletic physique that had been so celebrated. The “dad bod” trend became a thing where it was okay for men to be more round in the middle. But even with this new trend it still puts out a message that there are only certain body types that are acceptable. What if you are round in the middle and round all over? Is that not okay? And isn’t any guy who is a father technically walking around in a Dad-Bod? It is great that there is more room for different bodies, but we need to expand our acceptance to all shapes and sizes. And not only accept different bodies, but also recognize that the body doesn’t define who someone is as a person.
How can you help a male that you know is struggling with an eating disorder and body image? Just as with females, we need to work on celebrating the men in our lives with what they do and not how they look. We need to let boys know it’s okay to show emotion. It’s okay if they do not look like Superman. Having bulky muscles or not having bulky muscles doesn’t define the strength of a person; especially their character. We need to accept people of all genders and all bodies in all their glorious diversity. It isn’t about your body that defines you, but who you are as a person. If only people could be more impressed with the contributions we put out there instead of the size of our stomachs. Hopefully, with more men like Mike Marjama coming forward, it will decrease the stigma surrounding this mental illness and more men will seek the appropriate help that they need.
Carolyn Hersh, LCSW and our other therapists are able to work with people of all genders at Eating Disorder Therapy LA.
Title: Historical Trauma and Modern Day Oppression: How Does This Relate to Eating Disorders?
Description: For the past 30 years, eating disorders have been represented as a white, middle-class phenomenon. Due to the lack of representation of people of color and indigenous populations with troubled eating, these communities suffer from high rates of undiagnosed conditions, inaccessible treatment and culturally insensitive practices within the eating disorder world/community itself. In this presentation, participants will have the ability to evaluate eating disorders through a social justice lens that centers the experiences of people of color and indigenous descent people. Participants will learn about historical trauma and the white-thin-cis-hetero industrial complex. This session will also explore the legacies of colonialism on self-esteem, body-image, and food. Providers will receive guidelines on how to make services more accessible.
Bio: Gloria Lucas is a body-positive activist, punx-feminist, entrepreneur, and a public speaker. In 2014, Gloria started Nalgona Positivity Pride – a Xicana-brown-indigenous body-positive organization that focuses on the link between historical trauma and eating disorders – after personally struggling with an eating disorder. Like the womxn of color that came before, she creates spaces for marginalized folks to support each other and heal from the trauma of colonialism, eurocentric beauty ideals, and disordered eating in communities of color.
Gloria’s work has been featured in the Huffington Post, MiTú , Bitch Magazine, and The Body is not an Apology. She lives in Los Angeles with her boyfriend and their cats, Pepita and Mister Orange.
Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland) or street parking
March and April SIG meetings are open to all professionals. During other months SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org
It’s the season for the holiday party…and an endless supply of scrumptious appetizers! It is time to get your small talk on and gather around friends and family to whom you may or may not be interested in talking. It is time for holidays…and anxieties. Maybe you have a tendency to overindulge on all the goodies at the food table? After all, you rarely get a chance to eat these sweets or homemade savories, so might as well. Maybe overeating is your daily habit and something you are not even thinking about. If you have any anxiety about socializing or overeating at a party, then this article is for you.
A few years ago, I found that I couldn’t stop the snacking and grazing at parties. I would sometimes dread going to a party knowing that I would most likely overindulge on the sweet or savory delights. I would often wonder if people were watching me and taking notice of my extra size portions. It was a compulsive and conscious decision on my part because if I was eating, I didn’t have to worry about talking. I would think to myself, “What will I have in common with the other people at the party?” “What if I don’t have anything to say?” “What if I am not that interesting?” Maybe for you, there are other anxious thoughts: “I don’t want to share about my year.” “I don’t want to be reminded that I am still single.” “I don’t want to have to talk to strangers.”
Sometimes that table of food can be the way out of a dead conversation. If we are snacking at the table, we have a common interest and shared experience, and that common factor is the food. Many times, I would stand by the food table and just comment on the food with the people I was chatting with. And let’s say if I got into a conversation I wasn’t particularly interested in, I could excuse myself to go refill my plate. It became my escape behavior and after several years I realized I needed to address my anxieties and learn to better manage my social anxiety.
Addressing Social Anxiety
I had to develop a new focus when attending social events and parties. Rather than focusing on my discomfort, I started to focus my attention on learning about the other person. I started to find I could actually enjoy having a conversation. I also came to realize that I was becoming more of an explorer with every conversation. That was my new focus, and the other person was unaware of my anxiety or the reason for my probing. I was just learning how to actively listen to what was being said. And I became less preoccupied about food. I found I could focus on the way they talked or perhaps their posture. I heard what they said. I stayed in the conversation and asked questions about what they were saying. It was about being “present” and the first few times were both an experiment and an experience. It was scary at first and I had to push myself. Time went by increasingly faster as I became engrossed in other things besides food. I no longer needed to quell my anxiety by satisfying my taste buds. And, although this helped to get me started, the second phase involved strengthening my hunger and fullness cues.
Addressing the Temptations of an Abundance of Food
There were some other factors that played a role in my overeating at parties and that was what we often refer to here at Eating Disorder Therapy LA as “Diet Mentality.” A lot of times I would go to a party and say, “I couldn’t or shouldn’t eat something.” Or sometimes I was like, “I never have access to these goodies, I might as well eat as many as I can.” This is known as unhelpful all-or-nothing thinking. We can learn to change our thoughts. Cognitive Behavioral Therapy is a great treatment modality used to change thought patterns of this nature. Learning to find the grey area between all-or-nothing thinking takes work but helps us to avoid overindulging.
Addressing the Over Eating at Parties
Let’s talk briefly about the actual eating. Yes it will take some conscious planning and preparation to prevent overeating at the party.
If you struggle from overeating at parties, here are some strategies you might try:
Eat regular meals and snacks leading up to the party: Many times we try and restrict or skip meals prior to a party in anticipation of eating a lot at the party. This though sets you up to overeat. It is best to eat as regularly as possible.
Make it a meal: If the party is during an actual mealtime, then plan to eat what would feel like a meal. If you are planning to eat a meal beforehand, pre-plan that you are having a snack or dessert at the party and recognize your options will be about what really taste good.
Scan the table of goodies: Do a survey of the food and make decisions to be selective about what you want rather than just loading up the plate as soon as you get there. When you make your choices of what to eat, taste what appeals to you and eat what tastes good. If something isn’t appealing or satisfying, then you have the freedom to not eat it. At Eating Disorder Therapy LA we work with our clients to help them understand what being and feeling satisfied is about and understanding fullness.
It is normal to indulge on holidays: Yes is its! And we need to remind ourselves we can enjoy and practice mindful eating at the same time. Remind yourself as well that you can have these treats again soon, maybe buy them, or have them at another party. That way you won’t fall into the fear that you won’t ever have these foods again and over indulge.
Listen to when you get full: It might get a little disappointing to have to stop eating. But be present and mindful that this happens and the feeling will pass in a few minutes.
On May 8th, 2017 my mother died due to complications from cancer. It was an unexpected death. I still cannot believe she died. My mom was diagnosed in January and passed away in May. She had gone to the hospital for trouble breathing and never left.
I can clearly remember going back to my childhood home and seeing her sneakers in her room waiting for her to return to them. I cried so hard seeing everything she had touched just days before but left, never to feel her embrace again. I was one of those things she left.
It’s been more than a year now since I lost my mom. It was a year that tested me in so many ways: emotionally, physically, and spiritually. One thing I had to face was how my eating disorder and my longstanding recovery would play out through the worst thing that has ever happened to me.
I have my own history of emotional eating and bulimia nervosa. It started at a young age. Whenever I was sad as a child my mom’s solution to cheer me up was a trip to the bakery for a giant cookie. My emotional eating and my hatred of being the larger kid was just one of many factors that led me to a path of destructive behaviors of binging, purging, and restricting.
I’ve been through enough therapy and treatment that I am able to recognize moments when I find myself starting to eat mindlessly. I check in with what emotions or events are going on. I have, for the most part, overcome being an emotional eater. But, then I was hit with an intensity of emotions that I had never felt before. The seven stages of grief are very real and I definitely went through and felt each of them.
My anger, my sadness, my pleading to bring my mom back, to having brief moments of acceptance washed over me on a daily basis. My sadness felt like someone placed a brick on top of my heart. Trying to breathe became difficult at times. I was angry, intensely angry, at cancer, the doctors, the hospital, at God, at my mother, and at myself. We hear so often how eating disorders fester when we feel a loss of control. Losing my mother was the ultimate reminder “you have absolutely no control over this.”
In the early weeks and even months of living in a world where my mother no longer existed, I wanted comfort and distraction. I wanted food. I wanted alcohol. I wanted anything that would take this pain away. And in those moments of pure sadness, I consumed. I knew full well this wasn’t the way to handle my emotions. I decided I need to reach out to my dietitian because yes, even professionals need tune-ups. I remember sitting in my dietitian’s office crying because I gained weight and was feeling out of control with my body and my feelings. I quickly felt hypocritical as an advocate for all bodies are beautiful and guilty because a weight gain should not be something I should be crying about. I lost my mother. Worse things have occurred other than gaining a few pounds. My dietitian reminded me that I know how to eat and that my body will go back to where it should be when I honor my hunger and satiety cues. But, then she shocked me by saying, “Carolyn, maybe you needed to allow yourself to binge in those moments. So it happened. You binged. It’s done. Now, go back to your real coping skills.”
My dietitian gave me permission to accept my binges. She demonstrated compassion for me when I had no self-compassion. She was right. Sometimes we have to be okay with where we are at. My dietitian did not give me the green light to revert back to maladaptive behaviors. She pushed me back on a path of not beating myself up during a time where the last thing I needed was to hurt myself more.
So, how do you manage recovery in a time of grief?
Don’t go back to your eating disorder. Just don’t. You know it won’t help and when you are feeling low why make yourself feel lower? But, if you skip a meal or eat a few extra cookies just know that it is not a relapse. I do not consider my binging moments a relapse. They happened. I engaged and then I stepped away. Be gentle toward yourself and give yourself permission to say “It’s okay it happened. Now, what can I do to get back to my recovery?”
Go back to your coping skills. Maybe I could have engaged in binging and purging. Maybe I could have thrown my hands in the air and said: “what’s the point?” But I didn’t. In all honesty, I knew this wasn’t something I wanted. So, I made a list of things for me to do to help me through those really tough moments. I took time off from work and went figure skating with friends. The ice was always a very therapeutic place for me, and just being able to feel that cold air whip across my face me feel happy. I spent time journaling, cuddling with my dog, and reaching out to friends and family when I needed to talk. I began nightly walks with one of my girlfriends where we had heart to hearts. I made self-care a priority. You have to. The small lapses that I fell into never once trumped the real self-care that I was doing for myself. If I had beaten myself up for binges and weight gain then it could have sent me on that spiral back to a full relapse. Self-care may mean forgiving yourself for your lapses. Forgiving myself helped me continue to move forward.
Death really sucks. Losing someone you love is painful. It can be a torturous pain. There is no way around that. Losing my mother and thinking about her still to this very moment makes my stomach twist, my heart pound, and my eyes water. There will be bad days. I use a lot of radical acceptance in my grief where I acknowledge this is how it is and I have to figure out now how I continue to live in a world where my mom isn’t calling me. It’s hard to do. Believe me, there are days I do not want to accept this, but if I have to pull from my DBT workbook, acting the opposite is what gets me through the rough days. I don’t want to accept my mother is gone, but that is the reality. I do not, however, have to forget her and how she has impacted my life.
It’s okay to cry. It’s okay to feel whatever it is you are feeling and it is okay if those feelings come and go in minutes or if they last for days. There is no wrong way to grieve. During my grief I went to Nashville for a vacation, I would go out on weekends with friends and laugh, and I eventually moved to California. I managed to feel happy on some holidays and cried on others. I did not stop living, but I allowed for my grief to take space in my life.
In the end, going back to my eating disorder would just have caused more chaos in an already chaotic time in my life. I know it won’t give me control, it won’t make me happy, and it certainly will not bring my mother back. I have this blue butterfly pendant necklace my mom bought me before I went into an intensive outpatient program. It gave me strength then and I wear it now to continue to remind myself that my mother was every bit a part of my recovery and is every bit still a part of me. Now, why would I want to throw all that away?
Carolyn Hersh is available to see patients with eating disorders and has Saturday hours. Contact us for more information. 323-743-1122 or firstname.lastname@example.org
Title: Eating Disorders and the Impact on Siblings
Description: Kym Piekunka will present on the unique impact eating disorders have on siblings. While many studies have focused on how sisters and brothers affect recovery outcomes, Kym co-created an online sibling survey with Bridget Whitlow, LMFT, to better understand their experience and support needs. With 274 responses from five countries, specific themes have emerged. Come join us as Kym reviews these findings and utilizes her story to highlight the importance of supporting this population.
Bio: Since her sister Kacy’s death in 2002 from bulimia, Kym Piekunka became a speaker, blogger, and advocate focusing on her sister’s experience. Over a decade later, Kym observed the reality for siblings had not progressed. Sisters and brothers were sidenotes in articles, organizational education, conferences and treatment, so Kym switched gears. In 2017 she made it her mission to give the sibling experience a voice by creating the website KymAdvocates.com. Recognizing the lack of research and support systems surrounding siblings and the eating disorder impact, she co-created an online sibling survey. Currently, Kym is presenting on data results, expanding the survey in other languages, and developing sibling support systems.
Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland) or street parking