Breaking The Myth: Men and Eating Disorders

Male Eating Disorders
Photo by Fares Hamouche on Unsplash

by Carolyn Hersh, LCSW

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.

Eating disorders in males may look different.

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.

Source

National Eating Disorder Association

Recovery When Grieving by Carolyn Hersh, LCSW

Grief and Eating Disorder Recovery 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 lmuhlheim@eatingdisordertherapyla.com 

Curate Your Feed with Diverse Body Positive Accounts on Instagram

Photo, Resilient Fat Goddess Instagram

by Sarah Thompson, Resilient Fat Goddess and Lauren Muhlheim, Eating Disorder Therapy LA

“Body positivity can’t be just about thin, straight, cisgendered, white women who became comfortable with an additional ten pounds on their frame.” —Stacey Rosenfeld, Ph.D., Shape magazine (July, 2018).

Eating disorders are about so much more than body image, but the current diet culture, idealization of the thin ideal, and “war on obesity” make it much harder for people with eating disorders to recover. We are barraged on a daily basis by media images of people who represent only a small portion of the population.

As Dr. Muhlheim discussed in a previous post about fat photography, the mainstream media images we see are not diverse, and the images we do see of larger bodies are often portrayed in a particularly negative and stigmatizing way, adding fuel to the fire.

Thus, an important exercise for people of all sizes in recovery is to curate their social media feed by removing accounts that perpetuate the thin ideal and expand the range of body sizes and types to which one is exposed. Adding diversity to your social media feed isn’t only important for people in recovery, it can be just as important for partners as Sarah Thompson wrote about here. It would even be useful for parents and family members of those recovering.

The term used to describe the absence of representation in media was coined by George Gerbner in 1972. This phenomenon is “symbolic annihilation.” Gerbner was a Hungarian Jewish immigrant and communications professor who researched the influence of television trends on viewers’ perceptions of the world. According to Coleman and Yochim, Gerbner explained that “representation in the fictional world signifies social existence; absence means symbolic annihilation.” Representations, or lack thereof, lead to assumptions about how the world works and who holds power.

Gerbner did not assign symbolic annihilation to any particular group, so it has since been applied to many different identities. We can apply the concept to non-dominant systemic identities, such as larger bodied people, people of color, trans and gender-expansive people, disabled people, etc. If we don’t see bodies like our own represented, we may come to believe “my body doesn’t matter”. Often, this can turn into “I don’t matter”. This means that for people whose bodies are marginalized in any way, it is essential to see images of people that look like them.

We have developed a roundup of Instagram accounts to help you on the journey. While it is not comprehensive, it is a starting point. What follows are some Instagram accounts that show body-positive images that celebrate diverse bodies in ways that mainstream media does not.

At the time of this posting, these accounts are free of body shaming, fat shaming, food shaming, and disordered eating. Some are people in recovery from eating disorders. If we missed one of your favorite accounts that consistently publishes photos of bodies at the margins, please email us and let us know!

Larger-bodied women

@madeonagenerousplan

@iamdaniadriana

@themilitantbaker

@fatgirlflow

@fatwomenofcolor

@cosmiccollette

@bampowlife

@danielle_bex

@fatlippodcast

@shesallfatpod

Larger-bodied men

@bigboysarecute

@johnasavoia

@abearnamedtroy

@chubstr

@bear_skn

@zachmiko

@300poundsandrunning

People of color

@iamivyfelicia

@onebeautifulyes

@thefriendineverwanted

@nalgonapositivitypride

@sonyareneetaylor

@virgietovar

@genizeribeiro

@ihartericka

@diannebondyyoga

@mynameisjessamyn

@biggalyoga

@sassy_latte

@adydelvalle_

@melissadtoler

Gender diverse people

@transfolxfightingeds

@comfyfattravels

@chairbreaker

@thirdwheeled

@alokvmenon

@nonnormativebodyclub

@shooglet

@resilientfatgoddess

@thefatsextherapist

@watchshayslay

Older people

@efftheiragingstandards

@idaho_amy

@lamplight.space

@gidget3304

@glitterglama

@fruitbat5150

@26kleisen

@finally_bopo

People with disabilities

@the_feeding_of_the_fox

@dietitiananna

@theonearmedwonder

@rollettes_la

@disabilityisdiversity

@the_hapless_roller

@spookyfatbabe

@disabled_fashion

@princesscakep0p

@everybodyisworthy

Multiple Identities

@thebodyisnotanapology

@decolonizingfitness

@subversesirens

@fatkiddanceparty

@adipositivity

@underneath_we_are_women

@lkt_consulting

@flourorchalk

Other body positive accounts to follow

@sweetamaranth

@iamannachapman

@nolatrees

@bopolena

@bopo_watercolour

@shoogsart

@shelby.bergen

@neoqlassicalart

@lovefromdanica

@bopo.boy

Source

Coleman and Yochim. The Symbolic Annihilation of Race: A Review of the “Blackness” Literature. Perspectives. Spring 2008. http://www.rcgd.isr.umich.edu/prba/perspectives/spring%202008/Means%20Coleman-Yochim.pdf

August 2018 LACPA Eating Disorder SIG Event

Jaye Azoff, Psy.D., Los AngelesDate: Wednesday, August 22nd at 7:30 pm

Presenter: Jaye Azoff, Psy.D.

Title: The Anatomy of a Recovery

Description: Recovery from anorexia nervosa (AN) follows an unpredictable, windy path. Rarely does it come quick; there is no single trajectory, no infallible indicators of how a treatment will play out. Opinions about the recovery process vary, depending on whose perspective is being sought. The patient—the former patient—sees it one way—but there is no guarantee that the opinions of others, therapists, partners, loved ones, will concur.

This talk addresses the question in a unique fashion. A patient: a former patient, (a doctoral level psychologist) will share her account of a treatment that unfolded over roughly twenty years.

Several points will be discussed. Importantly, the former patient will consider 1) briefly, the etiology of her illness (and we will assume a basic understanding of eating disorders here); 2) briefly, how (some) of the various treatments were directed and integrated across the multi-disciplinary teams (and throughout the years) 3) how her protests and resistances—and there were many— were met, and with what explanations 4) most importantly, looking back, what aspects of this treatment are now recalled as influential, elements seen in a positive light, elements perceived as detrimental.

Perhaps most important for the purposes of this discussion is the concept of the “power struggle” – that all too familiar war our patients learn over years of treatment with us to get into with themselves which then becomes acted out with their caregivers. How can we as treaters do better at not engaging, and shift the power and responsibility back into their hands?

Namely, how can we teach them that if they are to get well, it will be because they choose to get well? How do we teach them that they “win” nothing by restricting their snack for an evening or vomiting their dinner because they feel hurt over something we as clinicians might have said or done to them? These are complicated constructs, but not impossible ones, and by using Dr. Azoff’s past as a case vignette, we might be able to chisel away at some of the answers.

Bio: Jaye Azoff, Psy.D., has been practicing in the fields of clinical psychology and neuropsychology since 2008, when she graduated from the California School of Professional Psychology in Los Angeles, where she trained under the Health Emphasis Track. Dr. Azoff did most of her field training at Children’s Hospital Los Angeles’ Keck School of Medicine, where she practiced in the hematology/oncology neural tumors unit and trained in many roles over nearly eight years, eventually advancing to become the team’s neuropsychology fellow. It was Dr. Azoff’s own recovery from an eating disorder that propelled her forward and launched her into the eating disorders field. Currently, she is an eating disorders consultant, and she is the owner and operator of Basik Concierge, the world’s only boutique concierge firm offering wraparound services for individuals with eating disorders and their families. She is also the In-House Clinical Consultant for the Kantor and Kantor law firm, which fervently works to attain treatment for individuals with eating disorders struggling to gain access to care. Dr. Azoff is a past board member of the Eating Disorders Coalition. She is a sought-after speaker, having formally addressed the United States Congress in the Spring of 2013, and travels nationally to speak to patients and families affected by eating disorders, as well as delivers in-services to clinicians and other individuals eager to learn about various topics related to eating disorders. 

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

RSVP to:  drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org