Ask Susan updated the 2nd Friday of every month!
April 12th, 2013
A: I’m so glad you’re bringing up this very important issue. I don’t believe everyone who develops an eating disorder was traumatized in childhood. But the statistics, such as they are, suggest that way too many were. For example, one study found 53-66% of people with eating disorders disclosed a trauma history: 20% reported having been sexually abused; 27% were physically abused; 29% were emotionally abused; 35% were neglected. Because this study didn’t measure many aspects of what we now understand as relational trauma, the figures are probably higher.
Having been traumatized can strongly predispose a person to the development of an eating disorder, given the right other “ingredients”. These include personal characteristics such as perfectionism, a tendency toward black-and-white thinking, the need for external approval, obsessive-compulsive traits and so on. Dieting behavior and cultural pressures are other key predisposing ingredients.
Understanding how eating disorders are unconsciously recruited as an attempt to cope with the ongoing effects of early trauma has been an invaluable step forward in fine-tuning eating disorder treatment. If you think you or someone you care about who has an eating disorder also has a trauma history, it’s important that this history be shared with the person providing treatment so the best treatment decisions can be made.
March 7th, 2013
A: I know this is a scary question for you and for most people undertaking eating disorder recovery. And I’m going to have to give you that frustrating answer: “It depends.” The biggest things it depends on are the type of eating disorder you have, whether you weigh too little to be healthy, and what your body type is.
If you have anorexia and/or you weigh too little to be healthy, part of your treatment will include intentionally gaining weight. Neither your body nor your brain can sustain you through the demands of recovery—or life—without sufficient nutrients.
When your weight doesn’t represent a medical danger, your body’s own “preferences” will have the most to say about where your weight lands. At least that’s the thinking behind set-point theory which holds that different bodies are genetically set to maintain different amounts of fat in storage. If you try to force your body below its preferred level through dieting or exercise, your body will take measures to fight you on it, like slowing down your metabolism or increasing your appetite.
The best bet for healthy recovery is to learn to eat and exercise in a healthy way and let your body “decide” what weight that puts you at. This is where all the other work of recovery comes in, like cultivating acceptance of your self as you are, rejecting cultural prescriptions for how you’re supposed to look, learning that your weight doesn’t determine your worth, and more.
I hope you’ll take a look at what others who are already on the road to recovery have to say about these issues at this site’s Visitor’s Forum., especially the part where they’re telling you why recovery seems worth it.
Meanwhile, all the best to you. Check in again and let us know how you’re doing!
December 15th, 2012
A: Your sister is very lucky to have this kind of support and concern from you, RT. You don’t say whether you have spoken to her about this, but this would certainly be the place to start. Just bringing up the subject conveys that her comfort and her recovery are on your mind and are important to you. The conversation might lead to you two collaborating on strategies that could be helpful to her. For example, she might appreciate having ways to participate in preparation that downplay involvement with food, such as bringing a centerpiece for the table, helping set the table, entertaining young kids, or being the hostess for guests who aren’t in the kitchen. She may have ideas about what foods she’d like to see present, or not present. (Just be careful with this one so the family doesn’t end up feeling the eating disorder is dictating the table, nor does your sister have to feel she’s robbed everyone of their favorite food traditions.) You might find she feels best making few or no alterations at all to your usual traditions due to her eating disorder. Whatever she decides, she’s getting a chance to think through what works best for her in recovery and to feel her family’s support as she does so.
Good luck and have a joyous holiday!
August 10th, 2012
A: “Drunkorexia” is not actually an official diagnosis. It’s more of a popular expression for a system many young people are experimenting with in an attempt to prevent weight gain due to excessive drinking. Similar to diets with point systems or food exchanges, a “drunkorexic” system restricts calorie intake from food on a particular day to compensate for calories from anticipated alcohol consumption.
There is nothing safe or scientific about this experiment. Beyond the usual dangers of food restricting, drinking on an empty stomach just magnifies the toxic effects of alcohol.
Studies show that students with eating disorders are even more likely than others to binge drink. And, of course, alcohol has the effect of disinhibiting impulses, so many a food restrictor ends up bingeing on food under the influence after all and then purging. There’s no good outcome here.
One final thought: Sometimes young people will talk about the problems of their friends or roommates as a way to test the waters about problems they are having themselves. So you may want to check whether your daughter has any concerns about her own eating and/or drinking patterns. Whether the problem is your daughter’s, her roommate’s, or both, remember there’s lots of help out there. A good starting place would be the college counseling center. If this does turn out to be a problem of your daughter’s and there are no adequate on-campus counseling services, please contact me again for further sources of support for your family.
June 7th, 2012
A: Welcome, Lucy! So glad you’re finding the blog helpful. And what a good question you ask! Of course, eating disorder recovery needs to focus on helping people find ways to reduce their ED symptoms in an immediate way. I assume the earlier in recovery a person is, the more he or she will need to focus on symptoms. But I always have my eye out for moments to start identifying and working on the underlying issues which gave rise to the eating disorder and continue to fuel it. In Eating Disorders for Dummies I say that the eating disorder is like a magician, “getting us to look over here, while the real action is over there.” And that “…staying focused on food and weight means never getting to the heart of what an eating disorder is really about.”
Although there are many factors that contribute to the development of an eating disorder, a very high percentage of ED sufferers experienced some kind of relational trauma in childhood. Relational trauma means either being overtly hurt, perhaps by caregivers, or not receiving the care and guidance a child needs to become a confident, skillful human being who has a sense of self-worth, can mange her emotions, and can form solid relationships with other people. If childhood didn’t provide these qualities, a person needs to develop them in adulthood to have a symptom-free life. When symptoms start to subside, someone who’s had an ED needs to go to work on repairing what was wounded and building up what’s missing so that freedom from the ED can be a lifetime thing.
Thanks for contributing to the conversation, Lucy. Best wishes as you continue in your recovery!
May 7th, 2012
A: You ask a really important question, Annie. There are some additional things I’d need to know to give you a good answer. Since I can’t ask you about them in person, I’ll ask them here in the hopes you’ll be able to think about them and sort this out for yourself.
The difference between exercise “addiction” — also called compulsive exercise — and just plain dedicated exercising has more to do with how you’re feeling about the exercise and about yourself than the actual behavior. For example:
- Do you feel you must exercise in order to make yourself acceptable?
- Do you exercise to “make up” for overeating? Or for eating, period?
- Do you feel guilty, worthless, depressed or anxious if you miss a workout?
- Do you feel you’ve “blown it” if you miss a workout?
- Do family or friends express concern or anger about the way your routine affects your relationship with them?
- Have you ever missed work (school) in order to work out?
- Do you feel weak or inadequate if you want to stop due to pain or fatigue?
If you’ve answered “yes” to any of these questions, certainly to several or more, you may wish to take a closer look at whether you’re using exercise for emotional or self-esteem issues in a way that’s not good for you or your recovery. Chances are, it has some of the same root system as your eating disorder. It would probably be useful to talk this over with whoever is helping you with your recovery.
Best of luck to you!
January 13th, 2012
A: First of all, kudos for nearly a year in recovery, Rochelle. I’m glad you’re participating in a group to support your recovery and that you’re stopping to think about their advice.
There are going to be lots of voices supporting your impulse to diet. I’m going to give you two monster reasons to listen to your group instead:
- Dieting so frequently leads to eating disorders, it’s known as the “gateway” behavior. It’s equally potent as a trigger for relapse.
- Dieting doesn’t work. The overwhelming majority of people who lose weight through dieting regain the weight and then some.
If you have an eating disorder, dieting too frequently reinforces negative feelings about yourself; for example, that the most important thing about you is what you weigh. Keep your focus on recovery. You’ve done so well. Showing up at your sister’s wedding with seven more months of solid recovery under your belt is the best gift you can give to either one of you!
September 9th, 2011
Answer: Hi, Fran. First of all, congratulations on 6 months of recovery!
I’m glad you’re thinking carefully about what to share in a new relationship rather than just jumping in. I’m going to suggest you shift the focus of your question from what you owe your fella to what you owe yourself. If you two are just getting to know one another, you don’t owe him information, other than things that directly affect dating you: Are you seeing other people? Do you only date parrot–lovers? Are you about to move to Tanzania?
The important question now is what will feel best to you and support your recovery? You owe it to yourself to determine whether he’s a trustworthy person with whom you can entrust more vulnerable aspects of yourself, eating disorder–related or otherwise. How does he react to other people with challenges in their lives? Is he supportive? Non–judgmental? Caring? Getting to know you better is a privilege he needs to earn!
Good luck with your relationship and with your continued recovery!
July 8th, 2011
A: You will be surprised at my answer, Lana. No, obesity is not an eating disorder. Or, as fat activists prefer to say it, being fat is not an eating disorder. This doesn’t mean people who are fat can’t have eating disorders. A number do. But you can’t tell from someone’s size what their psychological state is.
There are many determinants of body size. Genetics is an under–appreciated contributor. People may also gain weight for the more commonly–expected reasons: overeating and/or lack of exercise. But there are also many obese people who eat healthily and exercise regularly, the so–called fat but fit.
Your sister is lucky to have your concern, Lana. There are many good books and Web sites that will help you identify behaviors and thinking patterns indicative of eating disorders. For example, you might start with Something Fishy , a great all–purpose eating disorder Web site. You may also wish to check out Health at Every Size, a site representing the movement by the same name that emphasizes healthy lifestyle over a focus on weight.
Best of luck to both you and your sister!
March 11th, 2011
A: Dear Brighton:
First of all, I can tell how hard you’re working on your recovery, despite lack of resources, and how determined you are. I really applaud you for it!
A lot of people, unfortunately, find themselves in your shoes: rich on resolve, short on support. Fortunately, advances in technology have increased the options for people who have to reach beyond their immediate environment for support.
One important example is the expanding supply of online support options, such as support groups, chat rooms or forums. In an online support group, specific people purposely plan to come together online at a particular time, just as a face–to–face support group would. In a chat room, you can communicate in real time, but you won’t know until you get there who else will be present. With a forum, anyone can leave their comments on a particular topic for others to read and respond to in no particular time frame. You’ll need to register for any of these activities and abide by site guidelines to remain a participant.
Though the Internet can be a jungle, many of these groups are monitored (the only kind I’d recommend) and endorsed by reliable organizations. If this interests you, you’ll want to be sure to visit the wonderful Internet resource for all things eating disorder, Something Fishy. The site maintains a list of moderated online support groups, chat rooms and bulletin boards (also known as message boards or forums). Just a few of the Internet options include Joanna Poppink’s Eating Disorder Recovery Discussion Forums, Pale Reflections, an online membership community, The Eating Disorders Recovery Resources & Recovery Support Network (with 24/7 moderation of their online communities), and the Message Board forum of the Joy Project.
Phone meetings and phone therapy are other options for bringing far–away support to your doorstep. More and more people rely on video calling with services such as Skype for a more in–person experience. Something Fishy’s Treatment Finder includes an international list of individuals and organizations that offer phone or video meetings for people with eating disorders. Some are for free; some are fee for service. Pale Reflections, listed above for online groups, also maintains a list of international phone numbers for ED support.
Twelve Step programs also supply local support. This can be in the form of the more familiar face–to–face meetings. But many also have telephone meetings and the kinds of online chat rooms and message boards discussed above. The following programs have international listings: Anorexics and Bulimics Anonymous (ABA), Eating Disorders Anonymous (EDA), and Overeaters Anonymous (OA) .
Please be extra alert about using services at a distance if any of the following apply to you: you have anorexia, your eating disorder symptoms are still severe, or you feel suicidal. In each of these instances, your symptoms may impair your judgment and you need the on–site availability of professionals who can help you ensure your own safety.
I hope you find the kind of supplemental support that’s just right for you and that you continue toward a successful recovery.