There was a post on Lifehack the other day called, “3 Reasons Why Shame is Your Friend.”  I saw that headline and of course HAD to read it. It turns out it’s the third in a series, after “Why Fear is Your Friend”  and “Why Sadness is Your Friend.” How many times have we talked about these things in therapy… as negative influences?

Personally, they’re all pretty interconnected for me. I’m all about avoiding everything (seriously), and a lot of that is probably fear-based. I’m afraid of screwing up, I’m afraid of being attention-seeking, I’m afraid of being too needy, etc. And, a lot of those fears probably stem from shame. I’m ashamed that I’m not good enough, I’m ashamed that I want attention, and I’m ashamed that I ask for too much.

Now, throw in sadness, and you have a whole cycle. Shame –> Fear –> Sadness –> Fear –> Shame. Avoiding everything does not lead to happiness, that’s for sure. When you act on all those fears (meaning: don’t try things new things you could screw up, don’t develop relationships where you might need something, don’t allow others to care for you because you don’t want to demand “too much” attention), you feel depressed! I end up lonely, bored, and pretty hopeless.

So, how does Lifehack argue that all of these negative emotions are “Your Friend” ?

• Fear
  • Guides you towards what’s important for you
  • Motivates you to take action
  • Gives you a rush
• Sadness
  • Shows you what you care about
  • Helps you to appreciate what you have
  • Requires you to be authentic
• Shame
  • Shows you what you believe about yourself and what your vulnerabilities are
  • Deflates your ego
  • is actually a back-handed compliment

Read: they’re all red flags. I guess you could make that argument for every feeling, and that’s why you’re not supposed to label them as “good” or “bad.” Take the point about shame indicating your vulnerabilities, for example:

Now, when someone calls me ugly, I feel a flush of shame, because when I was a kid, I felt ugly, and part of me still feels that way sometimes, so that indicates that I am still carrying around that belief about myself, buried in my subconscious. When someone insults you and you get upset, part of you believes the insult might be true, that’s insight into what you believe about yourself, and it indicates what you might want to work on as personal growth.

Maybe if I just thought “hey, that triggered some negative belief about myself that I’m still carrying around from my childhood” whenever I screwed something up, shame wouldn’t feel so awful. But, that seems to require a lot of faith that whatever negative belief isn’t actually true.

Earlier, I said that “avoiding everything does not lead to happiness.” For me, I don’t think that happiness is even my goal in avoiding unknowns. It’s the belief that taking the risk isn’t worth it. That maybe the hurt of rejection, abandonment, and disappointment is too much to handle.

Clearly my thoughts are all over the place, but my point is really that while fear, shame, and sadness all tell/show you things, it’s what you do with that information that matters. I’m very capable of connecting: relying on other people > being vulnerable > shame that I can’t do it on my own > probably some maladaptive core belief that I’m not enough or that needing help isn’t okay. That’s exactly why I avoid it! Again, this leaves me at the great chasm between knowing and doing.

Therese refers to the tips/tricks she picked up in therapy as “emotional CliffsNotes.” Ever since reading the book, I’ve thought about what I would put in my own emotional CliffsNotes. I have a friend who would probably say I’m just looking for an excuse to make yet another list — which may be partially true — but hey, if I can make a blog post out of it too….

Anyway, a couple of months ago I ran across an awesome article over at Stepcase Lifehack, called “Can You Transform Without Getting Uncomfortable?” Craig’s main point was this:

Hypothesis: There is a positive correlation between how uncomfortable an individual is prepared to get and their likelihood of success – irrespective of the field of endeavor.

This idea reminds me of something my therapist told me once: that anxiety is a good thing. I thought she was nuts (or just wrong) at the time, since I was devoting so much time to controlling/minimizing anxiety. She explained though, that when you’re feeling anxiety, that’s when you’re making progress. The mental anguish that comes with facing uncomfortable things (like eating more, weight gain, handling conflict, being assertive, etc) is a good thing.  It means you’re making change… and that’s what you have to work through.

It was really weird for me to look at anxiety as some positive indicator of change rather than some big red “stop! uncomfortableness ahead!” sign. What I got out of the conversation at the time was that if I were waiting for recovery to be comfortable, it was never going to happen. Challenging the eating disorder was never going to feel good (at least not while still in the thick of it).

Reading Craig’s article put a different spin on it for me, though. I was still looking at anxiety as something inevitable that I had to push through to get to the other side. The blog post opened me up to the idea that uncomfortable does not equal bad. It’s just uncomfortable.

By the way, I’ve been meaning to write this post for a month (at least), but was re-inspired by something that I read on Carrie Arnold’s blog today:

The main factor for me was anxiety and fear about changing my behaviors. I was often tired of the eating disorder but unable to push through the anxiety that was keeping my ritualistic behaviors in place. Thus the status quo remained in place. My other issue was that this fear was coupled by my minimizing the issues that my AN behaviors created. They weren’t that bad, I could handle it, most people were on a diet- how was my life different? So how could I be motivated to work on a problem that I often wasn’t even sure I had?

I know that anxiety! It keeps me stuck, especially when it comes to the eating disorder.

“A relationship doesn’t have to be romantic to fall into the “toxic” category, of course. Many friendships, mother-daughter, boss-employee, and waiter-eater relationships qualify. If someone is bringing you down consistently, chances are that your relationship with him is toxic.”

Hmm, sounds like something that I can connect to eating disorders! (Imagine!). I’ve heard that “the eating disorder is like a bad boyfriend.” I guess that in this context, referring to the eating disorder as “Ed” makes a lot of sense. The boyfriend analogy aside, the eating disorder does fall under the category of “toxic relationship.” Just look at how relevant the 10 steps are…

1. Step out of denial - I just wrote a whole post about eating disorders and denial. The article suggest asking yourself questions like, “Does the ED leave you feeling energized or drained? Do I want to spend time on the ED or do I feel like I have to? Do I look to the ED for a response that I never get?”
2. Keep a log of emotions – I’ve had a hundred food journal variations, but I think they all had a section for thoughts and feelings.
3. Identify the perks - The eating disorder is doing something for you… it serves a purpose (maladaptive as it may be). Maybe it’s something you’re good at, or it’s a distraction from everything else in your life, or maybe it numbs overwhelming feelings. There are pros of the eating disorder.
4. Fill the hole - EDs are coping skills. If you take it away, you have to find some other coping skill to rely on. (See my whole series on coping skills). Recovery might leave you with other holes… like free time that you previously spent obsessing over food/weight or that sense of accomplishment that you got when the number on the scale went down.
5. Surround yourself with positive friends - the article is right on with this one:
   

   “Lots of support and friends isn’t going to cut it. You need the right kind of friends – i.e. those working on their boundaries as hard as you are, who aren’t enmeshed in their fair share of toxic relationships and therefore become somewhat toxic themselves. The stuff is contagious.”

   Eating disorders are competitive. Dieting and disordered eating are prevalent in society. It’s easy to be triggered and important to be surrounded with “normal” eaters.

6. Drop a note to yourself – I was glad to see this on the list, just because it makes me feel a little less crazy. I write notes to myself all the time.
7. Bribe yourself - I knew a girl who did this. When she was tempted to binge, she’d take the money that she wanted to spend on that and purchase something else for herself (nothing big – like $10 to $15).
8. Heal the shame - I think that shame is HUGE in maintaining eating disorders. The article references “inner-child work,” which I know is helpful for a lot of people.
9. Repeat affirmations - I am not an affirmation person, but I may be the only one. However, I am a QUOTE person… and while not really the same as an affirmation, I think that they can kind of serve the same purpose – to cheer you up, keep you motivated, remind you of something important, etc.
10. Allow some rest - need I really elaborate?

So, while I don’t think I’ll be telling my friend that my eating disorder is just like his relationship with his girlfriend… it’s an interesting idea.

I don’t know how to tell you this, but I’m kind of a big deal. People know me. I have several leather bound books. And my apartment spells like rich mahogony. I’m friends with Merle Olsen. He comes over on occasion.

- Ron Burgunday, Anchorman

There have been a number of posts lately about eating disorders on facebook and the prominence of “sick photos” (the first post coming to mind is Laura Collins “The faces in facebook“). While I have yet to run into any of that on FB, it doesn’t really surprise me to hear all of this. Being the “sickest” has always been some kind of competition (well, for many girls — not for everyone), and things like NG tubes are mile markers that show you’ve accomplished something. You’re that good at being sick.

The NG tube reminds me of this quote from Anchorman, because there are a whole list of silly “measures” of sickness. Just to give you an idea…

• How many times you’ve been inpatient. How long each of those IP stays were.
• How long you’ve had your ED.
• Number of trips to the ER.
• Stats around your low point — your low weight, lowest calories, hours of exercise, blood pressure and heart rate, number of laxatives and/or diet pills, frequency and size of binge/purge episodes
• Even things about refeeding (needing over 4,000 calories to gain, for instance)
• Medical complications, arrhythmias, NG tubes, J tubes, passing out, seizures or heart attacks
• Any disparaging comments from professionals, like “you will never recover” and “you are the worst case of anorexia/bulimia I’ve seen.”

In the world of eating disorders, sure, these are status symbols. I think that they have a deeper importance, though… these are physical signs that you are not okay. That somehow you are justified for being not okay because you are sick. Whatever is wrong is important; not only because you’ve been sick for years but because you have serious medical complications. It’s easy for others to ignore emotional hurt, but less easy to ignore physical hurt.

I think that some of the wanting to “brag” about your low weight or hours of exercise is because it DID take a lot of effort to not eat all day or exercise for hours on end (okay, maybe not-eating was easier than eating, but you sure thought about it all day). In your world it seemed like you were accomplishing something….

I could probably come up with a dozen other reasons why those NG tubes seem special to anorexics/bulimics. It makes them feel special — like there is something unique about them. It’s something easy to obsess over and focus on, rather than other stuff going on in life. You know the quote about “trying to make your inside match your outside?” Well, an NG tube may certainly do that. Maybe it does give you the permission to get better because you definitely can NOT give yourself that permission, for whatever reason.

What is more surprising to me is that all of these photos are on facebook… a place where their school friends, family members, community members, etc. can all see them. I understand that when you are THAT deep into your disorder, you don’t care if the whole world knows — heck, you want the world to know. But… I would have definitely felt too vulnerable to make that public of a statement. Good thing!

Anyway, the irony of it all (well, maybe irony isn’t the right word) is that the only people who see these “status symbols” as actual measures of anything are those who are in treatment with you! Those who are equally as sick! In the real world, “I’ve been inpatient four times and had an NG tube once” sounds like a lot like “I have several leather bound books and my apartment smells like rich mahogany.”

1. Mothers with eating disorders
I think that your mother’s weight and behaviors surrounding food are much more relevant in recovery than in the downward eating disorder spiral. Parents model for their kids — I’d argue that this is even true for adult kids (adult kids, ha — you know what I mean). While I think that the eating habits of everyone around you definitely influence your own, there is something about mom’s that sets the bar.

In recovery, you’re feeling particularly self-conscious about weight and food. You are looking around at others to figure out what “normal” is. You are also overly conscious of the size of everyone around you — as well as what they’re eating.

So… what if your mother is anorexic? Or, not necessarily even anorexic, but what if she is health-obsessed or a compulsive over-exerciser? You’re trusting your dietitian when she says that ALL women do need xxxx calories, and trusting your therapist when she explains that disordered eating is unhealthy and a poor coping mechanism. Maybe you’re still trying to convince yourself that you DO have an issue (denial = a large part of EDs) or that treatment is important.

And then there’s mom — who is underweight and not eating xxxx calories a day (not that you’re counting your mother’s calories). And she seems okay… and it’s not a problem for her… so why is it a problem for you?

You want your mom to be the parent. You want her to model what you’re supposed to do, because you don’t really know (or trust) what you’re supposed to do. Recovery is hard enough without having to wrestle with this size double standard. I don’t think it really matters what “size” your mother is, as long as she isn’t unhealthily underweight and/or actively losing weight while you are trying to recover.

2. Families changing their eating because of your ED
I’ve always been afraid that my eating habits would rub off on my family (or something like that) and change their eating. I guess I never really worried about my mom gaining weight while I was gaining weight… but with all the focus on the eating disorder, would my mom or sisters suddenly become more food and weight conscious? Or — would anyone pick up some of my ED tendencies?

It’s somewhat unfortunate that eating disorders don’t exist in a vacuum. I do think the size of people around you affect your perception and expectations of your own size. I also worry that eating disorders hurt families in several ways — maybe one of them being and increased obsessiveness over food and weight. And, if that is the case — I hope that doesn’t last.

Cammy

1. The nurse practitioner that I saw in college insisted that I NOT see a gynecologist.  This was after I had lost my period for several years, gained back to a normal weight, and still not gotten it back.  She insisted that there was nothing any professional could tell me and that if my body decided to menstruate again, it would.
2. I took an ED medical clearance form to my doctor, and on it there were two blanks for blood pressure–one for sitting and one for standing.  The nurse looked at it and said “Now that’s a silly question–I don’t see why they wouldn’t be the same.”  She took my blood pressure once and wrote the number down twice.
3. I was planning on starting accutane for acne when we learned that there was a high incidence of depression/suicide and accutane treatment.  When we mentioned this to my dermatologist (since I was already struggling with depression), she said “Oh, that statistic MUST be wrong.  When people have clearer skin they are happier!!”  (for the record, accutane did worsen my depression–even though it did really help my skin).
4. My cholesterol registered as high on a blood test (even though the bad cholesterol was low and my good cholesterol was really high… and this is common with anorexia) and my doctor sent me a letter instructing me to watch my diet and exercise more.

I feel like I could go on and on, but I will stop there.  Back in the day I took a lot of things personally (like being told that “if you lose 5-10 lbs then we’ll start monitoring you” or “all your labs came back fine so you are A-OK”) and as an indication that I didn’t have a problem and was asking for help when I didn’t need it… but really, once you’ve seen enough doctors, you start to realize that most of them just don’t know.  And the ones who do get it?  It’s usually because either they themselves or their loved ones have struggled with an eating disorder in the past.

While this probably sounds depressing, I actually think that the idea of remission is very validating. It gives you another shade of gray in the sick to healthy spectrum. Plus, I think there’s a fear (and hence a danger) that comes with the idea of being completely recovered. While recovery suggests, “You’re done! It’s over! You are cured, have a nice life!,” remission leaves the door open. To me it says “You’re doing great right now, but come back [to treatment] if you need to in the future.”

When you have been declared recoverED, do I think that you are less likely to go back and get treatment if things start to go south in the future? Absolutely. I mean heck, you recovered! The eating disorder is over. With remission, there’s more of a “okay, this is acting up again, I should do something about it” feeling. The relapse could be just as significant in either case, but it feels more reasonable to ask for help in the second case.

In the meantime though, I want to highlight a quote from Laura Collins’ article, “The size of the trigger or the speed of the bullet?”

An eating disorder is not a sign of deep wounds, but some people do have deep wounds, and it makes recovery harder.

I’m curious — this this a “duh” statement for everyone treated with the Maudsley Method? Because it basically goes against all of my inpatient and outpatient treatment, formal education, and research. Just to quote a few of the institutions, professionals, and resources I’ve had experience with:

“Eating disorders are serious health- and life-threatening physical disorders that usually stem from some underlying emotional cause.” – The Renfrew Center

“Genetics make the gun, environment loads it, and that an experience of unbearable trauma is what actually pulls the trigger.” – Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

“Eating disorders are real, treatable medical illnesses with complex underlying psychological and biological causes.” – National Institute of Mental Health

If you don’t see my point by now… it’s that I have always been told, eating disorders are not about the food. They’re a symptom, coping mechanism, etc. of something else.

That said, I don’t think that everyone has trauma… I’m not a fan of repressed memory therapy, because I think a lot of it is made up (or generated in the process).  Ruminating on traumatic events prolongs mental illness.  You can’t change what happened to you when you were three.  This is all true… but I also think that some people are using food to subconsciously avoid feelings/situations related to previous trauma, and in those cases, they need to be resolved in therapy.

I like Aimee Lui’s perspective on the matter.  You NEED the genetic component to develop and eating disorder.  They don’t really just happen to people.  Even if you have the genetic component, though, growing up in a wonderful environment can be protective.  I refuse to believe that you just inherit the anorexia gene and you’re doomed for a life haunted by an eating disorder (and if that’s the case, then I should never have children given my family history).  There IS a strong genetic component… but in all these genetic studies, you also have to consider environment!  Chances are, these kids are growing up with semi-similar relationships as their parents did.  There are just too many variables.

Anyway, I think that given genetics, environment CAN be enough… but for many people, it’s the unbearable stressing event that pushes them over the edge.  Those are the people with the trauma history.  So, regardless of whether or not you have a history of trauma, you at least have underlying relationship/environment issues to address

I found Rachel’s post to be very interesting — and largely true to my experience. In face, we often decide on the restaurant based on what we’re getting. Sometimes we get salads, other time’s it’s pizza… sometimes it’s just a drink and dessert. But usually it’s almost the same thing. I don’t think that it’s that odd… but my intake is definitely influenced by my dining partner.

My big exception to this, though… is going out to eat with other eating disordered friends. No, this isn’t “let’s encourage each other to only eat lettuce.” Pretty much the opposite, actually. I would NOT order something that I considered to be disordered while out with a friend who has also struggled. It’s some kind of spoke ED etiquette — no matter how you are REALLY doing right now, you have to do “well” at that meal. It’s just not cool to be triggering. You suck it up for one meal and do what you know you’re supposed to do.

Also, going even further… I definitely overcompensate when out with non-ED friends who know my history, or out with family. Why? Because I don’t want to look anorexic. They’re already more aware of my eating patterns (and often still watching me), and I just don’t want anyone to think that I’m not okay. My parents have put up with enough throughout the many years of the ED… I’m a self-sufficient adult. I a) don’t want to worry them, and b) want to be treated like an adult. Not a high-schooler who is still struggling with the same issues. And with non-ED friends… I’m just trying to avoid the anorexic identity. I don’t want that role. Oh, and I avoid hanging out with chronic-dieters… girls who sit at dinner blotting their pizza with a napkin or spending the whole meal talking about calories. Those girls are NOT fun. Refusing to get ice cream, go out for a drink, etc. — that’s not fun! I want to fall into the “fun person” category… not the anorexic who doesn’t eat and won’t go out.

So yes, I overcompensate. Yes, I’ll have a drink. Sure, let’s order dessert — I’m game. I could use ice cream, why not.

Granted I may be screaming at myself the rest of the night, and trying to compensate with not eating much at other meals… but I just don’t want to be the girl picking at her salad in the corner. I’ve been there, and it’s lame. So, now regardless of whether or not I’m doing horribly, you’re not going to witness it at dinner.

Performance eating? Definitely. My old nutritionist was very against this… but I don’t know. I would strongly argue otherwise.

Tags: eating disorder, anorexia, anorexic identity, eating disordered friends, ED etiquette, performance eating