“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.

1. Feeling your feelings – good, bad, and everything in between
2. Your body adjusts to where it needs / wants to be (based on your own genetics)

Johanna supports these two ideas with a lot of great thoughts, so I definitely recommend that you read the post.  However, what really caught my eye was one of the comments:

My therapist told me yesterday that “people try to get out of their eating disorder by going into their eating disorder.” I slipped a little in the past two days. My therapist said, “You’re in the hole, but you’re trying to get out of the hole by going farther in the hole. You don’t climb out of a hole by going down. It’s like people are hoping so hard that if they just go farther into the hole, they’ll find a secret back door that will let them out more easily. The truth is, there is no back door. It’s a cul-de-sac. It’s painful to be in the hole, and it’s painful to come out of the hole. But there is only one way out. Up.”

Laura so eloquently articulated something that’s going to take me five paragraphs to describe.  Everyone has heard the phrase about things having to get worse before getting better.  However, it doesn’t say MAKE things worse so that they can get better.  It doesn’t exactly work like that.  I see a couple of different situations where people “try to get out of the eating disorder by going [further] into their eating disorder”:

1. Trying to replace one symptom with another
2. Not feeling “sick enough” to recover
3. Waiting to hit rock bottom
4. Trying to do recovery perfectly

To explain a little further…

Trying to replace one symptom with another
Replacing bingeing or purging with restricting is not recovery.  Replacing restricting with compulsive exercise is not recovery.  It’s tempting to say, “okay, I’m going to stop bingeing and eat only healthy food and lose weight.”  I think this just exacerbates the binge > purge > restrict cycle.  It seems unintuitive… but I think part of the recovery process is learning to forgive yourself when you do screw up.  It’s being a little more lenient with yourself… not stricter.

Not feeling “sick enough” to recover
I’ve blogged about this several times.  There’s the whole “if I were really sick, then I would recover” idea.  Or “if I just lose 5 lb., then I’ll feel ’sick enough’ and will feel justified in trying to eat more and get better.”  There is no “sick enough,” though.  Digging a deeper hole is not the answer to getting out!

Waiting to hit rock bottom
This is the “I’m still functioning, it’s not THAT bad” rationalization.  Or the “I’ve been worse before” idea.  There doesn’t have to be a rock bottom.  While true that some people have that moment when something really awful happens and makes them realize they are ruining their lives and have to change, I’d say those individuals are more the exception than the rule.  I’ve had “rock bottoms” (note the plurality), and sure, they motivated me to change.  However, the times that I really committed myself to recovery were not near those bottoms!  I’m very guilty of the “I’m a functioning person so I’m fine” excuse.  I have to stop and remind myself, “Why would I want to wait until I lose my job, ruin relationships, have a heart attack, etc.?  Can’t I just avoid that horrible bottom and work on getting better now?”

Trying to do recovery perfectly
I know so many people who want to keep “restarting recovery” so that they can “do it right this time.”  Restating seems to imply getting worse… so that you’re back at the starting line to try again.  I’ve done this over and over with eating and my fear of having a slow metabolism forever.  If I’m not following my meal plan, yet maintaining my weight, I am convinced that I screwed up in the recovery process somewhere and am condemned to a life of having to watch my weight because I’ll obviously gain eating a normal amount of calories.  And then, what’s the solution?  To lose weight, of course… so that I can try that again and follow my meal plan and trust the science of it all.  When you’re deep in the eating disorder, it seems to make a lot of sense.  But, looking at it from the outside… why would I think that doing worse would be the solution to getting better?

Laura summed this up so well: You don’t climb out of a hole by going down.

Intelligent behavior requires strategic processing of numbers and abstract quantity information in accordance with internally maintained goals. For instance, we typically adopt a “less than” strategy when shopping for a product to pay the smallest amount of money. When searching for a job, on the other hand, our plan of action is “greater than”, and we strive to earn the largest sum of money. In such pragmatic situations, our decisions on quantities are guided by mathematical rules applied to them.

The monkeys learned the quantitative “greater than/less than”-rule and were able to choose the smaller or greater set size relative to the sample numerosity, independently of the absolute numerosity of the displays. While the animals were performing this task, neurons recorded in the prefrontal cortex of the frontal lobe exhibited interesting activity. Irrespective of the absolute magnitude of the dot sets, the brain cells exclusively represented the mathematical rule at hand. Approximately one half of these neurons were only active whenever the animal followed the “greater than”-rule, whereas the other half preferred the “less than”-rule.

“This new study provides valuable insight into the neurobiological foundations of highly abstract thinking that is necessary for mathematical operations. “First of all we want to understand how neurons process mathematical operations” Andreas Nieder explains. “At the same time, our investigations of the number sense are meaningful for assessing the very complex thinking processes that are necessary, for instance, when dealing with numbers.” It is the cerebral cortex at the frontal pole of the brain that constitutes the brain’s highest cognitive control center. This region of the brain also gives rise to mental activities that build personality.”

I think that the “greater than/less than”-rule could definitely apply to eating disorders.  You’re looking for the fewest calories when grocery shopping or at the gym calculating which exercise burns the most calories (these are pretty stereotypical examples, but stay with me).  In many ways, common eating disorder rules do involve a kind of math.

I’m stepping out of my realm of knowledge now… but I wonder if these rules could be applied to anxiety.  What about choosing the activity or food that causes the least amount of anxiety?  That’s math-like… I’m assessing the situation and choosing the smaller action relative to possible anxiety.  Am I stretching this?

Also, I think it’s an interesting connection that the cerebral cortex impacts mathematical processing AND personality.  There is definitely a relationship between how immersed one is in his/her disorder (which could mean more rigid adherence to self-imposed ED rules) and presence (or absence) of his/her personality.  I know there are lots of other biological explanations for this (I think every eating disorder blog is required to mention the Minnesota Starvation Experiment in at least one post)… but I think the possible connection is fascinating.

This evening I was reading Carrie’s post on overcoming core traits.  Personally, her post was very timely, having just finished reading the book, “When Perfect Isn’t Good Enough.”  That is NOT a book that I would normally pick up (I feel pretty well-versed in perfectionism), but my therapist handed it to me.  In hindsight, maybe I could have NOT read it and argued that I was challenging my perfectionism by not doing my therapy homework.  Oh well, next time…

Anyway, the book made a lot of good points, and I could write a dozen posts on it (maybe I will… another day), but one thing that really stuck out for me was the idea that perfectionistic behavior maintains perfectionistic beliefs.  I understand the whole idea of challenging perfectionistic beliefs and testing their validity – that wasn’t really a new concept for me.  What I am curious about, though, is if perfectionistic behavior can exacerbate perfectionistic beliefs, and therefore anxiety?

A year ago, I switched jobs to something that required a lot of persistence and focus to detail.  A LOT.  How perfect – I can get paid for my OCD-like tendencies!  When the job opportunity arose, I really approached the career change from a square block, round hole perspective.  Instead of trying to be less perfectionistic, I could just switch to a job that encouraged it.

After reading this book, I’ve started to wonder if my meticulous work makes my anxiety worse.  I can (and sometimes do) agonize over details all day.  I’m always engaging in perfectionistic behaviors.  Is that impacting my beliefs?  And do those beliefs influence other areas of my life?  Instead of work being an outlet for the OCDness, is it just making those tendencies worse?

I like my job and am not about to change that, but it’s an interesting thought.  Does perfectionism breed more perfectionism?  Even accross life domains?  Hmm.

If you don’t know what a “kudos chart is” – it’s a sticker chart.  You know those charts that your mom made when you were five that had actions like “make bed” and “brush teeth” on it?  Yep, those.  I heard someone refer to them as “kudos charts” on twitter several months back, and since my current chart is not actually using stickers, I’m going to go with that terminology.

My explanation is simple: a kudos chart worked for me when I was five, and twenty years later it is still a helpful tool.

What kind of things do I have on my kudos chart?

1. Follow meal plan
2. Take calcium supplement
3. Get 7+ hours of sleep
4. Go through the mail
5. Blog

That’s not all, but you get the picture – it’s a mixture of eating disorder goals and regular life tasks.  I never have more than 7 goals, for three main reasons:

1. then I’m not really focusing on the important tasks
2. it gets cumbersome to remember and record too many things
3. only seven fit on my chart

Not only do I get satisfaction of checking off items each day, but at the end of the day / week I add up all my “kudos” for my “kudos score.”  It’s a quick and satisfying way to motivate myself… and I think that other people could definitely benefit from such a tool.

• Fish (she can’t even be in rooms where fish was cooked 3 days prior. Unless it’s tuna fish… and she can eat shrimp)
• Cat dander (dog dander is fine, though)
• All legumes
• Nuts
• Latex
• Some dairy

…and I don’t remember the rest of it. In her words, “the only thing I am NOT allergic to is junk food.” Hmm. Anyway, all I could think was, “Who admitted her to this group! Why is she here?”

And the more she talked, the more I realized that her food allergies are, well, crazy. She has just recently acquired them… so recently, in fact, that she doesn’t even know all that she’s allergic to — it’s always changing. She doesn’t trust the medical tests because they yield different answers. The whole situation sounds very bizarre to me. There are people who are allergic to everything, legitimately, but this woman’s symptoms and allergies just didn’t make any sense.

So why is she in an eating disorder group? My guess is that she has been to 100 allergists that don’t know what is wrong with her and can’t find any explanation for her bizarre and inconsistent symptoms. One of these doctors probably decided that it was psychosomatic… and hey, it’s an eating issue, so she should be treated at a facility that specializes in eating disorders — right?

Clearly I think “no,” but before I get to that, a few notes about food allergies. There is most definitely a connection between the emotional, mental, and neural/biological components that comprise allergic reactions. These clips are from an article, “Some Psychosomatic Aspects of Food Allergy” (notice that this article is 55 years old… still, it’s interesting, and you can read the full text online!)

“Food habits are conditioned patterns of behavior. Some people get emotionally or allergically sick from eating certain untainted foods. Sometimes the cause of such illness is obvious; more often, the cause is unsuspected, and certainly not readily established as food-induced.”

“Foods become endowed with various dynamic emotional meanings according to the person’s upbringing, cultural and religious training, and personal life experiences. The most common untoward idiosyncratic psychosomatic reactions to food include nausea, vomiting, epigastric discomfort or pain, intestinal cramps, aerophagia, belching, and rarely diarrhea — all being part of the riddance reaction. The symbolic supportive values of certain foods are such that a person may overeat these foods when he is subjected to unusual emotional stresses.”

“In the variable food allergy, tolerance for a given food may vary so that at some times small amounts of the offending food will cause an allergic reaction. But at other times the amount of this food which must be ingested to cause an allergic reaction may be very much greater than any amount that the patient would ordinarily eat.”

I agree that there are probably psychological issues underlying her food intolerances… which does make it sound like an eating disorder. However, I think that she has somatization disorder — not an eating disorder.

Somatization Disorder: Individuals with somatization disorder claim to suffer constantly and for many years from many physical illnesses, yet they do not have any specific, diagnosed medical illnesses that can explain their symptoms. Still, these symptoms cause distress and negatively affect the individual’s ability to function day-to-day.

I think there is an inherently different mindset between someone with an eating disorder and someone with a psychosomatic food allergy. In the case of the later, the individual believes that he/she is biologically ill. She has some sickness that is making her ill. In the case of an eating disorder, I think there’s a lot more shame, self-punishment, control, guilt, etc. involved. This woman doesn’t have an Ed voice. That’s going to be my new criteria for having an eating disorder: the presence of Ed. Because as much as I dislike referring to the disorder / negative voice / whatever as “Ed,” there is no confusion over what I’m talking about. If you have an eating disorder, you know.

So, my conclusion? Psychosomatic food allergies are not eating disorders. They are a type of somatization disorder… and therefore should not be treated at an eating disorder facility (at least not in a group setting).

To summarize this article in a couple of lines:

Alabama is giving its employees roughly a year to start getting in shape or state employees will be charged $25 a month for insurance that would otherwise be free.

Some states offer benefits for healthy living, but Alabama is the first state to punish those not trying to slim down.

How many studies need to be published to show that dieting is not the answer?  And why is the government not taking medical conditions and eating disorder into consideration?  Are we giving the general population the necessary tools to improve overall health?  How exactly does Alabama suggest that these individuals go about losing the proposed weight?

We already live in a society that encourages negative body image and an unattainable physical ideal (note: I do not blame society for eating disorders.  still, it doesn’t help).  How awful is it to not only be receiving the “you are too heavy” message from the media, but from the government as well?  Maybe you are already struggling with weight, food issues, emotional eating, medical problems — who knows… and now you are going to be punished by paying an additional fee for weighing too much?  How shameful.

Shame doesn’t solve anything (and certainly won’t help the obesity epidemic).  Shame will lead to more emotional eating (you have to compensate for those awful feelings!), which will just dig people deeper into that hole.  I’m not saying I know how to fix things… but I’m pretty sure that this is not the correct direction.