This week’s video comes from a question I received on YouTube. The question had to do with how the fear of abandonment feeds as well as how it is related to our EDs. The first thing I want to acknowledge is that many people who have an ED also have Borderline Personality Disorder (BPD). BPD is a disorder that is usually characterized by instability in interpersonal relationships, difficulty with self-image as well as impulsivity. After reading that you can probably see why many people with ED’s also have BPD. What I would like to talk about in this particular video is why we have such a fear of abandonment and how we can deal with this fear in a more constructive way.
There are often two ways that we act out due to our fear of abandonment. We will either emotionally black mail the person we are in a relationship with to force them to stay. Or we will leave them before they can leave us. When we emotionally black mail someone, it is almost like we are threatening them. We will say things like “if you leave I will kill myself,” or “I will start cutting again if you leave me,” etc. When they come running back to us, or say that they have changed their minds, we have blackmailed them into staying. This can be horrible for any relationship, because we know that they would have left and probably still want to, which can feed our fear even more. The second way we deal is by running from them first. This is usually in romantic relationships, but I have had many clients who have run away from friendships as well. We feel that we would rather know when the leaving will happen and so we push people away and move onto the next relationship. In general, we don’t really like being alone so it should be easy for you to notice if you tend to run away.
So what do we do about it? Well, the first thing I would like you to do is to make a list of the people who are important to you. I want you to write down why they are important and whether you fear they will leave you or not. Through this journaling you will be able play out your fears without acting on them. Think of this as a safe place to talk about this. The second thing I would like you to do is to keep in touch with those people in your life that are important to you. I know we tend to isolate and withdraw from them when we actually want their love and support. So reach out, keep talking about it and let me know how it goes. Let’s keep working towards a healthy mind and a healthy body.
I have been reading a book called Appetites by Caroline Knapp. There was a passage that I felt accurately describes my view on eating disorders and why I approach recovery in the way that I do.
“I could not express what I’d been feeling with words, but I could wear it. The inner life—hunger, confusion, longings unnamed and unmet, that whole overwhelming gamut-as a sculpture in bone.”
I feel that it is the difficulty describing and expressing emotions that leads us to find other ways to deal with them. That isn’t to say that everyone who cannot deal or describe their emotions will end up with an eating disorder, but most people who suffer from eating disorders struggle to express their feelings. It is because of this difficulty that I find it helpful to add journaling and art therapy to all of my client’s treatment plans. Finding a new and safe way to experience and express emotion is paramount in recovery. That is why when you are not ready for treatment but are encouraged/forced to go, the emotions are completely overwhelming. The eating disorder is the only thing that we have to suppress the emotions, so when we go into treatment and our eating can no longer be used as an emotional barrier, those emotions rush in and take over.
The most common emotion that I hear about it shame. Why is this? What is it about having an eating disorder that leaves us covered in shame? Is it because of the secrecy of the ED? Is it because we have had a parent or friend act embarrassed at the idea of us having an ED? Or maybe it is because of our low self esteem and daily struggle with body image? Why do you think that you feel shame so often?
It is my belief that the shame we feel is actually misplaced anger. Instead of being mad at someone for doing something terrible to us, and comforting them, processing it and letting it go, we turn it in on ourselves. We begin by first thinking that we have no right to feel angry or upset and even the thought of confrontation leaves us in a cold sweat. So where does the anger go? Well when we ruminate over and over again in our mind about something that was done wrong to us, yet have nowhere to place the blame, we start thinking it was our fault after all. Maybe I did deserve to be slapped by my mom, I hadn’t cleaned my room like she had asked; or maybe I was too sexy and that family friend couldn’t resist molesting me. We begin to turn this hurt and anger inwards instead of outwards.
It is this anger and hurt that builds up and has no release. If we hate on ourselves so much, what can we do to show it? We can cut ourselves to release some of the pressure or we can starve ourselves so all we can think of is hunger, not hurt. People will definitely notice then. Or we can binge until all we can think about is how full we feel or how good the food tastes, not how sad we have been feeling lately. Instead of using our words to express emotion we use our bodies. We wear our emotions.
This is why I believe that art and journaling can be so therapeutic and slowly allow us to get back to expressing our feelings in healthy ways. We do this slowly so that we do not feel overwhelmed or create anymore anger or hurt to be used in an unhealthy manner.
Obviously, these are just my thoughts on this. What are yours? Do you feel that you have trouble expressing yourself? Or quite the opposite? Are there certain emotions that are easier for you to deal with than others? What ones are easy and what ones are hard? Why do you think that is? Have you found a way to express your emotions that is healthy and helpful? What is it about that way of expressing them that you find so cathartic? Share your thoughts and comments about this. I am simply giving my view point, but everyone is different and unique in their own way. So let me know what you think J
This video is kind of a follow up to my Toxic Friends Video. Based on the Structural Family Therapy, there are three types of family boundaries. Before I get into the three types, I want to make sure you know that I am not just applying these boundaries to family. I want you to think about all of your interpersonal relationships and evaluate what kind of boundaries you have with each of those people.
With that said, the three types of boundaries are clear, rigid, and diffuse. A clear boundary is one that is firm yet flexible. That means that you know what you share and do not share with this person, but if the circumstances change, you may have to change the boundary. An example of this would be that I may never talk to my boss about my family, but when my grandmother passes away I will have to share that because it now effects my work.
A rigid boundary is one that does not allow much communication at all. It can actually push people so far away that we become disengaged with one another. It is my thought, that our ED’s try to force these boundaries onto everyone we were ever in a relationship with because it helps the ED keep it’s secrets. So this boundary is not warm nor does it help build relationships.
The last type is diffuse, and this is the “non-boundary.” I call this type the “small town syndrome” meaning that everyone knows everything about each other. These are the relationships that usually leave us drained. These tend to also be the “toxic” type that we need to distance ourselves from. In all my time working with eating disorders, I find that although we create rigid boundaries with others, we are in relationships with people who have diffuse boundaries. Odd huh? They share everything and we share nothing. The thing about this that is toxic, is that they usually dump too much emotional baggage on us and we either shut down or use our ED to deal with it.
What I would like you to do is to grab your journal and take stock of you most interactive relationships and what kind of boundaries are in that relationship. I would encourage you to begin setting clear boundaries with those around you. An example of this would be to tell that diffuse, or toxic friend that you cannot talk to her after 9pm because you find yourself on the phone too late and then cannot sleep because your mind is racing with her issues (you don’t have to say all of that but you get the idea;) So you set some boundaries as to when you are available, and although at first you will feel bad for not always being there, you will begin to feel more free and happier about the relationships you are in.
So keep me posted and make sure to subscribe to my channel and comment and let’s continue working towards a Healthy Mind, Healthy Body.
I created this video to address some of the sites out there on YouTube and Tumblr as well as other social media sites that promote eating disorders. I know that people are struggling and that you deal with your eating disorder all day every day, but to create a whole website just promoting sickness is not something that I support. What I have hoped to create with my website is a healthy, supportive environment where people can feel free to share their struggles and their triumphs. I do not want people on here to be sharing their tips on how to maintain their sickness. I know when you are really struggling it is hard to get out of it and I am hoping that my site, my YouTube channel and all that I promote can be focused on helping one another better ourselves. Just to clarify this does not mean that you cannot talk about what struggles you have, I just mean that the tips given on my sites should be to help, not harm. By doing this I wish to continue creating a community working towards a Healthy Body, Healthy Mind.
I created this video because I have been hearing from a lot of you that you want to discuss the diagnosis of EDNOS (eating disorder not otherwise specified). Now EDNOS is really a “catch all” for people who have an eating disorder but do not quite meet the criteria for the other diagnosis. As I have said before in other videos, these diagnosis are created for professionals in the field to help with treatment planning and are used in order to receive coverage from an insurance plan. I truthfully believe most ED clients fall into this category because, as we all know, eating disorders are shaper shifters. You may restrict for a few months and fall into the anorexia diagnosis and then binge and purge for awhile and fit the bulimia criteria. Therefore, EDNOS is the only diagnosis that makes sense, right? So I hope that clarifies what EDNOS is and why it is used in treatment plans, and as always do not hesitate to comment below or leave your questions.
I hear from many people online that they would like to know more about the treatment options for people suffering from an eating disorder and what it is like in those facilities once they get there. The first option that I assume everyone is aware of is outpatient treatment. This means that you see a therapist, dietician, and any other members of your treatment team (see video for more information on this) on the regular basis. You would usually see your therapist and dietician weekly for an hour each, and see your psychiatrist and primary care doctor once a month or so. Then you go on to work, school or whatever it is you are doing. This is the lowest level of treatment.
The next option, and one step higher in treatment, is to enroll in an IOP (Intensive Outpatient Program). This program usually lasts for a few hours 3-5 days a week. This program includes your therapy session, dietician session and various group therapy sessions depending on how many days a week you attend. Obviously, the more days you attend the more intensive your treatment is and the higher the cost. All levels of eating disorder treatment can be covered by insurance depending on what type of plan you have.
The next level of treatment is enrolling in a PHP (Partial Hospitalization Program). Although it sounds like this will take place at a hospital, most eating disorder PHP programs take place at the same facility as the IOP like a house or office building. They will have a kitchen, where you will practice making your own snacks and meals (same as in IOP program) and different rooms for therapy and other sessions. A PHP program is more intensive and lasts almost all day (from 8am until around 8pm) for 4-6 days a week. It is pretty much the same as IOP it is just more time, more often and you get to have two sessions per week with your therapist.
If the previous levels of treatment are not helping you reach recovery you may want to try an inpatient program. This means that you will leave your home and come live in an inpatient facility for as long as you need to. During your time there you will be asked to give them your computer and/or cell phone and any magazines or books that they do not deem “recovery focused.” This helps you not fill your mind with body hating propaganda (i.e. Style or Vogue magazines). You will have a set meal plan, meet with a doctor as well as a psychiatrist each week to go over medications and to do blood work as needed. You will also meet with you dietician for an hour each week and your therapist for 2 hours each week. On top of that you will have various groups to fill the rest of your day.
The highest level of care that I am aware of is complete hospitalization. There are only a few programs that I actually like, because at this level of care you are, at times, placed with other people who are simply there for injuries or accidents. There is not much group activity although you will see a psychiatrist for about 20 minutes to do an initial evaluation and probably given a huge packet of paper to work on. This packet counts as group therapy and at times individual therapy. Like I said, there are a few great programs that do everything like an inpatient program but with the ability to care for you like a hospital. You are sometimes fed through a tube, or given shakes as meals and snacks. Usually if you find yourself at this level of care, you are placed on a re-feeding program so that your body is able to recover from the damage caused by your eating disorder.
As you can see, there are many levels of care for eating disorders, and what level you find yourself at depends on your need. My hope is that while in any program you learn more about yourself, how special you are and that you are worth recovery.
Looks like last week’s video didn’t post on Tumblr… So today, you will get 2 videos! Lucky you! Have a great day and don’t forget to leave me messages. I am always here to answer any questions you may have!
A VERY big thank you to everyone who is participating in our project "Healthy Mind, Healthy Body" I say “ours” because it is with YOU that I am creating this material…
Here is the project idea: Take my working knowledge of eating disorders (anorexia, bulimia, binge eating, EDNOS) and bring it to the masses by using social media like Facebook, Youtube, Twitter & Tumblr etc.
Step 1) Sean and I opened a youtube account and started putting videos up. Step 2) We opened a twitter account and reached out to the people who were “tweeting about ED’s Step 3) Opened a Facebook Page and asked you to forward it to your friends, family, co-workers etc…
Since doing this 2 weeks ago, the videos have been seen in over 20 countries around the world… I am truly humbled by that. This Youtube data & feedback that we have been getting is really cool and encouraging!
So A BIG thank you to everyone who is “sharing” the link’s to their friends and family. It means a lot to me. Keep spreading the word.
What is Anorexia Nervosa — Eating Disorder Video #6
This video is about the DSM definition of anorexia nervosa. I felt that it was important to go over what the criteria are because many people misuse the term anorexia. Anorexia is characterized by four criteria. The first being a person’s refusal to maintain an ideal body weight, which is know if vague but I feel that it is vague on purpose because everyone’s body shape and size is different. A person with anorexia can keep their weight low by restricting or purging and it is my experience that this will change over the course of their eating disorder. The second criterion is that this person will have an intense fear of gaining any weight. This is not like someone who knows they gain weight during the holidays and so they go to the gym more out of fear that they will gain the weight. This is much more severe, and the fears about weight gain monopolize their thoughts all day and night. The third criterion is that the person’s view of themselves is distorted. I do not mean that if you have a day where you look in the mirror and don’t like what you see that you have a distorted self perception, this is much more severe and no one can change their mind about how they think they look. The fourth criterion is the loss of your period. This is not required because many may have never had their period so they could not have lost it. Also, if a person is on birth control that can potentially force their body into having a period even if their body would not do so naturally. It is my hope that leveraging social media whether it is YouTube, Twitter, Facebook, Google+ and LinkedIn can help me reach more people and spread the word about eating disorders and how destructive they can be to the people who suffer from them as well as those closest to them.
Making your 1st therapy appointment - Eating Disorder Video #4
This video is about setting up your first appointment to see a therapist. I know that making that first appointment can be anxiety producing and very difficult. I also know that many people feel stigmatized by seeking help and I hope that by speaking candidly about therapy I can lessen the worry. It is my firmly held belief that all should seek out therapy, not just those suffering from eating disorders. Not ever having gone to see a therapist would be like driving a car and never taking it in for a tune up or an oil change. You can find a therapist by asking your friends and family, checking with your insurance, or asking your primary care physician. I also want to make it clear that just because you have set up the first appointment does not mean that if you do not like the therapist that you have to make another appointment. There are many studies that show the success of therapy is primarily based on the quality of the relationship between the therapist and the client, so make sure you do not settle for someone who does not feel comfortable to you. As always, it is my hope that by leveraging social media whether it is YouTube, Twitter, Facebook, Google+ and LinkedIn can help me reach more people and spread the word about eating disorders and how destructive they can be to the people who suffer from them as well as those closest to them.
Hi it’s Kati again, and thank you so much for tuning in. I want to tell you I’ve been loving your comments and questions, and they have kept me very busy creating more content, so keep the comments coming. What I’d like to talk to you about today is something that could be nerve-wracking for everyone, and that is setting up that first appointment with the a therapist. Now I know that going to a therapist gives a lot of people thoughts like “Oh maybe I’m crazy. “People always use it in a bad context like “Oh, you’re crazy you should see someone about that.” And things like that, but it’s my firmly held belief that everyone, not just me not just you, everyone should see a therapist. That doesn’t mean we have to see them everyday or twice a week but it’s nice to get a check up. That would be like driving your car for thirty years without getting the oil changed or never seen a dentist ever, and just assuming everything’s fine, that would be crazy right? That’s why seeing a therapist should be part of that checkup to make sure everything’s in alignment.
But I know that searching for one and making the appointment and just getting to the office is the hardest part so my recommendation is to first of all find out from friends and family. Anybody seeing somebody that they’re comfortable with? It’s possible that you will be comfortable as well, but if that’s not the case and you don’t feel comfortable asking someone you can also call your insurance company. See who’s covered and that can save you cost, and maybe you just ask a doctor that you already see like your primary care physician. They can have some great referrals for you, so then you get that number and that name and you make that call. The first appointment can be a little awkward. It’s almost like an odd date and they’re asking you a lot of personal information and you don’t really know them at all. But just so you know if you don’t jive with them if it’s not comfortable if you open the door it’s like this cowboy guys saddles out and your in like a buttoned up in a cardigan and you’re thinking “ehh” that’s probably not the right guy for you. You want to be as comfortable as possible. This person should feel almost like a long-lost friend, comfortable easy to talk to, they don’t feel too abrasive yet they’ll push you and guide you in a nice way. Now after that appointment is over, you’ve had your fifty minutes session they’ve asked you questions and you’ve ask them questions, don’t feel pressure to set that next appointment. This is really important, you don’t have to see them because you’ve seen them once. I’ve heard from way to many clients, “Oh I just stayed with that therapist for three years ‘cause I mean how would I cancel?” You just cancel, that’s what you do. I always tell clients when they come into my office after the first session, I say to them, “I would love to see you again, but don’t feel like you have to make the next appointment.” I’m open, but there should be no pressure. Because, there have been tons of studies done that prove that the actual reason therapy works is because of the relationship. So if the relationship isn’t there, there’s no need to waste your or the therapist’s time. I would encourage you reach out, ask around find that therapist and make that first appointment, and we will continue on this journey as we work towards a healthy mind, healthy body.