In Beating Ana: How to Outsmart Your Eating Disorder and Take Your Life Back, Shannon Cutts attempts to break through the loneliness of eating disorders with the war cry “Relationships Replace Eating Disorders.” Her method focuses on the importance of developing strong relationships with the self, family, friends, and a mentor.

Shannon Cutts is very familiar with living with an eating disorder; her own struggle, she tells us, began at age 11. The weight loss and damage to her bones and ligaments ended her future career as a blues and jazz musician and she dropped out of college.

After finding a mentor and getting on the road to recovery, Cutts founded Key to Life: unlocking the door to hope, an organization that offers events, workshops, concerts, and other activities designed to facilitate with healing from eating and related disorders. She also founded MentorCONNECT, a community that connects potential mentors and mentees. Although Beating Ana is her first book, she brings to it a voice of reason, reassurance, experience, and determination.

The book is structured like an outline. There are four parts, each consisting of several chapters. The chapters begin with an email exchange between Cutts and one of her own eating disorder mentees. Cutts then explains what the chapter will focus on, whether it is the mental argument that takes place at mealtimes or the constant internal stream of insults that may come with an eating disorder. Each chapter has an assignment for the reader and ends with an encouraging “Life Celebrating Affirmation” to be repeated in times of struggle.

The first part of Beating Ana is an introduction to Cutts and the Mentor Method. She shares the story of her struggle with anorexia and bulimia and introduces the reader to the idea that “relationships replace eating disorders. Period. The end.” Her “Mentor Method” is based on the sponsor method used within the Alcoholics Anonymous program; she describes the method as the “voluntary, ongoing, interactive relationship between the mentor and mentee (giver and receiver), for the sole purpose of facilitating progress in recovery.”

Cutts moves on to target the internal conversation that takes place in the mind of a person with an eating disorder. She introduces the “H.O.W. of Recovery (Honesty-Openness-Willingness)” which is another tradition of Alcoholics Anonymous, one that is very important to the recovery process. She also highlights the “F.E.A.R factor: False Evidence Appearing Real.” For example, to someone with an eating disorder, the F.E.A.R. may be “food is a toxic substance that we must avoid at all costs,” whereas the FACT is that “food is a must for our body to survive.”

The bulk of the book is taken up by part three, which focuses on what we can learn from films. However, the movies that Cutts cites and uses for each chapter do not focus on a character with an eating disorder; rather, they provide a lesson for the reader to focus on and an assignment that assists in learning it. The movies that Cutts refers to are varied: from “8 Mile” to “Catch Me If You Can” and “Something’s Gotta Give” to “Girl, Interrupted,” each movie has a lesson about perseverance, freedom, or the finality of death. This section ends on “A Beautiful Mind.” Focusing on the main character’s determination to gain control over his own illness, Cutts encourages the reader to make a list of his or her own “I can’t” scenarios and replace them with “I can” statements.

Finally, Cutts wraps up the book with a section that she says contains “some of the key techniques” from her own recovery work. She encourages readers to take control over their mind; to assert domination over the eating disorder voice; to make life and living the number-one priority; to accept that relapses may happen but to use them as “rocket fuel for recovery;” and to recognize that they are separate individuals from the eating disorders and that the eating disorder does not identify them.

Shannon Cutts makes a powerful impression. Although I do not have any personal experience with an eating disorder, I could feel the author’s words resonating with me and the encouragement and support they conveyed. I was even able to see where some of the lessons may even be applicable to my own life.

That being said, her book is probably not the best source for someone to turn to if they are attempting to understand, from the outside, the mind of someone with an eating disorder (e.g., a parent trying to understand their child). Indeed, the book is not meant for this use. It is specifically geared toward the person with an eating disorder. Although the lessons of each chapter are valuable, the chapters that are inspired by movies may be a bit abstract for some readers. For instance, the lesson from “Something’s Gotta Give” is that putting too much restriction on your life does not allow you to live. Being an adoring fan of said movie, I had to ponder this particular note on the plot for a few moments to begin to see the point that Cutts was attempting to make. Perhaps viewing the movie while working on the assignment that Cutts has paired with it (which is her suggestion) would help a bit more.

Overall, however, Beating Ana seems like a wonderful resource for someone suffering from an eating disorder. Shannon Cutts’s personal experience makes her an experienced ally and mentor to someone who may be lost on the path to recovery. Her cheerful determination and powerful enthusiasm make this book a great tool to keep on hand.

Beating Ana: How to Outsmart your Eating Disorder and Take Your Life Back
HCI, January, 2009
Paperback: 236 pages
$14.95

Over the years, Rose had tried various ways to cure her food and weight obsession. Although she had been able to achieve some temporary relief, nothing lasted for very long. She soon found herself back on the not-so-merry-go-round of failed diets and increasing self-hatred and desperation. Was there something Rose was not getting?

I did a thorough review of all her previous attempts to get better: the numerous diets, New Year’s resolutions, self-help books, a workshop here and there, also a couple of Overeaters Anonymous groups.

A pattern started to emerge: It seemed that every time she started to feel better and more in control of her weight she would stop getting support, because she believed she should be able to control her food and weight by herself.

She was able to keep the healthy momentum on her own for a while, but inevitably she would fall off the wagon and then feel terrible about herself again. She would beat herself up and resolve to do “better next time.” Years of this pattern had brought her self-esteem to an all-time low. She described herself as “a failure” and “out of control.” She had developed painful habits around constantly obsessing about her weight and hating her body.

The Band-aid Approach

I call this approach that Rose was using “Band-aid treatment.” She was not really addressing the underlying wound or problem; she was simply trying to feel better. There is nothing wrong with trying to feel better—we all do this. But if a wound keeps reappearing, the underlying cause needs to be explored and addressed; otherwise, the wound will keep getting reinfected.

Rose’s problem was that as soon as she experienced some symptom relief she would drop whatever support she was receiving, because she honestly believed she should be able to continue on her own. Dropping the support was sending her back into the negative cycles around her body and weight. She needed to stop the negative cycles long enough to be able to see what was driving them emotionally. In other words, she needed to stabilize patterns on the physical plane before she could explore what was happening on the emotional plane.

I was honest with her. I told her I wasn’t sure I could help. I predicted that after a few sessions with me she would start to feel better and then move on without addressing the real problem. I suggested that she decide on one method of treatment and stick to it until her recovery was rock-solid strong. I encouraged her to stop beating herself up for not being able to sustain recovery by herself. Most important, I stressed the importance of getting ongoing support if she really wanted full and lasting recovery.

Rose decided to see if my suggestions might work. As I predicted, pretty early on she experienced immediate symptom relief as she stabilized her eating and exercise routines. This was the “Band-aid stage” where she would usually quit whatever treatment or support she was getting because she felt better. She decided to give me the benefit of the doubt to see if keeping the support she got through our weekly sessions could help her sustain her recovery.

From my end, this was when the real work began. Now that problems on the physical plane had stabilized somewhat, we were better able to address the emotional issues that kept her trapped in negative cycles around her body and weight.

Rose worked hard. She looked at the deeply internalized messages she got from family around how much her value depended on looking a certain way. She explored the many overt and covert messages she received that fed her fears that if she didn’t look skinny she would not be loved, accepted or belong. She looked at how she used food to attempt to replace some of the comfort and nurturing she didn’t expect from her relationships. She explored the isolation she maintained because of the fear of others’ judgment. How food had become her drug was also explored: She used over- and undereating to stuff or disconnect from her pain. I had great respect for Rose’s courage and willingness to explore herself at this level.

Although Rose was getting a lot out of individual therapy, I encouraged her also to look for a group to join and maybe check out some workshops. I knew that if the outside world was not also factored in, her recovery would be hard to sustain. I explained to Rose the importance of hearing other women’s recovery stories so she could know she was not the only one going through this. She knew this intellectually, but emotionally she still struggled in isolation. She could reach out to me at her most vulnerable, but I knew her full recovery meant also getting this kind of emotional support outside my office

Luckily, where we live there is an abundance of groups and workshops that support women in better relating to their bodies and food. Rose chose a group that also used creative and expressive art. She had loved drawing as a child, so it was a delight to rediscover it.

She was surprised by what her art revealed. While this made her feel very vulnerable, she was relieved to see that the other women were also uncovering surprising, somewhat uncomfortable revelations. Seeing these other women share their experiences with the group gave Rose the courage to do the same. She was astounded at the amount of support she received, usually at the exact places where she would normally turn to food for comfort.

So why is support so important? As I have shown, in Rose’s case support helped her explore the underlying emotional wheels that were turning these painful patterns with food, weight and her body.

The next level of support was taking her very personal battle out into her community and feeling held there. This step was particularly important because the road to disordered eating usually is paved with social, cultural and familial messages that encouraged us to turn food into the enemy and our bodies into the battleground. Dysfunctional patterns with food and hatred of one’s body are learned behaviors; we were not born with them.

To combat the strong, negative messages we constantly get about our bodies from media, society and even family requires conscious effort and lots of support. We need other messages continually coming in that encourage us to focus on self-care, self-love and health of mind, body and spirit. Creating a strong community that feeds us these positive messages is the sure way to sustain a lasting recovery.

The sooner you get support the better. The women I meet who have been muscling through on their own for the longest are usually the lowest on the recovery scale. This is because the disordered eating has also created disordered thinking. Sadly, I rarely see their solo recovery efforts work. Instead, these women dig that much deeper into the battle with their bodies and appetites. Many years later when they realize how much energy they have wasted on this painful battle, they often experience great remorse that they didn’t get support sooner.

Reaching out for help and support is not weak. It takes enormous strength and courage. The better you are able to build community and support around your recovery, the longer your recovery will last, and the more empowered you will feel.

In Hope with Eating Disorders: A Self-Help Guide for Parents, Carers and Friends of Sufferers, Lynn Crilly tries to make these facts known. In the beginning of her thoughtful book, Crilly tells us why she is so invested in educating the public on eating disorders: “I will never forget the bleak times I faced as a mother, watching my daughter waste away, and how futile and frustrated I felt. These feelings are very often echoed in the faces of the carers I now work alongside, in my newfound career as a counselor.”

Crilly is obviously emotionally invested in her subject. This allows her to write from a place of compassion and empathy, as well as authority. By having gone through the familial trauma of eating disorders herself, Crilly knows firsthand what havoc they can wreak. In this way, Hope with Eating Disorders almost becomes something of a person to talk to in the midst of chaos; a therapist; someone from whom one can gain emotional insight and wisdom; someone from whom one can learn.

One area that Crilly skillfully addresses is how eating disorders affect not just the afflicted, but also the afflicted’s support system—the family. Crilly writes:

If you are a parent, you’ve become accustomed to providing your child with everything they require – physically and, when you can, emotionally. Finding yourself in a situation where, suddenly, you are unable to fulfill this role is incredibly frustrating. For any carer, the feelings of futility and despair as your loved one destroys their health and happiness with an eating disorder are incredibly difficult to deal with.

Unfortunately, this often goes unacknowledged. In many situations, carers of eating disorder sufferers go through a worse time than the sufferers themselves.

Crilly maintains this level of empathy throughout the book. Having been in such a position herself, she knows the realities. She knows both what the sufferer goes through as well as the carers. And as a counselor, Crilly has the knowledge to go along with the history. In this way, she is able to lay out the facts before providing wisdom and advice. For without truly knowing what one is up against, how can one combat it?

Crilly starts Hope with Eating Disorders with a small introduction, giving a brief synopsis of what the book includes. She then moves into discussing anorexia and bulimia specifically, and giving us the facts. After this, she discusses treatments and therapies, provides an interview with an expert, and then moves into some of the more culturally specific areas of eating disorders, including sports, the media and education.

It’s difficult not to recommend Hope with Eating Disorders. It bills itself as a “self-help guide,” and that is truly what it is. It’s a reference. It’s a go-to source for dealing with trauma. It’s, again, something of a therapist for those trying to aid the afflicted.

What Crilly really rams home is how no sufferer can go through this alone. They need someone to step in and get them help. As well, they need someone to empathize. Crilly writes: “By focusing on physical symptoms only, we’re missing the emotional signs. Knowing this is the carer’s greatest ally.” Eating disorders, at their core, are rooted in something psychological. There is something that is forcing the afflicted to go to such extreme lengths. And as Crilly points out, the key to discovering them is twofold: find proper treatment and give adequate support. Only through hope, belief and love can eating disorders be overcome.

Given how close to home this book is for Crilly, I’d like to close this review with a lengthier quote that provides a deeper statement of Crilly’s mission:

One of the most dangerous myths surrounding eating disorders is that they are a life sentence. It is distressing to see people managing their conditions, learning to cope with them on a day-to-day basis, with both the sufferer and their carers resigned to the fact that this is as good as it gets.

Hope with Eating Disorders will show you that full and lasting recovery is possible. It will allow you to see how you and your loved one can free yourselves from the prison of eating disorders and enjoy the liberty of a life that isn’t dictated by food, once more.

Hope with Eating Disorders: A Self-Help Guide for Parents, Carers and Friends of Sufferers
By Lynn Crilly
Hay House Insights: March 19, 2012
Paperback, 280 pages
$17.95

As I cried, I wanted to believe it was the alcohol that induced Mom’s words.  I had to believe it was the alcohol.  I don’t want them.  The words rang in my ears.  That’s the night my heart first broke.

White Elephants is the story of Chynna Laird’s childhood with an alcoholic, bipolar mother.  Not for the faint of heart, this memoir is a gripping tale that Laird colorfully paints for those unfamiliar with what it is like to grow up in this situation.

This review’s opening paragraph comes from a story in the first chapter. Laird overhears a phone call between her grandmother and her mother.  Her mom is drunk and on one of her many “vacations” and Laird’s grandparents are taking care of Laird and her brother, Cam.  Five-year-old Tami (the name Laird went by for most of her life) hears her mother say on the phone, “I don’t want them.”  This scene sets the stage for the drama that plays through the rest of the book.

No one seemed to understand the manic behavior and profound depression of Tami’s mother, Janet. Janet’s siblings and parents were constantly at their wit’s end. Laird describes several points when her mother was clearly actively suicidal.

Living in a chaotic home filled with binge drinking, verbal and physical abuse will leave its mark on a child.  Tami was molested and raped in her own home.  She and her brother started drinking at a young age and were both involved in drugs at various points.  They both struggled with anger.  Cam raged on the exterior, punching walls and sometimes turning on their mother, whereas Tami unleashed her anger on herself.  She was known among other high school students for crying when she was drunk. By the age of 15, she had begun cutting and even attempted suicide one night.  As she grew older, Tami struggled with her self-esteem and developed bulimia.

In hindsight, Laird is able to recognize the “angels” who played a role in her life.  She and Cam were close to their grandparents, who practically raised them. They were the only real parents that Tami had ever known and their influence was prevalent through most of her life. 

Her stepfather, Pat, rescued her many times from herself and from her mother.  At 15, Tami was drunk at a party and had to call Pat to pick her up.  When they got home, he hugged her and told her he was not going to ask what happened.  “I just wanted you to know I’m glad you’re both home safe…You’re better than this, Tam.  You’re better than she is.” 

However, when Tami finally realized that she needed help, she turned to her godmother, “Auntie Lois.”  Tami moved in with Lois and her family and began a daily ritual of having tea with her aunt.  Over tea, Lois would patiently listen while Tami spoke about the trauma, the alcohol, and all of the other dark secrets that she had been carrying for so long.  This was the turning point for Tami:

In that moment, as I felt Auntie Lois hug me – a person who really believed me, a person so close to God she could be considered an angel – the flood gates opened and I cried.  I cried for the little girl I never was.  I cried for all the times I hurt but couldn’t react.  I cried for not having a mother who loved me the way she wanted to.

White Elephants touched me much more than I expected.  Laird says that she wrote the book in hopes that it would help someone who has been in a similar situation.  Because she could not help her mom, she hopes that someone can find some help in her story.  Although I have not been through the trials that she has, her strength and determination to not allow her mother’s abuse to determine her future is admirable and inspiring.  The moment I began reading her book I could not put it down.  Moreover, after finishing it 24 hours after I started it, I was ready to read it again.  There are not enough adjectives to adequately describe White Elephants: inspiring, tragic, heroic, admirable, honest, and deeply moving.  There were points when I found myself crying along with Tami and others when I was cheering for her on the sidelines during her recovery.

I think that Laird accomplished her goal through her story.  Not everyone will be able to relate to the events, but I believe most people will be able to relate to the struggle of pulling yourself out of depression and finding your own feet to stand on.  In this way, Laird has most assuredly accomplished her goal for this beautiful book.

White Elephants – A Memoir
By Chynna T. Laird
Eagle Wings Press: February 1, 2011
Paperback, 280 pages
$14

Acts of violence have always been a part of human nature and will continue unless we become some sci-fi world with better living through chemistry and genetic manipulation. Sure, there are general reasons the experts will point to, such as alienation; access to guns; too much exposure to violence; a society whose leaders lack values; and families who are disconnected from community.

But the reality is that the great majority of teenagers are growing up in this environment and not killing anyone. That doesn’t mean we should ignore steps to reduce the negative influences on their lives and ours. It does mean that no matter what we do, there will always be tragedies. We simply do not have that much control over another person’s life. That is a frightening reality for most parents to accept.

But this doesn’t mean that parents shouldn’t be doing things that make it more likely that their children would turn out okay. Inside each home there are parents asking if their son or daughter could be in trouble and the parents might not know it. Or, even scarier, there are parents who see their children struggling and feel powerless to help. What do we know that will help?

Well, the research points to the same issue nearly every time: children who have stronger relationships with their parents are less likely to end up in serious trouble. My emphasis on “serious” is because too often parents are upset about issues that are not life-threatening or life-determining. Clean rooms, grades and homework, being disorganized, being impulsive and screwing up, foul language, a few extra holes in an ear, some grungy friends, some broken curfews, or the protective or manipulative “lies” that children use to try to get away with things – all normal adolescent behaviors that do not alone signify a child “going down the tubes.”

Adolescence is a time for many teens to experience disconnection and disorientation, to become confused and uncertain about their values or about their capacity for success. It is a time to be scared about changing bodies and changing friends and experiencing failures when success may have usually come easily. It is a time to defy and distrust authority. It is a time, especially in with the phenomenon of the Internet, when teens’ worlds expand exponentially and it is quite a challenge for them to digest and manage all to which they are exposed.

Parents often respond to this by waging battles for control. While it is essential to have some unequivocal rules that involve health and safety and to seek help from others if there are signs of more serious trouble (e.g., depression, explosive outbursts, eating disorders, substance abuse, marked change in personality), it is particularly important to focus less on content and more on process.

What does this mean? Simply, that nothing is a substitute for maintaining the connection between you and your teenager. Time must be found for one-to-one interactions. Parents must be ready to give their attention when a teenager is suddenly ready to talk. Parents need to spend some time inside the world of their teenager and try to do so without being too judgmental. Do errands and chores together. Find an activity that can be shared. Take a teenage child out to dinner occasionally. A parent whose work involves travel can bring along a teenage child and turn it into a significantly valuable time together. Know each other!

Remember that you most likely did some things wrong along the way. It can be helpful to share that. Why should your child be open with you if there is not some reciprocity? That includes sharing some of your current anxieties or mistakes. We all mess up. We all have our vulnerabilities. We all seek safety and security. In that way, you and your teen have much in common. The key difference is that a teen’s life has few real choices and does not have a valued place in our society. We ask them to be responsible but there is little immediate reinforcement for that except to keep the adults from being angry and disappointed with them. Believe in your child, even when he or she is struggling, or simply not meeting your expectations.

For some parents, there is the harsh reality that, despite doing a good job, their child is having significant problems, and the parents are being shut out while nothing seems to be helping. This is definitely painful and scary. Even with professional help and support from school staff, some child will fall into a “black hole,” influenced by biology, peers, and social forces. This underscores another reality about the tragedies that have been taking place: All the perpetrators have been male.

Our society gives out powerful messages that are absorbed by our children. What girls hear and respond to leads them to turn against themselves, especially in the form of eating disorders (and a skyrocketing rate of smoking). What boys hear and respond to leads them to turn against others, in acts of verbal and physical abuse. In the face of all this, parents are worried, possibly more than ever, about the health and success of their children.

But I must return to my primary message of urging parents to have a more optimistic outlook and to not let their anxiety sabotage what is most important, the relationship each parent has with each child. A friend and colleague, Bob Brooks, often speaks about the resiliency of children and what contributes to it. The research clearly indicates that the presence of a “charismatic adult” is one of the primary predictors of turning out okay.

So often I read the stories of successful adults who grew up under terrible circumstances and there is always reference to a parent, relative, teacher, or coach who believed in them and provided guidance and an available ear when needed. Dr. Brooks often ends his presentations by challenging parents to be that charismatic adult in the lives of their children. It is no guarantee that everything will turn out all right. Nothing can do that. But it does make it much more likely that you will end up with an adult child who is not only doing well but is also your friend.

The two women came together to write the 8 Keys to Recovery From an Eating Disorder in order to extend their help to the “more than 20 million people in the US alone [who] suffer from an eating disorder.”  They note, however, that it may be useful for the sufferer’s family and friends, as well as mental health professionals.

Since both authors are familiar with eating disorders on professional and personal levels, they understand that each person will have a unique recovery process.  For this reason, the book is not regimented and is designed so that you are free to skip around and read what interests you. To make it more personal, the authors include many writing assignments to help readers engage.

Most important, you don’t have to be completely ready to recover before you begin reading this book.  Costin and Grabb write “we don’t consider lack of motivation a weakness or problem; we understand it.”  They know that there often is a feeling of ambivalence toward recovery; they believe their job is twofold: to help their readers deal with this and to continue to motivate them.

Because these authors work so hard to make this text a personal experience for each reader, and since they are so familiar with the intricacies of the illness and steps in the recovery process, I would highly recommend them to anyone suffering from an eating disorder — especially if you feel alone.  These two strong women are proof that you are not alone and that you can recover.

Costin and Grabb are gentle in their guidance.  They do not push their readers, but consistently encourage and motivate.  They explain everything thoroughly, so that readers aren’t just receiving advice, but are actually learning about the recovery process. They also take the time to explain that their goal is for the reader eventually to recover. They are careful to use this word instead of “recovering” or “in recovery” because they both feel that being recovered is reaching a state of acceptance and having a proper perspective on food, weight and your own physical and mental health.  Additionally, they both feel that they are recovered and therefore want to help others feel the same.

While the goal is clear, Costin and Grabb don’t believe that recovery itself is a linear process.  This is why they encourage readers to explore the chapters in random order. They also are careful to explain that during the recovery process “your motivation, patience and hope will come and go.”  This is a constant reminder that the path is long, but their friendly and gentle advice will be by your side.  As shown in the quote, they directly speak to you as a reader, so you feel quite intimate with them. 

To make it even more personal, the authors encourage readers to keep a journal to document feelings and experiences during the process.  They give writing assignments in each section as prompts, and include example entries in the back, but they mostly want to help readers create a space where they can talk about their eating disorder and record all their thoughts and feelings.  This way, as readers get further along, they can return to those ideas later and get a sense of their progress.

The 8 keys that Costin and Grabb outline offer new perspectives.  It isn’t an attack on eating disorders; it is a journey of understanding.  Mostly, I felt the authors provided their readers with the vocabulary to articulate feelings and experiences.  For example, they give examples of common statements made by people with eating disorders, such as “I know I wear a size 4, but when I look in the mirror I see a fat person.”  This gives readers an opportunity to see themselves in the examples and also serves as a platform for the authors to demonstrate their keys.  In this example, they show how a person with an eating disorder is struggling with two selves: their healthy self and their eating disorder self.  In addition to providing examples like this, they also include their own stories and other real-life examples from people who have also recovered.

What I most enjoyed about Costin and Grabb’s approach was their compassionate tone and realistic advice.  They are invested in providing real hope, motivation and insight for readers.  Their attention to real-life issues, such as lack of motivation, fear, or even voicing concerns like the “need for distraction,” all show that they have intimate experience with this type of treatment.  At one point they include a short conversation between Costin and Grabb that happened during Grabb’s recovery.  Grabb says “What am I supposed to do with all these feelings?” and Costin says, “Feel them.”  I think this is a perfect demonstration of how they embrace the entire process of recovery.  

Costin and Grabb support their clients so they can learn to accept and understand instead of always having to fight their illness.  Their keys are clear and flexible.  Readers certainly will have to face some hard truths, but they are in charge of the pacing and do have someone who understands.

8 Keys to Recovery from an Eating Disorder: Effective Strategies from Therapeutic Practice and Personal Experience
By Carolyn Costin and Gwen Schubert Grabb
W. W. Norton & Company: November 7, 2011
Paperback, 296 pages
$19.95

I found the book to be both hilarious and sad. There were points when the author’s frustrations were becoming mine. This book is a no-holds barred, educational read that keeps the reader unable to put it down. I tip my hat to Stacy Pershall for sharing such a personal tale with us. It has changed my understanding of these disorders forever.

It seems to me the author was trying to share her very personal journey through early adulthood with BPD, BD, and various other problems. This she accomplishes in both an effective and entertaining manner. She told us her story from top to bottom, leaving nothing out. She also speaks very highly of Dialectical Behavior Therapy, though I’m not sure if she emphasized this as much as she had intended.

Her small-town childhood, her constant questioning of her identity are things that many people can relate to. Not knowing where one belongs, or who one is, are universal questions. Some people have a much easier time answering these questions than others. This is a concept I can personally relate to quite well.

I love Pershall’s honesty. On the medication front alone she offers anecdotes about her use of speed and alcohol; the side effects of prescription meds; the lack of correcting the underlying problem she experienced with pharmeceuticals; and her list of the plethora of meds she was prescribed.

Pershall’s describing Dr. Phillip J. Thornton as her savior of sorts is an experience that I think many people can relate to. Finding that one doctor, therapist, spiritual leader, etc. who seems to understand you, after you’ve been through a hundred professionals who never quite “got you,” is often a turning point in many people’s lives — perhaps a life-saving one.

Her bout with anorexia and bulimia was fully and simply described by the quote “Playing with anorexia is like playing with heroin, fire, plutonium, or Scientology.” — Humorous, yet scarily true. She is so direct and maintains a sense of humor through it all.

I found her connection to certain authors and novels to be interesting also. From Sylvia Plath to Anthony Burgess’s A Clockwork Orange, she showed a very eclectic interest in books with very independent protagonists. She even mentions William S. Burroughs, an eccentric writer of the Beat generation. It seems as though her brief foray into acting was another way to explore, and even become other, various characters.

Pershall’s mention of “splitting,” a dissociatiove experience common to those with borderline personality disorder, shouldn’t be ignored either. Her reference to splitting just before her breakup with Reese was classic.

I’d like to touch on her relationship with religion in response to he disorders. She said it best on pg. 188 with “IF THIS COULD BE PRAYED AWAY I’D BE WELL. ” It also intrigued me when she mentions her father considering mental illness as a sin. That, to me, is a scary, seriously antiquated thought.

I couldn’t imagine writing this review without touching on her tattooing. I understand where she’s coming from when she discusses on pg. 153 ” . . . something that scared me is exorcised, incorporated, with me forever. ” Getting tattoos seems to be her way of facing, and embracing, her fears.

I will end this with her speaking of BPD as an illness “that should be placed on the spectrum of impulse control disorders.” This seems like a pretty solid idea to me, and she goes on to explain it better, getting into the brain chemistry of it. It must also be noted how strongly she speaks of DBT, and how it changed her “because of two things: the focus on the dialectic, or gray area, between good and bad, and the strict adherence to the rules required.” The author speaks so highly of DBT, it seems as though anybody yet to find treatment for BPD or BD should give DBT a shot.

Loud in the House of Myself: Memoir of a Strange Girl
By Stacey Pershall
W. W. Norton & Company (reprint edition): January 23, 2012
$14.95

The whole idea of loving one’s body, however, is confusing. What does it even mean to love your body? One day, as I walked our dog around the block, it hit me. Loving our bodies is a lot like loving a dog:

1. Loving our bodies means placing respect, value and importance on physical needs for regular nourishment, fresh air, motion, and touch. Just as neglecting to value these needs is a complete rejection of a dog, it is also a complete rejection of our bodies.

2. Loving our bodies means investing time and energy into building a nonverbal, unique, and ever-evolving relationship. Like dogs, each of our bodies has its own particular needs and preferences that change over time, but does not have words to communicate those needs. As a result, figuring out what our bodies need takes ongoing relationship-building, with patience and attention.
3. Loving our bodies means recognizing that they live in the moment. This means that we have to be the ‘big’ brain for them – the ones who see the big picture and anticipate consequences of choices. Just as we would not let our dog eat two pounds of raw cookie dough, we sometimes must differentiate between our bodies’ momentary wants and its true needs, and may have to say no to some of our body’s desires.
4. Loving our bodies means exerting control through respect and cooperation. Neither dogs nor bodies just do what we tell them to. We need to have realistic expectations and then give them the support, consistency, and guidance to reach those expectations. When they do not ‘behave,’ it’s not that they are bad. It is that we haven’t properly supported them toward those behaviors, or that we have unrealistic expectations.
5. Loving our bodies means accepting that they are what they are. No matter how little a Great Dane eats, it will never be a Chihuahua. No matter how much exercise a Chihuahua gets, it will never be a Great Dane. We can either accept that our body is basically a certain shape and size, and become the healthiest of our ‘breed,’ or we can live in continual denial of reality and frustration with our bodies.
6. Loving our bodies means being patient with the time it takes to adjust to different routines and unfamiliar surroundings. Just as a dog is uneasy with change, so are our bodies – even if it’s a ‘good’ or fun change. During and after transitions, we must be supportive and gentle with our bodies.
7. Loving our bodies means accepting that all bodies, like all dogs, have physical impurities, imperfections, and messy parts. Our bodies are not perfect or pure. Basing our sense of self-worth on whether we are physically perfect or pure is as ridiculous as seeing our dog as bad for having an asymmetrical face, hip dysplasia, or bad breath in the morning. Similarly, trying to make our bodies pure or perfect through extremely restrictive diets or chronic use of plastic surgery is as misguided and potentially dangerous as it would be for a dog.
8. Loving our bodies means being trying our best not to use them as whipping posts for our anger about other things in our lives. Just as a bad day or feeling bad about ourselves may lead us to become annoyed with our dog (just for being a dog!), we also may focus our anger and frustration onto our bodies, blaming them for all that ails us. This is unfair and damaging.
9. Loving our bodies means getting back what we put in. Just as our dog repays us with loyalty and vitality when we care for its needs, our bodies reflect the care that we invest in them. The more we provide a balanced life for our bodies, the more balanced, calm, steady, and reliable our bodies will be for us.
10. Loving our bodies means doing what we can to care for them, while also recognizing that there are limits to our ability to protect them. Like a dog, our bodies get sick even when we try our best to take care of them. They also never live long enough, age in sudden jumps, and die before we are ready to let go.

Most of us were never taught anything about how to love our bodies. A lot of us are lost in a sea of media and social pressures to look a certain way and conflicting and unrealistic ‘expert’ advice about how to be healthy and disease-free. When you model and teach these basics of a healthy body relationship to your children, it can be an important part of helping them (and you!) to move toward sustainable health and wellbeing. And even if your teen rolls his or her eyes and continues to complain about fat thighs or narrow shoulders, or refuses to get off the couch and take a walk, be assured that you are doing what you can to embed the seeds of body respect into your child’s psyche, and that at some point those seeds will bloom.

Liu teaches creative writing at Goddard University’s MFA program, and her background comes through in the book. To begin, she doesn’t preach. She simply approaches the toughest issue about eating disorders (or ‘EDs’ as she refers to them): that no patient ever thinks they can get better. Then she gives step-by-step advice, accompanied by multiple real-life examples, to help encourage readers to begin a path to recovery. While the main audience is intended to be people with an ED, there is still a vast amount of information that someone without an ED can learn, especially if a loved one is suffering.

This book is essentially a collection of letters from people struggling with an ED — such as anorexia, bulimia and binge-eating — which gives readers the gift of realizing they are not alone. Liu chose to incorporate so many letters in part to combat the stigma surrounding EDs. She believes that the way the media treats celebrity EDs makes them more of a spectacle and often people think of them as “trivial girl problems.” Liu also uses all these letters to show that recovery is “as varied and complex as eating disorders themselves, and as powerful as the human spirit.”

This book is clearly organized into the stages of recovery: turning points, setting the stage for recovery, treatment, restoration, discovery and, finally, wise minds. Liu also creates a type of storyline through offering personal stories from people with EDs. Their individual examples are captivating and highlight the different ways that people approach recovery. For example, Liu includes a letter from a girl named Becky whose turning point came when she realized that she judged her success by numbers (grades, weight, etc.), while Steve suddenly realized he had to make a change when his body started hurting in places he “never thought could produce pain.”

It is difficult not to connect with the personal experiences, but Liu includes the science, too. In one case, she provides a chart of physical signs and symptoms associated with EDs. This is extremely useful because, as the section on turning points highlights, it takes a lot for a person to realize that he or she is suffering from a serious disorder.

I appreciated that Liu wanted to address the underlying issues of EDs. As stated, she begins by talking about the stigma associated with EDs and how that prevents people from understanding the severity of the diseases.

She also, though, wanted to provide people with the details of recovery. She begins by responding to a letter from a girl who is frustrated by a lot of the books that jump from explaining an ED to celebrating recovery, bypassing the recovery process itself. Additionally, Liu is careful to remind readers that an ED is “a distress signal, and you need to confront the real source of distress and find constructive ways to confront and manage that conflict.” This shows bravery, as well as true self-awareness, as she pushes people not simply to focus on fixing the surface of the problem.

Liu’s section on ‘setting the stage for recovery’ is likely the most important. Here, she draws the connection between the turning point — where a person realizes their issue — and what to do next. She encourages people to realize that EDs cause people to believe a variety of falsehoods. The stories she presents in this section are the most heartbreaking: people come to terms with why they’ve developed these serious disorders. Oftentimes, as Liu pointed out earlier, the ED is hiding a trauma and to recover, a person needs to confront this.

In this section there are also tips for how a parent, partner or spouse can talk to someone with an ED. Liu, being able to understand both sides of suffering from an ED and trying to help someone with an ED, provides a lot of comforting words and approaches for difficult situations. She then continues into a section on treatment that is full of facts, as well as a gentle, progressive approach to healing. She talks about medical insurance, how to choose a therapist, and nutrition counseling, but also about more personal ways of coping like journaling and letter writing.

The final sections on restoration, discovery and wise minds are a testament to her own success as a recovering anorexic. For those in crucial need of change, these chapters will be of more use after recovery, but will still instill hope whenever they are read.

I enjoyed that Liu presents everything in stages, and has multiple letters from people at every stage, so there is always something you can identify with. Liu delves into the details of how to deal with these serious diseases by looking at them holistically. She also seems to consistently realize that every action has a reaction, so she is careful to approach things slowly and with the utmost care.

I think this book will be a great comfort for both people with an ED and someone who has a loved one with an ED. Overall, Liu gears the book toward the person with an ED, but this stories in this book can be just as important for someone without an ED to begin understanding these terrible diseases.

Restoring Our Bodies, Reclaiming Our Lives: Guidance and Reflections on Recovery from Eating Disorders
By Aimee Liu
Trumpeter: April 26, 2011
Paperback, 240 pages
$14.95

This disease is devastating to young girls:

• Anorexia is the third most common chronic illness among adolescents;
• 95 percent of those who have eating disorders are between the ages of 12 and 25;
• 50 percent of girls between the ages of 11 and 13 see themselves as overweight;
• And 80 percent of 13-year-olds have attempted to lose weight.

However, an increasing number of middle-aged and older women are suffering from eating disorders, as well. It’s really no wonder when you consider our culture’s obsession with thinness and unrealistic bust-waist-hip combinations. You can’t thumb through a magazine without catching sight of a waifish figure or hit the highway without a seeing a perfect body in a bikini sipping a beer.

Statistics may lie about just how many women develop eating disorders later in their lives because the illness often goes undiagnosed by doctors. Weight loss and changes in appetite are common complications of another illness or side effects of certain medications. And physicians certainly aren’t looking for anorexia or bulimia in older age groups.

The Johns Hopkins Mood Disorders Clinic published information about an Australian study that is among the first to investigate poor body image and eating disorders in older women. Karen Swartz, M.D., Director of Clinical Programs at Johns Hopkins School of Medicine, writes:

Investigators surveyed a random sample of 475 women ages 60 – 70 about their eating behaviors, weight history, and attitudes toward their bodies. Around 90 percent said they felt very or moderately fat, and 60 percent reported being dissatisfied with their bodies. The majority of women had a body mass index (BMI) of 25, which is considered just slightly overweight, and wanted to have a normal-weight BMI of 23. Over 80 percent of the women made efforts to manage their weight.

Four percent of the women (18 total) met the diagnostic criteria for an eating disorder: One had anorexia nervosa, two had bulimia nervosa, and 15 had symptoms of an unspecified eating disorder that did not meet the criteria for anorexia or bulimia. In addition, another 4 percent of the women (21 overall) reported a single symptom of an eating disorder, such as using laxatives, diuretics, or vomiting to lose weight, or binge eating.

Typically, it has been assumed that as women age, these problems become less common, but this study suggests that the desire to be thin never fades. Some of the women may actually be experiencing recurrences of eating disorders they suffered from in their teens, 20s, or 30s. Others may have had continuous problems throughout their lifetimes. And still others may have developed the problems anew in their later years.

In the regular world, we desperately want to reach great heights of love and beauty and excitement and achievement, but must face the reality of falling short. We disappoint ourselves. We disappoint other people. Other people don’t behave the way we want them to and often hurt us.

In the regular world, we can try our best to be safe and still have unpredictable and cruel things happen to our loved ones and to ourselves. We have choices, but not control. We have power, but it is limited. We must continually make decisions based on limited information, among options that are all flawed in some way. We then have to live with the consequences of those choices.

Somehow we are able, through using substances like drugs, food, and alcohol, to carve out a world for ourselves in which these regular rules do not seem to apply to us. We gain access to times of feeling totally free, invincible, safe and completely fulfilled. At least for a moment or more, we get exactly and purely what we want, without jumping through any tedious hoops, and don’t have to think about the consequences.

So, is trying to change worth it? Especially when the path of recovery is painful, scary and incredibly frustrating?

Well, it is a tradeoff.

The price we pay for trying to opt out of regular life is that day after day, year after year, we become weaker and weaker — physically, emotionally and mentally. Our lives become smaller and smaller. Inside our brains and bodies, the same pattern is repeated again and again and again. We become bored and numb and stuck. We see life going on around us, but feel a wall of separation between the world of the living and ourselves.

When you choose to try to stop an addictive habit or behavior, you gain access to a regular life. Your power, in this regular life, lies in taking each moment, starting now, as an opportunity to make the best possible choice for yourself, and then another choice and then another choice. Your invincibility lies in your ability to depend on others even when it feels extremely uncomfortable. Your control over shaping your life lies in your willingness to stay the course on the bumpy and often circular path toward fulfillment.

Without the option of escape, your intelligence and creativity grow as you learn to work within the reality of human existence to make your life as amazing as possible. You are forced to find nourishing relationships in order to survive. Your world expands beyond the old patterns, and you have the energy and motivation to explore new experiences. You even have the ability to actually feel them.

Is this trade worth it? That is up to you.

In years past, an eating disorder stereotype existed. This person was female, white, usually first-born or an only child, a high achiever and from an affluent family. That stereotype is long gone. Today, anorexia and bulimia are equal-opportunity disorders. They flourish in every culture, race, ethnicity, socioeconomic group, and religion throughout our country. And, whereas eating disorders were once exclusively a female issue, this is no longer the case. Anorexia and bulimia are also on the rise in the male population.

In other words, no individual is exempt and no family is immune. The following is designed to provide parents with the information required to understand eating disorders and help prevent one from occurring in their home.

What is an Eating Disorder?

Eating disorders are serious psychiatric illnesses, not unlike depression or anxiety. Those with an eating disorder use food in an unhealthy manner to cope with unpleasant emotions or difficult life situations. Anorexia and bulimia are two of the most common and dangerous of these disorders.

Anorexia is defined by self-starvation. Those with this illness intentionally starve themselves to dangerously thin levels, at least 15 percent below what would be considered a normal weight. Anorexia is an addictive behavior. It is often accompanied by body distortion. This means the one practicing the behavior literally does not see what everyone else does. Regardless of how emaciated she becomes, she still sees an overweight girl in the mirror.

Bulimia is an extremely complex disorder that is difficult for most people to understand. It rarely occurs in very young children. It is far more likely to manifest in adolescents. When a girl has bulimia, she uncontrollably binges on large amounts of food and then purges through vomiting, starving, excessive exercise, laxatives, or other methods. This behavior also has addictive qualities. An individual with bulimia may purge more than 20 times a day.

Eating Disorders Contributing Factors and Warning Signs

What causes an eating disorder is highly individualized; it is rarely the result of one isolated event or life situation. Certain factors can contribute to the onset of an eating disorder in a child or adolescent girl. These include genetics; peer pressure; dieting; trauma; media influence; life transitions; athletics and perfectionism.

The most obvious sign of anorexia is extreme and rapid weight loss. These girls often diet obsessively, focus inordinate interest on calories, carbohydrates and fat grams, complain about being fat and display an extreme preoccupation with food. A girl with anorexia will never admit to being hungry, even though she is starving.

The key warning sign for bulimia is leaving quickly after meals and spending a long time in the bathroom. Visible indications of bulimia are scrapes on the fingers or hands, swollen glands in the neck or possibly broken blood vessels in the eyes. It is not unusual for a young person with bulimia to steal food from the family or a grocery store.

Body Image and Eating Disorders

Body image is how a person sees herself. It is rarely based on reality, but is far more defined by the culture in which she lives.

Unfortunately, we live in a society that places an absurdly high value on physical perfection and beauty. This obsession with perfection is most evident in the American media. Beautiful females are showcased everywhere, especially in magazines to promote any number of products. Often these photos have been altered or undergone a tremendous amount of computer manipulation to achieve perfection. The problem is, the girls scrutinizing these models believe they are real – that what they see is how that model actually looks.

By definition, adolescent girls are very self-conscious and body focused. When they compare themselves to these “perfect” females, they inevitably fall short. Their self-esteem takes a profound hit. They experience extreme body dissatisfaction. These girls can’t immediately grow taller or change their cheekbones, but they can lose weight. They start dieting. This is an eating disorder waiting to happen.

Parents and Eating Disorder Prevention

Although children are influenced everyday by many external factors, parents can play an important role in the prevention of eating disorders. Throughout a child’s life, food should never be used as a reward or punishment. Healthy, balanced eating should be modeled in the home. Exercise should be done for fun and health, not weight loss.

Mothers need to recognize the profound impact their own behavior has on their daughters. A mother who is always on a diet, obsessed with calories and fat grams, constantly weighing herself and focusing on clothing sizes, will encourage similar behaviors in her daughter.

Similarly, a father plays a vital role in the development of a daughter’s values and self-esteem. Although all parents are encouraged to avoid excessively complimenting or praising a child on her appearance, this is particularly critical where the father is concerned. While a girl is young, her primary male role model is her father. It is important for her to see that her value to him is not predicated exclusively on how she looks, or she is at risk for taking this same belief system and applying it to all men in adulthood.

Parental focus should be placed on a daughter’s unique talents or achievement in areas such as academics or athletics. Most important, every child should be highly reinforced for excellent qualities such as kindness, compassion or generosity.

Every day, girls experience peer pressure and are exposed to a host of negative media messages. That’s why it is so important to combat these issues through positive communication in the home. Parents need to talk about what truly has value in the real world and what does not. Value is found in the content of an individual’s heart and character, never the numbers on a scale. Further, when an eating disorder is indicated, early intervention by a specialized eating disorder treatment team is essential.

Due to the genetic component of eating disorders, anorexia and bulimia will probably always exist. However, through a great deal of love, support and open communication, parents can help their children develop a healthy relationship with food, combat the societal pressure to be thin, as well as maintain a strong self esteem and body image.

Copyright © 2011 Eating Disorder Hope. All rights reserved. Reprinted here with permission.

Body image is the picture in our mind’s eye of how we look to ourselves. It reflects our beliefs about how we think others perceive us and captures how we experience the feeling of “living” in our bodies.
– Adrienne Ressler, MA, LMSW, CEDS

Everyone has a body image and it develops from the moment of our birth. It continues as we experience life and incorporate the messages of our personal and more global culture. Although we may strive to balance an inner image that is more positive than negative, we are all susceptible to finding fault with ourselves.

By feeding ourselves a steady diet of self-criticism, however, we pave the way for a deprecating self to take control. Sticking to us like glue, this negativity has an impact on our inner self, and we often feel very small, diminished and even shamed. In a sense, we become “centered” in these thoughts, causing all of our decisions and actions to take form from our distorted perspective. This imbalance has the power to paralyze us and usually does when we let it roam freely in our minds.

According to Oliver Wendell Holmes, “The greatest thing in this world is not so much where we are standing, as in what direction we are moving.” Consequently, when our distortions beckon our low self-esteem, it becomes necessary to challenge them in order to regain a more balanced perspective. It is also essential to examine what underlies these thoughts, so we can consciously decide to what degree we will allow their influence to threaten our functional mobility.

Megan, a patient at The Renfrew Center in Florida, described the struggle between her positive and negative body image this way:

Over the years, I have grown to see myself the way I believe others see me, as a failure, a disappointment, and a burden. These messages feel like a knot in my stomach that keeps tightening and never loosens. They are like a voice in my head that keeps repeating that I’m no good and nobody wants me around. They cause me to feel heavy and weighed down. I have become a very sad, introverted woman, afraid I will be rejected if I speak out. I hurt myself by not eating, overeating or purging. I make sure I never feel satisfied, and I make myself believe that my accomplishments are not real.

There is a small part of me, however, that does believe that I am a strong, independent, lovable human being, capable of experiencing emotions and trusting myself.

In order to develop a healthier body image, Megan will need to build on her strengths and rebalance her body image so that her negative thoughts are no longer dominant. In short, she will need to:

• Learn about how her perception of self takes form and lives in her body
• Explore how she expresses herself through her body language
• Identify how she sees herself and perceives how others see her
• Examine how her image of herself impacts on her life
• Explore and develop strategies to expand her ability to resolve her body-image issues

Megan participated in a special group called Body Image Experiential at The Renfrew Center of Florida. This group format was developed in order to provide an opportunity for our residential patients to explore their body image issues from the inside out. Since our body image programming centered mainly around the media’s impact on a person’s body image, it was believed that a format that focuses also on the person’s relationship with their body stemming from their internal perceptions of themselves would be helpful.

The Body Image Experiential format embraces a psychoeducational, experiential and psychodynamic format, lending itself to:

• Helping participants explore and begin to understand what was driving their body image perceptions

• Acknowledging they were turning toward disordered patterns as a way of coping with feeling overwhelmed
• Challenging them to use their distortions as signals that could help them recognize something was wrong
• Trusting that if they were able to recognize what was wrong, they could take action in healthier, more effective ways, rather then automatically resort to eating disordered behaviors

First, patients are engaged in a discussion focused on a meaningful quote related to body image, such as “There is truth in every body” (Residents at The Renfrew Center of Philadelphia, 2002) or “It is not uncommon to hear someone with an eating disorder describe her relationship with her body as that of one with a stranger or even an enemy (Kleinman & Hall, 2006). Then, expressive movement techniques are developed by the therapist to embody understanding of emerging issues. The movement work is processed on a body level as well as a cognitive level. This is followed by each patient journaling on a worksheet developed specifically to contain body image notes called a BIN (Kleinman, 2002). Use of the BIN provides the patient with a means of externalizing insights as well as documenting them as a resource. Finally, mini goals are developed for homework to help patients create action plans on body image issues. Before the next group, the therapist reviews and writes feedback on each patient’s BIN. Patients acknowledge that the feedback provides them further direction, and support in working on issues identified in the group (Ressler & Kleinman, 2006). The written feedback also provides a cognitive framework of guidelines to assist continued exploration of issues.

In Megan’s case, the therapist told her that since she’d been able to recognize a positive message, she could use that small part of herself that she’d identified as “strong, independent and articulate” as her foundation for growth. She could develop strategies to transform the negative attributes she’d identified into positive ones. The therapist reinforced her suggestion by identifying each negative attribute Megan had identified and showing what she meant by adding, “For example, you said you are scared of rejection and afraid to speak out. Two of your mini goals this week can be to take a risk to speak out and assert yourself, as well as to connect with peers.”

The second week, Megan wrote on her BIN: “I am a little more optimistic and I feel empowered, but I am afraid and because of this, I still withdraw and feel meek. The good thing is that I am starting to respect myself, and in turn, treat my body with more respect by nourishing it and not feeling guilty.”

Wanting to encourage Megan to continue to move in this direction, the therapist wrote back, “Megan, you have identified and articulated what you need to do. Now you need to try to fear yourself less and trust yourself more. I’ll be glad to help.”

The third week, Megan wrote on her BIN, ” I use my eating disorder to make me feel less scared – more in control of my life. It moves the focus away from the things that I think I cannot accomplish so that I do not have to feel negatively towards myself for failing. I then focus on my eating disordered behaviors like counting calories, or distracting myself by keeping busy. My eating disorder helps me run away and be OK about it. I pull away from the people in my life and I don’t ask for help. When I run as fast as I can, I switch my focus immediately to something else, instead of facing what lies ahead. I never give myself the opportunity to learn from my mistakes. I feel the need to be successful at everything I face and as a result, I work myself sick. I am hard on me at all times. I am not sensitive to my feelings, I numb myself and this makes me tense and anxious.”

The therapist wrote back to Megan, “Although you are probably not aware of this, once again, you have identified what you need to do next. If you reverse the last statement you made, I am hard on me at all times. ( I am not sensitive to my feelings, I numb myself and this makes me tense and anxious), you will be able to work to transform problems you’ve identified into strengths that can work for you. Specifically, you will need to transform being hard on yourself into being kinder to yourself, like you would be with a friend; insensitivity toward your feelings into acceptance of all your feelings and subsequent needs, and numbing yourself into experiencing and expressing feelings so that you can be in charge of, rather than attempt to control what you feel.”

Megan approached the therapist following this group, asking for further help in implementing strategies and they decided to begin working together individually using dance/movement therapy to delve further into these issues (Kleinman, 2002).

By using the patients’ strengths to explore issues they identify, it becomes more possible for them to feel empowered, to consider removing their masks, to explore what lies behind them, and then to develop new ways to cope with their discoveries. Key to the success of this format is the dance/movement therapy component that builds on the notion that experiential understanding begets cognitive understanding (Kleinman & Hall, 2006). Adolescent girls and women with alexithymia find this format particularly helpful because communication continues to be available when words are not possible. Once engaged in interactions that focus on expressive movement, insights spring to the surface because of the visual and experiential clarity inherent in the movement metaphors.

Portions of this article have been excerpted from Kleinman, S. (2002). Challenging body image distortions through the eyes of the body. Proceedings of The American Dance Therapy Association, 37th Annual Conference. Columbia, Maryland: American Dance Therapy Association

References

Kleinman, S. (2002). Challenging body image distortions through the eyes of the body. Proceedings of The American Dance Therapy Association 37th Annual Conference. Columbia, Maryland: American Dance Therapy Association.

Kleinman, S. & Hall, T. (2006). Dance/Movement Therapy: A method for embodying emotions. The Renfrew Center Foundation Healing Through Relationship Series: Contributions to Eating Disorder Theory and Treatment Volume 1: Fostering Body-Mind Integration. Philadelphia, PA.

Kleinman, S. (2001). Body Image Notes (BINs).

Ressler, A & Kleinman, S. (2006). Reframing Body-Image Identity in the Treatment of Eating Disorders. The Renfrew Center Foundation Healing Through Relationship Series: Contributions to Eating Disorder Theory and Treatment Volume 1: Fostering Body-Mind Integration. Philadelphia, PA.

Susan Kleinman is a dance/movement therapist at The Renfrew Center of Florida, a women’s mental health center that specializes in eating disorders, depression, anxiety and trauma.

This article was originally published on Eating Disorder Hope, and is republished here with permission.

Movement defines us from the moment we are born until the day we die. From the first kick in our mother’s womb, until our dying breath, we participate in the dance of life and experience the power of movement (Kleinman, 1993).

Inherent in the dance of life is the ability to share the emotions of others. This notion appears to be intimately linked to the functioning of mirror neurons. According to an Italian researcher, Giacomo Rizzolatti, “Our survival depends on understanding the actions, intentions and emotions of others. Mirror neurons allow us to grasp the minds of others not through conceptual reasoning but through direct simulation – by feeling, not by thinking (Blakeslee, 2006).”

All successful therapy involves an interaction between the mind and the body (Kleinman & Hall, 2005, 2006). Dance/movement therapists work directly with feelings using the whole body as an empathic receptor and responder to the patient (Harris, 2008). This facilitates a process that allows therapists to discover and trust their innate ability to “attend” empathically, respond authentically, and translate nonverbal experiences into cognitive insights. Dance/movement therapists are taught to hone their native language into therapeutic skills that free them to spontaneously develop on the body language and nuances of those they are working with. Responding to the patient’s nonverbal signals, including tone of voice, facial expressions, eye gaze, and bodily motion, can reveal the otherwise hidden shifts in states of mind and body. Resonating with these expressions of primary emotions requires that the therapist feel the feelings, not merely understand them conceptually (Siegel, D. J., p. 290, 1999.)

The therapist’s own experiences of embodiment, ability to access unconscious material, and way of being in the body, is part of their sense of self, and plays an important role in the relationship between therapist and patient (Kleinman, 2004). Supporting this premise, Virginia Satir (p. 27, 1987) eloquently states “When I am in touch with myself, my feelings, my thoughts, with what I see and hear, I am growing toward becoming a more integrated self. I am more congruent, I am more ‘whole,’ and I am able to make greater contact with the other person.”

Techniques and concepts that underlie dance/movement therapy can be used to teach traditional therapists skills that can assist them in sharing the experience with their patients.

The artist Pierre Gauguin said, “I close my eyes to see.” When therapists are able to “see” from the inside out, through their experiences, they are able to understand in a way that goes beyond cognitive reasoning or thinking.

A hallmark of people with eating disorders is their tendency to try to control their feelings and focus on body distortions, obsessive thoughts and concrete, black and white thinking. As one patient explained, “It is much easier to focus on how many calories I have consumed in a day than it is to deal with day to day events such as arguments with my parents, getting good grades, or feeling accepted by others.” Patients who suffer from trauma, as well as those who become addicted to substances, frequently possess similar patterns in their quest to stay “safe” by detaching from their bodily felt experiences.

Helping patients with eating disorders reawaken their bodies by connecting with their feelings is critical to their recovery. People with eating disorders have shifted their life focus to make it about food, weight and the physical body. The challenge of therapists is to shift the focus back to the more natural way of living that includes experiencing feelings. Ignoring internal states amounts to burying feelings and the burial site exists in the body itself. Since feelings may fester underneath the body’s surface and erupt when they become intolerable, it behooves us to help our patients develop a stronger relationship with this vital part of themselves (Kleinman & Hall, 2006).

In order to facilitate experiences that help our patients experience and “move” their feelings, we need to not only be able to move our own feelings, but to understand how to do this without losing our therapeutic balance. Essentially, maintaining appropriate boundaries is necessary in order to balance attuning to our patients while simultaneously attuning to ourselves (Bloomgarden, Mennuti, and Cohen, 2003, p.9-10). Gerstein, Botwin & Kleinman (2004) state that “exquisite attunement to one’s self can permit therapists to sift through and discard feelings that indicate that they may be over-identifying with patients, while still allowing for the possibility that they may be also tapping into the patient’s issues in an embodied, less conscious, fashion.”

Hansen writes as a layperson, with bulimics as her primary audience.  Her findings are also applicable to individuals with other eating disorders, particularly binge-eating disorder (BED).  In addition to Hansen’s own story, Brain Over Binge draws from studies on addiction, brain chemistry, developmental psychology, neurobiology, and nutrition.  Her approach both critiques and builds a bridge to conventional treatments, offering a new and valuable perspective to therapists working with eating disorders and addictions.

The book’s three sections include a memoir about Hansen’s experience as a bulimic and her recovery; her research into the mechanisms underlying her eating disorder; and risk factors, such as low self-esteem and poor body image, that had been the focus of her unsuccessful therapy.

Hansen is straightforward and candid in describing her ordeal of near-constant quests for food, the pleasurable numbness and trances associated with bingeing, and marathon gym workouts to purge herself of calories consumed.  Her obsession with food and exercise exhausted her, jeopardizing her chance to lead a “real life.”  Her inability to control her urges produced “shame, guilt, disgust, isolation, and self-hatred.”  These feelings did not cause the act of bingeing but arose from it, a crucial distinction overlooked in treatment.

From age 18 to 22, Hansen had undergone psychodynamic therapy, cognitive-behavioral therapy, and addiction therapy, the approaches most widely used to treat bulimia.  She asserts that each approach makes false assumptions about the nature of the disorder, focusing on secondary issues rather than addressing bulimia head-on.  Particularly damaging is the view that bulimia is a disease that happens to people, rather than a conditioned behavioral habit over which the bulimic can take control at any time.

Hansen ultimately deprived her bulimia of its power by separating it from her other problems instead of connecting it to them as her therapists advised.  Her other problems then became more manageable because she could devote more energy to coping with them, rather than to her disorder.

“Throughout my years of binge eating, it was obvious to me that my urges to binge were inconsistent with my true self — the person I believed myself to be in the present and the one I wanted myself to be in the future,” she writes.  “My urges felt intrusive, often arriving when I least expected them and taking over my mind and body like a thief, driving me to do something I knew I’d regret.”

The drug Topamax (topiramate) produced only short-term relief, but offered Hansen a clue into the nature of her disorder.  “It had nothing to do with any progress I’d made in therapy,” she writes.  “I simply stopped having those all-too-frequent urges to binge, all because of a medication that somehow regulated my brain.”  The exact function of Topamax and other drugs in treating bulimia is unclear, but Hansen maintains that they, too, take an indirect approach.  “The drugs didn’t act on the real problem: the urge to binge.”

Jack Trimpey’s book Rational Recovery: The New Cure for Substance Addiction gave Hansen the tools she needed for her recovery.  She learned that her urges to binge came from her subcortex or “lower brain,” the seat of her survival instinct.  Kicked into high gear by her anorexia and by excessive exercise, her lower brain reacted to the threat of starvation by signaling her to eat even when food was plentiful.  The more Hansen gratified that urge, the more it became a habit, literally changing the neural pathways in her brain and giving rise to her “binge-created brain-wiring problem.”

She compares her lower brain’s signals to a child throwing a tantrum to get a toy.  Giving in to the child’s demands reinforces the tantrum.  The tantrum can then be practiced in additional situations; once rewarded, it becomes linked with those situations.  In this way, the “triggers” for Hansen’s binges kept multiplying; but they were only associations.  The true cause of Hansen’s binges had always been the urge to binge itself.

Trying to substitute her binges with other activities had failed, in the same way that responding to a tantrum with a hug fails if the child really wants a toy.  Hansen’s tantrums — her lower brain’s signals to binge — succeeded only because she paid attention to them.  Her attention led to increased neural firing, which in turn strengthened that pathway in her brain and literally fed her habit.

Her lower brain could not control her actions, but her prefrontal cortex (her “highest human brain” and the seat of her free will) could.  Hansen recognized her irrational urges as “neurological junk” unrelated to actual need.  Rather than try to fight, reason with, or “surf” those urges, she acknowledged their presence and otherwise ignored them.  Her detachment stripped them of their emotional significance, making them less of a threat.  Their neural connections weakened until the urge to binge simply faded away.  Hansen’s need to purge as compensation for her bingeing vanished in turn.

She likens her “brain over binge” technique to the practice of “mindfulness” taught by neuropsychiatrist Jeffrey Schwartz to people with obsessive-compulsive disorder.  Mindfulness involves observing spontaneous thoughts and feelings in a way that is nonjudgmental, as though they belong to someone else.  Doing so helps patients resist the urges associated with OCD.

Central to Hansen’s recovery was the knowledge that she could take matters into her own hands rather than make excuses for her behavior.  Contrary to what she had learned in therapy, bingeing was not her method of coping with life.  It was not part of a disease.  Blaming it on a trigger was an inaccurate assessment, even when doing so made her feel less accountable for her actions.  Her bingeing was a bad, persistent habit stemming from her own poor choices.

“I knew my thoughts were not under my control, but my actions were,” she writes.  “I found it infinitely more gratifying when I accepted responsibility for my behavior and chose to change it.”  She maintains that the bulimic always has that choice.  Readers familiar with Dr. William Glasser’s Reality Therapy may find similarities in Hansen’s “no excuses” approach.

Certain risk factors had predisposed Hansen toward the restrictive dieting that launched her bulimia.  Poor body image was one, but only a small fraction of American women with poor body image develop eating disorders.  Likewise, Hansen believes that low self-esteem has only an indirect link to eating disorders.

Age is another risk factor.  The higher-functioning, rational human brain does not completely develop until adulthood, and the lower brain is more survival-oriented until around age 20.  The lower brain is more prone to react to perceived threats of starvation at a time when the higher-functioning brain is less well-equipped to resist the urge to binge.

Hansen advises telling teenagers, especially girls, that post-pubescent weight gain is normal, healthy, and will stop.  Furthermore, restrictive dieting can be dangerous even when weight loss is recommended for health reasons.  ”Adolescents in a situation where they need to make changes to become healthier should be educated about survival instincts and why their bodies initially protest even healthy changes in eating habits.”

Traditional therapy can aid in recovery, which Hansen defines as “ceasing binge eating and preventing it from ever coming back.”  Bulimics who have lost the motivation to recover can use psychodynamic therapy to access their “true self,” so that their higher-functioning brain can resist the lower brain’s signals.  Cognitive-behavioral therapy can help correct faulty beliefs regarding weight and body shape.  CBT can also combine with the brain over binge technique, helping patients find alternative activities once the urges to binge are recognized as neurological junk.

Addiction therapy can help a binge eater avoid problematic foods while she detaches herself from her cravings.  If wished, the foods can then be gradually reintroduced in controlled amounts.  Finally, Hansen redefines the first three steps of Overeaters Anonymous, emphasizing self-reliance through the power of her own, highest human brain.

Like Hansen’s, my recovery from years of chronic bulimia was swift, complete, and attained without therapy.  Unlike Hansen, I had accomplished it through a radical lifestyle change unrelated to the disorder.  I had not experienced intrusive urges as Hansen had; instead, my bingeing had always felt like a conscious, purposeful choice.  Its usefulness to me faded after I took control of my life in other areas over a quarter century ago.

I believe the difference between Hansen’s journey and mine underscores the need for alternative approaches to a problem that can take many forms.  Hansen adds an important and needed voice to the literature on bulimia and eating disorders.

Brain Over Binge: Why I Was Bulimic, Why Conventional Therapy Didn’t Work, and How I Recovered For Good

Kathryn Hansen

Camellia Publishing, 2011

ISBN 978-0-9844817-0-5

Paperback, 309pp.