ChickSpeak

 Continued from last week, our final installment of our Q&A with Eating Disorder Experts, Aimee Liu, accomplished author, and Judith Banker, President-Elect of the Academy for Eating Disorders.Because we hear from you, our ChickSpeak community, often about topics ranging from a basic lack of self-confidence to full-blown anorexia and bulimia, we decided to enlist the help and support of an expert. Aimee Liu is the author of GAINING: The Truth About Life After Eating Disorders, just published by Warner Books. GAINING is, in part, a sequel to Liu’s very first book, SOLITAIRE (1979), which was also America’s first anorexia memoir. In her latest book, Aimee Liu revisits the questions of what really causes eating disorders and what it takes to fully recover. Aimee interviewed leading researchers and more than 40 other women and men with histories of eating disorders, then found the common threads of behaviors and traits that linked each story together. The end result is moving, strengthening and- beyond anything profoundly encouraging for anyone suffering and for loved ones trying to best be of support.After reading GAINING and being deeply impressed with Aimee’s honest and thoughtful examination of her own journey of recovery and her findings from in-depth research, we knew we had to share her book and break-through strategies with all of the women we care about, especially YOU.

AL: Below, Judith explains how low self worth develops and offers some excellent strategies for reversing this conditioned pattern.  I’d like to add that the reversal begins by training yourself to challenge all judgmental language.  What do words like bad, fat, stupid, ugly, or for that matter, perfect, really mean, anyway?  These are not objective or true assessments but labels used to compare and criticize that get branded into our psyches.  We may not be able completely to erase them or the damage they do to us, but with practice we can teach ourselves to notice when and how we use them - and how often they are uncalled for.  Then we can practice replacing these terms with others that are more accurate and constructive.  Instead of berating ourselves for feeling “fat,” for example, we can look deeper at what we’re really feeling, which may be angry or hurt or lonely (fat, after all, is not a feeling) and take concrete action to deal with the true source of distress.  Seeking out supportive friends, confronting the real source of unhappiness, cultivating activities that reduce stress and combat depression are all ways we can actively boost self-esteem.

JB: The answer to this question relates to your earlier question about developing a sense of identity. When we are infants there is no gap between our experience of need and the expression of that need. As infants we didn’t question whether or not we deserved to be held, fed, or have diapers changed.  We didn’t judge ourselves as needing “too much.” Over time our self expression gets shaped by the response of our environment. If our caregivers respond haphazardly or punitively to our expression of need we learn that our needs are not important or, even worse, that they are bad or wrong.

You can start to cultivate a sense of self-worth by learning to recognize what a genuine expression of your real self feels like. Practice listening to your own needs, thoughts, and feelings without judgment or self-criticism. Sometimes when you first start to do this, these expressions of your self will come through very quietly or subtly.  You have to listen very closely.  Writing these “self expressions” in a journal can be helpful. The next step is to gradually learn to identify ways to respond in attunement to your needs and feelings. By developing a responsive relationship with your self, by taking your own needs, experience, thoughts, and feelings seriously your sense of self-confidence, self-worth, and deservedness will grow.

2.  What advice would you offer someone who seems to succeed in residential programs but does not know how to transfer those skills over to regular life, with its stresses and busyness… and emotional undulations that the eating disordered individual feels ill-equipped to engage in a healthy manner?

AL:  This is an area that is beginning to receive long overdue attention.  Cindy Bitter, one of the women I interviewed for Gaining, works as a life coach in Rochester, NY, mentoring women through this phase.  Many treatment programs, as Judith mentions below, offer after-care programs to help patients transition back into daily life.  I believe there will be more of these services as therapists and patients alike recognize that recovery really is a gradual process.

My advice is to allow for imperfection, occasional backslides, especially at first, and not catastrophize these slips.  Instead, remember that the same skills that worked in treatment really will work out in the world, but they require ongoing practice and patience.  There’s a good phrase I heard recently: practice does not make perfect, but eventually it does make permanent.  What seems impossible today will, with practice, seem feasible next month and routine in a year or two.  Speaking for myself, I will never be happy-go-lucky or completely free of those “emotional undulations” you mention, but by developing an arsenal of calming, soothing, gratifying practices I have learned to effectively manage these swings without resorting to self-destruction.  Progress, not perfection, is the measure of success.

JB: The period of transition from the 24/7 support, camaraderie, and safety of a residential treatment program must be planned very carefully to avoid significant backsliding or complete relapse. It is common for people to underestimate the role the support of the residential community plays in their recovery. In these communities communication is honest and open, and support is easily available. In “regular life” these systems are not as reliable.

Whenever possible, take advantage of “step down” opportunities following residential treatment. There are day-treatment programs or intensive outpatient programs (IOPs) that provide graduated levels of support, allowing people to make a more gradual transition in to their everyday lives. If these formal services are not available, it is important to intensify your own outpatient services following discharge from residential treatment. Plan to meet more frequently with your individual therapist, physician, and nutritionist, attend a support group in your area, involve your family and friends in providing increased support for you during these critical weeks. This extra support will help you maintain the progress you made in residential treatment while you learn to cope more easily with the inevitable stresses and demands of your life.