While eating disorders such as bulimia, anorexia, and binge eating disorder have historically been thought to be “women’s disorders”, over one million men are suffering from these afflictions in relative silence. My guess is that many more men and boys are struggling every day with an eating disorder than the numbers report. With stereotypes looming about women feeling pressure to live up to societal beauty standards and using food to cope with stress, trauma, and anxiety, men who experience the very same struggles may be left isolated, feeling shameful and confused. With the increased numbers of eating disorders around the United States, one positive aspect is illuminated: more education, advocacy, and support is beginning to become available for men struggling with eating disorders.
Beginning March 29th, a new and open support group is starting at the Eating Disorder Foundation. Running every Thursday from 5:30-7pm, this group is sponsored by the National Association for Anorexia Nervosa and Related Disorders (ANAD) and is FREE and open to men who are struggling with any type of disordered eating or body image struggles. Facilitators Kate Daigle, MA, NCC and Clinton Nunnally, MA, LPC, are hopeful that this new group will open doors for men to find support in recovery from eating disorders.
What is different about eating disorders in men and women? Not a whole lot. In a clip I found produced in Britain to shed light on National Eating Disorders Awareness Week, one of the men talks about how criteria for anorexia nervosa includes amenorrhea (the loss of a female’s monthly cycle) and that he sees this as a gender bias against men who may be dealing with the same disorder. You can view the clip here:
According to the online eating disorder recovery site Something Fishy,
“The most common element surrounding ALL Eating Disorders, including Eating Disorders in Males, is the inherent presence of a low self esteem”.
Men are dealt with pressure to live up to standards, ideals, and stereotypes, just as women are. The image of the strong, muscular male underwear model or the skinny, fashionable hipster affect the way that men perceive themselves. They may be influenced by “what women want” in a mate and conform themselves to fit the desired ideal. In addition, men are supposed to be “the strong, stoic, protector” — one who doesn’t show or admit to emotions — based on Western standards, and this can create a great deal of pressure to fit all expected roles. Men, just as women, can control food in order to try to cope with feelings, or can feel out of control with food as a way of expressing underlying struggles.
We still have a ways to go to understanding how we can best support men in their recovery from eating disorders. I think the first step is admonishing the shame that is often attached to eating disorders. Shame is released by expressing it, addressing it, and letting it go. Here are additional resources for men struggling with eating disorders and for their families and loved ones:
Men With Eating Disorders Often Overlooked (a Talk of the Nation special audio report)
Men Get Eating Disorders Too (a non-profit to raise awareness about EDs in men)
I am hopeful that with these resources and with research to come, that men will not feel so alone or shameful about struggling with an eating disorder and that they might break the silence and search for treatment. If you know of any males who might benefit from the free support group please contact Kate Daigle at (720) 340-1443 or the Eating Disorder Foundation.
I am often asked: “What is recovery? How do I know when I am recovered from my eating disorder?”. With these perplexing concepts, there is no single correct answer. Recovery from anorexia, bulimia, binge eating disorder, or any other type of disordered eating is individualized and unique for each person. This special journey is what makes recovery from eating disorders both challenging and rewarding: during recovery, we each learn tools and embellish our strengths that will guide us to a life of balance and wellness for many years to come. We also may slip and stumble a few times during this journey. But staying the course is the key to sustained recovery.
Today, I’d like to shed some light on what to do once you have come to realize that you are “recovered” or “in recovery” from an eating disorder. Again, this is my perception — my feelings about my own recovery. They may help others, they may not. Take what helps. I am safe in assuming that the majority of those in recovery will agree that eliminating destructive and self-harming behaviors is a central key to recovery (behaviors such as bingeing, purging, restricting, over-exercising, cutting, and others). While it is normal to have occasional slip-ups of behaviors while working to find security in recovery, the true definition of recovery must involve a cessation of behaviors. Behaviors such as those listed above are symptoms of a deeper psychological issue. When working to find peace and wellness from behaviors, the root of the issue must be defined and nourished. When this is done, or is “in the process” of being uncovered, harmful behaviors will naturally cease because they will not be needed as a coping mechanism any longer.
One of my favorite quotes I heard recently by Cheri Huber reminded me of the complexity of recovery:
“Having an attachment ripped from deep in our being does not feel kind. Yet when it is gone, when the wound is healing, we can see that the process was one of pure compassion.” ~Cheri Huber
Eating disorders are like an attachment. They are like a relationship. They will never abandon us, deny us, leave us, or disagree with us. We can always rely on them. This is why it is so challenging to let them go — for all of the pain they have caused us, they have also satiated an inherently untended need. I interpreted this quote to mean that when we have our eating disorder taken away from us — whether it was of our own initiative or not — there is pain. The beginning stages of recovery are often the most excruciating; it can feel like ripping off a band-aid and exposing an open wound. Sometimes, it is too painful to bear, and we feel we need to continue using our behaviors until we are stronger in coping. When we sit with the feelings under the eating disorder, when we begin to heal, we can notice that giving ourselves compassion is one of the biggest keys in maintaining a solid recovery.
Here are a few ideas that might help in continuing to deepen your commitment to recovery:
1.) Define what the underlying struggles are, and always keep those in your awareness. This may come in the form of anxiety, depression, relationship difficulties or remnants from a traumatic event. You do not need to focus your awareness on these directly all the time, but tuck them into your consciousness so that you can be notified when you might need to cope with them in a healthier way.
2.) Remember what you have achieved. Again, this needs to be in balance — don’t re-traumatize yourself by vividly placing yourself back into what it was like to be in the eating disorder, but reflect on the steps you have taken, the victories you have obtained, and the strength you have deepened within yourself. Sometimes when I am feeling down, I summon up my gratitude for my own recovery and that I got myself there.
3.) Connect with community. It is always therapeutic to be part of a community that understands and supports you through your recovery. Recovery can be a life-long process in stages, and you may have different needs as you take steps down the road. This can come in the form of joining writing or poetry groups, if it is healing for you to write about your recovery. You also might participate in volunteer activities with local eating disorder support centers. In Denver, the Eating Disorder Foundation offers many volunteer opportunities or classes you can take and expand your horizons in their new support center “A Place of Our Own”.
This is only the beginning of a list of ideas to maintain recovery. What are some of your ideas? Remember always that the journey is challenging at times, but there is hope for a full, sustained, and healthy recovery from anorexia, bulimia, or binge eating disorder.
We have all endured some type of loss. Some of us, multitudes of loss. Mine might be a completely different type of loss than yours, and I may feel it most in my aches and pains, while you feel it in mood swings and emotional responses. There are thousands – millions – of losses that we all endure each and every day and not one person on this planet has not known what it feels like to lose someone or something that they hold dear. With all of this commonality — though it has diverse strands — why can’t we connect easier over our grief?
We all grieve in different ways….and we may not know our grief process until we experience a loss. Many people in mourning grieve in healthy and healing ways. Some of us close in on ourselves in protection; others yearn for open connection and community. Some of us shut down in hopelessness and depression; others lash out at loved ones with anxiety. Some of the most ineffective grief patterns….those folks who may not know what they are feeling or believe that they can feel better….can turn to violence against themselves or others in an effort to numb the pain.
A friend of mine, a bright and inspirational woman who was only 29 and pregnant when she was diagnosed with breast cancer, died last summer. This was an enormous shock to everyone who knew her. How do you deal with that kind of news? As the disease spread rapidly and viciously and took her life, just as she was starting out an exciting new phase of first-time motherhood. I cannot even imagine the loss that her husband, family, and newborn child have felt, and I know that I was shaken down to my very core by the unfairness and devastation of the event. To have the life of a beautiful, kind, and intelligent young woman (who was also just beginning her career as a counselor) taken away is an especially tragic loss, and the experience of it taught me a lot about myself. While nothing can take away from the tragedy of her illness, there was a ray of light in the process of coping with her situation, as people all across the country rallied to raise money, send love, and show their faith in her every step of the way. My friend knew how much she was loved. This was a gift!
A loss brought so many people together, and we are now helping each other grieve. This is the type of grief and loss that can have a silver lining, as community is formed in an effort to cope. Unfortunately, loss can have the opposite effect on some people, and it can actually divide families, foster anger and resentment, and result in further tragedy.
Loss can be defined in every color of the rainbow. Loss can encompass the death, illness, or other type of sudden change of a loved one — human or animal. Loss can be felt around the ending of a relationship or a job or a house. Loss can come at the change of a situation, such as moving to another state or shifting an emotional response. Loss does not need to be specific to a person, place, or thing — which makes it both easy and hard to define! What I am trying to relate is that everyone defines loss in his or her own way, and grieves for that loss in his or her own personal fashion. There is no “time limit” on grieving (though the DSM might want to convince you otherwise). There is no “right way” to mourn.
Many professionals have developed models that define stages of grief, such as Elizabeth Kubler-Ross’ model from her book On Death and Dying. This can be helpful and define some structure for mourners who are looking for guidance in uncovering their feelings. Kubler-Ross describes the five stages of grief as: Denial, Anger, Bargaining, Depression, and Acceptance. I have used this model in my work and have seen it be effective in helping clients define their own personal grief processes within the larger structure of the model. There are many such ideas about methods and stages of grieving, and if you find that this is an area which may be relevant for you, I encourage you to research them.
I have witnessed some clients shut in and dwell in solitude for a bit as they grieve; I have seen other folks reach out for support as they mourn; I have also seen many combinations of methods of coping. There is no paint-by-number answer to getting through one of the toughest things we will experience: losing a loved one, a special relationship, a lifelong dream. We are all unique individuals and we all cope in our own personal ways. I caution that destructive tendencies (addiction, substance abuse) can feel like effective coping mechanisms, but if they are used to extreme the loss only intensifies. If depression or anxiety take over and daily functioning is becoming more and more challenging and exhausting, I encourage you to seek professional help. Remember: you are not alone and you will get through this! It will get better.
I have been on both sides of “the couch”. I have been a client for many years and currently also inhabit the role of therapist with my own clients. I know how it feels to sit and talk to someone who you do not know on a personal level but still feel this uncanny and close connection to. I also am familiar with the sensation of sitting down with a client, sensing that certain natural anxiety that accompanies every session (even if I’ve been meeting with that person for a long time). Both therapists and clients have feelings and reactions. That is in part why people become therapists: because they can empathize, feel, and connect so deeply with their clients. Clients come to therapy because they would like to sort through some of the feelings and reactions they have to life circumstances…or to try to understand why they DON’T have feelings or reactions to those circumstances.
Feelings and emotions are natural and normal, and everyone has them. In therapy, where the room is safe and secure and there is a degree of comfort between client and therapist, emotions can play and explore the open air between the participants. A psychotherapy blog that I read talks about reactions that clients might have towards their therapists or towards a situation that are really not about that certain thing at all. Psychodynamic therapists call this projection. In this blog, the writer talks about feeling angry at her therapist and feeling that “the connection was lost” between them. As she works through this with her therapist, she realizes that she was upset with him because he was going on vacation for three weeks and she feared being lonely and losing her identity without him. Through this confrontation, she was able to work with her therapist towards developing more autonomy and she explored defense mechanisms that, according to psychodynamic theory, have been in place since the age of three.
In the above example, we can see how a reaction to a situation brought out some deep-seated feelings that the client was unaware of herself, and processing these with her therapist allowed her more freedom and release. This is an instance where the timing was right (the client was able and ready to go to the level of processing she needed to) and the relationship was built from enough trust that the two could sort through some uncomfortable feelings. But those circumstances are not always in place. Sometimes, the client is not able to yet make the steps towards understanding the deeper levels of his/her reactions and feelings, or the therapist is not prepared to hold the anxiety of such a situation and may allow her own feelings to enter the picture.
I have had clients expose a wide variety of emotions in session, and I am grateful that those clients felt safe enough with me to allow me to see them. There have been clients who have let me into their deepest thoughts, thoughts that they sometimes do not feel are “okay” to have. When working through challenging situations, such as when clients are trying to recover from an eating disorder, thoughts and feelings that have not been allowed to come out for fear of rejection can enter the therapy room. This is a healthy dynamic of the therapeutic process, as clients feel accepted despite their struggles. It is crucial that both therapist and client are prepared to work with these sensitive emotions when they are expressed, as they could be stuffed back down at any sign of judgment.
Fear of judgment or being unaccepted can be presented in forms of anxiety, withdrawal, dismissal, and aggression. I had a client that I had been working with for a long time whose eating disorder was spinning out of control. I could tell that she was terrified of this disorder because she felt torn between two very powerful forces: the temptation and addiction of the eating disordered behaviors, and the desire to be healthy and free. We worked for months exploring this tug of war and attempting to empower the voice of recovery that was buried inside of her. When we finally got to the point of challenging the eating disorder, she responded with anger and retreated back inside. The anger was a natural reaction that, if given the chance to work through it, could have been a tool for her to turn against the disorder. However, we did not get to explore that possibility and she never returned.
Timing and readiness for change are essential components to progress in therapy. The therapist must have the tools and experience needed to help support clients as they take steps towards expressing themselves freely and finding those answers that they came into treatment to uncover. One of the most difficult things for therapists to accept is if their clients are not yet ready for change. This is something only the client can decide, as it is ultimately their work. Through my learnings and wanderings as a therapist, I have come to accept that clients will make that commitment when they are ready and that is it my role to support them (and not push them) as they grow.
I found this amazing blog the other day called Voice in Recovery. It is a comprehensive narrative on the struggles, challenges, victories, feelings, and wonderings that occur along the path of eating disorder recovery. It is an accessible resource to all — those who are struggling with an ED, those who have recovered/are in recovery, and families and friends of those affected by EDs. The topic brought out recently in this blog that I was inspired to write about is honesty in recovery. The blog author talked about being honest with all of the feelings, cravings, desires, and motives that you might have in your recovery. I was struck by the HIDDEN theme in the post.
Eating disorders are complex and intricate mental illnesses that affect every part of a person’s life: their mind, body, emotions, feelings, soul, and their family and friends. The ED can completely alter the way that you perceive the world as your are seduced by the powers of the ED voice. The most essential ingredient in recovery, in my opinion, is the way that you fight back against the power of the ED, reclaiming who you are and revitalizing your strengths. To find yourself and reclaim that fighting voice, you must be honest — with yourself, your family, your friends, your therapist, and anyone else who is in your life and who you would like to support you in your recovery. While we are surrounded by people who love us and want us to be healthy, we cannot stand only on the feet of others…we must learn to stand on our own and we must turn inward and take a stark look at the factors that are contributing to the ED behaviors. This can be intimidating! It can bring feelings of guilt, shame, and loneliness – the very feelings that EDs thrive upon – to open ourselves up and try to heal the wounded parts. I VERY strongly suggest that you do this with the help of a therapist, someone who is trained to hold those feelings for you as you sort through them and find ways to not let them be so central to your perspective. Those uncomfortable and sometimes painful feelings that can surface when honestly looking at recovery may tempt you to close up and HIDE again…but they will not go away until they are exposed and you are freed of them.
Honesty is crucial in every part of life: in intimate relationships, in financial transactions, in college applications, and in legal documents. Being honest can bring with it a feeling of freedom and release. For someone who has suffered from an eating disorder, you may yearn for that feeling of freedom and release, but find yourself confronted with a dark and tangled forest of secrets, low self-esteem, and negative feelings that leave you exhausted before you even take a step. Being honest is the key to getting to the light on the other side, and with that honesty must come a promise to embrace yourself with acceptance as you wade through the tangled roots. I think the most liberating thing about honesty, whether it is in recovery from an ED or if it is involved in a relational issue, is the fact that you are letting a weight off of your shoulders that you may have carried around for some time. And as you feel emotionally lighter, there is less and less obstruction towards the freedom and healing that you have been working towards. Ultimately on a journey towards honesty, you will end up in a place where you can say “I am okay”. Those three words can be very powerful. When you are able to say “I am okay” and “there is nothing wrong with me”, and ED begins to lose its power and you begin to regain the strength you crave to design your own free life.
I have recently been intrigued by the concept of body memory, finding it to be a very real concept that can be a focus of therapeutic healing. I was reading a post that talked about how a body can remember a trauma or memory that may have happened many years ago, but that is somehow still trapped in the tendons, muscles, and morsels of a person’s body. What does this mean for a person’s mental well-being, and how does this experience shadow the mind-body connection that is so often used in therapy?
As I write a lot about body image, bodily harm, mental anguish that is projected onto the body, and other body-centered topics, I was curious about how eating disorders, emotional eating, and other types of body-involved mental disorders are connected to body memory. I have heard accounts of survivors of sexual abuse where the survivor talks about their muscles being tensed up and they “know” that there is emotional pain lingering in that part of their body. Getting a massage can be traumatic for someone who has had emotional pain felt in their body; I have learned about a new form of massage called Trauma Touch Therapy, which is a method used to release body memories in a safe way.
Bodies that are affected by and/or recovered from eating disorders may hold some of these same memories — of pain, shame, guilt, grief, loss. As a person heals emotionally, cognitively, and physically from a trauma — whether it is abuse by another, abuse by an eating disorder, or emotional anguish that results in such things as cutting — the body will hold some of those memories of times past in its tendons, whether it is as a protective mechanism against further trauma or, I wonder, because the body has coped with this memory for so long that it does not know how to let it go.
As we work through processing our issues, past and present, in therapy, does emotional release follow or precede with body memory release? Is body memory a therapeutic tool to help us cope and remember what we have survived, or is it a remembrance of traumas of times past that we just cannot let go?
This makes me think of war veterans or other victims who must get a limb amputated due to injury or illness. Research shows that the person’s body remembers that limb as if it is still attached for years to come. The body never really forgets. The effects of post-traumatic stress on the mind and body are intensifying as more people go to war, as the eating disorder epidemic increases, and as traumatic experiences that we may not even remember show up in body memory sensations.
As a therapist, this reiterates the importance of taking care of our minds and our bodies and remembering that they are connected in such deep ways. Yoga, exercise, breath-work, meditation, and mindfulness are all ways of highlighting the mind-body awareness to promote healing.
We all know what it’s like to start another school year. Sometimes you’re going back to the same school, one grade older. Sometimes you’re starting a new middle or high school, or even going away to college. There’s the excitement of the unexpected — who you will meet, what you will learn, how you will change. There’s also the underlying anxiety and nervousness of “will people like me?”, and “will I be accepted?”. I remember this all too keenly.
It is fall, and students are going back to school with visions of basketball games, cheerleading practice, football heroes, and chemistry tests floating through their minds. As a recent blog post http://www.goodtherapy.org/blog/school-stress-adolescent-eating-disorder-psychology-counseling/ noted, Back to School Stress can show up in many forms, and sometimes the overwhelming feeling of expectations and rules leads to the development of eating disorders.
How do you deal with it all without losing your self?? Whether it is being a part of the popular crowd, or earning A’s to get into a good college, we all have to cope with the stress of new and intimidating opportunities. Eating disorders can show up in the form of restricting amount and type of food, it can mean triggering a feeling that you can never exercise enough and that “goal” weight just keeps getting smaller. In other instances, eating disorders can involve bingeing on food until you cannot feel anymore, and then purging or using laxatives.
All of these behaviors, in some combination or another, really underline the emotional pain that is underneath. It is a pain that pangs as you wonder if being yourself, as you truly are, is “good enough”. It is a vicious cycle of being ashamed or embarrassed by these behaviors that you do not understand, and in turn hiding or lying about these behaviors because they have, at some point, “helped” to cope with overwhelming feelings. These behaviors in fact make the pain worse, and feelings of isolation and despair continue to intensify.
What can you do? Whether you are a parent, friend, or person affected by an eating disorder, first know that you are NOT ALONE. With over 10 million women and 1 million men (reported by the National Eating Disorders Association) showing symptoms of an eating disorder, the epidemic is growing and impacting us all. Secondly, know that you are not at fault for this — I repeat — NOT at fault for the issues, and there are many qualified professionals who are eager to help you. Families, loved ones, individuals, I challenge us all to come together in the mission to erase eating disorders and to educate the public about the causes, dangers, and treatment options.