The Journey Of Understanding And Treating Eating Disorders

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When I was an early career psychologist, if you had asked me my thoughts on working with eating disordered patients my knee jerk response may have sounded something like, “I don’t get it, if you’re hungry eat, if you’re not hungry don’t eat, simple”. Insert present self wanting to offer former self some words of advice- our relationship to food is often not that simple.

Flash forward a few years. No longer completely green and having made a big career change from working primarily with children ages 3-17, I found myself gearing up to work in a residential program treating you guessed it, primary eating disorders and substance use disorders. Fortunately, I possessed enough self-awareness to know that my old thinking patterns about treating eating disorders would be disastrous if I hoped to be successful and an agent of change. I threw myself head first into getting my hands on any and every book I could about eating disorders.

And then it hit me. While yes, eating disorders, as the name implies, are about a person’s relationship to food and their body, the research and hours of clinical practice I was participating in weekly began to emerge more unrelated explanations of these complex symptoms. It was in this phase of discovery that I had empathy for that early career psychologist who could not see this connection, not because of a lack of education or sensitivity, but because so often when something hits so close to home, we cannot or in some cases will not see it. While I credit my years of education and training as a psychologist in protecting me from developing disordered eating, I was no stranger to some of the more insidious characteristics of these disorders, including proneness toward perfectionism, a highly critical inner-voice and frequent experience of shame.

The metaphorical and emotional components of these characteristics, with all due respect, do make the food behaviors and body connection simpler to navigate. Those struggling with eating disorders will objectify their bodies, some in an effort to simplify the process of navigating their emotional landscape. Others will mirror their food choices with their belief system that may chronically say, “you don’t matter, you don’t deserve to take up space”, thus resulting in a deprivation of nourishment and spirit, threatening to erase their existence both spiritually and physically for good.

The physiological, emotional and spiritual components of healing from an eating disorder are long, laborious, AND possible. The healing journey is a simultaneous effort to address the tangible elements of restoring nourishment and signals to the body and addressing the intangible-the complexities of embodied emotions, repairing attachment injuries, noticing our subtle and sometimes intense sensations and spirituality to regain our footing and trust that WE DESERVE TO BE HERE.

Roth (2010) captures this integrative healing journey exquisitely in Women, Food and God:

Instead, ask yourself what you love. Without fear of consequences, without force or shame or guilt. What motivates you to be kind, to take care of your body, your spirit, others, the earth? Trust the longing, trust the love that can be translated into action without the threat of punishment. Trust that you will not destroy what matters most. Give yourself that much.

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Dr. Lesley Tate-Gould, PsyD, SEP

References:

Roth, G. (2010). Women food and God. Simon and Schuster.

Normalizing Healthy Conflict

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A lot of us were not shown how to disagree, argue, or have healthy conflict with other people, especially close loved ones. The role modeling of our parents at a young age resolving conflict is so influential to how we interact with people as adults when we don’t see eye to eye. Just like most things learned, a couple must practice. Step away from the comfort of sweeping things under the rug, exploding, or shutting down and step into courage; courage to show up in your relationship responsibility and maturely.

Connection, Break, Repair – This is the cycle of any close relationship. There is a connection with someone, building trust, shared interests, experiences. Then usually there is some sort of break where one person gets hurt, upsets the other, or loses trust. In a lot of relationships and families after the break there is no repair of what happened. Without a healthy repair and normalization of disagreements and differences, resentment can grow silently and patterns of withdrawal and unhealthy expression can develop. Repair is essential in managing healthy conflict.

Communication repair tools are meant to be used to get up and over differences or obstacles between two people. I have discovered that some couples (or just one partner) can desire lengthy explanations, emotional dialogue that can go on for hours, which can complicate repair with too many words. Now, I do know that some long conversations can be beneficial and feel good for couples at times, but learning a repair tool that can be used as practice and ease some disagreements and conflicts is key to normalizing healthy conflict.

I suggest couples set a day/time to have marriage/relationship meetings once a week for 20-30 minutes with no devices. This helps the two individuals to come prepared to talk and provides a space to pay attention to the health of their relationship. During these A lot of us were not shown how to disagree, argue, or have healthy conflict with other people, especially close loved ones. The role modeling of our parents at a young age resolving conflict is so influential to how we interact with people as adults when we don’t see eye to eye. Just like most things learned, a couple must practice. Step away from the comfort of sweeping things under the rug, exploding, or shutting down and step into courage; courage to show up in your relationship responsibility and maturely.

Connection, Break, Repair – This is the cycle of any close relationship. There is a connection with someone, building trust, shared interests, experiences. Then usually there is some sort of break where one person gets hurt, upsets the other, or loses trust. In a lot of relationships and families after the break there is no repair of what happened. Without a healthy repair and normalization of disagreements and differences, resentment can grow silently and patterns of withdrawal and unhealthy expression can develop. Repair is essential in managing healthy conflict.

Communication repair tools are meant to be used to get up and over differences or obstacles between two people. I have discovered that some couples (or just one partner) can desire lengthy explanations, emotional dialogue that can go on for hours, which can complicate repair with too many words. Now, I do know that some long conversations can be beneficial and feel good for couples at times, but learning a repair tool that can be used as practice and ease some disagreements and conflicts is key to normalizing healthy conflict.

I suggest couples set a day/time to have marriage/relationship meetings once a week for 20-30 minutes with no devices. This helps the two individuals to come prepared to talk and provides a space to pay attention to the health of their relationship. During these meetings, each partner can share two appreciations involving their partner (e.g., “Thank you for sitting with me Tuesday when I was not feeling well, I really liked that you brought home dinner when you knew I had a tough day at work”). Next, using a communication tool or format, each partner shares any concerns or suggestions they witnessed or would like to discuss (e.g., “When you did not respond to my text or answer my question, the story I told myself was that you were too busy out with your friends, In the future could you greet me when you come home before you go upstairs to read”)?

Having a designated time and place to pay attention and normalize differences plus identify positive things that have happened during the week is an excellent way to become more mindful of your relationship and become intentional in resolving conflict. I have often told couples that if you take only one thing away from our work together, I hope you commit to marriage/relationship meetings once a week with your partner. Practicing healthy conflict, getting together regularly, sharing positive things about your partner and relationship, and asking for what you and need and want in the relationship will transform you and your partner. You, then become the role model for the younger generation and help pass down a healthier way to be with the one you love.

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Alyson Peña, NCC, LPCC