Economists and bulimia

I can’t remember the last time I saw “economist” and “bulimia” in the same headline — I usually don’t put the two together.  However, this article (Eating-Disorders Experts Challenge Economists’ Conclusions About Bulimia) made some pretty interesting statements:

1. Bulimia Nervosa (BN) is an addiction rather than an eating disorder
2. Black females are 50% more likely to be bulimic than white females
3. “Bulimic behavior” is less likely among wealthier, better-educated families.

You should definitely read the article, but I have a couple of things to add to these points:

1. BN is an addiction
I always compare eating disorders and addictions — but I still wouldn’t put BN and alcoholism in the same category.  There are several key differences:

1. Lack of an addictive substance: Addictions require you to be, well, addicted to something — alcohol, opiates, cocaine, etc.  With bulimia, there’s no addictive substance.  I don’t think you can even argue “food” as the addictive substance.
2. No healthy use for symptoms: Occasional purging is not okay or normal.  I’d argue that anyone who purges has an eating disorder (at least on some level).  However, there are appropriate uses for alcohol, opiates, and even cocaine.
3. Goals of treatment: With addictions, the goal is to abstain from the addictive substance.  However, you can’t abstain from food (maybe from purging, but again, that’s only half of it).
4. Psychopathology: “Addict thinking” is not really the same as “eating disorder thinking.”  Similar — but not the same.

2. BN more common in black females
I don’t have much to say about this one, except that I’m skeptical.  I don’t think EDs are limited to certain races, but I think that if you looked at the cultural make-up of treatment centers, you’d find this claim to be false.  Yes, this is measuring those in treatment vs. BN prevalence — and there is likely a difference — but not a 30%+ difference!

3. Bulimia less common in upper-class families
Similarly, I don’t think that BN has socioeconomic limitations…

If for no other reason, the article at least challenges the many ED stereotypes.  It’s curious to me that a) there is no reference to males with eating disorders and b) the study is unique to bulimia.  I’d be interested to see if authors found similar results with anorexia.

In tune with each other

I’ve been reading Dr. Drew’s book, “Cracked: Life on the Edge in a Rehab Clinic.” There are a million things that I could talk about concerning this book, so don’t be surprised if it’s referenced several times in future posts. Tonight, the following quote really caught my attention:

“Most believe [addicts] connect around a common experience of pain and powerlessness without the fear of exploitation. Their pain is so raw and tender that getting them to start the process requires them to be convinced that their pain will be understood. They’re all people with extreme trust issues, and the only people they’ve ever trusted are other addicts. They understand each other. (Interestingly, doctors have discovered that survivors of torture have similar reactions to treatment. They don’t open up unless they’re around others who’ve been through similar horrors, as though the pain of being misunderstood would be too great of a risk.)”

If you’ve ever been in ED treatment (or addiction / trauma treatment, I assume), you know that there’s something very different about the relationships that you form with other ED patients. You know all about their relationship issues and what they are / aren’t eating — but don’t know their last name. They might be thirty years older (or younger) than yourself or living a totally different lifestyle. Maybe they are completely opposite of the type of people that you usually hang out with, and if you met them in any other context you probably wouldn’t hit if off. But… despite all these differences, just their having an eating disorder makes it easier to talk with them than non-ED friends that you’ve had for years.

I have good friends, but the closest friends that I have are all people that I met in treatment. I just can’t open-up to other people in the same way that I can with them. Some of it is their ability to understand me — that definitely is a large part. My non-ED friends cannot relate to my frustration over food rituals. But I think it’s more than just their ability to empathize. Because they have an eating disorder (and were in treatment), it means they are the kind of person who you CAN talk to about this stuff. They have issues, too. I don’t know how some of my “regular” friends will respond to the stuff that I tell them… however, I do know that these ED friends are not going to invalidate my struggles. They aren’t going to think that I am ridiculous, and I don’t have to feel so ashamed. Dr. Drew explains it so well — “the pain of being misunderstood would be too great a risk.”

Anti-ED Coach

I’d never heard of a “Sober Coach” until watching VH1’s “Sober House.” In the last episode (I think), Will, who is Seth’s Sober Coach, accompanies him to his first concert and make sure that nothing happens to jeopardize his sobriety. While watching this I thought, “Well that’s convenient — I could use someone protecting me from anything eating disordered.”

Upon thinking about it a little more, though, I wasn’t sure what this Anti-ED Coach would protect me from. Would he make sure no one served me diet coke? Or that we only went to public places with healthy-weight people? Or would he stand outside the bathroom (any bathroom) and make me count? Okay, so maybe the idea was silly.

However, then I went and Googled “Sober Coach,” and found a website that explains what a sober coach does. Wow, they do a lot… they really seem like “life coaches” to me. If I had to adapt the list from this website for eating disorders, it would look something like this:

1. 24 Hour Crisis Support
   1. Phone support available 24 hours a day, 5 days a week.
   2. Education on how to ask for help.
2. Daily, Weekly, & Weekend Planning
   1. Creating an hour by hour schedule when necessary.
   2. Learning to deal with free time and/or unstructured time.
   3. Establishing weekly goals.
3. Physical Well-Being
   1. Nutritional consulting.
   2. Support with eating disorder issues.
   3. Support for anxiety and depression.
   4. Creating a personalized self-care plan (acupuncture, yoga, body coach, personal trainers, etc.)
4. Career / Academic Guidance
   1. Finding a job / volunteer work / internship.
   2. Support with changing careers.
5. Fun / Passion / Purpose
   1. Learning how to have fun & explore different hobbies.
   2. How to build fun into weekly schedule.
   3. Finding one’s own aspirations and dreams.
6. Recovery Support
   1. Help in finding appropriate treatment.
   2. Daily relapse prevention plan.
   3. Support in establishing healthy friendships and relationships.
7. Team Approach
   1. Works with psychiatrists, therapists, dietitians, and outpatient programs to provide a team approach.
   2. Referrals to various professionals as needed.

If you look at the original website, you’ll see that I didn’t have to add much. If Sober Coaches really do all of the above, that’s pretty amazing. I need someone to educate me on “how to ask for help” and “how to deal with free time and/or unstructured time” ! I also like the idea of someone coordinating things with a treatment team. I think that often professionals don’t work well as a team or they don’t necessarily consider the input of the patient (when appropriate). It’s a nice thought to think you could have someone advocating on your behalf in those meetings…

I realize that this is probably realistic, but it’s an interesting thought. An Anti-ED Coach could play a role that I don’t think really exists right now in treatment. Many of these responsibilities don’t fall under the job description of your doctor, therapist, or dietitian. It’s tricky relying on your spouse / family members to serve all of these functions, too, because they all don’t necessarily mess with the nature of the relationship. For instance, if I’m having a bad night and freaking out about something food-related, I don’t really want to make my fiance listen to my possibly irrational rant about calories. At the same time, though, it wouldn’t be appropriate for me to call or email my dietitian about this, either.

I am fortunate enough to have ED friends in recovery who can support me and give me advice during tough times, but that’s still a different relationship that with a Sober or Anti-ED Coach. You always have to consider if you are hurting or triggering the friend with your ED thoughts and behaviors.

Chronic anxiety is better

Coloring aside (and other “active meditation,” I guess), there is something that I hate about meditation (guided imagery especially). Deep breathing maybe helps me when I’m starting to freak out, but I think that’s because I’m telling myself “chill, take a moment, calm down, relax, collect yourself, you’ll be okay.” However, breathing deeply does stop my heart from beating so quickly.

Meditation is different though. I think it’s frustrating and I feel so impatient with it. It’s supposed to be calming, but really it just wears on my attention span and my nerves. It’s like when you’re stuck sitting at a red-light in the middle of the night, and are the only car there. You are watching that light and a minute goes by…. another minute… and you start thinking, “Seriously? You have to be kidding.” Another minute goes by and you are convinced the thing is broken. FINALLY the light changes.

I’ve had several therapistic explanations for this:

1. I think I am a human doing, rather than a human being.
2. I am uncomfortable sitting with myself.
3. Meditating is letting my guard down and I am afraid to make myself that vulnerable.
4. That’s my eating disorder talking (which I don’t think is really even relevant in this situation, but I swear there are therapists who say this about everything)

I think I can sit with myself and be calm. I love long car rides, coloring, napping, walking the dog… if you don’t count any of these “sitting with yourself and being a human being,” then what else besides meditation fits into this category?

When I am feeling panicky and anxious, meditation is about the last thing in the world that I want to do. It sounds so wrong when you state it this way, but some degree of anxiety is less painful than meditation! I think it’s great that meditation is calming and refreshing for some people… but I am convinced that meditation is not for everyone, and that it’s not necessarily a symptom of mental illness.

Anorexic Handwriting

anorexic handwriting: small, meticulous, and linear — font-like.

I’ve been told more than once that I have “anorexic handwriting.” Aside from the fact that this label is very non-PC, I never really put eating disorders and handwriting together. When I was inpatient, I remember this girl had really, REALLY tiny handwriting. We’re talking microscopic, get out your magnifying glass-tiny. I’ve had both a nutritionist and therapist refer to my handwriting as “anorexic.” How exactly are you supposed to respond to that, by the way? Um, thanks? I’m working on it? (I would like to note, though, that the girl I knew with teeny tiny writing has since recovered from anorexia and changed her handwriting–interesting, don’t you think?)

Googling “anorexic handwriting” is pretty much a waste of time (there is one scientific article on the subject, which I will admit I have not read)… but I did read up a bit on “graphotherapy.” I’d never heard of it myself, so to quickly explain (from The Complete Idiot’s Guide to Handwriting Analysis):

A specialized branch of graphology sometimes referred to as ‘graphotherapy’ is actually a form of handwriting remediation. It makes sense that if handwriting is a true reflection of one’s psyche and the result of accumulated experiences, that changes made deliberately to handwriting can help one change uncomfortable personality traits.

Some systems of graphotherapy require the client to make changes to bits and pieces of their handwriting. For instance, the client might be instructed to change his writing slant, raise his t-bars, or adjust his lower loops. While changing one’s t-crossings might not be a big deal, meddling with the lower zone is.

In effect, making changes directly to the handwriting is like ripping away the client’s defenses without replacing them with something more positive. This kind of graphotherapy can be very damaging.

….hmmm, interesting. Maybe I should go back and add this information to my, Who said therapy couldn’t hurt anyone? post.

Using a series of writing movement patterns can help the writer make changes from the inside out, rather than the band-aid effect of changing bits and pieces of handwriting. Some amazing results have been reported by graphologists working with clients to change what they view as undesirable traits.

In Tucson, Ron Laufer has received media attention for his work with anorexic and bulimic clients. These young women had tried numerous other treatment without success, but the graphotherapy exercises seemed to make the difference.

So, next thing you know, there will be ED graphotherapy group. Right between Equestrian therapy and psychodrama…

Anyway, if I had to connect EDs and handwriting….

1. Perfectionism — a common trait among individuals with eating disorders. Why wouldn’t this extend into handwriting?
2. OCD — again, common among those with anorexia.
3. Control — I hate to perpetuate the “eating disorders are about control” theory, but I could tie EDs, handwriting, and control together.
4. Obsession with being small – okay, a stretch, but small handwriting and small bodies… why not.

Personally, I’m a little neurotic about handwriting. I will erase and re-write words and sentences if I think something is messy or if I make a mistake. Sometimes I’ll start all over with a new piece of paper. Let’s say I’m writing a card… sometimes I’ll write three versions of it (with different spacing and/or colors) and then choose the version that I think is the best. A little OCDish, yes.

Also… the physical act of writing is therapeutic for me. Some days when I am so anxious about work and just cannot get started, I will sit there and write a copy of my to-do list. Heck, I’ll find a psych article online that I like and take notes. Just because focusing on the letters and the organization of the paper somehow helps my anxiety. So…. maybe I just have nice handwriting from so much practice.

Just something to think about..

(because I know you are now just DYING to see it — this is a clip from a food log of mine from… oh gosh, I don’t know, sophomore year of college?)

The Bread Basket Dilemma

This question (turned argument) was posed the other night… Often when you sit down at a restaurant your waiter will come and sit a basket of bread (or tortilla chips if you’re at a Mexican restaurant) on the table–correct? Now, maybe you are recovering from bulimia and that basket of bread is really triggering. Is it disordered to say to the waiter, “No thanks, we don’t need the bread”?

Therapists response: Yes that is disordered because you should be able to have the bread on the table. If you are intuitively eating, you should be able to eat a piece of bread if you want it, or leave the basket alone if you don’t. That’s “normal.”

My thoughts: No, that’s not disordered–that is taking active steps to avoid a potentially bad situation. By asking for the bread to be taken away, you are taking care of yourself. You are acknowledging that the bread will tempt you to binge and instead of giving in to that urge you are saying “no thank you.”

I don’t think that recovery is about being 100% “normal”… but rather more like 95%. If you’ve struggled with anorexia in the past, then no, maybe joining Weight Watchers will never be okay. Sure, you should be able to stop losing when it’s appropriate… but why take the risk? Think about alcoholism–if you’re in recovery, should you meet your friends at a bar for an evening? Yes, you should be able to refrain from drinking… but again, why set yourself up for disaster?

To use a non health-related example, let’s think about money. People design budgets so that they don’t overspend. Maybe you should be able to have all of your money in the same place (we’re not considering investment returns here), but most people need that kind of structure. A little planning can go a long way.

So what are your thoughts? Where do you draw the line between healthy and disordered?

Grey issues in Eating Disorders

Top 10 Eating Disorder Controversies:
(In my opinion, and not in order of importance)

1. Full recovery is possible (to the point of being “cured”)
2. EDs are symptoms of a deep-seeded childhood trauma or toxic environment
3. Treatment should not be forced upon those who don’t feel ready to recover
4. Weight gain goals should be 100% of ideal body weight
5. Meal plans and/or monitored exchange/calorie counting is necessary
6. Without working through the underlying psychological causes of the eating disorder, one cannot completely recover
7. Anorexia, Bulimia, and Binge Eating Disorder are all on one disordered eating continuum
8. Society is largely to blame for eating disorders
9. Spontaneous recovery is possible (without professional treatment)
10. The AN diagnosis should not be dependent on weight or menses