Now you can facebook-stalk your therapist

There have been many blog posts written on facebook and pro-anorexia, however, lately I’ve been thinking a lot about facebook and recovery in general.

Facebook is really unique in that EVERYONE (okay, almost everyone) is on it.  If you’re an eating disorder patient, this means your professionals, the other girls/guys you’re in treatment with, past patients, your school / work friends who may not know about your eating disorder, your family members, etc.  In what other realm do all of these people connect?

For most people, “Facebook stalking” means checking out what that guy you liked in high school is doing now (or some variation of that idea).  However, for anyone in eating disorder treatment, Facebook stalking can mean following up on the girls you were in treatment with or tracking down all of the professionals you’ve worked with.

Luckily, there are privacy settings.  Some professionals even know how to use them.

I was pretty convinced that facebook could be nothing but hurtful to recovery until a girl I used to be in treatment with told me how she and another woman used it to keep in touch.  There’s probably a 20-year age difference between the two girls (for the sake of this example, let’s call the older one Kristy and the younger one Jackie), but neither of them had a lot of support outside of their families.  In the evenings they would talk on facebook (something I haven’t gotten into yet — facebook messenger).  Kristy would see the unhealthy things about dieting that girls would post on Jackie’s wall, with prom coming up, and they’d talk about it.  Jackie saw all the cute pictures of Kristy’s kids.  Basically, it served as an outlet for both of them — something that was missing in their outside world.

Now, you could argue that this isn’t different than email or IM, but I don’t think that IM bridged the age-barrier in the same way that facebook is now.  IM also doesn’t have the public information that facebook has — you can’t see how others interact with someone.

So what do you think about facebook — helpful or harmful to recovery?  Staying in touch with people you were residential with could definitely be triggering (especially if they are not doing well and you have access to their photos), but having the support of people who have been great friends is also valuable.  And I’d love to know — do professionals ever search for their clients on facebook?  Just out of curiosity?  For the record, I have never tried to friend a professional myself — although I won’t lie, I have looked at a couple of profiles.

Food rituals – ED or OCD?

Food rituals are pretty common among individuals with eating disorders… cutting things into tiny pieces, chewing a certain number of time, mixing weird things, eating everything separate, picking food apart, etc.  I’ll be the first to admit that I’ve never been terribly successful in eliminating my own food rituals.  As I was miserably failing my goal to “eat a bagel normally” this morning, I was thinking about what it was that seemed so necessary about the rituals.

I don’t think that cutting food up changes the calories.  I don’t pick things apart because it makes me eat more slowly.  I don’t think that eating food with a fork makes it safe.  For some reason, though, being able to do the food ritual makes that food manageable.  It’s a nervous energy.  Not picking the food apart KILLS me (well, or so it feels).  I just feel so driven to do it.

So, my question is — where do you draw the line between ED food ritual and obsessive compulsive behavior?  Of course the two diagnoses cross paths, but not everyone with food rituals has OCD (and vice versa).  Is it a food ritual if you think the action makes the food safe or unsafe?  Or if you think that somehow it affects whether or not you gain weight?  Or is it only an OCD behavior if you have other OCD behaviors (checking, counting, etc.)?  Can you be diagnosed with OCD if you only have food rituals?  Is that enough of an obsession/compulsion?  And, if your food rituals are more of an OCD issue than an eating disorder issue, do you approach treatment for that differently?

I’d love to hear your thoughts on this!

Parents, personality, and eating disorder symptoms

There have been many studies on family dynamics and the development of eating disorders, but I think that this is the first that I’ve seen that takes the next step and makes connections with specific symptomology: The dynamic relationship of parental personality traits with the personality and psychopathology traits of anorectic and bulimic daughters

Before I go further, I want to make two disclaimers.  First, from the article:

…we cannot infer a casual relationship between the parents’ personality traits and the daughter’s personality or psychopathology.  Moreover, correlational analysis does not define a direction for these relationships.  Nevertheless, some of the parental personality traits were specific to eating-disordered daughters, suggesting that they may be relevant.

Second, I in no way believe that parents cause eating disorders (just want to make that clear before I get any attacking comments).  I do think that parental personalities are significant, though.  Not only do they affect your core beliefs but they also influence the relationships that you have with your parents… which affect all of your other relationships in life.

So, with that said, on to my commentary of the article!

The study used several scales (the Clinical Global Impression Scale, Beck Depression Inventory, Temperament and Character Inventory, and the Eating Disorders Inventory-2) to assess personality and ED symptomology in daughters and their parents.  Among these variables were BMI, overall functioning, disease duration, eating attitudes and severity of ED behaviors, depression, and temperament.  The Temperament and Character Inventory (TCI) was a large part of the study, and previous to this article I was largely unfamiliar with it, so I’ll briefly explain it at the end of the post.

In short, the personality of parents, personality of daughters, and ED symptoms were all analyzed.  Among the results, some of the more interesting were:

1. In AN-R, father’s persistence predicted the daughter’s age of ED onset.
2. Also in AN-R, novelty-seeking, body dissatisfaction, and interpersonal distrust were all affected by the father’s reward dependence.
3. Mother’s self-directedness affected novelty-seeking in AN-P and BN.  The same was not true for AN-R.
4. AN-P exhibited the most severe eating psychopathology.  These girls had the greatest body dissatisfaction, drive to thinness, and level of depression.
5. Women with AN-R were less concerned about body shape than both AN-P and BN.
6. The father plays a larger role in personality-based family dynamics of ED women (especially with AN-R).

There are a MANY more conclusions than just those in the study, but I could probably write a whole series on the findings.  I’m trying not to do that.  There are a couple more things that I want to mention, though.  First, the paper discusses the personality types of the ED-daughters.  If you are a family member and are feeling attacked by this point, you might want to read this section since it’s not very complimentary to those with EDs, either.  No one escapes the article feeling good:

Restricting Anorexics – stubborn, obsessive, self-determined
Purging Anorexics – impulsive, immature, disordered personalities
Bulimics – explorative, disorderly, conflicting
All EDs – frightened by potentially harmful stimuli, immature character, low self-acceptance, low resourcefulness, low self-esteem

Now, what’s the take-home message from all of this?  Well, I think that the article does a good job of explaining the role of family therapy in the treatment of eating disorders.  Specifically:

Counseling or family therapy may help modify specific aspects of the parent-daughter relationship to produce specific changes in eating symptoms.

I like the point about helping the parents in family therapy.  To change your relationship and your home environment, you have to help your parents.  The things that you learn from them are reflections of both their own core values and their personality traits.  When they are struggling with their own anxiety, negative body image, etc,., that translates.  I think that when you (the person with the eating disorder) is in therapy and are being told things like it’s important to take care of yourself, you have to cut yourself some slack, what you think and how you feel matters, you don’t have to listen to the messages of society, etc., that it’s hard to believe these things and take them as truth when the people around you don’t.  Will my dad ever work on his anger issues?  Probably not.  Do I think it would help both him and I?  Sure.  Is my mom ever going to let go of her own disordered eating tendencies?  Unlikely.  Would her being healthy being a good influence on me?  Yes.

There is clearly a link between parental personality, the daughter’s personality, and ED symptoms.  I think that family therapy that helps the parents with their own issues then allows them to form healthier relationships with their daughters, which helps with her ED recovery.

——————————–

The Temperament and Character Inventory (TCI)
Purpose: Instrument used for the dimensional assessment of personality, with four dimensions assessing temperament and three assessing character.

Temperament:

1. Novelty seeking – level of exploratory activity
2. Harm avoidance – efficacy of behavioral inhibition system
3. Reward dependence – maintenance of rewarded behavior
4. Persistence – ability to resist frustration

Character:

1. Self-directedness – view self as autonomous and integrated
2. Cooperativeness – view self as part of society
3. Self-transcendence – how self is integral part of the universe

Or maybe you’re just anorexic

I have been extra tired lately.  VERY extra-tired.  I go through spells of this and am always fairly convinced that there’s something wrong with me.  It’s not normal for someone to get eight hours of sleep and need one – two naps during the day.  I end up having conversations with my fiance like this:

grey: I think that I’m anemic.
fiance: oh?
grey: I have all the symptoms — fatigue, headache, difficulty concentrating, pale skin, leg cramps…
fiance: Funny, those sound like the same symptoms of anorexia.

Then, the next month…

grey: I think I have hypothyroidism.
fiance: You don’t say.
grey: No, really — I have all the symptoms.  fatigue, dry hair, pale skin, cold intolerance, muscle cramps, depression, abnormal menstrual cycles….
fiance: Kinda like anorexia.

And again….

grey: I think I have mono.
fiance: Let me guess — lack of energy, loss of appetite and chills.
grey: Exactly!
fiance: You don’t have mono, you have anorexia.
grey: I could have anorexia AND mono.
fiance: Do you have a severe sore throat?
grey: Well…. not YET….

Humph.  He is right — these could all be consequences of the eating disorder.  For the most part I know this, but whenever I feel overly tired of cold or crappy, I really feel like it must be something else.  My eating isn’t particularly worse that day — why should I feel worse?

I think that I forget that how I treat (or mistreat) my body compounds over time.  If my eating has been off-track for the past three ways, having a great day today isn’t going to guarantee that I feel okay.  And, even on a larger scale, I think that years of disorderedness has taken a toll on my body.  My eating disorder is nowhere near as severe as it was back in high school, but I still haven’t been 100% over the years.  Now I notice how prone to headaches I am (very prone), how I often have stomach aches, how dysfunctional I am on minimal sleep, etc.  I can’t get away with the things that I used to be able to.  Because my weight is higher and I’m eating more, this doesn’t make sense to me — clearly something ELSE must be wrong with me (like anemia or hypothyroidism or mono).  But… maybe all the years of the eating disorder has taken a toll on my body.  Beyond the bone density and menstrual issues, maybe I am just not as resilient as I once was.

However… I am still going to have labs done at some point to rule everything out.  You know, just in case…. (and in secret hopes of proving my fiance wrong!)

Or maybe you're just anorexic

I have been extra tired lately.  VERY extra-tired.  I go through spells of this and am always fairly convinced that there’s something wrong with me.  It’s not normal for someone to get eight hours of sleep and need one – two naps during the day.  I end up having conversations with my fiance like this:

grey: I think that I’m anemic.
fiance: oh?
grey: I have all the symptoms — fatigue, headache, difficulty concentrating, pale skin, leg cramps…
fiance: Funny, those sound like the same symptoms of anorexia.

Then, the next month…

grey: I think I have hypothyroidism.
fiance: You don’t say.
grey: No, really — I have all the symptoms.  fatigue, dry hair, pale skin, cold intolerance, muscle cramps, depression, abnormal menstrual cycles….
fiance: Kinda like anorexia.

And again….

grey: I think I have mono.
fiance: Let me guess — lack of energy, loss of appetite and chills.
grey: Exactly!
fiance: You don’t have mono, you have anorexia.
grey: I could have anorexia AND mono.
fiance: Do you have a severe sore throat?
grey: Well…. not YET….

Humph.  He is right — these could all be consequences of the eating disorder.  For the most part I know this, but whenever I feel overly tired of cold or crappy, I really feel like it must be something else.  My eating isn’t particularly worse that day — why should I feel worse?

I think that I forget that how I treat (or mistreat) my body compounds over time.  If my eating has been off-track for the past three ways, having a great day today isn’t going to guarantee that I feel okay.  And, even on a larger scale, I think that years of disorderedness has taken a toll on my body.  My eating disorder is nowhere near as severe as it was back in high school, but I still haven’t been 100% over the years.  Now I notice how prone to headaches I am (very prone), how I often have stomach aches, how dysfunctional I am on minimal sleep, etc.  I can’t get away with the things that I used to be able to.  Because my weight is higher and I’m eating more, this doesn’t make sense to me — clearly something ELSE must be wrong with me (like anemia or hypothyroidism or mono).  But… maybe all the years of the eating disorder has taken a toll on my body.  Beyond the bone density and menstrual issues, maybe I am just not as resilient as I once was.

However… I am still going to have labs done at some point to rule everything out.  You know, just in case…. (and in secret hopes of proving my fiance wrong!)

The worst parts of eating disorders

The National Council for Community Behavioral Healthcare and AstraZeneca conducted a really interesting survey on the impact of bipolar depression on people’s lives.  There were a couple of points in the study that really caught my attention:

• The greatest concerns among people living with bipolar disorder are that their symptoms will have an impact on daily life, such as family, relationships, or job (73%), and that they will have long periods of depressive episodes (63%).
• Ninety percent of people living with bipolar disorder said that they have difficulty managing or completing day-to-day tasks due to their bipolar depression symptoms.
• When asked how they felt most of the time, only 27 percent of people living with bipolar disorder said they felt well-balanced and just 23 percent felt their depression was well-controlled.
• The majority of people living with bipolar disorder agreed that bipolar depression causes difficulty in their ability to manage housework (73%), run errands (59%), groom themselves (53%), and pay bills (49%).
• Sixty-one percent of people with bipolar disorder said their depressive episodes last longer than their manic episodes
• Fifty-three percent of people living with bipolar disorder agreed that they would rather feel “less than perfect” than go through another medication switch.

These findings got me thinking — what are/were the most disturbing effects of the eating disorder on my life?  I would have to say….

• Constant preoccupation with food that took away from my ability to concentrate on school / work.
• Low blood sugar and tiredness that further inhibited my school / work efforts.
• Heightened depression, anxiety, and panic attacks.
• Tension among family members due to their frustration/concern and my irritability.
• Avoidance of most social situations in fear of the event involving food.
• Isolation from friends.
• Lack of interest in all hobbies and many relationships, and. the inability to motivate myself to care about the things I once cared about.

I could probably make a list three-pages long, but these are probably some of the most upsetting elements of the eating disorder.  It would be interesting to see a similar survey to the Bipolar Depression Treatment Dynamic conducted for EDs.

It’s Your Reality

“You get to define which experiences are traumatic for you, whether or not it would impact others in the same manner.  It’s not the objective facts that determine whether an event is traumatic,  but your own emotional experience of the event.”

— Dr. Kathleen Young

This is just a quick post, but I read this on a trauma blog tonight and thought it was so well-put.  This is something that i struggle with a lot — whether or not something “counts” as significant.  Maybe I am making it up.  Maybe it was no big deal and I should have been fine.  Maybe I am fine and am just crying wolf.

I’m not even limiting this to trauma — of course I can extend it to eating disorders, too (because I have to somehow relate everything to eating disorders, or so it seems).  There’s always that fear that maybe I’m not sick enough to actually need help.  It’s not that I want to be sicker; I’m just afraid of asking for help that isn’t justified.  What if someone else in my position wouldn’t need help?  What if I’m actually okay-enough?

It is such a good reminder for me that my “own emotional experience” is my reality — and in the end, that’s what is important.  Regardless of whether or not it should “count” as significant, it affects me, my sense of self, my relationships, and my future.

It's Your Reality

“You get to define which experiences are traumatic for you, whether or not it would impact others in the same manner.  It’s not the objective facts that determine whether an event is traumatic,  but your own emotional experience of the event.”

— Dr. Kathleen Young

This is just a quick post, but I read this on a trauma blog tonight and thought it was so well-put.  This is something that i struggle with a lot — whether or not something “counts” as significant.  Maybe I am making it up.  Maybe it was no big deal and I should have been fine.  Maybe I am fine and am just crying wolf.

I’m not even limiting this to trauma — of course I can extend it to eating disorders, too (because I have to somehow relate everything to eating disorders, or so it seems).  There’s always that fear that maybe I’m not sick enough to actually need help.  It’s not that I want to be sicker; I’m just afraid of asking for help that isn’t justified.  What if someone else in my position wouldn’t need help?  What if I’m actually okay-enough?

It is such a good reminder for me that my “own emotional experience” is my reality — and in the end, that’s what is important.  Regardless of whether or not it should “count” as significant, it affects me, my sense of self, my relationships, and my future.

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.

Due next week: Therapy homework

Once in awhile, my therapist assigns me homework — usually for one of several reasons:

1. We only had time to touch on a subject in therapy and she wants me to keep thinking about it to flesh it out.
2. She wants to keep better track of my symptoms and I’m not very good at bringing up bad days (not because I’m manipulative and want to hide it from her, but because I never feel it’s “bad enough” to bring to her attention).
3. There’s something that I’m not able to say in person, and can much better articulate in writing.

I’m not anti-therapy homework, because it really is easier for me to write than to talk.  We started to talk about this in the comments of my last post, but I feel less uncomfortable and/or vulnerable when writing about issues than when talking about them.  Also, it’s helpful for me to be able to write and re-write my thoughts — I can spend 3 hours on that homework assignment if I want.  I can go back to old journals and do “research” (only I would come up with research for therapy homework!).  And…. I don’t have to necessarily be there when my therapist reads it, which means I don’t have to deal with the heavy emotions.

At the same time, though, I think a major problem with therapy homework is that it IS done at home.  Sometimes, if it’s a tough assignment, I end up really upsetting myself.  It’ll be 11:00pm and I’ll be sitting in my bedroom with old journals and reading things that I really should just burn.  My therapist isn’t there.  It could be a week until I see my therapist again.  Sometimes I’m still upset the next day, and it does affect my eating or mood.

Maybe I should put off any assignments until a couple of hours before therapy….