Size sometimes matters

Laura Collins raised a GREAT question today — Does (mom’s) size matter? While I have a lot to say about the matter, two main points come to mind:

1. Mothers with eating disorders
I think that your mother’s weight and behaviors surrounding food are much more relevant in recovery than in the downward eating disorder spiral. Parents model for their kids — I’d argue that this is even true for adult kids (adult kids, ha — you know what I mean). While I think that the eating habits of everyone around you definitely influence your own, there is something about mom’s that sets the bar.

In recovery, you’re feeling particularly self-conscious about weight and food. You are looking around at others to figure out what “normal” is. You are also overly conscious of the size of everyone around you — as well as what they’re eating.

So… what if your mother is anorexic? Or, not necessarily even anorexic, but what if she is health-obsessed or a compulsive over-exerciser? You’re trusting your dietitian when she says that ALL women do need xxxx calories, and trusting your therapist when she explains that disordered eating is unhealthy and a poor coping mechanism. Maybe you’re still trying to convince yourself that you DO have an issue (denial = a large part of EDs) or that treatment is important.

And then there’s mom — who is underweight and not eating xxxx calories a day (not that you’re counting your mother’s calories). And she seems okay… and it’s not a problem for her… so why is it a problem for you?

You want your mom to be the parent. You want her to model what you’re supposed to do, because you don’t really know (or trust) what you’re supposed to do. Recovery is hard enough without having to wrestle with this size double standard. I don’t think it really matters what “size” your mother is, as long as she isn’t unhealthily underweight and/or actively losing weight while you are trying to recover.

2. Families changing their eating because of your ED
I’ve always been afraid that my eating habits would rub off on my family (or something like that) and change their eating. I guess I never really worried about my mom gaining weight while I was gaining weight… but with all the focus on the eating disorder, would my mom or sisters suddenly become more food and weight conscious? Or — would anyone pick up some of my ED tendencies?

It’s somewhat unfortunate that eating disorders don’t exist in a vacuum. I do think the size of people around you affect your perception and expectations of your own size. I also worry that eating disorders hurt families in several ways — maybe one of them being and increased obsessiveness over food and weight. And, if that is the case — I hope that doesn’t last.

Art therapy for everyone

I am officially the LAST person to blog about this study, but my thoughts seem to be pointed in a different from the other posts that I’ve read.

The Psych Central article, “Half of Young Adults Have Mental Disorder,” states the following:

“A total of 45.8 percent of college students and 47.7 percent of young adults not in college met the criteria for at least one psychiatric disorder.

The most common disorders in college students were alcohol use disorders (20.4 percent) and personality disorders (17.7 percent), whereas those not in college most frequently met criteria for personality disorders (21.6 percent) and nicotine dependence (20.7 percent).”

Now personally, I don’t lump alcohol use disorders and nicotine dependence under the umbrella of psychiatric disorders. Definite health problems — yes. Addictions — sure.

I think that Health News explained these results much more accurately:

“The effects of today’s lifestyles are taking some telltale tolls on many, and most especially on young adults. A recent analysis of more than 5,000 young people between the ages 19 to 25 has revealed that almost 20 percent of young adults in America have psychiatrics disorders that interfere with their everyday lives. Furthermore, the percentages of young adults who are abusing alcohol or drugs are even higher.”

20% is still a pretty alarming statistic, especially since the study found that “less than 25 percent of these college-aged youngsters who suffer from mental problems actually seek treatment.”

Laura Collins blogs that “it is obviously NORMAL if half of young adults have mental disorders.” Personally, I feel that when a majority of individuals of a disorder, that it is time to redefine “disorder.” Think, what if we considered yo-yo-dieting a diagnosable eating disorder? It’s definitely unhealthy and probably stems from personal issues, cultural expectations, other mental health issues, etc. but is it a disorder?

My point is that maybe the baseline of “normal” needs to be adjusted. I guess that there are two ways that you could approach this… either say that the quality of “normal life” should be lower (aka: moderate depression, anxiety, and substance abuse being the norm) or that society as a whole should be healthier.

Making society healthier is clearly the harder option. However, the first option of just accepting a degree of mental illness as a fact of life, is pretty depressing.

I would never say that all of these mentally-ill college students shouldn’t receive help… but I think when percentages start to reach this magnitude you need to look at global changes rather than specific, individual treatment. It is impractical (and nonsensical) to try and setup each of these kids with a therapist, psychiatrist, group therapist, etc. Counseling centers are already overloaded — no way could they handle that.

There is a lot of talk about the stigma that surrounds mental illness and its corresponding treatment. I don’t think that you can wait for this to subside to make mental health treatment more available, though. It needs to work in the opposite direction — first make treatment more common and easily accessible.

I think that college kids are much more open to getting help than others realize. My school had “stress reduction” as a PE class — and it was ALWAYS full. It was probably one of the hardest classes at the University to get into. Why aren’t there five of them? Why isn’t there a stress reduction group at the counseling center? I guarantee you that if there were a pre-med support group, that it would be packed. The pre-med track is stressful and probably causes a lot of the anxiety, depression, insecurity, and whatever else that causes more significant mental illness.

Why aren’t there art therapy groups at Universities? I was in IOP during my freshman year and my two best friends would kid that they wanted to make up eating disorders so that they could go to art therapy, too. Why do you have to have a significant mental illness to go to art therapy? Everyone could come up with something to process.

The system is setup so that you have to be sick to get help. The mental illness stigma is encouraged by the barriers to treatment. Seriously, create a program of “supportive groups” — regular misc. process groups, art therapy, stress relief groups, career-centric groups, psychodrama, grief & loss therapy, relationship issues group — whatever! I swear that students will come. If you offer a little more support to everyone, then treatment will seem less weird and fewer people will reach the point of needing intensive help.

A different definition of “normal”

While it may have just been a “thought experiment,” it was great to read this post from Laura Collins. As I mentioned in my Dr. Drew entry, I think that eating disorder recovery and long-term maintenance needs to be taken as seriously as other addictions. Using even once isn’t okay… so why is losing a pound?

I think that cutting corners signifies a change in mindset. It doesn’t matter if you’re still technically eating a normal amount of calories… if you’re not following your meal plan, you’re restricting. Sure, there are some behaviors that are just habitual… but for the most part, the behaviors are going to follow your thoughts. So, if you’ve been cruising along pretty well in recovery for awhile… and then start occasionally skipping little things… that is significant.

My question now is… is skipping a meal every once in awhile maybe normal? And if it is… does that make it okay for someone with an ED history to skip a meal on occasional? Or, are they never able to have that degree of flexibility because of their past and genetic predisposition?

I’ve been visiting family this past week. On the drive up here (9 hours), my boyfriend decided he wasn’t getting lunch — not hungry. I wasn’t terribly hungry and wans’t about to stop and eat by myself. By the 5th hour of the trip, though, I was ready to have a breakdown (I’m sure low blood sugar was no helping) over my boyfriend skipping lunch. He definitely doesn’t have an eating issue, but I still need the people around me to eat normally ALL the time.

Am I capable of just skipping an occasional meal — assuming that’s normal? I guess missing one meal isn’t a big deal. But what kind of parallel can you draw between than a drug/alcohol addiction? Will I feel the need to restrict again? Will I feel like it’s justifiable because other people skip meals?

The lines between healthy and unhealthy, normal and eating disordered, are all blurred. Is there less of a grey area if you’ve struggled with an eating disorder in the past? Could someone else’s habits be fine for them, but disordered for me?

A different definition of "normal"

While it may have just been a “thought experiment,” it was great to read this post from Laura Collins. As I mentioned in my Dr. Drew entry, I think that eating disorder recovery and long-term maintenance needs to be taken as seriously as other addictions. Using even once isn’t okay… so why is losing a pound?

I think that cutting corners signifies a change in mindset. It doesn’t matter if you’re still technically eating a normal amount of calories… if you’re not following your meal plan, you’re restricting. Sure, there are some behaviors that are just habitual… but for the most part, the behaviors are going to follow your thoughts. So, if you’ve been cruising along pretty well in recovery for awhile… and then start occasionally skipping little things… that is significant.

My question now is… is skipping a meal every once in awhile maybe normal? And if it is… does that make it okay for someone with an ED history to skip a meal on occasional? Or, are they never able to have that degree of flexibility because of their past and genetic predisposition?

I’ve been visiting family this past week. On the drive up here (9 hours), my boyfriend decided he wasn’t getting lunch — not hungry. I wasn’t terribly hungry and wans’t about to stop and eat by myself. By the 5th hour of the trip, though, I was ready to have a breakdown (I’m sure low blood sugar was no helping) over my boyfriend skipping lunch. He definitely doesn’t have an eating issue, but I still need the people around me to eat normally ALL the time.

Am I capable of just skipping an occasional meal — assuming that’s normal? I guess missing one meal isn’t a big deal. But what kind of parallel can you draw between than a drug/alcohol addiction? Will I feel the need to restrict again? Will I feel like it’s justifiable because other people skip meals?

The lines between healthy and unhealthy, normal and eating disordered, are all blurred. Is there less of a grey area if you’ve struggled with an eating disorder in the past? Could someone else’s habits be fine for them, but disordered for me?

It’s not just genetics

One of these days, I will start a “Grey’s take on the Maudsley Method” series. Not because I think that it’s wrong or right, but just because I think it’s really interesting and have a lot to say about it.

In the meantime though, I want to highlight a quote from Laura Collins’ article, “The size of the trigger or the speed of the bullet?”

An eating disorder is not a sign of deep wounds, but some people do have deep wounds, and it makes recovery harder.

I’m curious — this this a “duh” statement for everyone treated with the Maudsley Method? Because it basically goes against all of my inpatient and outpatient treatment, formal education, and research. Just to quote a few of the institutions, professionals, and resources I’ve had experience with:

“Eating disorders are serious health- and life-threatening physical disorders that usually stem from some underlying emotional cause.” – The Renfrew Center

“Genetics make the gun, environment loads it, and that an experience of unbearable trauma is what actually pulls the trigger.” – Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

“Eating disorders are real, treatable medical illnesses with complex underlying psychological and biological causes.” – National Institute of Mental Health

If you don’t see my point by now… it’s that I have always been told, eating disorders are not about the food. They’re a symptom, coping mechanism, etc. of something else.

That said, I don’t think that everyone has trauma… I’m not a fan of repressed memory therapy, because I think a lot of it is made up (or generated in the process).  Ruminating on traumatic events prolongs mental illness.  You can’t change what happened to you when you were three.  This is all true… but I also think that some people are using food to subconsciously avoid feelings/situations related to previous trauma, and in those cases, they need to be resolved in therapy.

I like Aimee Lui’s perspective on the matter.  You NEED the genetic component to develop and eating disorder.  They don’t really just happen to people.  Even if you have the genetic component, though, growing up in a wonderful environment can be protective.  I refuse to believe that you just inherit the anorexia gene and you’re doomed for a life haunted by an eating disorder (and if that’s the case, then I should never have children given my family history).  There IS a strong genetic component… but in all these genetic studies, you also have to consider environment!  Chances are, these kids are growing up with semi-similar relationships as their parents did.  There are just too many variables.

Anyway, I think that given genetics, environment CAN be enough… but for many people, it’s the unbearable stressing event that pushes them over the edge.  Those are the people with the trauma history.  So, regardless of whether or not you have a history of trauma, you at least have underlying relationship/environment issues to address

It's not just genetics

One of these days, I will start a “Grey’s take on the Maudsley Method” series. Not because I think that it’s wrong or right, but just because I think it’s really interesting and have a lot to say about it.

In the meantime though, I want to highlight a quote from Laura Collins’ article, “The size of the trigger or the speed of the bullet?”

An eating disorder is not a sign of deep wounds, but some people do have deep wounds, and it makes recovery harder.

I’m curious — this this a “duh” statement for everyone treated with the Maudsley Method? Because it basically goes against all of my inpatient and outpatient treatment, formal education, and research. Just to quote a few of the institutions, professionals, and resources I’ve had experience with:

“Eating disorders are serious health- and life-threatening physical disorders that usually stem from some underlying emotional cause.” – The Renfrew Center

“Genetics make the gun, environment loads it, and that an experience of unbearable trauma is what actually pulls the trigger.” – Lui, Aimee. Gaining: The Truth About Life After Eating Disorders.

“Eating disorders are real, treatable medical illnesses with complex underlying psychological and biological causes.” – National Institute of Mental Health

If you don’t see my point by now… it’s that I have always been told, eating disorders are not about the food. They’re a symptom, coping mechanism, etc. of something else.

That said, I don’t think that everyone has trauma… I’m not a fan of repressed memory therapy, because I think a lot of it is made up (or generated in the process).  Ruminating on traumatic events prolongs mental illness.  You can’t change what happened to you when you were three.  This is all true… but I also think that some people are using food to subconsciously avoid feelings/situations related to previous trauma, and in those cases, they need to be resolved in therapy.

I like Aimee Lui’s perspective on the matter.  You NEED the genetic component to develop and eating disorder.  They don’t really just happen to people.  Even if you have the genetic component, though, growing up in a wonderful environment can be protective.  I refuse to believe that you just inherit the anorexia gene and you’re doomed for a life haunted by an eating disorder (and if that’s the case, then I should never have children given my family history).  There IS a strong genetic component… but in all these genetic studies, you also have to consider environment!  Chances are, these kids are growing up with semi-similar relationships as their parents did.  There are just too many variables.

Anyway, I think that given genetics, environment CAN be enough… but for many people, it’s the unbearable stressing event that pushes them over the edge.  Those are the people with the trauma history.  So, regardless of whether or not you have a history of trauma, you at least have underlying relationship/environment issues to address