Saturday, September 27, 2014

Don't wait for an earthquake to shake you into action.

I was talking to a guy from San Francisco this week, and the subject turned to earthquakes. This long-time SF resident and survivor of the big quake of 1989 offered some very practical advice for me to share with my son, a San Francisco newbie, fortunately naïve about the seriousness of going through an earthquake. His focus was not on what to do during the crisis—although that advice is critical as well—but rather what to do before hand. How to be prepared for this challenging situation, because being prepared, as he put it, is the surest way to increase survival.

Imagine that while sitting and discussing such matters my mind moved to you, my dear readers. No, there’s no need to worry about earthquakes for most of you. Rather, the subject of preparedness as a means to ensure survival and minimize damage struck me as most fitting—whether you struggle with an eating disorder or living free of diet rules.

Have a plan, he said. In San Francisco that might mean knowing which are the secure places to hover—the solid doorways and tables to stay under. But before it strikes, he emphasized that it’s critical to have an action plan: to keep cash on hand—because you never know when you’ll need it and ATM machines simply don’t work in these situations. Have a plan for communicating with those you’re close with—because electric doorbells to apartment buildings will fail and telephone lines other than landlines will fail. A transistor radio helps you connect with the world—to reality check what’s going on outside of your own limited space. You’ll need light of course—so batteries and flashlights need to be stashed to access easily.  And of course a supply of non-perishable food as well as water. Decision-making when undernourished will surely be compromised.

Time to come out of hiding and ask for what you need.
You can guess where I’m going with this. Yes, the analogy applies to you who are metaphorically on no greater solid ground. Communication is key to survival, and planning for opening these channels is critical. Can you tell your partner you’re struggling? Can you ask for help shopping and cooking to ensure your health and nourishment? Can you simply say “I need a place to eat dinner tonight?” Can you ask them to keep the pastries off the counter when you are trying to avoid impulse eating? Can you ask for a referral to a therapist or a behaviorally oriented dietician?

Where’s your transistor radio, so to speak, your exposure to the world outside of your own thoughts? Admittedly the cultural media may not be the most fitting reality check for sane thoughts, for diet-free messages, unfortunately. What I mean is that you need exposure outside of your own disorder thoughts—someone that can ground you when you are limited inside your own space. Were you really happier when you were so much thinner? Did staying on that crazy diet truly improve your quality of life? Your mental health? Or are you using magical thinking like the way we recall old boyfriends/relationships, fantasizing about how awesome it all was--when really it was nothing of the sort? Do you think you’ll restrict just for now and then be able to simply normalize your eating? Think again!

Do you have a grounding place to run to—your doctor, therapist, dietician, perhaps even a higher level of care—if your foundation is shaking? Do you have ready to eat food for when resources are tough to come by? A reserve for when, due to all the stress, your ability to organize and think through what’s best to eat may be impaired?

Where will your light come from when the power goes out? Do you recharge with talk therapy, or maybe yoga or meditation? Do you get spiritual support or guidance from wise friends or loved ones?
You may get no warning before the quake, before the shake up to your healthy behaviors and thoughts. So have a plan. Be prepared.

What steps will you take? Please share—we can all use to hear some ideas!

Read more about slips and relapses:

Sunday, September 7, 2014

It's your mom's fault? Words and genes: what we can do about eating disorders

It's all your mother's fault.
Really, it's about lack of approval from your dad.
If you're a boy or a man, it must mean you're gay.
If you aren't underweight you certainly don't have anorexia.
As long as you're eating healthy foods, you're okay.
It's simply a choice.
Once you've had it, you'll never truly recover.
It's all about appearance and weight.
You have to be ready to recover.

True statements? Not at all. These commonly held misbeliefs about eating disorders do only harm. They minimize the complexity of eating disorders and the struggle of those suffering with anorexia, bulimia, and binge eating disorder. 

They prejudice everyone from those living with an eating disorder, to providers treating those they may or may not know have eating disorders. 

They lay guilt on parents who may be among the best supports for their kids in recovery, as evidenced by the FBT model. 

They stereotype people based on weight--as if BMI alone determines severity of eating disorders! My normal weight patients who subsist on 400 calories surely know better. As do those of my disordered obese patients who have struggled with size discrimination for most of their lives and are no less free of obsessive thoughts, patterns of severe food restriction and symptoms of starvation. Yes, weight, size and appearance mislead.

And if we wait until someone is "ready" to recover, it just might be too late. Yet just these past weeks I've heard that this was the guidance conveyed by a therapist 'treating' a patient with an eating disorder--"you've got to wait until you're ready" they were foolishly advised; no, undernourished people don't tend to make the wisest and healthiest decisions. That's right up there with the wisdom of the cardiologists who recently minimized the very serious risk of severely restricting intake; suggesting no need for worry because Sara was not actively purging (simply overexercising and restricting) or that Dan's low heart rate must just be a result of being an athlete (a starved one, that is, with a low metabolic rate).

Yes, there is work to be done.

Eating disorders need science, not stigma

Here's yet another brilliant idea from Cate Sangster (the first I'm familiar with is her suggestion for an eating disorder recovery cookbook, which we created to great acclaim--food to eat). This time, in recovery, Cate puts her social media savvy and creative thinking to great use with this ice bucket alternative to help us get answers about eating disorders. Like Cate, I support Dr. Cynthia Bulik's move to create a genetic database to better understand eating disorders, and the organization, Charlotte's Helix which was created to help make it happen. In the US, check out this link to ANGI to donate. Please check out the resources on this site as well, to arm you with correct information about eating disorders.

"Learn From Genes, Not Jeans, About Eating Disorders."
I have followed Cate's lead with my educating arm (pic on right), and encourage you all to do the same--and to donate $20 to Charlotte's Helix or ANGI or other worthy eating disorder organizations. Share your pics  on Twitter, Pinterest and Facebook, too!