Wednesday, March 18, 2020
Mortality and risk assessment for anorexia nervosa in acute-care hospitals: a nationwide administrative database analysis
Clients and Clinicians Facing Fears: Exposure Therapy for Eating Disorders
By Kelsey E. Clark, MS Posted in Gurze Eating Disorders Review 2/2/20
Background
Fear is a normal emotional response that occurs when we feel threatened. We perceive a threat, and to protect ourselves we try to avoid the feared situation. In some cases, fear and avoidance lead to significant distress and interfere with our daily lives. For example, they can get in the way of work/school or damage our relationships. When this happens, this may indicate a person has a mental illness. Many individuals with eating disorders have fears related to eating, shape, and weight. A person may fear fatness or may fear perceived consequences of fatness, such as social rejection. Such fears are often behind eating disorder thoughts and behaviors.
Exposure therapy immerses individuals in situations so they confront experiences they fear or avoid. This facilitates learning new associations with the feared/avoided things. Exposure therapy is strongly supported by research for treating anxiety and fear-based disorders such as specific phobias, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, and social anxiety disorder. For example, imagine exposure therapy for someone who has a specific phobia of spiders: The therapy client and clinician would work together to decide on situations so the client can face their fear. They might look at photographs of spiders, videos of spiders, be in the same room as a spider, and even hold a spider. This way, the client’s feared expectancies about what will happen can be challenged. Clients can see that they are able to tolerate anxiety, distress, and uncertainty.
Exposure therapy also has a growing evidence base for treating eating disorders. In eating disorders treatment, exposure therapy looks different from one person to another. A client might eat feared/avoided foods, induce urges to binge eat, induce urges to use inappropriate compensatory behaviors such as purging, or induce physical sensations such as feelings of fullness. They could also break eating rituals, confront their reflection in the mirror, imagine and describe in detail the experience of gaining weight, or stop using a body checking behavior. This explores and challenges the client’s feared outcomes. Feared outcomes look different from one person to another. Clients might fear they will immediately or ultimately gain weight, will be unable to stop eating, will experience unrelenting physical discomfort, or will experience never-ending emotional distress. Facing these fears violates these expectancies! Clients then learn they can tolerate and make it through these uncomfortable situations. By riding out the wave of fear, clients can reach treatment goals and live the life they want to live.
The Problem
Despite strong research support, many clinicians do not use exposure therapy. Research has found that many clinicians are nervous about exposure therapy. Apprehension is understandable—at first glance, exposure therapy sounds like the opposite of what clinicians want to do! Exposure therapy makes clients uncomfortable and distressed, when clinicians’ goal is to help clients to feel better and live by their values. Many clinicians fear that exposure therapy will cause clients to drop out of treatment, that they won’t be able to complete exposures, or that it will be intolerable to clients. Prior studies have debunked such concerns that exposure therapy is infeasible or unacceptable. Yet, exposure therapy remains underused.
The Research Study
As part of a larger eating disorders treatment study, we developed a novel three-session exposure therapy module. This treatment is individualized to address clients’ core fears. The treatment also provides opportunities for clients to practice skills they learn in treatment: emotion awareness, emotion regulation, and emotion tolerance. The present study aims to explore the feasibility and acceptability of this eating disorders exposure therapy module and explore the concerns of clinicians. We predicted that the exposure therapy would be feasible—that is, practical to use and able to be fully delivered as planned. We predicted that it would be acceptable—that is, judged as suitable and useful, and that clients would respond positively to it. A sample of adults with bulimia nervosa completed the exposure module. The treatment module included three exposures and one mood induction exercise intended to heighten emotions for the exposure. We used a mixed methods approach to comprehensively examine qualitative and quantitative data. We completed video coding of therapy sessions and analyzed questionnaires clients and clinicians answered before and after each session.
The Results
Broadly, our results indicated that the treatment is feasible and acceptable, as we hypothesized. On average, clinicians were able to complete the exposures as planned. Clients brought necessary supplies with them for exposures most of the time. We found that no clients dropped out of treatment immediately following the exposure sessions. We found that clients appeared to understand the rationale behind exposures and believed it was helpful. Clients expressed strong satisfaction with the exposure session content and strong satisfaction with their clinicians. One client stated that exposure was an “uncomfortable experience but also powerful.” Another client reported that exposure therapy was “extremely helpful, because [they] had to learn to sit with negative feelings.” These results support that it is possible to treat eating disorder clients with exposure therapy and that clients will judge it positively. With these initial results, we will be able to update and refine the treatment before examining the treatment in future research studies and disseminating it on a larger scale.
The Research Implications
Our findings support previous research and indicate that exposure therapy has untapped potential in treating eating disorders. Future work will continue to explore the efficacy of exposure therapy and explore why exposure therapy works. We will also explore how to spread the word about exposure therapy so that more clients and clinicians are aware of it. We will learn how best to address myths and misconceptions about this type of treatment. Our results indicate that instead of avoiding exposure therapy, clinicians should approach exposure therapy with the same degree of psychological flexibility they aim to foster in their clients.
Conclusion
The idea of facing our fears certainly sounds frightening! This is true for clients and clinicians alike! However, exposure therapy is based on the idea that continually avoiding things we fear robs us of the chance to learn that our fears won’t necessarily come true. This avoidance perpetuates our problems when fear/avoidance get in the way of the life we want to live. By approaching the things we fear instead of avoiding them, we learn how to accept the discomfort and uncertainty that are a normal part of life.
The Familial Red Flag
By Kate Funk, MFT, LMFT
Posted in Gurze Eating Disorder Review 2/2/20
I was in treatment for an eating disorder and remember having zero insight into what caused my eating disorder. I had no clue how my family dynamics may have contributed to my behaviors or cognitions. I had no idea how my Dad’s anger and frequent travel or my Mom’s depression and disordered eating affected me. I remember the other clients dreading family therapy and I questioned what was so hard about it. I didn’t have any understanding that my family could be a part of the problem. I couldn’t imagine anything being involved in the development of my eating disorder other than my low self-esteem and a desire to be thin. As I soon learned, the reality is that eating disorders are much more complex than self-esteem or a society placing importance on a specific physique. Our environments, experiences and culture all influence the development of eating disorders and must be addressed in order to successfully heal from them.
My parents had known each other since they were 11 years old and decided to announce their divorce post my leaving residential treatment. Coincidence? Probably not. In no way am I blaming my parents for my eating disorder or my recovery on their divorce, but I do believe that the environment in which I grew up played a role in the development of the disorder. The family therapy we went through helped my parents gain insight into their own work, which allowed them to see how their marriage wasn’t what it once was. Eating disorders can be red flags that something in the family system isn’t working. That was certainly the case for my family. My illness served as the official announcement that we needed help as a family and it was the catalyst for family therapy and my parents own individual therapeutic work.
I remember my Dad struggling with guilt in a family session pleading, “I gave you everything – vacations, cars, clothes, everything you ever wanted and now I am to blame!” It’s not about blame, but is about how certain environments can hide or nurture the eating disorder. My parents had given me every opportunity a parent could dream of giving. But, I came to learn I am very sensitive and pick up on everyone’s emotions and feel things quite deeply. I internalized my parents’ problems as my own. I worried about my Mom’s mental health and internalized my Dad’s anger to be about me, and my eating disorder was the perfect escape. I remember telling my Dad things that happened may not have affected others the way they affected me, but with my temperament my parents’ unhappiness became my own. The development of the disorder requires the perfect storm of temperament, biology, personal psychology, environment, and events that occur in our lives. Those realizations were probably the most important part of my treatment; they allowed me to let go of the guilt and recognize I wasn’t broken beyond repair … that everyone in my family had a role to play and that we could all work as a team together to heal. No one person causes an eating disorder, but the perfect storm of events must occur to create one.
These stereotypical nuclear family anecdotes are most likely not helpful for older adults with eating disorders, but more than likely the seeds of the eating disorder were there much before adulthood. Striving for perfection, comparison in the family, feelings of not being good enough, and family secrets can certainly impact the way we grow and become adults. Adults with eating disorders often find themselves in family dynamics that contribute to or hide the disorder, as well. High achieving couples, emotional avoidance, physical or emotional distance, and traditional gender roles can certainly impact the development or maintenance of the eating disorder. Often adults in recovery are able to change their cognitions and extinguish their behaviors but the same environments where the disorder thrived is certainly not likely to promote change and wellness.
It is important and highly recommended that family therapy be a part of treatment for adolescents, but family therapy is imperative for any person in recovery. If someone is being asked to change everything about the way they think and behave in their daily life, how are they going to sustain these changes if everything around them is exactly the same? It is possible, but the odds are certainly against them. Secrecy, shame and certain family dynamics that maintain the secrecy and shame are breeding grounds for eating disorders and it’s critical for recovery to move beyond them. I encourage all people with eating disorders to have family therapy to help each member of the family learn their role in order to help themselves and the client heal.
Eating disorders are an opportunity for all family members (whoever they might be – significant others, close friends, extended family, etc.) to reflect on their role in any dynamics that may have contributed to the development of the eating disorder. Taking the time to do this provides the space for each participant to consider the shifts needed to support healthy changes. I believe family therapy is the most effective way to establish these healthy changes for the entire family system.
Anorexia Nervosa & Social Anxiety Disorder: A Systemic Review
By Michelle L. Miller, BS and Jennifer R. Ferrante, BA, BS
Posted in Gurze Eating Disorders Review February 2, 2020
Individuals with anorexia nervosa often struggle socially, battling fears of public scrutiny and judgement regarding their weight and shape1. Up to 34% of individuals with anorexia nervosa will experience symptoms that meet clinical criteria for social anxiety disorder, and many more will experience subclinical symptoms2. Additionally, study participants are often recruited from treatment programs; this excludes those individuals whose social anxiety may have prevented them from initiating or maintaining treatment, and likely results in an underestimation of the true prevalence of social anxiety in this population. A better understanding of the relationship between social anxiety and anorexia nervosa is crucial for improving diagnosis, treatment, and overall quality of life for individuals with anorexia nervosa.
Among individuals with anorexia nervosa, symptoms of social anxiety are often associated with concerns regarding one’s appearance. For example, social appearance anxiety, or anxiety specifically related to fears of negative evaluation of one’s appearance, is positively associated with symptoms of social anxiety in individuals with anorexia nervosa3. Interestingly, this social appearance anxiety does not appear to be restricted to weight-related concerns, as patients with anorexia nervosa and non-weight-related body image concerns score higher on measures of social anxiety as compared to individuals with anorexia nervosa and exclusively weight-related body image concerns4. Social anxiety related to both weight-related and non-weight related body image concerns may represent the high prevalence of body dysmorphic disorder5 or the increased public self-consciousness6-7 among individuals with anorexia nervosa.
The social anxiety that individuals with anorexia nervosa experience is complex and cannot be solely attributed to concerns regarding one’s appearance. Symptoms of social anxiety among individuals with anorexia nervosa are also positively associated with alexithymia traits, such as difficulty identifying and describing feelings8, as well as internalized shame9. In addition, underlying traits may exist that predispose a person to develop both anorexia nervosa and social anxiety disorder. For example, individuals with anorexia nervosa are more likely to possess certain traits associated with social anxiety, such as public self-consciousness6-7, interpersonal distrust10, perfectionism11-12, doubts about being understood13, doubts about being the same13, and poor interoceptive awareness6 as compared to healthy controls. Conversely, extraversion is negatively associated with symptoms of social anxiety among individuals with anorexia nervosa and may serve as a protective factor against social anxiety in this population6.
Alternatively, social anxiety in itself may represent an underlying vulnerability promoting the development and progression of anorexia nervosa symptoms, as 74% of individuals with an eating disorder report the onset of social phobia as preceding the onset of eating disorder14. Once an individual develops symptoms of both social anxiety and anorexia nervosa, these symptoms may exacerbate each other. For instance, individuals with more severe social appearance anxiety3 and who use more social safety behaviors15 also experience more severe symptoms of anorexia nervosa. Symptoms of social anxiety may allow symptoms of anorexia to progress via preventing individuals from entering and maintaining treatment of their eating disorder. Specifically, increased social anxiety among individuals with anorexia nervosa and bulimia nervosa is associated with less likelihood of entering outpatient eating disorder treatment after an initial intake appointment16.
Even if individuals with comorbid social anxiety and anorexia nervosa enter and maintain adherence to a treatment program, they may face unique challenges during eating disorder treatment. The same traits that may create a vulnerability for the development of comorbid social anxiety and anorexia nervosa, such as interpersonal distrust10 and doubts about being understood13, may also impede the formation of the therapeutic alliances crucial for treatment maintenance and success. An inability to enter, maintain, or benefit from treatment may explain the association between more time ill with anorexia nervosa and more severe social anxiety symptomatology17. Further research is needed to better understand and elucidate the complex relationship between symptoms of anorexia nervosa and social anxiety, with the goal of identifying interventions that will make anorexia nervosa treatment more feasible and effective for individuals with comorbid social anxiety.
Tuesday, January 21, 2020
Emotion Regulation Challenges Among Teenage Girls Who Have Anorexia or Depression
Contributor: Staff at Timberline Knolls Residential Treatment Center
Given the physical, psychological, and social transformations that are characteristic of adolescence, it is not uncommon for a teen to experience temporary challenges related to healthy or appropriate emotion regulation strategies.
For teenage girls who have developed anorexia nervosa or a depressive disorder, the likelihood that they may engage in unhealthy emotion regulation strategies may be more pronounced. In turn, these dysfunctional or self-defeating strategies may exacerbate their struggles with anorexia and depression.
Healthy vs. Unhealthy Emotion Regulation
As defined by Abigail Rolston, B.A., and Elizabeth Lloyd-Richardson, Ph.D., in a document created for the Cornell Research Program on Self-Injury and Recovery, emotion regulation refers to “a person’s ability to manage and respond to an emotional experience effectively.”
Rolston and Lloyd-Richardson cited meditating, talking with friends, seeking therapy, and maintaining appropriate self-care as examples of healthy emotion regulation. Unhealthy emotion regulation strategies, they noted, include substance use, self-harm, aggression, and withdrawal.
Rolston and Lloyd-Richardson also observed that adolescence can be a “particularly precarious” time, with adolescent girls at elevated risk for interpersonal stress, which can prompt them to employ unhealthy emotion regulation strategies.
In a 2015 study that was published by the journal Frontiers in Psychology, lead author Ines Wolz of the University of Tübingen and her co-authors cite a relationship between emotion regulation, body image, and disordered eating. The authors also report that, in the absence of appropriate emotion regulation strategies, individuals may engage in unhealthy eating behaviors in an attempt to control or process their emotions, which can lead to the onset of an eating disorder.
Increased Risk Among Teenage Girls Who Have Anorexia or Depression
According to a 2019 study that was published by the Journal of Eating Disorders, both anorexia and depression can predispose adolescent girls to struggle with maladaptive emotion regulation strategies. The study was led by Anca Sfärlea and Sandra Dehning, both of whom are affiliated with the Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy at University Hospital, Ludwig Maximilian University of Munich.
Sfärlea and Dehning’s study involved 86 girls ages 12-18. Twenty-five of the study’s subjects were experiencing anorexia nervosa, 26 had been diagnosed with major depression, and 35 had neither condition. The girls who had either anorexia or depression had received either inpatient or outpatient care at University Hospital Munich. The girls in the “healthy” group had been recruited either from previous studies or via local advertisements.
Sfärlea and Dehning determined that the girls who had anorexia or major depression were much more likely than those in the “healthy” group to struggle with maladaptive emotion regulation. For purposes of this study, the researchers identified acceptance, problem-solving, and reappraisal as examples of appropriate or adaptive emotion regulation strategies. They listed rumination, avoidance, and suppression as examples of maladaptive emotion regulation strategies.
Potential Impact of Emotion Regulation on Treatment
In Sfärlea and Dehning’s study, the girls in the anorexia nervosa and major depression groups also demonstrated an increased prevalence of alexithymia, which is an impaired ability to recognize or discuss one’s emotions.
The authors of a 2017 study by researchers at the University of California San Diego and Dartmouth College reported that difficulties related to alexithymia appear to have a greater impact on emotion dysregulation among patients who were treated for anorexia nervosa.
A 2019 study from the United Kingdom suggests that alexithymia may complicate the treatment process. “It has been frequently observed that people experiencing alexithymia may find it difficult to engage with and benefit from psychological therapy,” the authors of the UK study wrote.
The Value of Comprehensive Care
As the multiple studies cited in previous sections indicate, the risks associated with anorexia nervosa and depression are not limited to the symptoms that are directly linked to these disorders. Unhealthy emotion regulation strategies and alexithymia are two of the many potential effects that can further complicate the lives of individuals who develop anorexia or a depressive disorder.
Anorexia is more common among adolescents than among adults, and more prevalent among girls than among boys. In the abstract of a 2016 study in the journal European Child & Adolescent Psychiatry, the authors report that “symptomatic anorexia nervosa showed the earliest onset with a considerable proportion of cases emerging in childhood.” The authors also observed that “eating disorder symptomatology is common, particularly in female adolescents and young women.”
For teen girls who have developed anorexia, an elevated risk for concerns such as depression, emotion regulation difficulties, and alexithymia is among the many reasons why comprehensive treatment may be most valuable. Effective care that can identify and properly address the full scope of a teen girl’s physical, mental, and behavioral health needs can best prepare her to make sustained progress toward improved well-being.
Sources
Brown, T.A.; Avery, J.C.; Jones, M.D.; Anderson, L.K.; Wierenga, C.E.; and Kaye, W.H. The Impact of Alexithymia on Emotion Dysregulation in Anorexia Nervosa and Bulimia Nervosa over Time. Eur Eat Disord Rev. 2018 Mar;26(2):150-155. doi: 10.1002/erv.2574. Epub 2017 Dec 21. PubMed PMID: 29266572. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29266572
Hemming, L.; Haddock, G.; Shaw, J.; and Pratt, D. (2019) Alexithymia and Its Associations with Depression, Suicidality, and Aggression: An Overview of the Literature. Front. Psychiatry 10:203. doi: 10.3389/fpsyt.2019.00203
Nagl, M.; Jacobi, C.; Paul, M.; Beesdo-Baum, K.; Höfler, M.; Lieb, R.; Wittchen, H.U. Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. Eur Child Adolesc Psychiatry. 2016 Aug;25(8):903-18. doi: 10.1007/s00787-015-0808-z. Epub 2016 Jan 11. PubMed PMID: 26754944. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26754944
Rolston, A. and Lloyd-Richardson, E. What is emotion regulation, and how do we do it? Cornell Research Program on Self-Injury and Recovery. Retrieved from http://selfinjury.bctr.cornell.edu/perch/resources/what-is-emotion-regulationsinfo-brief.pdf
Sfärlea, A.; Dehning, S.; Keller, L.K.; et al. Alexithymia predicts maladaptive but not adaptive emotion regulation strategies in adolescent girls with anorexia nervosa or depression. J Eat Disord 7, 41 (2019) doi:10.1186/s40337-019-0271-1
Wolz, I.; Agüera, Z.; Granero, R.; Jiménez-Murcia, S.; Gratz, K.L.; Menchón, J.M.; and Fernández-Aranda, F. (2015) Emotion regulation in disordered eating: Psychometric properties of the Difficulties in Emotion Regulation Scale among Spanish adults and its interrelations with personality and clinical severity. Front. Psychol. 6:907. doi: 10.3389/fpsyg.2015.00907
Masculinity, Males, and Muscles: Teaching our Young Men to Honor Their Bodies
I do a lot of writing for Eating Disorder Hope, something that I enjoy and take seriously. Often I write in the third-person and approach a topic with the attitude of a journalist objectively reporting on a topic. At times, I put more of my own experience as a therapist into an issue, hoping that this will benefit readers.
And sometimes, I’m presented with a topic that feels like it could land me in deep waters. Writing on the subject of masculinity is one of those moments.
In light of the recent #Metoo movement, I am particularly sensitive to how masculinity has harmed and degraded women. It is lamentable that we participate in a culture which objectifies and uses women as commodities.
I’m also aware that some would like to label all traditional ideas of masculinity as toxic.
So, it is with great humility that I offer my thoughts on helping raise boys to honor their bodies in the hope they do not develop self-contempt, body hatred, or body dysmorphic disorder.
Actually, rather than offering many thoughts on the topic, I bring one, what I hope is substantial, concept to the table; we need to honor people as people and celebrate the dignity of each individual.
Some men are physically and athletically gifted; others are rocket scientists. Some like the University of Nebraska’s assistant football coach Jovan Dewitt posses are both (before coaching, he was a rocket scientist for NASA). There are female athletes, politicians, mathematicians, and surgeons. Some are black, some white, some brown. Some African, some Asian, some Brazilian.
There are individuals, like my friend Daniel who has severe autism and can’t communicate in full sentences but lights up a room with songs and movie quotes. And there is a 16-year-old Asperger’s sufferer who is challenging world-leaders to treat climate change with urgency.
Among the nearly 7 billion people on planet earth, you can find both a black, female gymnast amazing the world with a triple-double tumbling pass and a young man with Down’s Syndrome starring in a movie about a Peanut Butter Falcon.
Personally, my worldview is one that honors the dignity of all people. And the body is a necessary, beautiful aspect of being human. Bodies do limit and shape us, such as in our career choices.
Because of my size and lack of speed, I won’t ever be a player in the National Football League. Meanwhile, the physical limitations of Stephen Hawking did not stand in the way of his reshaping how we understand space and time.
In other words, I see the body as an essential aspect of human identity. Yet, alone, it cannot sustain the burden of defining someone’s value or identity.
Being athletic may provide advantages and opportunities in our culture not afforded to those who can’t jump as high or throw as far. Yet these abilities do not measure the true impact one can make in the world around them.
In light of this, let’s teach young men to see their own bodies as worthy of care, but not as definitive statements on their masculinity or dignity. And let’s encourage them to do the same with each individual they meet, regardless of race, gender, ability, or appearance.
REFERENCES:
Heady, C. (2018, March 19). Huskers assistant Jovan Dewitt has teaching outside linebackers down to a science. Retrieved December 18, 2019, from https://www.omaha.com/sports/college/huskers/teams/football/huskers-assistant-jovan-dewitt-has-teaching-outside-linebackers-down-to/article_81d7a6df-714e-59d0-b5c5-090c1a9d6011.html.
About the Author:
Travis Stewart, LPC has been mentoring others since 1992 and became a Licensed Professional Counselor in 2005. His counseling approach is relational and creative, helping people understand their story while also building hope for the future. Travis has experience with a wide variety of issues which might lead people to seek out professional counseling help.
This includes a special interest in helping those with compulsive and addictive behaviors such as internet and screen addiction, eating disorders, anxiety, and perfectionism. Specifically, he has worked with eating disorders since 2003 and has learned from many of the field’s leading experts. He has worked with hundreds of individuals facing life-threatening eating disorders in all levels of treatment. His website is wtravisstewart.com
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published January 3, 2020, on EatingDisorderHope.comReviewed & Approved on January 3, 2020, by Jacquelyn Ekern MS, LPC
Setting Reasonable Expectations for Eating Disorder Recovery in 2020
Our culture is constantly chasing the concept of instant gratification. In fact, this is one of the factors that make an individual vulnerable to developing disordered eating patterns as a “quick fix” to achieve a certain appearance or resolve personal or mental health challenges. But, eating disorder recovery is not a “quick fix”.
It is this same desire for instant gratification that can lead to disappointment in recovery. Once the brave decision to recover is made, we want it just to happen. The sad truth is that deciding to recover is only the first step of many.
Be Honest About Where You Are in Eating Disorder Recovery
The first step to setting any realistic goal is first to establish the truth about where you are at this very moment. If we aren’t being transparent about our current disordered thoughts and behaviors, we can’t even begin to consider what a realistic expectation is.
Precisely where you are in recovery is where you need to be to begin the process of moving forward.
Narrow Your Focus
The clear goal of eating disorder treatment and recovery is to become recovered. Before you click the “back” button because I just stated something incredibly obvious, consider that goal.
Doesn’t it bring about more questions than guidance and answers? What does eating disorder recovery look like? What does it look like for me? Who decides? Do I have to be recovered mind, body, and soul to achieve it?
When we set our sights on the umbrella goal of “being recovered,” it’s hard to know what that looks like. This not only makes it confusing on where to begin but can be disconcerting when we don’t allow ourselves to feel successful until we’ve risen to this giant and overwhelming challenge.
Narrow your focus to more attainable, smaller goals that lead up to ultimate eating disorder recovery.
Are you beginning with weight restoration, finding a treatment facility, engaging in therapy, looking for a dietitian, communicating with your loved ones, processing past trauma, changing your self-talk?
All of these may be necessary at some point in your journey, but based on where you are right now (see above), what needs to come first? Once you’ve determined that, break it down even smaller.
If you decided your goal is to recover from an eating disorder and get into eating disorder treatment in 2020, you will first need to find a treatment center and consult with your doctor. You should also ask your insurance company what will be covered, work through how you will get there, and consider how to arrange your job or school while you are in treatment.
All of this sounds incredibly overwhelming, and often, we set a goal, consider the steps it will take to achieve, feel overwhelmed, and throw in the towel. Instead, write out each step and place them in the order they need to be accomplished.
Start with the first one. That is your goal.
Give Yourself a Deadline
Alright, we have a smaller goal. Now, we need to consider a realistic timeline for achieving it.
Using the example above, your first goal might be to consult with your doctor. What is a reasonable time in which you can schedule and attend an appointment with your doctor?
This turns your goal into something less intangible and overwhelming and makes it manageable based on your capabilities. “I will schedule and attend an appointment with my doctor within the next month to ask about eating disorder recovery and referrals.”
In this way, you exactly know what your goal is, what it will look like once it is achieved, and exactly how much time you believe is reasonable to have completed it.
Going “small” in this way not only helps you to feel in control over your recovery process but gives you more opportunities to feel successful and pat yourself on the back.
If we only say “I will be recovered,” we don’t know what that looks like and won’t give ourselves credit for progress until we are fully and completely recovered, which takes time. This can break-down our momentum and feelings of self-worth in the meantime.
Making your goals specific, attainable, and timely helps you to make them more realistic, thus leading to eating disorder recovery!
About the Author:
Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published January 8, 2020, on EatingDisorderHope.comReviewed & Approved on January 8, 2020, by Jacquelyn Ekern MS, LPC
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