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That Voice in Your Head: Don’t Take It Out on Your Body

Jen Gaudini

Expert Advisor to Monte Nido Jennifer L. Gaudiani, MD, CEDS is nationally known for her work on the medical complications of eating disorders. She recently opened the Gaudiani Clinic, a unique outpatient medical clinic specifically dedicated to adults with eating disorders. Dr. Gaudiani shares her work with clients who are faced with “that voice in their head” in this week’s blog post. 

That voice in your head is as familiar as it is judgmental and unkind: “You’re not good enough. You’re not thin/disciplined/organized/accomplished enough. You’re not meeting expectations as a partner/sibling/parent/child/professional/student. You haven’t done enough today to deserve rest and self-care.” So many people walk around every day with some version of this voice in their heads. And all too often, the next step is to take it out on your body, imagining the voice could be satisfied, or “good enough” could be achieved, if somehow the ideal body shape/size/nutrition plan/exercise regime could be accomplished.

Of course, this logic is pure nonsense, borne of endless marketing schemes, haunting images of people who don’t even look like that themselves, and a society that seems to keep getting more demanding while offering less compassionate support. The truth is: when you eat a wide variety of foods, and plenty of them, practice moderation (most of the time), and move your body in ways that bring you joy and help you stay strong, your body will take the size and shape that was pretty much genetically predestined. Love it or not, that’s the body you have, and only you can be its caretaker over the years. Totally separate from your body (really!), you can learn to use a kinder voice in your head, gently recognizing accomplishments and disappointments without judgment. Everyone needs self-care, just like everyone needs air to breathe.

I’ve been an internal medicine physician who specializes in eating disorders for eight years, and I’ve taken care of some of the sickest adults in the country. I’ve listened to a lot of stories from extraordinary people who developed a life-threatening mental illness as the voices in their head became intolerable and forced them to numb themselves through starvation, purging, binging, and substance use. Everyone’s story is different, but almost everyone I’ve cared for talks about that voice in their head.

You might be one of the lucky ones who rarely hears the voice, or who naturally (or after lots of work) has learned to answer judgment with kindness, and keep emotional struggles separate from body image. Or you might have struggled for years with this relationship between soul and body, going on diets (that aren’t sustainable and don’t work but sure cause a lot of crummy days in the process), thinking a certain size or shape will make everything else better. (They don’t.) Or you might have developed disordered eating or an eating disorder like anorexia nervosa, bulimia nervosa, or binge eating disorder. You’ve suffered terribly, as have those who love you, as the eating disorder turns the voice in your head into a fiendish, cruel, jealous, and insatiable presence. Even as that voice tells you nothing bad will happen to you as long as you just keep restricting, binging or purging, you actually end up with a disorder that carries the highest death rate of any mental illness.

My message is this: the voice in your head can be costly, really costly. You can choose to answer back to the voice when it tries to play its same old song: “I am enough. I’m doing what I can. I’m proud of the way I stood up for myself today. It was painful when I had that argument with my boss/mom/daughter, but I think I learned something, and I didn’t aim to wound. I’m going to put my feet up now even though there are a ton of things on my to-do list, because I need a break.” Your body deserves enough delicious, varied food to fuel it adequately, and the activity you do should be a celebration of the ways your body can move…never a punishment or an atonement. Keep working to untangle the voice in your head from the care you give your body. Body and soul will thank you in the long run!

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


Does Body Image Always Have to be the “Last Thing to Go”?

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Monte Nido Assistant Clinical Director Jessyka Young, LMHC explores the use of yoga therapy in eating disorder treatment in this week’s blog post. She explains how yoga can help clients to listen to and become attuned to the signals and needs of their bodies.

“Body image is the last thing to go”. This statement seems to be an old adage in eating disorder treatment and recovery. I know that I am guilty of telling countless clients this.

Since becoming a yoga therapist, I’ve found myself questioning whether body image has to be the last thing to go, or whether there are ways to give clients a different perspective and appreciation of their bodies while they are in treatment. If we can change our thoughts about food, why can’t we change our thoughts about our body?

I’ve had the fortunate opportunity to do yoga therapy sessions with clients in our PHP and IOP program at Monte Nido San Diego. The yoga therapy I am trained in is called Phoenix Rising Yoga Therapy. It is a trauma-informed, client-centered modality that uses the body as a tool for increased awareness. In my experience, the body can be a direct gateway to one’s true self or soul. I’ve had a client refer to our sessions as individualized “Body and Soul”, a group I have run at Monte Nido for over three years and which many clients say is particularly effective in connecting to a deeper, healthier “Soul Self”.

Another client wrote to me about our yoga therapy sessions, “I have never really listened to my body, in fact I tried my hardest not to. But you gave me the space and opportunity to do that.”

Bessel van der Kolk, MD writes in The Body Keeps the Score, “One of the clearest lessons from contemporary neuroscience is that our sense of ourselves is anchored in a vital connection with our bodies.” In eating disorder treatment, clients have accustomed themselves to not listening to their bodies’ messages and cues. What if, instead of waiting for the recovery process to deliver body acceptance, there were a way to actively work on rebuilding the connection?

Interoceptive awareness, the signaling and perception of internal bodily sensations, is often defective in those suffering from eating disorders. Yoga is a great way to help increase interoceptive awareness and aid in the healing process. Just as we use exposure work to challenge our clients’ distorted thoughts about food, I believe body work can be a form of exposure work; exposing clients to the reality of their body in the present moment, the physical sensations, emotions, thoughts, and memories. Yoga therapy is a mindful, nonjudgmental approach to body awareness, allowing clients to gain a new perspective of their body in order to integrate all parts of themselves.

To give you a taste of what yoga therapy is like, here is a short activity:

Ask yourself the question, “What do I need to do today?”

Allow your answer to come to mind naturally, and just go with the first thing that pops into your head.

Close your eyes and take 3 deep breaths, in through your nose and out through your mouth.

Inhale and raise your arms up over your head, exhale swinging your arms down, and fold forward, letting your head and arms hang heavy. Repeat this 2-3 more times.

Come up to stand and start twisting side to side, allowing your arms to hang heavy, as if they were wrapping around your body with each twist. Do this several times at whatever speed feels right for your body.

Roll your shoulders, backwards and forwards a few times.

Scrunch them up towards your ears on an inhale, and let them drop on an exhale. Repeat this 2-3 times.

Then take your hands and rub them together, creating some friction. When you start to feel some heat, place your hands anywhere on your body that is calling to you (i.e. your face, neck, heart).

Keep your hands wherever they landed and take another 2-3 deep breaths, in through your nose and out through your mouth.

Ask yourself the question again, “What do I need to do today?”

Notice if the answer has changed, or the intention.

What happens when you listen to your body for the answer?

I believe the body holds an incredible amount of wisdom, and that by working directly with it we get to extract and develop that wisdom to be used as a tool for healing. I am grateful to work for a company that incorporates yoga into its programming, and I hope to continue the conversation and exploration of how yoga can help our clients heal.

“Yoga teaches us how to be “in” our body, use our body, and take care of our body with understanding, awareness and acceptance.”

– Carolyn Costin, Yoga and Eating Disorders: Ancient Healing for Modern Illness.

 

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


Men with Eating Disorders

doug

Doug Bunnell, PhD, FAED, CEDS is an expert clinician and leader in the eating disorder field. He brings over three decades of experience and a wealth of knowledge to his role as Monte Nido Chief Clinical Officer. He shares important information about treating males with eating disorders in this week’s blog post.

Most of what we know about eating disorders is based on what we know about women with eating disorders. Most of what we know about men with eating disorders is based on what we know about conventional models of masculinity. Most of what the two of us know about either of these topics is heavily influenced by our own gender, sexual identities, and ethnic backgrounds. These are the limitations that we, as psychotherapists, bring to the room when working with males- an underserved population in the world of eating disorder treatment. By examining the differences and similarities between how males and females with eating disorders present clinically we hope to shed some light on issues to be aware of as clinicians and how we can move towards a more comprehensive treatment of the eating disorder population.

Conventional wisdom tells us that one in ten people with eating disorders are male, but data suggests that 25% of diagnosable cases occur in males and that males have higher rates of disordered eating (Hudson et al., 2007). As is, unfortunately, easy to imagine, it is suggested that under reporting is a result of stigma, lack of sensitivity and detection, and gendered perceptions of eating dieting. The lower occurrence of eating disorders in males may, however, also be attributed to gendered differences in the risk and maintaining factors for eating disorders .

A difference in biology, brain organization and temperament, for example, are factors that appear to insulate men against risk. Mood disorder vulnerability also seems to put males at a lower risk as they have a greater tendency towards externalization as opposed to the female tendency for internalization- a trait that can serve as fuel for the eating disorder. Generally speaking, men present with less harm avoidance, less drive for thinness, and less body dissatisfaction; with what we know about eating disorders, this discrepancy should also account for the lower prevalence in the male population. That being said, it falls on us, as clinicians, to make sure we bring a certain awareness of clinical features and differences into our female-normed assessments to work against the risk of underestimating rates and severity.

One feature that is similar in both women and men with eating disorders is that men with ED present differently than men without ED- they may be struggling with depression or other impairments. The many ways that males and females differ in eating disorder presentation, however, lie in the manifestation of the illness; for that reason, it is of the utmost importance that we, as clinicians, maintain an acute awareness of our language during assessment. It is not as pertinent, for example, to assess for a “fear of fat” with a male client as males tend to idealize a body that has less fat and more muscle, therefore they tend to fear “softness” rather than “fatness”. A preoccupation with the need to be “lean” might be more relevant to males with eating disorders rather than the drive for “thinness” often seem in females. Additionally, males with eating disorders may present with use of steroids and human growth hormone. These factors are all important when assessing males on a drive for muscularity scale, male body checking scale, and obligatory exercise scale.

In addition to maintaining awareness in assessment of males, it is equally critical to maintain acute awareness of the language we use in the treatment of males. For a clinician accustomed to treating females, it is likely common to use very emotionally charged language such as “opening up”, “sharing”, and even referring to “fat as a feeling”. Not only are men generally less familiar with eating disorders than women, for better or for worse, men have been socialized by an unspoken male code to not be weak or vulnerable and to prioritize leadership, work, and self-sufficiency. While it is an adjustment from the way we work with female clients, it does not have to be an obstacle in helping our clients. Instead, we can work with decisional balance- weighing the pros and cons of change versus the pros and cons of no change with our male clients. By leaving what works for female clients at the door, we serve our male clients better and respect their sense of masculinity- however that may look for any one individual.

As individuals working with an already stigmatized disorder, it is important to constantly learn and keep an open mind and consider how much additional bravery it takes for a minority of an affected population to seek out our help. While we have made great strides in the treatment of eating disorders, there is always room for improvement. By embracing the difference in our experience as treatment providers, we will be able to work more successfully with this underserved population and further contribute to the work we all do to counter eating disorder stigma.

 

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


Why I Walk

tamie-gangloffMonte Nido & Affiliates Regional Outreach Manager Tamie Gangloff, MA, MFT led the West Chester, PA NEDA Walk last year in the hope of bringing people together to raise awareness about eating disorders. In this week’s blog post, Tamie shares some of her personal journey to living a fully recovered life as well as what inspires her to walk. 

Between 1995 and 2002, I went to treatment for my eating disorder several times. I had resigned myself to the fact that I would occasionally go to treatment and continue to manage until I would inevitably fall apart and need to go to treatment yet again… that belief changed in fall 2002. I was sitting in day treatment, listening to a woman speak about her devastating battle with her eating disorder and her recovery. This woman had fully recovered! She described a full life with love, work, play and family. The woman sitting before me was truly recovered in every aspect of her life including her relationship with food and her body. At that moment, my life changed. I made the decision to do whatever I could and whatever was suggested to me because I knew that I too could have that same full and free life.

Several years into my recovery, I started to speak out and talk about my struggles, but more importantly, my recovery. I wanted everyone to know that recovering was arduous and painful but not as painful as staying sick. I wanted them to know, if they did the work, they could also be recovered. I wanted to bust the myth that someone with an eating disorder will always be ‘in recovery’ and have to work hard at it everyday to merely “manage” it. That is not my truth or the truth of the many colleagues and former clients that live lives free of an eating disorder; where it is truly a thing of the past.

I walk because there is hope and, if I don’t walk, someone may not hear that message of hope that they need to hear. I walk for those that we have lost in this battle, including my friends and former clients. I walk for our youth! Last year, my family attended the walk and my niece was thrilled to be a part of it. She loved carrying the banner and being front and center in the walk selfie. While we were walking, I asked her what she learned that day. She said that she learned that she is beautiful and that everyone is beautiful. I walk so that my niece and nephew can live in a world without eating disorders.

I have been blessed to create and participate in countless eating disorder awareness events over the years. Last year, was my first year as the walk coordinator for the West Chester PA NEDA Walk. It meant so much to me because I struggled terribly with alcoholism and an eating disorder when I was a student at West Chester University. At that time, there was very little awareness or support for eating disorders. I’m so grateful to be able to help raise awareness so that others do not have to struggle as I did. We have many volunteers and attendees from WCU and I want them to know that there is hope.

I am grateful to work with many volunteers that are recovered or are new to working in the field of treating eating disorders. It is an honor to be able to mentor and work with these men and women. Remembering the walk from last year, I recall that there were several people who reached out for support and were able to get help for their eating disorders. That is what this is about. For one morning, an amazing group of people take a pause from their lives and join in our family to learn more about eating disorders, share resources, support one another, give hugs, sip coffee, stroll through the park and share hope. If just one person learns something new, feels supported and feels hope, then I have done my job!

The 4th Annual West Chester PA NEDA Walk is Saturday, November 5th! I hope you will join us! If you are interested in attending, please visit the West Chester PA NEDA Walk site. If you have any questions, contact me at tamiegangloff@www.montenido.com.

 

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.


Damsels, Witches, and Vampires: Attending to the Monsters of Anorexia

Monte Nido Eating Disorder Center of Manhattanmelissa-daum Primary Therapist Melissa Daum, LMFT uses metaphor to help explain the challenges of living with an eating disorder. In her post, Melissa sheds light on the “monsters” clients face as they work toward full recovery.

With Halloween upon us and the crisp chill of fall in the air, ’tis the season where our fascination with all things macabre is invited to come out and play. However as a psychotherapist, hauntings, possessions, and spells are not a seasonal novelty but a daily occurrence, as individuals come seeking relief from their inner demons and psychic pain. In my work with people in whom eating disorders are their primary symptomatology, I have found that certain monster metaphors recur again and again: The witch and the vampire.

Vampires, with their distinct dietary limitations and co-morbid sleep disorder, maintain perpetual youth by feeding off the blood of their victims. Vampires have no reflection in the mirror, and are both endowed with supernatural powers and isolated from human contact. These qualities make the vampire an appealing love object — he is untouchable and desiring, magical and dark. I have heard young woman describe their devotion to “Ed” as this kind of romance with an inner demon lover. He professes his undying love for her, and through him she perceives herself to be elevated from the trappings of her ordinary life, including her need for food.

While the vampire image expresses the romance an individual may feel toward her anorexia, the witch image has to do with her ambivalence toward womanhood. Witches are often imagined as female outsiders who are keepers of spells and sorcery. Witches can be glamour queens or hags, or both at the same time if she drinks the right potions. Usually witches were rejected or betrayed at an earlier point in time — Maleficent didn’t get invited to Aurora’s christening, the witch in Rapunzel had her garden raided by Rapunzel’s dad, the Wicked Queen in Snow White got demoted from being the fairest in the land — thus the witch keeps the damsel as a hostage for debts she is owed. Time stops for the damsel, often through sleep or imprisonment. This spell reflects the kind of frozen state anorexia promises.

Through the monster we arrive at a situation of bound up vitality. The reality of the anorectic’s internal hostage situation can literally cause a “hold up” with regard to her progress in treatment. It can be tempting to regard the eating disorder as the monster and the individual as the innocent damsel in distress, resulting in an oversimplified idea that one must kill the monster to be free. Instead, it may be more useful to imagine the eating disorder as a compromise to keep the monster and the damsel simultaneously satisfied (or simultaneously deprived). Thus we no longer have the binary structure of monster versus damsel, as the damsel is now a kind of monster in her own right — the shell of a girl, polite, pretty, and sweet, awaiting rescue.

Like all beloved monster stories, the monster is not always what it appears to be on the surface. When someone we care for is struggling with an eating disorder, the myriad of external complications can perpetuate avoidance of the competing pressures within. These painful inner loyalties must be attended to for psychic growth to occur.

For more information about Monte Nido please call 888.228.1253, visit our website and connect with us on FacebookLinkedInTwitter, and Instagram.