Carolyn Costin’s workshop at this year’s National Eating Disorders Association conference was all about recovery, gathering strands from current research, feedback from recovered patients and strategies she’s come up with after 35 years of clinical experience. Costin, who herself recovered from an eating disorder, is founder and executive director of The Eating Disorder Center of California and Monte Nido, with centers in California and Oregon. The session was packed, and it’s no wonder; she is a dynamic, witty speaker with a no-nonsense style born of years of experience in the trenches. Here is a brief summary of her information- and advice-rich talk.

• Recovery is when you accept your own natural body size and shape, have a healthy relationship with exercise, and when you won’t compromise yourself to reach a certain number on the scale. Another sign of a return to health is “when you reach out to others for comfort and help, not your eating disorder.”
• “Your healthy self will heal your eating-disordered self. In other words, your eating disorder can’t be more powerful than you are, because it resides in you and is part of you. The idea is to integrate the two selves over time. The work of the patient, with the help of a therapist, is figuring out what anxieties and issues the eating disorder is solving, and how to replace the eating disorder with healthier coping mechanism. (I know, easier said than done, but clarity about your objective always helps.)
• Costin has patient’s journal before bingeing, because this, she said, “gives access to the part of you that binges.” She also has patients journal about “my last binge,” write a dialogue with their eating-disordered selves, role play, write a thank you letter and then a goodbye letter to their eating-disordered self. She has them write about their worst eating-disordered day, too.
• Learn to tell the truth. Don’t say, “I don’t like pasta.” Say, “I’m afraid of pasta.” This is the first step to overcoming the fear.
• Eating disorders are both about food, and not about food. While non-food issues (anxiety, trauma) may have helped trigger the disorder, you need to regain a healthy relationship with food in order to recover. Food is the phobic object, and you have to be hands-on with it.
• Feel your feelings. Learn “affect tolerance,” or how to live with unpleasant, scary or hurtful feelings, instead of turning to food to mask those feelings.
• Find meaning and purpose outside of yourself. “Religion is the bridge to spirituality and too many people get stuck on the bridge.” Eating disorders are the same: the eating-disordered person seeks something larger, but gets stuck in the eating disorder.
• Advice for counselors, equally applicable to parents, is: Adopt the attitudes of empathy and constructive curiosity. A supportive, empathetic relationship is crucial to recovery.
• Be a positive role model (in other words, “be okay with your own body,” model healthy eating at meals).
• Don’t take sides against the eating disorder. Be for the recovery process, not against the eating disorder).
• Think in the long term: Those who recover don’t throw in the towel.

Marcia Herrin and Nancy Matsumoto are co-authors of The Parent’s Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home (www.childhoodeatingdisorders.com)