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Times of Change and Transition


Shari Botwin, LCSW has been counseling survivors of eating disorders and trauma in her Cherry Hill private practice for over 20 years.  She has appeared on several national media outlets offering commentary on the connection between developing an eating disorder after living through some type of abuse. Shari has also published feature articles on the Cosby trial, the Orlando nightclub shootings, the Paris massacre and the anniversary of 9/11. In the coming months Shari will be featured on global podcasts on topics related to recovery. In this weeks post, Shari discussing the challenges that might come during times of change and transition.

A recurring theme in my practice when working with someone recovering from an eating disorder is the role of transition and change. Whether I am meeting someone for the first time as a teenager or I have a patient that returns to therapy after being in remission from symptoms for ten years, a shift in one’s life plays a significant role in the eating disorder coming to life or resurfacing.

Many people struggle with separation and change, not just patients that report eating disorders. It is not the change itself that is the problem, it is how we are equipped to deal with whatever milestone or life events that come our way.

Through the years I have met several seventeen and eighteen year old girls who are preparing to leave home and go to college. When they enter therapy they are perplexed by the recent changes in their thoughts and feelings about food. I was working with one young woman who reported having a great relationship with food until she became a senior in high school. She told me, “All of a sudden I find myself struggling with thoughts and feelings about food and weight.” After a few sessions I met with mom and started exploring how she had handled transitions earlier in her life. I remember mom saying, “She has always had trouble starting something new.” Mom told me about her separation anxiety when starting kindergarten and then again when going off to middle school. Once we began talking about her fears of leaving home to go to college Christy and I were able to make sense of her eating disorder. I remember asking her, “If you weren’t thinking about food so much what would you be thinking about? And what are you most afraid of?” Christy told me there was a part of her that did not want to grow up. We realized that if she shrunk herself up she could in some ways keep herself a child. Christy also spoke about her fear of losing her parents and that her eating disorder was a way to mask these irrational ideas. Once we reframed that she would not lose her parents, but that the contact would just be shifting once she left for school she was able to tolerate the upcoming changes.

I have worked with other patients who have had to confront significant loss during times of change. Surprisingly happy life events such as weddings, pregnancies and having children can lead to devastating affects with the eating disorder if the feelings are not acknowledged. I see a lot of trauma survivors with a history of eating disorders and some type of childhood abuse. Many of them used symptoms of different types of eating disorders as a result traumatic experiences left undigested and unacknowledged. Before I began counseling others I spent several years in therapy working through my childhood abuse and anorexia/binge eating disorder. Years went by where my eating disorder was in remission. In my late 30’s I decided to start a family and was blessed with a child after turning 40 years old. While this was by far the happiest time in my life it also stirred up some deep rooted loss and shame.

I always tell my patients no matter how much time goes by, if you find yourselves having urges to reconnect with your eating disorder most likely it is telling you that something needs attention. While I spent years grieving the loss of my family of origin, becoming a new mom brought up new feelings I had not addressed. Rather than giving into my eating disorder I worked hard with my therapist to name all the feelings and talk about what it was like to bring a child into my world and know I had no parents of my own to share that with.

I remember working with another patient, Samantha, who had been in remission from her binge eating for over 10 years. She started seeing me months before her wedding. She was thrilled with her choice of partner and expressed joy about her wedding day. But she also told me, “I do not understand why, but I am in symptoms almost every night since I picked out my wedding dress.” We explored the part of her that was avoiding grieving her losses associated with starting a family of her own. She was able to talk about the death of her mom in adolescence and the pain she was trying to push away. Samantha went to therapy immediately after her mom’s passing. She spent a few years learning how to replace the bingeing with connection and ways to manage her feelings. I remember asking her, “What is it about getting married that makes you miss your mom the most?” It was so painful for her to express the sadness about her mom not being able to share that day with her. Samantha also reflected on her desire to have children and how “more than anything I wish my mom could be here for all of that.”

Recovery from an eating disorder at times can bring up the most dreadful of feelings. The hope in what I did after giving birth to my son, or how Christy could voice her fears of leaving home, or Samantha could allow herself to revisit new feelings of an old loss is we all found ways to put words to our experience. Change, whether happy, sad, good, or bad can bring up the worst of feelings. The eating disorder becomes the comforter, the punisher, the coping mechanism to feelings we wish we could make go away. It is scary to think an eating disorder can resurface at any time, even years after being in recovery. Rather than deny its appearance or act like it is not there, the best thing we can do is use it as information and find ways to make sense of it. Times of change for anyone is stressful and triggering. Use the feelings as an opportunity to work through something in your life that still needs attention rather than spend all those hours, days and weeks destroying the most beautiful parts about you!


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