Overeating

Being overweight is a condition that is still subject to public humiliation as a part of the social norm. It is often thought that it is one’s fault for the size of their body, and that it is entirely within their control to change the size of their body. It’s thought that if one can just “pull themselves up by their bootstraps” and try a little harder that they, too, can torture their bodies into submission to become the size that they desire [insert diet culture here].

Until 2013, it was not acknowledged by the medical/mental health community that being overweight was part of a diagnosable eating disorder, although many of those who struggled with overeating and sought help were categorized into the “unspecified” eating disorder category. Then, in 2013, the DSM-5 was published, which includes Binge Eating Disorder (BED)(see link for criteria and more information) as a diagnosis.

While the DSM-5  acknowledged one diagnosis to characterize overeating as an eating disorder, there are three different categories of overeating: binge eating, compulsive overeating, and grazing. Binge eating consists of eating the amount of food in two meals (doesn’t have to be meal food) in two hours or less. Binge eating is often associated with planned binges where large amounts of food are gathered and food is eaten in one sitting (if binge eating is followed by purging, symptoms cross over into Bulimia). Compulsive overeating has a control flare to it, and can be characterized by needing to finish a certain amount of food – such as a whole box of cereal or three containers of Twinkies. Grazing is when one eats small amounts of food continuously over a long period of time so that they end up overeating but don’t realize it because of how much time passes. I find this is very common with people who are “too busy” to sit down and eat, such as moms, who nibble as they can, but keep coming back for more and eat too much. In my experience, those who have been diagnosed with BED typically have a mix of these types of overeating when they present for treatment, but may only focus on one or two types as treatment progresses. Working with a therapist who has eating disorder-specific knowledge can be helpful to identify these patterns, discover and understand the root of the behavior, and plan and practice to change behaviors.

It may surprise some to know that one of the first questions I often ask my clients is “How were you taught to eat?” This is usually followed by a puzzled look, and some sort of reply that they never really thought of it before. Digging in, however, often they were taught disordered eating as a child, or it was reinforced in some way, or their parents had eating disorders themselves and passed down not only their genes, but also parental teachings and modeling that may have reinforced disordered eating patterns. I certainly don’t encourage anyone to play the “blame game” as far as past experiences go, but rather to just understand why people acted the way they did to the best of your ability, to try to accept it (and forgive it if necessary), and then make a plan for how to move ahead. This is in line with the DBT teachings of “distress tolerance” and specifically “radical acceptance.” For some of my clients, this meant writing letters that can be burned – as a way of letting go and/or sending the message on to someone who has passed.

For those diagnosed with BED, there is always a web of shame and guilt being carried around related to their eating and body. Some have tried any diet or diet program or diet pill that they could get their hands on in an effort to mold their bodies to the desired shape no matter the cost – literally or figuratively. They have been told, and now believe, that they are just not trying hard enough to win at the game of being able to have the “perfect” body. There becomes an acceptable fixation on losing weight, and our “diet culture” is thriving as a result.

The truth is that we don’t get to pick what shape our bodies are. If we are in tune with our bodies, eat when we are hungry, and stop when we are full, and do an amount of “joyful movement” that feels good, your body will even out to be the size that it is supposed to be – or the “set point.” For people diagnosed with BED, this may mean accepting that their body size following treatment may not look like the “goal weight” they came into treatment imagining – which is usually their lowest weight that they were as a teenager or young adult. Many feel a sense of defeat at the task – to accept their “larger” bodies would mean accepting a lifetime of have a “bad” body size that can and likely will impact how others perceive you. However, when one can give over control of the shape of their body back to their body through being in touch with cues such as hunger/fullness, they end the losing struggle of trying to shape one’s body into something it simply isn’t. It’s like setting down the tug of war rope you’ve been battling at for years – there can be a real release of tension if this can be achieved.

One way to work towards alleviating some of the shame and guilt associated with an eating disorder is to be able to put an arm’s length between one’s “authentic” self and their “beast” (eating disorder/mental health concern/trauma, etc.) by being able to characterize behaviors or thoughts from the beast. An example would be “My eating disorder got mad at my husband for showing me a video about a woman with an eating disorder” as opposed to “owning it” – i.e. “I got mad at my husband…” While this causes some of my clients to struggle with their feeling the need to have accountability for their actions, often these thoughts/behaviors are dichotomous for someone with a beast. They are inclined to do/say/think something that, at the same time,their “authentic self” can rationalize against. The internal struggle is very difficult for many, and results in an internal dialogue that can be very “loud” when triggered. One can learn to recognize these thoughts, and then start to fight back against them (see Positive Self-Talk). Eventually, with practice, it becomes easier to fight back against urges, and then they become manageable and less intrusive on one’s life.

If you are reading this and wondering if you or someone you know might have some of the symptoms of Binge Eating Disorder, I would encourage you to get an assessment done. You could contact your insurance to ask about who might be covered for you. It is an incredibly brave step to decide to speak to a professional, but it is the first step to getting help against a difficult condition. Eating disorders can be “vicious” and may require professional support to navigate.

Finally, I would encourage everyone to be more compassionate towards themselves. As some of my RD co-workers preach, use “balance, moderation and variety” in your eating. Avoid strict rules in your eating. Listen to the signals from your body the best you can and respond to them. Understand that no one is a “perfect” eater. The goal is stability, not skinny. Love your body, you only get the one.

“Don’t work harder than your client”

One of my first social work supervisors told me this – “Don’t work harder than your client.” It caught me off guard – I had always thought that I should just give my all to help others, and had always taken that as my mission. It took some self-exploration and real-world experience to realize the truth in this statement, as well as its broad application to interfacing with people on a day-to-day basis.

We can all think of a friend, co-worker, family member, etc. that seem happy to accept help only to abandon any work done without any further follow-up. It can be mystifying for those in the helping role – after all that energy was spent on someone else, it was only wasted. I learned how to professionally separate myself from my clients not only so that I could leave my work at work, but also so that I could gauge where my energy was most useful, as it is a finite resource.

In working with clients as well as in my personal life, I have learned to set expectations at a more reasonable level, which often meant lowering my previously set standards. Lowering standards can be a loaded statement – sometimes people – especially perfectionists – feel this is unacceptable and that others should learn to meet their higher standards instead. While this, in theory, sounds good, it sets one up to be disappointed when others can’t meet those standards. I find that the reason that others are unable to fulfill their responsibilities often is seated within their mental health concerns, so when they feel personally responsible for disappointing others, they take ownership of the shame of their mental health concerns, and it can effect their self-esteem, which just makes everything worse.

Instead, I work towards having a compassionate approach in which I try to help my clients separate themselves from their “demons” – whether they be depression, anxiety, an eating disorder, or something else like grief or trauma. In doing so the hope is to strengthen their “authentic selves” to be able to overcome the barriers in front of them. As a regular practice, changing thoughts that are from the “demons” to those of the authentic self – i.e. “She is judging my body shape” to “I don’t know what she is thinking, but I will choose to assume positive intent.” Often times this process is one through mindfulness so that one can identify these thoughts and begin to learn to sort them and let unhelpful thoughts go. It is also a process that typically involves learning to be self-compassionate and taking the perspective of self (body and mind) as friend, not enemy.

So, in the end, my supervisor was right. Pushing people and expecting more than they are capable of just sets everyone up for failure. Adjusting expectations and having compassion for self and others fosters personal growth.

Perfectionism

Perfectionism is a very complicated term, in my opinion. It carries with it this connotation of someone who is very “type A,” who is meticulously clean and organizes everything. This is a very narrow view, however, as it is a general mindset that is much more pervasive. Perfectionists hold impossibly high standards in many areas of their life – that things must be or go “perfectly.”

In some ways, this can be a real strength. Any perfectionist can tell you that they likely had very high standards for themselves when it came to grades, and they can be very detail-oriented, which certainly can be a prized skill. They are likely pretty good friends, having impossibly high standards for themselves as friends to others.

In other ways, these impossibly high standards can cause problems. The core nature of life as a human is imperfection. Waiting for a “perfect” time, or expecting someone to be the “perfect” friend, family member or partner can be a set up for failure, as perfection is not ever a likely outcome. Wanting to be “perfect” is also a personal set-up – you will always fail at that. Perfectionism creates standards that are usually very unlikely to ever be met fully.

How do we start to reverse this rigid way of thinking? Well the first step is always awareness. Often times perfectionists use what is called in CBT “black and white thinking.” This is the idea that the perfectionist is thinking of things in terms of black or white, ignoring all the “gray area” in-between. An example might be – “I screwed up and ate a handful of M&M’s, so I might as well finish the bag.” The person is thinking that the choices are to not eat any M&M’s, or to eat the whole bag, ignoring the “gray area” of being able to eat anything between one handful and the whole bag. They are thinking in terms of perfect or not perfect. Try noticing if you might be using this “cognitive error.”

One way to try to better accept the “gray” between the black and white is to use a skill from DBT‘s distress tolerance skills – “radical acceptance.” This is the idea that you have no power to change what happened before, but you do have the power to change the future. By identifying and naming what is going on, we can  make a plan of attack of how to change it. Say you have a family member who is difficult to get along with, and you struggle to handle they way they are, although they are not likely to ever change. You might choose to accept that they are as they are, and choose to respond in a way that feels good to you. This lessens expectations that they should be perfect.

Maybe you are a perfectionism when it comes to your personal standards – you feel that you should always look or act perfectly. You might do some introspection – what led you to this line of thinking? Do you have a parent that is a perfectionist that may have passed along some of their trait? Do you feel like others in your life have impossibly high standards for you? You might try to do some work around trying to “radically accept” your own unique traits or challenges. Try to be a good friend to yourself by being compassionate and forgiving. You might try to incorporate some more Positive Self-Talk into your life and/or seek out some therapy as an additional support.

One sneaky way that perfectionism creeps into some people’s life is through what I call “passive perfectionism,” or avoiding doing something because you fear not doing it the “right way” or perfectly. This leads to procrastination, which increases stress, and can increase pressure to do things perfectly when you finally get around to doing it, if you do it at all. This can also be related to perfectionists

stopping creative hobbies (i.e. drawing, painting, writing, etc.) because they aren’t “good enough,” even if they never intend to share the products of their art with anyone.

In what ways can you create more appropriate expectations in your life? Can you start to let control go of needing perfection and start being able to accept things as they are? Once you do, you can stopping living in the black and white, and start living in the gray, or as my clients like to call it, the “sparkly rainbow.” Sparkle on my friends.

 

Mindfulness

Mindfulness has become something of a buzzword lately. Although simple at face value – mindfulness is the act of paying attention to the moment in the moment – it is a complex idea to put into action. The problem many of us face is that we are so accustomed to multi-tasking, numbing, and doing things that take our mind out of the moment, that it seems like a huge battle to try to change that. And why is it important? For the long explanation, see this video. Actually paying attention to one thing at a time in the moment that you are doing it can really change the way you think.

In what ways is multitasking built into your life? Do you have a cell phone bothering you while you are working? Is your smart watch buzzing while you are trying to have an in-person conversation? It feels that the more technology becomes a part of our daily reality, the easier it is to multitask. But the problem with multitasking is that by splitting your attention amongst various tasks, you don’t get to give your full attention to anything, and so all the tasks suffer. Are there ways in which you can cut multitasking out of your life?

In our pop-a-pill culture where we are so intensely medicated by both medical professionals and through legal and illicit drug use that is has become the norm to just numb through difficult emotions or pain instead of figuring out how to cope with them. One drug we don’t talk about as much is food – people who compulsively overeat often turn to food when they are not hungry, but rather to numb them from their negative emotions. This provides a temporary fix until the guilt sets in about overeating, and can be especially difficult, as you can’t cut food out of your life like you can with drugs. Seeking therapy can be one way to unload all of the emotions that you might have been “stuffing down” or “numbing” over time so that you can release the pressure that builds.

Sometimes people are driven not to be mindful, because when they are quiet and alone, thoughts related to depression (that usually brings unhappy memories from the past), and anxiety (which usually makes us worry about the future) or other mental health concerns. If you find it is difficult to be alone with your thoughts, then it is time to find someone safe to share them with. You might start with a friend or family member, but may find someone outside your social life, such as a therapist, helpful with this. If you have any thoughts of harming yourself or others, please seek help immediately by contacting emergency services/911 or a local crisis resource.

Part of mindfulness is being in your body in the moment. For some people, this may be somewhat of a foreign concept. We, especially as women, tend to take a position of desiring to change our bodies, never accepting them as they are, the only body we will ever have. By getting back “in” your body and getting in touch with its signals and feelings, often acceptance starts to build, and the body becomes reintegrated with the mind, which are really two halves of our whole selves. To start, you might try a body scan. This involves sitting quietly in a comfortable spot with your eyes closed, focusing on relaxing different parts of your body. This falls into the category of “guided meditation,” and can be a great way to get started with mindfulness. Try a search on YouTube or download an app – Calm and Simple Habit are some of my favorites.

If you’ve already explored some meditation, and thought “I’m no good at this,” or “I just can’t sit quietly for that long,” consider that your mindfulness skills are like a muscle to be built up over time. In the video above, Ron Siegel describes your mind as a puppy that you need to be patient with and train by being patient and bringing it back to the task at hand each time it strays. He also describes trying to think of your thoughts as clouds in the sky, just letting them float on by without getting stuck on them or judging your thoughts. During guided meditations, such as the one linked above, it can be easier to keep your mind on task, because there is a voice to focus on and to go back to. After a while you may prefer “open meditation” or just sitting quietly without any guidance, usually for a set period of time.

Once you start to be in touch with your body, you will start to realize what an amazing machine it is – it is smart enough to tell you when it is hungry, what it is hungry for, when it is full, and when it is tired or in pain. If we can listen to these signals and respond appropriately, our bodies have the opportunity to find balance and calm. For more information about how to find peace with eating through honoring your body’s signals, check out intuitive eating.  If you struggle to be able to identify when you are hungry and when you are full, or feel that you eat for reasons other than being hungry, you may consider seeking out an eating disorder assessment. Work with an eating-disorder-informed therapist and/or dietitian may be helpful in reestablishing those cues.

Challenge yourself to integrate mindfulness into your life one bit at a time – such as setting an alarm to do a 5-minute meditation during your break at work, or finding a meditation that helps you fall asleep. See what sort of calm and peace you can bring to your life by being mindful in this moment, using all your senses, and observing all that is going on inside and outside of you without judgment. Be your body’s own best friend and figure out how to receive all the communication it is sending you, and how to take care of yourself best.

Positive Self-Talk

If you struggle with your body  or self-image, you probably have some negative self-talk going on. You might have thoughts about yourself that reaffirm that negative self-image. This sometimes makes it difficult during “down time,” when those thoughts that you might otherwise be able to escape with distraction creep in and can be unavoidable. How can you turn the tide on years of self-abuse?

Think of how you treat yourself. Would you tolerate a friend treating you that way? Would you let someone tear you down and call you names? If you have appropriate boundaries with others, you shouldn’t. So why is it acceptable to treat yourself this way? Why do we have different standards for how we treat ourselves and how we treat others? Of course it is not fun to be alone with yourself if you are just plain mean to yourself – it would be like having to spend time with a nasty friend that you can’t get to leave.

One way to start moving from negative self-talk to positive self-talk is through affirmations. Try to figure out what you are telling yourself during the negative self-talk – maybe even start journaling the thoughts that go through your head while you are changing clothes, weighing yourself, or interacting with your body during some other triggering event. The first step is always recognizing that it is going on, and accepting it for what it is. Then, try to flip that negative statement into a positive statement.

One example might be “I am not pretty enough.” This would be a statement that you believe now. You could transform this into a statement that you would like to believe in the future, but may not fully believe now. Such a positive statement might be “Some people think that I am pretty,” and in the future that might become “People see my beauty inside and out.”

If you really struggle to find any positive statement that you feel you could believe in the future, you might choose an appreciation for that part of your body – i.e. be thankful for your legs that allow you to get where you need to go, or a neutral statement – i.e. “I have brown hair,” that is neither negative nor positive, and then move towards positive once you can accept the neutral.

While this seems fairly straight-forward, it does require some repetition. Think of how many times you might have told yourself that negative message – now you need to counteract that by pounding that positive message into your head instead – the key is repetition over time. You might put your affirmations onto an index card and post it in your closet where you get dressed each morning, or on a mirror where you a likely to be critical about your reflection. Some of my clients have recommended the “Think Up” app, which you can use to record your affirmations in your own voice to play back over and over again.

If you struggle particularly in front of the mirror, you might consider covering your mirrors for the time being. If you need your mirror do your hair, for example, you might cover up the rest of the mirror so you can’t see your body, but only your hair. Or, if the mirror is not needed, you might consider getting rid of it for the time being. When you feel that you can catch your negative thoughts and change them into positive thoughts, you can reclaim your mirror.

Also, if you find that you are weighing yourself frequently, and that you are unhappy at the result, that you may consider getting rid of your scale. Sometimes the fixation on a single number can be problematic, and not knowing can alleviate some anxiety. If you do decide to continue weighing yourself, don’t do it more than weekly. If you know that knowing the number stresses you out, you can also request that your doctor not discuss your weight number with you at appointments.

In addition, check your closet. Do you have enough clothes that fit you right now and make you feel good when you wear them? Consider getting rid of your clothes that are too small, or at least getting them out of your closet for now if you can’t bear to part with them. You might even consider trading in your too-small clothes for new ones at a thrift shop such as Clothes Mentor or Plato’s Closet. Putting on clothes that don’t fit can trigger negative self-talk that can be troublesome and can be avoided by wearing clothes that you feel good in.

In short, many of us have negative self-talk that we can choose to transform into positive self-talk. Keep track of negative statements, and turn them into neutral or positive statements that you would like to believe. Repeat, repeat, repeat. Be your own best cheerleader, and watch your self-confidence soar.

Goal setting

So many of us have lofty goals that we hope to achieve some day in the future, but may struggle with how to get there. Large goals can seem overwhelming, and it can be hard to know where to start.

From my frame as a therapist, I would approach this from sort of a “treatment plan” perspective. A treatment plan is a set of specialized goals, objectives and interventions with a set time frame for re-evaluation. This means that a larger goal is stated, and broken down into smaller goals, or objectives, that lead up to a goal. An intervention is the action taken to move towards your goal. If planning and organization are helpful to your mental health, this can be a really concrete way of setting your course.

For example – say your goal is to get a job in a field that is new to you. While this sounds simple, it is not an action that can be taken in one step. You might break down the actions needed to get to your big goal. Objectives might be to re-do your resume, talk with those already in the field, and to search and apply for positions. Within each of those objectives, there are many smaller goals that can be underneath each. For example, to re-do your resume you may need to write a draft, have it edited, and then finalize a copy. You may write out your goals and objectives in a way that flows from the first action you take to the final one. You may also choose to set goals as far as when you would like to complete each task. Then, you would decide what sort of interventions would help you achieve each objective or part of an objective. An example would be that, to have your resume edited, you may need to reach out to someone willing to lend you some time and expertise. You may set an end date of when you would like to re-evaluate your plan.

Maybe after three months or so, you could check to see – what objectives have you completed? What objectives were you unsuccessful at completing or did you not get to yet? Then you can update your plan to reflect what goals you are working on now. You might need to re-evaluate some objectives – sometimes objectives you don’t complete are objectives that just aren’t right for you, and they need to be re-written or scrapped altogether.

Another aspect of change and goal setting for many is a sense of accountability. I’m sure each of us can think of a time when we had a great plan in place, but it just faded away because there was no one there to keep us on track. If this feels familiar to you, you might want to find a friend or family member who is also looking to make positive change in their life, and see if they want to be an accountability partner with you. Perhaps you meet for coffee every month to check in, or just have a phone call now and then to see how goals are going.

I do not recommend doing weight loss challenges. I feel that they encourage disordered eating and negative body image, and also push others to further compare their bodies with others, with can be very troublesome. If you would like to change your eating behaviors, I would recommend moving towards variety, balance and moderation, and just comparing yourself to your own progress.

In our clinic we would say “Stay on your own place mat,” because comparing yourself to others isn’t fair. You don’t have their body, their food preferences, their family, their job or their life. You do what works for you, and that is all you can do. Please read my article on Relationships with food for more reflections from working with clients with eating disorders.

Making changes in our lives can feel daunting and difficult to approach. However, if we break down big goals into more “digestible bites” then it seems much more doable. It is never too late to to follow your authentic self and have the life you dreamed of.