Did you answer yes to any of these questions?

If you answered yes to any of these questions, you need to know that bullying leads to children’s eating disorders or other dysfunctional behaviors. More and more children are finding they need treatment for an eating disorder who are younger than 12.

Bullying is dangerous and can even lead to suicide. The internet has exposed the terrible truth about the effects of bullying. Remember, Phoebe Green, who hung herself at age 15 because of cyber bullying.

Only recently have we as health care professionals begun to look at the seriousness of bullying particularly after reported teenage suicides. Does your child use the internet? If so, be alert. Know that the internet has exposed the terrible truth about the effects of bullying, severe enough to drive some kids to self-harm or suicide.

Bullying effects millions of students but parents and teachers don’t understand the serious outcomes. When professionals or parents tell kids to ignore teasing, or to just get on with it, this not the kind of advice or understanding they need.

What does bullying looks like?

1. Emotional or verbal abuse looks like “Fatty fatty two by four, can’t get thru the kitchen door” or Piggy, piggy!
2. “Hey Jew boy.”
3. Cyber abuse is on Facebook where everyone from your school can see it.
4. Cruel emails can be sent from anywhere.

A person can be picked on by an individual or group with more power. Someone with more power may be peers, older kids, even teachers or parents. Bullies choose their victims because they look different, have a different religion, or are disabled. Bullies pick on a person simply because the person is shy or is gay or is a lesbian.

We must never forget that bullying is a severe form of abuse, i.e. emotional abuse, verbal and sexual abuse. Being excluded socially is a form of abuses. Verbal bullying, cruel email, or cyber-bullying (posting insults online) are forms of abuse.

Bullying like most forms of abuse is ongoing, like water dripping on a stone. The person being bullied lives in a constant state of fear. Everything in his or her life is affected. School work and health are both affected. A person being bullied can get stomach-aches, diarrhea, and headaches from the stress.
Kids abused by peers or family members can suffer from depression, low-self-esteem, and anxiety occasionally or a great deal of the time. They might even consider suicide!

Here are 8 tips to help you protect yourself from bullies. What advise will help if you feel bullied or know someone who is being bullied?

1. Tell someone about it, a teacher, a friend, a parent — tell anyone but tell right away.
2. Stick together with your friend who is being bullied — never leave him or her alone.
3. Learn to ignore the bully. Don’t add wood to the fire.
4. Don’t get physical (or angry) with the bully.
5. Practice feeling and looking confident. Posture is a give-away.
6. take small steps to be in charge of your life. This is where a good coach can help.
7. Talk about the bully and bullying to anyone and everyone. The more public you are, the bully will hide out.
8. Find true friends, friends that can offer you unconditional friendship.

If you’re a kid, find an adult who can guide you step by step through the process of taking charge of your life.

As you grow in confidence, you’ll stand taller knowing that no one will bully you again.

Enthusiastic CARF surveyors said July 23, 2010, “Mirasol is light years ahead of any other program in the country.” Continuing they said, that in all of their years working in the mental health field, they had never seen a program as excellent as what we do at Mirasol.

CARF, a national accrediting agency that examines and awards accreditation to more behavioral health facilities than any other agency, examines Mirasol every three years. A CARF endorsement means that a program’s policies and standards meet the highest possible criteria of excellence. An accreditation by CARF is proof of excellence in all areas of a facility.

Last Thursday and Friday two CARF surveyors arrived. Both of them were long-time inspectors. One member of the team was an RN with 30 years of experience in the mental health arena. The other was a man with behavioral health experience as a social worker but also an experienced surveyor having done surveys for CARF for over 25 years.

When the survey was over, our management team and the surveyors gather round for “the” report. The entire staff had worked for months making sure that we had everything ready. After the CARF people gave their report, I was stunned. I knew that we had an excellent program. I knew we were really good, but I didn’t imagine in my wildest dreams how good we are!

Basing their comments on our outcome data and after viewing our treatment at the units they said our treatment was like magic.

I have never wanted to play the game of outcomes. “Mine is better than yours. “ “No, mine is much better…….. “ Statistics can be manipulated and when I hear someone claiming a success rate of 92% at a year, I know it’s not true.

The CARF team made me promise that I would share some of our numbers with our stakeholders which are all of you!

When someone enters treatment, we do quite a lot of psychological testing. Two of the most important psychological instruments we administer are the Eating Disorder Inventory-III and the Beck Depression Inventory.

I’m going to give you all of this information just as we gave it to the surveyors. It’s rather complicated but you can read the numbers – I’ll help.

The Eating Disorder Inventory 3 (EDI-III) is the third edition of a test that reports in multiple scales. The test consists of 91 questions answered in terms of frequency of behaviors from always to never.

Reports consist of 21 separate scales; three are validity scales, four are eating disorder risk and composite scales, nine are psychological scales, and five are psychological composite scales. Results are presented as percentiles for all, anorexia, bulimia, and EDNOS diagnoses.

For simplicity of reporting percentiles of two risk scales/composite scores are used, each chosen for broad-based relevancy to Mirasol’s program, the Eating Disorder Risk Composite (ERDC) and the Global Psychological Maladjustment Composite (GPMC).

In addition, the 9 psychological scales, including Low Self-Esteem (LSE), Personal Alienation (PA), Interpersonal Insecurity (II), Interpersonal Alienation (IA), Interoceptive Deficits (ID), Emotional Dysregulation (ED), Perfectionism (P), Ascetism (A), and Maturity Fears (MF).

These will all be compared for pre and post scores for the total, anorexic, bulimic, and EDNOS populations.

B Results: The information presented in the following chart is based on residents who completed the program during the years of 2007, 2008, 2009, and through June 2010.
You can readily see the differences between the pre-scores and the post-scores. But look at the post scores for EDRC for 2007, then 2008, 2009, and finally 2010. You’ll see that the scores progressively get lower – meaning that our patients are getting a lot better!
Now do the same for the GPMC.

You can readily see the differences between the pre-scores and the post-scores. But look at the post scores for EDRC for 2007, then 2008, 2009, and finally 2010. You’ll see that the scores progressively get lower – meaning that our treatment is more and more effective and our patients are getting a lot better!
Now do the same for the GPMC.

Risk Scales and Composite Scores

2007 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 22) 53.27 28.00 56.55 31.45
Anorexia (N = 9) 64.89 47.67 63.89 45.78
Bulimia (N = 13) 45.23 14.38 51.46 21.54
2008 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 34) 54.06 21.50 54.44 25.21
Anorexia (N = 11) 62.18 37.18 56.64 28.18
Bulimia (N = 20) 44.70 9.40 50.35 19.85
EDNOS (N = 3) 86.67 44.67 73.67 50.00
2009 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 20) 49.35 13.60 49.35 18.15
Anorexia (N = 3) 61.67 40.67 52.00 36.00
Bulimia (N = 13) 41.85 3.46 52.08 13.54
EDNOS (N = 4) 64.50 26.25 38.50 19.75
2010 Results Pre EDRC Post EDRC Pre GPMC Post GPMC
ALL (N = 11) 46.10 11.82 44.00 10.27
Anorexia (N = 6) 42.33 17.5 31.83 14.17
Bulimia (N = 5) 50.60 5.00 58.60 5.60

Here are the results for the individual scales as named above. Take a look at the self-esteem scores – pre and post 2007, 2008, 2009, 2010. The improvement is substantial with lower scores each consecutive year.

Psychological Scale Scores
2007
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N = 22) 56.5 30.6 53.6 31.0 51.2 32.8 62.6 50.5 58.3 29.1 62.8 48.5 57.0 42.3 57.2 39.1 56.0 44.6
Anorexia
(N = 9) 60.7 45.1 59.9 45.6 50.2 38.6 69.9 53.1 59.2 39.8 66.2 58.0 67.7 53.2 63.6 49.6 66.2 56.3
Bulimia
(N = 13) 53.7 20.6 49.2 20.8 51.9 28.8 57.5 48.7 57.6 21.8 60.4 41.8 49.5 34.7 52.8 31.9 49.0 36.5

2008
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N =34) 59.2 26.6 54.7 23.6 54.0 34.4 60.1 43.2 56.3 25.7 51.6 43.4 56.5 45.2 45.8 24.0 55.1 34.2
Anorexia
(N = 11) 68.1 30.8 62.3 26.0 58.9 42.1 59.5 44.5 55.8 26.2 45.3 34.8 59.5 54.3 41.3 21.0 59.5 45.8

Bulimia
(N = 20)
52.2
21.4
47.7
19.5
50.5
26.1
57.8
39.3
54.1
21.0
53.6
44.4
50.7
38.6
45.9
23.5
54.5
27.5
EDNOS
(N = 3) 73.7 46.3 74.0 42.0 59.0 62.0 77.3 64.7 73.3 55.7 61.7 68.3 84.3 56.7 62.3 38.7 43.3 36.0

2009
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N = 20) 47.8 17.7 53.1 18.9 46.5 27.8 53.9 34.7 58.5 22.8 50.9 35.5 52.7 39.0 50.5 18.3 43.9 35.7
Anorexia
(N = 3) 44.0 41.0 52.7 37.7 61.7 62.0 42.7 39.3 81.0 45.0 38.0 41.7 41.3 27.3 51.3 28.0 58.3 67.7
Bulimia
(N = 13) 52.8 13.2 59.0 15.4 46.5 19.9 61.3 38.1 55.5 18.6 54.9 33.2 52.1 35.4 45.6 14.3 46.5 31.5
EDNOS
(N = 4) 34.3 14.5 34.3 16.0 35.0 27.8 38.0 20.0 51.3 19.5 47.5 38.3 63.0 59.5 65.5 24.0 24.3 25.3
2010
Results Pre
LSE Post
LSE Pre
PA Post
PA Pre
II Post
II Pre
IA Post
IA Pre
ID Post
ID Pre
ED Post
ED Pre
P Post
P Pre
A Post
A Pre
MF Post
MF
ALL
(N = 11) 47.4 15.2 47.6 14.4 40.8 14.6 55 24.9 50.6 16.2 47.2 22.8 52.5 31.8 38.8 14.2 45.5 21.3
Anorexia
(N = 6) 32 19 32.7 19.3 34.5 17.3 56.3 34.7 49.3 16.5 38 19.5 43 25.8 30.5 21 37.8 21.5
Bulimia
(N = 5) 65.8 10.6 65.6 8.4 48.4 11.4 53.4 13.2 52.2 15.8 58.2 26.8 63.8 39 48.8 6 54.8 21

Last but certainly not the least is one of my favorite tests, the Beck Depression Test. It’s short, only 21 questions, and highly accurate. The client answers the questions on a scale of 0 to 3, with three indicating the strongest symptoms and the 0 indicating few symptoms. Most of the clients who admit to Mirasol are severely depressed when they come in.

Look at these scores, pre-treatment and post-treatment from 2007, 2008, 2009, 2010. The post treatment scores show that there is very few, if any, depressive symptoms existing. All of the patients have greatly improved feelings of well-being.
2007 Results Pre BDI Post BDI
ALL (N = 23) 34.26 18.13
Anorexia
(N = 9) 41.00 26.33
Bulimia
(N = 14) 29.93 12.86
2008 Results Pre BDI Post BDI
ALL (N = 34) 31.50 13.03
Anorexia
(N = 11) 35.45 16.00
Bulimia
(N = 20) 27.85 10.00
EDNOS
(N = 3) 41.33 22.33
2009 Results Pre BDI Post BDI
ALL (N = 19) 30.42 7.89
Anorexia
(N = 3) 28.67 17.00
Bulimia
(N = 12) 31.42 7.25
EDNOS
(N = 4) 28.75 3.00
2010 Results Pre BDI Post BDI
ALL (N = 12) 29.83 10.5
Anorexia
(N = 6) 25.67 12.17
Bulimia
(N = 6) 34 8.83

I hope to keep reporting outcome information quarterly as well as reporting long-term outcomes. We have found that our treatment results are long lasting – at one year, 70% of our clients are still in recovery. This does not mean that they have not slipped a time or two, but because of our Focused Continuing Care, the slips have been very short lived.

We’ve all read about anorexics that have died at very low weights. I somehow downplayed the fact that bulimia is a killer as well.

Someday Melissa was founded in 2010 by Judy Avrin following the death of her daughter Melissa to an eating disorder. A 501(c)(3) nonprofit organization, Someday Melissa’s mission is to promote recognition and awareness of eating disorders and the importance of early treatment. Along with Danna Markson, LCSW and director Jeffrey Cobelli, Judy created a documentary, “Someday Melissa, the story of an eating disorder, loss and hope.”

Mind-Body Connection

My state of mind affects my body. Wherever thought travels, a chemical travels with it. The chemicals in my body are then affected by my thoughts. This means that who I am on the inside affects who I am on the outside. I am not just guessing at this, it is not some New Age notion that neurochemical and physical makeup are interconnected. My state of mind and my level of inner spirit have the power to impact and improve me physically. Today I will affirm within me that I have a beautiful and healthy body and mind. I will thank a Higher Power for giving me a healthy, strong and beautiful body. I will do this as often as I can remember to do it throughout my day.

My body is beautiful, strong and healthy.

The same is true of the face, which is shaped and formed according to the content of the mind and soul, and the same is again true of the proportions of the human body. Thus can this member of astronomy describe each kind of soul. For the sculptor of Nature is so artful that he does not fashion the soul to fit the form, but the form to fit the soul.
Paracelsus, 16th century physician, alchemist

Every once in awhile, I get a marvelous article from my friend, Rick Hansen. Feeling like a really good person is always one of my goals and Rick gives some good thoughts on how to do this!

We end up not feeling like a good person in a number of ways. For example, I once knew a little girl who’d been displaced by her baby brother and fended off and scolded by her mother who was worn down and busy caring for an infant. This girl was angry at her brother and parents, plus lost and disheartened and feeling cast out and unloved. She’d been watching cartoons in which the soldiers of an evil queen attacked innocent villagers, and one day she said sadly, “Mommy, I feel like a bad soldier.”

Later in life – whether in school or adulthood – shamings, moral indictments, religious chastising, and other criticisms come in many shapes and sizes. Feeling morally compromised – the essence of not believing you’re a good person – is fed by related though different experiences of worthlessness, inadequacy, and unlovableness: as my ranch-born father would say, “feeling like you’re the runt of the litter.”

I’ve also known people – including myself – who have done bad things, or said them or thought them. Things like hitting an animal, risking the lives of their children while driving buzzed, being mean to a vulnerable person, stealing from a store, feeling contemptuous, or cheating on a partner. These don’t need to be felony offenses to make one feel guilty or ashamed.

In effect, to simplify, it’s as if the psyche has three parts to it: one part says, “you’re not good”; another part says, “you’re good”; and a third part – the one we identify with – listens. The problem is that the critical, dismissive, shaming voice is usually much louder than the protecting, encouraging, valuing one.

Sure, there is a place for healthy remorse. But shining through our lapses of integrity, no matter how great, is an underlying and pervading goodness. Yes it may be obscured; I am not letting myself or others – from panhandlers to CEOs and Presidents – off the moral hook. But deep down, all intentions are positive, even if they are expressed problematic ways. When we are not disturbed by pain or loss or fear, the human brain defaults to a basic equilibrium of calm, contentment, and caring. And in ways that feel mysterious, even numinous, you can sense profound benevolence at your core.

Really, the truth, the fact, is that you are a good person. (Me, too.)

When you feel deep down like a bad soldier – or simply not like a good person – you’re more likely to act this way, to be casually snippy, self-indulgent, selfish, or hurtful. On the other hand, when you feel your own natural goodness, you are more likely to act in good ways. Knowing your own goodness, you’re more able to recognize it in others. Seeing the good in yourself and others, you’re more likely to do what you can to build the good in the world we share together.

1. Take in the good of feeling cared about – When you have a chance to feel seen, listened to, appreciated, liked, valued, or loved: take a dozen seconds or more to savor this experience, letting it fill your mind and body, sinking into it as it sinks into you.

2. Recognize goodness in your acts of thought word and deed – These include positive intentions, putting the brakes on anger, restraining addictive impulses, extending compassion and helpfulness to others, grit and determination, lovingness, courage, generosity, patience, and a willingness to see and even name the truth whatever it is.

You are recognizing facts; create sanctuary in your mind for this recognition, holding at bay other voices, other forces, that would invade and plunder this sanctuary for their own agenda (such as the internalization of people you’ve known who made themselves feel big by making you feel small).

3. Sense the goodness at the core of your being – This is a fundamental honesty and benevolence. It’s there inside everyone, no matter how obscured. It can feel intimate, impersonal, perhaps sacred. A force, a current, a wellspring in your heart.

4. See the goodness in others – Recognizing their goodness will help you feel your own. Observe everyday small acts of fairness, kindness, and honorable effort in others. Sense the deeper layers behind the eyes, the inner longings to be decent and loving, to contribute, to help rather than harm.

5. Give over to goodness – Increasingly let “the better angels of your nature” be the animating force of your life. In tricky situations or relationships, ask yourself, “Being a good person, what’s appropriate here?” As you act from this goodness, let the knowing that you are a good person sink in ever more deeply.

Enjoy this beautiful goodness, so real and so true.

By the way, I’m a really good person too! — Jeannie

A while back, at the entrance of a gym, there was a picture of a very thin and beautiful woman. The caption was “This summer, do you want to be a mermaid or a whale?”

The story goes, a woman (of clothing size unknown) answered the following way:

“Dear people, whales are always surrounded by friends (dolphins, seals, curious humans), they are sexually active and raise their children with great tenderness.

They entertain like crazy with dolphins and eat lots of prawns. They swim all day and travel to fantastic places like Patagonia, the Barents Sea or the coral reefs of Polynesia.

They sing incredibly well and sometimes even are on cds. They are impressive and dearly loved animals, which everyone defend and admires.

Mermaids do not exist.

But if they existed, they would line up to see a psychologist because of a problem of split personality: woman or fish?

They would have no sex life and could not bear children.

Yes, they would be lovely, but lonely and sad.
And, who wants a girl that smells like fish by his side?

Without a doubt, I’d rather be a whale.

At a time when the media tells us that only thin is beautiful, I prefer to eat ice cream with my kids, to have dinner with my husband, to eat and drink and have fun with my friends.

We women, we gain weight because we accumulate so much wisdom and knowledge that there isn’t enough space in our heads, and it spreads all over our bodies.

We are not fat, we are greatly cultivated.

Every time I see my curves in the mirror, I tell myself: “How amazing am I ?! “

Have they done a thorough literature review on the recovery rates of people from eating disorders? Stuart Agras tells us that only 32% of all people who have had treatment are eating disorder free at the end of a year. This included inpatient, residential, and outpatient therapy. Anorexia is the leading cause of death in young women. 20% of people with anorexia will die.

I see the women who admit to Mirasol for treatment. A good number of these women wouldn’t live if they didn’t receive the care they need. A couple of days in the hospital for refeeding doesn’t cut it. I’m talking about treating them nutritionally, physically, emotionally — real mind/body treatment because that is the way someone recovers from an eating disorder much more quickly than they would in outpatient therapy.

I remember the court case in Minnesota where Kitty Westin sued Blue Cross of Minnesota because they refused treatment for her daughter, Anna, who died from an eating disorder. Anna was only 16. Now Minnesota pays for eating disorder treatment.

A few lawsuits that would cost the insurance companies $1,000,000 or more will get their attention and paying for treatment will seem much cheaper in comparison to paying out large amounts in lawsuits.

Insurance companies are making huge profits. They need to care for the women in our society who suffer from these conditions.

We all need to get behind the lawsuits. We need to write or call our congressmen. We need to shout loud and clear. We need to let people know that we will not accept this kind of treatment — or should I say non-treatment?

Grrrrrr………….

I love to answer the phones at Mirasol and speak with people who are calling us for information. Some people have been to several different treatment centers and are old pros at the admission process. Some people have never been to treatment but have been seeing a therapist. Other people are simply out there, very ill, and they’ve never attempted to get any help.

When I talk to people about previous treatment or lack of previous treatment, I get the comment, “I don’t think I’m sick enough for treatment.” They have an unbelievable list of reasons they shouldn’t get treatment.
See if you can identify with anything on this list:

1. I don’t want to. Wow, what a concept. I think I’ll wait. I’d rather have a root canal!

2. I’m not sick enough. Everyone (yes, everyone) has used this excuse at some point. Other variations include:
a. I’m not thin enough. My weight is okay. I’ll be the
heaviest person in treatment.
b. My labs are okay. I’m really healthy.
c. I don’t have serious health consequences.
d. If it were really a problem, my spouse / doctor / friends / parents would have said something.

3. I can’t take the time off from work – This excuse is not unreasonable, but what about having a life-threatening disorder? What about getting fired from your job because you can’t do the work? What about getting treatment, coming back, and doing super work for your boss? You need to be around to do your job and to do a good job.

4. It’s too expensive – Clients say this and parents say this! However, there are ways to find money. Some treatment centers have sliding scales. There are free, research-run programs in some areas. I know of a behavioral health lender that has very reasonable terms for the borrower. Many other people borrow money from family members. I remember one patient I had who borrowed $5000 from 10 different family members. Still, finances are a barrier for many people.

5. I had treatment before, and it didn’t work – This is another excuse that I hear frequently from people. How about saying this? “I didn’t fail treatment, but the kind of treatment I had failed me!”

6. I can do this on my own — This is another one that everyone has used, usually to put off therapists, doctors, and parents. If you could do it on your own, you would have done it by now.

7. There’s no treatment near me — You’ll have to be creative. You can find treatment of some kind, even if you’re going to AA or Al-Anon meetings.

8. I’m too old – Adolescent females are not the only people in the universe who have eating disorders. At Mirasol, my oldest client was a woman who was 74! More and more older women are showing up with eating disorders.

9. Shame — So many people with eating disorders feel a lot of shame. “What will everyone say if they know I’m going for treatment?” It’s none of their business first of all. You tell them you’re going to a retreat center. Sometimes it seems like jumping off of a cliff without any idea of where you’ll land! But take a risk and do it!

There are lots of reasons to NOT seek treatment, and many of them are valid. However, reasonable or not, they are still excuses and they help keep you sick.

What could ever be better than that?

However, I have so much knowledge that I have to get out to all of you who are in recovery, in early recovery, or are still suffering. I would also appreciate it if there is something you particularly have questions about or if there’s something you want to learn about eating disorders. I’m your gal.

I saw an article the other day in our local paper, the Tucson Daily Star, titled More Hospitals Offer Alternative Therapies. The article was a reprint from the Los Angeles Times.

Hospitals today are offering meditation and relaxation training. Medical, clinical hypnosis is offered as well and is a god-send in helping release some of the patients fear and stress. Over 65% of all hospitals offer alternative therapies for pain management. Massage therapy and body work in particular are effective.

It’s not only hospitals and treatment centers that want alternative therapies but the patients themselves want the best that both conventional and alternative medicine can offer.

I remember when I opened Mirasol in July of 1999. In August of that year, my husband and I went to an IAEDP (International Association of Eating Disordered Professionals) conference in Phoenix. At that time, I had a staff of 4 people including myself. I was doing biofeedback with finger temperature sensors. The programs were only 2 weeks long. I still talked extensively about integrative treatment and people thought I had holes in my head.

They weren’t laughing in my face but almost. Who ever heard of something called neurofeedback? Whoever thought about using body work and acupuncture with eating disorders? Even the terms Mind/Body/Spirit was still rather new and not embraced by the treatment community. At that time the only therapeutic modalities were cognitive-behavioral therapy and interpersonal therapy. Maybe a facility would throw in a horse.

No one is even thinking about laughing now. Today everywhere I look, I see the words holistic, alternative, and organic, and I see a huge list of therapies. I see even programs that are strictly medical model talking about Mind, Body, Spirit.

I used to feel resentful as the years went by and more and more centers began to use alternative therapies. “They’re just copying me,” I thought.

Now I look upon all places using alternative therapies with joy! People need to heal from the tops of their heads to the bottoms of their feet (or tippy-toes). I can’t imagine any person truly healing without healing their whole selves – Mind/Body/Spirit.

I have always tried not to use another person’s material when writing my blog, but this article is so exceptional, I need to share it with everyone!! It comes from a website, www.eatingforlife.org.

What to do if you think someone may have an eating disorder
Eating disorders are not about the food. There is always a deeper problem that is causing the person to focus so intently on food. The eating disorder is the outward manifestation signaling that there is an inner problem (e.g. self-esteem, family issues, depression, anxiety). An eating disorder is a person’s attempted solution to that problem. The eating disorder will begin to go away when the inner problem is addressed, and usually counseling is helpful in this process.

Make sure you approach the person one-on-one. If a group of you is concerned, it is very important that one person be chosen to talk with the friend. Group confrontation can make a person feel “ganged up on” and can cause a friend to feel betrayed, as if everyone has been talking about them. The goal is to support your friend, and often a group confrontation can leave a person feeling like they have been betrayed by their support system.

Make a plan to approach your friend in a private place. Try to choose a non-stressful environment where you will have time to talk at length, if necessary.

Present what you have observed and what your concerns are in a non-confrontational, caring way. Tell him or her that you are worried because of what you have noticed and that you would like to offer some help. Stay away from saying “we’ve been talking and are worried” – focus on what you yourself have seen, it is less threatening. (Friends who are too angry or hurt to talk supportively should not be the ones to confront.)

Offer human company and empathy. You don’t need to agree with the person’s feelings or stance. There is a place for challenge, advice, information, pep talks, jokes, and confrontation. Generally, that place is after she or he feels her or his experience is understood and accepted for what it is.

Listen carefully and non-judgmentally. Give the person time to hear what you have to say and to verbalize their feelings. Ask clarifying questions and then accept whatever they have to say without judgment. Encourage him or her to talk about their feelings.

Do not argue about whether or not there is a problem. Power struggles are not helpful. You could say, “I hear what you are saying and I hope that you are right and that this is not a problem. But I am still concerned about what I have seen and heard because I care about you.” (It is best not to say what other people feel or what they have noticed. Speak with “I” statements.)

Do not lay guilt trips, like “Look what you are doing to your family or roommates”. We are each responsible for our own feelings. Bear in mind that people with eating disorders yearn to know that someone could both know the worst about them and love them and care about them anyway.

If the person denies the problem, becomes angry, or refuses treatment, understand that this is often a part of the illness. They have a right to refuse (UNLESS their life is in danger). You may feel helpless and angry. You might say, “I know you can refuse to go for help, but that won’t stop me from being concerned. I may bring this up again later – maybe we can talk about it then.” Follow through on this, and other promises you might make. Your friend may need time to process what you have said to them. Don’t expect an immediate positive response, the important thing is to follow through and be consistent.

Provide information and resources for treatment. Make sure that you brush up on your knowledge of eating disorders before you talk to your friend, and be sure to offer resources to your friend. Encourage her or him to see a counselor, nutritionist, or physician and offer to go with them to the first appointment. Remember that recovery is a long process. It may take a while before your friend is feeling better and it is important for you to remain supportive throughout the entire recovery process.

Do not try to be the hero or rescuer – you may be resented. If you do the best you can to help on several occasions and the person does not accept it, stop. This does not mean stop being aware of their behavior, but you have done all it is reasonable to do. Eating disorders are stubborn problems, and treatment is most effective when the person is truly ready for it. You may have planted a seed that helps them get ready.

Make sure you get support for yourself. It can be difficult to live with someone who is dealing with an eating disorder. Get the information and support that you need.

For continuing support of your friend:
Remember that she or he is more than the eating disorder. Don’t let it become an identity – focus on his or her other characteristics that make them great. The more you help him or her identify his or her positive attributes, the easier it will be to let go of the “eating disorder” identity.

Don’t be afraid of conflicts or problems. These areas need to be brought out into the open, not hidden. Be sure to keep lines of communication open.

Do not focus on weight gained or lost. Focus more on their mental state. If you say, “you look thin” you are focusing on appearance and feeding into their behavior. If you say, “you look healthy” she or he may think you are saying, “you look fat.”

Don’t focus on achievements – grades, promotions, etc. Instead, talk about his or her inner qualities and strengths. Set an example – be good to yourself and she or he will see that it is possible.

Stay positive! People do recover from eating disorders. Many people who recover acknowledge the importance of friends who believed in them and kept trying to reach out to them.

Women’s Resource Center
Boston College

Eating Disorder (NIMH)

This article hit me on two different levels.

1- In our struggles with insurance companies I often find myself wondering how they fail to realize that investing in solid treatment will not only lead to lowering the suffering of the individual we are working with, but also in the long run save insurance companies money in the long term health problems which result from eating disorder behaviors.

2-This study states “that obesity prevention programs that stigmatize obesity or create a sense of blame can actually contribute to eating disorders.” Goes along with awareness of weight bias.

http://www.time.com/time/health/article/0,8599,1889742,00.html?xid=tweetbut

This is a struggle we are engaged with every day at Mirasol. It seems like in the past few years insurance companies are tightening their reins, but this case sends the message that the court system will enforce mental illness parity. Especially in light of studies indicating that eating disorders have the highest mortality of any mental illness.

I’m delighted to recommend Joanna Poppink’s book, Healing Your Hungry Heart: Recovering from Your Eating Disorder. I was in close communication with Joanna while she was writing this book, and I know the heart and wisdom she poured into the pages.

When I read early versions of the manuscript, I knew we had a fresh new voice bringing inspiration and practical tools for eating disorder recovery.

Joanna wrote this book for mature women. I believe you will find it of great value in your own recovery and in understanding the struggles of those you love.

Healing Your Hungry Heart (Conari Press, 2011) gives frank descriptions of the often secret emotional and personal challenges of living with an eating disorder and how to use them as opportunities for healing.