Find peace with food and overcome disordered eating.
Eating Disorder Therapist
Overcome disordered eating and find peace with food
by Harriet Frew on September 29th, 2020

Read article at the Counselling Directory.

by Harriet Frew on September 29th, 2020

Read article at the Counselling Directory.

by Emma on August 17th, 2020

By Emma 
We hear a lot about how controlling weight and eating can be motivated by the desire to appease a general sense of not being good enough, to meet an ideal standard or to find a way of feeling in control. There is still a stereotypical image of the person with anorexia as white, middle class, intelligent and female. What we still don’t talk about much in any meaningful way, is the link between eating disorders and trauma.

At around the time I developed anorexia I was living in an environment of unpredictable threat, frequently finding myself in a hypervigilant, anxious state. I had no frame of reference from which to make sense of my experiences, didn’t trust my own perceptions and had no one who was able to consistently reflect my feelings back to me. Despite this, I had some protective relationships, my sister and I were able to validate one another, I did well at school and was able to use this to find a way through.

When we do not feel safe, it is quite natural to find ways of creating a sense of safety. Often these ways of coping can be creative, necessary and useful at the time they develop. This is important, as we often see eating disordered behaviours as only undesirable, not understanding the function they may serve for someone. Personally, the strategies I developed worked quite well in the original environment I found myself in. They included striving as hard as possible to get things ‘right’, trying not to bother anyone (‘I don’t need anything’) and exerting as much control over my body as possible in the form of weight loss. These strategies allowed me to feel a sense of mastery in at least one area.

Within a CFT model this can be seen as the ‘drive’ and achieving system being overdeveloped and being used as a way to try to regulate the ‘threat’ system. I definitely found the ‘easy win’ of restriction self reinforcing, but I also think it became a way of desperately communicating that I was ‘not ok’ without having to actually say words. It wasn’t very effective, but it was all I had at the time. I don’t think people develop eating disorders deliberately and I definitely think that once that mindset has a grip it can feel extremely difficult to untangle yourself without help. I didn’t have help and so I became quite stuck, and my eating disorder became the ‘problem’ that was visible. In some ways anorexia began to silence me, just as  the situation I found myself in did.

Thanks to a number of protective relationships, I also functioned highly in a range of ways (I worked, developed friendships and romantic relationships). This was obviously helpful but it also meant that when I did become aware of the existence of eating disorder services I didn’t realise that help was available for people like me, who ‘functioned’ but underneath really struggled, and therefore my anorexia kept a grip to varying degrees for quite a long time.

One of the themes that drove my eating disorder was being quite cut off from the awareness of my own needs. At a relatively young age I had needed to become quite self sufficient, and cope alone. Consequently I felt guilty for desiring normal amounts of attention, frequently felt ‘too much’, and felt bad for wanting help or enjoying the feeling of someone being kind. Underneath my emotional experience had become quite constricted and I probably seemed quite shut down to people who knew me. It is difficult to acknowledge that (even with the best of intentions) you have been left to face unmanageable things and so it can be easier to decide that you don’t need anything at all. If we have experienced trauma that involves bodily violation (whether through violence or other forms of abuse) we can also develop intense discomfort in our body, and restricting or other eating disordered behaviours can be a way of managing this.

In hindsight my commitment to weight loss felt like a furious rejection of a whole range of needs and a desperate attempt to be ok on my own. Of course this doesn’t work very well because we exist in relationship to others and the need to feel seen and connected to people who care about us and are able to tolerate all the different parts of us is one of the most fundamental aspects of being a human.

What I now see is that anorexia creates a very fragile veneer of order, control, predictability. It keeps a person in a state of being tightly constricted. If this continues for long enough you probably don’t even realise you are in this state. It becomes normal. The problem with this strategy over the long term is that it can leave us very disconnected and cut off from both our emotions and our body, and so increasingly unaware of what we actually need. And so restriction, denial and a sense of not being allowed a whole range of normal things can become a relentless, self perpetuating cycle. It stops us from seeing in colour and it prevents us from processing. Recovery can involve getting back in touch with feelings we shut down early on in the development of our eating disorder and this can be difficult as it can feel like our worst fears about weight restoration are really happening.

Recovery for me has involved working not only on the behavioural aspects of regulating eating, interrupting compulsive exercise habits, restoring weight, it has also involved working on the emotional and relational aspects of my experiences. This can take time (years ago I struggled to verbally name feelings even though I was able to identify them). It has also involved a process of ‘opening up’ within my personal relationships as well as within therapy. Some relationships have been hugely significant in my recovery not only from anorexia but also from all the other difficult stuff that became reactivated through the process of restoring weight. There is something very powerful about receiving kindness, being listened to, validated, given time and space and understanding. I think it is important to say that opening up to the right people at the right time is also important, and sometimes this is tricky to gauge, especially at first. You do not owe everyone your story.

If anorexia involves keeping things very structured and controlled, it can be the case that we want to recover in a neat, tidy, linear way, too, but I have never seen a true recovery that looks like that. Recovery, at least for me, required beginning to engage with things that felt very messy, and finding ways to begin to navigate what I discovered as skillfully as possible. I used to say that I felt ‘reckless’ with food when I allowed myself something different or less ‘safe’. But when you are very stuck in a restricted place, being ‘a bit reckless’ can simply meant moving closer towards the middle, towards an appropriate amount of ‘allowing’ and ‘indulgence’. I think we can apply this to emotions too. To get unstuck sometimes we need to do things that feel utterly unfamiliar or reckless, or approach experiences that feel quite terrifying. We do not have to do to ourselves what was done to us. If you have been very squashed down or dismissed, moving towards a place of allowing yourself things or using your voice can feel like a big risk. It can also feel unnerving to suddenly become aware of feeling ‘needy’ or wanting closeness to others if this is not your usual state. This is another reason that it is difficult to navigate recovery alone.

We need the right people around us, who can help us to weigh up what ‘recklessness’ really looks like and who can tolerate the process alongside us. So reconnecting to the parts of ourselves we have lost touch with or become disconnected from can be challenging. I have found compassionate mind training helpful in beginning to reconnect with my ‘compassionate self’ and use this part of me to encourage myself to gently approach difficult feelings rather than avoid them.

So recovery isn’t always about fixing what is wrong with us. Sometimes it is also about exploring what happened to us. It can involve beginning to allow yourself to use the voice you already have but have become quite disconnected from. This may not always be comfortable. Social structures can silence us as well as internal beliefs and fears. It requires genuine courage to get in touch with the parts of ourselves that have been silent for too long. So developing trust with someone, ideally a number of people is important. Sitting with painful things with someone who can tolerate all the different aspects of you is important. Words and naming things can feel important.

We can use art, writing, or political action or whatever works. Responding to our needs can also involve setting our own boundaries, both internally and externally. Developing a sense of social responsibility and connection can feel important. Trauma can of course be collective as well as individual and understanding how our individual experiences fit within a wider social narrative can be a turning point. So the work of recovery is not only about food and weight, it is also often about imperfectly, messily finding a way towards a warmer, kinder, more nurturing relationship with ourselves and others.

by Victoria Stockwell on August 7th, 2020

By Victoria Stockwell - The Hungry Girl Podcast

In October 2014, I achieved the award that marked the pinnacle of my fitness competition career: the coveted Bikini Model Pro Card. Onstage, smiling for the winner’s photographs, I appeared the epitome of health and fitness. But, in reality, I was suffering from serious physical and mental damage.

I have had a disordered relationship with food since the age of 11 when I developed anorexia. Over the years, I have also suffered from bulimia, body dysmorphia and binge eating. When I was in my late 20s, entering the world of physique competitions triggered a major relapse into these destructive patterns of eating.
 
Fitness competitions are a misnomer. The irony of these events lies in the very title itself: fitness is not necessarily synonymous with health. I was a fitness model, yet I was far from fit. I ignored my body’s appeals for food and rest, instead rigidly adhering to a punishing diet and training regime that I hoped would make me muscular and lean.

This strict plan means that most competitors become disconnected from their bodies and what they truly need. Unsurprisingly, therefore, in the fitness world disordered eating is extremely common. Female athletes have the same risk factors as women in the general population, supplemented by the additional risk factor of reducing their body fat to dangerously low levels.

Body fat is decreased during the final stage of competition preparation, which is masochistically known as ‘cutting’. This typically begins eight to twelve weeks prior to a show, depending on the amount of fat that must be lost in order to create a winning physique.

This process increases the female competitor’s susceptibility to three inter-related disorders, known as the Female Athlete Triad. The components of the triad are osteoporosis, amenorrhea and disordered eating.

Osteoporosis occurs because limiting calorie intake leads to a decreased production of the hormone oestrogen. Since oestrogen plays a crucial role in calcium resorption and bone growth, reduced levels can lead to brittle bones. Even though I was following an extremely restrictive diet, I naively thought that any damage would be offset by my strength training which typically increases bone density. After competing, however, I was sent for a DEXA scan, which revealed my bone density to be borderline abnormal.

Not only does a low level of oestrogen lead to weak bones, it also causes menstrual dysfunction where the cycle can be delayed, or can stop altogether (amenorrhea). Owing to my restrictive eating habit, I have lost my period on numerous occasions over the years. When I experienced amenorrhea during competition preparation, however, this was the last occasion before I learned that I was infertile. Three very costly and emotionally traumatic IVF cycles later, and I am still waiting for my miracle baby.

While osteoporosis and amenorrhea are widely experienced by female athletes, the most common aspect of the triad is disordered eating. This includes extreme calorie restriction, binge eating, and purging via excessive exercise or self-induced vomiting. These abnormal patterns of behaviour are caused by the competitor’s strict diet.
 
My own insubstantial food plan exacerbated my pre-existing patterns of disorderly eating. I was so hungry that I couldn’t keep any ‘forbidden’ food items in the house since I had moments of ‘weakness’, where I would ‘give in’ and binge. A teaspoon of peanut butter could easily become a whole jar.

I unsuccessfully attempted to alleviate my troublesome appetite by drinking litres cherry Pepsi max and chewing sugar free gum. The Pepsi, however, gave me headaches and heart palpitations; and I chewed so much gum that I eventually wore away my teeth and had to have the bottom ones filled.

Hunger increases during the final weeks of preparation, when carbohydrates are drastically decreased in order to boost fat loss. Reducing carbohydrates to less than 20g per day releases ketones which the body can then use as fuel. This process produces various side effects, however, including nausea, headaches and fatigue.

In order to avoid these undesirable symptoms, competitors typically cycle carbohydrates. This involves enduring several consecutive low carbohydrate days, followed by a high carbohydrate ‘refeed’ day to aid metabolism and ensure continual fat loss. I didn’t know at the time, but this established a pattern of eating which would later turn into a vicious cycle of binging and restriction.

In the end, all my hard work paid off. I won. And I got my pro card. But was it worth it? On show day, the audience admire and applaud your physique. But they don’t see behind the curtain. They don’t see what it takes to be that woman holding the trophy. And they don’t see what happens afterwards.

Stepping off stage was the beginning of a relapse into my most serious and dangerous anorexic phase to date.

I was so terrified of losing my stage physique that I continued to restrict my calorie intake over the next couple of years. I lost body fat, and I also lost the muscle that I worked so hard to gain. My body literally ate itself. My glutes, the prize aspect of every bikini competitor, became saggy and deflated. My coccyx was so bony that I had to sit on a cushion. I was constantly cold from the inside out and handfuls of my hair fell out in the shower. I couldn’t go to the gym; I couldn’t even walk 10 minutes to the shop without feeling faint.

Eventually, my internal organs began to shut down and my hormones stopped functioning. I developed bradycardia because the muscles in my heart had shrunk.

I lost over 2 stone before I was admitted into an eating disorders hospital, where I spent 18 months as an outpatient. I was emaciated and mentally broken, a shadow of the woman who triumphantly raised the winning trophy.

In my experience, having your dream body does not make your life better. For me, it did exactly the opposite.

Whether you are preparing for a fitness competition, or just trying to manipulate your body through diet and exercise, I hope this has brought attention to the physical and emotional damage that can be caused by valuing aesthetics over your mental health.

I am now working towards food freedom and body acceptance. I still have my competition bikini as a memento, but its time in the spotlight is over and it is resolutely HUNG UP.

by Victoria Stockwell on July 11th, 2020

By Victoria Stockwell

Restricting food intake is the number one cause of eating disorders. NEDA reports that ‘35% of “normal dieters” progress to pathological dieting and that 20-25% of those individuals develop eating disorders.’[1]
  
 But why is this the case?  

  In 1944, a study was conducted that documented the effects of following a restrictive diet. This was the Minnesota Starvation Experiment. Led by Dr Ancel Keys, a team of researchers set out to find the most effective methods of rehabilitation for the millions of people who experienced starvation during the Second World War. They did this by restricting the diets of 36 young, healthy, male volunteers for a period of 6 months.

  The study found that externally induced starvation led to various psychological and physiological changes. These changes are typical of what might occur when we engage in extreme or chronic dieting. As a former Pro Bikini Competitor, I experienced similar effects when severely reducing my calorie intake in preparation for the stage. This eventually led to a full blown relapse into anorexia nervosa.

  The Minnesota Starvation Experiment was in three parts: an initial 3 month control phase, during which the men ate normally; followed by 6 months of semi-starvation; and finally, 3 months of refeeding.

  During the first stage, the daily calorie intake was approximately 3500kcal. This was then halved to 1570kcal in the second, semi-starvation phase.

  Likewise, achieving the lean competition physique involves being in a calorie deficit for a long period of time. For the average woman, the recommended daily intake is 2000kcal.[2] When preparing for a competition, however, this can drop almost to 1000kcal. This is the figure established by The World Health Organization as ‘the border of semi-starvation.’[3]

  The Minnesota Experiment’s protocol required participants to lose 25% of their body weight during the process (an average of 37lbs.)[4] This meant sustaining a weekly weight loss of approximately 2.5lb.  

  Aside from obvious external indicators such as sunken faces and protruding ribs, the men experienced decreases in body temperature, low blood pressure, anaemia, dizziness and fatigue. They also suffered from decreased heart rate and metabolic functioning.

 These symptoms can also arise when preparing for a fitness competition. Striving to attain the extreme aesthetic requirements causes various physical afflictions. These closely resemble the symptoms of starvation since the lean stage physique is essentially in a state of chronic malnutrition. This produces dysfunctions that affect multiple organs within the cardiovascular, gastro intestinal, endocrine, skeletal, and central nervous systems.[5]

 As well as causing physical illness, reduced caloric intake also leads to psychological depletion. The Minnesota men experienced various neurological deficits: lack of concentration anxiety, irritability and depression. Depressive episodes are both a physiological result of reduced dietary energy intake, and a psychological response to constantly fighting hunger.

  Participants were also fanatically preoccupied with food: it was the principal topic of conversation and the subject of their dreams. They collected menus and cookery books; and some even expressed a desire to become chefs after the experiment had ended.

 This obsession is also true of competitors. My fellow bikini models and I constantly talked of and thought about food: comparing our meals, watching food channels, and compulsively starring at ‘forbidden’ food items in the supermarket.

 A common symptom of calorie restriction experienced by both study participants and competitors is heightened cravings. As with food obsession, cravings are survival mechanisms that ensure that the starving individual seeks out nutrition. In the fitness world, cravings are typically for sugary carbohydrates such as biscuits, chocolate and ice cream.

 Following the semi-starvation phase, the men underwent 3 months of restricted rehabilitation where their daily rations were incrementally increased to 3200kcal. Their extreme hunger did not abate, however. According to Dr Keys, this was because the calorie increase was still not sufficient ‘to allow tissues destroyed during starvation to be rebuilt.’[6]

 Finally, there was an eight-week period during which there were no limits on food intake, during which the men would often binge on 8000-10,000kcal a day. As a result, they frequently vomited after meals and one was admitted to hospital to have his stomach pumped.

 This extreme huger, known as hyperphagia, is also typical of anorexia recovery. It is the result of the body’s attempt not only to restore weight, but also to repair the physical damage that has occurred during starvation. Throughout my own recovery, I had frequent binges where I could easily consume a frightening 10,000kcal in one sitting and still not be satisfied.

 Despite having no previous history of eating disorders, participants continued to be preoccupied with food, binge eating or restricting their calorie intake long after the study had ended.

  Like the starvation imposed upon the men in this study, the extreme diet required for a competition can lead to obsessive and destructive food-related behaviours for women who have no previous histories of disorderly eating.

 The experiment revealed that malnutrition itself causes these symptoms: eating disorders can be created just by depriving the body of food through dieting.

  This means that many, including myself, have hung up their sequinned bikinis. Like the Minnesota men, we have found starvation ‘too damaging to our psychological and physical wellbeing.’

Listen to Victoria's Podcast - The Hungry Girl Podcast HERE.


     
   [1] http://www.eatingdisorderhope.com/treatment-for-eating-disorders/special-issues/dieting

[2] http://www.nhs.uk/chq/pages/1126.aspx?categoryid=51

[3] Feminist Perspectives on Eating Disorders, ed. by Patricia Fallon, Melanie A. Katzman, Susan C. Wooley (The Guilford Press: London, 1994), p.8 'From Too "Close to the Bone": The Historical Context for Women's Obsession with Slenderness', Roberta P. Seid

   [4] http://www.seven-health.com/2013/08/controlling-weight-part-2/

   [5] http://emedicine.medscape.com/article/89260-overview#a0101

   [6] https://academic.oup.com/jn/article/135/6/1347/4663828






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Find peace with food and overcome disordered eating.