Oliver-Pyatt Centers Clinical Director Stephanie Diamond, PhD, CEDS specializes in eating disorders and personality disorder co-morbidities. In her writing, Dr. Diamond shares a glimpse into the inner world of someone struggling with an eating disorder and about the importance of self-compassion in eating disorder recovery.
Think about your own inner dialogue. Is it kind, gentle, friendly? Is it aggressive, rejecting, demeaning? Both? Neither? For the less fortunate among us, self-critical thoughts come automatically, while thinking kindly about oneself might feel inauthentic or indulgent. Why is it some of us struggle to treat ourselves in the manner that we might treat a friend?
The inner world of someone with binge eating disorder (BED; or any other eating disorder) can often be an unfriendly place. The stream of consciousness thoughts within the mind of the person who is struggling tend to be skewed toward self-critical, self-deprecating, and self-blaming statements. The person is fairly constantly under siege by these negative, judgmental and disapproving and shaming thoughts about self. Ah, shame… what a dark and haunting emotion. Shame is a destructive emotion that makes us feel less-than and fosters isolation. The eating disorder enters as a way to manage the shame, and often exacerbates these feelings. It is a nasty positive feedback loop. And it is no coincidence that shame is often a main target in psychotherapy during the treatment of BED.
How do we target shame, you ask? Well, there are many ways we can work to take that terrible monster down! Have you heard about self-compassion? It is about self-kindness, it is about recognizing our humanness, and it is about mindfulness of reactions to our painful thoughts and feelings (Neff, 2003). And, amazingly, self-compassion may just be the best antidote to shame.
Don’t worry if you find yourself self-compassion-deficient. You are not destined to remain that way, as there are methods for you to develop more! Self-compassion is not an all-or-nothing thing. It is not about “having” or “not having” self-compassion. Self-compassion exists on a continuum, and like anything worth having, it takes work and practice. How might your life be different if you were a little kinder to yourself? What might change? Can you dare to imagine…? Might you have more patience with yourself; might you befriend your body; might you forgive a mistake you made?
Let’s not forget that when it comes to eating disorder recovery, the very act of honoring your body’s hunger and fullness cues is an act of self-compassion. The practice of self-compassion can make all the difference in helping a person bridge from self-destruction to self-actualization. We need to nurture a self-compassionate voice to counter the self-critical one, otherwise, recovery will likely remain out of reach.
So, what can you do today to nurture some gentleness and loving-kindness towards little old you? You deserve it!
Oliver-Pyatt Centers Clinical Project Manager Wendy Shoaf, MS, LMHC, LPC will present at OPC’s First Wednesdays Breakfast Series for Clinical Profressionals on September 7th. With over seven years of experience working with eating disorders, as well as disordered eating patterns, Ms. Shoaf will share her expertise on “Dining Hall Decisions: Helping your client know when they’re ready to go back to college”.
College and young adulthood present unique challenges in the eating disorder recovery process. Ms. Shoaf will identify and examine these challenges– from maladaptive behaviors, to mealtimes and managing food, to social and academic stressors. She was also discuss the barriers to rematriculating following treatment and ways to address resistance from families and other key people in students’ lives.
Through this presentation, participants will be able to identify three challenges unique to college students who are in recovery for an eating disorder. Additionally, participants will be able to identify three barriers to returning to college and strategies to address them, as well as, identify resistance that presents within familial and other relationships and how to address them whether the student is living at home or away.
Breakfast begins at 9 am and the presentation will be from 9:30-10:30. 1 CE hour will be offered for: PhD, PsyD, LMFT, LMHC, LCSW, LPCC, and RD. If you would like to join OPC’s First Wednesdays on September 7th, please RSVP to Florida Outreach Manager Callie Chavoustie at email@example.com or RSVP here by September 5th.
Dr. Stacey Rosenfeld is a licensed psychologist, certified group psychotherapist, certified eating disorder specialist, and the author of “Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight”. Her work also focuses on substance use disorders, anxiety and mood disorders, fertility challenges, relationship concerns, and sport and exercise psychology. In addition to directing Gatewell Therapy Center in Miami, she is a cooccurring (eating disorders and addictions) consultant at Oliver-Pyatt Centers. Dr. Rosenfeld works with individuals, couples, families, and groups, using cognitivebehavioral therapy (CBT), dialectical-behavioral (DBT), psychodynamic therapy, and motivational interviewing approaches.
A significant percentage of those with eating disorders also struggle with alcohol and substance use disorders. In 2003, the National Center on Addiction and Substance Abuse issued the seminal report, “Food for Thought: Substance Use and Eating Disorders,” which highlights this relationship. (1) The report found that:
Individuals with eating disorders were up to 5 times as likely as those without eating disorders to abuse alcohol or illicit drugs, and those who abused alcohol or illicit drugs were up to 11 times as likely as those who did not to have had eating disorders. Specifically, up to 50% of individuals with eating disorders abused alcohol or illicit drugs, compared to 9% of the general population. Conversely, up to 35% of individuals who abused or were dependent on alcohol or other drugs have had eating disorders, compared to 3% of the general population.
Other research has offered similar findings. Struggling with an eating disorder or a substance use disorder increases one’s chances of developing the other disorder.
It appears that the most highly correlated eating disorder with substance misuse is Bulimia Nervosa (BN). A 2007 largescale study found that those with BN had a higher lifetime comorbidity estimate of substance use disorders (SUD) than those with Anorexia Nervosa (AN) or Binge Eating Disorder (BED). (2)
A more recent study documented a similar finding, with patients with BN using alcohol/other substances more commonly than those diagnosed with ANR (Restricting Type), BED, or Eating Disorder Not Otherwise Specified (now called Other Specified Eating and Feeding Disorder). This study also found that patients with ANBP (Binge Eating/Purging Type) used alcohol/substances with greater frequency than those with ANR and that participants’ frequency of binge eating and purging varied with the frequency of their substance use. (3)
Why might eating and substance use disorders so commonly cooccur? Let’s take a look at some possible explanations:
Common genetic underpinnings: We know that both eating disorders and substance use disorders have significant genetic components. Is it possible that the same genes are responsible for both disorders? One study suggests so. A 2013 twin study found significant genetic correlations between alcohol dependence and, in this case, binge eating, as well as between alcohol dependence and the use of compensatory behaviors (e.g., purging, use of laxatives/diuretics). The authors concluded that alcohol dependence and the tendency to engage in binge eating and compensatory behaviors are influenced by common genetic factors. (4)
Common psychological factors: Psychology and behavior are influenced by genes, biology and the environment. Those who struggle with eating disorders and alcohol/substance problems often have difficulty managing emotions and/or trouble with impulse control – both disorders may reflect these challenges. Symptoms of these disorders may serve a similar function in helping individuals selfmedicate anxiety, trauma, depression, etc.
Some substances are used specifically in the service of an eating disorder. Many patients report using substances to aid in restriction, bingeing, and purging. Even if unintentional, the frequent use of alcohol/drugs can lead to eating disorder symptoms, which, if unchecked, can spiral into disorder.
Using substances to cope with eating disorders symptoms: When asked to discuss the relationship between their eating disorders and alcohol/drug misuse, patients typically comment on the use of alcohol/drugs as a mechanism to “quiet” their eating disorders, particularly body image distress. What begins as a (maladaptive) coping strategy becomes its own disorder.
Symptom substitution: Many patients report that as they try to reduce their reliance on eating disorder symptoms (or alcohol/drugs), symptoms of the other disorder increase. We often discuss this as the “WhacAMole” phenomenon take away one behavior, and another develops/strengthens in its place. Symptom substitution highlights the importance of addressing both disorders simultaneously.
Some of the same approaches can be used to treat eating disorders and substance use disorders. These include CBT, DBT, family therapy, motivational interviewing and targeting other co-occurring conditions, including mood disorders, anxiety, trauma, self injury, etc. When eating disorders and substance use disorders co-occur, it is crucial that they be addressed in tandem to prevent symptom substitution or symptoms of one disorder triggering the other. Further, even moderate use of alcohol/drugs might impact those in eating disorder recovery, with many substances interfering with hunger/fullness cues and impacting judgment, impulsivity and emotion regulation. Patients with eating disorders who do not have co-occurring substance use disorders might still opt for a period of alcohol/drug abstinence until they are more stable in their eating disorder recovery.
3 http://onlinelibrary.wiley.com/doi/10.1002/erv.2410/abstract?userIsAuthenticated=true&deniedAccessCustomised Message=