Treating Anorexia: The Recovery Process

online conference transcript

Kathleen Young Psy.D. , our guest, has fifteen years of experience treating eating disorders. She has studied and helped many with eating disorders such as anorexia nervosa, bulimia nervosa, and compulsive eating. Here, Dr. Young discuss recovery from anorexia, treatment of eating disorders, eating disorder relapses and shifting between being anorexic and bulimic.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

David: Good Evening. I'm David Roberts, the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Treating Anorexia: The Recovery Process."

Before I introduce our guest, here is some basic information on Anorexia. You can also visit the Peace, Love and Hope Eating Disorders site in the HealthyPlace.com Eating Disorders Community.

Our guest is Kathleen Young, Psy.D., who has fifteen years of experience treating those with with anorexia, bulimia, and compulsive eating. She is located in Chicago, Ill. Besides obtaining her Doctorate in psychology, Dr. Young received additional training in the treatment of eating disorders at Northwestern Memorial Hospital and the University of Arizona's Medical Center.

Good evening, Dr. Young and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Many people talk about wanting to stop being anorexic, yet they find it extremely difficult to accomplish that. Why is that?

Dr. Young: Hi everyone! It's great to be here. That's a good question. I think its important to remember that anorexia is a complex disorder and that it begins as an attempt to cope with, or manage, some circumstances and feelings in the individual's life.

David: Just so we are all on the same page here, when you use the word "recovery," what do you mean by that?

Dr. Young: I think of it as having two components, the surface or behavioral level of working towards a healthy relationship with food, and the underlying issues such as feelings, personal issues, and self-esteem for example. We can't just focus on the food or eating behavior.

David: Are there cases that you can think of, where it would be impossible that a person could recover?

Dr. Young: I would never want to think that in advance! I believe that recovery from anorexia nervosa is possible, even if only to some extent. It is ultimately up to the individual.

David: What does it take, inside the person, to bring about a significant recovery?

Dr. Young: It often takes first getting to the point of being sick and miserable with how things are. It often takes the motivation of pain to make us want to change! It also takes perseverance and patience with what can be a long process, as well as, the willingness to let go of rigid ideas about weight or food. However, the last happens gradually with a lot of support.

David: We have some audience questions, Dr. Young, and then we'll continue with our conversation:

Lexievalle: How do we acquire a support system for recovery?

Dr. Young:That is very important, Lexievalle. Without support from others, it can be harder to give up the comfort of the old behaviors. The first step is getting an experienced therapist. There are also many free support groups in most areas, such as ANAD (National Association of Anorexia Nervosa and Associated Disorders). The internet can also be a source, as we see here :)

brewnetty:Recovery is being able to eat without fear, right?

Dr. Young: Brewnetty, that's a great way to put it! Often anorexics become very afraid of food. It can seem like the enemy, rather than a part of healthy self care. I would also add the ability to value yourself for aspects beyond weight and appearance.

David: One of the things I would like you to clarify, because we get emails that go something like this: "I'm hardly eating or eating very light meals. I'm always concerned about food, but I don't weigh 78 pounds. Am I still anorexic?" Could you answer that question, please?

Dr. Young: Yes, I hear that a lot too. "I'm not thin enough to have a problem." Anorexia does not require any specific weight. It is diagnosed by:

• the drive for thinness
• pattern of restricting
• weight loss
• loss of menstrual period

However, you still may have an eating problem even if you do not meet all the criteria. If it takes up a lot of your time, and energy, and makes you unhappy, it is a problem.

David: Here are some more audience questions:

joycie_b: I understand that Anorexia is about emotions, not the actual food. If this is true, then what is the best way to help my friend to talk about what she ate that day and help her realize it was not "too much" or should I not bring it up at all?

Dr. Young: Joycie, it is great you want to help your friend! This is a common concern, because actually focusing too much on the food and eating can make things worse, since needing control may be a factor for the anorexic. It's helpful to honestly express your concerns and what you see one time and then ask how you can be of support. You should be there to listen, validate feelings, and tell your friend all the great things about her or him.

David: Joycie, here's a great resource for family and friends of those with eating disorders.

EHSchic: I am not eighteen yet. Is there anywhere that I can get help (as cheap as possible) without my parents finding out?

Dr. Young: EH, I know that's tough. You may need to consider whether its worth involving them to get financial help and whether they can be of any support. Sometimes anorexic's don't want to tell parents for fear of hurting or burdening them, but that is part of the problem because your needs are important. If it is really not an option, than please check at any local colleges or universities, because they usually offer counseling programs. You can even check any community health centers. ANAD is a group that runs free support groups in many areas.

David: Dr. Young's websites are here:

• Counseling Referrals located at: http://www.counselingreferrals.com
• and Affirming Alternatives located at: http://www.affirmingalternatives.freeservers.com

Dr. Young, how would you suggest that teenagers with eating disorders broach the subject with their parents? Many say they are afraid to because their parents would be disappointed in them or feel let down or they don't want to burden them?

Dr. Young: Right. I know it is tough and may go against a long family pattern. Sometimes it helps to share a book on eating disorders, or written information, like from a website. Basically, tell them whichever way you can, the behavior and how you feel about it. Let them know you love them and need their help and support. Family therapy is often important to change the old habits of all family members that contribute to the development of anorexia.

chatter:Doctor, do you find it difficult to deal with the families of anorexia sufferers in the way that they perceive the disease? For example, a family may think recovery is as simple as making the sufferer eat again and not recognize the emotional and psychological issues behind anorexia. (how to support someone with anorexia)

Dr. Young:Chatter, yes that is often the case. Families need to be educated about the eating disorder and they have to learn that telling someone to eat, will not fix the problem. It is not a "just pull yourself up by your boot straps" type of situation. If it were that easy, you would have done it already!

Krystie: I am twenty-eight years old and have taken on many anorexic tendencies just in the last year-and-a-half alone. Because of my age, I am regarded as childish and looking for attention; treated as though I am using this as a game, when I have spent so much time, effort, and money to overcome this. How does an adult sufferer begin recovery with this societal attitude?

Dr. Young: Krystie, I am sorry you are encountering that bias! How unfortunate. Women and men of all ages can suffer from anorexia. Because it does often begin in adolescence, there may be that confusion. Try to find a good therapist with experience with anorexics at different ages, and a group (or treatment program) with an age range as well.

David: Here's another question from an adult, Dr. Young:

scarlet47: I am fifty-one years old and have had anorexia for four years. I also have PTSD (Post Traumatic Stress Disorder) and self-harm. All stem from abuse and a frightening fear of abandonment. Is this becoming more common with middle age women? Mine never started with the thoughts of wanting to be thin. I had high blood pressure and they said I needed to lose weight, as opposed to taking medications. I guess I went to the extreme. I have been with a private therapist and have lost twenty-five pounds since. I feel so alone because most eating disorders seem to be associated with teenagers. Thank you.

Dr. Young: Scarlet, thanks for sharing. You also raise important points. One is that anorexia may be part of a more complex picture. It may be one reaction to trauma in the past, like another type of self-harm. Or weight loss can be a symptom of depression. It is important to have a skilled clinician to help you differentiate.

David: I did not realize how many people develop an eating disorder in adulthood. Here's another audience member with a comment:

rcl: Mine started at age 40 !!!!

Dr. Young: I think women of all ages are susceptible. This is a frequent choice for coping, given society's focus on thinness and appearance in women. Getting thin and not eating, can feel like succeeding in the world's eyes. On the other end, girls as young as five, are now talking about being fat and needing to diet!

David: I'm wondering, in these circumstances, were these people predisposed to anorexia and just never developed it until something "kicked in"?

Dr. Young: We don't really know if people are biologically predisposed, set up by their family dynamics and society, or even some combination. It may be that a person used other coping mechanisms earlier, or may have had alcohol or drug problems, so the eating issues did not surface until later. Any time of life transition or stress can be a kind of trigger for developing issues that were lurking beneath the surface.

lanie: Which methods of treatment of eating disorders are most successful when dealing with an anorexic teenager?

Dr. Young: Family therapy is usually crucial, since the adolescent is often still at home. Individual therapy is necessary, as well. Many individuals, may also work with a nutritionist, to help make food plans.

hopedragon:Dr. Young, thank you for chatting with us tonight. How big is the chance of anorexia coming back after beating it twice? I recovered from anorexia about a year ago and I'm afraid it's coming back.

Dr. Young: Thank you, Hope and everyone. Sometimes there remains a vulnerability to these issues. With stress or loss, that may be the way you turn to cope without even meaning too. It is important not to get discouraged. You have accomplished a lot and can put it into practice again. You may just need a refresher :)

David: So are you saying, if you feel an eating disorder relapse coming on, get back into therapy a.s.a.p.?

Dr. Young: Definitely! The tendency may be to ignore it, but that never works. The sooner the better, before the behavior gets very entrenched again.

Clubby8346: Dr. Young, I am in so much confusion about anorexia right now. About four years ago, I dealt with anorexia for about two years. I was strong, and thank God it was so bad that I overcame it on my own. About one year ago, two of my family members were murdered. It seems like, since then, I have turned to food more and more. I eat all the time and now I find myself wanting to be anorexic again because of all the weight I have gained. I also eat to feel comfort. What should I do?

Dr. Young:Oh clubby, I am so sorry to hear about your loss. Anyone would be rocked by that kind of trauma. Often, women who have anorexia may develop another type of eating disorder at some point such as bulimia or bingeing (binge eating). It's all part of the same spectrum. Of course, anorexia is the culturally preferred disorder. Have you ever heard anyone say "I wish I could be anorexic for awhile?" You need support and help through this trauma and the way it is being expressed is through your eating and not eating. I hope you seek help.

LucyDean: Is it possible to control your problem eating patterns when you are having to deal with relationship and family problems and other anxieties?

Dr. Young: Sure, it just takes planning ahead! Identifying triggers and difficult situations is part of the therapy process. Then you can plan for alternative behaviors. If your family is making you nuts, can you call a friend, go for a walk, yell in the car, etc.? You get the idea?

David: A moment ago, you mentioned a spectrum of eating disorders, where a person may cross between one disorder like anorexia to another, like compulsive eating. Here's a question on that subject:

caraaddison: What advice would you give to someone who is no longer anorexic, and now allows herself to indulge to the point where it is very, very hard to stop? When I am eating cookies, let's say, I can't stop and tell myself it's okay. Then I eat a large amount and later I feel so bad about it. What can I do to find the happy medium of emotions?

Dr. Young:That's a question I bet many share! Remember, starving yourself sets everyone up for the likelihood of bingeing or compulsive overeating, eating later in ways that feel out of control. The best prevention is to make sure you are eating enough, as well as, well balanced meals throughout the day. You may not be the best judge of that. I suggest a few visits with a nutritionist to help develop a meal plan. I believe that foods like cookies need to be worked into the plan so you don't feel deprived.

David: Here are a few audience comments on what's been said tonight, then we'll continue with more questions:

Sonja: Yes, I have had people say they are so envious of my thinness. They have no idea what it feels like to be wiped out physically by a simple cold turning into pneumonia! I think I don't eat because it means taking up space. It is like, by being as small as I can, no one will see me. It is never been about being fat or thin for me.

earthangelgrl: A lot of people say they want to be.

Clubby8346: What can I do? I am so alone and long to be anorexic again.

rcl: I am anorexic and bulimic. I fight the bulimia with the anorexic behaviors and the anorexia with bulimic behaviors. I seem to do it by days. So I have three days right now when I am "bulimic" and four days when I do not binge and purge, but eat only a salad. To be free of the bulimia and anorexia, I think I have to win the fight against one or the other of the eating behaviors first. Is that right? Second, which one do I try to get rid of first?

Dr. Young: Thank you all for your honest sharing. You really demonstrate the pain that is part of this disorder. It is a vicious cycle and often bingeing and purging follow some period of restricting. It is that physical and emotional deprivation. It all starts with re-learning to eat in a healthy way. Sometimes you have to commit to not purge no matter what first. You also need to get help from a therapist to identify what you are using this to cope with, and how to cope instead. Who of us could give up a means of coping without anything else to put in its place?

David: Here's another audience comment:

abumonkeywolfe: Some days, I get so overwhelmed and don't think I will ever overcome the vicious cycle of my eating disorders.

Dr. Young:I can understand, abu! Many people feel that. It helps to have someone else who can hold onto hope for you and help you through those points.

abumonkeywolfe: Speaking of cost, for those of us with limited funds, what options are available? I've struggled with my eating disorders for nearly thirteen years now. I've asked for help several times through free counseling services available to me, and was turned away. Now that I've joined the work force, time and money are serious concerns in finding help.

Dr. Young: Yes, finances are always an issue. There are referral services to help people find sliding scale or low fee therapy. You need to research your area, do an internet search, or ask someone to help you find resources if you are too overwhelmed. Then there are free support groups and twelve step groups like Overeaters Anonymous. Some anorexics and bulimics find OA meetings helpful and think about restricting, bingeing and purging as their "addiction. I wish there were a simpler answer! You can contact me through my sites by email and I can share the resources I know about.

jode101: I've been anorexic for five years and I have severe health problems now. I was wondering if there was an average time it takes for someone to get over this disease?

Dr. Young: That is a good question. I don't know of any figures off the top of my head. I expect that the longer it has gone on, the longer it may take to heal. Another factor is how willing you are to gain weight if need be to get well.

halle: I am twenty-three and have had anorexia subtype purging for what seems like forever (since I was thirteen). Is there any way to change something so long standing? I'm in medical school and I think that this is my coping mechanism. The stress isn't going away and I am kind of lost at the moment. I feel like it is not going to change.

Dr. Young: I understand why you feel that way and medical school is stressful, but it is never too late. The sooner you seek help, the sooner you can get better. You really can find other ways to cope and feel good about yourself. However, it can be scary. Some say the eating behavior can feel like a best friend, but what a destructive one. We haven't talked about this aspect, but anorexia is life threatening and can have long term health consequences. It is so worth getting help.

jode101: Dr. Young, how do you educate a spouse about an eating disorder, if they don't believe or understand it is a real disease?

Dr. Young: Jode, that's tough, and furthermore, not being validated like that, may be part of the problem. Sometimes an outside party can help, or even a book or an article. The bottom line though, is to do it for you, no matter what other people believe. You all deserve it!

David: We touched on eating disorder relapses earlier, but apparently it's a real concern among many in the audience tonight. Here's another question on that:

vancek: I am twenty-one and have been anorexic for about two years now. I have never been anywhere close to recovery, but for a while I was doing better (though my nutritionist questions even that). Anyway, I'm really relapsing again, and now I am scared. It seems that I get worse when stressed. I have a really hard time even admitting most of the time that it's getting bad and I need suggestions on pulling out of a relapse?

Dr. Young: Sharing, like you are here, is a great step. You need to admit to those you work with, that it feels like a relapse. Try to trust their recommendations on what will help you manage stress differently. Some suggestions are relaxation techniques like breathing and yoga. These can be great. Good luck! And remember, progress is often up and down like this.

David:Thank you, Dr. Young, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a large eating disorders community here at HealthyPlace.com. You will always find people in the eating disorders community, interacting with various sites.

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com.

Thank you again, Dr. Young.

Dr. Young: Thank you all for this opportunity. I wish you the best in your healing journey.

David:Good night, everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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