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Ashley Solomon, Psy.D is a psychologist who specializes in the treatment of eating disorders, body image, trauma, and serious mental illness.

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Tag: diagnosis

10 Jun

Could Naming Your Eating Disorder Help or Hurt?

Ideas to Consider 239 Comments by Ashley @ Nourishing the Soul

On the heels of a wonderful #aedchat, I’ve been spending a lot of time thinking about the concept of externalizing eating disorders. (If you missed the tweetchat, you can read the entire transcript here.) To grossly over-simplify, externalizing an eating disorder refers to the technique of considering the eating disorder as a separate entity from one’s self.

Jenni Schaefer, author of Life Without Ed, is often credited as being the first to really popularize this idea. In her book, now ten! years old, she talks about assigning her eating disorder the name Ed and coming to think of Ed as an abusive boyfriend, one that she loathed but was also afraid to leave. Jenni shares over the course of the book how creating this distance between herself and the eating disorder allowed her to garner the strength to begin fighting back, eventually making real change and forging a path to recovery. Creating “Ed” was a starting point for her in changing the way she saw herself and the disorder.

Many other therapeutic traditions have adopted a similar approach. Narrative therapy teaches individuals to reconceptualize their disorders garner a new sense of strength and the power to rewrite their stories. to In Family Based Treatment, for instance, practitioners introduce the eating disorder as a separate entity, a grave disease, to patients and families. The rationale is that the family needs to be united against this “intruder.” Indeed, many families come to this on their own. They observe how this awful “being” has seemed to come to posses their child, leaving at times a shadow of their loved one’s former self in its wake.

In my own work, I’ve heard from countless individuals how externalizing their eating disorder helped them begin to distinguish between their own thoughts and those of the eating disorder. Over time they began to recognize their true (“healthier”) self as distinct from this disorder who’s goal was to trick and deceive them. Once they were able to recognize this distinction, they could begin to attend more to the true self, letting the Ed or Ana or Mia fade further into the background (or kicking him or her to the curb).

While I observe how powerful an intervention this can be, I do find myself concerned that it has become almost an expected part of the treatment process. When one group member in an eating disorder group I run expressed that this didn’t resonate for her, other members told her that she would “get there” and seemed to indicate this as a sign of her not being further along in recovery.

Eating disorders can be so insidious and I think externalizing and visualizing them can be helpful in undermining their strength. But this doesn’t work for everyone. And not only that, I think there are some potential costs that come for some with treating the eating disorder as a separate entity. Hearing Dr. Kelly Vitousek talk at a conference a couple of years ago, I was struck by a number of these costs.

For one, I worry that it oversimplifies a very complex and nuanced issue. One of the issues that we continually challenge in eating disorder treatment is the practice of dichotomous (“black and white“) thinking, and creating two selves – healthy/sick or good/bad — seems to perpetuate that approach. It could be more powerful, in some cases, to consider the complexity of the disorder and acknowledge that the traits we may associate with each “self” — e.g. perfectionism with the anorexia — are not solely good or bad. Those traits are part of the person himself or herself and can be used in pursuit of more or less workable goals.

Further, while they are painful and destructive, eating disorders often emerge initially as a means of self-protection and safety. For some, a the world has become too dangerous or chaotic or unpredictable and the eating disorder serves an important function. To separate it from one’s self and villainize it could prevent one from fully acknowledging the role the eating disorder has played.

Some individuals end up feeling invalidated by this approach, that what they think or feel is treated by others as “just Ed talking” versus him or her. When I once remarked to a patient of mine that it felt like “Ed” was the loudest person in the room and I wished I could hear her instead, she became very upset and reminded me that she was the person behind all of the words, and it was important that I hear them all, not dismissing any because they were “Ed’s.” It was an important learning moment for me, and I’m cautious, even when a patient externalizes her own disorder, to not treat what is shared in that way.

And finally, could seeing the eating disorder as distinct from one’s self impair accountability? I’ve observed this go various ways with individuals with whom I’ve worked. I do think there can be a risk is over-externalizing, to the point where an individual feels that they are actually powerless over this much stronger being. The person feels that he no longer has any control, so why bother? It requires energy to fight a monster, and if someone is physically malnourished and weakened by the symptoms, they could feel unable to take on Ed, finding it easier to submit.

The bottom line is that this is an intervention that should be used judiciously. It’s not a one-size-fits-all approach, and one has to consider the individual or one’s self before determining if creating an “Ed” is the right way to go.

Have you used this technique in your work or recovery? If so, what was your experience?

14 Mar

Healthy apps that could change your life

Current Events, Education 14 Comments by Ashley @ Nourishing the Soul

Recently I was minding my own business, browsing facebook – to read up on the latest news from eating disorder centers and body image blogs, of course – and what do I get but an invitation to learn… wait for it… “How sexy is your name?”

I immediately dismissed the invitation as junk, until I found myself thinking back to the the application and the question it posed a few moments later. How sexy is my name? I wondered. Does it sound sexier if I put “Doctor” in front of it? And more importantly, Why does anyone care enough to create a program to provide an answer?

After that, I decided to browse the app store to see what other philosophical questions creators were posing and what I found was, well, disheartening. From apps based on the concept of “Hot or Not” to ones in which you could remove blemishes from your profile picture (I guess I need to add facebook airbrushing to my media literacy curriculum. Sigh…), there were tons of applications that just felt icky. And yes, icky is a technical term in my field.

My mind started mulling over the post that I would write on this topic, when I thought, Hey, there have got to be some really positive, healthy apps out there too. Check me out – always looking for the positive! Or something.

What I found was that there truly are some awesome apps out there for your smartphone that can make living a life balanced in body, mind, and spirit a bit easier. Who says technology has to be the end of healthy civilization as we know it?

Here are some of the best that I found. Please be advised that some of these do have a cost attached, but no more than $1.99. I got your back, right?

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Daily Affirmation:

If you have trouble coming up with your own affirmations, let your iPhone do it for you. This app offers inspirational phrases and positive self-statements, a strategy that many therapists encourage clients to use to boost self-esteem and body image. This app even lets you select a category, such as “Career” or “Anxiety.”

affirmation

Zen Timer

It can be difficult to be deep in a meditative state and watch the clock. This app takes care of that by signaling when your time has elapsed with the high-quality ringing of a Tibetan singing bowl. Set your phone to Airplane mode to prevent interruptions and you’re set!

zentimer

A.D.A.M. Symptom Navigator

Curious about that mole on your neck or have an unexplained headache? This app allows you to search your symptoms based on your gender, age, body type and more to find out if your ailments might require medical attention. It’s based on the A.D.A.M. Health Illustrated Encyclopedia, so this is legit, people.

adam-symptom-navigator

eCBT Mood

So I don’t want to put myself or my colleagues out of business here, but this app is pretty darn cool. Based on the principles of cognitive-behavioral therapy, it allows you to assess your stress, log and explore your thoughts, feelings, and behaviors, and challenge your automatic thoughts and core beliefs. It’s like a therapist in your purse. That’s a weird visual.

ecbtmood

Authentic Yoga with Deepak Chopra

Whether you’re a certified yogi or a total yoga beginner, this app will help you learn various poses and customize routines, as well as connect you to others to ask questions. It’s a beautifully done application and now you have no excuse to not keep up with your practice while traveling!

yogaapp

TED App

To expand your mind and potentially even your heart, download the free TED app. This simple tool brings you ideas worth spreading via your own phone or iPad. You can watch incredible speeches by the best of the best and learn a little something instead of playing that silly Angry Birds game. (A personal TED favorite is Dr. Brene Brown’s talk on vulnerability. Go watch it now!)

TED1

Have you ever used an app to enhance your mind, body, or soul? What are you favorites?

NTS-Medium

22 Dec

Paying it forward :: Interview with Shannon Cutts {Part II}

Interview 3 Comments by Ashley @ Nourishing the Soul

Welcome back for Part II of this inspirational interview with author, advocate, and musician, Shannon Cutts. In Part I, Shannon shared how relationships replace eating disorders. In today’s post, she shares some of the lessons she has taken away from being both a mentee and mentor, as well as how to navigate the difficult but rewarding world of helping someone in recovery. You can also take a moment to watch Shannon in action spreading her message of hope through words and song.

NTS: What have you learned from your own mentor?

SC: She reached out to me and offered me her support, and that is why I am the person I am today. She would set down ground rules – but all of these rules were very life-affirming and loving towards ME, not the eating disorder. Over time, with that consistent support and love from her, and reassurance that YES, I could achieve my goal to not choose my eating disorder over my life anymore, and that YES, I was worth fighting and recovering for, I chose my relationship with her over my relationship with the eating disorder.

My current mentor, Lynn, has supported me for nearly a decade now, and also serves as Vice Chair on MentorCONNECT’s board. I always joke that she probably had no idea what she was getting into when she accepted me as a mentee! Because of my mentors, most especially Lynn, I have absolute faith that I can become a better me. I know I can slowly but surely transform into the me I have always dreamed of being. I have faith in humanity and in love, and in the givingness of others – and my own ability to give and to love as well. And I know that what I do and who I am are not the same – today, through my mentor Lynn’s guidance and support, I can even get angry at my actions and still unconditionally love who I am. That, to me, is a bona fide miracle.

If everyone who joins MentorCONNECT has the opportunity to meet a Lynn, then that will be my dreams for the community fulfilled.

NTS: What have you learned from being a mentor and from your mentees?

SC: I have learned that being invited to serve as someone’s mentor is the greatest and most humbling gift a person can receive. It is truly amazing. To know that my life inspires someone – that they see something in me that they hope to experience in their own life one day – that they entrust bits and pieces of their private behind-the-scenes reality with me – it inspires me to continue giving my best every day and working on my own evolution as well so I can be a better servant, mentor, friend, and human being.

Being a mentor – “paying it forward” – is also an essential part of maintaining my own recovery progress. In the Alcoholics Anonymous communities, it is required to take a “sponsee” if you want to “graduate” from the Twelve Steps. This is because the sponsee will never really own what they have achieved if they do not have the chance to teach someone else what they have learned.

We have many mentors on MentorCONNECT who tell us that serving as a mentor is a great reminder of why they want to dedicate themselves fully to maintaining their own recovery. One of our mentors allows us to use her quote to answer questions like these: “I can say that so far being a mentor is an insurance policy in the fact that I wouldn’t even think about relapsing…reason being…….hearing their pain and suffering as they deal with ED. It reminds me what I left behind and saddens me because I want to make it better quick but I can’t; it’s a process. It’s a lot of work but I love it so far. It’s a great addition to my recovery.”

NTS: How do you know when you’re ready to assist others in their journeys?

SC: On MentorCONNECT, we have a policy that before a person can serve as a mentor, they must have experienced twelve consecutive months in sustained recovery, which we define as “largely free from eating disordered thoughts and coping behaviors.”

It is very important for a mentor to be significantly recovered in this way because serving as a mentor can otherwise be triggering and can produce a relapse if the mentor is not ready.

Of course I did not have this policy as a guide when I first began serving as a mentor, but I did have a full commitment to maintaining my own recovery. I had seen how devastating an eating disorder could be and after working so hard to recover, I was not only committed to staying in recovery myself, but to helping others survive the hell that is an eating disorder without having to do it virtually alone like I did.

NTS: How might someone handle a situation in which they thought they could be a support to someone else but then feel overwhelmed or unprepared?

SC: That is such a great question – and it happens sometimes. The best way to handle a situation such as you describe is always to reach out for help. On MentorCONNECT, we have so much support for all of our members. Fully 10% of MentorCONNECT’s membership is significantly or fully recovered. We have a large Leadership Team and each one of us is available to offer insight, guidance, and personal support to our mentors and the membership.

We also encourage our mentor members to enter their volunteer service with outside sources of support already in place. A person who does not have support themselves is rarely in a good position to support others. So ideally, they would be able to reach out for support from their own team. From there, honesty is always the best policy. It is perfectly okay to say to someone you have been supporting, “I did not expect this, but I am struggling again. I would not be doing you or me a service to continue supporting you without taking care of my own recovery needs first. I care about you and I care about me, which is why, for now, I am going to encourage you to seek support elsewhere.

On MentorCONNECT, should this situation ever arise, our more experienced mentors are prepared to help and guide the mentee to make a new mentoring match, and help the mentor as well to reframe their membership from the perspective of someone who joins primarily in search of support versus someone who joins primarily to offer their support.

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If you’re interested in becoming part of MentorCONNECT, you can learn more on the website. Or follow on twitter for the latest updates.

What have you learned from the mentors (formal or informal) in your own life?

NTS-Medium

14 Jul

Picky, Picky :: Do Selective Eaters Have a Disorder?

Current Events 12 Comments by Ashley @ Nourishing the Soul

Putting a pea in front of my mother’s face produces a similar reaction as one might expect from hiding a rattlesnake under someone’s pillow. Her face quickly contorts and she draws back in horror, afraid the small, green ball of poison might… shudder… touch her. The thought of putting it in her mouth and swallowing elicits panic. You’d sooner get her to sell one of her children (likely me, following this blog post).

My mother is what we commonly refer to as a “picky eater,” or what scientists, including psychologists, are now calling, a “selective eater.” Her preferred diet includes an extremely narrow repertoire of American foods, sprinkled with the occasional pizza or pasta. Interestingly, scientists have observed that picky eaters tend to have a not only small, but similar catalog of food choices. They tend to select items that are paler in color, such as white bread and pasta or pizza with cheese (hold the spinach!).  Also noteworthy, some scientists have found that almost all picky eaters like french fries (although, really, who doesn’t?).

A recent Wall Street Journal article suggested that the American Psychological Association is considering recognizing “selective eating” in the upcoming revision of the diagnostic manual. This new issue would, reportedly, be classified under the category of Eating Disorder, Not Otherwise Specified, a term used for individuals with symptoms that do not meet criteria for a major disorder. The WSJ article led to some hot debate on whether pathologizing people with picky palates is going too far. However, the DSM-V draft website makes no mention of selective eating as a potential inclusion.

While it’s easy to get frustrated with my mom for limiting our restaurant options to three places and for not being willing to try the beautiful appetizers I’ve made, researchers and clinicians point out that selective eating is often not voluntary. Many selective eaters feel desperate to expand their tastes, reporting extreme embarrassment and shame over their pickiness. These individuals are not the friend who has an aversion to green olives. These are people who limit their social engagements and feel anxiety around major events due to their distinct and restricted preferences. And for most individuals, these eating habits began even before they began feeding themselves.

Typically problems begin in childhood, a period during which some narrowness of food choices is expected. However, for adult selective eaters, their comfort level never expands. They continue eating stereotypically “childlike” foods, such as cheese pizza and chicken fingers. Researchers at Duke University and the University of Pittsburgh are currently trying to enhance our understanding of selective eating, recently launching the first national registry of picky eating. The public is asked to log on and describe their peculiar eating habits so that scientists can explore the phenomenon.

Currently, many researchers believe that selective eating is related heavily to aroma and texture. This makes sense to me as I consider my mom’s description of peas (her most loathed food) as slimy, slippery, and mushy (said in a disgusted tone). Makes anyone want to recoil, right? She, like many other selective eaters, cannot get beyond the texture of the food. Forget taste. She would have to actually be willing to touch them to determine whether the taste was acceptable. Evolutionary psychologists tell us that we are in fact wired to prefer foods less that evoke images of morbidity or bodily functions (in color, texture, etc.). I’ll leave this topic at that.

Fortunately, there may be hope for selective eaters. Duke University, like many other institutions, offers treatment for picky eating that is based on cognitive-behavioral principles, particularly exposure. Selective eaters are encouraged to develop improved assertiveness skills (to handle people like me, who harass you for not wanting to try the thing on the menu that you can’t pronounce), as well as methodically incorporate new foods. While there is limited evidence currently demonstrating the effectiveness of the treatment, results will be forthcoming. If the evidence suggests it works, which it is likely to, my mom will be on the next plane. But don’t offer her gourmet snacks onboard. She’ll just take the pretzels.

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