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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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10 Jun

Could Naming Your Eating Disorder Help or Hurt?

Ideas to Consider 267 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?

17 Feb

Could a recovery app help you beat an eating disorder?

Ideas to Consider 11 Comments by Ashley @ Nourishing the Soul



When people talk about how hard eating disorder treatment is, it’s not often the actual sessions with a therapist or dietitian or the meal group they’re attending that they’re talking about. It’s usually the time in between session that poses the biggest challenges for individuals working their way into recovery. And while the meetings with providers can help guide someone on the right path, it’s generally the time outside of those meetings that make up the steps to real recovery. That’s when real life happens.

Real life is hard work, and it’s the stuff that challenges all the plans and commitments made in the safety of a therapist’s office. Whether it’s developing a plan to utilize a coping skill or practicing mindful eating at each meal, memory and motivation can easily wane when someone finds himself on his own.

That’s why both professionals and recovered people alike decided that there had to a better way to help people stay connected and committed to their goals. If only there was a device that was nearly always with you that could track data and send alerts… and maybe it could even make calls too? Oh, yes! Your mobile phone!

Many individuals with eating disorders are downloading a secret weapon in their battle against their eating disorder. Tucked between their Instagram account and Candy Crush are mobile apps that are helping these individuals stay on track. There are a number of apps out there, but some of the most popular include Take Control, Recovery Record, and Rise Up + Recover.

How do they work? They harnass several of the factors that we believe are important to recovery and make them completely mobile. They center heavily around the concept of self-monitor, meaning that users can document things like what they ate for each meal, if they engaged in any eating disorder behaviors, and if they were able to practice copings skills. Many of the apps will offer positive reinforcement — a virtual high-five — when, for example, someone practices mindful eating.

Some apps allow that accountability extend to an individuals providers’ as well, allowing their progress and struggles to be seen in real-time by their therapists or dietitians. This can not only save time in the next session, but it gives more accurate and thorough information to the people who need it.

Apps can also help track your moods, eating patterns, and other factors and alert you if you are at high risk to engage in binge eating, for example. Many people with eating disorders report feeling that the time before a binge episode feels like their on “autopilot,” so getting a notification that to proceed with caution and reminder to go engage in some self-care could help stave off the behaviors before they begin.

Most of the app creators caution that they apps are most helpful in conjunction with traditional treatment, at least right now. A team at Drexel University will soon be studying if these apps could replace certain aspects of treatment at some point. In the meantime, though, apps can provide a great avenue of additional and unique support outside of the therapy room.

Nothing is a panacea, of course, and one of the issues that these apps’ developers are facing is that users sometimes abandon them not long after downloading. That’s where, I believe, using them as a tool in your ongoing treatment will help. When your therapist is checking in and helping facilitate the use, retention is likely to improve. And just like in therapy, it’s up to the individual to be honest and open when logging meals or determining the trigger for a purging episode.

But for individuals who are ready and willing and confront their eating disorder, apps can provide an effective, efficient, real-time tool.

Have you ever used a recovery app? If so, what was your experience like? If not, would you ever consider it? 


**If you weren’t able to join me for the recent AED TweetChat on recovery apps, you can read the transcript here.

18 Feb

When Eating Disorder Treatment Fails

Guest Post 6 Comments by Ashley @ Nourishing the Soul

Loved ones of those with eating disorders can find themselves feeling confused and helpless when treatment just doesn’t seem to be working, A psychologist, eating disorder expert, and a personal role model, Dr. Dana Udall-Weiner shares a bit of her wisdom here on NTS today about this difficult juncture in the recovery process.

When family members first learn that their loved one has an eating disorder, most are quick to ask an obvious question:  What’s the treatment?   Which is usually followed by another obvious question:  How long will it take?

Given that we’re talking about conditions with intimidating, Greek-derived names like Anorexia, it’d be easy to assume that medical and mental health professionals have this whole treatment thing figured out.  You’d think that all that data would lead us to a well-established treatment protocol—one administered consistently, reliably, invariably to patients around the world.  Something like an antibiotic for the food-impaired psyche.

Yet the reality is less constant and less comforting: Anorexia, Bulimia and Binge Eating Disorder are conceptualized and treated in various ways.  In the story of eating disorder treatment, there is a loosely organized narrative, with many disparate threads.

You can imagine the disappointment and frustration most people feel when they learn this stark fact.  You may have felt that way, too.

Though we’re learning more all the time, eating disorder research is still in its infancy.

Here’s what we know:  Eating disorders most likely develop due to a multitude of factors which include genetics, ongoing biological processes, and environmental influences.  They are not “caused” by mom’s poor body image or dad’s vegetarianism; they are not inevitable in the children of adults who meet diagnostic criteria.  But there is evidence for heritability:  People are more likely to develop an eating disorder when a first-degree relative has one.  And we know that parental eating patterns, as well as attitudes about weight, impact children—for better or worse.

Here’s the good news:  There are some treatments that seem to be relatively good at reducing eating disorder symptoms.  But the most important word in that sentence is relatively.  Relative to other treatments, Cognitive Behavioral Therapy is fairly effective for Bulimia and Binge Eating Disorder.  Relative to other treatments, Family-Based Therapy is fairly effective for adolescents with Anorexia.

Sadly, this tells you very little about your loved one, and how he or she will respond to treatment.   And that’s the bad news.

During treatment, some individuals very quickly gain insight about why their difficulties began.  For example, many Anorexics will tell you that they actually didn’t feel particularly fat before the eating disorder began to eat away at their lives; rather, they were experiencing something overwhelming—either external circumstances or their own internal response–which seemed impossible to tolerate or control.  The answer, they found, was to restrict their caloric intake; this, at least, seemed to grant them a sense of mastery over their bodies (and lives).  But even an insight as profound as this does not guarantee weight restoration or recovery; for this, the individual actually needs to eat.

The act of eating, however, is never as simple as piling food on a fork and directing it toward a waiting mouth, just as refraining from vomiting is never as simple as avoiding a toilet.  These behaviors have meaning, and they become part of a set of behaviors around which the individual organizes her life.

So why isn’t treatment more successful at getting people to abandon these worn out patterns?

Treatment can stall for a laundry-list of reasons which include: physiological factors (either associated with the eating disorder, or co-occurring and unrelated); psychological factors, including undiagnosed or untreated conditions; attitudes and beliefs about recovery; therapeutic factors that relate to the type of treatment being conducted, the setting in which it takes place, or to the therapist; and environmental factors, which include things like family influence and the media.

But regardless of why your loved one may have plateaued in treatment (or even failed to leave the starting gate), you can take important steps like these to right her course and encourage recovery:

  1. Learn all you can about eating disorder treatment in order to determine whether your expectations are realistic.
  2. Share your concerns with the treatment team and ask how they think things are going.
  3. If necessary, get a second opinion; consult with another medical or mental health professional to get feedback about whether your loved one’s experience is typical or cause for alarm.
  4. Think about whether environmental factors might be reinforcing the eating disorder.  Some things to consider:  Is your loved one participating in activities—such as ballet or gymnastics—in which a thin body is idealized?  Is she benefiting from the eating disorder in any way, such as getting attention from parents or increased respect from peers?
  5. Talk with her directly to see whether or not she thinks she’s making good progress; it could be that her decision to refrain from “fat talk” with friends represents a major accomplishment in her eyes, even if she’s made little progress in changing her eating patterns.
  6.  Educate yourself about which eating disorder symptoms are most dangerous, so that you can assess how she’s doing, make informed decisions about her care, and accurately communicate your concerns with her treatment team.  For example, poor body image is generally less worrisome than vomiting after meals.

In some ways, eating disorder treatment can feel like the Wild West—vast, loosely mapped, and ruled by contending factions who each want to stake their claim.  But even on stretches of unmarked trail, we generally know how to steer (willing) people toward health and wholeness.

It is not enough.  It is what we have.  And with additional years of ongoing research, our cartography skills will only improve.

If you’d like to learn the specifics about why treatment fails, as well as why research findings don’t always apply to your child, please watch my video, “When Treatment Stalls or Fails: Why Your Child May Not Be Getting Better.”  You can find it on my website, ED Educate, ( 

30 Jan

You Should Know :: Food to Eat

You Should Know 5 Comments by Ashley @ Nourishing the Soul


If someone has ever told you that there’s no simple recipe for eating disorder recovery, well… they’re right. But fortunately there is now a set of easy (and delicious!) recipes that can aide in recovery from destructive eating habits. It’s called Food to Eat and it’s the new book by Registered Dietitian, Lori Lieberman, and eating disorder survivor, Cate Sangster.

It would be easy to call this a recipe book for eating disorders, but that would be grossly over-simplifying what it offers. Rather than a cookbook,  Lori and Cate have created a fabulous resource for individuals working their way towards recovery. They put they heads together to develop a book that teaches readers not only great-tasting recipes, but how, and even why, to approach food.

Creating a food-focused book for a food-fearful set of readers is no easy task, and Cate and Lori are able to do it with sensitivity, skill, and even humor. The book shifts back and forth between the two authors’ perspectives, so readers get a chance to hear from both an experience nutrition expert and someone who’s been in the trenches of an eating disorder for many years. The book makes it clear that the two didn’t always agree on the approach to take, and I appreciated the candor and richness that resulted.

What others might appreciate is the focus on developing an awareness of one’s own stage of readiness in tackling cooking and food preparation. The authors are cognizant that individuals are at various places in recovery and that even making something simple can be a major hurdle. They respond both firmly and with compassion about the importance of making small steps towards a healthier tomorrow.

At the heart of the book are several chapters worth of recipes. They are divided by the preparation time required, from less than 20 minutes to greater than 40. They include helpful symbols indicating useful information such as whether the recipe is vegetarian-friendly or requires some per-prepared ingredients. It’s obvious that the recipes were selected carefully, with a diverse set of a readers in mind. None require intensive kitchen skills and they are rich in flavors and nutrients. Each is accompanied by beautiful photography of the prepared dish. What’s great too is that those following an exchange system of meal planning can find this information in the appendix.

Developed for those in recovery, this is really a book both for individuals in the trenches of disordered eating, those on the other side, and people who care about them. It’s a fun, helpful guide to eating well, and a book that could have a place in every kitchen. (And now it’s even available for the iPad!)

What are your favorite things to make?

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