I recently worked with a client who shared how a support person kept encouraging her to work out to help with body confidence. This is a common thought for people with eating disorders. Often clients share workout plans with me they hope will help them cope with their body dissatisfaction, but they’re just reinforcing and masking the eating disorder!

In and of itself, exercise is obviously, not bad, but it often can be a symptom of an eating disorder. It is often a symptom that can be “swapped” for another. For example, suppose someone with restrictive eating starts eating more. In that case, their eating disorder may encourage them to engage in more strenuous exercise to combat the negative self-talk the increase in consumption has caused or to mitigate weight gain, which may be necessary for their wellness. If you are numbing out eating disorder thoughts with exercise, substances, or other compulsive behaviors, you aren’t truly challenging the eating disorder. A way to think about this is if someone with alcoholism gets sober but smokes marijuana every time they think about alcohol, they aren’t truly dealing with the urges to use alcohol; they are numbing them out! This phenomenon happens when someone stops restricting or purging and starts exercising or exercising more intensely. We aren’t helping the person deal with their fears around weight gain or their body changing; we are just allowing them to find another way to control their body shape and weight.

Often people will point out how exercise is healthy and good for mental health, so it should be a part of someone’s life and is healthier than restricting or purging. This is true, but it is more important that we help clients with eating disorders learn to nourish and accept their bodies naturally. To fully recover, we have to give up controlling our bodies completely. We can only do this by eating regularly throughout the day, finding and maintaining our body’s natural set point, and eventually incorporating exercise into a healthy lifestyle. If we rush this process, clients may do better with their food intake but aren’t dealing with the underlying feelings and thoughts that caused the eating disorder.

People with eating disorders aren’t just obsessed with what they look like (and some aren’t at all!); their brains have created a universe where food and body are all that matter to help distract them from painful experiences and feelings. We need to help them re-learn how to take care of their bodies so they can tap into the underlying issues and learn to cope with them instead of masking them with food and body concerns.
This can be a confusing concept for supports, especially those who are avid exercisers. We must know that the client needs to re-learn how to care for and trust (not control) their body to recover fully. If you are struggling to understand someone’s relationship with exercise, I encourage you to ask to join a session with your loved ones’ care team; it can be helpful to understand that a healthy behavior for the average person may be causing obsessive thoughts, fear, anxiety and preventing full healing for someone with an eating disorder.

One of my favorite parts of being a therapist is reviewing clients’ therapeutic writing and creative works. I recently asked my clients in a small group of women with eating disorders to write letters to their bodies from their “soul selves”. “Soul self” is a term coined by Carolyn Costin to describe who we truly are outside of our eating disorders and at our core healthy selves. The following writing from one the clients struck a chord with me and she was kind enough to share it with me to post here:

“Dear body—

Aren’t you tired? Tired of carrying the weight… of trying to be smaller, stronger, toner— enough? Don’t you see that all the change you desire will never be enough?

If it’s not your belly, then it’s your arms, if it’s not your cellulite, then it’s your stretch marks. You’re clothed in insecurities — wasting away — focused on goals and calories. It’s still not enough. It’s never enough. You look in the mirror and you want to disappear — the problem is, you just don’t see clear.

You focus on your arms and not the way you pick others up and pull them in.

You don’t like your hips even though they help make you a woman.

You try to flatten your stomach even though it deserves fuel.

You can run miles, lift hundreds, and climb mountains but you still find fault in you. You can wear the crop top and be a size 2, and you still will say… “I just wish.”

All of the sacrifice will never suffice. You choose to skip moments and memories and instead think about “if only.”

I wish you saw beauty in your brokenness, recognized strength in your independence. Took pride in your accomplishments. Celebrated your intelligence. Found joy in your skin.

You are loyal, you are kind, you are full of wit. But your broken mirror often makes you just want to quit.

I wish you could wear confidence like a blanket, lift your head high, and piece the mirror together so you would finally see…

You are enough.”

I’ve witnessed many loved ones look at me with desperation as their loved one with an eating disorder tells them how they have once again triggered them. Eating disorder “triggers” (a trigger is a topic or phrase that can cause an increase in eating disordered thoughts and urges) are ever-evolving, complex, and unique to each individual. The eating disorder will embellish and distort our words so that the person with the eating disorder hears a different message that increases their eating disorder behaviors and thoughts. Topics that the eating disorder most commonly confuses and misinterprets revolve around food, weight, appearance, and exercise. Your seemingly benign comment about your own body, fullness, or food preferences may be twisted and misconstrued in a way that you would never have imagined! Treading lightly around these topics and potentially trying to avoid them all together can be beneficial and necessary early in the recovery process. So how does an eating disorder translate these comments? I thought I would highlight a few examples here.

Support says:

“Ugh, I can’t eat food from (insert restaurant name) it’s too greasy”

ED translation:

“If you eat food from there you will be fat and disgusting”

Support says:

“I haven’t eaten all day!”

ED translation:

“You shouldn’t have eaten breakfast, no one eats breakfast, but weak people like you”

Support says:

“I shouldn’t have dessert.”

ED translation:

“You’re not allowed to have dessert. Eating dessert is wrong.”

Most commonly, supports will say to me, yes that makes sense, but that’s not the real world, people are going to trigger them at work, at school, etc. so why should I avoid these topics they are going to experience anyway?

This is a good point, but it’s so much more complex than that! Think about a time when you received difficult criticism at work, with a partner, or friend. Now say that you’ve tried to shake it off and it’s not bothering you so much anymore, and you go home, and your family brings up the same topic which brings about the same flurry of negative feelings. You shake it off, and you turn on the TV and the first commercial you see brings up the same criticism and so you turn off the TV and go out for a walk, and you see an advertisement on a street sign also bringing up that same criticism. That’s a snippet into what it’s like to have an eating disorder in our society’s diet culture. We are constantly bombarded with messages that we need to watch what we’re eating or work out harder, these increase the eating disorder’s thoughts and urges and make us feel like maybe it’s not so bad to work out harder, maybe I shouldn’t be eating sugar? Why am I eating my meal plan if no one else is dieting and working out? Etc. It’s true that the world will continue to talk about dieting and exercise, but it’s very different when our homes are filled with these messages as well. People in recovery need a place where they don’t have to be on guard ready to battle triggers. It’s not possible to do this perfectly, but it is possible to try and you will definitely get better at it. It’s been 16 years since I was in treatment and my Dad still “doesn’t talk about bodies”. Which I must say is one of the sweetest ways for him to show his respect for all I’ve been through. Those comments don’t bother me anymore, but I love that he respected my recovery enough to listen to me all those years ago.

Talk to your loved one about what their triggers are and if there are things that aren’t helpful for them to hear. Ask them how they would like you to deal with slip-ups, and how you can best support them if you hear triggering topics while you are outside of the home with them. It’s a process to let go of diet culture in our everyday conversations, but I really think the world is a little better for it.

Having a loved one in a treatment center can be incredibly difficult for both the supports and the person with the eating disorder. Often this can put unanticipated stress on the family and friends worrying about their loved ones’ wellbeing. This blog post will explore these potential issues and concerns and manage some of the more common situations I have encountered working both inside a treatment center and as an outpatient professional.

Within the first two weeks or so of treatment, your loved one will more than likely call you panicked and upset. Treatment is asking them to let go of the very thing that has kept them emotionally afloat, the eating disorder. This realization absolutely should cause an increase in anxiety, fear, and panic. Often clients will want to go home early and plead with their family to help them discharge early. I remember in my own recovery journey losing my mind after a particularly hard meal and begging my parents to come to get me. Calls like this are standard, especially in the first few weeks of treatment. Obviously, you want to make sure your loved one is safe, and I would encourage you to reach out to the facility’s clinical director and get more insight into what they see is going on. Common upsets at the beginning of treatment include; meal plan issues, scheduling issues, and feeling as though group therapy is ineffective.

If you were put into a home with strangers, were told to eat everything on your plate, had to tell your feelings to these strangers, and weren’t allowed to leave, you would probably have some issues with that too! I recommend listening to your loved one and hearing out their frustrations. Validate their emotions and experiences and ask them if you could join a family therapy session to help work out these issues. Often clients will just want to go home and will be frustrated if you aren’t on board with this plan. Let them know that your goal is to help them get well above all else. If that facility isn’t the right fit, you will help them find an alternative, but you want to help them get adjusted and feel more comfortable if possible.

Often time loved ones are terrified by how upset their family member seems in treatment. Unlike depression or anxiety, were getting better feels good, eating disorders feel excruciating to let go of. The eating disorder screams at them that they are gaining too much weight, losing their identity, becoming unloveable, ugly, fat, lazy, or ordinary. Of course, anyone who was feeling that way would be miserable! As the client learns to cope with and challenge these feelings they will start to feel these feelings will become less intense. Making friends in treatment and feeling “a part of” can often be the thing that helps clients cope with these feelings and not feel so alone with them.

These emotions are normal and commonplace. In fact, whenever I see a client not having an emotional reaction to treatment, I am curious why that is and will try to help them get in touch with those emotions. Emotions are a good sign; it means they are starting to feel again! Eating disorders numb us from our real emotions; you can’t think about how you are feeling when you are only thinking about food. If the emotions are starting to flow again, they are getting back in touch with their emotions, which can be incredibly overwhelming. Although it is painful to hear your loved one in distress know that it is necessary for their healing. Listen, validate and offer to be involved in their treatment. Clients are often terrified of their emotions, so having family and friends support them through those feelings will be a powerful experience for them.

Now that you know your loved one is safe, it’s time to take care of you! Supporting someone with an eating disorder is incredibly challenging, so now is the time to process what you’ve been through and see how not only can you help your loved one but offer yourself the time to support you! I suggest reaching out to your loved one’s team to get referrals for someone knowledgeable about eating disorders so they can help you grapple with everything your family member is going through.

Treatment is a challenging road for family members, friends, and of course the clients. The more we can listen and validate their pain, the more comfortable sharing it with us when they return home. If things seem particularly difficult, contact the clinical director and clinical team members to get more information. These difficult conversations in treatment will help you and your loved one learn to navigate challenging situations outside of treatment. Take this time to know your family member is safe and use it to take care of you!

I had this random thought in a session this week. How come some people look at their addicted parents and think oh God, I don’t want to be anything like that, but the same person can look at that same parent and see their dieting and workouts as admirable? I have worked with many clients who have seen their parents’ behaviors as things they wanted to stay clear from, addiction, divorce, domestic violence. But at the same time, they look at their parents’ disordered eating and dieting as admirable, all while these behaviors cause similar harm and torment. Why is that?

           I was thinking about my own Mom’s disordered behaviors, and I remember plenty of positives like going out to buy new clothes when she lost weight, her excitement as she noticed her progress at the gym, the praise that family and friends gave her for her weight loss. Those memories stick out to me, but I never really thought much about the negative memories related to the same behaviors. I never thought about her constantly asking me if she was fatter than the woman in front of us at the check outline. I don’t remember her calling herself “bad” after eating too much. I don’t think about the ambulance ride when her pulse dropped too low. I don’t think about the secretive eating or the times we felt sick together after we binged. Some of these things even became inside jokes between us. It wasn’t funny. None of it was.

           Our eating disorders hold on to those positive memories and glamorize them. We use these memories as kids to justify why we need to buy into diet culture. We believe controlling our weight is the key to our happiness. This is an incredibly dangerous mindset to have, and I COMPLETELY fell into it as a kid. I held onto those positive memories and believed that I could have fun shopping trips, constant compliments, and praise if I were as thin as humanely possible. I assume this is due to the toxic diet culture we live in, but what if I had someone who could have helped me dig a little further below the surface? My Mom was in obsession and pain. None of it was glamorous. None of it was fun.

           My Mom today still doesn’t acknowledge her eating disorder. This is beyond frustrating, but it’s her journey, not mine (I constantly have to tell myself this). This reflection isn’t meant to blame her, but instead, reflect on why as a society, we see the negative caused by other maladaptive coping skills and are often motivated to live differently, but we hold on to the glamour and excitement of our family’s eating disorders and fall right into the same traps. We mindlessly fall right into the same painful paths that are right before us. How can we help future generations see these behaviors and steer clear of them? How can we spread the truth of what life in an eating disorder or even disordered eating is like? We need to talk about this.

I often send clients resources and figured I would post them here so everyone has access to them! Below you will find my favorite inspiring and useful resources I like to send clients.

Podcasts

Recovery Bites Podcast

I am on episode 11 if you want to check it out!

Recovery Warriors

Books

8 Keys to Recovering from an Eating Disorder

Life Without ED

Your Dieting Daughter

Body Posi Power

The Body Myth

The Body is Not an Apology

Youtube Videos

8 Keys to Eating Disorder Recovery with Carolyn Costin

Stories of recovered people

Blogs for Supports

Enabling vs. Supporting

Enabling vs. Supporting Part 2

Blogs

Recovered vs. Recovery

Carolyn Costin Blog

Yoga 4 Eating Disorders Blog

Recovery Warriors

“I should be past this by now”

Life after Residential

Online Groups

Free recovery support groups for adults, supports, and a designated group for LGBTQ+

Well Williamsburg has eating disorder support groups for BIPOC, Jewish women, and a body image group for teens

Trauma

What is CPT?

Cognitive Processing Therapy Manual (great for clients and clinicians)

PCL 5

Suicide Resources

Suicide hotline

Crisis text line

Frequently I hear clients say things like, “well, I can’t even feed myself” or “everyone will think I am crazy if they find out I can’t even feed myself. These statements are always loaded with so much shame and self-loathing. The statement always breaks my heart just a bit. Yes, eating is one of the first tasks we learn to do when we enter the planet, and yes, most people take the process of eating for granted. But… That does not mean it’s a simple concept. At all.

Think about all the variables that go into eating. Am I hungry? But am I really hungry or just bored? What am I going to eat? What am I in the mood for? What do I have access to? Do I want to cook or order something? Do I want something warm or something cold? Do I want to eat while working, or do I want to take a break? Those are just a few of the limitless variables that go into the process of eating that a “normal” eater faces. Add to that an eating disorder screaming at you and a MILLION food and body rules that diet culture is continuously bombarding us with, it’s no wonder that you “can’t even feed yourself”. Having an eating disorder is one of the most torturous thing I’ve ever experienced, and getting better was the hardest thing I’ve ever done. It’s not just feeding yourself. It is learning to find balance in an incredibly imbalanced world. It is about learning to satisfy your needs and desires. It’s about tuning into yourself when the whole world is asking for your attention. It’s about letting go of the things that no longer serve you and breaking free of others’ expectations. It’s about becoming an ally to your body. These aren’t easy tasks for anyone, let alone for someone who has a brain pleading them to do the very opposite.

It’s not just people with eating disorders that relearn ways to nourish themselves! Everyone goes through changes in their relationship with food at times. My fiancé often talks about all the White Castle burgers he ate in college and all the beer he washed them down with. He is still an incredibly astute burger connoisseur, but he’s developed a much more balanced way of eating as he’s gotten older. He never had an eating disorder, but his ability to feed himself has still evolved.

At your most basic core, you know how to feed yourself; you put food in your mouth, you chew, you swallow. You know how to do that; it’s your relationship with food and body that needs some work. You are relearning what it means to feed yourself, and honestly, with the million different diets that are constantly being marketed to us, it’s not just you that’s needing to revamp your relationship with food and body.
So the next time you get down on yourself for not caring for yourself, find some grace for your process. Eating is an incredibly complex thing, and every aspect of our culture is confusing our most basic needs and wants. Take a breath and know that you are doing hard things, and with continued practice and perseverance, you will find your way to learn to nourish and heal your body, mind, and soul.

(graphic: unknown origin)

Often clients talk to me about their fears about recovery. If they recover, who will they become? If they recover what will their friends and family see when they look at them? When they recover what will they do with their free time? Who will they be if they aren’t the “fit one”? Who will they be if they aren’t the gym rat? Who will they be if they are no longer the”thin friend”?

I remember having similar feelings and fears. It felt like everyone else in my life had a superlative that perfectly explained their unique skills, aptitudes and correspondingly defined their worth as a human being. There was the dancer, the athlete, the smart one. I was convinced that I had nothing to offer the world. I was no one. I had no talents or skills that made me stand out. My identity was a blank slate just ready to be created into whatever I chose to fill it with, but this fact left me with an aching emptiness. I felt that everyone saw me as empty and pathetic, the way I felt inside.

My eating disorder came to the rescue and gave me an identity, and in the beginning, I got compliments about how “tiny” or “disciplined” I was. Those comments stuck with me; they felt like badges of honor that validated my very existence. Giving up that positive reinforcement felt like the biggest threat to my sense of self that I could imagine, but let’s play that out for a moment. Did I want my legacy on this planet to be about my size or my eating habits? Did I want my life to be minimized to a disorder?

At one point, I honestly did, but healthy Kate, who was still deep inside my soul, didn’t care about what I looked like. Healthy Kate cared about things that truly mattered, not the size I wore. I wanted to make a difference in people’s lives; I wanted to feel genuinely connected to others. I wanted to feel like I mattered. I knew that I was NEVER going to get there with my eating disorder. It was too hard for me to start a conversation in my disorder because of how self-conscious I was. It was too difficult for me to think clearly. It was too challenging for me to clear away the fog of counting calories and hurting myself to think about how I could be of service to others. It was impossible to create a new, meaningful life for myself when I couldn’t care for myself.
As I got into a groove in my recovery, I started to daydream about what I wanted my life to be. I daydreamed about where I wanted to live, what I wanted to do for fun, what kind of job I would find. I created a vision, and I worked towards it. Just one step at a time. I moved to PA. I got a part-time job. I ate my food. I felt the feelings. I went to therapy. I applied to graduate school. I started helping people. I kept eating the food. I met new friends. I fostered those relationships. Just ONE step at a time. Each meal. Each urge fought. Each time you reach out, that is a step towards the life you want.

Grab a journal, and answer these questions:
1- Where do you want to live in 5 years (country, state, city, house, décor, pets)?2- If you didn’t have your eating disorder, what would you do for fun?
3- What relationships do you want in your future, and what relationships should you leave in the past?
4- If you could do anything you wanted to make money, what would you do?
5- How do you want people to remember you? What are some small steps you could take this week/ month to work towards that legacy?
6- What do you value most? (google a values list if you need to) How can you live a life aligned with those values?

Think about these questions, journal, vision board them, manifest them. This is your life. Only you can make these things come to fruition. It will take time to manifest and create that life, but each day you have choices to move towards that life or away from that life. Do you want your legacy to be, “they were really dedicated to the gym” or “man, they wore the tiniest clothes”? Or do you want it to be something much more beautiful for that? I left behind “the skinniest girl in the room” identity for a friend who is always there and will always make you laugh, the dog Mom who loves her pets more than anything, to an authentic, wild, creative, understanding woman. I am SO much more than my body. My body allows me to be all those fabulous things, but it will never be who I am. So now it’s your turn. What are you going to choose?

           I got engaged this past December and will be getting married this upcoming August.  Over the summer, I got fitted for my wedding dress and was proud of my ability to try on dresses of all different shapes and see my own beauty within them. Then, my Mom, who played a role in my eating disorder, commented about my size to the lady measuring me. I tried to let it go, but suddenly, I was a kid again with her buying my clothes that didn’t fit me in some weird body dysmorphia of me. In the car, on the way home, I mentioned the comment to her and asked her why she made it, and she said she didn’t know, and that she didn’t mean anything by it.

           I started thinking about that comment, and how for anyone struggling with body image, how wedding planning and stupid off handed comments may completely derail them. It shook me, someone, which is recovered and entered recovery 15 years ago. The wedding industry is a harsh world fueled by perfectionism and comparison that torments most. Every esthetic detail must be perfect and live up to some imaginary ideal. Every resource, both mentally, physically, and financially becomes spread thin.

            It becomes ingrained for women somewhere in our childhood that we must want to get married with all the bells and whistles. Even for someone like me, who wasn’t sure they wanted to get married, I even started falling into the spell of the wedding shoulds. I should have a wedding party (which I didn’t think I wanted originally). I should have two wedding gowns. I should have a floral archway. I should look perfect in my dress. I have been “shoulding” all over myself.

           Of course, those stressors aren’t enough; diet culture has to put it’s greedy hand in the pot of wedding planning as well. If you look at any bridal magazine or website, there are plenty of fitness and diet ads and articles to get “wedding-ready”. For anyone struggling with body image or an eating disorder, this could be an incredibly triggering experience. Yes, you want to look fantastic on your wedding day, sure, but at what cost? Are you willing to jeopardize your life, sanity or soul to lose a few pounds or have the perfect arms in your wedding dress? I wanted to write this post with a few of my tips to eliminate dieting and exercises effect on your wedding planning process.

Tip #1: Your fiancé already loves what you look like!

           Hopefully, if you’re engaged, you have found someone who knows you inside and out and loves the real you. Your partner is engaged to you, not because of what you could look like. They’re engaged to you because they love you! Think about it in reverse, if your partner struggles with body image and wants to lose weight, what would you say to them? How can you say that to yourself?

Tip #2: You want to be able to look back and remember the day, not starving or an exercise routine

           If you have had an eating disorder or even dieted, you know that when you are malnourished and obsessed with food and body, you look back on your life and see a fog of random memories of what you ate and how you got away with using your eating disordered behaviors. The food takes over. That will happen again on your wedding day! Do you want to look back on the day and remember all the love and details that you’ve worked so hard to put together, or do you want to remember what you ate or didn’t eat and how you left your rehearsal dinner early to work out? This will be the most memorable experience of your life, do you want to be present for it? Or do you want to be numbed out and clouded by an eating disorder?

Tip #3: Play the story out

           If you decide to lose some weight or “tone” your body, what will the end result be? If you’ve had an eating disorder, more than likely, the end result won’t be those goals. The end result will be some disordered eating nightmare that goes above and your goals. Your wedding planning and wedding experience will be high jacked by your eating disorder. Your eating disorder will make the experience more about the relationship you have with your ED than your relationship with your fiancé. This is simply unacceptable! You are getting married to your partner, not your mental illness, kick ED to the curb and get intune with your partner.

Tip #4: Focus on what’s more important

           When you think about your wedding, what is more, important to you? Is it that you have the smallest waist possible? Or is it that you feel the love between you and your fiancé? Is it about how you will spend the night bingeing on wedding cake in the wedding suite? Or is it that you can be fully present with your family and friends? 

Tip #5: Ask your fiancé and close friends and family for support

           If you feel the pull to buy into diet culture’s thoughts about weddings, talk about it! Tell your partner that you are feeling yourself getting pulled into the diet culture web and what you need to help yourself break free from it. Let them know that it would be helpful to be reminded of why they think your attractive or the things they are looking forward to the wedding day. Seeing things from their perspective could be the grounding force you need. If you feel pressure from friends or family to lose weight or get “wedding-ready,” let them know that those comments aren’t helpful, and it’s not beneficial for you to hear them. Remind them that you know they are coming from a supportive and even exciting place, but it’s not helpful for you at this time! The more you ignore these comments, the more they will grow and trigger you moving forward.

           Weddings are incredibly stressful and time-consuming, but they are meant to be a time to celebrate the love you have found with your partner and their ability to accept and love you for you, not your body or the body you wish you had. If you need support from friends, family, or a therapist or dietitian, do not be afraid to reach out; losing your footing in recovery or being pulled back into the ED will never be worth the size of your dress or suit or whatever fabulous thing you’re planning to wear!