Window of Tolerance

I have been wanting to write about the window of tolerance for a long time.  It has only been directly addressed in one treatment center that I attended, and I think it is incredibly helpful...

The window of tolerance refers to a zone of "emotional arousal that is optimal for well-being and effective functioning," (Siegel, 1999). 

When we are within our window of tolerance, we are able to effectively cope with, process, and integrate emotional arousal.  However, when we are outside our window of tolerance, we are unable to complete these essential functions. 

What is the shoreline of recovery?

I was recently listening to a program on NPR about what makes world-class athletes so great.  There was a story about a woman who was attempting to swim across a large channel of water.  She was swimming through a thick fog and became overwhelmed with fatigue.  She called for the boat to pick her up and climbed into it with a heavy heart.  A few minutes later, the fog cleared, and she saw that the shoreline was only about 1 mile away.  She said, "If I had known the shore was so close, I would have kept going."  Five months later she returned to the channel and completed the feat.

I entered treatment and therapy for the first time over 10 years ago.  The work towards "recovery" is relentless, and I often wonder, "how much further do I have to go?"  I feel as if I am perpetually stuck in a fog, not knowing whether I have a few meters or a few thousand miles left before I can drag myself onto the shores of recovery.  Just like the woman in the story, I think that if I knew how much further I had to go, I could muster my strength and finish. 

But recovery from an eating disorder is not black and white.  

OFTEN, I HAVE NO IDEA WHAT THE SHORE EVEN LOOKS LIKE. 

 

Let me demonstrate the obscurities of recovery from an eating disorder...

The Energy of Emotions

Eating disorders often serve the purpose of numbing us out, letting us escape from the pain and suffering of our daily lives. 

We feel sad, angry, hopeless, helpless, overwhelmed, etc --> 

we use eating disorder symptoms --> 

we feel numb. 

MISSION ACCOMPLISHED. 

We think we're getting rid of the emotions. 

But the thing is, we're not. 

We're just pushing them down. 

Comorbidity

Many people who have eating disorders often have other mental health disorders.  I have seen statistics stating that 50-75% of people with EDs will struggle with depression at some point, and 2/3 of individuals with EDs struggle with anxiety of some type.  This contributes to the fact that eating disorders are complicated and truly unique.

It is important to gain a full understanding of each disorder, as well as the relationship between the various disorders specific to each person.  In some cases, the eating disorder is actually a symptom that is underlying a different primary psychological disorder.  In other instances, the eating disorder may be primary, with other mental health diagnoses secondary.  It is important to explore the relationship between the disorders, as this can help guide treatment and lead to more effective outcomes.

We Admitted We Were Powerless

Although there are many differences between eating disorders and other addictions, it can sometime be useful to look at eating disorders as a type of addiction.  Many people with addictions believe that they are "in control" of their addiction.  Specifically, people with eating disorders often feel that they have complete power and control over their body and over food.  However, this is just an illusion.

"I admitted I was powerless over my eating disorder and that my life had become unmanageable."

Eating Disorder Lies

It is common in eating disorder treatment to learn to separate yourself from the eating disorder.  As you practice doing this, you become better at recognizing what is the eating disorder and what is your authentic self.  The eating disorder is a professional at telling you lies and trying to convince you that they are true.  

For those with eating disorders:
As you read the list of common eating disorder lies below, notice how they make you feel.  Which lies does your eating disorder tell you?  Are there any messages on the list that you believe to be true?  Are there any messages that you used to believe were true but now recognize as false?  How did you come to realize that those messages were lies?  Consider writing about the messages you still struggle with, or bring them to your therapist or trusted support person.

For support people:
Imagine what your life would be like if the following messages played in your head over and over again.  How would these messages impact your life?  What would it feel like if you believed some of the messages to be true?  How can you help your loved ones separate themselves from their eating disorders?  Remember, it is NOT your job to convince your loved ones that their thoughts are lies, or to criticize them for having crazy/stupid/selfish/weird/silly/irrational thoughts.  Your job is to provide unconditional support to your loved ones, and to show them that they are still lovable and worthy, regardless of what they think.

1. I am either fat or I am skinny.
2. Having an eating disorder makes me special.
3. I am more disciplined than other people because I have an eating disorder.
4. I don't deserve to get help.
5. Treatment for an eating disorder just makes people fat.

Gratitude for Support

As we celebrate mother's day today, we often find ourselves reflecting on the significance of loved ones and support people in our lives.  This can bring up many emotions in us - gratitude, anger, joy, resentment, envy, loving, lonely, shameful, hopeful, scared, abandoned, and so on.  We may think about who we consider to be part of our family, ways in which our family has been both absent and present throughout our lives, what role our family plays in our illness and our recovery, and our role in building our own families.  We think about what our support people mean to us, and what qualities we appreciate most from them during our times of greatest need.

Beyond the Exterior

What do someone struggling with anorexia and someone struggling with binge eating disorder have in common?  To put it in society's terms, what does someone who is starving him/herself and afraid of getting fat have in common with someone who is overeating and is fat or obese? 

Is it possible that all eating disorders, regardless of how they manifest, share underlying similarities?

Staying on Track Day to Day

 The process of recovery can be very overwhelming.  Sometimes we get lost in the big picture and forget about the little things we can do each day to stay on track.  

It can be helpful to create daily rituals to reaffirm your dedication to recovery and to remember why you are working so hard.  

The following are some daily activities you can do to help you stay on track.  Pick 2-3 activities and commit to them for at least a week.  At the end of the week, reflect and adjust your activities so they best fit your needs.

• List 3-5 things you are grateful for - remember the little things
• Read something inspirational
• Connect to your spirituality
• Call/talk to one supportive person
• Write down specifics about how you are going to follow your meal plan for the day
• List the reasons why you are following your meal plan and exercise plan TODAY

The Disease of Silence

EATING DISORDERS ARE DISEASES OF SILENCE.

Often, those of us with eating disorders are silently screaming for something - attention, love, understanding, nurturing, help, escape, forgiveness, acceptance, etc.  

But we feel unworthy, unlovable, and undeserving, so we don't ask for help.

We spend so much of our lives denying our needs, that we can actually forget what they are.  We may even lose the ability to ask for help or to communicate effectively with others.

At some point, the ED becomes a silent scream for... something... but even we might not know what that something is.

As a person struggling with an eating disorder, it can be helpful to identify what you are really trying to communicate, what you need, and what you desire.  It can be especially helpful for our support people to understand what is going on beneath the surface of our masks, and the messages our eating disorders are trying to convey.

***Read the list and then scroll all the way down for an activity***

What my eating disorder is trying to tell you...

I desperately want to be accepted

I need to feel loved
I have no idea who I am

I am afraid of life

I hate that life isn't fair 
I just want you to listen
Sometimes the weight of my sadness is unbearable
I hurt myself because it's the only feeling (pain) that I can stand to feel
I am terrified of not being good enough 
I'm afraid of growing up and dealing with all the things a grown-up must think about
Words and actions hurt me even though they aren't meant to

To Feel or Not to Feel

An important part of the recovery process is learning to identify and experience emotions.  It is common for people in the early stages of recovery to go through what I call the "thawing out phase."  Often, one of the purposes of the eating disorder is to numb emotions.  As people begin to replace the eating disorder with healthier coping mechanisms, it is common for emotions to emerge.  It can feel uncomfortable and even scary when emotions start to surface.   

Many people wonder, "now that my emotions are here, what am I supposed to do with them???"  Although it is important to experience your emotions, it is also valuable to know when to contain them.   

Below is a brief assessment to help you decide whether to experience or contain your emotions, followed by  suggestions on how to experience your emotions in a healthy way.

Benefits and Consequences of the ED

We know that eating disorders are dangerous and cause us pain.  We are told that our eating disorders lie to us and manipulate us.  The  losses caused by our eating disorders have been tremendous... relationships, family events, school, jobs, connection with our spirituality, confidence, our ability to feel joy, and so much more.

We know we SHOULD let go of the eating disorder.  And yet... many of us continue to hold on.  Why?  Although we know that eating disorders have many consequences, we wouldn't hold on to them if they didn't give us something in return.  

Embracing our Strength

Eating disorders are full of lies.  They tell us that we are unworthy, unlovable, undesirable, fat, ugly, stupid, and so on.  It is painful to meet so many amazing, intelligent, creative, compassionate people who believe the lies their eating disorders tell them.  If only they (we) could see what others see in us. 

A common lie for eating disorders to tell us is that we are weak.  The eating disorder tells us that the only time we are being strong is when we are using symptoms and numbing our pain.  This lie can have devastating effects on the recovery process.  It can get in the way of our motivation if we believe that the only time we are strong is when we are in the eating disorder.  Even more importantly, it can stop us from even trying to recover, believing that we are too weak to do the necessary work.

The lies the eating disorder tells us could not be further from the truth!  People with eating disorders have an immense amount of strength.  However, we have been using our strength in unhealthy (and often ineffective) ways.  If we can begin to recognize our strength and power, then we can harness it towards recovery.

The following article from Eating Disorders Review.com is a wonderful illustration of this concept...

Understanding and Interrupting Relapse

The recovery process from an eating disorder can be long and arduous.  It often feels like two steps forward, one step backwards.  Slips and relapses occur.  It is important to understand the process of relapse so you can intervene sooner rather than later. 

The following is an excerpt from an article on addiction relapse.  I think it is very applicable to eating disorder relapse, and provides a nice illustration of the process...

[Relapse] is the progressive process of becoming so dysfunction in recovery that self-medication... seems like a reasonable choice.  The relapse process is a lot like knocking over a line of dominoes.  The first domino hits the second, which hits the third, and soon a progressive chain reaction has started... Each domino in the line (i.e. each problem that brings us closer to [symptom] use) gets a little bigger and heavier until the last domino in the sequence is ten feet tall, four feet wide, and a foot thick.  As this 10,000 pound domino begins to fall on us, it is too heavy for us to handle alone... When the last domino falls, it hits us from behind when we're not looking.


So here we are, moving along in recovery.  We tip over one small domino.  No big deal!  That domino hits the next, and then the next.  A chain reactions gets started.  The first dominoes are so small that we can easily convince ourselves that it's no big deal.  We look the other way and start doing other things.  All of a sudden a huge domino falls on us from behind, crushing us to floor, causing serious pain and injury in the process.  We need to make the pain go away and we reach for old reliable - the magical [symptoms] that always helped us with our pain in the past.  [We are now fully engulfed by the eating disorder.]

(Understanding Relapse by Terence Gorski)

Read more for examples of the relapse process and helpful tips on interrupting relapse...
 

Autobiography in Five Short Chapters

Autobiography In Five Short Chapters
~Portia Nelson~

Chapter I

I walk down the street.  There is a deep hole in the sidewalk.  I fall in.
I am lost... I am helpless.  It isn't my fault.  It takes forever to find a way out. 

Chapter II

I walk down the same street.  There is a deep hole in the sidewalk.
I pretend I don't see it.  I fall in again.  I can't believe I am in this same place.
But it isn't my fault.  It still takes a long time to get out. 

 

Chapter III

I walk down the same street.  There is a deep hole in the sidewalk.  I see it there.
I still fall in... it's a habit... but, my eyes are open.  I know where I am.
It is my fault.  I get out immediately. 

 

Chapter IV

I walk down the same street.  There is a deep hole in the sidewalk.  I walk around it. 

 

Chapter V

I walk down another street. 

Read on for some questions to consider and journal about...

Journaling Prompts

Journaling can be a very helpful tool for many people.  It can help you get in touch with your emotions, thoughts and beliefs, tap into your motivation, clarify the past, or dream about your future.  Journaling is also a great way to explore your identity.  Sometimes it can be difficult to start, so the following are prompts to get you started.

Identifying and Experiencing Emotions

For many, an eating disorder serves as a way to numb emotions.  Many people with eating disorders have a difficult time identifying their emotions, and may only experience "negative" or painful emotions.  When faced with the task of identifying their emotions, they may feel confused or even angry..."why do I need to feel my feelings if all I feel is pain?"  People with eating disorders are also often out of practice at experiencing, expressing, and moving through their emotions.  In many ways, the eating disorder has been their coping tool for dealing with difficult emotions, or even their way of communicating with others.  Therefore, it is important to learn how to experience and express emotions in a healthy and effective way.

Values

It is common for people with eating disorders to struggle with issues of identity.  They often feel as if their eating disorder is an integral part of who they are.  It can be terrifying for a person to let go of an eating disorder because it means letting go of the person they know.  Individuals with eating disorders often wonder, 

"Who am I without the eating disorder?" 

One thing to consider when you are exploring who are is your values.   

At your core, what values do you hold?  Below is an activity to help you identify your values...

Eating Disorder Myths

 Eating Disorder Myths:

• You have to be emaciated to have an ED.
• In order to recover the only thing you need to do is eat.
• People with bulimia are never underweight.
• People with anorexia are always underweight.
• People with eating disorders who are overweight must have binge eating disorders.
• If your weight goes up you're getting better.
• If your weight goes down you're getting worse.
• When you reach a healthy weight you are recovered.
  

Do's and Don'ts for Support People

Support people often wonder, "What can I do to help?"  In my opinion, the most helpful way you can  support someone is by offering unconditional love and concern.  Unconditional support means that you let go of judgment.  It means that you seek to understand each person as an individual.  Unconditional support means that you remember that everyone is doing the best they can, even if it doesn't appear that way to you.

Eating disorders can be incredibly confusing to understand.  Every eating disorder is unique, and every person who struggles with an eating disorder has different needs.  Ask people directly what would be most helpful for them, and remain open to the idea that needs are constantly changing.  Remember that you, too, are doing the best you can, and that it is okay to make mistakes.  Be patient and give yourself grace.

It is okay to be confused and to express that confusion.  Sometimes the most helpful thing to say is simply, "I don't understand this disease.  It doesn't make sense, and I know that's okay.  I'm still here for you."

Although everyone is unique, there are some general "do's and don'ts" that apply to many people with eating disorders.  You can use the following as a general guideline, but remember to ask people what they find most helpful.

Important things to Remember

I believe that recovery is a journey, not a destination.  The journey is filled with hills and valleys, turns, twists, and roadblocks.  Here are some important things to remember as you make your way along this incredibly difficult path of recovery... 

• There is no such thing as a "perfect recovery."
• There is no way to "fail" at recovery.
• Recovery must be your number one priority.
• You are much more than an eating disorder. 
• You deserve to love and be loved.

Our RIGHTS as Humans

  Many people with eating disorders struggle with low self-worth.  Often, people express that they don't feel like they "deserve" help.  It is important to remember that we are ALL worthy simply because we are human. 

I have the right to...

1. Experience all of my emotions including joy, fear, sadness, confusion, hope, pride, happiness, shame, guilt, loneliness, excitement, and so on.
2. Give and receive unconditional love.
3. Decide what I like and do not like.   
4. Develop and grow at my own pace. 
5. Give others the responsibility for their own beliefs, decisions, feelings and thoughts.
   

Pledge to My Body

One of my favorite quotes about accepting our bodies...

Pledge to My Body

I hereby agree from this day forward to fully participate in life on earth. I agree to inhabit the appropriate vehicle for participation…a body. As a requisite for the sustaining of that body, I agree to eat consciously. This agreement fully binds me for the duration of my stay on earth.

At my core...

At my core, I truly believe that we are all doing the best we can with the resources that we have.   

AND we can do better, try harder.   

How can we possibly do both?   

We can live in the moment.  We can practice acceptance of “what is” right now.  AND we can continue to learn and grow.   

We can surround ourselves with people, ideas, words, and images that inspire us and teach us new ways of thinking and being.  We can say yes to what is helpful and nourishing, and we can say no to what is harmful and discouraging.  We can recognize our values and act from them.  We can continue placing one foot in front of the next as we move along this unpredictable, messy, sometimes awe-inspiring journey.