Eating Disorders Answers

Should I leave my husband with bipolar disorder?

I am sure the question of whether to leave your husband is a perplexing one. Being married to someone that has been diagnosed with bipolar disorder can certainly have its complications. The fact that you have noticed improvements while your husband was on medication may have been encouraging to you. Many times people who have been diagnosed with mental disorders discontinue their medication when they feel better and notice improvements. I am curious to know why he is not currently taking his medication? Has there been a consult with you, your husband, and his psychiatrist to address the issue of him not taking his medication? The fact that he was hospitalized after having a manic episode after stopping his medication is concerning and the fact that he is talking to himself can indicate that he is spiraling into paranoia. Finding firearms in your home especially after having an agreement not to have them in the home is a direct boundary violation on your husband's part. Loaded weapons in the hands of someone who is in a paranoid manic state could be extremely dangerous. The best practice would be to remove any weapons and ammunition from the home and store them in an armory or gun safe. Your safety is paramount. Living with someone who is diagnosed with bipolar is one thing. To live with them while unmedicated can be unpredictable. To live with them unmedicated with multiple loaded guns in the home could be very dangerous and life-threatening. Personal boundaries are essential in living a healthy and fulfilling life. It is important to know what your boundaries are with regard to your husband. Perhaps you requested he stay with relatives until he stabilized. That was a boundary. Perhaps you will define some boundaries with regard to his being medicated and the loaded weapons in the home? You may find help from support groups for loved ones who live with partners diagnosed with mental disorders. The question to ask yourself is, "What do I need in order to feel safe in this relationship?"  When you can honestly answer that question you will know the answer to your question of whether or not to leave your husband.
(M.A., LMHC, CPC, NCC)
Answered on 09/27/2021

How do I stop this life long struggle of losing and gaining weight.

Hi Fluffy! Weight is a tough thing to target, very little has to do with an actual weight typically and more about what the weight (either at a lower weight or a higher weight) means to you personally.  What do I mean by that?  Well, it's complicated (isn't everything?!?!).  How are you feeling about yourself when you are at a higher or lower weight, what do you notice about your thoughts in both areas, what do you hear or see other people around you say to you?  All these things make imprints on our minds either consciously or subconsciously and then we act on them.  We all do things for secondary gain.  There is again in weight loss as well as for weight gain, and likely it happens that we have polarizing thoughts on this.  Some people use weight to hide away from problems (if people see that I am bigger then they don't see that I have relationship issues or parenting issues or sexual identity issues etc.) if I'm smaller people notice that I am confident, healthy, and more outgoing and don't see my lower self-esteem, self-loathing or (...) and they are focused on the wrong.  My guess is that if we dug deep into your thoughts both in weight gain and in weight loss there are specifics that you are either not being truthful about in yourself or that you might be avoiding altogether.  So, in my estimation, the cycle of weight loss and weight gain is more about the thought process surrounding the thoughts you have about yourself more than it is about the actual weight.  If we can target the thoughts and events that cause the change in eating habits we can then target the behaviors and keep them consistent (when in the weight loss cycle) and halt them when you start to notice the scale creeping up again.  There will never be perfect even weight, our bodies aren't designed like that.  That being said acknowledgment that the weight is a symptom of something else altogether will help get you started on your journey.  Hope this helps. ~Michelle
(MS, LMHC)
Answered on 09/27/2021

How easy is it to find a therapist that specialises in ARFID

Hello DragonPunch, Thank you so much for your question. I am sorry for your experience of not being able to find a therapist in the UK that specializes in your particular eating disorder. I want to assure you that there are many counselors here on the BetterHelp platform that would be able to work with you and that can help you find some relief from your symptoms. How the BetterHelp matching system works is that you will fill out a brief questionnaire and then you will be matched with a counselor who meets your preferences as well as has the expertise to address the concerns that you need help with. The second system in place is that the counselor initially believed to be a good match will have a chance to review the questionnaire and make a determination whether they feel they have the expertise. It is important to note that the more information you share on the questionnaire the better - as being very transparent about what you are needing helps reduce the risk of you being paired with someone who can't address your concerns.  Another great benefit of the BetterHelp platform is that you have the ability to very easily switch counselors at any time if you feel that the counselor you have been paired with is not a good match if you are simply not comfortable with a counselor because of how they approach your concerns, or for any other reason you may not be quite comfortable with them. It is your right as a consumer to find a counselor that you are comfortable with and who you find their process to be helpful.  I want to spend some time assuring you that there is help for ARFID, and despite it being a new addition to the DSM 5, the disorder itself has been around and there are many techniques in therapy that can be helpful in helping you to address your symptoms and to feel like you have more control over your eating habits. I certainly hope, that regardless of whether you try the BetterHelp platform, or whether you are finally able to find a specialist in the UK, that you are able to find someone who can come alongside you as you work towards wellness. I wish you the best as you consider your options. Thank you again for your question.
(MSW, LCSW, CADC)
Answered on 09/27/2021

How do you start treatment for body dismorphia?

Hello, Thank you for taking time to reach out to seek some more information with what you are dealing with in your life.  I see you have already taken some postive steps to try to figure out what is going on and to see what you can do to work on your body dysmorphia.  I will talk about the types of treatment modalities used by mental health professionals so you can consider your next move in achieving a healthier lifestyle. I support the view that it is extremely important for anyone with Body Dysmorphia Disorder (BDD) to seek professional help. If your body dysmorphia is occurring with other health disorders it is doubly important to address and treat the body dysmorphia, as lingering symptoms of BDD can often perpetuate eating disorder behaviors making it difficult to manage your recovery without professional support.   Treatments for BDD can include any or a combination of the following: Psychotherapy: The goal of this individual counseling approach is to correct any false beliefs about your “flaws” and reduce harmful, compulsive behavior.  Psychotherapy focuses on both cognitive therapy (teaching patients to identify and replace their negative thoughts with positive ones) and behavioral therapy (similar to the cognitive therapy approach but focusing on behaviors instead of thought patterns).   Medication: Often, antidepressant medications are prescribed to help relieve any compulsive symptoms. Group and/or family therapy: It can be important for family members to understand BDD and recognize its symptoms so they can better support your recovery, so family or group therapy is often suggested as part of the recovery process. As with all mental health disorders, BDD treatment is tailored to an individual's needs, so it is important to talk to your health professional to find the best BDD treatment approach for you. During the course of treatment your mental health therapist may introduce some exposure to certain elements with are prevalent in your live.  Exposure aims to decrease things like - mirror checking, camouflaging, and other compulsive behaviors. It is also intended to prevent other types of behaviors such as avoiding social situations. CBT is effective for many people with the type of your symptom, but some people with BDD do not respond to a significant level to create change. Some improve slightly, and for others they are unwilling to participate in ERP. For these reasons, it is useful to consider a different approach in conjunction with CBT.Acceptance and commitment therapy, or ACT, is one such treatment. ACT focuses on tolerating thoughts and symptoms, rather than trying to change, dispute, and generate alternative interpretations to problems. People with resistant BDD may benefit from ACT because it teaches how to tolerate anxiety-provoking situations.This type of therapy incorporates the core concepts of mindfulness, acceptance, and value-based living. Mindfulness: Developing the ability to be present in the moment and the ability to observe without making judgments. Acceptance: The ability to distinguish between pain and suffering and being able to tolerate and live with pain. Value-based living: The ability to live according to your values and not your symptoms; living fully now instead of waiting to reduce your symptoms. The mindfulness aspect of ACT entails learning skills that aid in accepting thoughts and feelings. In the case of BDD, you practice the acceptance of thoughts such as “I have a big head” and feelings such as “I am unlovable.” This is achieved by engaging in a variety of mindfulness exercises such as taking a silent walk and simply observing thoughts, feelings, and sensations as they come up. Mindfulness allows you to realize that you can experience many events but that you are never defined by these events. Acceptance - Many people with BDD experience intense feelings of suffering as a result of this preoccupation. In moments of struggle they avoid and try to control unpleasant thoughts. ACT helps you ride out moments of suffering and struggle.First it addresses your willingness to experience common symptoms such as unwanted thoughts, images, and situations. Next comes the introduction of the idea that unpleasant internal stimuli are not as harmful as you assume.With time, you will learn more flexible ways to respond to stressful thoughts that decrease suffering and struggle. ACT focuses on changing your reaction to triggers such as thoughts about your head instead of changing your thoughts about it.Some people with BDD also suffer from depression. ACT aims to differentiate between a label and a thought -  Label: “I am depressed.” vs. Thought: “I am having the thought that I am depressed. ”This helps you learn the difference between a thought and a sense of self. In ACT, it is important to be aware that we are not our thoughts. This process assists in decreasing the emotion attached to such thoughts.  Value-based Living ACT involves value-based living. For many with BDD, their appearance is their only value. ACT helps identify other values, which can serve as guides to live your life. Clarification of values involves distilling urges and feelings to see what is truly meaningful to you.For example, someone with BDD might appear to value appearance, but values-clarification exercises might reveal that the true values are human connectedness with corresponding desires to be loved and wanted. Therapeutically, this value can be pursued in ways that de-emphasize the importance of attractiveness. Part of this component includes an agreement to live life for its values and not for symptom reduction. In turn, this increases commitment to living a healthy life and assists in commitment to therapy. A Meaningful Existence ACT treatment goals include living a meaningful existence according to your values, focusing on the present moment, and tolerating emotions. So to conclude - ACT with CBT serves to increase the acceptance and motivation to engage in treatment.  During your treatment goal setting you and your therapist can address your nutrition needs and plan together the best course of action so that you can achieve your desired goal of wanting to gain 20lbs and be within your BMI while considering your need to attend to your iron deficiency and if necessary, will recommend a consult with a subject expert in nutrition management. Body Dysmorphia is highly treatable. There is life beyond the disorder waiting for anyone who is willing to seek help and recover!     Kind Regards, Gaynor 
(MA, LCSW)
Answered on 09/27/2021

Are there counselors that specialize in body dysmorphic disorder?

Hi lillobby, Thank you for using BetterHelp.com's "Ask a Counselor" feature. My name is Elizabeth and I am a licensed counselor with more than 7 years experience in working with individuals, couples and families. I will do my best to help answer your question and give you some coping techniques. To begin, I want you to know that feeling insecure about weight and appearance is increasingly common today in today's society. Individuals are constantly inundated with images of women (and men) that are not only realistic but they are also dangerous, as they present images that are unhealthy and unrealistic. So please understand that you are not the only person who may be struggling with how they appear and their weight. Let's look at some coping techniques that may help you work through these insecurities. First of all, I encourage clients that struggle with body image issues to delete social media and be very careful about what images they look at. Again, any photos in magazine or in print are totally photoshopped. They do not accurately represent how a healthy woman's body should look like. Also, social media is filled with influencers who also contribute to unrealistic standards, as filter are used very heavily to make their social media presence appear a particular way. Remember--social media and photographs are not reality. Secondly, I would recommend that you start a journal of the things you like about yourself. You can start small and write about 3 things you like about yourself per day. I want you to reflect on your strengths and focus on the unique things that make you unique. The other great thing about journaling is that there are no rules about how to journal. You can write what you and and when you want. The only recommendation I have is that you should try to write at least once a day in order to gain the most benefit from journaling. Finally, I would encourage you to speak to a counselor who can help you work through your insecurities. BetterHelp.com has a vast network of counselors with varying expertise and can work to pair you with a counselor that can best meet your needs. I hope you found this answer helpful. Take care and best wishes.
(MA, LCPC, LMHC)
Answered on 09/27/2021

What you think I can do to get better

Setting healthy sleep habits is essential for emotional well-being. Sleep deprivation effects your quality of life both emotionally and physically. Repeated lack of sleep can lead to moodiness, increased anxiety, problems focusing and thinking, and memory loss. Additionally, it can lead to weight gain, high blood pressure and a weekend immune system. Many studies have shown that chronic sleep deprivation has long term effects on an individuals overall well-being.  Causes of poor sleep are many. Some of these include to much stimulation before going to sleep such as watching TV, playing video games, consuming to much caffeine, too much stimulation in the home and uncomfortable sleeping areas.  If you are stressed, depressed, unfulfilled or have inconsistent work hours, getting a good nights rest will become more difficult. However, poor sleeping habits can be corrected with some changes and practice.  Simple changes in lifestyle and practicing good sleeping habits can help you achieve rest and calm. Following these simple steps will aid you in getting to sleep and decreasing your anxieties; 1) Go to bed at the same time every night. Set up a consistent schedule. 2) Start doing regular relaxing pre-sleep activities. This can include practicing deep breathing, taking a warm shower, meditating. 3) Leave the electronics alone at least 45 minutes before you go to sleep. Put your cellphone away, turn the TV and/or the computer off. This will block out external stimuli and allow your mind to relax.  4) Get exercise at least 2 hours before going to bed. Movement and exercise have proven to release chemicals in the body that elevate mood. 5) Eat healthy and avoid eating right before going to bed.  6) Limit caffeine, alcohol or nicotine before going to bed. These are all known to effect sleep cycles.  Practicing these habits will help you establish a routine and healthy lifesyle and help you get the rest you need and deserve! If you continue to have difficulties it is best to speak to a medical doctor. There might be an underlying medical condition that may effect your ability to get to sleep.  Reaching out for help is the first step and you should be congratulated. With the right interventions prognosis for improvement is good!  
(LCSW-R, CLC)
Answered on 09/27/2021

What’s the best way to build self confidence and master discipline?

Good evening, I understand that you said you "struggle with body dysmorphia and insecurities and lack the discipline to make a consistent change about it". I understand that you are looking to build self-confidence and master disciple. If we were working together I would first want to explore when this began to form as an issue. I would ask you to identify a time when self-confidence wasn't an issue and when being disciplined wasn't either. After some exploration here, I would want to see if would could find a trigger for want cause you to change. Like was there a significant trigger? If we could find anything, then I would explore that with you. Your concern for self-confidence and mastering discipline maybe rooted in something else. If we do the work and explore this you may find the issues reoccur as we haven't identified the root. I often recommend the book Unf*ck Your Brain by Faith Harper. She curses and if you're sensitive to this, it may not be the book for you. I can often additional suggestions. You can find the book from local retailers or even do an audio copy and listen to the book. Have you formally been diagnosed with body dysmorphia? Or is this something you've come to self-evaluate based on your behaviors. I would also explore these behaviors with you and seek to better understand how you see yourself. And again exploring when you didn't have the problem of seeing your body the way you currently do. I would also encourage you to do a cleansing of your environment and thoughts. Examining if there as people in your environment that perpetuate your thoughts and feelings about your body image. Exploring thoughts you tell yourself. Then I would encourage you to confront those negative thoughts. Building motivation is a little different. Techniques I use for that are establishing/creating SMART goals. Specific, measurable, attainable, realistic, and time limited. The use of planners, calendars, alarms, alerts, and finding people you can be accountable to. First being accountable to you and then adding in others you can be accountable to. Best of luck with this!
Answered on 09/27/2021

How do i stop my binge eating disorder?

Hi Bananas46?   How much work have you done trying to uncover the roots of why you binge eat?  I think it could be helpful to seek out therapy for this as most compulsive/addictive style behaviors occur in the context of people not wanting to feel their own feelings.  So what is it about your feelings you are trying to avoid?  What function does this behavior have?  Distraction is a good coping skill, but that's one that is only avoidance based and not getting at the root of things.     Hence, you might benefit from therapy aimed at building up distress tolerance.  Typically, the most common form of this therapy is DBT (Dialectic Behavior Therapy).  That would aid you to build up distress tolerance, but also learn new coping skills at he same time for when you are triggered t compulsively eat.  Usually that form of therapy needs to occur over several weeks, but there is not quick fix to change a compulsive/addictive behavior.   Another option is to join a support group.  Most people who enter recovery from substances do benefit from support groups of various kind, whether they be 12 step based or not.  People seem less likely to do so when the issue is food.  I thik a lot of people assume that OA (overeaters anonymous) is only for obese people - It isn't.  Aside from that there are other support groups for binge eating as well.  Those offer accountability and support from other people who can relate to you and not judge you.   I have heard from many binge eaters and/or food addicts that there are certain types of food that they know they cannot buy or have in their house or else they will binge on this. Have you taken inventory of what these types of food may be?  For most people they are sugary or heavy in carbs (or both).  Im not suggesting to engage in restrictive eating, but certain types of unhealthy food may be best left on the store shelf.   Lastly, you might look into hypnosis as an option.  There are many subconscious factors in play when you engage in binge eating and hypnosis could potentially cut to the root of it and produce a quicker behvior change, but you'd need to follow up and do other therapy work as well.   Hope some of this help!
(LMHC, CAP)
Answered on 09/27/2021

How can I improve my relationship with eating?

Hi Jbop,   I read your assessment and I see you are struggling with low self-esteem, self doubt, and lack of confidence. I see you utilize food for comfort exhibiting binging, negative internal thoughts, and increased emotions, and self-blame.  It appears you are struggling with past trauma perceptions of your body contributing excessive energy to indulging increasing the negative thought of how you look today.  You are concern with how you perceive your body and the results you are able to recognize from your actions.  There are several ways to improve your relationship with eating.  You must first work through your struggles of low self-esteem and lack of confidence.  This is done by recognizing why you overindulge, sneak eat, or question your weight.  You will have to work through your triggers to your questioning of body image or weight to increase positive ways to cope and work through your challenges.  This will be done by identifying if you experienced teasing in your past, negative comments from family, nutrition deprived with a negative comment followed, or any type of body shamming. It is very important to recognized what you triggered by or oriented to defeat and challenge your thinking to be productive.  You can try prepping your food daily to avoid overeating.  Exercising in routine to during your challenging times to eat implementing replacement of food with exercise.  Try implementing pleasurable things that are immediate like painting, journaling, walking, music, or reading to replace binging overeating when you are thinking negatively or challenged with your thoughts.  This will decrease you overeating, sneaking, and thinking that you or your body is not right.  You have to start with your thoughts first by challenging yourself in the moment as you work on your self-esteem believing that you are enough. Be mindful of your grocery shopping to buy things you enjoy in proportions instead of bulk to eliminate eating more for comfort.  I suggest you work with a therapist to discuss and explore your triggers and trauma centered around overindulging and coping with food for comfort.  The therapist will help you identify the root of your negative thoughts to increase self-control.  It will be beneficial to identify self-doubt and low self-esteem to increase your awareness of what you are going through to increase alternative ways to replace and challenged your actions.  A therapist will assist you during your low and high moments and help you see your strengths to succeed to have a productive lifelong term.
Answered on 09/27/2021

What do I have to do? What are the steps that I can make to get out of this situation?

Hello, blue wide sky. Thank you for reaching out for support with your personal dilemma. It sounds like the struggle you have had with your weight started young and has caused you some deep-rooted insecurities that were further reinforced by others teasing you. Your self-esteem was again triggered in your senior year with you feeling inadequate as a student. I find it interesting that the classes you were in at the time were anatomy and medical classes which consist of the examination and exploration of the body closely and I wonder if the content in those courses also triggered you, besides the difficulty.  In an attempt to cope, it sounds like you are exhibiting symptoms of an eating disorder or at the very least an unhealthy relationship with food. The fluctuation between restricting food, binging, and purging is considered an unhealthy coping skill which it seems like you have developed out of feelings of anxiety and loss of control. I am not diagnosing you as having an eating disorder; however, I feel it is important for you to understand that eating disorders are categorized under anxiety disorders. My first recommendation is for you to seek a medical evaluation, like a physical exam. It is necessary to make sure there is nothing physically going on for you. I think it is important to rule out any existing health concerns that may have contributed to the weight gain earlier on for you when you described yourself as being overweight even though you never ate a lot. As well as making sure you have not developed any significant responses or damage from the food restriction, binging, and purging;  especially with the mention of digestion issues. It will be important to know if your body is deficient in necessary vitamins so that you may start replenishing and healing your body. Another helpful resource would be a nutritionist to help you develop a balanced food plan. Your body and mind respond to the lack of food as fuel. You falling asleep or not being able to fall asleep is all attributed to your body and mind being deprived of fuel. When we do not get enough food and sleep, it can significantly impact our energy level, emotional stability, and brain functioning.   In conjunction with your physical health, is your mental and emotional health. Learning what triggers your responses to food and anxiety is important so that you can implement healthier coping strategies. There are two different forms of therapy that are found to be effective for your symptoms and behaviors. Cognitive Behavioral Therapy (CBT) focuses on identifying thought patterns and behaviors that contribute to your eating issues and then developing skills to modify and help manage them. Dialectal Behavioral Therapy (DBT) focuses on managing difficult emotions and learning skills to change the behaviors associated with eating issues.  Unhealthy and dangerous eating behaviors or relationships with food are challenging to navigate alone, for the mere fact that food needs to be part of our daily lives and is a basic necessity. I highly recommend that you engage in counseling in order to effectively treat and heal yourself. I hope my feedback has been helpful and I wish you luck.
(MSW, LICSW)
Answered on 09/27/2021

How can I stop binge eating?

For the binging and overeating, you would need to get to the root of when you do it.  You said that you can moderate throughout the day but at night not so much so that particular time of day is worth exploring.  I can't say with certainty but it sounds like you're boredom eating so try filling that time with something else: tv, social media, good book, etc.  Look at your habits throughout the day, is it because you have things to do at work or chores to do at home that your active preoccupation leaves you no time to eat then you may need to find some meaningful things to do at night.    Secondly, the desire to want sweets as part of your diet means you need to look for healthy snacks.  Almost all snacks in today's society have an alternate low something version, consider buying those instead of the traditional versions, even give yourself an opportunity to explore new snacks.  You also want to look at healthy snacks that have a higher serving size so you really feel rewarded.  An example of this would a Lay's Poppable bag of chips with serving size 20-30 pieces as opposed to a traditional bag of chips.  I would advise trying to go cold turkey, this usually further fuels over-eating if you experience a relapse.     Third, if you're truly lacking the control, you and/or your family should help you gain that discipline back.  Much like a pill counter, you could ration out snacks for the day or the week, secure the other items or have a family member secure the other items and once you hit your max, that's it for that day or week.  The Brand 'The Kitchen Safe' also makes containers with timers on them, once it's locked you may not be able to get in to it until the next day pending settings and features.    Last might be to offest your food choices.  If you really feel like you have to have something, then you may need to buy those opportunites meaning working out with a calorie counter. If you eat a snack with 400 calories then you exercise and give those 400 calories back to yourself.    Overall, regardless of how you use to look, it takes time to build true discipline.  Make a plan and stay steady for at 21+ days.  Get an accountability person if you can to keep you honest.  Start to phase out those unhealthy snacks for better ones.   Hope this helps!     
(MSW, LCSW, BC-TMH)
Answered on 09/27/2021

How do I get out of the mental state that is causing my eating disorder

Thank you for reaching out and asking your question. It is unfortunate that you are unable to afford services and I would like to help you in the best way possible. I don’t know your history and will not assume the causes of developing an eating disorder. However, I hope this answer will give you some guidance in being able to implement small changes that will lead to bigger success. Eating disorders is a cycle of anxiety that consists of behaviors, thoughts, and emotions. It is a cycle of intense shame for those struggling and can be a source of confusion. The cycle is repetitive and individuals suffering will often find it impossible to stop. Over time, the frequency of the cycle tends to increase, and this pattern becomes more firmly ingrained in the brain.   No single cause for eating disorders has been established. Although a preoccupation with body weight and body shape seem to be central to all eating disorders, research has so far shown that eating disorders are associated with (but not caused by)many different factors, which may be genetic, cultural, social, behavioral, psychological or biological. Therefore, any “cause” of an eating disorder may be multifactorial and complex.  However, no matter the frequency or length of time that someone has engaged in this pattern it is possible to step out of it. What interventions are used to help break this cycle: Decide not to restrict food or calories. People struggling with bulimia frequently wish to continue restricting calories with just cutting out the binge/purge components, making this one of the most difficult decisions to altering the cycle. However, to break the cycle, there must be a willingness to let go of calorie restriction as well as restricting types of food which can lead to feelings of deprivation. Normalizing eating patterns is essential to freedom, and a dietitian can help provide guidance in ways to do this.      Practice mindfulness. Bingeing and purging are methods to avoid internal experiences. Practicing mindfulness helps to process what is happening in the body and with your thoughts rather than trying to stop or change them. There are many mindfulness practices, but we  encourage urge surfing, which is centered on the notion that our urges and intimate experiences are ever changing and thus time limited. Urges are like a wave with a peak of intensity and then a gradual decline. When we are at the center of an urge, however, the thought that this will ever be different tends to go out the window. In urge surfing, we encourage our clients to notice what the urge or craving feels like in the body and to stay with it, noticing how the urge and the intensity change over time. Staying with the urge allows for a reach to the other side and a decrease in intensity.           Develop a plan for when urges to binge or purge hit. There are likely several things someone would rather be doing than engaging in bingeing or purging. However, in the heat of the moment tunnel vision sets in and the focus narrows to just bingeing and purging. Making a list of 5-10 things to do other than engaging in the behavior can be a helpful reminder when the urge hits.           Agree to delay binge eating or purging. An intense urge can be overwhelming and feel everlasting. Delaying the engagement in the behavior by five minutes can make the process seem less overwhelming. At the end of five minutes, a commitment to another five minutes may be possible, and perhaps the next time may be a delay to 20 minutes. Regardless of the amount of time, simply creating that space for a delay provides an opportunity for a different decision to be made rather than acting on auto pilot.          Write a letter to yourself. Writing a letter to yourself about why you don’t want to engage in the binge/purge cycle can be a helpful reminder. Think about writing a letter to your struggling self during strong urges. What would you need to hear, what would be helpful at that time? Often letters are comprised of validation for how difficult the current experience is, a reminder of life goals and how this behavior interferes with achieving them, and encouragement to take some other specific actions instead. Keeping your letter close is encouraged as it can be a powerful tool to have in the throes of urges.          Make a list of positive affirmations. Listing positive self-statements for each stage of the cycle is another idea. What are affirmations are needed to refrain from restricting, to stop from binging or purging, or to cope with the shame that comes from this behavior? The key is to write statements that are at least somewhat believable. They do not need to feel like absolute truth, but should not feel totally out of the realm of possibility.          Identify the thoughts that typically precipitate a binge or purge. Many people will say they have no thoughts before a binge or purge; they just engage in the behavior. However, later the contributing factors are identified. They may say things such as, “Well, I already had one, so I might as well have the whole box” or “If I don’t get rid of this I am going to gain weight.” Identifying these thoughts and then countering them with something more truthful can be helpful. Try this tip – draw a line down the middle of a piece of paper lengthwise, on one side of the line write typical thoughts, on the other side write ways to re-frame these thoughts to ones that are more recovery oriented. The act of writing this out allows for a different perspective than the one contributing to the use of behaviors.           Identify and address the most vulnerable times during the day. Often a daily pattern develops for when the binge/purge behavior occurs. For many people, times of heightened vulnerability are the transition to home from work/school or late in the evening. Developing a schedule for what to do during these times of vulnerability can help in practicing the skill of coping ahead, and lessen the likelihood of engaging in behaviors.           Practice healthy self-care. When we look at the cycle, feelings of increased tension and emotions can contribute to a binge. There are aspects of self- care that can lessen our vulnerability to these triggers. Identifying simple changes may increase the quality of self-care and can decrease vulnerability to the engagement in behaviors. The following are some ways to assess self-care are: Exploring how much sleep you are getting. What are you doing to cope with stress? What are you doing for enjoyment? Is there a healthy work/life balance? Are you treating any physical illnesses? Are you staying connected to others?      Enlist social support. One of the most helpful tools is simply letting others into your world. While extremely challenging, picking up the phone to call a friend or loved one and speaking out loud that you have an urge to binge or purge can be extremely helpful.        This list is by no means exhaustive but is just a few ways to start breaking the cycle. When working to break the cycle. In the beginning, it may feel like your urges are lasting for hours at a time, and you may doubt your ability to do this. The more you can refrain from gagging in the cycle; the more manageable the urges will become.
(DPC, LPC, NCC)
Answered on 09/27/2021

Do I need help?

Hello, thank you for writing!  First, I want to congratulate you on your first child.  While that is a wonderful and exciting time, there are certainly difficulties that come along with it.     Pregnancy, childbirth, and the postpartum period each bring their own levels of upheaval to the female body.  It impacts every area of your being including, physical, emotional, and hormonal aspects.  Considering a system approach, each of these aspects of your being interacts together and can make life, in general, more challenging.  When one of these aspects of functioning differently, all areas are affected. When all areas are impacted, it can leave feelings of distress.   When you think about emotional eating, my guess is that it is meeting a need you have and on some level makes you feel better.  It also can make you feel worse when the consequences become evident.  A helpful approach to this is to look for other options that help provide the same level of relief.    Ideally, I am sure you would like to just quit the emotional eating, the best way to ensure the sucess of that is to find another strategy that helps you feel better in the moment.   Secondly, are there barriers to the healthy lifestyle you would prefer to live?  It seems like you are aware and familiar with the needed healthy habits, however; there maybe issues to keeping those from happening.    Can you identify those?  If there are things there that we should adjust, that would be something to consider and problem solve or brainstorm ways to remove them.     Consider your supports.  Are there individuals to help you with accountabiliy and possibly tangible supports too, like childcare while you are grocery shopping, food prepping, or exercising?  A solid support plan can make a tremendous difference in your overall success.     In conclusion, I am thinking of an approach that draws strength from a couple of different areas.  1) Grace with yourself because your body has done so much, growing, birthing, and caring for a baby are not easy.  2) Consider the need that the emotional eating is meeting. Look into other options to meet that need.  This is probably a matter of problem solving and brainstorming.  Trial and error might helpful to find a new strategy and making it work for you.  3) Identify and remove barriers.  There may be barriers you are not fully aware of and some that are loud and clear.  Sorting through and problem solving those will be helpful to ensure you success.   Will therapy be helpful?  I think that it very well could help.  A therapist can provide an insight and help with identifing and processing the challenges you face.  Identifying the root of the emotional eating is something therapy could likely help with too.  A support or person that helps with accountability would be beneficial to anyone. Someone rooting for you, cheering you on for succes, and just being present and in your corner is something that you might benefit from.     I do feel you would find therapist a helpful avenue to address these concerns.  if there are barriers to obtaining the service and help, I would encourage you to explore the outline discussed above to see if you are able to use that move yourself in a positive direction.  
(MSW, LCSW)
Answered on 09/27/2021

How do I gain self-confidence gradually?

How do I gain self-confidence gradually?   I read where you shared that self-esteem issues have made your social and sexual life impossible. You shared that you have major body dysmorphia and you are hyperaware of the way your body and your face looks to other people. You also shared that you are not confident at work and you can not talk in a group. I also read where you shared that you hate your body and you have self-limiting beliefs. Your question is how do you gain self-confidence gradually?   Based on your question, I would highly recommend that seek help from a professional counselor and or professional therapist to discuss how to gain self confidence gradually. A professional counselor and or professional therapist can help you learn to implement effective coping skills to deal with your current low self esteem issues that have made your social and sexual life impossible along with discussing and implementing coping skills to decrease your thoughts regarding body dysmorphia. Behavior interventions, Psychotherapy, and Cognitive Behavioral Therapy (CBT) have all been beneficial in treating individuals who have struggled with feelings of low self confidence and body dysmorphia.  A professional counselor and or professional therapist can assist you in learning how to effectively implement coping skills to decease your feelings of low self confidence and body dysmorphia. A professional counselor and or professional therapist can introduce you to deep breathing techniques, stress relaxation techniques, calming techniques, progressive muscle relaxation, and imagery as a means of decreasing your feelings of low self confidence and body dysmorphia along with discussing the mental health effects of your social and sexual life.   In an effort to decrease your uncomfortable emotions from your feelings of low self confidence and body dysmorphia you can also try to commit to changing the way you think. It will take a lot of practice, dedication and determination to alleviate uncomfortable emotions from your feelings of low self confidence and body dysmorphia. However, trying to do this will help you feel better and it can lead to your feeling much better and becoming more productive. You can recognize when it is happening and when you find it happening you can choose to think about something more productive. You can also look for solutions by committing to learning from your mistakes and solving your problems so you can productively move forward, set aside time to think when you notice you are experiencing uncomfortable emotions from your feelings of low self confidence and body dysmorphia outside of that scheduled time, remind yourself that you will think about it later, distract yourself with a self care activity and you can practice mindfulness. Mindfulness is the key to living in the "here and now." When you become mindful, you will be completely present in the moment. It can be like a form of meditation that takes a lot of practice, but over time and with consistency, it can be very beneficial in decreasing or eliminating uncomfortable emotions from your feelings of low self confidence and body dysmorphia in an effort to help you experience an overall healthier mental well being.   Overall, I highly recommend that you seek help from a professional counselor and or professional therapist to properly assess your feelings of low self confidence and body dysmorphia along with the emotional distress that has affected your social and sexual life. Emotional and mental distress can look different for everyone because mental health is not a one size fits all. Therefore, it is very important to get personalized treatment for your specific and current mental and emotional needs in regards to your  feelings of low self confidence and body dysmorphia. Best regards!
(EdS, LPC-S, NCC, BC-TMH)
Answered on 09/27/2021

How do I overcome an eating disorder that only happens when I’m stressed?

Hello and thank you for your question. Let me start by saying that issues related to body image and eating disorders can be addressed - you can make progress and get better.  It will be a journey and take time with consistency, hard work and support. Based on the information you provided, it seems that you have been struggling with issues and symptoms related to eating disorders for a long period of time. Have you thought about seeking counseling? Solely trying to work on food  and body/image related compulsions, negative thoughts and other related symptoms can be challenging. A counselor can provide you guidance and support in dealing with challenges you are experiencing and feeling. I highly recommend you connect with a counselor for addition help beyond receiving an answer to this question. The mind hand connection you reference and information you provided indicates that you have good insight into your your thoughts, behavior patterns and intentions.  However, consistency with your decision to to refrain from purging and making healthy food choices is difficult. Breaking the cycle of self punishment can be trying. I suggest starting with setting small goals to eat healthy and be consistent  - one day at a time and if needed one healthy meal at at a time.  Also, monitor and work to be at least neutral with your thoughts. The current negative thoughts you indicated can fuel your feelings and thoughts of failure, that can lead to self punishment: overeating and purging. Also, I suggest using mindfulness practices to help you be gounded/centered/calm if/when you may be feeling overwhelmed or having incessant thoughts of overeating. Mindfulness practices can be in various forms: mindful eating, deep breathing exercises, rhythmic and boxing breathing, progressive muscle relaxation and focusing exercising. I usually recommend the apps: Calm and/or Headspace. Also, YouTube has a variety of mindfulness resources - guided meditation, music and more. Please explore and begin a practice gradually. As I conclude this response, I encourage you to not give up or quit. You can accomplish your goals and overcome your current struggles. Pace yourself, set reachable goals and work on all or nothing/negative thinking. I hope this response is helpful. Wishing you the best on your journey. 
(PhD, MPH, MSW)
Answered on 09/27/2021

Is it healthy to lose weight by as much restricting and exercising as you can or an ED?

Hi Atlas   Thanks for your question. It sounds like you are bordering on a very unhealthy area and could be teetering on developing an eating disorder. I would recommend you see your doctor right away for an assessment. It isn't healthy to lose so much weight in one year. I would also be especially interested to know your height. This is another important factor as well as your age.    Either way your body needs more than 1,000 calories per day for its optimal functioning.    Focus on mindful eating. Mindfulness means focusing on the present moment, while calmly acknowledging and accepting your feelings, thoughts, and bodily sensations." The tenets of mindfulness apply to mindful eating as well, but the concept of mindful eating goes beyond the individual. It also encompasses how what you eat affects the world. We eat for total health.   Here are some tips. 1. Begin with your shopping list. Consider the health value of every item you add to your list and stick to it to avoid impulse buying when you're shopping. Fill most of your cart in the produce section and avoid the center aisles-which are heavy with processed foods-and the chips and candy at the check-out counter.    2. Come to the table with an appetite-but not when ravenously hungry. If you skip meals, you may be so eager to get anything in your stomach that your first priority is filling the void instead of enjoying your food.    3. Start with a small portion. It may be helpful to limit the size of your plate to nine inches or less.    4. Appreciate your food. Pause for a minute or two before you begin eating to contemplate everything and everyone it took to bring the meal to your table. Silently express your gratitude for the opportunity to enjoy delicious food and the companions you're enjoying it with.    5. Bring all your senses to the meal. When you're cooking, serving, and eating your food, be attentive to color, texture, aroma, and even the sounds different foods make as you prepare them. As you chew your food, try identifying all the ingredients, especially seasonings.    6. Take small bites. It's easier to taste food completely when your mouth isn't full. Put down your utensil between bites.    7. Chew thoroughly. Chew well until you can taste the essence of the food. (You may have to chew each mouthful 20 to 40 times, depending on the food.) You may be surprised at all the flavors that are released.    8. Eat slowly. If you follow the advice above, you won't bolt your food down. Devote at least five minutes to mindful eating before you chat with your tablemates. 
(MSW, LCSW)
Answered on 09/27/2021

What can assist me in decreasing my restrictive eating behaviors?

There are 3 main goals you need to begin with. The main goal needs to be assessing what has you restricting your food? What is it in response to? Keeping a daily journal of your emotions around eating can help you to discover this and any patterns you may have. 2nd goal should be to maintain a certain number of calories weekly. A general diet is usually around 2000 calories a day. You should have 3 small meals and 3 snacks. Planning your meals for the day can help you get into the habit of eating regularly. Your habit of reading labels is not a bad thing, you should always know what is in the food you are eating. If you find you are ruminating over the labels, use a 4 count deep breath before and after reading. You would breathe in 4 counts, hold for 1 count, then blow out like blowing through a straw for 4 counts. Repeat as many times as necessary to help you to refocus. Use calendar reminder or alarms on your phone to keep you to 2 hour intervals for eating. 3rd goal is to practice coping skills and self-care regularly. Restrictive eating is an emotional response which helps us to take control over something when we lose control over something else. Developing a self-care routine and regularly practicing your coping mechanism helps to relax the mind and maintain focus on what we can control.   Here is a list of self-care tasks you can complete daily: Basic hygiene such as bathing and washing your hair. Mindfulness meditation  Exercise Time with friends and family Setting life goals Saying "no" when needed Self-pamering including taking a long hot bath, facial mask, mani/pedi, and any other body maintenance. Getting regular sleep Coloring, painting, and other arts or crafting options. Dancing Swimming Taking a drive Going to a museum or other tourist attraction in your areas. Take a walk around your neighborhood or through a forest preserve or walking path.   Coping mechanisms to practice: Deep breathing Listening to soothing music Grounding techniques Distracting yourself by picking a color and naming objects in the vicinity that are that color. Taking a newspaper, magazine, or book and choosing a letter and finding that letter on each page. Progressive muscle relaxation  Positive affirmations
(MA, LCPC, NCC)
Answered on 09/27/2021

What do I do if I can’t afford private counselling?

I am so glad that you reached out to get some help for your eating disorder. 10 years is a long time but each day is a new day! Better help offers help with finances for those who need it. It would be worth it to reach out to customer service to see if they can make it an affordable option for you to seek help. I am glad that you spoke to your GP about your concern and sorry to hear that the person they referred to you dismissed your concerns by saying it wasn't severe enough. The whole point in seeking treatment is the prevent it from spiraling as you mentioned.  I am not sure if you have social media but there are some great resources and groups for those that suffer from eating disorders. In no way am I saying these groups can replace professional help but they can help create a support system with other people who struggle with eating disorders. There is also a hotline that you can reach out to and a website at: https://www.nationaleatingdisorders.org/help-support/contact-helpline With seeking professional support you'll be able to identify the emotional and psychological drivers behind the eating disorder. Because there are so many different types of eating disorders I can't provide you with any specific advice but by taking the first step and asking for help you are in a good place that many struggle to get to. Many people with eating disorders do not own up to them and hide them and will do so at any cost and the fact that you have sought out this resource shows the hope that is within you. Again please contact customer service and see what financial assistance they can provide so that you can get the proper care that you need. Also Try to reach out to others and your support system and open up to them and be vulnerable and share what is going on so that they can support you through this journey of healing. Journaling can be very helpful in exploring some of the underlying issues that the eating disorder could be masking underneath the surface so to speak.  I wish the best of luck to you and this healing journey.  
(M.Ed, LPC)
Answered on 09/27/2021

How could online therapy be helpful?

I don't know if online counseling would be different for you.  Some people say that talking on the phone without having someone look at them makes them more comfortable.  The more comfortable you are, the better the relationship will be and the more honest and free you will feel to open up about what is happening on the inside.     There are many different reasons that therapy might not work for you. One being that you might not have had the right counselor.  That doesn't mean you had a poorly trained or a "bad" counselor but not all personalities work together well.  You might not have really understood one another or picked up on one another's nonverbal cues as easily as with other people.  If the fit was not right can you say that you were truly honest about what was going at at the time you were in therapy?   Another reason may be that you are harder on yourself than others.  Are you sure there was no improvement?  Did you ask others around you, whom you lived and worked with?  More objective people in your life may have seen changes within you that you might not have recognized.  Those changes could have come from the work you did in therapy.   Next being the work.  Are you able to look yourself in the mirror and honestly say you did the best you could do in your time in therapy?  How truly engaged were you in the sessions, paying attention, not day dreaming and being focused on the session.  Then, if there were homework assignments or suggestions to do outside of therapy  -  were they done.  Therapy is a process in which we work on change.  But the change doesn't happen by spending just one hour a week talking or compaining to another invidual.  You truly do have to work on the skills discussed in the sessions outside of the sessions.  Many therapists will ask you to practice skills such as meditation, yoga, thought reframing, etc.  Before you say that therapy doesn't work, did you do all the work?   Another reason it might not work is consistency.  It's disheartening to hear that therapy doesn't work from those who cancel often.   Now I am not saying you are one of those people, I am just asking that before you think it really does't work for you that you can be sure you had the right person and did the right amount of work to assist yourself.
Answered on 09/27/2021

How can I know the difference between the stuff my head tells me about me and what’s true? Because it feels like I’m lying to myself to say it isn’t when all the facts say that it is.

Oftentimes people seek counseling to gain an objective opinion about themselves, their decisions, and "performances" in relationships and everyday life. They seek an opinion from a person who isn't involved with them directly or doesn't have a stake in their affairs as does a parent, family member, friend, co-worker, spouse, or significant other, so instead, they turn to a counselor, a trained and experienced listener, and behavioral expert. In this fast-paced highly competitive culture, most feel a push towards conforming to desired standards of top-notch performance and psyching oneself up through positive self-talk and affirmations in hopes of setting that mindset towards achievement. Numerous books and psychological theories proposing the rationale of "you are what you think" and valuing Happy Talk, though at times, carried to such an extreme, can invalidate the reality that all is really not so well all of the time. Those who struggle, despite the Happy Talk, and there are many, then start to question their own self-perceptions. What is actually true? "If I can't talk myself into being happy or performing greatly, I'm a failure and something must be fundamentally wrong with me. Not only because I'm a bad performer, but because I can't do Happy Talk." Skilled counselors know that reframing "negative thought patterns" and Happy Talk affirmations are not always helpful, and can actually have the opposite effect leading to feelings of failure and self-questioning. Those struggling with anxiety need to hear at times that their thoughts are "real" and valid. Rather than dismiss them, it's important to accept and tolerate distressing thoughts and feelings. Only through the consistent commitment of accepting and tolerating the emotions that disturb and frustrate, can they calm and quiet down. At least enough so to enable one to make a conscious plan of action. The counselor walks with the client in his or her journey to change the inner voice and self-perception, facilitates a calming space, and encourages skill building leading to behavioral change. This happens over time through empathic listening and an acceptance of the client's fears, anxieties, and self-perception. The counselor understands that these are simply some of many feeling states and thoughts that are experienced throughout the day and is confident in the client's strengths to manage them.
(MSW, LCSW, CADC)
Answered on 09/27/2021