When Your Doctor Doesn’t Get It

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I’m currently 5 months pregnant and have had some frustrating experiences with the midwives I see, even though I told them from the first appointment that I have a history of an eating disorder. But they are hyper-focused on food and have suggested fad diets. The last midwife I saw asked me to walk her through a typical day of my diet, starting with breakfast. I told her I was not comfortable with that (I’m very protective of the recovery I worked so hard to achieve!) and I don’t want to find myself triggered by focusing too much on diet. She said she wanted to be sensitive to that, but then proceeded to be anything but and asked me questions like, “Do you eat fast food?” with a judgmental tone.

Unfortunately, it’s common for people with eating disorders to have run-ins like this with the medical community. I’ve heard some doosey stories from clients, let me tell you, including the patronizing but typical, “Just eat,” or “Just stop it” responses when they finally have the courage to disclose their disorder.

So it’s completely understandable that for many people with an eating disorder, going to the doctor is a very anxiety-provoking experience. Sometimes, it can even be downright triggering. Here are some tips to help it be a more positive experience, as well as what to do when your doctor just doesn’t get it.

  1. Tell your doctor about your eating disorder or history of an eating disorder. I know, I know… I just talked about how awful doctors’ responses can be. And it is, admittedly, just a really uncomfortable conversation to have. But they don’t have an opportunity to respond well if they aren’t told, and they will hopefully show some sensitivity (there really are some who do!).  Also, some meds are not recommended for people with certain eating disorders because of possible adverse reactions like seizures so your doctor needs to know your entire medical history when prescribing things for you.
  2. Opt to do a blind weight or don’t be weighed at all. You can close your eyes or stand backwards on the scale while they weigh you so you don’t see your weight. Or you can just not be weighed at all. You might get some pushback, but it is your right to refuse.
  3. Communicate with your doctor about what triggers you. Whether it’s avoiding being weighed or declining to talk about a fad diet that’s being suggested, you can draw boundaries by saying you don’t feel comfortable discussing those things. IMPORTANT: I’m not suggesting automatically shutting your doctor down about these topics, because ideally, they should be a part of the team helping you be healthy. And you need to be sure your motivation for avoiding these topics is pro-recovery and not to hide or maintain your eating behaviors. But some doctors just aren’t sensitive or informed enough about eating disorders to be helpful. So if you’re realizing your doctor falls into that category, be your own advocate and remember that you, not the doctor, are in charge of your care.
  4. Find a new doctor if necessary. If advocating for yourself and offering your doctor some education about eating disorders isn’t working (or you don’t want to even put that effort in), don’t be afraid to part ways with your doctor. We as patients are consumers, which means if we’re not comfortable with the service and treatment we’re receiving, we have every right to take our business elsewhere and shouldn’t feel guilty about that at all.

A big part of eating disorder recovery is learning to find your voice, so these tips are not easy to do. But they are an opportunity to practice using your voice, taking charge of your life, and realizing you are capable. You can do it.

Much love,
Cherie Signature

About Cherie Miller @ Dare 2 Hope
Cherie Miller, MS, LPC opened Dare 2 Hope Counseling to help clients all over the country get free from their food, weight, and self-confidence struggles. Her specialty is eating disorders, including anorexia, bulimia, binge-eating, orthorexia and other unhealthy eating patterns. Contact her here.

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A Potential Flaw in Positive Thinking Psychology

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Photo Credit: ileanaandrei.ro

There’s a lot of talk these days about positive thinking and how important it is to change your thinking to improve your health and happiness. And while I won’t argue that our mindset affects our feelings and behavior (because I believe it absolutely does), I am concerned that we can put too much emphasis on thinking. That’s a big statement for a Cognitive Behavioral Therapy (CBT) therapist to make! But here’s the balance that I would like to bring to the discussion: Though highly influential, thoughts are not an all-powerful force in our lives.

There are potential drawbacks to believing that everything we think affects our behavior. So even while we acknowledge the significance of our thoughts and strive to have healthier, more constructive thinking patterns, let’s also recognize some limitations of our thoughts. For example, thoughts…

  • do not always reflect what we really believe, feel or want.
  • do not always mean we will act on whatever that thought is.
  • do not always reflect reality.

Let’s take a closer look at why each of these points is relevant.

#1. Thoughts do not always reflect what we really believe, feel or want. We all have had bizarre, maybe even dark thoughts that pop into our heads at times—that is a normal part of being human. It does not mean you are “crazy” or a bad person. Some people struggle with these types of thoughts more than others, particularly people with issues like anxiety, obsessive-compulsive disorder, or postpartum depression. On the extreme end, I’ve had clients who had intrusive thoughts about things like stabbing their spouses or molesting their child (even though they had no reason or desire to do such things), and they worried it meant there was something evil inside of them. Being bothered by your thoughts is a sign that they don’t reflect your wants or values. In cases like these that go beyond the “normal” occasional bizarre thoughts we all have, there are often biological causes for these thoughts. There is sometimes trauma in that person’s past that can be influencing these thoughts.

#2. Thoughts do not always mean we will act on whatever that thought is. Thoughts do not automatically manifest into behavior. None of my clients who had bizarre, or even violent, intrusive thoughts ever acted on them because that is not who they were.

Now, sometimes our thoughts do line up with our feelings and that makes it more likely we will act on them, but it doesn’t mean we have to. This is key for my clients in eating disorder recovery, who might have obsessive thoughts about not eating or about thinking they are fat (and also feeling fat). Though it can be incredibly difficult, they can choose not to act on those thoughts. In her book, Life without Ed, Jenni Shaefer describes it as “disobeying” the eating disorder. We can have thoughts and feelings about harming ourselves and decide to call a friend instead. A tape can play in our head about how that big presentation at work will be a flop, but then it turns out we nail it.

#3. Thoughts do not always reflect reality. Thoughts, like feelings, are not facts. Research confirms that much of what we worry about doesn’t even happen.¹ And just because we think something doesn’t make it true. We can think we’re ugly and actually be attractive. We can think we’re an idiot and be very intelligent. We can think we are boring and socially awkward while in reality, people find us engaging and pleasant to be around. The stories we tell ourselves are just that: stories. And sometimes stories are only partially true or sometimes they are completely false.

It is really, really good news that while we work on changing detrimental thoughts, we are not completely at their mercy until they change or go away. We can still choose to ignore or to act opposite of our thoughts when they aren’t healthy. Remember friends, we are not just thoughts… we also have a will and a conscience and many other elements that make up who we are and drive what we do.

Much love,
Cherie Signature

¹References: “85 Percent of What We Worry About Never Happens” By Don Joseph Goewey (www.huffingtonpost.com/don-joseph-goewey-/85-of-what-we-worry-about_b_8028368.html)

About Cherie Miller @ Dare 2 Hope
Cherie Miller, MS, LPC opened Dare 2 Hope Counseling to help clients all over the country get free from their food, weight, and self-confidence struggles. Her specialty is eating disorders, including anorexia, bulimia, binge-eating, orthorexia and other unhealthy eating patterns. Contact her here.

When Recovery Is One More Way to Beat Yourself Up

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Most people with eating disorders struggle with perfectionism… and that certainly includes how they approach the recovery process. Is that you? Do you hold perfectionist standards for what recovery should look like and how long it should last? These standards are based less on the reality of recovery and more on the unhealthy expectations of yourself that contributed to the eating disorder in the first place. There is no room for error, little compassion for oneself, and the notion that recovery should be relatively quick once the decision is made to get better.

But dear one, that approach to recovery will leave you feeling like a failure because unrealistic expectations are always a set-up for failure. Recovery is worth it, yes, but no doubt about it, it is also messy and hard. And it always takes longer than we want it to. Going into the process accepting these things can help you avoid feeling discouraged or giving up entirely. So let’s create some new rules for recovery that are more compassionate, realistic, and ultimately, helpful. Here were my 5 rules for recovery when I was in it. I’ve seen clients come up with some amazing others. Make your own list and read them whenever you’re feeling frustrated with yourself about recovery.

My 5 Rules of Eating Disorder Recovery

1) I will not rush recovery. I will give myself whatever time I need to heal properly and wholly. And I will not be angry with myself for how long it takes.

2) I will not expect healing to be a straight path. There are going to be bad days and setbacks and temptations to give up. But I will keep going and will not let recovery be just one more area in my life where I demand perfection from myself.

3) I will not make excuses; I will take responsibility for my thoughts, feelings, and behaviors.

4) I will say my affirmations out loud every day, even if I don’t believe them. Even if it feels stupid or weird.

5) I will not listen to the inner terrorist, and I will challenge her lies with Truth.

I’d love to hear some of the ones you’d put on your list!

Much love,
Cherie Signature

About Cherie Miller @ Dare 2 Hope
Cherie Miller, MS, LPC opened Dare 2 Hope Counseling to help clients all over the country get free from their food, weight, and self-confidence struggles. Her specialty is eating disorders, including anorexia, bulimia, binge-eating, orthorexia and other unhealthy eating patterns. Contact her here.

How to Love a Porcupine

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At an eating disorder support group I led recently, a mom said the one “gift” her daughter could give her was to try and recover from her anorexia. She was struggling with understanding how her daughter could see the damage her eating disorder was doing to their family and still refuse to even try recovery. Without saying these exact words, I believe her feelings were akin to, “If you loved me, you would stop.”

Anyone who has been in a relationship with someone with an eating disorder or substance addiction can probably relate to that. In your head, you might know it has nothing to do with you, but it feels like it does. And often, when you push people to get better before they are ready, they will act in pretty unloving ways to defend themselves. It can be be like trying to hug a porcupine…the more you try to help, the more you get hurt. This frustrating cycle usually leads to feelings of resentment and maybe even pretty strong anger—on both sides.  So how do you get out of the cycle without giving up on the other person? Here are some tips on how to love a porcupine (i.e. someone not ready to recover).

#1. Realize how difficult it is to even choose recovery, much less walk through it. Another girl in the group who has an eating disorder told that mom that her own mother had expressed similar things to her in the past before she started into recovery. “I love my mom so much. I felt like I would do anything for her… but she was literally asking me to do the one thing I couldn’t do at the time.” This brave young woman went on to explain that the fear was overwhelming, even to the point of overwhelming her love for others. “I was absolutely terrified at the thought of treatment and gaining weight.”

#2. Be a learner. Unless you have an eating disorder, you can never fully understand what it is like to have one, but you can educate yourself to become more sensitive and knowledgeable. There are a lot of books on the subject (see recommended reading at the end), online resources like NEDA and ANAD, and possibly some support groups local to you. If your loved one is willing to share about their experience, that is of course, an ideal place to learn. Eating disorders by nature tend to be surrounded by secrecy and shame, but there are things you can to make it more or less likely he or she will open up. Which leads to #3…

#3. Work on being a safe person. As you learn more about eating disorders, you’ll be more attune to things that could be detrimental for your loved one. Even with the best of intentions, people often say or suggest things that are triggering or insulting. Oversimplifying their struggles by telling them to just eat or to just stop throwing up, assuring them they look great, or suggesting diet plans are examples of common but counter-productive attempts to help.

In general, taking a non-judgmental approach that doesn’t shame, scold, or criticize the other person is more likely to foster open communication. Assure him or her that you want to understand better than you do now and that you’re ready to listen… and then really listen. At times, it will be appropriate to encourage them to get help, but if you jump to that too quickly, the other person is more often than not going to feel misunderstood. Check out this article from NEDA for more detailed tips on talking to a loved one about his or her eating disorder.

#4. Draw appropriate boundaries. This is a tricky one that could probably be its own blog post. Basically, you have to figure out where the line is between supporting someone and not trying to control them. Trying to control others doesn’t usually work and can even make them more resistant to change (thanks to that rebellious nature in all of us). For example, unless they’ve asked you to provide some accountability, comments about what they are or are not eating will likely backfire. Pushing someone to recover before they’re ready usually means recovery won’t be successful, even if they appear to be going through the motions. The person’s own motivation is key.

There are some exceptions to these principles. One is in cases where the eating disorder is so severe that medical care is necessary and then yes, intervention could mean life or death. If you’re not sure whether you’re in such a situation, talk to a medical doctor or therapist who is familiar with eating disorders.

The other exception is if you are the parent of a child or teenager. Naturally, your boundaries with that person are already different because they are under your care and you are responsible for their physical and emotional well-being. In that case, I believe forcing a child into treatment might make sense. But keep in mind the same caveat about personal motivation applies… recovery won’t happen until that person, regardless of age, decides for themselves to really try.

Following all these steps won’t guarantee you don’t get “poked” while trying to help. Believe it or not, people with eating disorders feel like they have a lot of reasons to stay sick and the thought of recovery can be, as that young woman said, absolutely terrifying. The fear and shame that accompany eating disorders make recovery hard to consider. Take care of yourself and resist the temptation to take on “fixing” them. Offer patience, support, and honesty, and by all means, seek out help and support for yourself! It’s not easy to love a porcupine.

Much love,
Cherie Signature

Recommended Reading:

Brave Girl Eating

Surviving an Eating Disorder: Strategies for Family and Friends

Life Without Ed

About Cherie Miller @ Dare 2 Hope
Cherie Miller, MS, LPC opened Dare 2 Hope Counseling to help clients all over the country get free from their food, weight, and self-confidence struggles. Her specialty is eating disorders, including anorexia, bulimia, binge-eating, orthorexia and other unhealthy eating patterns. Contact her here.