Last week, the American Medical Association released a policy statement about Photoshopping models and eating disorder prevention.

The statement:

Advertisers commonly alter photographs to enhance the appearance of models' bodies, and such alterations can contribute to unrealistic expectations of appropriate body image – especially among impressionable children and adolescents. A large body of literature links exposure to media-propagated images of unrealistic body image to eating disorders and other child and adolescent health problems.


The AMA adopted new policy to encourage advertising associations to work with public and private sector organizations concerned with child and adolescent health to develop guidelines for advertisements, especially those appearing in teen-oriented publications, that would discourage the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image.


"The appearance of advertisements with extremely altered models can create unrealistic expectations of appropriate body image. In one image, a model's waist was slimmed so severely, her head appeared to be wider than her waist," said Dr. McAneny. "We must stop exposing impressionable children and teenagers to advertisements portraying models with body types only attainable with the help of photo editing software."

And if the AMA had left out the mention of "eating disorders" at the end of the first paragraph, I wouldn't have had anything to say except to nod my head in agreement.  Because the alteration of images is appalling and imappropriate and, indeed, harmful.  The problem is the link to eating disorders.  The AMA said there was a "large body of research" linking media exposure to eating disorders.

So I went looking to see if I could find this large body of research.  I went to PubMed and searched for "eating disorders media" and indeed, I pulled up 264 studies on the subject.  But if you read the studies more closely, you'll see that there's lots of links between "disordered eating" and "eating pathology" and "body image dissatisfaction" and media exposure, but there's very little mention of linkage to outright, diagnosable eating disorders as spelled out by the DSM-IV.  One study did actually say that "media contributes to the development of eating disorders," but when I looked at the studies cited, all I saw were examples that linked media exposure to disordered eating.

A lot of the media coverage of the story has said that Photoshopped images "promote anorexia."  I'm not entirely sure I understand what that means.  I think I know what they're getting at--that looking at these images make you more likely to develop anorexia--but there's no actual evidence that this is true (at least, none that I could find).  We don't think ads for disinfectant somehow promote OCD.  We also don't think that those Bluetooth headsets promote schizophrenia because it looks like you're talking to yourself.

I think the big difference is that people don't think they know what it's like to have schizophrenia because they've been paranoid at one time or another, or that they've had a rather animated conversation with themselves.  But people do think they know what it's like to have an eating disorder because they've dieted and asked their husbands if these jeans make their butts look big. 

It's a common mistake, confusing disordered eating and eating disorders.  Many men and women are unhappy with their bodies and are on a diet.  People with eating disorders also often express extreme body dysmorphia and restrict their food intake.  They do look alike on the outside, but the internal experience is very different.  Dr. Sarah Ravin summarizes the difference between disordered eating and eating disorders as follows:

Disordered eating is very widespread in our country, especially among women. I define disordered eating as a persistent pattern of unhealthy or overly rigid eating behavior – chronic dieting, yo-yo dieting, binge-restrict cycles, eliminating essential nutrients such as fat or carbohydrates, obsession with organic or “healthy” eating – coupled with a preoccupation with food, weight, or body shape.


By this definition, I think well over half of the women in America (and many men as well) are disordered eaters.


The way I see it, disordered eating “comes from the outside” whereas eating disorders “come from the inside.” What I mean is this: environment plays a huge role in the onset of disordered eating, such that the majority of people who live in our disordered culture (where thinness is overvalued, dieting is the norm, portion sizes are huge, etc) will develop some degree of disordered eating, regardless of their underlying biology or psychopathology.


In contrast, the development of an eating disorder is influenced very heavily by genetics, neurobiology, individual personality traits, and co-morbid disorders. Environment clearly plays a role in the development of eating disorders, but environment alone is not sufficient to cause them. The majority of American women will develop disordered eating at some point, but less than 1% will fall into anorexia nervosa and 3% into bulimia nervosa.

I think it's great that the AMA is trying to protect children and adolescents from companies that would turn actual women into bobblehead models (the woman in the Ralph Lauren ad looks a bit like a bobblehead since her head is so disproportionately large compared to her body).  Our ideas of what "normal" and "healthy" look like are disorted and it is harmful.  On that subject, the research is clear.

It seems odd, doesn't it.  Medication has side effects--lots of them, in fact.  You can hear them rattled off in the same droning-yet-chipper voice in every pharmaceutical commercial on the air.  But therapy?  How can therapy have side effects?

Time Magazine had a follow-up to a story about a family in Michigan who used a controversial therapy to help treat their autistic children.  And that's when everything unraveled.  The story itself is sad and even frightening, but that's not the point of the blog.  What struck me was a paragraph at the very end:

We don't often consider the "side effects" of nondrug therapies. But the Free Press series shows just how harmful it can be to buy into a technique or therapy that offers nothing but hope. Many things that help can also harm, which is why we need sound science before any new technique is widely adopted — let alone used as evidence in custody or criminal cases.

It struck me that some ED therapies are the same way: they offer hope, perhaps, but no solid results to back up their efficacy.  And that any treatment can have side effects, even if it's not in pill form. 

Eating can be extremely anxiety-provoking for those with EDs, and that anxiety can be expressed in panic attacks, defiance, self-harm, temper tantrums, and more.  But eating can also be thought of as "therapy" for eating disorders, as a type of exposure and response prevention.  The anxiety is a side effect, and sufferers and families should be warned and prepared for this.

The autism story is also a case study in the fact that therapy can, in fact, actually be harmful to patients and families.  Recently, Becky Henry wrote about how parent-blaming in traditional eating disorder treatment tore her family apart. I know lots of examples of lives stunted or lost, of families wrecked because of ineffective and inappropriate treatment.  Going to therapy isn't something we can think, "Well, it can't hurt, can it?"

Actually, yes. It can. 

Therapists and families need to do their homework before just signing up for weekly psychotherapy to make sure that the therapy's benefits outweigh any potential side effects, and that there's good evidence to show that it will help rather than harm.

It's once again time for your weekly Sunday Smorgasbord, where I trawl the web for the latest in ED-related news, research, and more, so you don't have to.

Eating Disorder Recovery: Courage In The Everyday.

Cognitive flexibility and clinical severity in eating disorders.

Teens & Stress: for moody teens, its all in the head.

Suicide attempts in anorexia nervosa subtypes.

The benefits and risks of online therapy.

One of the reasons why relapse is so common: Our brains can't ignore 'rewarding' objects.

Psychosocial Correlates of Shape and Weight Concerns in Overweight Pre-Adolescents.

DBT developer Marsha Linehan talks about her own experiences overcoming suicidality.

E-health for individualized prevention of eating disorders.

Anorexia: How 15-year-old Sophie fought and won her battle.

Virtual reality exposure in patients with eating disorders: influence of symptom severity and presence.

Stanford program takes aim at eating disorders.

Adolescents' dieting and disordered eating behaviors continue into young adulthood. Interestingly (though not surprisingly) most media outlets said the study looked at eating disorders, not disordered eating. There is a difference, people.

Estrogen replacement increases bone density in adolescent girls with anorexia nervosa.

Last night, my parents and I went to one of those summer outdoor movie things. The festivities started around dinnertime, and there was catering by a local restaurant. We'd eaten there before and found the food okay but kind of pricey. So we opted for subs instead.

We stopped on our way to the movie, and my mom and I split a gigantic sub (lest anyone worry it wasn't enough, we also brought other snacks to eat). My dad ordered after us, and so he picked out his toppings last as well. Which is when things got interesting. He asked if he ciuld put bacon on his sub; indeed he could.

Then he said (almost to himself): Yeah, bacon. Bacon sounds really good.

Which is when it hit me: that's not at all how I thought about my toppings. It wasn't about taste, not really. It was about adding stuff that wouldn't jack up the calorie count. The idea of ordering just what tastes good is pretty foreign to me anymore. And the idea of adding bacon--bacon!--just because it sounded good was a concept that seemed like it was from another planet.

It's sad to realize just how long I've lived and thought this way. It doesn't even occur to me to ask myself what I like. I just try and find something that's safe and that I won't hate. On the one hand, I know this will be something to work on in recovery. On the other hand, if I can't even figure out what I like, then how am I even going to start on this?

I guess if you asked my dad, he would find my way of ordering off a menu just as baffling. Why not order what you like? Because it's scary. Because what if I start eating and don't stop? If I'm not eating something I really like, I'm much less likely to eat more than I "should."

The obvious answer is to drop the food rules about what I should or shouldn't eat, or how much of it. My problem is that it seems normal now. My default is ordering low-cal. I don't want to deal with the anxiety pushback. I just want to be normal...

One of the things I'm struggling with a bit right now is balancing how far I've come with how far I still need to go.  Thinking about how much more work still needs to be done is rather overwhelming--but that doesn't change the fact that it's ultimately still rather necessary.

I read an interesting blog post on Psychology Today titled How to Become a Great Finisher.

Some interesting bits of the post:

Koo and Fishbach's studies consistently show that when we are pursuing a goal and consider how far we've already come, we feel a premature sense of accomplishment and begin to slack off. For instance, in one study, college students studying for an exam in an important course were significantly more motivated to study after being told that they had 52% of the material left to cover, compared to being told that they had already completed 48%.


When we focus on progress made, we're also more likely to try to achieve a sense of "balance" by making progress on other important goals. This is classic Good Starter behavior - lots of pots on the stove, but nothing is ever ready to eat.


If, instead, we focus on how far we have left to go (to-go thinking), motivation is not only sustained, it's heightened. Fundamentally, this has to do with the way our brains are wired. We are tuned in (below our awareness) to the presence of a discrepancy between where we are now and where we want to be. When your brain detects a discrepancy, it reacts by throwing resources at it: attention, effort, deeper processing of information, and willpower.


In fact, it's the discrepancy that signals that an action is needed - to-date thinking masks that signal. You might feel good about the ground you've covered, but you probably won't cover much more.

I don't think the author is saying that a feeling of accomplishment is bad, but it can be premature. I've met many people who tell me how much more they're eating than before, or how much less they're purging. Which is all well and good (it really is), but when you're still regularly undereating or purging or engaging in any other ED behavior, there's still a massive problem. Yes, you've made progress and give yourself a pat on the back, but (and this is the hard part) don't stop there!

When you're doing something as intense and lengthy and grueling as ED recovery, it's easy to want a break and get complacent.  Taking a little time to breathe and regroup is one thing (my friend Charlotte reminds me, and everyone else, to breathe regularly); but you also can't stop forging ahead. 

A metaphor I love came from the preface to Laura Collins' Eating With Your Anorexic. Psychologist James Lock writes that recovery is like climbing a sand hill: if you stop, or don't get all the way to the top, then you'll slide back down to the bottom.  Although acknowledging how much progress you've made is wonderful, it's also important to consider what's still left to be done.

That's where it gets tricky.  I compare how I'm doing in recovery now to when I was at my sickest, and I just want to say "But look at how much work I've done! Look at how much better I'm doing! Can't I just stop here?"  The problem is that stopping "here" ultimately means a slide backward, and beginning that slog all over again. 

Like so many things in recovery, the answer isn't an either/or question.  It's figuring out to celebrate progress made while balancing that with continuing forward motion.  That being said, I can barely figure out how to walk and chew gum, so we'll see how this multitasking goes...

Check out my new Body of Evidence post:

When exercise becomes dangerous.

There's also a list with signs and symptoms of exercise addiction for you to use.

Enjoy!

I finally feel I have a moment to breathe.  I've been so busy the past few weeks that I really haven't gotten to just sit back and take a breath.  The upside is that I really do love my job, and so extra work isn't always a bad thing.  But I've been generally feeling stressed and utterly exhausted.  I usually wake up in the morning and feel ready to head right back to bed.

The ongoing insomnia isn't helping anything, either.

Still, I'm exhausted. 

I know I need to regroup for a bit, in order to face the next round of work, and the next round of recovery work.  I've written before that my work is a huge motivator for me in recovery.  For one, it gives my brain something to think about besides weight and calories.  And my identity is very tied up in what I do, so it gives me something positive with which to affiliate myself.

Because of this, and the fact that I work from home, makes it very easy to overwork myself.  Overwork isn't really any better than overexercise, and I'm psychologically and behaviorally prone to both. The other factor is financial--I had a couple of slow months earlier this year, and I can't afford more of that.  So I have anxiety driving me both to keep up financially and also to prove myself as a legitimate science writer.

I have plenty I need to do tomorrow, but I am also making a conscious effort not to overdo it.  To relax with TV show reruns in the evening and crochet, or read, or play with my cat.

So, yes.  Breathing.  Breathing is good.  I can't work if I burn out, and so working less now will let me do more later.

At least, that's what I'm telling myself.

Pulling myself out of this slip has been exhausting.  It's gotten harder over the past week or two, not because anything has necessarily changed, but because I'm getting burned out.  On the one hand, I can feel the subtle shifts happening; on the other hand, it's just the same old, same old.  It's one thing to push yourself to eat more for a short period because it's time-limited.  Eventually, the hell will be over.

I thought I would pull out of the slip much faster than I did.  Perhaps I misjudged exactly how many difficulties I was having. The other factor is that weight gain is going much more slowly even on more calories.  My life feels like a never ending assembly line of meal-snack-meal-snack-meal-snack.  Seriously?  Shoveling in this much food every day is exhausting.  Like I said, there has been progress, but there haven't been signs that the daily shit-ton of food is going to decrease anytime soon.

I had a bit of a meltdown about it the other day.  I was tired of all of the recovery work, tired of the food, tired of always feeling like the sick person.  I was about ready to throw in the towel.  But my therapist had reminded me of something: last week we had talked (briefly) that if I continued to progress weight- and behavior-wise, then we could talk about reintroducing some mild activity.

Apparently I have progressed, and now I am officially off exercise restrictions.  I get a few short walks during the week at this point.  The idea is to move up slowly so I don't just plunge back in head first and everything goes to pot. 

This event greatly improved my mood, and not primarily from the OMG--I can go back to exercise now! standpoint.  It was also that, for the first time, I could see the light at the end of the tunnel.  I don't know when it will be, but sometime soon I can transition from refeeding mode back to recovery mode.

It's been hard, too, because I generally don't get much feedback on how I'm doing.  I would know if I lost weight, and I don't really like being patted on the back for gaining, either.  It makes me feel horribly guilty.  So it was hard for me to judge exactly where I was along the path, which only added to my frustrations.  I don't want or need to be praised for every bite, but a little feedback would have been helpful.

There's still tons of work to be done, even when this phase is over.  I know that getting back to where I was still doesn't make me where I ultimately need to be in recovery.  For now, though, I'll take what I can get.

It's once again time for your weekly Sunday Smorgasbord, where I trawl the web for the latest in ED-related news, research, and more, so you don't have to.
Living in Australia and want to participate in treatment/research studies? Look no further.

Eating disorders treatment in men.

Ghrelin, appetite and gastric electrical stimulation.

"Recovery isn't just something you talk about, it's something you actively do."

Refeeding in anorexia nervosa: increased safety and efficiency through understanding the pathophysiology of protein calorie malnutrition.

Pregnancy-related depression linked to eating disorders and abuse histories.

Redefining phenotypes in eating disorders based on personality: A latent profile analysis. {{If someone has a copy of the actual study, I would greatly appreciate if you could email it to me at carrie@edbites.com}}

Brain’s hot mess center discovered. I think my "hot mess center" is very active!

A placebo-controlled pilot study of adjunctive olanzapine for adolescents with anorexia nervosa.

Branding Asperger's So It Evokes Real People, Not Just Rain Man.

An fMRI Study of Self-Regulatory Control and Conflict Resolution in Adolescents With Bulimia Nervosa.

Flocking to the Familiar under Stress.

Serotonin transporter binding after recovery from bulimia nervosa.

We must ask WHY having ED would be considered emasculating – what traits of manhood are necessarily being compromised?

An exploration of the tripartite influence model of body dissatisfaction and disordered eating among Australian and French college women.

Eating disorders and weight loss surgery.

Associations between body checking and disordered eating behaviors in nonclinical women.

Parents of Eating Disorder Patients Look to Past Autism Activism for Inspiration.

Survey on eating disorders related thoughts, behaviors and dietary intake in female junior high school students in Taiwan.

Body image problems? Purge your closet.

Death in the Pot: The poisonous history of food.

After a long, busy, and rather stressful day yesterday, I settled down to (yet another) House rerun.  This episode (Season 7, Episode 12) wasn't necessarily one of my favorites, but as I watched, I realized that it does contain one of my favorite scenes.

The setup (briefly): the patient of the week is a waitress (Nadia) with a perfect memory, and House's team of doctors are trying to figure out if and how this fits in with her other symptoms. They eventually diagnose her with perfect memory as a form of OCD secondary to a genetic condition.  Right after they give her the diagnosis, one of the doctors (Chase) goes in to talk to her.  The following dialogue ensues:

Chase: You said you didn't have a choice to be the way you are. Now you do. [He pulls out a small bottle of SSRIs.] They've been effective in treating OCD.
Nadia: You mean, lose my memory?
Chase: Not entirely; it would just be more like everybody else's.
Nadia: My memory is the only thing that has ever made me special.
Chase: If you want to be special then it means being alone. [He leaves the pills on her tray and walks out.]

It's a feeling I know all too well--realizing that thing you felt made you special was both an illness and wrecking the rest of my life. This realization was rather sobering.

When I'm in the midst of the eating disorder, it's all too easy to forget that starving isn't a sign that I'm really special. It's just a sign that I'm sick.  Only I didn't always understand this. After all, one of the most maddening and frustrating symptoms of anorexia is the fact that when you're in the midst of it, it's even harder to understand that this "specialness" you feel--the only thing you can find to be proud of, the only way you know to make sense of the world--isn't really all that special.  It's the byproduct of a diagnosis.

Having that "one special thing" pulled out from under me shook me to the core.  Then, of course, I told myself that, diagnosis be damned, my ED behaviors made me special.  After all, click on any "health" section and you will be inundated with stories about how to lose weight.  I was good at eating less and exercising more, and the precise reason why didn't matter all that much.

Except that hiding behind a diagnosis is no way to live a life. You'd think it would be a fairly easy, straightforward decision: life without anorexia and a chance at happiness and relationships OR anorexia, loneliness, and death.   But the illusion of specialness is a powerful thing. If I wasn't starving myself, then what? I felt that I would be nothing, a nobody. Even as the disease wrecked everything in my life, I hesitated to make meaningful changes because I feared what would happen to me without the only thing I thought made me special.

I'm still trying to figure that out.

Ernest Hemingway was rumored to have been challenged to write a story in just six words. His masterpiece?

For sale, baby shoes, never worn.

(Snopes.com raises some doubts as to how true this story was, but it's still a haunting piece.)

This story and the whole six word autobiography craze got me thinking about whether we could put together some good six word recovery stories.

A few of mine:

Start eating, keep eating, never stop.

But it is about the food.

Fall down? Get right back up.

Your task, dear readers, is to share your own six word recovery story. Ideally, I will include them in my book and share a compilation of all them on the blog.

So what are you waiting for? Start sharing!

I was watching reruns of House the other day, when this little snippet of dialogue caught my attention:

Emotionally, you may be you want to run away. But in my experience, if you're staring at a pitbull in some guy's backyard, you're better off staying right where you are. Face the problem. That way, it can't bite you in the ass.

I generally try to run away from my problems.  You could look at my exercise issues as a literal attempt at that.  I've been known to deal with upticks in ED thoughts and behaviors by simply hoping they'll go away.  They didn't.  The hilarious part is that is that is really shocks me when that doesn't work.

The quote really reminded me of what recovery is about: learning how to face those pitbulls head-on. The ED allowed me to mentally run away from all of the crap in my life that I just didn't want to deal with.  Much of it was related to anxiety and depression, but plenty of it was just life.  I kept running away and kept getting bit in the ass.  My solution wasn't to turn around and face it, but to try and run even faster.

Again, it didn't work.  Again, I was shocked.

Avoidance is (in my opinion) one of the key ways an ED "works" in our lives.  By channeling all of our energies into our disorder, life starts to melt away.  Everything becomes about finding food or avoiding food or throwing up that food, and the other stresses seem less...stressful.  Because they're secondary.  All of this other crap in our lives are the pitbulls in the quote.  We run away.  They bite us in the ass.  The more we run, the bigger their teeth get.

Not to mention that the ED itself creates its own pitbulls.  I found myself falling further and further into the ED in order to avoid the pile of crap that the ED itself was creating.  It seemed much easier to avoid it with ED behaviors than it did to face the mess of my life and start cleaning up.

Avoidance of anxiety-provoking things brings short-term relief because we're avoiding the anxiety.  Duh.  But the anxiety continues to build and the urge to avoid grows higher and higher.  Facing the anxiety (returning that phone call, accepting your role in a negative situation, eating those scary foods) is harder, short-term.  I also know that I'll feel better knowing I've tackled whatever it is, and not having the task sitting over my head.

One of the hardest parts of recovery is stepping away from the running away.  Between the anorexia and the OCD, I don't remember a time when I didn't avoid life with any number of rituals and avoidance techniques.  So it's all very new to me.  And it's hard.  Really hard.  Avoidance is engrained, and so are the fears of dealing with real-life stuff.  The irony is that, anxiety aside, I'm no scaredy cat.  I like a challenge.  So there's nothing else to say but: bring it.

I spent the last few days visiting my relatives in a different state. Aside from the fact that they're generally completely barmy, I survived the visit.  As my parents and I were driving home this morning, my dad was programming the GPS to bring us back home. It should have been relatively straightforward--after all, we knew where home was, and all we needed to do was actually get there.

The problems started when all three of the route options sent us straight through Washington DC at rush hour.  If you've never had to navigate DC traffic during rush hour, let me summarize the basic idea: avoid it at all costs.  So how to get around DC?  We knew there was a way around, but what exactly was that route and how did we get there?

In the end, my dad and I figured out a compromise: we'd follow the GPS for a bit and then pull over and try and figure out an alternate way around DC.  Which worked--kind of.  Until we lost the road that we were supposed to be following and we start driving through the backroads of Maryland and Virginia.  Okay, not so much.  From passing the freeway exit countless times, I knew of a road that was larger (and less nausea-inducing) than the one we were on, and one of the towns where it passed through.  So we plugged the town in, and ultimately found our road.

Except that this post isn't about how to use GPS in all sorts of strange ways the directions really didn't tell you about.  It's sort of about recovery.  As we were figuring out our directions, I was thinking that many times in recovery, I had therapists and guidebooks telling me where I needed to go.  Most of the time, they pointed me in the right directions.  But it's easy to find roads on maps; it's another when you know about traffic patterns, possible construction, and other conditions.

There will probably be a time in your recovery (there was in mine) when the conventional wisdom doesn't quite seem to fit your circumstances.  When life throws you a detour and there's not a damn thing you can do about it.  For me, the biggest disruption was recovery itself.  I had to step off the career path I had mapped out from when I was in middle school because the ED was getting in the way, and I was no longer sure that I wanted what I thought I wanted.  Most GPS systems can handle minor detours and help you get back on track. But it's less helpful with major detours, when all of the directions you had are temporarily less than useful. 

This is when you flip off the GPS and its directions for "home" several hundred miles away.  You're still headed home, of course, towards recovery and life and happiness, but by a different route.  Instead of tackling that entire route, you just take the next fifty or so miles.  Get me to a place that's marginally closer to where I want to be so I can re-evaluate the best route.  Then you keep doing this, over and over and over.

I didn't just wake up and "decide" I wanted to be a writer.  It was a slow series of decision, each of which led me closer and closer to the career I wanted.  With recovery, I intended to bull on through, except that I kept running into detours and roadblocks.  I had to get used to that quasi-human voice saying, so maddeningly patiently, "Recalculating..."

I'm not saying to buck your therapist's advice because it's inconvenient.  It's not about finding ineffective (but less painful) ways of getting to where you want to go.  It's about taking life one turn, one road, one decision at a time.  I always thought that doing this would mean I would forget where I was headed.  Not all decisions would bring me closer to my career goals, which might mean that I find myself the opposite of where I wanted to be.  But it's not an either/or thing.

I never really thought about this until I literally had to switch off the GPS and focus on getting to where I needed to be by the best way I knew.  It meant some detours and a lot of motion sickness, but we also avoided the nasty traffic and arrived home at a decent time.

It's once again time for your weekly Sunday Smorgasbord, where I trawl the web for the latest in ED-related news, research, and more, so you don't have to.

The benefits and risks of online therapy.

The link between body weight and income.

Can dieting ruin a marriage? The first entry in a new blog by a "folklorist of fat."

Challenging perfectionism and winning in recovery.

Developing brains and eating disorder susceptibility.

Robot being programmed to make chocolate chip cookies from scratch.

New York State might require mandatory training in eating disorders for all physicians. It's a good thing, but I'm really curious to learn what that training would actually teach them.

NHS plans new eating disorder unit for Scotland.

One in ten children and teens with OCD will develop an eating disorder.

The genetic mutations that can lead to autism spectrum disorders in boys may lead to EDs in girls. The jury is still out, but it's fascinating research.

More and more college cafeterias post nutrition information. File under: why I'm really glad I'm not an undergrad these days. Most of the studies say that this information really doesn't change people's eating habits, so why do we persist? Sigh...

Women binge eaters most likely to eat evening snacks, least likely to eat breakfast.

Brain tissue volume changes following weight gain in adults with anorexia nervosa.

Psychobiology of borderline personality traits related to subtypes of eating disorders.

Objective and subjective binge eating in underweight eating disorders.

Patterns of pregnancy weight gain in women with eating disorders.

Associations between body checking and disordered eating behaviors in nonclinical women.

Serotonin receptor moderates the relation between changes in depressive and bulimic symptoms in adolescent girls.

Thom Rutledge (the co-author of Jenni Schaefer's "Life Without Ed") has some classic bits of wisdom on his Facebook page that he calls "Thom's Nutshells." I was browsing through them just now and came across this gem that really resonated:

You can give up control of your life but still stay in charge of it.  Like the t-shirt says: shit happens.  Benjamin Franklin said the only two certainties in life were death and taxes; he should have added crappy events, too.  But letting go of control and accepting that shit does, indeed, happen, doesn't mean that you just sit back and be passive.  You can still be in charge of how you respond to all the shit that will inevitably happen.

{{This post has made me wonder whether I really should have dropped my philosophy class in college. Though a large motivation was the fact that the professor reminded me of Shaggy from Scooby-Doo, and I couldn't look at him without snorting or giggling. Neither of which would have boded well for my grade.}}

One of the most annoying parts of regaining lost pounds (even just a few!) is the hypermetabolism and accompanying hot flashes. I feel like a woman in menopause.

I've come to find the hot flashes appear on a regular schedule.  I eat, and then...wait for it...wait for it...I suddenly want to find an ice bath.  They only come after eating, usually within 15 or 20 minutes.  My therapist tells me it's a good sign, that my body is frantically burning up all of the calories (errr, nutrition) to repair itself. Personally, I just think it's the weight gluing itself to my ass really, really fast.

Which might be true, but it's annoying and frustrating to deal with several times a day.  I wish it would just stop.

And I'm kicking myself because I should have known better than to let the ED back in, even just a bit.  That I shouldn't have been this stupid.

I know that hot flashes will eventually pass.  That my body will adjust.  That (gulp) the pounds will go on, and the return to homeostasis is one of the benefits to weight gain/health/whatever positive spin you want to put on it.

I was reading one of Grey Thinking's posts from around Memorial Day (you don't want to see the number of unread items that are in my Google Reader right now), and she said this:

I think this is a huge roadblock for many people in recovery — having a lot of insight and knowing what they need to do, but not being able to do it and make changes (or not really wanting to).

It was certainly a massive roadblock for me.  Insight into the "whys" of an eating disorder was seen as my ticket out of my disorder.  Maybe if I uncovered the family dysfunction.  Or the ways in which I felt out of control.  Or could understand why I felt the need to be thin. My insight into insight is this: it's a little a lot overrated.

I knew I was a perfectionist and a control freak--in fact, I frequently thought I wasn't good enough to be considered a legitimate example of either of them.  And there was family stuff, sure.  Who doesn't have family stuff?  I'd always had body dysmorphia.  I didn't know it was body dysmorphia, of course, but there was that, too. Insight really wasn't my problem.  Many of the young adults I met in treatment had some amount of insight--and yet there they were, back in treatment.  Just like me. 

I'm not convinced that having insight into what caused your eating disorder will get you well. But insight is still important to recovery.

So what in the hell do I mean by that?

An eating disorder is hard to understand while you're actually in it.  It seems obvious and sensible at the time, but when you look back, you sort of scratch your head.  So having insight into why you're acting so weird only works if you know you're acting weird. As well, the strength of the insight that promotes change has to be greater than the anxiety (or whatever awful feeling you happen to experience) that will happen as a result of that change.  Let me tell you--insight is very vague and ephemeral. Anxiety provokes action. Anxiety wins every time.

For me, insight into my illness's origins hasn't been the most useful thing to get me on the road to recovery.  As for keeping me on the road to recovery, that's a different story.

Here's the thing: insight comes in many different flavors.  Thus far, I've talked about the "why" flavor--why did I get sick, what caused this, etc.  The insight that has been useful to me is of the "now what" flavor--what I need to do in order to stay well, what my triggers and weaknesses are, what to do if/when I start to struggle.  It's still insight, but it's a different variety, and I use it totally differently.

For one thing, this type of insight is being used by a brain that is at least on its way back to normal functioning.  For another, there's not quite the uphill battle.  It's more of a let's-keep-this-rock-from-rolling-back-downhill kind of effort.  Okay, yes, you're still fighting gravity, but at least you don't have to get the boulder moving.

To take a line from Forest Gump, insight is as insight does.  To take Grey Thinking's tagline, "Becoming aware of your crap and actually overcoming your crap are two different things."

It's once again time for your weekly Sunday Smorgasbord, where I trawl the web for the latest in ED-related news, research, and more, so you don't have to.

Cosmic cookery: How religious groups helped launch the health-food movement.

Recovering From An Eating Disorder In Today's Weight-Centric Society.

How the Mind Reveals Itself in Everyday Activities.

Family Based Therapy for anorexia: excellent outcomes.

Testing a cognitive model of generalized anxiety disorder in the eating disorders.

When a Child’s Anxieties Need Sorting.

Hypomania across the binge eating spectrum.

Heavy in School, Burdened for Life.

Emotional eating in anorexia nervosa and bulimia nervosa.

Bye, Bye Food Pyramid. Hello, "My Plate".

Public competition to come up with new nutrition label design. I like what the first commenter says: "“DANGER – Package contains food. May be tasty. Be afraid, be very afraid.” Maybe include an image of a scowling old woman wagging her finger."

Tactile body image disturbance in anorexia nervosa.

For people who consider size acceptance dangerous.

No matter what a food contains, if the package says 'diet,' it won't make you full.

10 Steps To Conquering Perfectionism.

Why You Need to Take an EDNOS Diagnosis Seriously. The first sentence made me cringe, but the rest of the article was pretty good. It's a subject that needs a LOT more attention.

Eating Fat, Staying Lean.

How starvation makes you "food crazy."

Estrogen replacement drug improves bone density in anorexia patients.

For much of the past few weeks, my long hours working were because I was desperately in search of a story assignment.  This past week, I actually had said story assignments and now I'm busy completing those stories and sending out feelers for future stories.

Same long hours, only I'm actually getting paid.

I feel this is a good thing.

The real benefit (besides the paycheck, that is) is that all of this work keeps me somewhat distracted from the fact that I feel like a cargo ship.  Even when I can't forget about my ocean liner status, my work reminds me that I can still be a successful person even if I put on weight, or even if I'm not exercising and eating heaps more than the average person.

My work gives me a sense of purpose that not much else does.  I like what I do, and I find it more rewarding (long-term) than the eating disorder. Not letting myself get too sick to work is a huge motivator for me.  The drive I had for all those years to lose the most weight is still there.  I'm just trying to reign it in a bit and redirect it into something more positive.

Of course, this drive still has many of the same pitfalls as when I was anorexic.  I never feel good enough.  I always feel the need to be doing more.  I worry that I won't be successful.  I have that constant refrain in my head: "I suck, I suck, I suck."  It's very easy to throw myself into my career to avoid these anxiety-provoking thoughts in the same way I did with the eating disorder.  I realize I can very well transfer one bad "habit" for another.

It is a risk.  On the other hand, when I can quiet the cacophony in my head, I also find my work engaging and fun.  I am driven to write well, but I rarely feel driven to write, period.  That's something I want to do. 

My career won't cure my eating disorder, but staying busy with, well, life is a big help.

I've mentioned before how much I love to crochet.  Yarn is some of my most serious therapy.  The rhythm of the work, and the joy of making something with my hands is just incredibly soothing.  I try to do it every day, although I'm not always successful.

I realized earlier today that I've never shared pictures of some of my projects.  My most recent one is an afghan for my parents for Mother's and Father's Days.  I started it in early March, although I worked on several other projects in the meantime.  I'm now almost finished--I just have to finish the trim around the edge and then I'm finally (!) done.

I first learned how to crochet when I was in residential treatment.  We were stuck inside one day, and I was bored out of my mind.  I knew the basics of knitting, but nothing of crochet.  So my friend E taught me the basics.  I could never master anything more than the basic knit stitch, no matter how hard I tried. Nor was manipulating two needles that easy for me.  But I took off with crochet.  It's just wrapping yarn around a stick.  All you have to do to make the different stitches is wrap the yarn a different number of times.  I'm not practically giving myself stigmata with knitting needles, either.

It's become a huge part of my recovery.  When I get stressed or upset after eating (which has been known to happen a time or two...) I just pick up my yarn.  It takes enough of my concentration to tone down the obsessions, but it doesn't take so much concentration that I can be too upset to work.

How about you? Have you found crafting or creative projects an important part of your recovery? Share your thoughts in the comments!