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March 16, 2019

ED Big Questions

Answering the Big Questions

Recently we received a request for help with a school assignment, a young woman who is a high school freshman in Missouri. We receive many such requests and often help students navigate our website or locate additional resources, but this request impressed us because the questions she asked really get to the heart of eating disorders and show so much understanding of a very complex issue for someone her age. Really, aren't these the questions we all ask ourselves, every day, even if we have worked in this field for many years? We put the question to Mirasol clinicians and are are delighted to reproduce their responses, below.

Meghan Gilliland

Meghan Gilliland, LMSW
Primary Therapist

Rachel Nelson

Rachel Nelson, MS, ATR
Art Therapist

Julia Quiñonez:

Julia Quiñonez, BS
Clinical Administrative Liaison

What, in your opinion, is the biggest cause of eating disorders?

Meghan Gilliland: In my experience, eating disorders are something people develop as a way to manage overwhelming feelings, thoughts, and experiences. There are influences from our culture and media that have an impact on body image as well, but I think those elements are often more on the surface of an eating disorder and there are deeper roots. My role at Mirasol is to help our clients understand and address the underlying trauma that is at the root.

Rachel Nelson: Trauma.

Julia Quiñonez: In my opinion, the biggest cause for eating disorders is a combination of things. Firstly, dysfunctional eating behaviors are extremely effective for supporting disconnection. In a society where we are not taught how to feel or how to express our emotions, we are left with a need to disconnect from the world and from ourselves. What better way to do that than through dysfunctional eating behaviors? Eating disorders can also come with an added bonus which can be thinness. Especially for those people who struggle with anorexia and/or extreme purging behaviors, they will likely be at a low weight — which is a desirable trait in our society. Oftentimes, people are rewarded with compliments and praise when at the worst of their disorder. While eating disorder behavior can start off as a benign way to "numb out" or disconnect, it can quickly form pathways in our brains which causes the eating disorder to function like any other addiction, which makes engaging in the behaviors be out of a person's control.

What are the first steps to recovery for an eating disorder patient?

Meghan Gilliland: Many of our clients come in to residential treatment when their eating disorder behavior has gotten out of control and is severely impacting their day-to-day life. Restricting, binging, purging behaviors in addition to overexercising can become so severe that a person's health is compromised and they may even need hospitalization to get stabilized. All of our clients are evaluated by medical professionals and a dietitian when they begin services with us so that they can determine an appropriate meal plan and activity level to get the client returned to health. The client also begins therapy and learns skills and tools to help them regulate their distress.

Rachel Nelson: First step would be admitting that you have an eating disorder or struggle with food. Next step would be to surrender to the fact that what you are doing isn't working and being open to the perspectives of professionals and trying out different ways of doing things.

Julia Quiñonez: I think that the first steps to recovery can be different for every person, but all include some sort of readiness/willingness for change. I have heard many people throughout my time in this field say that eating disorder recovery is the hardest thing they have had to do — even harder than staying sober from drugs and substances. Because there is no abstinence from food, recovery includes a relentless dedication to following a meal plan, resisting urges to act on behaviors, and honesty and accountability.

How do you teach self-love?

Meghan Gilliland: One of the ways I approach this is by helping clients understand all of the various aspects of themselves, and how their eating disorder behavior developed as a tool to help them. Most clients feel a lot of shame about having an eating disorder. When they understand that the behaviors developed to help them, and that they can also develop new behaviors to replace these, this helps to reduce the shame. I see self- love as having a lot to do with reducing shame and understanding all of the aspects of ourselves rather than trying to beat ourselves up.

Rachel Nelson: Love this question. I think the first thing is to ponder is: what is it "to love"? Also normalizing that loving the Self is hardest for everyone...so making a list of what is easy to love — maybe it's an animal or a little brother or niece. Then using your imagination to direct that towards yourself in some way. Sometimes I ask clients to ask themselves, "What would a person that loves/cares for themselves do?: To try on the idea. It takes a lot of practice but it does get easier. Sometimes it works to use the word "compassion". Having compassion for your inner child. And that's a way in. I know that the people who are wanting to find that self-love are more likely to than the people who don't have that desire. Desire to get better is a crucial element, and from what I've seen, determinant to finding relief/recovery from an eating disorder.

Julia Quiñonez: Teaching self love to individuals who have practices and deep beliefs of self-hatred is extremely difficult. In my experience, it needs to be an organic progress, and it takes a long time for people to get there. Practicing non-judgmentalness with clients, regardless of the behaviors or the relapses, can be a strong message for people to receive. Self-compassion work can also be a good way into teaching self-love. I think having people in this process that can model self love is extremely important for people in recovery.

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