Monday, December 5, 2011

Mothers, Daughters and Food: Handing Over the Reigns

Karen, an attractive, fit and fashionable 48-year-old mother, has come to get help for her 17-year-old daughter Ashley’s weight problem.  “I’m really worried about her health. She’s put on 30 pounds since middle school.  She’s a bright and beautiful girl, but her weight is making her miserable,” she told me.  “She’s never had a boyfriend and she’s avoiding her friends.  Every time she gets in the car, she’s buying junk food. I’ve tried dieting with her, signing her up for gym memberships and personal trainers. I’ve offered to buy her a new wardrobe if she lost weight.  Nothing motivates her! I’m afraid whatever I do is only making things worse.”

The next week, I hear Ashley’s story. She’s overcome with tears as she describes her struggles with food and her mom.  Perceptive, sensitive and academically accomplished, she’s very hard on herself. “I can’t understand why I can’t get my act together in this one area!”  She feels hurt by her mother’s pressure to lose weight. To Ashley, whether it’s shopping together, having a meal, or going for a walk, it feels like every encounter is an opportunity for her to feel judged by her mom.  

Ashley’s mother’s concern about her weight is an octopus whose tentacles wind through every interaction, choking the fun out of their relationship. Her mother’s unspoken message is: “I’m disappointed and embarrassed by you. Something’s wrong with you, but I’m at a loss.”

This painful pattern between Karen and Ashley is the age-old dance of millions of mothers and daughters. 

To the Moms: Let Go.
Your daughter’s problem is not that she isn’t motivated enough. She doesn’t need to be “incentivized” with clothes, trips or cash if she drops weight. Believe me, she wants it as much as you do.
What’s happened is that your daughter’s struggle with food  -- an area that should be a negotiation among her head, her belly and her heart -- has become a relationship issue between the two of you. Over the years, your concern and disappointment in her weight has taken up residency in your daughter’s psyche. Your feelings are so salient that she can’t discern the subtle signals in her own body. 

You may be a successful, take-charge woman, used to influencing outcomes. But as difficult as it may be to accept, this one’s out of your hands.  Perhaps you’ve struggled with your own weight issues. Your fear for your daughter has intensified your involvement in her problem. You’d do anything to prevent her from suffering the way you have.  Or perhaps you’ve never had food issues and your daughter’s drama is a mystery to you.  Maybe you can eat and exercise without all the fuss, and you view her struggle as a character flaw. 
Whatever your story about food, you can’t solve her problem.  It’s time for you to let go. 

When I say “let go,” I mean not offering to diet with her, not cutting out weight loss articles for her, not asking after her walk how many miles she went. It means not sighing when she reaches for seconds or stiffening when she orders fries. It means not showing off your skinny jeans or bragging about how great you feel after your workout. It means never uttering, “Are you sure you really need that?”

Letting go means trusting that she’ll figure out her weight issues on her own time table.  It means accepting that this might take years, not weeks or even months. 

At the same time, it doesn’t mean denying support if she ASKS for it. If she can’t afford a dietician, therapist or personal trainer and you can, this could be a meaningful gift, if it’s freely given.  No checking in about “how it’s going,” with the implication “I better see results on the scale.” If that’s your mind-set, don’t bother. It will only become another place for her rebellious instincts to sabotage the process.

Here’s the New Paradigm: your role is to develop a more loving and connected relationship with her, whatever her size. This means consciously, deliberately never implying that her value goes up as the number on the scale goes down. She gets that message every day in the culture. Your role is to be a buffer –to detach her worth from her weight.    

To the Daughters: Grab the Reigns and Take Five Steps

Step 1: Get your Mom out of your food. Your relationship with your body is yours and yours alone. That means doing the right thing for your body, not rebelling against your “controlling mom” by eating junk and lying around. Grab the reigns. Instead of rebelling against her, rebel against the diet mentality...which leads to Step 2.
Step 2: No more counting points, fat grams, pants sizes, calories and pounds. Letting go of the numbers might seem scary, but be honest: all that counting only raises your anxiety, which makes you want to eat! Steps 1 and 2 should lower your anxiety. Good.  Breathe. 
Step 3: Become a Belly Whisperer by learning to discern the signals in your gut. It’s recognizing when you’re eating past the point of satiety, and when you’re eating because you’re procrastinating, rebelling, rewarding yourself, or taking a break. At this Step you’ll still do all these things, but you’ll watch yourself do it and imagine better alternatives.  Even if you still choose to eat, the key is that you’re turning your compulsion into a choice.  Even if nothing changes behaviorally, you’re making progress. These deeper changes must take place in order for lasting behavioral (and weight) changes to occur. 
Step 4: Make a different choice.  Instead of eating when you feel like procrastinating, try painting your toenails or reading a magazine instead.  You’ll notice you feel better.  The new choice will reinforce itself, making it easier to do it again.      
 Step 5:  Choose healthier foods because you feel better when you eat better. This feels very different from eating healthy because you’re “on a diet” or because your mom is watching. By the time you get to this step, the change in your eating is organic and based on self-love rather than a capitulation to your mom’s wishes.  Organic changes stick.  But getting to Step 5 takes time, so be patient!    
A final word to you both:
Getting the Food Fights out of your relationship is an important developmental milestone in the lifecycle of the mother-daughter relationship.  From the day a little girl is born, the mother-child bond is embodied through food and feeding. The path to a healthy separation around food issues can be bumpy and painful, but the rewards to you as individuals and for your relationship are well worth the struggle!


Sunday, December 4, 2011

Speech at EDIN's Celebrity Dance Challenge, December 3, 2011

Fifteen  years ago when we started EDIN, eating disorders were a taboo topic in schools.  People avoided talking to kids about these issues out of their fear of creating problems. But we started planting seeds.  We started openly addressing the issues surrounding eating disorders for the first time.   Now high schools, middle schools and elementary schools all over this state are using our model and our materials, creating student-run EDIN Clubs and hosting creative, educational and fun events throughout the year focused on media literacy, the dangers of dieting and the importance of Loving Your Body. 

Fifteen years ago, the Obesity epidemic was a blip on the screen. But with the increased attention on this issue, EDIN has been at the forefront of efforts to make the connection between obesity and eating disorders, advocating for a non-diet approach to weight issues, shifting the focus from being skinny to being healthy.  

We were thrilled this year when The Georgia Department of Education decided to feature our children’s book “Full Mouse, Empty Mouse” in its Georgia Eat Smart Initiative to combat obesity, sending the book to every elementary school in Georgia.  Now instead of kids starting on diets, they’ll be hearing about respecting the signals in their bodies and healthy ways to cope with feelings. Without EDIN to balance out the cultural pressures to diet, we’d be ushering in a new generation of anorexia, bulimia and binge eating.    

But what’s truly gratifying is to hear about EDIN’s impact on an individual scale.  I was recently approached by a teacher who thanked us for bringing EDIN’s programming to the school.  She admitted that she’d been suffering from binge eating disorder for years, and through EDIN’s website she’d found a dietician and a therapist who were helping her recover.  Or the mom who attended an EDIN talk at her kids’ school focused on preventing eating disorders, who reached out to us saying, “I’ve had bulimia for 30 years.  I realize now that, for my kids, I need to get help.”

THIS is true prevention, because that mom and that teacher will now be passing down the right messages through their words AND their actions, to their students and their children.

Prevention is about changing a belief system. It’s about changing the way we talk to each other and the way we talk to ourselves so that we can provide a buffer  from the cultural trends that vilify fat and glamorize anorexia. We have our work cut out for us. 

This past Tuesday 9 million people watched the Victoria’s Secret Fashion Show, and Model Adriana Lima walk down the runway with a LOWER body mass index than is required to receive a diagnosis of Anorexia.  Asked how she achieved this body, she shared that she worked out twice a day for months, then drank only liquids for the nine days leading up to the show then didn’t eat or drink anything for 12 hours before the show, forcing her body to devour any ounce of fat that was left.  Not only were people unconcerned about this potentially life-threatening behavior, but the Twitter-verse lit up after that show with people inspired to start starving themselves to look like her.  

No other potentially deadly mental illness is so highly promoted and glamorized in our culture.  I just hope it doesn’t take an angel collapsing on the runway from cardiac failure for America to wake up. 

Thankfully you, here, tonight, are awake!  Thank you for coming tonight and for helping change things.  For ourselves and for our kids, keep fighting the fight.  THANK YOU!

Saturday, September 24, 2011

Eating Disorders: Stigma & The Social Cure

Two decades ago, people would only whisper the words “breast cancer.”  Susan G. Komen, as she lay dying from the disease, asked her sister, Nancy Brinker to try to raise awareness.  Because of Nancy’s tireless outreach, people now discuss breast cancer openly.   Along with this new openness, Susan G. Komen for the Cure has raised millions of dollars for research that has helped save lives.

Today the topic of eating disorders is where breast cancer was twenty years ago.  There is still tremendous shame and stigma surrounding these problems, which only increases the suffering of victims and their families.  Anorexia, binge eating and bulimia are still viewed as shameful, disgusting, embarrassing and a sign of mental weakness. 

There is a community of eating disorder survivors, family members and treatment providers working hard to remove this stigma.  I decided to use theater to break through defenses and touch folks at an emotional level.   Back in 1996, I wrote the play “What’s Eating Katie?” about a 13-year-old girl who struggles with an eating disorder.  In the show, the Eating Disorder (ED) is played by an actor representing a separate character (based in the Narrative Therapy approach which “externalizes” problems).  This technique allows the audience to hear what it sounds like inside of Katie’s head. Katie, like most eating disorder sufferers, is a high achiever, one of “the best and brightest.”  She is a perfectionist who want to make everyone happy. Like the canary in the toxic coalmine of our culture, she’s the one who succumbs to the stress and pressure.  Audience members relate to Katie since we all have an internal negative voice; the only difference may be that Katie’s internal negative voice is meaner, more controlling and highly destructive. 

   My goal in creating the show was to rip the lid off this topic, even though many adults are afraid to address eating disorders out of their fear of glamorizing them or giving kids ideas. In fact, the ideas that teens take from this show are: dieting is ridiculous; starving leads to moodiness, spaciness and weakness; binge eating is an out-of-control nightmare; and throwing up is both addictive and dangerous. The only rational conclusion is to respect, feed and take care of your body!

I’m happy to report that over the past 15 years, high schools and colleges around the country (as well as Scotland and Australia!) have performed this show.  Act I takes place over the course of one day, when ED recruits Katie into engaging in an extreme diet that takes a frightening turn.  Act II takes place three months later when we can see the toll that ED has taken on Katie, her family and her friends.  It ends with an uplifting scene in a therapist’s office where Katie begins her journey towards recovery.

Between scenes are hilarious “ads,” spoofing the diet, fashion, fast food and fitness industries.  The idea is not to “blame” these forces for Katie’s eating disorder but to place her struggle within a wider cultural context.  By seeing plainly the manipulations of the  corporations that profit from making us fat, insecure and then thin again, the audience will be better at critiquing the core messages that can lead to unhealthy behaviors (“You will be popular, loved and happy if you are THIN, so get there no matter what the price!”)  By making the messages explicit, they have less power to influence attitudes and behaviors.   

One of my favorite things about this project is that the purveyors of the new messages are the teens themselves. An audience of middle school kids is going to be much more open to messages in a show performed by high school students than to adults lecturing them about taking care of their bodies.  We know that peers are a potent influence regarding attitudes and behaviors; unfortunately we typically hear about how this influence leads kids to dangerous places (sex, drugs, rock 'n' roll!).  The idea of this show is to use "peer influence" for Good rather than Evil.  This process has been dubbed "The Social Cure." 

I recently updated the script to including cell phones and texting, Google and Facebook (none of which were around in 1996!). But I wanted to bring the show to the next level by turning it into a musical.  I stumbled upon a gifted actor-composer-music director named Bryan Mercer. He knows how to make a show fresh and engaging, hip and meaningful.  We feel that the combination of my 20 years as a psychologist combined with his 30 years in musical theater will allow us to create a show that will both educate and entertain today’s sophisticated youth audience.

In order to help fund this stage of the project, I decided to work through the website.   If you care about this issue, we want you to be part of this project!   Your donation (large or small) will allow us to fund the composing of nine songs and the recording of the tracks.  We’ll reach out nationwide to promote this as a fresh, bold way to address dieting, weight stigma, body image and eating disorders.  We’ll also approach local schools and community groups about performing the show in Atlanta in 2012.

This is a life-changing and potentially life-saving project. The show will engage and enlighten cast and audience members and provide hope for sufferers and loved ones. Ultimately, it encourages people to seek help because recovery is possible.  We hope that you want to be part of it!  Click here to find out the how we will be thanking you for your gift (including writing your name into the show!)

Thank you~

Friday, September 16, 2011

Surgery on Your Stomach Won't Fix a Problem in Your Head

Bariatric surgery has catapulted us into a Brave New World. These days many eating disorder therapists are seeing a new type of client: the pre- or post-bariatric surgery patient. While we may not be schooled in the gastrointestinal and hormonal intricacies of obesity surgery, we are knowledgeable about the complex interplay of emotions, relationships, trauma and food. Unfortunately, bariatric surgeons may have only had one class (that’s class, not course) on eating disorders in medical school.

Many in the eating disorder community are adamantly opposed to this surgery. They view with suspicion physicians who are quick to promote the procedure as the Holy Grail of weight loss rather than viewing it as a last resort. And while insurance companies may insist on six months of pre-operative nutritional counseling, they do not insist on (and often balk at paying for) pre-operative psychotherapy.
It’s hard for me to take a hard-line stand on the surgery itself. I know people who’ve destroyed their health, developed eating disorders and alcoholism, gained back all the lost weight and even died following gastric bypass surgery. I also know people who’ve lost weight and kept it off, and whose quality of life has improved 1000 percent following surgery. They have no regrets and tout it as a life-saving operation.
Get Thee to a Therapist!
I met a bariatric surgeon who’d conducted his own extensive pre-surgery assessments of his patients. He was shocked to find that 80 percent of his patients who were about to undergo surgery reported being sexually abused as children.
I wasn’t shocked at all. It’s widely accepted in the psychology community that sexual abuse survivors often develop problems with overeating. An abuse survivor may use food to numb her feelings or punish herself. She may try to make herself less attractive by gaining weight. Over the years, eating can become a default way of coping with negative emotions, while being overweight becomes self-defining.
Now imagine this woman gets gastric bypass surgery to “fix” her weight problem, without stepping a foot in a therapist’s office. Post-surgery she may be ill-equipped to cope with negative feelings since her default mechanism has been taken away. As her body changes and men start noticing, she may be unprepared for the sense of anxiety that she cannot identify or manage.
This is the patient who may turn to alcohol, cigarettes or shopping for emotional anesthesia. Or she may just eat her way around that tiny stomach pouch. Once I met a woman who lost and then gained back 250 pounds post-surgery.
More tragically, ERs have a short-hand for the post-surgery patient who’s binged and burst through the tiny stomach-pouch. “GBGB.” Gastric Bypass Gone Bad. GBGB can be deadly.
“Those who do not learn from history are bound to repeat it.”
Doesn’t it make sense that a person who is 100 pounds overweight should address his or her “food issues” before getting gastric bypass? Here’s a story to illustrate the work that needs to happen between your ears before someone opens your gut.
Brad is a bright, vivacious and extremely likable guy. A successful man in a long-term relationship, when he arrived for pre-surgery psychotherapy he weighed 386 pounds. Here are just a few of the themes that we addressed during our year together.
Early family messages
When we explored why Brad had ignored his health, he stated that he believed he was not worth the effort. So we dug deeper.
Brad was adopted. He never felt like he “belonged” to his parents. His mother was obsessed with her own fitness but rarely cooked or cared for her son. Brad always sensed that his mother felt burdened by his needs. Brad’s father was a harsh disciplinarian. A controlling military man, he’d measure the hangers in Brad’s closet to be sure they were one-inch apart. Sharing these stories helped Brad realize that his parents did not love him in the way that he needed to be loved. This insight was accompanied by deep sadness. This “grief work” helped him let go of his old self-perception. Acknowledging that their treatment of him was more about their short-comings than his value as a son, he recognized that he was worthy of the effort it took to take care of himself.
Brad had internalized his father’s perfectionism along with an equally powerful rebelliousness. If you’re surprised to think of someone weighing over 380 pounds as a perfectionist, here’s how it works: If I can’t be Perfect, why bother?
Perfectionism and Complacency are flip sides of the same coin.
In therapy Brad recognized that his harsh self-talk not only didn’t make him a better person, it actually contributed to his weight gain. Brad recalled a high school gym teacher who had believed in him and pushed him to get fit. With her encouragement, he started to feel good about his body. Realizing that her positive approach had helped him get in shape years ago, he started speaking to himself in kinder tones, rather than listening to – and rebelling against – his internalized father.

Current Relationship Issues
Brad’s partner was a caretaker. He loved to feed Brad, but a bit too well! Brad suspected his partner might be sabotaging him since he’d gained 100 pounds in the time they’d been together. We anticipated ways that Brad’s weight loss might alter the dynamics of the relationship. Brad’s new confidence would likely make him more assertive, which would add stress and conflict.
Brad’s partner decided to get in therapy to work through some of his own issues. This helped prepare them both for a new post-surgery relationship, especially with regards to food, love, power and control.
The Update
Following his surgery, Brad accepted a job in a new city. It’s been a year. Here are his words:
“As far as the surgery itself, it was actually better than expected. The doctors…made sure I understood any potential complications, discomforts, recovery times...The side effects were exactly as expected…The positive effects far FAR outweighed any of the negatives…It’s been 12 months and I’ve lost 170 pounds…Within 2 weeks…my blood pressure was completely normal…
Within 7 months, my sleep apnea had improved... My energy levels soared and are consistent throughout the day. Food went from being something I was completely obsessed with to almost an afterthought – who knew I had to remind myself to eat...I had not realized how limited I had made my life, avoiding all the anxieties like air travel, small chairs, parties, social activities…I am more social, throwing parties, going to clubs, going dancing, hiking…I started at 386 pounds. Today I weigh 216 lbs. If I didn’t lose another pound, I would be content…
And the take-away:
“I feel like (our) therapy was extremely beneficial in dealing with the issues of satiety (emotional versus physical), the feeding of the emotional stuff, acknowledging what my triggers were, and more. I really attribute my success to the therapy I had before surgery, and the lessons I learned from it that I have brought forward post-surgery. I know other bariatric patients that had little to no therapy, and their success has been very limited. My recommendation would be get some serious therapy before you embark on a surgical solution.”
Amen Brother.
Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for and You can visit her on the web at and

Wednesday, September 7, 2011

Depression: It Gets Better

A core belief of depression is not only that “Life sucks,” but “It Will Always Be This Way.” This hopelessness can lead to suicide.

That’s why I’m so grateful to the folks who are reaching out to gay youth with the “It Gets Better” message. Started by Fort Worth City Councilman Joel Burns, who spoke openly about his struggles growing up gay, the message to “hang in there” past the pain is simple but profound. The “It Gets Better” message is at the core of psychological resilience.

I recall my mom giving me that message when I was a kid by repeatedly counseling me, “Tomorrow this will be behind you and you will be looking back on it!” I have used this belief to calm myself through anxieties throughout my lifetime.

Many of my therapy clients were not so lucky.

Their parents did not give them life survival skills because they were too caught up in their own pain. My clients-as-kids dared not imagine a brighter future; life was about minute-to-minute survival. Fantasizing about a happier time was a luxury they could not afford. Keeping expectations low protected them from being blind-sided by more disappointment. Why set yourself up, when the other shoe always drops?

This adaptive survival strategy becomes a problem when they’ve grown up, escaped their dysfunctional families and built loving homes. They cannot allow themselves to see and appreciate how far they’ve come, to experience joy in the present, nor to dream. Expecting to suffer, they make sure that they do, even if it is of their own making. Plagued by chronic anxiety, they still anticipate the worst. They may call themselves “cautious”or “realistic,” but this life-stance can morph into chronic negativity and even paranoia.

I use a powerful imagery exercise with these clients. Here’s how it goes:

Close your eyes and connect to a recent moment when you actually DID feel good, even if it was fleeting. Now turn up the volume on that moment and really EXPERIENCE it. Then, while holding onto that feeling, imagine yourself walking back into the past, down a long hallway with many doors. Pick a door and walk through. You’ll see a vision of a child in the distance, sitting in front of your childhood home. As you get closer, you notice that the child is a younger version of you. Sit down beside that child and let them know, “I’m from your future, and It Gets Better.” This child has been waiting for your arrival, waiting to hear from you. The child has been wanting to share the pain they’ve been experiencing, so you just listen as the child shares their pain and sadness and anger. After a while, pick her up and carry her with you away from the house, through the door and back into the Here and Now.

Often a person who has experienced a painful childhood is reluctant to go back and greet this child-part of herself. She may say, “That’s ancient history. It doesn’t affect me now. Why go back and feel all that pain again?”

Far from “not being affected” by our histories, in fact, that CHILD may be running the show (like the little man behind the curtain in The Wizard of Oz). The kid-part can lead us into poor relationships and bad career choices. She may push love away, or fuel deep sadness, uncontrolled rages, gripping addictions or paralyzing anxieties.

Sometimes the reluctance to travel back in time is really because deep down she believes she was essentially a bad kid and deserved the poor treatment she received. Or she fears that if she connects to that kid, she’ll feel burdened and drained by her incessant needs and demands.

In fact, by re-connecting to and embracing your child-part, and letting yourself know that this time you will be heard and cared for properly, you may start to feel more whole… and more hopeful. When the kid-you hears “It Gets Better,” the adult-you may be able to actually relax and experience some childlike joy again.

Re-connection and hope will get you through…

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for and You can visit her on the web at and

Carrying a Family's Weight

Cara has been seeing me in therapy for several years for help with her food and weight issues. A bright, attractive woman married to a great guy, she has a significant amount of weight to lose. Over the years, she has lost weight through dieting only to gain back more than she originally lost. The extra weight holds her back sexually with her husband, decreases her physical activity and has contributed to arthritic pain. She fears that cancer, heart problems or diabetes could be in her future.

Through the course of our work, she has made tremendous progress in multiple areas. She’s set up her life to pursue her many creative gifts, including building a career that combines her business savvy with her passions. She and her husband have improved their communication. She has widened her network of support and developed deeper and more authentic friendships.

However, her weight has barely budged. Frustrated with herself and this therapy process, she wonders if the change will ever take place. She has trouble trusting that, in fact, she has been putting the pieces in place for her to finally succeed.

There is a term in Science called “homeostasis,” defined as: the property of a system that regulates its internal environment and tends to maintain a stable, constant condition. Family therapists use this term to describe the family system. Members of a family often feel pressure to remain the same so as not to throw the system off balance. Rigid families discourage change, while flexible families are more likely to evolve in positive directions together.

In a healthy family, the dramatic weight loss of one member may cause everyone to get healthier; the system is flexible enough to “bend” and it can re-organize itself at a higher (healthier) level. But in a rigid family system, one member losing weight may put too much pressure on the family. Sometimes the family cannot bend that far, and it breaks.

For Cara, the fear of this break is at the root of her weight problem. Losing the weight for good will take a profound and deep mental shift. In order to consistently make the daily changes, she will have to re-write her family story--a story which was composed generations ago. Then she will need courage to hold onto her new story while remaining engaged with her closest family members.

Cara grew up in a working class family in a small town. Her parents divorced when she was a kid and it was her job to care for her younger sister, do well in school and be the emotional caretaker for her parents. As a child she comforted herself with food (like everyone in her family). No one spoke of, nor thought about, the concept of emotional needs. Life was about daily survival.

Cara grew up fast. Bright, exceedingly capable and responsible, she pretended that she was fine so as not to trouble her family. Over the years, her weight climbed as she buried her feelings in food. She went to college, got a job and left her small town for the big city.

Cara was saddled with two conflicting family messages: while it was her role to bring esteem to her family (they loved to “brag on” her successes) it was also conveyed that she should never act “too good” for her family. The no-win message was:“Succeed!... but don’t make us feel bad about ourselves. Make us proud, but don’t get too big for your britches.”

As an adult, Cara can now see from the outside how her family has made and continues to make poor life decisions, how they are often the cause of their own misery. There is a sense of fatalism and passivity in her family. In all the things they say and do, this message is conveyed: We are unlucky. Bad things happen to us. Let’s pray things get better some day, but we might as well EAT since our fate is out of our control.

As a successful, married woman hundreds of miles away, Cara has proven to herself that she is the writer of her own script. But when it comes to her weight, Cara has bought the family myth: There is nothing I can do about it. We’ll just see what happens. Maybe someday it will change.

But the core fear is that eating healthy, exercising and feeling good in her body will mean that she has out-grown her last connection to that which is familiar. When she goes home, their idea of fun is eating lots of fattening and delicious food. They bond through Food and the misery of being overweight. If Cara makes a healthy food-choice in their presence, they chide her for being a “party-pooper.” In her family the unhappy, over-weight women view women in healthy bodies as alien, superior creatures: it is an “Us vs. Them” mentality.

While being an “Us” may kill Cara, being a “Them” feels like abandoning (and being abandoned by) the family she loves.

Cara will need to accept that it is possible to BOTH take care of her body AND love and connect to her family members. She will have to develop stronger psychological boundaries, so that their suffering does not become her burden to fix. When they tease her for being healthy, she can learn to not take it personally. Cara can find a new way be part of her family, with physical energy and healthy self-worth.

There may be more tears shed in my office as she grieves the loss of the old, familiar way of being close to her family, but she can learn how to forge new healthier bonds without sacrificing her own well-being.

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for and You can visit her on the web at and

Recovering from Bulimia in Micro-Moments

“I’ve done everything you wanted me to do to stop the bulimia. I’ve stopped spending compulsively. I’m taking medication. I come to therapy every week. I’ve talked about my childhood. I know my triggers. I even know what to do INSTEAD of binge and purge…But I am STILL doing it every single night! Maybe I need to stop therapy and see if this thing clears up on its own.”

Cate’s story is a tale of the insidiousness of an eating disorder. Her problems began in high school when, as an overweight teen, she decided to join the swim team to lose weight. Swimming and starving, she dropped pounds rapidly. After feeling invisible for years, the attention she received for her svelte body was a high she had never encountered and as addictive as heroin. When she started binge eating (a common occurrence after a spell of starvation) she learned to rid her body of the calories through purging. She would never be “fat” again, no matter the price.

At that time, she could not know nor foresee the price she would pay. A daily and seemingly endless cycle of starving, over-exercising, binge eating, and throwing up lasted throughout her teens and twenties. By the time she arrived in my office at 29, her eating disorder was a firmly entrenched part of her daily routine.

Fed the media stereotypes of what a person with an eating disorder “looks like” (young, emaciated, sickly, depressed, isolated) Cate is the last person anyone would suspect. Over 16 years she has thrown up over 5,000 times, although miraculously there are no outward signs. She appears to be the picture of health. A stunning beauty with a body that other women would envy, she has perfect white teeth and thick flowing hair. She is bright and successful at her job, and she is kind, compassionate, funny and popular. From all outward appearances, she has the perfect life. After successfully hiding her bulimia from the world for half of her life, those her know her would never suspect the secret daily hell she endures.

So how is Cate going to get better?

There are a number of stages on the road to recovery. Over three years in therapy, despite her frustration with herself, Cate has made progress. She’s been creating the conditions that will support a healthy life. She now takes medication to treat the underlying depression and anxiety that have fueled the bulimia. She’s curtailed a too-active social life that left little time for exercise or alone-time. She started volunteering with a charity that helps her feel like she matters. She joined a therapy group where she learned that people who knew her whole story could love her.

So now it’s time to put it all together.

A purge is the grand finale of a series of micro-decisions made in micro-moments, most of which take place just below the surface of awareness. Fatigue, hunger, boredom, stress or just the time on the clock – any of these common daily occurrences –can set the destructive routine in motion.

Cate will need to be mindful and aware of how each of these tiny moments can lead to seemingly innocuous decisions that then lead inexorably to the next problematic decision, until the point where turning the thing around is like stopping a locomotive.

First, knowing herself well and collecting years of data, she’ll need to anticipate each possible trigger and prepare for it in advance. This means having tasty, satisfying healthy foods on hand when the voice tells her to grab some candy. She’ll need to carry an inspirational book when her brain says, “Bored? Head to Starbucks for a cookie.” She may need to knit when she feels like procrastinating, text a friend when she feels lonely, walk her dog when the voice calls her lazy, and remind herself that even if she gains a few pounds that being addiction-free will make her more beautiful.

It’s about being ready every time that seductive little bugger says,

"Honey, I can make that icky feeling go away. You deserve it. Screw recovery! You can be good tomorrow.”

The final and most challenging step is to re-commit to recovery during those key moments. It’s easy after throwing up to promise to be good tomorrow. It’s easy sitting on the therapist’s couch to vow to do the right thing.

But in the moment….?

The turnaround comes when you realize it’s not going to be any easier to get your act together tomorrow. The pay-off may not be instant, but you’ll feel proud of yourself an hour from now if you defeat the monster. That good feeling is BETTER than the high of the food, and it’s just a few minutes away. And tonight you will sleep sounder having had a binge-free/purge-free day.

And even if no one else knows – no one shames you when you binge or applauds you when you don’t – even if only YOU know that you did the hard thing in that moment, that is enough. If you can get through one day, then you can get through another day. Just as that first purge morphed into 5,000, the healthy moments will turn into days, then weeks. The micro-moments will add up and a new normal will be established. Then you are Free.

Today matters. This micro-moment matters. You matter. Adopting this belief is where addiction ends, and real living begins.

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for and You can visit her on the web and

Tuesday, September 6, 2011

Thinnest Girl in the Room

“Losing weight is the only thing I’m good at.”
I’ve heard these words spoken (with no irony) by gifted athletes, accomplished performers and class valedictorians. I’ve heard them uttered by people who are stand-outs in whatever it is they choose to accomplish in their lives. In Jane Fonda’s speech at a gala to raise money for our eating disorder organization, she shared the story of her 25-year battle with anorexia and bulimia. With compassion in her voice, she stated: “Eating disorders happen to the best and brightest…. We just want to be perfect.”
It appears that some kids come into the world perfectionists: no amount of external reinforcement will quell the sense of not being enough. Others are raised by critical or high-pressure parents whose high standards they’ve internalized. It appears most are born to loving parents who are only hard on themselves.
Whatever the causal combination of nature and nurture, negative self-talk is especially vicious for eating disorder sufferers.
Typically they’ve received accolades and awards for their many gifts and achievements, yet they feel invisible and unimportant. Some admit to me that they are afraid to give up their eating disorder because they believe it is the one thing that makes them special and unique.
In a world where the majority of the population is dieting and hating their bodies, it’s little wonder that our kids internalize the message that the one achievement that truly matters in life is the ability to deny oneself food. For those who discover that they have this capacity, it can be as exciting as discovering the Holy Grail. They may be starving, obsessed with food, and experiencing negative side effects of malnutrition yet they are still asked, “How do you do it?!” People who don’t know any better laud them for their “willpower,” “healthy eating” and“self-discipline.” They are even told by their doctors (who are weary of treating overweight patients) “You don’t LOOK anorexic.”
It’s no wonder they are confused when I describe their eating disorder as A Problem, when they (and many around them) view it as The Solution.
Abigail is bright, creative, intellectually gifted, artistically talented, keenly sensitive and perceptive. When I ask her about her fear of letting go of her eating disorder, she tells me, “It’s the one thing that I’m good at. It’s what makes me Special.”
I respond, “I think the fact that you are good at ignoring the needs of your body is, in fact,the least interesting thing about you.”
This remark is met with stunned silence. Abigail feels both insulted and flattered by me. “Rather than making you Unique and Special,”I explain, “your eating disorder robs you of your uniqueness. It causes you to think the same monotonous thoughts and act out the same food rituals as the millions of other eating disorder sufferers. The people who love you and know about your problem do not see you as more “Special” because of it. They thought you were unique and special BEFORE this eating disorder stole you from them. They miss you! In fact, they feel sad for you that you will not allow yourself to have fun when there’s food around. They are upset because your eating disorder is robbing the person they love of joy, laughter and pleasure. Instead of striving to be the Thinnest Girl in the Room, you can learn to be happy being the Abby-iest girl in the room.”
My hope is that this alternative perspective will provide a new way for her to start thinking of herself in relation to her eating disorder. It will take many repetitions before it starts to sink in. After all, it’s just one hour a week of me versus the 24/7 media-machine bombardment of the Anorexic-Belief-System (“You will be happyrichfamouswealthyenviedspecialloved if you are THIN THIN THIN”). You, too, can be a counter-cultural Force for Good. Simply pause for a second before you heap praise on someone for their healthy eating or their weight loss. It may seem like the right thing to do, complimenting someone’s efforts and accomplishments in this difficult arena. It may even seem insensitive to NOT say something, but use your words carefully. You never know what goes on behind the scenes; comments about food and weight can be highly loaded for some people.
Instead, if you want to truly give someone a meaningful gift of the heart, compliment them on their spirit, their laugh, their kindness, their integrity, their funny perspective on the world~ those things that TRULY make them unique.
There’s no real reward~ and there may be a heavy price to pay ~ for being crowned the Thinnest Girl in the Room.

Dina Zeckhausen is a nationally known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for and You can visit her on the web and

Updating Your Self-Ware

I forgot I was a therapist for a few minutes. I got caught in the oldest trap in the book: trying to talk someone out of their belief system. Angie, a 32-year-old woman who had overcome sexual trauma, emotional abandonment and loss, still saw herself as a “failure” and a “loser.” She had recovered from a severe eating disorder and years of wishing she was dead. Now a sober, healthy adult, she’d maintained her sanity and, most importantly, her integrity. She was in a loving relationship and on her way to a successful career doing what she loved. Yet, despite all that she’d accomplished, she held fast to the belief that she was weak and fragile. And she sure as heck wasn’t about to let me talk her out of it.
One of the most memorable books I read as a college psych major was “The Three Christs of Ypsilanti.” It was about a fascinating experiment performed in the 1950’s at Ypsilanti State Hospital in Michigan. Dr. Milton Rokeach decided to take three schizophrenics who each believed they were Jesus Christ and have them live, eat and room together for two years. (Today such an experiment would never pass the Ethics Board!) Rokeach was curious about whether men confronted with two others claiming to be the same person would alter their belief system about their identities. These guys struggled mightily with each other over the course of the experiment, yet in the end, each held steadfastly to their belief in his own divinity, declaring the other two to be crazy.

Each day I am confronted with the distorted beliefs of clients who are severely underweight yet state with great conviction and emotion that they are “fat and disgustingly obese.” I can argue until I’m blue in the face, presenting them with rational, objective data (weight charts, the size of their clothes, the worries of their loved ones), but they still declare, “I’m sorry, this is what I SEE when I look in the mirror.”
One need not be struggling with schizophrenia or anorexia to hold tightly to inaccurate self-assessments. Many of us view ourselves through a distorted lens.
In my role as a psychologist, I get to ask some pointed questions. In the beginning of therapy a standard query goes: “What experiences do you think helped shape your beliefs about yourself?” This leads to an exploration of their early life experience and the key messages they internalized from their parents, sibs, peers, boyfriends, teachers and preachers. We also explore their personality and the unique filter they brought into the world. Sometimes understanding (and challenging) the source of the negative self-perception can actually help a person start to question whether it still applies (or ever applied)!
However, here’s where things gets interesting: a person may have the insight and self-awareness to realize they are holding onto an outdated version of themselves, yet they are deathly afraid to give it up. They may have shifted seamlessly from typewriter to keyboard to touchpad, but when it comes to updating their Selfware, they are still writing with a stick in the dirt.
Instead of attempting to use logic to argue them out of it, a better step is to ask: “What if you could suddenly see yourself more accurately? What if you left here today with a clear, realistic sense of yourself? How might you carry yourself differently through your day and your life?”
The beautiful woman who views herself as fat and ugly says: “I would be more affectionate with my husband. I push him away because I don’t feel deserving of his love and affection.”
The intellectually gifted woman who fears others will judge me says: “I would start writing the novel that’s in my head because I wouldn’t be so paralyzed by others’ reactions.”
The creative woman who believes she can’t complete anything says, “I would start taking better care of my body and saving my money instead of always living in the moment. I’d start trying to build a better future for myself.”
The handsome singer who sees himself as hideous says, “If I felt good about the way I looked I would write more songs, perform at more venues, and push myself further in my music career.”

The courageous woman (whom I mentioned at the beginning) who thinks she is fragile and a failure says, “If I viewed myself as stronger and more resilient, I’d allow myself to be more fully present, to experience my feelings and to connect to people. I wouldn’t be so afraid of getting hurt.”
Even knowing the upside of adopting a more forgiving and balanced self-perception, we view our old story as a “crutch” (even though it causes us to fall down) or a “security blanket” (even though it leaves us out in the cold). Given the choice, we pick familiar pain over the unknown.
Here’s my version of a helpful metaphor from Anita Johnston, the author of “Eating in the Light of the Moon”:
You are holding onto a log while you float down a rushing river. The log (your old familiar self-defeating beliefs or behaviors) may have saved your life at some point, but there is a waterfall up ahead. You can hear the water crashing on the rocks below. You may let go for a moment to swim around the log, but you don’t trust yet in your ability to swim. You build up your strength until there comes a moment when you have to take a leap of faith in your ability to survive. In a burst of courage, you push off from the log and discover…
….you can swim afterall~
Solid ground and a richer life welcome you on the shore…

Dina Zeckhausen is a nationally known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for and You can visit her on the web and

What Happens When Mom Has an Eating Disorder?

Flight attendants have it right – and the advice is just as useful for those on a plane as well as off. “Remember to place the oxygen mask over your nose and mouth before assisting your child.” In other words, fail to take care of yourself and you won’t have what it takes for your kid. This is especially true for mothers with eating disorders. Anorexia is the most blatant form of self-neglect. Its theme is the refusal to meet the body’s most basic needs (for food) but it often entails the denial of other important needs (i.e. love, pleasure, intimate connection).
While the stereotype is that eating disorders are a current day affliction caused by media images, they’ve been around for centuries. Generations of women have suffered, but they were undiagnosed and untreated. Some wound up in mental hospitals or experienced chronic illness and early death from malnutrition or suicide. Those who were higher functioning got married and had kids.

When an eating disorder goes untreated for decades it becomes an entrenched and defining quality of one’s self-concept.
I’m the thin one.
I’m the one who resists the treats at the restaurant.
I’m the one who cooks for others but never succumbs to temptation.

The “pride” in being able to achieve these victories over the body’s needs is a substitute for self-worth. Like saccharine, its momentary sweetness has no real substance behind it.
Unfortunately, the older generation of moms had little awareness of how living on nicotine, caffeine, saccharine and adrenaline would affect their offspring. Their adult children often struggle with a deep and abiding sense of emptiness.
Olivia sits in my office, the daughter of one of these moms. “I’m grumpy,” she starts off one summer morning. “Actually, I’m hung over, as in ‘Food Hangover.’ Had dinner with Mom last night.”
A successful, attractive professional in her late 40’s, Olivia secretly binge eats whenever she spends time in the presence of her mother. That night before, Mom had come through town and taken Olivia out for dinner, ordering a side salad with no dressing and black coffee (“…always the damn black coffee!” Olivia fumes). Her mom excused herself several times to step outside for a cigarette. She looked with judgment and disdain as Olivia ordered dinner off the menu. By the time dessert arrived, Olivia was planning her post-dinner binge back at the house.
Olivia felt like her mother wore her anorexia like a badge of honor. During her childhood Olivia’s mother never ate dinner with the family. When they went on vacation, her mother would avoid eating all day, admonishing the kids, “You’re not hungry!” when they started asking for lunch around 2:00 p.m. Sometimes Olivia would discover her mom quietly eating a box of crackers late at night in the dark kitchen; she’d hide the box like it was heroin.
Because she was chronically hungry, Olivia’s mother was often irritable and short-tempered, blaming Olivia for being “overly dramatic” or “too needy,” a trait most loathed by someone with anorexia. Because her mother’s cup was empty, she perceived her daughter’s normal needs (for love, food, attention) as burdensome. Because Olivia was a bright, sensitive child, she could come to no other conclusion than that she was faulty, unlovable, too much, a disappointment. Despite her many friends, her professional success, and her delightful and effervescent personality, for 47 years Olivia has held firmly to this core belief.

Thankfully, today there is less shame and greater awareness about treating eating disorders. Moms who are suffering are seeking help.
Kerri, a mother of three, had become so depressed from her food rituals that she was not able to parent her kids, spending hours every day in her darkened room. She avoided family meals, then binged and purged when they were otherwise occupied. She sought therapy when she became frightened by her suicidal plans. She’d written the good-bye letter to her kids and staked out the bridge she was planning to drive off. But her eldest daughter was on the verge of puberty and starting to worry about her body image. This was Kerri’s wake-up call. She did not want to abandon her daughter at such a crucial stage. She remembered feeling emotionally neglected by her mom at 13 and believed that this contributed to her bulimia.
She called me for help, petrified to reveal her secret to her husband, but ready to break bulimia’s 30-year grip.
Kerri has worked hard in therapy these past two years. She is now fully engaged as a mother because she is trying to meet her needs by getting sleep, eating meals, exercising, taking medication for depression (and having hot dates with her husband!). She has meaningful discussions with her daughters about their changing bodies, saying the things that she wished her mother had told her at that age. Her kids now see her as a source of love and support rather than a source of pain.

Meanwhile on a summer morning, I try to help Olivia stop taking her mother’s inability to love her personally. Even as the Adult Olivia knows her mother has an untreated illness, the Kid Olivia still believes the faulty messages that her mother conveyed. So Olivia will need to fill the emptiness with real acts of love. She can nourish her body with rest and exercise and delicious meals (with no guilt). She can fill her heart with the love of her close friends. She can feed her soul by making a difference in the world.
Food is as essential as oxygen for our survival, but you never hear people feeling guilty for breathing too much, or making ridiculous statements such as: “Wow, you look great! Are you cutting back on oxygen lately?”

Maybe when a woman decides to become a mother, her doctor should say something like: “You are about to embark on an important journey. Please be sure to feed and nurture yourself before you attempt to nourish a child.”

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for and  You can visit her on the web at and