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

The Gift of Depression

So you’re driving along in your life and the Check Engine light comes on. You ignore it, maybe even put some tape over it. You hear a clunking sound; you turn up the radio. All of a sudden, the engine seizes up. You can’t move forward. It’s lonely and foggy out here. You look around and the reality hits you: “I am Depressed.”

The most insidious quality of Depression is that it steals the energy that allows you to do the things that will help you feel better. If you either cannot sleep or can’t get out of the bed, you are drained of the energy to be with people, feed yourself well and exercise. Your self-worth drops; those things that brought you joy only cause numbness. It’s time to get thee to a mechanic.
The recipe for recovery typically involves two parts (although not always!): Part 1: Medication, and Part 2: Psychotherapy.
Some folks try to omit one ingredient. One way to think of it is that sometimes Part 1 gives you the strength to do the things that you learn about in Part 2.

As someone in charge of Part 2, I view Depression as a gift (if used properly!). The gift is that it can be the impetus to reach out for help. Seeking therapy is both a gift to yourself (how awesome to be able to talk about yourself for an hour) and a courageous act (you may make discoveries that push you out of your comfort zone.) Sometimes the places where you get stuck are unconscious remnants from your childhood: exploring your patterns with an outside observer may help you move your life in a new direction.
I have noticed a number of themes amongst my clients battling Depression.
Lack of connection.
An older single man found himself eating boxes of cookies every night to soothe his Depression. His alcoholic mother had not filled his emotional tank when he was a kid; as an adult he had trouble comforting himself when he was alone. A former alcoholic himself with 20 years of sobriety, he was encouraged through therapy to re-started attending AA meetings each morning. He made breakfast dates and dinner dates. He plugged his friends’ numbers into his cell phone and scrolled through his address book when he felt lonely (instead of hitting the cookies). Over time his Depression lifted as he internalized the awareness that he was loved and an important part of the web of human existence.
Lack of meaning.
A middle aged woman had spent 20 years raising her kids. When they left home, she cared for her sick mother. When her mother decided to move in with my clients’ brother, my client became severely depressed. In therapy she realized that her life had lost its purpose: to care for others. She realized that volunteering at the local children’s hospital could meet that need. It helped her realize that she mattered, and lit up her heart when the hospitalized children smiled at her.

A stalled grief process.
A single woman who had struggled to find a healthy romantic relationship lost her father to cancer. He had been her sole source of unconditional love, as her mother was critical and judgmental. Left without her father’s love, her grief morphed into Depression. She felt paralyzed month after month; she withdrew from her friends and comforted herself with her dogs, TV and food. As she spoke in therapy about her father, she realized that the way to honor his legacy of unconditional love was to give that love away. Rather than waiting for a man to love her, she started exploring the possibility of adopting a child. This re-energized her and gave her father’s loss meaning.
Anger turned inwards.
One woman became suicidally depressed after 40 years of tolerating her emotionally abusive husband. She feared speaking up because he could get “so mean.” In our sessions, she realized that painful experiences in her childhood had taught her to please others and caused her to believe that she was helpless to change bad situations (hence, her decision to end her life rather than speak up!). She learned in therapy that she had a right to express her dissatisfaction in her marriage. Her husband attended some sessions, and her new assertiveness changed the dynamics in their marriage. He learned to listen and not interrupt; she learned to tolerate his insensitivity and discovered she had a thicker skin than she realized. As she found her voice, her Depression abated and their marriage improved.
Not measuring up.
A teenage boy wanted to die. He’d just seen the roster for the school’s football team and he had not made the cut. His family lived for football, and his parents had spent the past year talking about his try-outs for the upcoming season. When he didn’t make the team, he was devastated at having disappointed his parents. But when his parents responded with support instead of disdain, he felt relieved. When the coaches encouraged him to switch to a new sport, the cloud of Depression lifted. His life wasn’t over, it was just turning in an unexpected direction.
Unexpressed creativity.
A 40-something wife had put her creative energy on hold for over 12 years; her husband’s job kept him away from home and caused her to act as a single mother. For years, she had neither the time nor energy to devote to her significant artistic talents. When she came to see me, she was binge eating and purging to medicate her Depression. When she demanded changes in her marriage, her husband was willing to make changes to his work situation. This freed up time for her to pursue her creative pursuits. Her brain chemistry changed when she was engaged in her art; she realized that she ignored this aspect of her psyche at her own peril!

The well is dry.
A depressed nurse came for help. While she loved caring for her patients, she was on-call 24/7. She gave and gave, but had no chance to fill her own cup: friends, yoga, exercise, sewing had all fallen by the wayside. She took a medical leave. She realized that she had difficulty setting boundaries in a number of areas in her life, especially with her mother. As she started to say “No,” she freed up energy for herself. As she decided to shift her nursing career to one that accommodated a saner schedule, she felt more like herself again.
So if your Check Engine light is on, ask yourself:
§  Am I feeling disconnected?

§  Is my life lacking meaning or purpose?

§  Are there tears I need to shed over a loss?

§  Is there anger I need to express?

§  Am I not measuring up to some fantasy ideal?

§  Is my creativity stifled?

§  Has my well run dry?

And if you need help finding the answers to these questions, your mechanic has an open bay.

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