Eating Disorders in the Family: Support for the Overlooked Tween

Recently, there’s been a growing awareness of the problem of eating disorders among women who are middle-aged and older. Guidebooks have been developed for the adult offspring of these moms to help them support their ill parent.   

But what if the child of the eating disordered mom is just a kid?  And what about the young siblings of teenage eating disorder sufferers?

Children between the ages of eight and 13 often end up as collateral damage in these families.

At a highly tumultuous stage of emotional, cognitive and physical development, tweens who live in a family wrestling with an eating disorder may be anxious, confused and overwhelmed by conflicting messages about food and their growing bodies. Often the needs of these kids are subsumed by the family’s total immersion in the illness and recovery of the “sick” family member.  

Imagine these scenarios from the child’s perspective: 

• A 10-year-old girl attempts to eat dinner but feels guilty when her mom serves a substantial meal to the family while only allowing herself dry lettuce and black coffee.   
• A 12-year-old girl notices her body changing. Dealing with this normal pre-pubertal weight gain is challenging enough around her skinny friends, but she’s mortified to discover that her exercise-addicted older sister wears smaller jeans than she does.  
• An 8-year-old boy feels an ineffable sense of dread when he hears his mom vomiting in the bathroom after dinner every night.  Afraid something is terribly wrong, he takes his cues from his Dad, holding his fear inside since he’s learned that “Mommy’s problem” cannot be discussed openly.       

Fast forward 20, 30, 40 years.  These are the adults suffering from depression, low self-esteem, addictions and eating problems.  Being raised in these families profoundly shapes their self-concept, their relationship with food, their interpretations about their emotional needs and their body image. They may struggle with feeling “too needy” in their intimate relationships. They may be driven by a chronic need to please and take care of others.  They may wrestle with drug addiction or develop their own eating disorders, having never learned to relate to food in a healthy way.  

Thankfully, even kids in these trying family situations can be remarkably resilient if certain needs are met. Here are ten fundamental needs of these kids:        

1. Additional sources of emotional support outside of the immediate family
2. An intellectual understanding that eating disorders are an illness so they don’t blame their family member or themselves
3. An awareness of the ups and downs of the recovery process
4. The knowledge that their feelings about the situation are normal, along with appropriate ways to manage sadness, anger, fear and envy
5. Healthy ways to deal with boredom, anxiety and perfectionism
6. A vision of Normal Eating
7. An understanding of the complex connection between food and feelings   
8. A dose of media literacy to inoculate them to “eating disorder messages” in the culture
9. A knowledge of why restricting food (i.e. dieting) could be potentially dangerous for them
10. A positive body image based on their body’s functions and abilities, not based on weight, shape or size   

It’s important to help these kids understand what is happening to their loved one and normalize their response to the crisis in the family. They need permission to have their own needs and feelings about the situation, while learning healthy coping skills and how to support their loved one. 

Focusing on the needs of these kids is vital prevention work. The combination of Nature plus Nurture puts them at high risk for developing eating disorders or other addictions. With the proper help, they need not become collateral damage in a family’s war against an eating disorder.   By engaging with them and addressing their needs directly, these tweens can grow into resilient teenagers and mentally healthy adults.  

Dina Zeckhausen, PhD, is the author of “The Ultimate Tween Survival Guide to Eating Disorders: Understanding Them, Preventing Them and Helping a Loved One.” (Zeckhausen, 2012).  Dr. Cynthia Bulik writes: "The Ultimate Tween Survival Guide" addresses the unique needs of young tweens who are struggling to make sense of their loved one’s eating disorder.  Grounded in the most current research on these complicated illnesses, Dr. Zeckhausen has created an accessible, hopeful and empathic resource to help support your loved one’s recovery."  

Learn more at www.tweensurvivalguide.com.

Grief: Losing Mark

This is a hard one to write.  I could say I was too busy or have nothing new to offer on this subject.  But truthfully, my hesitation about facing this column is that words feel inadequate, hollow, empty.

All I want to do is tell you about my cousin Mark, present you with a slide show of his big life, create a documentary, share a thousand stories. But I only have 1,000 words and this is about what it’s like to lose someone we love.  

How do we bear the pain?  How does it change us? How can we thrive and not just survive?  

So there’ll be no bullet points, no “Top Ten Tips on How to Cope with Loss.” I’m just going to share my reactions and experiences over the year that followed the worst day of my life. 

Driving home from work on March 16, 2011, my cellphone rang. My mother was sobbing: an airplane crash, my cousin Mark in the plane, he was dead. 

I’ll never erase the sound of anguish in her voice as she cried those horrific words.  A sick feeling emanated from the pit of my stomach, crawled up the back of my throat. I left my body. This was not happening.  Sweet Mark, whom I’d known and loved like a little brother since he was born… 

I don’t remember the drive home.  At the house, in a daze I sat at the computer and Googled “plane crash Longbeach.” And there it was: scenes of wreckage, a plume of smoke, witness reports…then the victims were identified and there was Mark’s name and his smiling face.   This bad dream was only getting worse.  

Mark and five buddies were on a small plane headed to Salt Lake City for a ski trip.  Immediately after takeoff, the plane banked and plunged to earth.  Only one man survived.  

Mark was only 44, a gifted athlete, a kind and generous man, a devoted father to his three teenage kids.  He had made an indelible impact in his community.  His motto was “Go Big or Go Home.”  His memorial service included a bike ride, a beautiful outdoor service and a Hawaiian paddle out ceremony with hundreds of people on surf-boards wearing leis. 

For weeks afterwards, my mind flashed with images, which triggered a fresh torrent of tears.  Alternating between images of the crash itself, was the gut-wrenching pain I felt for those who’d be most affected by his loss on a daily basis. I’d picture Mark’s mom losing her beloved son, his kids who’d experience a gaping hole in their lives. I’d imagine Mark’s two younger brothers and the indelible bond of this threesome since losing their Dad when they were kids.  I’d cry for Mark’s wife and the responsibility she’d feel to be strong for their kids.  I grieved that he would be missing from our family gatherings, that my kids wouldn’t experience a life-long relationship with their uncle. 

Mark was such a large presence that he seemed invincible.  I always felt that our family was blessed with good fortune, but deep down I feared that one day our “luck” would run out.  Mark’s death was so sudden, violent and unexpected that it shoved my previous world view off its axis.  I never imagined that THIS would be the unforeseen tragedy that the Universe had in store for our family.   

  

In those first few months I wondered what other tragedies were waiting around the corner. I started imagining horrific scenes of tragic accidents, deaths and losses happening to those I loved.  Anticipating worst case scenarios, my mind was trying to ward off death.  

Those first few months were an emotional roller coaster filled with flashes of pain, fear, sadness, disbelief, and then spells of denial.  But each morning I’d wake up, slapped by the harsh truth that Mark was really gone.   

As the denial wore off, I became more aware of a profound and deep sense of the fragility of life.  Even though I felt more vulnerable, the panic subsided.  While the pain and sadness were still very present, a new sense of peace was taking its place.     

Eventually more life-energy returned, which I experienced as a deep connection to Mark. He had a “Go-for-it,” “No-Excuses” philosophy of life.  Connecting to his drive, I found myself saying yes to new projects and no to things that didn’t feel like a valuable use of my time.  I took on new challenges with renewed optimism. 

  

I also started to experience each moment more fully.  I’ve become more present with my children, aware that in the blink of an eye they’ll be leaving home.  And because I know that at any moment I could be taken from them, I fill their love cups to the brim, pouring every drop of me into them.  I take extra time to focus on them, listen to them, touch them.  I’ve become more appreciative of all of my relationships and try to infuse more love into my interactions with others. 

  

I have also found myself feeling greater empathy to anyone experiencing grief or loss.  I now know from the inside how hard it is to navigate this world with a huge ball of pain in your heart.  

I still cry a lot in my car listening to the radio. Two popular songs can trigger a flood of tears: “If I Die Young” by The Band Perry and “Live Like We’re Dying” by Kris Allen. Rather than turn the station when these songs come on, I cry without regard to the concern of people in the adjacent vehicle.  The other place I weep is at my computer.  I click on certain Facebook pages- Mark’s page, his kids’, his wife’s, his brothers’, his mothers.’  Their words and pictures help me feel connected to the community of people who love, miss and were impacted by Mark’s life.  This alleviates some of the loneliness of the grief.  My heart needs these Tear Releases.  It doesn’t feel right when I go too long without crying. 

Near the anniversary of Mark’s death, my family flew to Salt Lake City to ski, embarking on the trip that Mark never got to complete. I wondered if I’d have a panic attack on the plane, but instead a feeling of calm washed over me. As we flew into Salt Lake City, a bright moon rose over the Rocky mountains.  “Hello, Mark.”  

I felt his presence traveling up the lifts, surveying the gorgeous craggy mountains and watching daring skiers carve turns on the off-trail runs.  Mark would’ve been one of those guys hiking with his skis on his back, then whooping with joy as he gracefully dominated the mountain.   

I stuck to the groomed trails and wore a helmet for the first time in 45 years of skiing (no more illusions of invincibility).  I warned my boys, “Be careful!” and caught my breath as I watched them ski away into the woods.    

        

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 ShareWiK.com. You can visit her on the web at dinazeckhausen.com andMyEdin.org.

Binge Eating and Obesity: Overcoming the Need to Numb

     When people think of eating disorders, they picture the starving 15-year-old girl or the college student throwing up after a cookie binge.  I’d like you to expand your definition.  The 40-year-old woman about to undergo gastric bypass and the successful businessman who is 80 pounds overweight are both wrestling with eating disorders that are no less harmful and debilitating than anorexia and bulimia.      

     Unfortunately, these particular eating disorder sufferers are more likely to encounter a physician than a therapist.  The sad truth is that most physicians are woefully under-trained in nutrition or the psychology of over-eating.  Many doctors write prescriptions for obesity-related ailments but have neither time nor expertise to address underlying causes.  Many feel helpless and frustrated with overweight patients, viewing them as “awkward, unattractive, ugly, and non-compliant” (Obesity, Research Journal, 2003).  Since physicians report having “lower respect” for their overweight patients, it’s not surprising that many of these patients, sensing this disdain, avoid the health care system altogether  (Journal of General Internal Medicine, 2009). 

     

     Recently, I’ve seen an increase in overweight clients entering therapy.  Some are verging on diabetes.  For others, this is their last stop before bariatric surgery.  Still others arrive after surgery, stating, “I know I need to get my head on straight if I’m going to keep the weight off.”    

So many people want quick, simple solutions to this complex problem.  I’d like to share just a few of the themes that come up in our work together so you’ll understand why a diet, a pill or even surgery often won’t do the trick.   

  

***

*Growing up as an overweight child who was teased and bullied for her weight, Jan’s self-worth is in the gutter.  She’ll need to learn to separate her "Worth" from her "Weight," no easy feat in this culture. By developing compassion for herself, taking better care of herself will start to feel right.  (How can you take care of something you hate?)   

*Uncovering and resolving childhood trauma is crucial.  As a child, Danielle used food to both punish and nurture herself after she was sexually abused by her stepfather. She unconsciously kept on extra weight as protection from unwanted sexual advances growing up.  As she works through this trauma in therapy, she’ll learn to establish healthy boundaries so it will feel safe for her to live in a body that attracts attention.  Therapy will also help her become more accepting of her own sexual needs and desires.   

* As a teenager, Tom gained 50 pounds after his mother died from cancer, soothing his feelings of loss and sadness with food.  He’s been unable to shed the weight through dieting.  Allowing himself to grieve will free him of the need to numb through binge eating.  

*Abby alternates between Denial and Panic.  She refuses to look at pictures of herself or gaze into a mirror.  Whenever she really sees her body, she becomes overwhelmed, angry, helpless and despondent.  Abby is learning to see herself accurately as well as manage her anxiety about her weight.  Until she faces and accepts the reality of where she is in this moment, she will continue to use food as soother, comforter and numbing agent. 

*Gary is learning Patience.  Now that he’s got his eyes open, he wants the weight off fast.   He must resist the siren call of “Lose 30 pounds in 30 days” lest he follow that with “Gain 40 pounds in 40 days.”  It will take time to re-wire his brain since it has followed the same neural pathway (i.e. bad feeling=go eat) for decades.  It may take a year to lose those 30 pounds forever, but more important than looking good at the reunion a month from now is being able to dance at his grandson’s wedding 20 years from now.  

*When you look at Sarah, you would not guess that she is a Perfectionist.  But this is the most common attribute shared by every person struggling with an eating disorder.  For binge eaters, the logic goes, “If I can’t follow my diet to the letter, then I might as well eat whatever and however much I want!”  It’s All or Nothing, Black or White, On or Off.  I remind Sarah that the goal is Normal eating, not Perfect eating.  Normal eating is flexible and probably averages out to about 80 percent healthy, 20 percent not-so-much.  This is a formula that a person can live with forever.  

*Ken is intrigued when I suggest he start listening to his body.  He realizes that he has tuned out the signals in his gut for decades. He ignores his satiety signals and barely recalls the last time he experienced hunger.  As we explore his fear of hunger, tears accompany his memories of childhood neglect and loneliness.  Ken is surprised to discover that connecting to this sadness actually helps him feel more alive and whole.  Discovering his ticket out of his eating disorder lies in his gut and not his brain is a new and exciting (and scary) concept.       

*Amanda is learning to recognize the Voice of her eating disorder. It says “I love you and I can make you feel better right now.”  It comes from the primal part of her brain focused on immediate pleasure.  But she can learn to shift into her frontal cortex where she has the capacity to think of the Big Picture.  In a different part of her brain, she can imagine how she’ll feel after she’s overeaten, how she’ll feel in the morning when she wakes up stuffed, how this binge will impact her health over time.  Her challenge is to stay conscious, awake and connected to the big picture when the Voice whispers, “Worry about all that stuff later…”    

*At age 60, Brenda is finally learning to say “No.” Her life-long pattern of taking care of everyone else’s needs only led to resentment, angry blow-ups and debilitating guilt.  Over-eating had been her way to take care of herself.  She’s learning that saying no to others frees up time and energy for activities that are truly fulfilling (and not just filling!).  

***

     Recently a YouTube video from Britain’s Got Talent went viral. It features Jonathon Antoine, an overweight teen who sings like Pavarotti.  Before he sings, you see disdain and disgust on the faces of audience members.  Then he opens his mouth and we discover he is gifted, vulnerable, sweet and courageous.  Our harsh judgment is suddenly transformed into a rush of compassion.  

     Perhaps we can hold onto this little moment of insight when we step away from our computer screens.  We might all feel a little lighter. 

     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 ShareWIK.com. You can visit her on the web at dinazeckhausen.com andMyEdin.org. Follow her on Twitter @drzeck.

Preventing Eating Problems in Our Kids

Eating problems among children are epidemic, with obesity rates in some states as high as 33%.  Some schools are sending Body Mass Index (BMI) “report cards” home to parents in an attempt to address this problem.  While many parents are, in fact, aware of their children’s weight status, education about nutrition and exercise are not always sufficient to address these complex issues.

The fact is that many children (like adults) use food to comfort difficult feelings.  Parents may put their kids on diets (or a child may start her own) but these efforts are rarely effective and may actually backfire.  Depending upon a child’s personality, putting a kid on a diet may produce obesity in the rebellious child (“I’ll just binge when Mom’s not looking”) or anorexia in the compliant child (“I’ll make Mommy proud and eat PERFECT from now on!”).

Interestingly, children with anorexia and over-eaters share two common traits:

1. they misread or are disconnected from their hunger-fullness signals
2. they are not very good at labeling feelings.  The technical term for this is “Alexythymia”—Latin for “lacking words for feelings.”

The bottom line is this: if you want to help prevent your kid from developing an eating problem, obsessing about carbs, fat grams and calories, you may be barking up the wrong tree.   The best approach may be to help your child tune into her body, learn to interpret its signals accurately, trust the wisdom in these signals and then to respond to them appropriately.

Radical concept, I know. It may even seem like a Herculean task if you’re a chronic dieter and baffled by your body’s subtle language.  Do you use food for comfort, for reward, or to numb your stress?  Have you embarked on a diet because your career, marriage or life felt out of control?  Helping your child understand and trust her body can be tough if you have an ambivalent relationship with your own.

So Step One is for you to start listening to the subtle language of your own body.   How often do you use food – or the restriction of food--to meet non-food related needs?  Keep track for a day and let me know what you discover~

Dina Zeckhausen is a nationally-known psychologist who specializes in treating adults, teenagers and children with eating disorders and body image issues. She is a regular ShareWIK.com columnist and the author of the children's book, "Full Mouse, Empty Mouse: A Tale of Food and Feelings."  You can visit her on the web at dinazeckhausen.com and MyEdin.org.

Remembering Lisbeth: Tribute to a Fallen Soldier

This past week, Lisbeth Rhine, the head of the Eating Disorders Information Network, lost her battle with anorexia.  Her death is a devastating blow to those who knew and loved her as well as the eating disorder recovery community as a whole.  It is especially tragic when a person who is a champion for this cause succumbs to the illness.  We feel an overwhelming sense of futility and hopelessness when we lose a warrior on the front lines.   

I met Lisbeth when she joined the EDIN board four years ago.  She was passionate about the issue because she had battled with an eating disorder for decades, dating back to her days dancing with the Atlanta Ballet.  She was an active and involved board member, always raising her hand when we needed a volunteer.  When EDIN needed a new executive director, Lisbeth stepped in as interim director.  She did such an excellent job that the board made her role official.

Lisbeth took on the role of running a nonprofit just as the economy was tanking.  Dozens of charities were closing their doors. Lisbeth made sure EDIN was financially sound, sometimes refusing to pay herself so that EDIN would be in good shape.  She was a dedicated steward of our resources, eliminating expenditures and making us a lean, mean nonprofit machine.  

Over the years Lisbeth’s role expanded.  In the tough economy, she steered EDIN away from annual galas to a popular new fundraiser, the Celebrity Dance Challenge (CDC). She worked tirelessly behind the scenes to organize these highly successful, entertaining (and affordable) events.  

Even as the leader of an organization, Lisbeth was uncomfortable in the limelight.  Two years ago, I was invited to dance in the opening Bollywood number at the CDC.  Just before the big night, a dancer dropped out. I convinced Lisbeth to take her place.  Lisbeth’s dance background was evident as she instantly picked up the moves.  Remembering her out there onstage, I imagine this was a healing experience for her.  After the high-pressured world of ballet, here she was in a rocking, sexy, funky dance.  It was gratifying to watch her take a risk and experience dance in a new way.  

Despite dancing in front of crowds, Lisbeth had a terrible fear of public speaking, an important part of her new role with EDIN.  She recognized that it was important for her to conquer this fear, so after some coaching and encouragement, she started addressing groups of kids, teens and parents.  This past fall, she even spoke at the CDC, openly sharing her own struggle with an eating disorder.  For someone who held her cards close to the vest, this was a big moment.   

To see how much she had grown personally and professionally, people might think that she had conquered the demon, maybe even driven him out of town.  This is why we were all so shocked by her sudden and unexpected death.   

An event like this leaves survivors with a painful mix of feelings.  After the initial shock is a wave of guilt.  “What could I have done?  Did I miss the signs?  Could I have saved her?”

After the guilt comes anger: “How could she abandon us?” 

Then, the loss of hope: “How can we defeat an enemy that destroys our leaders?”  

Then, guilt about feeling angry: “How can I be angry at someone who suffered and died? I am horrible.”  

Please do not feel guilty for feeling angry.  What happened should make you feel angry.  We all feel angry at the senselessness of this loss.  

Losing Lisbeth is wrong.  

Those of us in the trenches often feel like David fighting a cultural Goliath.  We need tireless optimism and hope to keep soldiering on.  Such a loss can steal our resolve or throw us off our trajectory.    

So we must utilize and channel our hurt and anger.  Used properly, anger propels us to act.  This is why it’s helpful to think about the Eating Disorder (ED) as an entity separate from the person suffering from it.   This is the only way to understand how a loving, kind and caring person like Lisbeth can hurt herself.  Lisbeth was tormented by an inner bully so evil that it took her life.  

Be angry about this.  Be angry at ED.  Be angry about all the places that ED appears in our lives, then speak up, confront it, challenge it and change it.

Lisbeth’s death does not make any sense, but her life was important.  The way to honor her life is to continue in her mission.  And that means we must love fiercely.  Be brave in your love, and give your compassion away freely, not just to others but to yourself.  Beating yourself up only feeds the enemy.   

Finally, I want to share a beautiful poem that was sent to me today.  Obviously the universe wanted me to share it with you.   

The Summer Day by Mary Oliver

Who made the world?
Who made the swan, and the black bear?
Who made the grasshopper?
This grasshopper, I mean-
the one who has flung herself out of the grass,
the one who is eating sugar out of my hand,
who is moving her jaws back and forth instead of up and down-
who is gazing around with her enormous and complicated eyes.
Now she lifts her pale forearms and thoroughly washes her face.
Now she snaps her wings open, and floats away.
I don't know exactly what a prayer is.
I do know how to pay attention, how to fall down
into the grass, how to kneel down in the grass,
how to be idle and blessed, how to stroll through the fields,
which is what I have been doing all day.
Tell me, what else should I have done?
Doesn't everything die at last, and too soon?
Tell me, what is it you plan to do
with your one wild and precious life?

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 ShareWiK.com. You can visit her on the web here and at MyEdin.org.

Not All ADD Kids Bounce off Walls

     A few decades ago, a kid like my 12-year-old son Schuyler may have been labeled as spacey, absent-minded, creative, forgetful, or lazy depending upon the perspective of the viewer.  But by viewing his struggles through the lens of Attention Deficit Disorder (of the Inattentive variety) we’ve been able to better manage our frustrations and devise strategies for addressing the problem.  

     ADD/ADHD symptoms, like all psychiatric issues, fall on a continuum of severity.  Because Schuyler has a mild case, we’ve not invested in the $1000 testing battery, filled out the parent and teacher checklists, nor met with a psychiatrist to discuss medication.  Parents of children with more serious and disruptive cases may need to take those steps to chart a course of treatment for their child. I recognize that we are fortunate.   

     As the second child, Schuyler came into the world wired differently than his older brother.  He was incredibly sensitive to nuances of emotion and human interactions.  His heightened responsiveness also meant he was overwhelmed by sensory stimulation: too much light or heat or volume sent him into a crying jag. His Dad and I, both psychologists, chalked it up to his DNA; of course, we’d bring a highly sensitive kid into the world.   

     In elementary school we noticed problems.  His teachers would comment that while he performed well in class, he was not good at completing homework assignments and dropped balls academically.  Each year his teachers had different interpretations of the problem.  His third grade teacher put a positive spin on it: “Lots of gifted kids march to the beat of their own drummer.”  (What parent doesn’t like hearing their kid is “gifted”?)  His fourth grade teacher viewed him as simply disorganized and worked on developing systems for remembering homework, projects and tests.  (I appreciated her pragmatic approach).  His fifth grade teacher, a military man, seemed less patient, perhaps viewing him as the undisciplined product of touchy-feely parents. 

     Schuyler’s self-concept hinged upon the opinions of his teachers, rising and falling based on his slip-ups and the subsequent interpretations and judgments of the key adults in his life. None of them mentioned Attention Deficit Disorder.  Perhaps they were being respectful of our profession; perhaps they’d been warned not to diagnose kids.  I had a stereotyped notion of the disorder, assuming ADD kids bounced off walls, were loud and difficult to manage.  Schuyler was sweet and easy, just forgetful and absent-minded.  

     But by the end of fifth grade, I was at my wit’s end.  Schuyler could not keep up with his things.  He'd lose his sweatshirt on the playground the first day he'd bring it to school. In the mornings he’d step over the backpack that had been strategically placed in the middle of the hallway.  Day after day he came home without the necessary books for homework or having written down the wrong assignment.  

     My husband and I tried to temper our reactions, but Schuyler could sense we were frustrated.  He wanted us to be proud of him and he’d get very down on himself.  Sometimes at night he’d share his fear that he wasn’t as smart as his classmates or he couldn’t handle school.  

     Finally, I Googled “Symptoms of ADD” and there was a spot-on description of my child.  I learned that children with ADD/ADHD may be:

- Inattentive, but not hyperactive or impulsive.

- Hyperactive and impulsive, but able to pay attention.

- Inattentive, hyperactive, and impulsive (the most common form of ADD/ADHD).

     Since he was neither hyperactive nor impulsive, I delved into the description of “Inattentive signs and symptoms:"

    "It isn’t that children with ADD/ADHD can’t pay attention: when they’re doing things they enjoy or hearing about topics in which they’re interested, they have no trouble focusing and staying on task. But when the task is repetitive or boring, they quickly tune out.  Staying on track is another common problem. Children with ADD often bounce from task to task without completing any of them, or skip necessary steps in procedures. Organizing their schoolwork and their time is harder for them than it is for most children.  Kids with ADD/ADHD also have trouble concentrating if there are things going on around them; they usually need a calm, quiet environment in order to stay focused."

     There was something liberating about this description.  I decided to share my discovery with Schuyler.  “Schuyler, I think you have ADD.”  His reaction? He cried tears of relief, saying, “You finally UNDERSTAND me!” …and now he better understood himself.  

     Schuyler just completed his first year in middle school, a year of lockers, five different binders, six teachers and multiple classroom changes.  It was a year of juggling sports, music and drama, of new friends and new routines. 

     Thankfully his school focuses on helping sixth graders get organized.  His favorite teacher did a daily after school “Backpack Check” to be certain he had the right books.  While there were some dropped balls, he made it through without major trauma and without medication.  

     We realize we’ll need to be vigilant for the next several years.  Whenever we got lazy and didn’t check his backpack or look online for upcoming tests, he’d slip into old habits.  The new habits are still not established and it’s too easy for balls to get dropped.  

     Next year we’ll tighten the reigns, easing up when he’s on top of things.  Rather than sending him to his room to do homework, we’ll sit with him and check it when he’s done.  We’ll get test schedules from the teachers and study with him to reduce his anxiety about being under-prepared.  

     We’ll also feed him healthy food and be sure he gets to bed at a decent hour.  We’ll try not to over-schedule him since he drops balls when he’s juggling too many of them. We’ll better monitor his video game usage since it steals his time and attention from academics. 

     In other words, we’re going to have to be focused, attentive and conscious parents for a few more years.  As tempting as it is to back off, middle and high school will involve more social, extracurricular and technological distracters than ever.  By trying to instill good habits now, we hope that he’ll need less external support down the road and may be able to avoid medication in high school or college.      

     You might be thinking, “Why NOT just put him on Adderall?”  While his attention might improve, at this point we believe the costs outweigh the potential benefits for him. He’s already quite thin and we worry about the appetite suppressant quality of stimulants.  We don’t want him either losing weight or getting low blood sugars, which can lead to migraines (another downside of his environmental sensitivities).  We don’t want to create sleep problems, increase his anxiety, set him up for the energy drop when the dosage wears off, make him prone to future drug addiction, or, worst of all, change his personality.  

     So for now we are focused on a behavioral approach.  Re-wiring his brain from the outside isn’t easy, but it seems like a solid investment of our time and energy.       

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 ShareWIK.com. You can visit her on the web at dinazeckhausen.com and MyEdin.org.

Eat, Drink and Be Miserable

These days I see many women seeking help for binge eating only to discover they have serious drinking issues.  This week’s column is from a client who discovered the only way to fix her binge eating was to tackle her binge drinking.

Here’s her story: 

 

Awake.  Aware.  This is how I feel today.  It is Day 19 of my “60 Day Challenge,” a challenge I created to break free of my self-destructive behavior.  I’ve had an unhealthy love of alcohol and food that’s shaped my life for years.  

If you met me, you’d see an average 34-year-old woman with a few extra pounds.  In my work life, you’d see a successful go-getter.  Family and friends see a woman with a huge heart. But look below the surface and you’ll find someone without self-love or confidence.  

People use the term “rock bottom” when discussing addictions: my rock bottom wasn’t becoming homeless or a DUI.  My rock bottom was a family wedding. My mind was reeling before I left, anxiety through the roof.  When was the last time I’d seen Aunt Ginni? I’ve gained 20 pounds! What about my brother? At least eight pounds... And everyone takes pictures at weddings.  How many times will I have to “Remove Tags” on Facebook? 

How did I deal with this anxiety? Drinking and eating. By the second glass of wine, the anxiety was a distant, muffled sound.  I spent my entire wedding vacation over-drinking and over-eating. Back home, the tears wouldn’t stop because I’d spent a week around family I hadn’t seen for years, but every moment was spent feeling self-conscious about being fat, then self-medicating with food and wine.  No relaxation or appreciation of the precious moments that were in front of me.  

That was my rock bottom.  

I’ve got a beach trip in August, the first time we’ve had a family vacation since 1999.  I knew in my sobbing that I didn’t want to waste another opportunity to enjoy my family.  I wanted to go to Florida and not worry about trekking to the beach in my bathing suit.  More importantly, I want to feel truly present and confident that I’m making healthy decisions– bathing suit or not! 

I’ve known about my issues with food, but the elephant in the room was the alcohol, my segue into food.  Any control over my food is lost after glass number two of wine. The capoff to a drunken night was Taco Bell.  I’d wake-up hungover, drag myself to work and have the perfect hangover lunch: cheeseburger? Nachos?  Pizza?  I’d feel just good enough after work to do it all over again.

My "60 Day Challenge" included a commitment to exercise, eat smaller portions of healthier foods and no alcohol.  The last part scared me the most. I didn't trust that I could stick with it.  I feared for my social life.  Many of my friends love to drink!  How would they respond to my decision? Would I be any fun?!  

It turns out my fears were unfounded.  Here’s what’s happened:

1) The response was unanimous: overwhelming support. Mom hugged me and cried and told me that she’d stop drinking for 60 days, too.  We made countdown calendars with inspirational/funny sayings and send a picture text to each other every morning.  My friends say how proud they are, and many have opted not to order alcohol when we go out. 

2) I really DO have fun when I'm sober! I still laugh and make other people laugh. Plus, I have clear memories of the good times.

3) Relief!  I never realized I’d been basing my decisions around alcohol. If someone wanted to plan a non-drinking evening, my first thought was "Bor-ing"!  Since I always expected to be hungover, I’d avoid morning plans. Now meeting at 7:30 a.m. for a bike ride sounds great, whereas before I wouldn’t have considered it.  

4) I’m more aware and in touch with my emotions. I’d spent so many years numbing with wine, now I’m forced to "feel" raw emotions.  This actually feels healing. While I was always conscious of my bad decisions, I was hovering above myself in a haze.  All I knew was that negative voice, encouraging instant gratification with no regard for the big picture. Now I hear my Voice of Reason.

5) It’s not easy. I’ll never be "fixed." There was a part of me that thought that if I got skinny and sober I’d miraculously be happy, wake up every morning loving myself, find a wonderful man and live happily ever after.  I see how silly it was to think all my struggles would disappear. Being thinner and sober won’t solve all my troubles, but I’ll be better at dealing with them. I am a work in progress.  

6.) When I have the urge to binge, I ask myself: 1) How will I feel while I’m eating an entire pizza? (Great!) 2) How will I feel an hour afterwards? (Like Shit!) 3)  How will I feel tomorrow morning?  (Disappointed, beating myself up, spiraling into self-destruction).   This line of questioning is not fail-proof, but it’s very helpful (and applies to drinking, too!)

***

So today is Day 30! When I think back to the self-doubt and fear I experienced on Day 1, I feel so proud!!  I just returned from visiting my brother, my biggest challenge yet. We share the same love for beer and wine. When I arrived, my mind shifted to the old way of thinking.  It was tough to ignore my craving for a drink. But I tuned it out, and thankfully my brother didn't drink either. Phew!  We saw the hilarious musical, Avenue Q. In it are characters called the "Bad Idea Bears."  They constantly egg on this poor guy, urging him to make bad decisions.  He was depressed so they talked him into buying beer.  Then they convinced him to buy a case instead of a six-pack to save money! I laughed, re-naming my little voice my “Bad Idea Bear” (BIB). 

My BIB tries to convince me to come back to the fat, drunk side because that’s the cool, fun place to be!  I’m learning to ignore BIB and build up an arsenal of arguments to confront it  My ultimate goal is to let self-love speak louder than BIB and to implement the concept of moderation. This is the only acceptable relationship with food and alcohol moving forward. If I can live that way, I won't have to go on extreme diets or never drink again. 

This past month has brought me an unbelievable sense of awareness.  I find myself relating my life to music. The song that best describes me now is Katy Perry’s “Wide Awake.”  When I need empowerment, I play that song and sing at the top of my lungs.  It is exactly how I feel in this moment.  

Aware.  Awake.  Wide Awake.

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 ShareWiK.com. You can visit her on the web atdinazeckhausen.com and MyEdin.org.

Responding to Sexual Abuse: The Keys to Healing and Thriving

Sexual abuse shatters and disrupts the core of a person’s sense of safety, self and worth.  The damage inflicted can influence every aspect of a person’s existence. Because sexual abuse attacks the body and soul of the victim, it can cause shame, depression, disconnection from one’s own body, distrust in others, tumultuous relationships, addiction and eating disorders.   

At the same time, human beings are amazingly resilient.  Children who are abused by the same person in the same ways may grow up and turn out very differently.  An abuse survivor may into a drug addict or she may turn into Oprah Winfrey. 

Many variables determine the course of one’s life after sexual abuse.  How a victim copes may depend upon the relationship to the abuser, the frequency of the abuse, the nature of the abuse (from inappropriate touching to penetration), the stage of development of the victim, and whether physical force was used or other insidious forms of emotional manipulation. 

In my practice, I often work with adults who experienced sexual abuse as children or teens.  They typically show up for help dealing with other problems: depression, eating disorders, marital infidelity, addiction or trust issues.  It can take months or even years before an abuse history is uncovered.   When the story does come out, it is not uncommon to hear that the adults in their lives handled things worse than poorly.  In fact, their response to the abuse often compounded and deepened the damage.

·      Sherri’s mother not only didn’t believe her when she said that her step-father had molested her; her mother stayed married to him. “I had to just shut up and deal with it if I wanted to be part of the family.”

·      When Catherine’s mother discovered that Catherine had been abused by an older cousin, she beat her daughter for “bringing shame on the family.” At the time Catherine was seven years old.

·      Ashley’s mother was well aware that her husband was raping their daughters.  Even after he’d been incarcerated multiple times for these crimes, her mother continued to take him back, setting up Ashley and her sisters for more abuse.  

These stories may seem extreme, but they are just the tip of the iceberg.  Because of their family members’ denial, narcissism, or mental health issues, these women were shown not only that the abuse didn’t matter but that THEY didn’t matter.  It’s no wonder that they have suffered from poor self-image, tumultuous relationships, addictions, self-harm and eating disorders.  

These days we know more about brain development, reaction to trauma and ways to help victims of abuse recover. We are better equipped to shore up the resilience of a victim and increase the likelihood of a positive outcome in their life, if we handle things correctly.  

In the case where adults discover that a child or teen has been abused, there are several important steps that may help ensure the best possible result for the victim: 

1.    Adults need to believe the child who shares a story of abuse

2.    The adult must protect the child from any future incidents of abuse by physically removing the perpetrator from the child’s life and/or taking legal action

3.    The victim must be told (sometimes over and over) that in NO WAY was the abuse their fault and that it was 100 percent the perpetrator’s fault (despite what the abuser may have told her).

4.    The child needs permission to experience and express his or her feelings about the abuse (through crying, play therapy, art, poetry, journaling, self-defense, etc.).  The adults’ job is to help the child learn healthy and appropriate ways to do this.  

5.    While making sure the child does not feel at fault, adults should help the victim develop a safety plan in order to empower him/her to feel safer in the future.

6.    The victim must be taught healthy ways to self-soothe (positive self-talk, relaxation, meditation, etc.) so she or he does not turn to addictive behaviors for comfort.

Even those survivors whose family members took all the WRONG steps can still heal as adults. Typically the path from victim to thriver involves a therapeutic intervention.  An excellent book that outlines the path of healing is Dr. Judith Herman’s Trauma and Recovery.  Herman describes a number of stages in the therapeutic process. 

Here is a brief overview: 

·      Healing Relationship: Since sexual abuse is a breach that occurs within a relationship, healing from the trauma must occur within a relationship (i.e. you can’t go off by yourself and “fix” your abuse!).  The unique boundaries of a therapeutic relationship (confidentiality, a predictable time and place, a focus on the client’s needs) can make it an ideal place for the survivor to start to heal. 

·      Safety: A client who has been abused might “test” the safety of the therapeutic relationship by pushing the boundaries.  If the therapist consistently holds onto the boundaries in a loving but firm way (unlike their parents who may have had rigid, harsh or no boundaries) then the client will start to feel safe.  They will need to believe that the therapist can “handle” their feelings without rejecting, dismissing or humiliating her.  This takes time.  Be patient. 

          

·  Remembrance and Mourning: When the safety of the relationship has been established (which may require months or years) then the client may go into more details about their story. They may tell stories from their life that they never thought they would share. Breaking the silence and telling the entire story is very empowering, especially if the perpetrator or the family imposed silence.  Long-buried feelings of shame, sadness and anger may be felt and expressed for the first time.  The therapist can help the client accept these feelings and start to look on the child who experienced the abuse with more compassion. Grieving the childhood that they wished they’d experienced is often part of the process. 

· Reconnection: As the stories are told, feelings released and coping skills developed, the client will start to choose, create and build healthier relationships outside of the therapy office.

·  Commonality: The survivor will start to feel less alienated from the rest of the world, and they’ll experience greater connection to self, others and the web of life. 

Through this process, people can free themselves from the grip of their abuser and live a life with new meaning and purpose. They can integrate the story of abuse into the rest of their life story and put it in its proper perspective.

This therapeutic process can allow them to tap a surprising reserve of energy-- energy which used to be used repressing and numbing the memories and the pain.  Many who go through this recovery process discover creativity, productivity, generosity and even gratitude that they have never experienced before.

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 ShareWiK.com. You can visit her on the web at dinazeckhausen.com and MyEdin.org.

Heed the Cavewoman

Most of today’s afflictions and addictions are a direct result of our desire to not know what we know.  There are times when we cannot bear the anxiety, anger and grief that accompany harsh reality. Humans are constantly devising new methods for numbing our awareness: from cigarettes to heroin, from shopping to cellphones.  We find ways to leave our bodies because powerful emotions make us uncomfortable.  Knowing the truth can have frightening implications.  

A man involved in an intensely destructive marriage keeps himself numb with alcohol so he can better tolerate the craziness: “I’m afraid if I divorce her, she’ll kill herself.”   A woman who hates her job soothes her pain with chocolate every night: “I’m too fat to leave; no one would hire me.” 

This need to numb is a natural part of the human condition. We hone this skill in childhood.

***

When I was young I spent much of my summer barefoot, resulting in frequent splinters from wooden docks and rafts. There was nothing scarier than my mother approaching my tender heal with sharp implements, so I developed an effective numbing technique.  Whenever I got a splinter, I’d inform Mom and then run up to my bedroom where I’d will myself into an instant, deep slumber.  Mom would tiptoe in with her tweezers and needles, deftly removing the splinter like a surgeon operating on a sedated patient.  I’d awaken refreshed and splinter-less, running back outside to play.            

***

But my splinters were minor irritations compared to the pain of trauma, abuse, and loss that many kids experience.  Trapped in their bodies and their families, to maintain their sanity they must find ways to check-out without physically leaving.  Some kids escape into a world of imagination or develop severe dissociation. Others turn to junk food, cutting or starving to numb the pain. 

While these techniques are adaptive for surviving the pain of childhood, becoming an Expert Numb-er can hinder your decisions in adulthood.  Your gut is primal; it is a finely tuned Cavewoman built for survival.  She tells you when to Say No, Get Out, Save Yourself.  Silence her and you may end up in the wrong place, the wrong career, the wrong relationship.   

***

In my early 20s I dated a man who was stable, successful and kind.  After two months he proposed; in two more months we moved in together.  On paper, he seemed like great husband material. In my head, I couldn’t find a compelling reason NOT to marry him.  

The day we moved in together, I felt myself leave my body.  We’d have minor disagreements which would turn into days of silence and distance. I remember hovering above my body like those “near death” experiences, watching Dina below and thinking (with apologies to The Talking Heads) “This is not my beautiful life!”  I was floating downstream towards a rushing, crushing waterfall called “My Wedding.” 

I had a massive splinter, and I was sleeping deeply.  Mom took me wedding dress shopping, but I was not really there. She sensed that something was amiss, but she couldn’t fix it this time. I couldn’t remove the splinter myself because I couldn’t feel it.  

Around that time I went to my friend Martha’s wedding.  Through my fog, I watched her kissing and laughing with her new husband. At one point she grabbed me enthusiastically: “Oh my God, Dina! Congratulations on your engagement!  Tell me all about him; does he make you laugh?!”   

Her simple question brought me surging back into my body.  I fumbled through an answer, but something had shifted.  I couldn’t marry him. We had a fundamental disconnect.  Sure, we didn’t fight but we didn’t laugh either…not in the way that I needed to laugh.   No wonder I had left my body. But once I was back inside myself again, there was no turning back.  Soon after that, the Cavewoman spoke and told him: “We’re not going to make it.”  Then I was moving out and moving on. 

I’m so grateful that Martha asked me the key question which brought me back into my body, before the invitations, the vows and the babies.

***

I’ll bet you can recall similar Ah-Ha moments in your life, when the light bulb went on, when you suddenly saw something so clearly that it inexorably changed the direction of your life.  It was a feeling in your gut, wasn’t it?

Unfortunately, the notion of “listening to your feelings” has gotten a bad rap. Teenage bullies and narcissistic 20-somethings are blamed on parents who’ve over-indulged their kids’ feelings.  The Tough-Love-Suck-It-Up philosophy of the Tiger Mom movement is our culture’s typical knee-jerk over-correction.       

But there is a middle place.  

It’s about valuing the wisdom in our emotions and having the courage to view feelings as useful information. As a therapist, my emotional responses to my clients’ stories provide me with important clues.  But being “in touch with my feelings” doesn’t mean I cry all day long.  This ability to connect to my emotions helps give me both empathy and resilience.

I’m hopeful about our culture’s surging interest in yoga and mindfulness. These practices can help us tune back in to the stirrings of the Cavewoman.   

If you spent much of your childhood trying to leave your body, being present takes a courageous and concerted effort.  But you ignore your inner CaveWoman at your peril. Without her wisdom, you don’t know that your hand is on the stove until you smell your flesh burning.  Honor her and you’ll access the energy, courage and focus to run away from danger and towards a fuller, saner life.