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What My Eating Disorder Won’t Let Me Say: Letter from my Teenage Self

shutterstock_459573091Dear family, friends, healthcare professionals, teachers, and coaches:

          Please be my hope holder. I have eaten food out of trashcans. I have stolen food. I feel horrible, disgusting, and oh so ashamed. I desperately need you to believe in me, because, honestly, sometimes I think that I’m going crazy. My world is spinning out of control, yet, amidst this inner turmoil, I somehow look okay.

          You can’t tell how I’m doing by looking. Sure, I wear a smile, and, my resume seems to indicate that I have a bright future ahead. Physically, I even “look normal,” friends say. I might not appear sick or malnourished, but I am. A body size isn’t an accurate barometer for pain and suffering. Neither is an official eating disorder diagnosis or lack thereof.

          I’m more than a diagnostic label. While 1 in 200 adults in the United States have experienced full-blown anorexia nervosa, bulimia nervosa, or binge eating disorder, at least 1 in 20 (1 in 10 teen girls) have suffered with key symptoms—and need help. Not every eating disorder fits neatly into a little diagnostic package. Lesser-known eating disorders are not less than. In fact, Other Specified Feeding or Eating Disorder, OSFED, can be just as serious, or more so, than other eating disorders. No matter what diagnostic code my insurance company denotes by my name, I deserve recovery. (Sometimes, I need you to remind me of this.)

          Recovery feels backward. Imagine trying to do everything with your non-dominant hand. If you are right-handed, write with your left hand. This is how uncomfortable, how unnatural, recovery feels. As strange as it may sound, bingeing, purging, and restricting have helped me to navigate life. Eating disorders serve all kinds of purposes, including coping with anxiety, avoiding underlying depression, and pushing down past traumas. In this way, an eating disorder isn’t about food at all. Paradoxically, to heal, food is the best medicine.

          I can’t “just eat.” This is why I need help from experts. Something as seemingly simple and biologically driven as fueling my body (babies do it) feels impossible. I can’t just eat any more than a cancer patient can magically make dangerous cells just disappear. An eating disorder, like cancer, is a life-threatening illness that requires immediate attention.

          I might refuse help. I don’t want to be a burden. I feel guilty for spending money on treatment. Not to mention, I don’t believe that I am sick enough to deserve help. (Remember how I said that I’d need you to remind me that I am indeed deserving.) If my eating disorder were just a phase that I could stop, I would have by now. I don’t like to admit it, but I am still just a kid. I am a kid with a starving brain, one that can easily lose sight of this whole recovery thing

          Full recovery is possible. Apparently, I wasn’t born with an eating disorder but rather traits that made me vulnerable. I am learning that these traits, like perfectionism and persistence, aren’t inherently bad, but that I can use them for good. Being perfectionistic means that I am motivated and driven. What if I could use these beautiful traits in the service of recovery—and life—rather than my eating disorder?

          Recovery can bring us closer together. We hear a lot about how eating disorders tear relationships apart, but we don’t hear enough about how recovery can bring people together. You didn’t cause my eating disorder, but you can do a lot to help me get better.

          It’s not your fault. Nothing you did—or didn’t do—caused my eating disorder. Fifty to 80 percent of eating disorder risk is genetic and heritable. Add this stat to a culture that celebrates eating disordered behaviors (think dieting and over-exercising), and it’s no wonder I developed the illness— and that it hid for so long, from all of us. I’ve actually received compliments for having the psychiatric illness with the highest mortality rate, praise for killing myself. It’s all very confusing.

          You don’t have to understand. What my eating disorder drives me to do and say is hard for even me to grasp. What I need from you are love and support. I need you to believe me. If I say that I hate my body, I need for you to truly listen rather than reassure me over and over again. (You have probably noticed that doesn’t work.) Consider saying something like, “I believe you. I don’t understand what that’s like, but I’m here for you.” When in doubt, ask, “How can I support you?” Please keep this dialog open, because starting the conversation myself feels scary.

          Have patience with me. I might yell at you. Even if you say something inspired and helpful, something that I asked you to say, I might get upset. I’m more irritable than ever. This isn’t about you. I’m mad at myself. I’m mad at my eating disorder, which I am learning, in therapy, to personify as “Ed.” Much of the time, I can’t tell the difference between my thoughts and Ed’s. It might help for you to try this therapeutic technique, too: separate me, the person you love, from the eating disorder—the one who yells and pushes you away.

          I need you. Ed doesn’t like me to need people. This is similar to how, at times, he tells me that I don’t need food. At other times, I binge and purge people just like I do with food. But, beneath Ed’s lies, I do need you. I thank you.

          Beneath my eating disorder, I’m still here. Sometimes, you might think that the person you used to know—the “real me”—is gone. But, I haven’t gone anywhere. I am more than my illness, and I am learning more about who I am every day. No one would choose to have an eating disorder, but I am beginning to see the gifts of recovery emerge. Finding my voice is one.

Love,
Me
P.S. Many years later, as an adult, I can finally say: full recovery is possible!

A Senior Fellow with The Meadows and advocate for its specialty eating disorders program, The Meadows Ranch, Jenni Schaefer is a bestselling author and sought-after speaker.

Special Note from Jenni: I would like to thank my incredible community on Facebook, Twitter, and Instagram for providing key insights for this article. This post would not exist without all of your heartfelt comments. I am forever grateful for your support.

References:

  1. L. Klump, J. L. Suisman, S. A. Burt, M. McGue, and W. G. Iacono, “Genetic and Environmental Influences on Disordered Eating: An Adoption Study,” Journal of Abnormal Psychology, 118 (2009): 797–805.

K.T. Eddy, N. Tabri, J.J. Thomas, H.B. Murray, A. Keshaviah, E. Hastings, K. Edkins, M. Krishna, D.B. Herzog, P. Keel, D.L. Franko, “Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up,” Journal of Clinical Psychiatry, 2017 Feb; 78(2): 184-189.

  1. J. Thomas, L. R. Vartanian, and K. D. Brownell, “The Relationship between Eating Disorder Not Otherwise Specified (EDNOS) and Officially Recognized Eating Disorders: Meta-analysis and Implications for DSM.” Psychological Bulletin, 135 (3) (2009): 407–33.
  2. Thomas and J. Schaefer, Almost Anorexic: Is My (of My Loved One’s) Relationship with Food a Problem? (Center City, MN: Hazelden 2013, 2013).
  3. Strober, R. Freeman, C. Lampert, J. Diamond, and W. Kaye, “Controlled Family Study of Anorexia Nervosa and Bulimia Nervosa: Evidence of Shared Liability and Transmission of Partial Syndromes,” American Journal of Psychiatry, 157 (2000): 393–401.

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Helping Your Teenager Avoid Fad Diets and Improve Her Relationship with Food

shutterstock_269712278Every week there seems to be a new fad diet, claiming to be the latest and greatest method to “lose weight, and lose it fast!” Low carb, high fat, no fat, only plant-based foods, Vegan, Keto, Atkins, Whole 30, Paleo – the list is endless and ever-changing.

The trouble is, dieting in any shape or form can be destructive and potentially triggering, and especially for a teenager who may be susceptible to mental illness or an eating disorder. Fad diets come and go because they are simply not sustainable for the long-term, nor are they a realistic way of living.

Most individuals who attempt a fad diet may see some initial weight loss but often regain the lost weight plus additional pounds as well. This can create a vicious cycle that triggers many consequences, including damages to physical and mental health, low self-esteem, and poor body image. Research has found that 95% of diets fail, and most individuals who diet will regain their lost weight in 1-5 years [1]. Teenagers who diet can be at increased risk for other health-compromising behaviors, including substance abuse, unprotected sex, and smoking.

The Appeal of Dieting Among Teenagers

For teenagers who are becoming more autonomous and independent, dieting can have a luring appeal or something to try, simply because it is trendy and socially acceptable. On the surface level, dieting may seem like an innocent attempt to be “healthier”, but in actuality, dieting can progress into disordered eating or be a precursor for an eating disorder [2]. Dieting also gives a false impression that weight is something that can and should be manipulated, but this is a dangerous mindset, especially for a growing teen.

The concern with weight and shape is also very prevalent during the adolescent years, and teenagers are constantly exposed to an unrealistically thin beauty ideal that is portrayed in the mainstream media [3]. While there may be a variety of reasons for a teenager to be drawn into a fad diet, the desire to achieve a thinner body size and body image dissatisfaction, in general, are motivating factors behind the majority of weight loss attempts [4]. Research on adolescent dieting has found that 41% to 66% of teenage girls and 20% to 31% of teenage boys have attempted weight loss at some time in the past [3].

Teenagers are highly influenced by their friends and peers, though research has shown that adolescents’ communication with parents has a stronger impact on their health and well-being [5].

How to Help Your Teen Avoid Fad Diets

While it may seem impossible to be a voice of reason over the external noise your teenager may be exposed to, the good news is that you are more influential than you may realize. There are many different approaches you can take to help educate your teenager about the dangers of fad dieting and encourage better eating behaviors. Here are some practical ways that you can help your teen avoid fad diets and the associated consequences:

  • Keep communication open: It’s important for your teen to feel that they can talk to you, to reinforce the fact that they can always communicate with you about anything. Make consistent and regular time to check in with your teen and ask open-ended questions to prompt conversation. Listen intently and give her uninterrupted time to share with you. This will help build trust and encourage her to speak with you about various things going on in her life.
  • Be aware of red flags: If you are talking regularly with your teen, it’s important to be aware of anything that might seem off, in both conversation and in behavior. If you notice her skipping meals, avoiding social events, or disengaging from activities she previously enjoyed, these things should not be ignored. Gently communicate your concerns and try to get to the root of the problem. Remember – dieting is not about food, there is likely an underlying issue that is triggering her urge to lose weight or diet.
  • Have regular family meals: With overloaded schedules today, family meals have become more and more scarce. Making this a priority for your family ensure that you are having time to connect on a regular basis. This also allows you the opportunity to observe any behaviors in your teen that may warrant more attention. Just like you would schedule other important activities, make family meals part of your regular calendar.
  • Be the example: Teens learn and observe behaviors from their parents and the people they live with. If you teenager observes you or another parent regularly dieting or speaking negatively or your body, this will likely influence her perception of herself as well. If you frequently jump from fad diet to fad diet, feel unhappy in your body, or are actively trying to lose weight, consider how this might impact your teen. Enlist the help of professional support if needed to nurture a more peaceful relationship with food and your body.

Connecting to Help and Support

At The Meadows Ranch, we understand how important the family system is and the necessity for nurturing and supporting relationships. If your teenager is struggling with chronic dieting or an eating disorder, this can be difficult to understand and accept, which may disrupt the overall family dynamic. Know that you are not alone on this journey, and we are here to help your family heal. Recovery from an eating disorder is possible, and families are an integral part of the journey. Connect with us today to find out how we can help.

References:

[1]: Statistics on Weight Discrimination: A Waste of Talent, The Council on Size and Weight Discrimination, Accessed 12 July 2018

[2]: Pathological dieting, precursor to eating disorder, Philadelphia Eating Disorder Examiner, Accessed 12 July 2018

[3]: Dieting in adolescence. (2004). Paediatrics & Child Health, 9(7), 487–491.

[4]: Wertheim, EH, et al. Why do adolescent girls watch their weight? An interview study examining sociocultural pressures to be thin. J Psychosom Res. 1997 Apr; 42(4):345-55.

[5]: Tomé, G., de Matos, M. G., Simões, C., Camacho, I., & AlvesDiniz, J. (2012). How Can Peer Group Influence the Behavior of Adolescents: Explanatory Model. Global Journal of Health Science, 4(2), 26–35.

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Five Warning Signs You Need a Higher Level of Care for Eating Disorder Relapse

shutterstock_1123409633-1024x680Recovering from an eating disorder is a process that involves diligence, perseverance, and the support of people and professionals who know how to best help you. The eating disorder recovery journey is highly individual and will look different from one person to the next. A common experience among women recovering from an eating disorder is a relapse episode, or temporary regression to past eating disorder behaviors.

While eating disorder relapses do not mean that a person has somehow “failed” at recovery, the experience of a relapse could reflect that more help and support is needed along the recovery journey.  Research on eating disorder relapse is limited, but studies have found that risk of relapse may be higher among women with more severe eating disorders [1]. Studies have also found that the rates for relapse are higher in the first 18 months post-treatment [1].

Understanding Eating Disorder Relapse

Just like eating disorder recovery, the experience of a relapse will look different for everyone. While there is no current standardized definition of relapse, there are certain red flags to be aware of that might indicate a regression back to past eating disorder behaviors [2]. Understanding what these indicators might look like for you are important for early intervention and to connect to the support you need to maintain your eating disorder recovery.

Because eating disorders affect multiple aspects of a woman’s life, including her physical health, emotional and mental well-being, relationships, and more, it’s necessary to regularly assess these different areas to determine if greater help or support may be needed in recovery. For example, a woman recovering from anorexia may appear to be physically well (i.e. weight restored, eating regularly and a balanced variety of foods, etc.) but if she is struggling with intense body negativity or anxiety/depression, these are signs that shouldn’t be ignored, as more help might be needed.

Signs You Need a Higher Level of Care

Part of maintaining eating disorder recovery for the long term is to take an honest look at where you are, being proactive in caring for yourself, and not being afraid to ask for help if and when you need it.

The process of recovering from an eating disorder is not something to be “perfected” or a journey that you need to be on alone. Even after months or years of treatment, you may experience a relapse – and that is okay. Eating disorder recovery is often described as taking two steps forward and five steps backward; whatever direction you are moving in, you are still making progress toward freedom and a full life restored from what your eating disorder may have taken from you.

In some cases, an eating disorder relapse may be something you are able to recover from fairly quickly. In other situations, a relapse can be more severe and something that begins to escalate into a situation that you can’t control. Whatever your experience may be with a relapse, remember that you are not at fault. A relapse doesn’t mean you have failed or won’t be able to continue with your recovery. What is important is to connect to the resources you need to get you back on track. Be aware of these signs that might indicate you need more help and support healing from a relapse during your recovery:

 

  1. You can no longer feed yourself well: If you’re having trouble feeding yourself, maintaining weight, or if you are unable to sustain a meal plan, this may mean you need some intervention to help you troubleshoot the underlying issue. Feeding your body regularly and consistently is foundational to lasting recovery, and an inability to eat should never be ignored.
  1. You don’t engage in activities you previously enjoyed: If you find yourself isolating more from the people you love or are purposefully avoiding activities and social situations, this could be a red flag related to an eating disorder relapse. Isolation is a characteristic of past eating disorder behaviors that you should be aware of.
  1. Neglecting self-care: Being unable to maintain self-care, such as regular hygiene, moving your body in ways that feel good, staying current with doctor/therapy appointments, etc. can be an indicator that you are having trouble taking care of yourself appropriately.
  1. Re-emergence of eating disorder behaviors: If you have slipped back into maladaptive eating behaviors, such as restricting, rigid eating, binging or purging, this can be a sign that you may need more support to help you get back on track with your eating disorder recovery plan.
  1. Obsessive thoughts about weight and food: If you are having incessant thoughts about food and your body that you can’t seem to get rid of, this may mean that you need extra help in your recovery. It is never normal to be constantly thinking about food and your body, and if this pattern re-emerges for you, you may need additional support.

If something seems off to you at any point of your recovery, pay close attention to these red flags. You can never have too much support along your journey, and intervention at a higher level of care, even temporarily, can help troubleshoot any issues you are encountering in your recovery.

Relapse Prevention and Hope for Recovery

Part of relapse prevention for an eating disorder is ensuring that you have adequate treatment, to begin with. Wherever you may be in the process of recovering from an eating disorder, it is never too late to connect to the help and support you need. Whether you are just starting the process or are experiencing a setback in your recovery after years of treatment, professional intervention can help you get back on track and support you in building the skills needed to maintain your efforts. You deserve a lasting recovery that allows you to experience the fullness that life has to offer you.

At The Meadows Ranch, we understand the eating disorder recovery journey and can help you through the highs and lows. You don’t have to do this alone. Connect with us today to learn how we can help you recover from an eating disorder or get you back on track after a relapse episode.

References:

[1]: Berends, T., van Meijel, B., Nugteren, W., Deen, M., Danner, U. N., Hoek, H. W., & van Elburg, A. A. (2016). Rate, timing and predictors of relapse in patients with anorexia nervosa following a relapse prevention program: a cohort study. BMC Psychiatry, 16(1), 316. http://doi.org/10.1186/s12888-016-1019-y

[2]: Khalsa, S. S., Portnoff, L. C., McCurdy-McKinnon, D., & Feusner, J. D. (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders, 5, 20. http://doi.org/10.1186/s40337-017-0145-3

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Dialectical Behavioral Therapy for Depression and Bulimia

Eating disorders, including anorexia, bulimia, and binge eating disorder, often co-occur with other mental health conditions, such as mood disorders. Mood disorders that might interplay with eating disorders include anxiety, depression, post-traumatic stress disorder, and bipolar disorder. Research has found that mood disorders occur more frequently among individuals with eating disorders than those without eating disorders, making the illness and prognosis more complex [1].

A combination of mental illnesses that can develop alongside one another is bulimia nervosa and depression. Because of the severity of symptoms that can result from these co-occurring mental illnesses, professional and comprehensive treatment is necessary for healing and recovery. Important treatment options to consider for co-occurring bulimia and depression include psychotherapy, medication management, medical nutrition therapy, and more.

How Bulimia and Depression Overlap

Bulimia is an eating disorder characterized by binge eating, purgative behavior, and depressed mood following eating binges [2]. Depression and bulimia often overlap with one another, and the combination of these mental illnesses can perpetuate the binge/purge cycle of bulimia while intensifying depression.

For women who struggle with both depression and bulimia, it can be difficult to pinpoint how these illnesses develop alongside one another. Research has shown that there are several factors that influence the development of mental illnesses, such as bulimia and depression, including genetic predisposition, exposure to trauma, environmental stressors, and psychosocial factors [3]. Just like the age-old question of “what came first – the chicken or the egg?” it’s unclear if depression can be a precursor for an eating disorder or vice versa.

The experience of bulimia and depression is highly individual, based on the woman and her unique set of circumstances. In some instances, a woman struggling with depression may resort to maladaptive eating behaviors as a means of coping with the pain and isolation of a mood disorder. In other situations, bulimia can be a trigger for depression, and the recurring act of binging and purging can result in physical, mental, and psychological consequences that precipitate depression.

For these reasons, a combination of treatments and therapies are needed to address the root causes of these mental illnesses. A woman suffering from co-occurring bulimia and depression would need to have these conditions treated simultaneously to optimize healing, as these illnesses go hand-in-hand.

DBT is an Effective Treatment

One promising treatment for co-occurring bulimia and depression is dialectical behavioral therapy (DBT), a form of psychotherapy that includes skills for emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness. In simpler words, DBT helps women transform destructive behaviors into more positive outcomes.

This an essential component of recovery for a woman who may be using the damaging behaviors of bulimia, such as binging and purging, to cope with her depression. DBT has been shown to be an effective form of therapy and treatment, specifically for people diagnosed with eating disorders, as it helps them better regulate their emotions, reduce stress and anxiety, control destructive eating behaviors, and build self-management skills [4].

The main skills developed through DBT include the following:

Distress Tolerance: Learning how to tolerate painful and/or difficult situations, not avoid or try to numb it, which is necessary for someone using bulimia to cope with depression.
Emotional Regulation: How to change desired emotions, which can support a woman who is suffering from the weight of depression.
Mindfulness: Learning how to be aware and present in the moment; again, for someone who may be using bulimic behaviors to escape from depression, this can be helpful for learning how to engage in the present moment.
Interpersonal Effectiveness: Learning how to ask for what you want while maintaining healthy boundaries and self-respect in a relationship.

While DBT alone is not a sufficient treatment for a woman dealing with both depression and bulimia, it can be a powerful form of therapy for breaking free from the vicious cycle that recurs with these mental illnesses. It can also be effective in helping a woman build new tools for coping with difficult circumstances in a positive manner, rather than resorting to eating disorder behaviors.

DBT therapy for bulimia and eating disorders can be facilitated by a specialized psychotherapist with professional background and experience in these co-occurring illnesses. Treatment centers, like The Meadows Ranch, offer the full scope of treatments needed to help a woman overcome these illnesses, including DBT, which is an evidence-based approach for healing from mental illnesses.

Finding Hope for Recovery

In the throes of an eating disorder and mental illness, like bulimia and depression, freedom from the oppression of these conditions can feel like an impossible feat.

If you or someone you love has been struggling with both a mood disorder, like depression and an eating disorder, it is important to understand that you don’t have to go through this alone. Working with a multidisciplinary treatment team can help you tackle the hard issues involved with these mental health conditions and give you hope for a future that is not dictated by depression and an eating disorder.

At The Meadows Ranch, we can offer you the safe space you need to heal and find true and lasting recovery. You don’t have to wait to start living; your best life can start today. Connect with us to learn more about our approach to healing for co-occurring mood and eating disorders.

References:

[1]: Godart, N. et al. Mood disorders in eating disorder patients: prevalence and chronology of ONSET. Journal of Affective Disorders 2015. Volume 185, pages 115-122

[2]: Hinz, L. D., & Williamson, D. A. (1987). Bulimia and depression: A review of the affective variant hypothesis. Psychological Bulletin, 102(1), 150-158.
http://dx.doi.org/10.1037/0033-2909.102.1.150

[3]: National Eating Disorder Association, “What are eating disorders? Risk Factors”, https://www.nationaleatingdisorders.org/risk-factors Accessed 1 June 2018

[4]: The Linehan Institute, “What is DBT – Overview”, https://linehaninstitute.org/dbt/

 

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30 Things You Need to Know about Trauma and PTSD: PTSD Awareness Month

shutterstock_1094267261-1024x680My therapist prescribed me to drink more alcohol. I had described symptoms of posttraumatic stress disorder (PTSD), yet once again, the diagnosis was completely missed. Even worse, this uniformed therapist suggested that I drink wine “medicinally,” beginning in the morning, to help cope with what he said was high anxiety. What makes this horrible advice even more dangerous is the fact that upward of fifty percent of those with PTSD also battle substance use disorder.

PTSD is often missed, and trauma is frequently dismissed. It is no wonder that so many of us who struggle don’t know it. Many of us already think “what happened to me wasn’t that bad,” so PTSD is nowhere on our radar. Using specific language like the words “trauma” and “PTSD” isn’t about labeling but rather about serving as a compass for help. This PTSD Awareness Month, let’s work to get the truth out about posttraumatic stress disorder, thus, getting more help to more people:

  1. Trauma can be viewed as anything less than nurturing that alters your view of yourself and how you relate to the world. Mike Gurr, Executive Director of The Meadows Ranch, tells patients, “If it’s important to you, it’s important.”
  2. Traumas not deemed PTSD-worthy, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), can lead to PTSD symptoms just as severe as traumas that do qualify.
  3. Among those who experience trauma, up to 20 percent will go on to develop PTSD.
  4. Those who develop PTSD are not weak. In fact, PTSD has a lot to do with genetics and biology. As one example, based on hormone levels, researchers can predict—prior to deployment—which soldiers will develop PTSD in the war zone.
  5. Sexual assault, more than combat or any other type of trauma, is most likely to result in PTSD.
  6. Women are twice as likely as men to develop PTSD.
  7. Some individuals who don’t meet the rather strict diagnostic criteria for PTSD in DSM-5 experience just as much impairment as those with full-blown PTSD. Researchers call this partial PTSD; it deserves help.
  8. One reaction during a trauma—lesser known than fight or flight—is freeze. Think deer in the headlights. Without seeking professional help, people who freeze during trauma might ask themselves for the rest of their lives, “Why didn’t I do anything?”
  9. People who develop PTSD did do something during their trauma. They survived. Fighting, fleeing, and freezing are all biologically appropriate responses to a trauma.
  10. The average lapse in time between the onset of PTSD symptoms and a diagnosis is twelve years!
  11. PTSD is often misdiagnosed as bipolar disorder, borderline personality disorder, depression, schizophrenia, and anxiety.
  12. Known as delayed expression PTSD (or delayed onset), symptoms can surface years after the trauma happened.
  13. Although not included in DSM-5, clinicians and researchers widely agree that “complex PTSD” is a separate and unique form of the illness, one derived from exposure to multiple traumas, particularly in childhood.
  14. People with PTSD are not crazy. PTSD is actually a normal reaction to an abnormal experience—a trauma.
  15. PTSD can be passed on through DNA from parent to child, known as intergenerational trauma. Children of Holocaust survivors might struggle with PTSD symptoms even though they have never experienced a trauma directly themselves.
  16. One of the greatest protectors against developing PTSD is social support.
  17. People with PTSD are not dangerous. Many don’t even experience anger as a symptom.
  18. PTSD looks different in everyone. Analyzing the various ways that the hallmark symptoms can manifest, there are 636,120 possible presentations of PTSD!
  19. PTSD is no longer categorized as an anxiety disorder. Some with PTSD experience the disorder more as shame or grief-based and less as anxiety or fear.
  20. Alongside PTSD often comes problems like eating disorders, substance use, depression, and insomnia.
  21. Trauma can be stored in the body as chronic pain.
  22. People with PTSD can’t just “get over it” any more than someone can just get over a broken leg. PTSD is a brain injury, one that needs treatment.
  23. When people with PTSD are triggered, they have essentially lost access to their prefrontal cortex, the rational, decision-making part of the brain. This isn’t their fault, yet they can learn to take steps in accountability by seeking support.
  24. Longtime “gold standard” evidence-based treatments for adults with PTSD include Eye Movement Desensitization and Reprocessing (EMDR), Prolonged Exposure, and Cognitive Processing Therapy, all of which involve exposure to the trauma memory.
  25. Avoiding trauma-related thoughts, feelings, situations, and things can be a central maintaining factor of PTSD. (e.g., If someone avoids driving after a car accident, the likelihood of developing PTSD increases.)
  26. To heal, living an exposure-based life can be key. We need to approach thoughts, feelings, situations, and things that scare us. (e.g., In the previous example, with support, get out on the highway and drive.)
  27. A newer, promising exposure-based treatment called Writing Exposure Therapy can be completed in as little as five sessions.
  28. Somatic Experiencing® (SE), a body-oriented trauma treatment with a growing body of evidence, does not require a person to directly revisit trauma memories.
  29. PTSD is not a life sentence. While the trauma can’t go away (it’s history), with treatment, PTSD symptoms can and do.
  30. Posttraumatic growth describes the positive transformation that can grow out of adversity, out of trauma and PTSD.

I stopped seeing the therapist who encouraged me to drink wine for breakfast. Ultimately, I connected with excellent treatment providers, and I recovered from PTSD, albeit slowly. With help, research shows and personal experience proves, we can take our lives back from the treacherous illness. No one chooses to have PTSD, but people can and do choose to get better.

A Senior Fellow with The Meadows and advocate for its specialty eating disorders program, The Meadows Ranch, Jenni Schaefer is a bestselling author and sought-after speaker. For more information: www.JenniSchaefer.com

References:American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Arlington, VA: American Psychiatric Publishing, 2013).
D.M. Sloan, B.P. Marx, and D.L. Lee, “A Brief Exposure-based Treatment vs. Cognitive Processing Therapy for Posttraumatic Stress Disorder: A Randomized Noninferiority Clinical Trial,” JAMA Psychiatry, 75(3) (2018): 233-239.E.C. Berenz and S.F. Coffey, “Treatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorders,” Current Psychiatry Reports 14(5) (2012): 469–477.J. A. Gordon, “Update from the NIMH” (presentation given at the Anxiety and Depression Conference, Washington, DC, April 5-8, 2018).
M.J. Friedman, T.M., Keane, P.A. Resick, Handbook of PTSD, Second Edition: Science and Practice (New York, NY: Guilford Press, 2015).
National Center for PTSD (2016, October 3). How Common is PTSD? Retrieved from https://www.ptsd.va.gov
P. S. Wang, P. Berglund, M. Olfson, H.A. Pincus, K.B. Wells, and R.C. Kessler, “Failure and Delay in Initial Treatment Contact After First Onset of Mental Disorders,” National Comorbidity Survey Replication, 62 (2005).
R. A. Josephs, A.R. Cobb, C.L. Lancaster, H. Lee, and M.J. Telch, “Dual-hormone Stress Reactivity Predicts Downstream War-zone Stress-evoked PTSD,” Psychoneuroendocrinology, 78. (2017): 76-84.
R. Yehuda, N.P. Daskalakis, L.M. Bierer, H.N. Bader, T. Klengel, F. Holsboer,  E.B. Binder, “Holocaust Exposure Induced Intergenerational Effects on FKBP5 Methylation,” Biological Psychiatry, 80(5). (2016): 372-80.
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How PTSD Treatment Cured my Back Pain and More on the Mind-Body Connection

I was diagnosed with osteoporosis in my early twenties. Why were my young bones already losing tissue? Women who struggle with anorexia nervosa, like me at the time, are at a higher risk for developing the disease.

I also believe that my eating disorder may have contributed to my sluggish thyroid. Many people don’t realize that the malnutrition in patients with eating disorders can lead to abnormal thyroid function.

An eating disorder is a serious, life-threatening mental illness that directly impacts every part of your body, from the hair on your head to the tips of your toes, and everything in between. After all, an eating disorder impacts eating, and, truly, we are what we eat.

Some additional physical effects of eating disordered behaviors are listed below.

Restricting:
• Hair loss or thinning hair
• Dry and brittle nails
• Menstrual irregularities, which can contribute to bone loss
• Baby fine hair (lanugo) covering the body

Bingeing and/or purging:
• Swollen salivary glands (appearance of “chipmunk cheeks”)
• Sore throats and hoarse voice
• Tooth decay
• Acid reflux

Restricting as well as bingeing and/or purging:
• Gastrointestinal problems like stomach pain and bloating, bacterial infections, and slowed digestion called gastroparesis
• Cardiovascular issues, including heart failure (Anorexia nervosa has the highest mortality rate of any mental illness. About half of these are sudden cardiac deaths.)

Our mind impacts our body

Over ten years after entering treatment for my eating disorder, I embarked on my second recovery. This time, I was battling posttraumatic stress disorder, PTSD. Since I no longer struggled with eating (full recovery is possible), I didn’t think that PTSD would impact my physical health quite as much. Boy, was I wrong!

The chronic stress put on my body by PTSD took a serious toll. I developed a laundry list of physical problems, ones that I had never struggled with before, including costochondritis (a fancy word for inflammation of the cartilage in the rib cage), shoulder pain, recurrent high fevers, perturbed thyroid hormones (once again), interstitial cystitis (bladder pain), lower back pain, among many others.

The following are just a few of the physical problems associated with PTSD:
• Musculoskeletal problems like chronic pain
• Gastrointestinal issues like bloating, heartburn, indigestion, gas, acid reflux and other irritable bowel problems
• Cardiovascular problems
• Compromised immune function

When I entered a treatment program for PTSD, I was surprised that, like me, every single patient suffered with back pain. Our group even began informal research, as we’d ask each new person who admitted, “Do you have back pain, too?”

According to one study, the National Center for PTSD reports that 51% of patients with chronic low back pain also have PTSD symptoms.

The National Center for PTSD also shares that approximately 15% to 35% of patients with chronic pain have concurrent PTSD. Interestingly, only 2% of people who don’t have chronic pain have PTSD.

For some with PTSD, the chronic pain is a direct result of their trauma (e.g., car accident or assault). Here, the pain can serve as a reminder of the traumatic event, which can understandably exacerbate PTSD.

Our body impacts our mind

So, in the same way that our mental health can impact our body, our physical health affects our mental health. When I developed all of those physical problems related to PTSD, you can imagine that I became even more depressed and anxious.

Cancer diagnosis and treatment can be accompanied by increases in anxiety and depressive symptoms. Diabetes can do the same. And, let’s not forget about anger and fear, which can come along for the ride with many physical illnesses.

Our mind and body are one

This National Women’s Health Week, let’s not forget that mental health is inextricably linked to physical health. As another example, PTSD and eating disorders both actually change the brain, which is the most complex organ in the body. Research is currently underway that will help us to view mental health disorders through a lens of biological markers, rather than symptoms.

In an attempt to heal my body during PTSD recovery, I went back and forth to doctors. Think cortisone shots, physical therapy, chiropractor adjustments, and more. I spent thousands of dollars on these experts when, for me, what I really needed to focus more on was recovering from PTSD.

In my personal experience, the physical problems, including most of the chronic pain, went away with PTSD treatment and recovery. Essentially, I needed to check myself into mental health treatment in order to heal my lower back. That said, there is, of course, a place for medical doctors and others in healing physical pain. Today, I see a doctor who is helping immensely with a bit of lingering shoulder pain.

Importantly, like eating disorders, PTSD is not a life sentence. While trauma doesn’t go away (it’s history), with treatment, PTSD can heal.

What about my osteoporosis? It’s gone. My doctor said that food was the best medicine. Today, my bones, like my mind, are strong and healthy.

Remembering mind, body, and spirit

Let’s not forget about the spirit, which, for me, was a big part of becoming whole and healthy. Spiritual concepts like a belief in a higher power and letting go are what fueled my hope that healing in all realms—the physical and mental—was possible.

This National Women’s Health Week, what steps can you take to better your health?

A Senior Fellow with The Meadows and advocate for its specialty eating disorders program, The Meadows Ranch, Jenni Schaefer is a bestselling author and sought-after speaker.

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What I Wish I’d Known as a Teenager

What I Wish I’d Known as a Teenager:

Lessons Learned about Mental Health

I worried about grades as a teenager. I mean, I really worried.

Today, I know this was not typical anxiety about school. Looking back, I struggled with obsessive-compulsive disorder and perfectionism. Among other things, I was obsessive-compulsive about never wasting time. Not. One. Second. Further, I was laser-focused on getting nothing but 100 percent of the answers right on everything.

I remember audio recording myself reading my textbooks aloud. Then, when doing “unproductive” things like walking to class or driving to the store, I could listen to my textbook recordings. OCD wouldn’t allow me to talk with friends on the way to class or to listen to music in my car, as these activities were deemed a waste of time.

My roommates in college were flabbergasted by this and my other behaviors. You’re studying, yet again, on a Saturday night?

I wish I had known that this level of anxiety, as well as isolation, was a problem.

 

 

Little did I know, in the end, my grades weren’t going to matter that much. If I could get all of that over-studying time back, I would put it toward what truly counts in life, like meaningful relationships. I’m not saying that learning isn’t important. Memorizing my textbooks word for word wasn’t necessary or productive. In fact, I barely retained anything that I learned from semester to semester. Part of the reason for this memory loss has to do with my next lesson learned.

I wish I had known that my relationship with food and my body wasn’t normal.

I should have been diagnosed with anorexia nervosa in college, but most people were too busy giving me compliments to notice that I was suffering from the mental illness with the highest mortality rate of any other. You look great. How do you stay so thin? However, my parents were worried, so I visited my college doctor who asked one so-called diagnostic question, “Do you eat?”

Yes, I ate, and the ironic thing about my eating disorder is that it wasn’t truly about food, shape, or weight. Instead, anorexia was, in part, about that painful, unrelenting perfectionism. Restricting and bingeing helped, in the short term, to turn down the knob on anxiety, not to mention, to mask my underlying depression.\

I was malnourished. My brain wasn’t working. Back to my earlier point, this, in addition to the fact that OCD and perfectionism didn’t find sleep productive, is why I didn’t retain that information that I’d worked so hard to memorize.

I cannot fathom how I got by on so little sleep.

I won’t mention a specific number of hours here, because I don’t want to be triggering. When I speak at colleges, I have learned that today, there is an even more rampant race to see who can sleep the least. Yet, research tells us that getting enough sleep is required for optimal learning and health. I didn’t know that back then.

Something else that I wish my friends and I had understood is the prevalence of sexual violence on college campuses.

April is Sexual Assault Awareness Month. Sexual violence can lead to posttraumatic stress disorder (PTSD), substance use disorder, depression, and other trauma-related problems. What I know now: if you have to ask yourself whether sex was consensual, it wasn’t. By definition, the idea of consent means that you would know.

This is a message many of my friends and I desperately needed to hear. If I had, when I experienced sexual assault with a boyfriend in my late twenties, I might have known to call it what it was. I believe that we should take the “date” off “date rape” because it seems to minimize the assault. I’d later develop PTSD as a result.

I will be talking more about PTSD and all of these topics on this blog in the months to come, as I am honored and excited to be the newest Senior Fellow of Meadows Behavioral Healthcare! As it turns out, joining this incredible team had nothing to do with my near perfect college transcript and everything to do with how mental illness has knocked me down over and over again, and, importantly, with the support of professionals and loved ones, I have learned how to stand back up again, each time.

Gratefully, I no longer struggle with OCD, nor PTSD. I have tools to deal with anxiety, ones that don’t involve dieting, nor bingeing. Getting plenty of sleep helps. I have even learned to embrace this perfectly imperfect—and what I now see as a wonderful—life.

Most of all, what I know now that I wish I could go back and tell my teenage self is:

You are not alone. Mental illness is real. You didn’t choose it, but you can choose to get better. Help is available, and above all, healing happens.

 A Senior Fellow with The Meadows and advocate for its specialty eating disorders program, The Meadows Ranch, Jenni Schaefer is a bestselling author and sought-after speaker. For more information: http://www.JenniSchaefer.com

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