Addictions and Eating Disorders

Proposed Topics and Table of Contents

Lucy Papillon, Ph.D. — Fri, 21 Apr 2006 14:02:00 +0000

How do I tell if a patient has an eating disorder or “I“ have an eating disorder? What are the main signs to look for in the way they talk about food, weight, control, etc. or “I” speak about these same topics? Topics: Bulimia, Anorexia
What are the first steps that I as a professional or I as a person who may have this disorder must walk through?
What is bulimia and its variations?
How does a professional treat bulimia?
What is overeating and compulsive eating?
How does one stop such a pleasant “addiction” (is it an addiction?).
What is anorexia and its set of variations?
How does a professional treat anorexia?
What are the dangers of an eating disorder?
How does Spirituality begin to interact and interweave with Psychology during sessions with a professional?
Who should I go to if I think I might have a disorder? Or, as a professional, how to do bring up that food is a defense and not the true issue in the session?
What are the main causes of anyone having an eating disorder?

How does a professional help patients with eating disorders?

Lucy Papillon, Ph.D. — Tue, 06 Jun 2006 14:15:00 +0000

Turning to the professional, I want to underline the most important aspect of your time with the patient. You must go slowly and you must realize that they have no language for their feelings. If you ask them how they feel, no matter if they are severely anorectic or bulimic, you most likely will get “I feel fat.” You won’t get a genuine feeling because they have had to tune out (or have never learned how to feel from the start).

Before you accept a patient, though, you must be sure you have the credentials to deal with this kind of issue. So many say they have dealt with people that are overweight so they know what to do - they don’t and can often miss extremely necessary information and clues along the way. It is a very challenging situation to be in a session with a person who has an eating disorder, so you need to be trained in the various levels, stages, things that must be paid attention to, etc. I do trainings all the time for therapists so I know what kinds of questions they/you may have and what the answers are, after being known as “the expert” since the eighties.

Anyway, if you know that you are well-skilled in this area, the first thing you must do is insist on their having a physical and that you will need a copy of the results - a blood work-up being one of the things you will want to see. They also must agree to tell the physician that they have an eating disorder. Often, they just go in and say they need to have some blood tests but not say how come.

The most important part of any psychotherapy with these patients is building trust, more than anything else that happens, the relationship you develop with the patient who has this disorder can either facilitate or limit your ability to assist them.

Since I will be talking about several things in the columns ahead, I won’t go into any more detail about the process. This particular segment is for you to get information on the first step when you know someone has an eating disorder.

If you don’t feel qualified, once you have heard their admitting to the disorder, it is certainly critical, and you know this, that you refer them to someone you trust who does know a lot about how to treat them and has shown you, over the time of your knowing them, that they do have the background and experience to handle the patient.

Reading articles and looking up information on the internet are not sufficient, in the least, to feel that you (or someone you refer them to) can or should begin the process with these patients.

This group of patients is very complex and has learned, in order to survive, an extremely embedded way of coping with horrid childhoods, very painful experiences. I always, in fact, talk to them, from the start, about how much they are to appreciate, rather than abhore, the eating disorder because it did provide a way for them to survive whatever they had to go through as they were growing up.

I must have faith that both you as a patient and you as a psychologist who is taking on the responsibility to treat them will be authentic - meaning will be honest with yourself and the other, supportive of yourself, and open to going through the journey, whatever that means and however long it takes, to have the healing occur.

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What are the first steps that I as one with an eating disorder must walk through?

Lucy Papillon, Ph.D. — Tue, 06 Jun 2006 14:26:00 +0000

If you have an eating disorder, you must first not only admit it, but then you must take a step to do something about it - take an action. You can find a list of psychologists that deal with eating disorders from doing a search on the internet. That is the most efficient way. It is very important that you are ready, though. So many say they want help but when they get into my office, they are extremely hesitant to make any commitments around changing their way of eating (or not eating if they are anorectic) plus they are very reluctant to consider the idea that food is not really the main problem, rather deeply-held unhealed issues from years earlier are.

It is extremely critical they you find someone that you are comfortable with right from the start. Don’t stay with a psychologist because you sense you might hurt their feelings. This is your life we are talking about and you must be clear with yourself, first, and then to them about how open you imagine you can be. You are in charge now, maybe for the first time in relationship to someone else, in terms of choosing the match for you. I personally think it is important to find someone who integrates spirituality with psychology because I firmly believe that that is the only way for true healing to occur.

A bulimic said to me many years ago, “I will binge to the point of unconsciousness until my Soul is no longer starving.” It is a very powerful statement, one I will never forget. One of the reasons for binging is to feel that “full” feeling, the sense that one isn’t empty anymore. But, of course it is never food that can fill one up, it is all about finding meaning in one’s life. You, as one with a disorder, can’t know that yet. You will, over time, though, get a sense that, indeed, your eating disorder is a defense against issues you’ve not wanted to examine that make you want to stay numb. When you aren’t connected with yourself, you can do many things that aren’t satisfying for you but you think they will be - “maybe this time,” you say to yourself.

So, the very first step is to say to yourself that you do have an eating disorder, that you are tired of being tired, tired of trying to manage it, tired of the obsession with food, tired of having to hold this huge secret inside and act as if nothing is wrong, tired of worrying about the possible side effects that could happen, including death (both for bulimics and anorectics), tired of having to have your whole life revolve around food, whether you eat or don’t eat on a particular day, tired of the scale getting to decide how you feel at any one moment of the day, tired of not enjoying life because there are so many rituals you have to attend to, tired of lying to suspecting people, tired of the stress you are always feeling, tired of the energy that it takes to deal with all the guilt, the shame, the many feelings that are attached to the eating disorder, just tired.

Then, once you find that you have the courage to find someone, you go to a session. When you have found the one that you know can assist you, you must begin to uncover all that you have kept deeply inside of you for the years that you have been doing the behaviors that surround the eating disorder. You also have to refrain from telling your psychologist that “You have no issues other than your obsession with food.” That is never ever true, so it is very important that you drop the belief, even if you don’t buy that it is untrue - yet.

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Anorexia

Lucy Papillon, Ph.D. — Fri, 19 May 2006 20:30:00 +0000

Anorexia is driven by some of the same internal conflicts and turmoil that bulimics have. I put them into the same psychotherapy group I did daily at the in-patient hospitals, even though many on the staff told me that the bulimics would scare the anorectics with their focus on food. I found it extremely beneficial to place them together. Both bulimics and anorectics are absolutely consumed with thoughts about food. I am treating an anorectic currently who said to me this week: I know my friend has an eating disorder too, she is completely obsessed with food, she can talk about nothing else but that. I need to get away from her now that I am in treatment. These two disorders have a love-hate relationship with food. It is an intense one.

One may surmise that anorectics hate food and don’t want to go near it. That is not true. Anorectics think about it, want it, and work hard at figuring out a myriad of ways to stay away from it. Think about the analogy of a relationship. If a person has broken up with someone they love very much, they still think about them all day long, every day and everything reminds them of that person. Same thing goes on with the anorectic. She looks at food, longs for food, wonders how little she can eat and still stay as thin as she wants.

One important sign to look for in anorectics is that they lose a lot of weight in a short time. They deny that they are thin and they are not yet thin enough, according to them. No one can convince them that they are too thin, they do not “see” that and only want to become thinner, when they are in the midst of the disorder. Another sign to take note of is that they wear loose clothes so no one really knows how thin they are. They are extremely distorted in the views they have of their body. When I worked at the teaching hospital as well as the hospital program I developed and then directed, I would have anorectics draw how they saw their bodies and then have them lie down on another sheet of paper, outlining their bodies for them. They refused to see the difference, they continued to insist that the picture they drew was the accurate one.

Anorectics exercise excessively. They will push themselves to a dangerous edge with the exercising. They never think they have exercised enough given the food they have consumed in a day - which may only be a piece of lettuce and a carrot.

Anorectics, in truth, are a bit easier to spot because of the signs that are difficult to hide. Additional ones include that they don’t eat with you, they say they are never hungry and they always seem to find some place they need to be or go around meal time.

When you begin to see that someone (or yourself) is lessening their input of food and then the next day eating even less and so it goes throughout a few weeks, it is time to take action.

Even when I have had patients I have placed in a medical hospital because they were dangerously thin (58 pounds, 20 year old), I would walk in and ask how they were feeling that day and they would respond: I feel fat. Anorectics, even more than bulimics, although true for both, do not know how to verbalize feelings, they usually use that phrase for any feeling they have.

If you have or anyone you know has any of these signs (or others that you notice), first get them to a physician for a physical to be sure their blood count is within normal limits, then place them with a professional. Don’t start with a nutritionist because then it becomes a power struggle around food when food is never, and I mean never, the real issue. Eating disorders are a symptom of deeper, significant, unhealed wounds that must be addressed if the person is to move beyond this painful and yet pervasive situation in their lives.

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Bulimia

Lucy Papillon, Ph.D. — Fri, 19 May 2006 20:37:00 +0000

Bulimia was only named in the middle eighties, as I was finishing my internship at the University of California, Irvine Counseling Center. I discovered that, suddenly, without any seeming reason at the time, the counseling center was flooded with students who needed to be seen as soon as possible. The intake counselor asked all of us if we knew about eating disorders. No one on the staff at the time had ever heard of the word “bulimia” but I just said of course I’d be glad to see them. I heard time and time again the exact same story - precisely the same scenario. I had no resources to turn to that could assist me in the process of helping them. There was no literature at all on the subject, none. No research had been done, no one had ever even talked about it in any journal anywhere. I was on my own.

Eventually I discovered how come so many students were coming into the center all within a month of each other. An article had come out in Glamour magazine that was called “Full Stomachs, Empty Lives.” Once I found the article, I began to understand the influx of students. This article described what I had been hearing over and over. It, though, had said that, though these girls had thought they had found the perfect way to lose weight, they actually had a disorder that could be very dangerous, which is true. That was thus the reason I was treating so many in a short time. They had gotten scared from reading about something they had no idea was a “disorder.“ They had convinced themselves that they had the best-kept secret for losing weight and they were indulging in it several times a day.

Many horrible consequences can occur from binging and purging plus using laxatives. Deaths occur that are the direct result of electrolytes becoming so unbalanced that the body can’t sustain life. I have witnessed 22 year olds losing their teeth and, even if they haven’t yet lost any teeth, certainly the enamel has been permanently damaged due to the vomiting. Many other serious effects can occur from having this disorder.

Yet, it continues to be epidemic. In fact, the statistics show that younger and younger girls are starting to become bulimic (I have had several men over the years in my practice, but 94% of the people I see are girls/women). Also, I must point out that many women into their 40’s are coming into therapy, having had the disorder for over 20 years. In fact, I was in the Los Angeles Times several years ago, for they were doing a comprehensive article about a bulimic I was treating when I was on the medical school faculty at UCI, appointed as the chief psychologist for their in-patient eating disorder program. She had had the disorder for almost 20 years and was in the program because of how much her life revolved around binging and purging - it was her life. She said my working with her felt like I was trying to remove her arm or her leg. She was that attached to her daily ritual of the bulimic pattern.

Early on, certain activities that young girls get into can start the process of binging and purging, such as dance, gymnastics, swimming - any sport that focuses on being a particular weight and keeping it there to be eligible or at least considered for professional participation in it. It, though, can also begin due to family dynamics. I will be discussing that in a later column.

What are some of the other signs that someone has bulimia? Not eating at meal times, finding food that is hidden under the mattress in their rooms, in drawers, under furniture, hording food that is even still in the family kitchen, being very possessive about food so that overreactions of anger occur if “someone,” anyone really, tries to take any of the food that they have designated as their own.

Finding that someone goes to the bathroom right after a meal may be an obvious sign that someone has bulimia. Another is that they stay up late or disappear at times during the day and no one seems to know where they are. They often hide food in their car or eat in their car to avoid being caught so they are out of the house an unusually large amount of time.

Unexplained outbursts of rage, very little tolerance for anything, excess exercise, weighing at least once a day if not more, disgust with their clothes and how they look, withdrawn, secretive, hiding out in their room if they are home, and other changes in behaviors and emotional tones are still more signs of bulimia.

When they do come home with food, notice the kinds of food that end up in the refrigerator - things like gallons of ice cream, lots of milk and other easy to vomit soft foods such as cakes and yogart. Bulimics are experts in what foods will “come up” easily, so they buy what they can easily get rid of. Eventually though, as one 44 year old bulimic told me last week, they can eat anything and easily vomit it. The body gets used to getting over-full and then vomiting comes almost naturally. She said she no longer has to be careful about what she eats, it will all be “gotten rid of” almost instantaneously. In fact, she will do this behavior several times within an hour or so, binging, vomiting, binging once more immediately and then vomiting again.

Bulimics can become very adept at covering what they do. They are often in positions where they can either stay up late at night or do it when people aren’t home or, if they are, are paying attention to other things. One other way that bulimics can get rid of the food they have just over-indulged in is to get into the shower and vomit there.

Before I turn to anorexia, it is important to note that bulimics become quite addicted to the cycle and are terrified to stop. They believe they will get fat (one of their major fears, obviously) and also they think they must do all of the behavior in order to get the kind of emotional relief that, for a moment, they feel.

If a child starts talking about going on a diet or begins to eat less at meals but you find food you have bought missing, begin talking to them instantly about what they are feeling - not necessarily about food, about pressure at school, discontent at home, other things that you may have noticed when you stop to think about it.

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How do I tell if a patient has an eating disorder?

Lucy Papillon, Ph.D. — Fri, 19 May 2006 20:41:00 +0000

How do I tell if a patient has an eating disorder or “I“ have an eating disorder? What are the main signs to look for in the way they talk about food, weight, control, etc. or “I” speak about these same topics?

I am going to start with the basics, so I will address what you need to pay attention to. I have seen patients both inside of an inpatient unit and in my office for many years who continually say to me - I don’t have a disorder, I have just found the best way I know to keep my weight the way it is. I like being a size one. I used to be a 12 and now I am a one. Let me be. I am fine. If someone says that to you (or you say that to yourself), know that you are talking with someone who is in denial (or minimizing) the truth, that she in fact does have an eating disorder. By the time they get into my office, of course I know that they have a disorder, but I also know they are going to refuse to admit it or even to allow themselves to take this opportunity to explore the possibility in depth. How come they are even in my office, at a presentation I’m giving or inside of a hospital? That’s a great question, many are only there because someone forced them to be. I have one right now who said that her husband would divorce her if she didn’t get some help. What help she keeps asking herself? She is so embedded (and I use that word advisedly) in her disorder that she finds it impossible to imagine not having the chance to eat whatever she wants and then vomit to get rid of it.

I am going to begin with bulimia and then turn to discussing anorexia.

You have an eating disorder if you are using either laxatives, vomiting, diuretics, or all of these to get rid of the food, most often an immense quantity, that you consume. Now, that doesn’t mean you do it every day, you may do it twice a week, only on week ends, or periodically, but, if you are doing it as a way to control your weight, you have a disorder. Let me say that a “disorder” means that you have a distorted view of food, a distorted perspective of what use it serves for you and a distorted perception of how much you are focused on it throughout the day (and night). Some have bulimia and are overweight because they have stopped vomiting or taking laxatives (or rarely ever did), yet still binge.

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Introduction: Mind/Body/Spirit Matters

Lucy Papillon, Ph.D. — Fri, 21 Apr 2006 14:25:00 +0000

I have been a clinical psychologist in the Los Angeles area for 23 years, having started out on the Medical School Faculty at University of California, Irvine. In that position, I was appointed to the teaching hospital, where I was the chief psychologist for the inpatient eating disorder program. We were recognized as the facility where physicians across the country would send their toughest patients. Thus, we had quite a challenge, providing treatment for those who had failed over and over in other outpatient or inpatient situations.

I treated only eating disorder patients, not only at the hospital but in my practice as well. I became known as the expert in the field, especially since very few even knew what the term “bulimic” meant at that time (back in 1983). I spoke internationally and one of my papers was chosen for the first International Eating Disorder Conference in New York City.

I still treat many patients with severe obesity, bulimia, night eating (a new corollary of binging), anorexia and the variations that arise from these challenges. I find every patient, without fail, to have many issues with their parents, with control, with obsessive/compulsive traits and, surprisingly, having had some form of incest or molestation in their past.

What is horrifying to me, besides the dangers of these disorders, is that younger and younger people are coming in with their parents, having said they felt they were too fat and were going on severe diets. Most, as you might guess, are far from fat and, in fact, often somewhat underweight.

I am writing a weekly column to heighten awareness of many psychological, spiritual, holistic issues that arise daily in my practice. I am starting with eating disorders because I find it extremely important to assess and start treating it as soon after it starts in the patient as possible. If a current patient (who has not mentioned she thinks about her weight or food in an obsessive way) even hints at beginning to starve herself or to vomit periodically, I have several alarms ring simultaneously inside.

I find that when someone has been doing the behaviors of those with eating disorders of any kind for several years, they are extremely tough to wean from these behaviors. There are many so-called rewards for their continuing to use this defense (which of course is what it is) and find it self-satisfying to such an extent that they don’t even want to consider treating that. They state they have come in for various other reasons. When a new patient comes to my office, stating she feels she has a disorder, it does not by any means mean that she is ready to begin deep work on herself and stop this dangerous behavior.

Early on I had a patient come into my office one day and state: “I will binge to the point of unconsciousness until my soul is no longer starving.” Even before she came in, though, I was and still am integrating spirituality (in the broad sense of that word) with psychology, knowing that only with both addressed will the patient truly heal.

Spirituality calls forth a part of the patient that often they have never thought of. Thinking that they don’t “need” it, they never talk about it as if it is relevant. Spirituality, though, is the critical aspect of treatment that focuses on the emptiness that all, at some point, report in their lives. It brings a sense of belonging, a sense of connectedness to something greater than they are and that they can begin to embrace as a Loving Force, mirroring to them what they haven’t had an experiential experience with until that moment. It is gently introduced, often after the patient speaks of that emptiness, the void that food has filled up until they began to see the detriment it was causing in their lives, which it inevitably does.

I will, over the next 12 weeks, be covering the following subjects, specifically related to eating disorders.

Lucy Papillon, Ph.D.

Lucy Papillon, Ph.D. — Fri, 21 Apr 2006 13:52:00 +0000

Lucy Papillon, Ph.D. is a noted author of two books and host of a television series called "Breaking Through". She is a licensed clinical and media psychologist with offices in Beverly Hills, CA.

Crises are moments that demand reflection, reevaluation, decision and, often, concrete change. Such has certainly been my experience. Returning to "normal" was not even a possibility after the trauma of September 11. I did turn, in my unceasing dis-ease, to the Psalms. I found I couldn't leave them once I began to take them in, for they were Soul-soothing for me in a way nothing else had been. Then what I began to change concretely was my commitment to the vision of my Center.

I am the founder and director of the Center of Light, located in Beverly Hills. My intention, as a clinical psychologist, is now to expand it even more, treating the mind, body and spirit in such a way that every aspect of a person's life will be addressed. I will expand the structure so that professionals from several disciplines can contribute to this wholeness. I will of course continue to interweave psychology and spirituality as I work with someone, placing both within the context of whatever a person's challenge is. I believe that they are essential for complete restoration. Reclamation of all of who one is as well as honoring one's chosen path to God are part of complete healing and must begin in one's internal realm, then spread across the community and on into the world.

I have been on the medical school faculty at the University of California, Irvine. I also developed, staffed and then directed a well-respected psychiatric program at a prestigious hospital in Dallas. Most recently, I was appointed to the faculty at the University of Phoenix, Los Angeles Campus.

Until recently I was a psychologist for the California prison system, assisting inmates as they struggle to find their way in an extremely restricted environment. I also volunteer several days a month at a homeless mission in downtown Los Angeles assisting them as they move through whatever obstacles they seem to see that prevent the fulfillment of their ultimate Soul purpose.

I have been a keynote speaker and lecturer across the country for many years as well as a media psychologist, appearing on television, radio and in print. In addition, I produce (and host) a weekly television show in Los Angeles called Breaking Through.

I believe in the resiliency of the human spirit, which keeps standing when no other part of us can.