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Rescuing
The Child In the last issue of our newsletter, I promised to write more about shedding others' opinions about qualities of our personalities. I said, "then we can decide for ourselves that we are 'good enough'." I realize this statement implies that you simply just 'decide' one day that you are good enough and Bingo! you feel 'good enough'! Oh, if only it were that simple. Recovery from an eating disorder comes in layers. You may work on the surface of an issue the first time you uncover it. Later you may find that the same issue comes to you needing work on a deeper level. When the same issue comes back a third (fourth, fifth or sixth) time, you are probably ready to resolve the issue at your core! At the heart of these core issues are self-definitions that our "parts" cling to like a leaky lifeboat. We can talk about these definitions, we can analyze them and look for the distortions in them, we can substitute other words or phrases, we can treat ourselves like a friend,… but if we don't actually change why the part clings to this definition, it will continue to be a problem for us. It is imperative that certain conditions exist in the recovery process before you can change the way the parts relate to one another. If you have not read my article "From Critic to Ally" (http://awakeningcenter.net/volume-4-2.htm#ally) I urge you to do so and work on that before going on to this issue. If you go inward and work with the "child parts" without having a cooperative relationship with the critics first, the critic can attack the child and make the problem worse. In the last issue of the newsletter I wrote about how other people's opinions of us become part of our self-definition. Let's go back to "Bonnie"*. During her recovery, she did a lot of work to unburden herself from her family's problems, but she still struggled with some unhelpful self-definitions - especially one that insisted she was a liar! Situations would happen in her adult life, such as trying to get out of a request that she did not want to fulfill or sparing a friend's feelings about a new hairstyle, and "Boing!", Bonnie was flooded with feelings of being trapped, shame and self-hatred, "I am bad! I am a liar!" We had already worked with her critic and so we knew this was not from that part. Deep down inside, a young part of her was stuck in the past, clinging to an old burden. We began to investigate this burden and tearfully Bonnie admitted as a child she "always" lied, that she "never" told the truth. (If you analyze these two statements, they are all-or-nothing statements, overgeneralizations, mental filters and many other cognitive distortions covered in the book Feeling Good by David Burns ©1980.) As a child she felt compelled to lie to "build herself up" in other's eyes, mostly because she didn't feel good enough to be liked just for herself. She also lied because she had a creative mind and vivid imagination - something as an adult she could learn to love about herself, but as a child she was shamed for. But a big reason she lied was to get out of no-win situations at home. But lying to get out of these no-win-situations, created another no-win situation because she hated herself even more whenever she did it. Do-si-do, around we go: lie, self-hate, lie, self-hate..... She had a memory that stuck with her. She had been caught in a lie (probably because the lies of a 6 year old are pretty transparent) and her mother "Renee" tried to force her to admit that she had lied. She knew, even at the age of 6 that if she admitted she had lied she would be punished severely. So she stuck to her story. This enraged her mother and she was adamant that Bonnie had to admit she had lied. Bonnie remembers sitting there on a stool, crying in the middle of the kitchen with her mother screaming at her for hours! Whenever Bonnie felt like "a liar" in the present, she had flashbacks of sitting on the stool in the kitchen - with all the emotions of that day flooding back: trapped, scared, shame, self-hatred. A big part of recovery is being able to see that you are likeable, even though you received many messages that someone may not have liked you. (Often times people like Renee had trouble separating a person's worth from their actions and behaviors - one can be a good enough person even if they occasionally lie.) Bonnie and I found a "part" inside her who felt sorry for the little girl - who saw her as an innocent victim who was forced to protect herself in a hostile situation. This part said, "I want to help her, to take care of her, to rescue her - but how? My mom is always standing over the girl, screaming. I'm afraid of her." We needed to get past her fear and rescue that child. First we did some math, at this point in her recovery Bonnie was older than Renee in the original scenario! She realized how young Renee actually was when Bonnie was a child - her mother started having children when she was barely more than a child herself by today's standards! How unprepared Renee was for such an awesome responsibility! In Bonnie's mind the mother figure looming over the little girl started to shrink. Bonnie's fear lessened to the point that she felt able to enter the situation as an adult. This adult part of Bonnie was angry at how Renee was handling the situation. Reminding herself that she was older than Renee and a lot more educated too, Bonnie spoke to Renee in a firm and authoritarian voice, "Stop this, look what you are doing to her! You are the adult! Get a hold of yourself! Leave her alone! You don't do that to little kids! She's just a little girl. I'm not going to let you do this to her anymore!" And because Bonnie was older than Renee, Renee stopped and listened to her. Renee was shocked that someone was standing up to her! She was scared of Bonnie! As Bonnie repeated over and over, "You don't do that to little kids! She's just a little girl!", Renee began to "deflate". She wasn't this big scary monster, she was just a pitiful, uneducated, young, overwhelmed mom who had meager resources to handle the complexities of raising children - especially one with such an active, creative, imaginative spirit. Bonnie now could move from her angry part to the loving nurturing part who could take care of the little girl. Bonnie told the little girl that she was going to take her away to someplace where she could be loved and protected. The little girl felt relieved! Bonnie imagined holding the little girl in her lap, stroking her hair and telling her that she loved her. As Bonnie explains, "I found to my surprise how easy it was to love that little girl! She had wonderful qualities that were easily loveable. Ironically the same qualities that my mother got so angry at! I kept telling her that she was loveable and likeable, just for who she was - that she wasn't a liar. She wasn't "bad". That she was a good girl. I needed to teach her in a warm and loving way when it was appropriate to exaggerate or embellish, and when it was appropriate to tell the truth." This helped Bonnie open up to the honesty within her - to decide to value that and to live according to her values. *Bonnie is a composite of several clients; names have been changed to protect their privacy. This work was done over a series of sessions, not all at once. Amy Grabowski, MA, LCPC: "I am writing a book on recovering from eating disorders. I invite you to be a part of this process through a series of free lectures/dialogs/discussions based on the chapters of the book." Please Note:
Body-Dysmorphic
Disorder Although many people are familiar with the conditions of anorexia and bulimia, there is less familiarity with the condition body dysmorphic disorder. Body dysmorphic disorder, as with anorexia and bulimia, involves significant concern with body image and appearance. Unlike anorexia and bulimia, eating disturbances are not diagnostic criteria, although eating disturbances may coexist with this condition as part of a different diagnosis. Body dysmorphic disorder is receiving more attention as it is being increasingly recognized as a serious and potentially debilitating condition. Those with body dysmorphic disorder have a distorted body image due to extreme preoccupation with a slight or imaged defect of a body part despite a virtually normal appearance. Common targeted areas of preoccupation include the skin (acne, scars, wrinkles, blemishes), hair (too little, too much), facial features (nose, lips, overall symmetry), breasts and genitals. This preoccupation contributes to impairment socially and professionally. The inability to curtail the preoccupation can result in poor self-esteem, restricted interests, isolation, anxiety, depression, an eating disorder and multiple plastic surgeries in an attempt to fix the perceived defect. Often there are unrealistic expectations of how a surgery can ameliorate the perceived defect and all of the attendant preoccupation and distress. Characteristics of body dysmorphic disorder can include constant mirror checking, excessive time spent on physical appearance, continuous reassurance seeking from others about appearance and camouflaging the area of concern in elaborate ways in hopes of minimizing its perceived significance. Often all negative and difficult feelings and events are attributed to this imagined defect. As with other conditions, there is a continuum on which people can fall in terms of number and intensity of symptoms, degree of symptom interference and level of awareness. Usually symptoms are present by late adolescence or early adulthood, although the symptoms may not actually come to clinical attention until later. It is thought to occur equally among men and women. Hypothesized etiologies are both environmental and biochemical. Given the prevalence of societal images that project a narrow and unobtainable standard of beauty, it is no wonder that people struggle with feeling comfortable with who they are and how they appear. Some understand the self-punitive self-conceptualization as a displacement of anger that might be difficult to express toward the original source. Others believe that an alteration in serotonin is associated with the condition, either shaping the tendency towards symptom development or secondary to symptom production. Some consider body dysmorphic disorder to be a variant of obsessive-compulsive disorder which is characterized by intrusive, upsetting thoughts that are difficult to control (obsessions) and/or rituals that are conducted in an attempt to master or alleviate the anxiety (compulsions). Body dysmorphic disorder can be understood as analogous to obsessive compulsive disorder if the preoccupations about one's negative self image are thought of as obsessions and mirror checking, reassurance seeking and camouflaging behaviors are thought of as compulsions. Conceptualizing the similarities between the two is important in that it can help guide treatment recommendations. Medications that alter serotonergic activity in conjunction with therapy have been shown to be of benefit with both obsessive-compulsive disorder and body dysmorphic disorder. The class of medications called the selective serotonin reuptake inhibitors (i.e., Prozac, Zoloft, Paxil, Celexa) has helped to attenuate the frequency and intensity of the preoccupations and behaviors. This class of medication is also beneficial in treating depression and anxiety, two other conditions that commonly coexist with body dysmorphic disorder. Therapeutic approaches include insight-oriented treatment where symptoms are examined in terms of their meaning and historical significance and cognitive behavioral treatment where symptoms are reconceptualized as outgrowths of dysfunctional thinking patterns and actions. Sandra Sheinin, M.D., Psychiatrist, has a special interest in issues pertaining to women's mental health and can be reached at 773-929-6262 X 6. |
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