d. Eating Disorders (blog 4): The perfectionism prison - and how to escape it

In this blog, the fourth blog in my short series looking at eating disorders (ED's), I'll look at:  Perfectionism - and how to overcome it.


Are you a perfectionist?

Let's see.  I'll make up a scenario - and, as you read it,  ask yourself if it sounds in any way like you! 

I hope, for your happiness and health's sake, that it doesn't. 

If it does, however, you have my sympathy and my understanding - because I was a text-book perfectionist until my early 30's! 

And, being a perfectionist made me feel:  depressed; anxious; exhausted; miserable; and it resulted in me having a very low self-esteem. 

I never felt good enough!  No matter how many exams I passed, how many A-grades I achieved, or how well I did in my endeavours. I always felt inadequate. 

For me, my perfectionism mostly related to academia and my career .  I wasn't a perfectionist in domestic affairs, sports,  creative pursuits, or anything else much. And it was in those activities, where I wasn't  a perfectionist - that I felt the most relaxed and happy.  There was a clue for me!  Although, I couldn't see it - then. 

Looking back, I  must have also been a  perfectionist  in the area of  body image - because I suffered with  ED's during my teens. Most, if not all, sufferers of ED's have perfectionism relating to body image.  They crave a 'perfect'  body shape (whatever the media tells us that means) - and the sufferers of ED's  always fall short of their goal.  This is why they always feel that their body shape is inadequate - and they feel that they are too fat!   No matter what their weight is.

I recall, when I suffered with an ED, that I never felt even remotely attractive, or good enough - in my body shape - or in my general appearance.   I always thought that I needed to lose weight - no matter how thin I became. And, I always felt like a complete failure.


I am thrilled to say, however, that I am no longer a perfectionist in anything!   And, if you are a perfectionist, I can show you the pathway to escape as well - if you choose to leave that impossibly  'perfect-world'.


Without perfectionism in my life, I am now content, and happy, and I am so much more productive!  I get more done - because most things that I do now are good enough!   And I can move on to the next project - without  endlessly tweaking the last one.


And I am absolutely fine with my body shape, and my weight,  and my achievements now.  In fact I'm more than fine.  I'm pleased with who I am, and what I've done with my life.  I'm proud of myself - although I am also aware of my weaknesses.  But I don't have to be perfect - so I'm still OK with that - weaknesses, mistakes, imperfections, and all! 

My self esteem is healthy now.  And, with that, I'm healthy … and happy … and enjoying my life - finally.   (I have discussed self esteem in blog 3).


One of my favourite words in the English language, now, is the word:  Average. 

I love to allow myself  to be average!  Anything beyond average is a huge success!  So, I see my self being successful constantly.  And, with that, my self esteem has recovered. 

My favourite phrase is:  'that's good enough.' 

Those words and thoughts are so liberating!  I've set myself  free! Those words are my new happy mantra for life.


Note:  It's been said that the best way to keep someone a prisoner - is to make sure that they never know that they are in a prison. 


I didn't know that I was in a self-imposed prison - when I was a perfectionist.  I just knew that I was miserable, and I felt like a constant failure. I couldn't see the walls of my prison. Now, however,  I can see those walls - and they were built from my own  perfectionism. 

But you can't fight a foe - that you cannot see - and you are not aware of.

You'll need help if you want to escape from the 'perfectionism-prison'.   And, that is what I'll discuss in the second  part of this blog - when I look at cognitive behavioural therapy - or CBT.

You might also read other books on the topic, or you could visit a psychologist,  psychiatrist, or a counsellor - who is trained in CBT.  Usually, only a relatively small number of sessions are needed to learn CBT.  Usually only  5 − 20 sessions will be needed - unlike the years of therapy needed for the less effective psycho-analysis - a la Freud. 


But, more about CBT later in this blog.  For now, we will discuss the horrible affliction:  Perfectionism.


And here we go with the scenario  I mentioned earlier:

                                                
                               
 Scene:  'Jane-the-perfectionist goes in to the office'.  Take one.



Jane walked into the Cardiology department. 

She kept her gaze to the ground.  She was sure that no-one in the department liked her much.  She was also pretty sure that they all thought that she was not only incompetent, but also, probably, the worst registrar they'd seen in many years. She wondered if they were shocked that someone, as incompetent as she was, had passed their specialty exams.  Although, she reminded herself, she couldn't be completely stupid - because she had come top of her high-school academically.  She'd received straight A's through-out high-school, actually.

Jane's mind wandered back to her glory-days in high-school.  She had felt better about herself back then - although, she had still felt extremely stressed most of the time.  She had always presented her assignments perfectly.  She had always studied so hard and, with that, she had managed to reassure her fragile ego - that she was almost good enough - as long as she continued to achieve A-grades.  If she had ever received a B-grade - she crumpled into a crying insecure mess.  

But, now - without grades - how could she tell whether or not she was good enough?  She never felt good enough.  She felt like a fraud most of the time.  Pretending that she was coping. Pretending to be confident in her job. Pretending to be competent.  She now hid from the world - behind her 'confident' social-mask:  smiling only on the outside.

Jane crept toward her office.  She hoped that she could avoid any accusing glances. She wondered, again, for the tenth time that morning, whether or not she had made any mistakes on the previous work day. She wondered whether anyone would  tell her off, or be angry with her during the day. What if she hadn't done her dictation well enough? What if she'd missed something?

She'd stayed back well past the time when most of her colleagues, the other registrars, had gone home.  She needed to check that everything was done well enough.  However, even then, she'd worried that she might have missed something. 

'Hello, Jane,' the receptionist smiled, and she gave Jane a cheery little wave.  'You look nice today.  That colour really suits you.'

'Oh, thanks, Marie,' Jane replied. 'It's just one of my old dresses.'

Jane always felt awkward when she received compliments.  She knew that she didn't deserve to be complimented. She knew that her legs were fat.  She also needed to get a better hair cut. Her hair was also a boring mousy-brown. And she needed to lose some weight.

Oh, God! she thought.  I should say something nice back to Marie.  What should I say? I'm so slow and awkward!

'Have a nice day, Marie,' Jane finally added - before she raced away to her office.

As Jane walked away, she hit her head with the palm of her hand.  What a stupid comment that was, she thought.  Have a nice day !?  That's what you say at the end of the day. Not in the morning!  Not when you'll be working together for most of the day. How could I say something so dumb? Can I do nothing right?  I say the most stupid things!  I'm sure that everyone thinks I'm a complete idiot.

Jane opened her office door.  She put her bag down, and turned on her computer.  She then saw a note waiting for her on her desk.  A note!  What had she done wrong?!  Why would anyone leave a note - and not just talk to her instead?  Maybe it was really awful?  Maybe she would be sacked?!  Jane peeked at the handwriting on the paper. She recognised it. The note was from her boss - Dr Jones, the Head of the Cardiology Department!  Oh my God!  What have I done wrong? she thought.

Jane picked up the small sheet of paper.  Her palms were already sweaty, and she noticed that her hands were shaking.   Had she made a mistake?  Was he angry with her about … something? 

She read the short letter. 

The  note was asking her when the second draft of her research project would be finished.  Jane stared at the note.  She slumped into her chair.  She stared at her computer.  She thought back to the first draft of her research project.  She had taken three times as long as the other registrars to finish it - because she had also put in three times the work as they did!  Just like she always did.  She had worked so hard on that project - only to be told that it wasn't  good enough!

Jane felt awful. She knew that she should have finished the second draft by now.  She had been avoiding it deliberately.  Ever since all the criticisms which she had received with the first draft.  She couldn't face all that again! She knew that she couldn't cope with being criticized -  attacked with critical words all over again.  She had felt like such a complete loser after the first lot of  'constructive comments'  from Dr Jones about  her project.  She had even thrown his comments, and the entire first draft of the project, into a bin. 

Eventually, she had retrieved it; covered, as it was then, with custard and food scraps. But, she still couldn't bare to look at it.  Those critical comments - scorning her.  Mocking her.  So she'd dumped it under a pile of books in her study - and tried to forget all about the it. 


Jane felt the tears running down her cheeks.  She knew that she was a complete failure - at almost everything she did. 

There weren't enough hours in the day - to work as hard as she needed to … to do things well enough … to ever feel good enough. 

She screwed up the note - and tossed it back onto her desk. She didn't want to look at it. Further evidence of her own incompetence!

Jane felt so tired. She looked at her desk clock. It was only 9am.  There was still an entire long and miserable day ahead.



                                               * 


Same scene: 'Jane, without the perfectionism, goes into the office.'  Take two.



Now Jane - mark II - after 15 sessions learning CBT with a Psychologist  (where Jane learned about perfectionism - and ways to overcome it  -  which I will discuss later  in this blog) - and then after lots of practice over the next six months. 

Jane then jumped into a time-machine and re-did the whole scenario - because she wanted to see if the changes in her thinking would make any difference to the outcome of that truly horrible day - earlier in the year.  

Also, she'd never traveled in a time machine before - and she wanted to see if it actually worked!  And it did.  So here's a repeat of the same scene with our new-improved Jane (who is no longer a perfectionist).


Note: Jane can still remain a high achieving, conscientious person who strives for excellence.  However, she has dropped the 'perfectionism' thinking and behaviour. And replaced it with a happy life and a new motto of:  'That's good enough!'  All of those high achievers reading this - can breath again.  You can still achieve a lot (if you want to) - without being a perfectionist.




Jane walked into the Cardiology department.  She smiled at the receptionist.

'Hi, Marie.  How are you?'

'Fine, Jane', the receptionist said as she looked up from her computer. ' You look nice today.  That colour really suits you.'

Jane smiled as she looked down at the jade-green dress she was wearing. 

'Thanks.  I got this from my trip to Melbourne over Christmas.  I'll tell you all about it later over coffee - if you've got time.'

'Sure!' the receptionist smiled back.  'I love clothes shopping in Melbourne. I love a lot of things about Melbourne.'

'Me too!' Jane laughed as she strode up the passage. 'Let's have a coffee after clinic.  I'll bring you a flat-white from the cafe on level two.'

Jane soon came to her office.  She entered the room and turned on the light.  As she walked toward her desk,  she saw a note waiting for her there.

She glanced briefly at the paper.

Oh, darn! she thought.  Nothing too interesting.  No coffee-catch-ups from her friends - or other social-outing suggestions.  If she wanted to catch up with her colleagues for coffee, later in the day, she'd have to page them. Or maybe, she thought, she could just finish up at work a bit early -  and they could all go out for pizza.  Jane loved outings with her colleagues: pizza's, movies, bands playing at local pubs. A lovely time to relax, and chat together, and have some fun.  After all, they were all still only  in their mid-20's.

Jane looked again at the note.  She recognised the hand-writing.  The note was from her boss, Dr Jones, the head of the Cardiology department. 

Well, that can wait, she thought.  I need a coffee first.  I'll read that when I check my e-mails.  Jane left her office, and she returned a few minutes later with a steaming hot drink, and a couple of biscuits.

Resting the cup on her desk, Jane plonked herself down into her chair, turned on her computer, and picked up the note again. She read it quickly.

Good, she thought.  A note about the second draft of my research project.  Done and dusted!  She smiled. 

The second draft of the research-project hadn't taken Jane very long to complete. She had found that the suggestions made by her boss, with the first draft, had made the re-write incredibly easy.  His 'constructive comments' and been very useful!  Hugely helpful, actually.  And she did thank him for all the kind thought he'd put into those suggestions.  With his helpful ideas, Jane had managed to finish  the entire second draft  of the research-project in a single evening.  And, since then,  she'd  managed to have a great social life with her friends:  blues bands, beach trips, movie nights, cafes.

Jane opened her bag.  She took out a manilla-folder.  She'd brought the second draft of her project  in to work  with her.  She'd been planning to give it to her boss some time during the week.  May as well be this morning, she thought.  Get that out the way.


Jane felt happy. She looked at her desk clock. It was only 9am.  An interesting and challenging day stretched out before her.  What fun this all is, she thought, as she took a sip of her coffee. 

    


                    *                                   *                                   *

                                   
One scenario.  Same events. 
The difference: perfectionism - present (take one) or absent (take two).
The outcome - Different thinking.  Different behaviours. Different feelings. 

The long term outcome - Massive!  And that is what we'll discuss in this blog.

                                                     *

The differences in these two scenario's - are what this blog is about:
Perfectionism:  What is it?   How to get rid of it.  How to replace it with an alternative way of thinking - and with that - find health and happiness.


And why, in a blog series discussing eating disorders, would we look at perfectionism?

Because perfectionism results in many health problems, including:

- eating disorders   and

- low self esteem
- anxiety
- social phobia
- obsessive compulsive disorder
- depression
- drug and alcohol abuse
- suicide

- and, ironically, less success - as procrastination, and a paralysing fear of failure,  anxiety with obsessiveness, and a depressed mood - results in the perfectionist becoming much less productive.


In the third blog is this ED series - we looked at the first three external causal factors for ED's: dieting, body image, and self esteem.


Well, the fourth external factor - is perfectionism.

Perfectionism can be eliminated, and, in doing so, a path to recovery from ED's can be found.   Perfectionism can also contribute to the other external causal factors for ED's - poor body image and low self-esteem.

So eliminating perfectionism - can have many positive outcomes - which all help with recovery, and prevention, of ED's.  And a much happier life as well.



So what is Perfectionism?

Well, if you have an ED - then you probably have at least some of the traits.

Perfectionism, in psychology, is a personality trait  in which a person strives to be perfect  - in their pursuits - and they set themselves an extremely high performance standard.

However, beyond these things  - there are a number of other features:


1. Impressing others is very important:

Perfectionists have usually learned, early in their lives, that  success in their endeavours will result in - praise and reward from others; while failure will result in - punishment and disappointment  from others.

Perfectionists enjoy impressing others with their achievements.

They can also believe that part of their identity lies in being highly successful in their achievements:    'I achieve, therefore I am.'

 However, this becomes a double edged sword:  A drive to perfection and impressing others - is associated with a deep fear of the consequences of 'not doing well'. 

A lifetime of frustration, disappointment, and self-doubt can result.


2. The drive to perfection can lead to one becoming a workaholic:

Becoming a workaholic  is then related to many physical health problems (related to stress, and lack of exercise, and lack of time to cook healthy meals, and so on )  and social problems - as little time remains to spend with friends or family.

The perfectionist will often acknowledge that his extremely high standards and expectations for himself are tiring - but he will rationalize that he needs the pressure of perfectionism - to achieve the levels of excellence that he craves.

This is not true - however.  If anything, perfectionism reduces success.


3. Procrastination.

Some of the causes of procrastination are a fear of failure, and anticipating the disapproval of others (worrying about what other people will think).

Ironically, perfectionists can often become less successful - as their perfection paralyses them.  They either spend huge amounts of time triple-checking that things are 'perfect' enough,  instead of simply saying 'good enough,' and moving on to the next  project.  Or, they delay starting projects - because they fear  being criticized by others - if the projects aren't  good enough or perfect.

Note: I wrote an earlier blog about procrastination. 


4. Perfectionists are often very critical of others:

- Being judgemental of others can be a defence mechanism.  People often reject in others  things that they can't accept in themselves.

And, as I have discussed in other blogs, people can often see qualities in others - which they already possess in themselves.  So, they may not be consciously aware of why they are so critical of others. 

For example, a person who is perfectionistic at high-school in academics - may criticize others in her class for being stupid or lazy.  However, subconsciously - this is how she sees herself.  These are the words she thinks in with regards to herself - subconsciously (as automatic thoughts - discussed later in this blog).

And, for perfectionists, there can be a lot to reject. So, they criticize most people.

However, by becoming more tolerant of others - some perfectionists may find that they can be less tough on themselves.

(For example:  a perfectionistic ED sufferer may be happier with their own body - if they were less critical of the body shapes of other people.)


5.  Perfectionist often have black and white thinking:

Many perfectionists have 'black-and-white' thinking. This can also be described as 'all-or-none' thinking.

This means that instead of seeing a middle ground - where things might a 'somewhere in between' - or 'grey' ; black and white thinkers tend to see things as one or  the other.

So they have either done perfectly in a pursuits - or they have failed. 

In an ED they see themselves as being fat or thin.
So if they are not 'thin enough' - then they must be 'fat'!    A nice and healthy 'middle-size' is not considered.

There are many problems with this type of thinking.   Obviously, a perfectionist would feel like a complete failure - if an endeavour was anything less than perfect.  Even if it was 'very good' - as that is still classified as a 'fail' to them.

Any B's - in a straight A report card - would be like a lead-weight pulling their self-esteem further down.  They will have failed - again!

Perfectionists tend to be very driven and determined.  And for this reason they can 'diet' until they starve to death.  They can exercise for many hours each day - getting up before dawn and going to bed after midnight. 

They can work and starve themselves to death!


6. Perfectionists often  won't confide in other people.  They battle their demons  alone.

Perfectionists often have an intense fear of failure and rejection.

And, with this, they can be afraid of letting themselves become exposed to others, or vulnerable to criticism and rejection. So, they can avoid opening up to others to discuss personal issues (even with people very close to them).  They will likely bottle-up  their personal fears,  mistakes, weaknesses, inadequacies, or worries.

Perfectionists often feel like they must always be strong and in control of their emotions.

It is in part, for this reason, that perfectionism is associated with an increased risk of suicide.


7. Perfectionists tend to obsess over, and get upset  about every mistake

Whether they forgot a tiny detail on a report, or they were a little late to a meeting - perfectionists tend to ruminate about these minor mistakes, and they will usually become disproportionately upset by them.  They may have regular 'melt downs' and become withdrawn and depressed by minor things. Or become very angry and fly off into huge temper-tantrums.

This can make it hard to work and live with people like this.

Perfectionists lack a deep and consistent source of self-esteem - and so any perceived failures hit them very hard.  Their self-esteem is damaged - again.


8. Perfectionists take any criticism as an attack on them personally.

Perfectionists tend to take every mistake personally - and so they are less resilient than other people.  They can't bounce back from setbacks so easily.  Each challenge beats them down a little further - and convinces them even more that they are 'not good enough.'

One of the deepest fears, and beliefs, of a perfectionist - is that 'they are not good enough.'  They will filter events (dismiss the evidence for their competence, and focus only on the evidence supporting their inadequacies) to confirm this belief.


9. Perfectionists tend to become very defensive when they are criticized.

Perfectionists have a very fragile self-image, and they worry constantly about what other people might think of them.

As a result of these things - they will jump to defend themselves at even the slightest criticism.  Even when no defense is needed.


10.  Perfectionists never feel that they have done enough to feel satisfied with themselves.

Because 'perfection' does not exist - it is an impossible goal - perfectionists always have the feeling that they have never reached an adequate level of achievement.

No matter how much they achieve - there will always be more to strive for - before they feel that they can be satisfied and relax.  And hope to feel good enough.

They never arrive at that place of peace and self-acceptance.


11. Perfectionists tend to take pleasure in the failures of other people.

Perfectionists feel like failures constantly.  They can rarely measure up to their own unrealistically high expectations.  And their self-esteem is battered about as a consequence of this.

In psychology there is a phenomenon called 'leveling.'  Leveling relates to the situation in which we feel most comfortable when we see ourselves  'level' with our peers.  However, when we feel inadequate to others (below their 'level'), we may try to pull ourselves up to their level - to achieve an equal level again (ie keep up with the Joneses; get fit if our friends or husband does), or we could pull others down to what we perceive is our own level - so that we might again feel adequate (at an equal 'level').   

So, in seeing other people fail - a perfectionist will feel more level (or equal) to those other people - and, resulting from this, they will enjoy some improvement in their low self-esteem.

For this reason perfectionists gain some pleasure when they see that other people fail - as they constantly feel like a failure themselves and, as such, they constantly feel inadequate and less than their peers.


12. Perfectionists suffer with constant feelings of guilt and shame - resulting in many mental health problems.


Perfectionists often suffer with constant feelings of guilt and shame - because they dwell on their failures and inadequacies constantly.

And these negative emotions, along with all the pressure they feel to succeed - results in many associated mental problems, such as: depression, anxiety, ED's.


                                                                      *


So, perfectionism is not about simply striving for excellence, or striving to be very healthy. 

Perfectionism is an endless struggle to be perfect (an impossible goal) in order to gain social acceptance, and feel good enough as a person.


As the author and researcher Brene Brown said:

"(Perfectionism) … a way of thinking and feeling that says this:  'if I look perfect, do it perfect, work perfect and live perfect, I can avoid or minimize shame, blame and judgement.' "

    

                                    *                            *                         *


So where are the keys to escape the hell-hole prison of perfectionism!


I'm glad you want to leave.  You'll be much happier out here in the free world of 'that's good-enough' and 'average'.  It is such a lovely place to live. And you can still achieve a whole lot - if you want to.


As I've said - you'll learn to love those words: Average; that's good enough.  They are the keys to your escape.

You'll find: your self; a healthy self-esteem; contentment; great relationships, a more productive life; lots of enjoyable times that, as a workaholic, you would have missed … and so much out here in this lovely colourful and free world of average.


I read once that it's like there are two doors for you to choose to walk through. 
- One door has the word Average on it.  The door is plain and the word seems uninspiring. 
- The next door is elaborate, and ornate, and beautiful - with the fancy gold-lettered word Perfect  on it.

Wow!  Which door-way to walk through?

But, don't be fooled.  It's a trick!

Open the 'Perfect' door - and there is only a brick wall behind it.  'Perfect' doesn't exist.  There is no such thing as a perfect world - anywhere!  You'll kill yourself trying to get there.  And, you'll never find it anyway.

However, open the 'average' door - and you will be in for a wonderful surprise:  A lovely free and happy world awaiting you.  Don't be fooled by the dull appearance of the word and the door.  Average is your key to happiness.  That world is marvellous.

Although, don't worry you high achievers out there. You can still strive for excellence!  You can still be conscientious and hard working.  But you will have a more balanced  life and a more free and lovely life - when you let go of any illusions that perfect exists.


Now, how do we change your thinking to a more happy and healthy way of seeing the world?


The answer to that is via:  Cognitive behavioural therapy (CBT)

I will briefly explain the nature of CBT in this blog. 

However, for a more detailed understanding of it - and to learn it properly - I would suggest that you could either:

- book into a psychologist, psychiatrist, or a counsellor who has been trained and who has experience in CBT, and/or

- read books which teach and train you in the use of  CBT , and/or

- find on-line (computerized) CBT courses/ teachings.


The good news is that CBT is not only very effective to help you to think in a more healthy and realistic way, but it will also teaches you how to deal with stressful events in every other area of your life - and - it is quick and fairly easy to learn.

Unlike the very long path of psychoanalysis (a la Freud)- which can take years with a psychiatrist - after which time-  it is still much less effective than CBT. For CBT can be learned in only 5 − 15 sessions.  And, it can be learned on-line or from books as well - is costs or access to health professionals is a problem.

However, with regards to ED's - I would strongly suggest CBT is done with a health-care professional - as there will be many other aspects of treatment which will need professional care as well (as I've discussed in earlier blogs).

CBT can then be consciously practiced - until the new healthier way of thinking and viewing the world becomes automatic (sub-conscious) - and then you won't need to concentrate so much on the process of CBT.  However, even while learning CBT - you'll notice that you already feel calmer and happier.

CBT has been practiced and researched for over 30 years - and it has been proven to be extremely effective for treating many emotional, behavioural and psychiatric conditions.

CBT has been found to be as effective as medications in the treatment of mood disorders - such as depression and anxiety.  However, CBT can also be used in addition to medications - as well.  Your treating health-care worker can sort this out for you during your sessions. 

It might also be that you may benefit from medications for anxiety and depression and an ED - just for the time being -  until the CBT has become more learned and its effect kick in.  Then the medications may no longer be necessary.  You could discuss this with your doctor.



Rather than go into all the details about CBT (which is too long for a blog entry and which you can be read elsewhere) - I will summarise just a few basic features about CBT - as a form of introduction to it.



CBT - Cognitive Behavioural therapy:


A. The cognitive part of CBT:

The cognitive part of CBT helps a person to change the upsetting and unrealistic 'automatic thoughts' (rapid and sub-conscious thoughts) which occur constantly through each day in response to events which occur routinely - and which may cause  sufferer of anxiety, phobias, obsessive-compulsive disorders, depression, ED's and so on - to become very upset and distressed and have difficulty coping with their lives.

Some of the unrealistic and maladaptive automatic thoughts are listed below.  These can then be identified, by a person using CBT,  as they occur through the day - and they may be replaced with a more adaptive and healthy thought (cognition).  These healthier thoughts will eventually become automatic (sub-conscious) and an individual will be able to cope with events better- and feel less anxious and depressed.


Note: Events per se do not have emotions attached to them.  We interpret events, in our lives, and we attach emotion based on how we interpret events.

For example: A glass of milk might be spilled.

1.  I might become very upset, burst into tears, throw the entire carton of milk at a wall … and punch whoever spilled the milk  - in response. 

OR

2.  I might wipe up the milk and pour another glass.

The event (spilling milk) is itself without emotion.  However, my response will depend on the way I think about the event in my head. How I interpret it and explain what it means - to myself. 

And that is where CBT can have a wonderful effect - to change the way I think about events that occur in my life - so that I can become less upset by them.

So, the basic idea of CBT is:

Your thinking determines your mood, and if you change your thinking, you can change your life.

                                                                *

A few common types of negative thinking:


1. Black-and-white thinking:
'I have to do things perfectly because anything less is a failure'.

2. Disqualifying the positives:
'Everything in my life goes wrong.  I hate my life.  My life is one problem after another.'
A variation is being overly judgemental:
People aren't nice anymore.  The world is falling apart.

3. Negative self-labeling:
'I'm a failure'. 'If people really knew me - they wouldn't like me.' 'I'm useless.'

4. Catastrophising:
' I failed my test so I'll never get into university now!'  'I spilled the milk and the whole carpet in ruined now.'

5. Excessive need for approval:
'I am only happy if people like me.' 'If someone is angry - then it is probably my fault.'

6. Mind reading:
'I can tell that people don't like me by the way they act when I'm around.'

7. Should statements:
'I should work harder.'  'I should have got an A on that assignment.'
I comment I read once was: 'Don't should on yourself.'

8. Disqualifying the present:
I'll relax later.  I'll catch up with my family another time.  I have to do this now.

9. Dwelling on pain:
'If I dwell on why my relationship ended, then maybe I'll feel better'. 
Or - 'If I worry enough about my problem, then maybe I'll feel better.'

10. Pessimism:
'Life is a struggle.  I don't think people are meant to be happy in life.' 'If something good happens in my life, then something bad is usually about to happen.'

11. Over-generalizing:
Things never work out for me.  I'm always making mistakes.

12. Fortune-telling:
Why even bother - because I know this will never work out.  I'll never pass my test.

13. Awful-izing:
I felt awful when I was late for the meeting. The meal I cooked was terrible.
(Third degree burns to 80% of your body is awful and terrible.  Late for a meeting is 'inconvenient', and the meal cooked may be 'disappointing, and a little over-cooked'.)


B. The behaviour part of CBT:

The behaviour part of CBT varies with the problem being treated.

For example -

Phobias:  gradual exposure to the feared object/activity/situation - will reduce the associated anxious feelings and the avoidance of those things. 
This may be essential for an individual to function in their life.  

Mood disorders:  Relaxation techniques may be helpful to acutely manage uncomfortable feelings associated with many mood disorders - such as panic attacks, exposure to feared events/objects and so on.

Perfectionism:  Experience behaving in a deliberately imperfect way - and learning that you will be safe and fine - will help a person to overcome perfectionism.  (ie. deliberately handing up an assignment with a few spelling mistakes in it - or incorrect grammar.  Then when nothing much happens - and the sky doesn't fall down on you - you'll gradually learn that imperfection is safe and OK).


                                                   *


There are many wonderful books which discuss and teach CBT. 

And, you'll find that CBT  is surprisingly:

- quick

- easy , and

- incredibly effective.

And it can be useful in the recovery from ED's. 


So, that is the end of my fourth blog in this short series of blogs looking at ED's.  And, even for readers without ED's - some of these blogs may be helpful for your own health and happiness.


And, to underline my own glorious  'imperfectionism'  - I will leave this blog now - spelling mistakes, typo's and all - and get ready to go out to see a Blues-band at a pub in Adelaide tonight. It's a cool autumn Saturday night - and I don't expect the band to be brilliant.  But it will be nice just to go out and listen to music - and chat with my husband - and have a nice glass of coke. 

I'll look fairly average - in a wonderful care-free sort of way - wearing a maxi-skirt , a jumper, and flat sandals. I'll cook an average sort of dinner before we go (fish and vege's), and anything and everything else I do tonight will be easy and simple and relaxed and … average.

And I will enjoy that.  And I'll feel happy and content with that. And that is what it means and feels like to live in the lovely relaxing and peaceful world of … average.


My point, in the last paragraph or two, about going out, was made for two reasons:

1.  Being average and quitting perfectionism is easy - once you get used to it.  You can still achieve a lot and have a great life - if you want to.

2.  Give yourself a break from the ED  - if you are suffering from one currently.  Start to build your healthy and happy life - away from numbers, and calories, and food, and weight ...

Let yourself enjoy, or at least experience again, other things - music, movies, country walks.  These things will gradually build up your new healthy life, and help your self-esteem, and pull you out of the social-isolation that ED's hold you in.

Also, sometimes a behaviour can precede the emotions.  So, even if you don't feel like going out and having a nice walk somewhere -  you could try just going  anyway - and, eventually, you may start to look forward to these walks, or outings.

In this way - activities away from the ED - can begin to fill up your day - and your life and lift your mood - give you some peace from the relentless ED thoughts about weight and numbers - and help to distract your thoughts away from the ED illness.  Maybe - eventually - replace the illness…

But - all one tiny step at a time.

At least think about it.

And in the meantime - until you feel you're ready to go out and do things in the world more - I'll hopefully give you some ideas about outings which you may like when you feel ready.  And know that you will likely need help with your recovery.  A doctor or psychologist would be a good place to start.


                                            *


Speaking of wonderful outings (to inspire you to get out a little) - my family and I will soon be taking a lovely short holiday in a picturesque  Georgian cottage in the Adelaide hills. The two-storey house comes with a huge lake (which it sits next to), a row boat, many glorious acres of pretty countryside, and views out to the Mount Lofty ranges.

If you'd like to see the cottage - and become inspired to arrange a little sojourn to the country yourself (even for a day) then google:  Apple tree cottage Balhannah images.

I've bought a little video-camera - although I'm technically-challenged - so, it may take me a while to put up any nice video's, on this blog site, of the lovely places to see in and around Adelaide - here in South Australia.

I hope that I will work out how to do that soon.  But Adelaide has a lot of lovely Australian experiences and scenery to see and enjoy.

In fact, the Lonely Planet's Best in travel 2014 - Top 10 cities - listed Adelaide as no. 9.  And Adelaide was the only Australian city in that list.  So, it really is a lovely place to see and experience.  I'll hopefully show you what I mean soon (if I can work out the camera thing) -


                                             *


My blog - in this ED series - for next week will discuss: Positive (adaptive) coping strategies for dealing with stress in your life - away from ED's, alcohol, drugs, and other negative (maladaptive) coping strategies.



And, before I leave for this week, to anyone suffering with an ED, know how truly important you are in the world.  Trust me that you'll be able to see it as you recover. 

When I suffered with an ED - someone told me: 'It won't always be like this.  It'll get better …'


And it did.  So much better, in fact, than I could have dreamed.  I just had to choose to fight to recover from the ED … and persevere … and ask for help … and be patient and hopeful.

And that is my advice to you.  But - you are infinitely important.  You're meant to be here - in your life journey - with the rest of us - struggling on.


                                        *

An Update from my lovely 'Average world' - about my Saturday night - mentioned above - just to demonstrate the points I made about the 'Average-world' being wonderful (behind that dull appearing Average-door.  Don't be fooled by the name - 'Average'):

It is now Sunday morning - the night after 'Saturday night'. 

I wanted to update you on my 'Blues Band' outing - which I mentioned that I would spend only five minutes getting ready for.  I think it actually took me only two minutes to get ready: a quick change of skirt and jumper, no make-up (I don't wear make-up), teeth clean - and out the door!  

'That's good enough!'  I thought as I left.

 I went with my husband, and my 17 year old  daughter (who has also recovered from an ED - like me - and, like me, she is so thrilled that she chose to recover - and learn to love the word 'Average').  

It was a cool autumn night in the city. The roads were still wet - from earlier rain - but the rain had stopped and the weather was mild, when we arrived.  

The blues band were playing near to Chinatown in Adelaide. And, as we walked to the venue, we could smell the beautiful aroma's of Asian cooking from the restaurants.

We found the place, paid our money, got the back of our hands stamped - and in we went.

The venue was fairly small and - typical of many old building in Adelaide - it was a converted-church.  The arched windows remained, and the band had set up to play on an old altar. Around 80 - 100 people were already inside - chatting and laughing.  A few were dressed for dancing - and I noticed that there was a small dance floor immediately in front of the stage. The room was cosy and warm, so I was able to take off my jacket.

We bought drinks - and found a lovely seat on a plush lounge suite - right up the front near the stage.

 Soon the blues band began.  

And, for the entire night, I was swept away - into a wonderful 'timeless-world' of music.  

I loved it from start to finish! 

And, between songs, my daughter and my husband and I had some great conversations and many laughs.

Now, I'd better go - as I'm meeting another friend, with our kids, to walk in the autumn leaves in the Adelaide hills - Mount Lofty botanical gardens.  The weather today is sunny and lovely.

If you'd like to see the beautiful Mount Lofty gardens - Google the following:

Google:  'Mount Lofty Botanical gardens images'


And, if you'd like to experience the band from last night (which you can in this great 'computer age' - just Google the following:

Google:  'Lazy Eye blues band - Don't call the doctor'   (I did like that song).  

And there are many other songs on that site(note: the band were dressed exactly the same last night.  Same striped pants on the female guitarist, same fedora hats on the men). 


And that is just a lovely little example - of the wonderful world of 'Average' - where true happiness can be found.

Take care - and I'll write again next week.



 

c. Eating Disorders (blog 3): Dieting, Body Image, and Self-esteem

It's known that eating disorders (ED's), like most other medical conditions, are the result of both genetic factors (genes account for up to 80% of the development of ED's - which is why ED symptoms tend to run in families) and environmental (or external) factors.  A 'nature-nurture' phenomenon - like so many health issues.

So Genes load the 'ED gun' and external factors 'pull the trigger'.

Genes cannot be changed.  External factors can - and they might even be avoided.  

Rogue ED genes might never become expressed, and an ED may be completely prevented - if  we can identify and change the causative external factors.  And, for those individuals with an already established ED - changing those external factors might lead to recovery from the ED, and prevention of future relapses!

So, what are these external causes for ED's - which might make such a difference in the lives of ED sufferers ?  

Well, there are a few and I will discuss them over the next few blogs. However, in this blog, the third in my short series of blogs discussing ED's, I will look at the first three in the list :  Dieting, Body image, and Self-esteem.

And, in discussing these external causative factors for ED's - we will begin our discussions about  preventing ED's, recovering from ED's, and avoiding  relapse of  ED's.

1.  DIETING:

Dieting is the single most important risk factor for developing an ED. 

Now for some scary statistics:

- Studies have shown that among 12 to 17 year olds, 90% of females and 68% of males have been on a diet of some kind.

-  At any given time, approximately 68% of 15 year old females are on a diet!  Of these 8% are severely dieting. 

- It is known that adolescent girls who diet only moderately are 5 times more likely to develop an ED than those who don't diet, and those who diet severely are 18 times more likely to develop an ED.

Studies show that 35% of 'normal dieters' progress to 'pathological dieting'. And, of those, 20 − 25% progress to partial or full-syndrome ED's.

My advice from my own experience of recovering from an ED, 30 years ago, with no relapses in that time is this:  

NEVER EVER DIET!     NOT FOR ANY  REASON!  

NEVER!    

I hope that is clear.

AND, NO!    DON'T DIET EVEN THEN!   I am reading your thoughts.  Never diet means … never … never … never … never … never …  Ever !!

If you're ever remotely tempted to diet - imagine my imploring face, and my words:  No!!!  Don't do it!   Diets don't work!  You'll get depressed, feel like a failure - again - (I'm sure it won't be your first failed diet), and you'll put on even more weight … or even worse …  you may develop an ED! 

For me, the 'never diet'  philosophy has been really fantastic!

My weight has remained exactly the same  for the last 30 years!  Since I was a teenager!  Without ever dieting!  ( Yes … enough with the exclamation marks!  Sorry!  I'll stop now …)

My weight is in the normal healthy BMI range - and stable.  And that is all I'll say.  No numbers.  No more numbers.  Focus on simply on a single word - 'healthy'.

Note: No numbers.  

To recover and avoid relapse from an ED - avoid numbers.   Not even a BMI number. Except to say that your weight is in the 'healthy' range. We will discuss later the rule about 'no more numbers'.  

Instead - focus on health. And lots of other things - hobbies, for instance, or building an actual life - where you go out and do things (not exercise and buying diet food!) and have fun and … achieve things.  Actual things - not just existing as someone who looks a certain way.  That is not being anything. That is simply existing.  An inanimate picture on the wall could do that.  A vase of flowers could do that.  A rock on the ground could do that. You are more than numbers and a body.   Inside … in your mind. That is you.  Demonstrated by the things that you do.  The path in life you walk.  The people you interact with. The legacy you leave behind. Your soul. 

After you recover from an ED - ignore numbers!   In fact, during recovery from an ED - ignore numbers.  In fact, for anyone, it is a good idea to not become a slave to numbers !

Think only 'healthy' and 'that'll do'.  Average is OK.  Average is a wonderful and liberating word.  I will write a blog soon about that wonderful word.  The antithesis of that awful, enslaving word - 'perfect'. In fact 'perfect' doesn't exist!  'Perfect' is a lie !

I have had four children.  During each pregnancy I gained around 17 kg! (The obstetrician weighed me.  That is the only reason I know those numbers).  

I managed to lose all the weight within 3 − 4 months, after each baby was born, without ever dieting.  I lost the weight so that I could fit into my old, but lovely, clothes.   And, I liked my old weight.  It just felt 'comfortable and healthy' for me.  So, I went back to that without much effort at all.  And no diets.

I will discuss weight management later (ie. maintaining a healthy and stable weight - without developing an ED or dieting) in another blog. 

Weight control is mostly to do with learning to listen to 'hunger signals', and moderation. Similar to how the French stay slim.  But not dieting. And, nothing 'nuts' - like eating only cabbages for weeks, or meat all day.  That is not only unhealthy - but, who could, or would want to, do that for the rest of their life?! 

A healthy weight is about - 'common sense'. A balanced and healthy-ish lifestyle. Without any diets.  Moderation is one of the keys.  

And, no!  A stack of exercise is not necessary either. I don't exercise formally.  I only go on family walks weekly, for an hour or two.  And I occasionally swim (once a week if I'm lucky.  Or, more accurately, if I can be bothered!  Let's be honest). And none of that is for 'weight control'.  My exercise is purely for fun and relaxation. 

Although, I'm not against exercise, of course.  Exercise is a great way to reduce stress; it's good for your body generally; it can be fun; and it will help you control your weight.  But, it is not absolutely necessary for a stable, healthy weight. And excessive exercise is not good for you, either.  Many people with ED's are addicted to exercise. So, it's things done in moderation again.

Studies repeatedly show that dieting doesn't work!

If you have an ED - dieting will perpetuate the ED.

If you've had an ED, like me, the dieting will probably cause you to relapse.

And, dieting is not the answer to staying in a healthy weight range. (BMI ~ 18.5 − 25).

Research has shown that the traditional dieting approach of restricting both calories and food types show poor results in achieving long-term weight loss. 

Within five years, many dieters regain any weight they lose and often end up heavier than before they began. They also tend to develop unhealthy attitudes to food, and lose their natural ability to recognise when they are hungry or full !

Young women who start dieting before the age of 15 are more likely to experience depression, binge eating, purging and physical symptoms like tiredness and anaemia.

Dieting to control weight during adolescence is not only ineffective, it may actually promote weight gain. A study of adolescents showed that after three years of follow-up, regular adolescent dieters gained more weight than non-dieters.

High frequency dieting and early onset of dieting are associated with poorer physical and mental health, more disordered eating, extreme body dissatisfaction, and more frequent general health problems.

And, as I mentioned in my second blog on this topic, it's been reported that the Dieting industry has a 98% failure rate.  

And with that would come a 98% rate of reactive-depression, and a 98% rate of  feeling-like-a- complete-loser.  And 98% of you reading this - will not be in the 2% who succeed with diets - long term.  That's called maths.

Another study showed that 95% of all dieters will regain their lost weight within 5 years.

Diets are not the long term answer. 

                                                                *

2.   BODY IMAGE:

Body image relates to:

- How you see yourself  - in the mirror, or in a photo, or in your mind. 

Note: This is not always correct and may be quite different  to how you actually look!

- What you think about your own appearance - including your memories, assumptions, and generalizations.   

This can lead to preoccupation about your body shape and weight.

- How you feel about the way you look.  This relates to the amount of satisfaction or dissatisfaction you have about you body - height, shape, and weight.

- What behaviours you engage in - as a result of how you feel about the way you look. This effects the way you sense and move your body(ie. slouch, hunch over, confidently stride).

If a person is dissatisfied with way they look, they might also isolate themselves - because they feel bad about their appearance. Or they may engage in destructive behaviours to try to change the way they look.

A)   A negative body image:

Definition:  

- A distorted perception of your shape (how you see parts of your body unlike they really are).

- You think that only other people are attractive - and your body size and/or shape is a sign of your personal failure. This can lead to preoccupation with body shape and weight.

- You feel ashamed, self-conscious, and anxious about your body.

People with a negative body image are more likely:

- to develop an ED

- to suffer from feelings of depression, isolation (ashamed to go out), low self esteem, and obsession with weight loss.

B)   A positive body image:

Definition:

- A clear, true perception of your shape (you perceive parts of your body as they really are).

- You accept and appreciate your natural body shape.  And you understand that a person's physical appearance does not equate to their value as a person and their character.

- You feel proud of your own body shape and refuse to worry about calories, weight, and excessive exercise, or even plastic surgery,  to look differently.

** A positive body image is important because:

A person with a positive body image is able to accept, appreciate, and respect their body.

A positive body image is a factor which helps protect  individuals from developing an ED - even if they are genetically at risk. So, it is a preventive factor.

Also, if an individual is able to develop a positive body image - this will greatly assist them to recover from an ED, and protect  against future relapses.

A positive body image will also help:

- self esteem - which determines how a person feels about themselves, and this can affect every aspect of one's life, and contribute to happiness and well-being.

- self-acceptance - which helps a person to feel comfortable and happy with the way they look, and less affected by the 'unrealistic' images in the media, and pressures from society (regarding shape and 'being thin').

- develop a healthy outlook, and healthy behaviours - as it is easier to maintain healthier habits when you allow yourself to 'eat if you're hungry' (respond to healthy 'hunger cues') and feel more positively toward yourself and, as such, feel happier and more confident. 

** A negative body image is important to avoid  because:

A person with a negative body image has negative thoughts and feelings about their body.

Furthermore, people who over-value their body image in defining their self-worth can become develop:

- a low self-esteem, 

- become depressed, 

- develop ED's, or remain unable to recover from ED's, or relapse with an ED,

- become fixated on trying to change their body shape - which can lead to unhealthy practices with food and exercise, and even plastic surgery.

And when these practices don't achieve the desired outcome (which they usually don't) - physically or emotionally - an individual can develop intense feelings of disppointment, guilt and shame.  They may isolate themselves from others - and the whole miserable cycle escalates.

ED's become increasingly likely.

C)  The external factors which can cause a negative body image:

A negative body image is an internal problem (in your mind) - but the causes are usually external - and as such they can be prevented or changed.

Some of these external causes include:

1. The media:

One of the most common external factors in the development of a negative body image is the media.

The media includes a number of different platforms: television, magazines, internet, and advertising.  The images portrayed on these sites are unrealistic, unobtainable, and highly stylised ideals which have been fabricated by stylists, artists,  and digital manipulation - and cannot be achieved in real life. 

Furthermore, most models are thinner than what has been determined to be a healthy weight range, with respect to 'body-mass index' (BMI).  In the US, for example, as I mentioned in the second blog of this ED series, the average woman has a BMI of 24 (normal range: 18.5 − 25).  The average model has a BMI of 16 (anorexia nervosa range BMI definition: <17.5)!

The body type portrayed by advertising as the 'ideal' is possessed by only 5% of American females.

97% of girls in grade 5 − 12 reported that they wanted to lose weight because of magazine pictures.

70% of girls in grade 5 − 12 reported that magazine pictures influenced their idea of a 'perfect body shape.'

80% of women who answered a People magazine survey responded that images of women on television and in the movies made them feel insecure.

Those people (which seems to be most females) who don't feel they measure up in comparison to these images, can feel intense body dissatisfaction - ugly, inadequate, too fat … a loser.

As I mentioned in blog one, of this ED series: in 1998, 38 months after television first came to Nadroga, Fiji, 15% of girls, aged 17 on average, admitted to vomiting to control weight.  74% of girls reported feeling 'too big and fat' at least sometimes.  Fiji has only one TV channel, which broadcasts mostly American, Australian, and British programs.

2. Cultural pressures:

Cultural factors can adversely affect body image.

In our western culture - in recent decades we have come to glorify 'thinness' and place a high value on obtaining the 'perfect body'.  

We have come to value people (movie stars, pop-stars, models) based on their physical appearance and not as much on inner qualities.  This may explain why media personalities work so hard on their appearance - with plastic surgery, and drastic measures to lose weight or 'body sculpt' (liposuction and so forth), or digitally manipulate images of themselves.

Our culture has also developed a rather narrow definition of beauty - which may explain why there is so little 'body-shape' diversity among models.  They all look almost exactly the same - in their body shape and height and weight.

In our weight conscious society today, those individuals with a larger body size are also more likely to develop a negative body image.

Furthermore, our culture teaches us that being accepted by others is necessary at any cost.

Unfortunately, this has led to the belief that in order to fit in (achieve social acceptance) we must look a certain way.

3. Peers:

Body image is often shaped during late childhood and adolescence - although body dissatisfction can affect people of all ages.

Adolescent girls are more prone to body dissatisfaction than adolescent boys, although the rate of body dissatisfaction in males is rapidly increasing and approaching that of females.

Friends who diet and express body image concerns and model weight loss behaviours - can increase the likelihood of an individual developing a negative body image - regardless of their actual body type - and acquiring similar weight loss behaviours (ie. dieting, purging, diuretic or laxative use, smoking).

Teasing an individual, by peers, about appearance, or weight, or body shape, regardless of their actual body type - will result in a higher risk that the teased individual will develop a negative body image. 

4.  Family:

Other family members who diet and express body image concerns (worry about weight and physical appearance) can be negative role models (similar to the effects of peers) and result in an individual within that family developing  a negative body image. 

Conversely, belonging to a family environment that does not overemphasise weight and physical appearance - has been found to be protective against developing a negative body image, and ED's.

Other family members with ED's might also model their ED behaviour, as well as passing on their ED genes - and both of these factors might explain why ED's more often run in families.

Studies have found that another socially protective factor in families was to eat meals together on a regular basis.  

The converse is true for families who rarely sit down and eat meals together. 

Longitudinal studies into the association between family meal frequency and disordered eating behaviours in adolescents found that - regular family meals during adolescence played a protective role for extreme weight control behaviours in girls, although not in boys.

5. Sporting Activities:

Athletes are another group at higher risk of developing a negative body image and ED's.  And, although many of these athletes develop disordered eating to keep their competitive edge, others use exercise as a way to maintain their weight and figure.

ED's are especially prevalent in sports where 'thinness' is a factor - such as ballet, figure skating, gymnastics.

Men can often struggle with binge eating following excessive exercise while they focus on building muscle rather than losing fat.  But, this goal of gaining muscle can be just as much an ED as obsessing over thinness.

The following statistics (taken from the book: Abnormal Psychology - by Susan Nolen-Hoeksema) shows the estimated percentage of athletes that struggle with ED's based on the different categories of sport :

                                                                                        
  Category of sports                        Estimated % with ED's                            
- Aesthetic sports (dance, figure skating, gymnastics)   - 35%

- Weight dependent sports (judo, wrestling)                  - 29%

- Endurance sports (cycling, swimming, running)          -  20%

-Technical sport (gold, high jump)                                -  14%

- Ball game sports (volleyball, soccer)                          -  12%

6. Personality traits:

Some personality traits can put an individual at higher risk of developing a negative body image, and with that, at higher risk of developing an ED.  Some of these traits are as follows:

- perfectionism 

- high self-expectations

- competitiveness

- driven

- tendency to depression and/or anxiety and/or loneliness

- low self-esteem

- troubled family and/or personal relationships (social phobia common)

- difficulty expressing emotions and feelings

- A history of being teased or ridiculed based on weight or size

- A history of physical and/or sexual abuse

D) How can you improve your body image?

* It is important to know that there is no right or wrong appearance.  

Throughout history, and across different cultures, the definition of 'beauty' has and does vary greatly.  It is all arbitrary and irrelevant. For example, in some cultures, girls' feet were bound, and crippled, all in the name of beauty.  In other cultures people stick metal rings around their necks, to elongate the neck, until they look like a giraffe, in the name of beauty?!  Or, in the past, European women would paint their faces with lead-based white make-up - and die of lead poisoning - all in the name of beauty!! How is starving one-self any less ridiculous than any of that?  

That was a rhetorical question people!  The answer is: 'No!  It's not less ridiculous.  Starving oneself is at least as stupid!  And everyone wanting to look exactly the same - is just as bad!'

If you can't see that yet - let's keep working on this: discovering your own individual beauty - which is more about who you are, what you do with your life - than what you look like. And your soul, the real you, is where true beauty lies. 

Health and happiness and contentment in your life is what actually matters. 

And seeing yourself as unique, and valuable - with your own talents and qualities.  

Not  a superficial imitation of anyone else !  

Also, there is a limited amount that you can change about your body.  Your height, muscle composition and bone structure is fixed by genes.  But - that is you!  Value that as I hope you'll learn to value your self!

* Some tips:

a) - Focus on your positive qualities, skills, talents - will help you appreciate your whole self.  (ie. kindness, music abilities, artistic skills, sense of humour)

b) - Say positive things to yourself everyday.

- write any old thing that is positive.  

- If possibly, write the homework that I suggested at the end of blog 2 (list 3 people you admire and 3 qualities about those 3 you admire.  Those are usually qualities you possess.  We tend to see things more clearly in others than we do in ourselves).

- when I did this (write a list of positive things about myself) while I was recovering from an ED - I found it hard to think of anything good about myself.   When your self esteem is in your boots that can happen.  But, a friend helped me make up a list of 10 things - and I forced myself to read them everyday - from a piece of paper I kept in my purse.  

It really does help.

Internal positive talk - will help combat all the negative internal dialogue going on in your head for the other 23 hours and 59 minutes of the day!) 

It's a beginning.  Recovery will take quite a while.  This is all a start.  

But every journey of 1000 miles - begins with a single step.

This is the journey back into a happy and wonderful life for you.  A healthy and lovely life - like mine has been since I recovered.

c) Avoid negative and berating self talk.

We'll cover this in the next blog - 'cognitive behavioural therapy' or CBT.

It is amazingly powerful.

That internal critic telling you that you are never good enough - can be shut down for good.  You can learn this. Your brain is plastic and can change and learn to become more positive and kind to you.  CBT helps so many things - self esteem, mood, contentment, body image ... 

d) Focus on appreciating and respecting your body.

Sure, you may not like your nose, or your ears, or your eyes, or your glasses, or your … (insert any one - or a long list - of the things that you think could be more perfect) … but also realise that you have a lot to be grateful for.  

You my not like your chubby legs - but at least you can walk!  You may not like your glasses - but at least you can see!  You may not like your nose - but at least … you're not suffering with third degree burns to 80% of your body !  

Things could always be worse.  So, with that in mind - trivialities like not being 'perfect' (a constantly shifting goal post anyway) is not anything worth dwelling on for too long.


My children tell me that I have a habit of saying to them, when they come to me with problems:

'Well, it could be worse!'

And, it could be! 

Of course, my children and I discuss their problems, we problem-solve, and so forth. But we also put problems into perspective.  Things are often not as bad as you think. In a week or so we will probably not even remember what these problems were.  Some things also work out for the best - when you look back.  You learn and grow from difficult times.  

There's an old saying:

Smooth seas never made a skilled sailor.

And, things could usually be worse … and they're not.  So, that's something to be grateful for.

We could all count at least some blessings in our own lives - no matter how hard our lives get.  I do that everyday. I am constantly mindful of lovely things in my life - no matter how small:  a lovely view, a beautiful fiery sun-set, an interesting conversation with someone.  Even in my darkest and saddest moments - I can always think of things that I can be grateful for. And that includes reminding myself that things could be even worse:

So, let's think of any number of 'it could be worse' scenarios.

In addition to whatever problems you currently have in your life - it could be worse. In addition to those problems (or challenges) you could also be: 

blind; blind and - deaf; blind, deaf and - completely paralysed;  blind, deaf, completely paralysed and -  about to be trampled by (insert relevant collective noun) of elephants; you could have fallen off the side of an ocean liner and no-one can hear you scream and the boat is steaming away … and the sharks are coming...

You get the point.  

No matter how bad things are - in most cases it could be worse.  It could start raining - and you're far from home with no umbrella - and the worst electrical storm hits  -  and the most boring and annoying person you've ever known is now with you  endlessly complaining about … everything … and you fall in a ditch and break your ankle - on top of everything you're currently experiencing in your life (blindness, deafness, paralysis …)

And, even then - it could be worse.

I often see life in this way.  I acknowlege all the good things in my life - everyday.  This is called being a 'cup half full person - rather than a cup half empty person'.

And if things go wrong - I acknowlege - 'when at least … didn't happen'. (Insert some scenario from the above list).

e)  Set positive health focused goals - rather than 'weight loss goals'.

For example you may like to eat a little more fruit and vege's for the vitamins and minerals and fibre they contain. Not to lose weight!

And you may like to hike along a very long trail - to see a lovely view, or swim a kilometre - for the fitness side and the relaxation.  And not to lose weight.

This will put the focus on your overall 'well-being'.

f) Make a point of appreciating your own beauty (eyes, nice skin, hair etc) and try not to compare yourself with others.  

As the poem Desiderata says:

If you compare yourself with others, you may become vain or bitter, for always there will be greater and lesser persons than yourself.

Also, while we're talking about that lovely poem, another quote is lovely:

Nurture strength of spirit to shield you in sudden misfortune.  But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness.

Remember- what is unique and different about you - makes you 'you' - special and a valued soul.

3.  SELF-ESTEEM:

Finally, I will briefly discuss self-esteem - in my list of potentially modifiable external factors - which, if corrected, can result in prevention of ED's, recovery from ED's, and the avoidance of relapse of ED's.

 Definition:  Self-esteem is the judgement that a person has of themselves and their worth (positive and negative).

It includes:

- Beliefs:  for example, 'I am competent', 'I am worthy.'

- Emotions: for example - despair, pride, shame.

A person may have positive or negative self-esteem in:

- a small area about oneself: for example, 'I am a good dancer', or

- globally about oneself:  for example, 'I believe that I am a bad person, and I feel bad about myself generally'.

Psychologists usually regard self-esteem as an enduring personality trait.

The importance of self-esteem lies in the fact that our view of ourselves and our value - affects the way that we are, and act, and relate to other people in the world.

The healthiest expression of self-esteem is when we don't need approval from others (fame or flattery) but we approve of ourselves already and unconditionally (ie regardless of our looks, shape, size, achievements, failures).

Experiences in our lives determine the nature of our self-esteem (attitudes to ourselves and feeling of self worth):

*  Pre-school years:  

Our parents are the most significant influence on self-esteem.  An emphasis on unconditional love is important for a child to feel cared for and respected.

These feelings translate later into self-esteem as the child grows.

* School years: 

-Academic achievements or failures - contributes significantly to self-esteem.

- Social experiences - children'compare' themselves to the other children - in activities, and see differences between themselves and others.

- Adolescence - peer influence - becomes much more important. 

-Social acceptance is very important.  Rejection and loneliness can lead to low self-esteem.

* Parenting style:

- caring, supportive parents who set clear standards for their child and allow them to voice their opinion in decision making  results in higher self esteem for the child.

Childhood experiences that contribute to a high self-esteem:

- being listened to

- being spoken to respectfully

- receiving appropriate attention and affection

- having accomplishments recognised

- mistakes or failures acknowleged and accepted 

Low self-esteem experiences in childhood:

- being harshly criticized

- being abused - physically, sexually, or emotionally

- being ignored, ridiculed, or teased

- being expected to be perfect all the time

Self-esteem has been found to increase during adolescence and into young adulthood.

High self-esteem was associated with:

- higher levels of mastery

- low risk taking

- better health

Personality types are associated with self-esteem.

Higher self esteem was associated with personalities which were: emotionally stable, extroverted, and conscientious.

Low self esteem can result from various factors, including:

- genetic factors

- physical appearance or weight

- mental health issues (depression and anxiety can lower self esteem)

- socioeconomic status

- peer pressure and bullying

A person with low self esteem can show some of the following characteristics:

- they experience heavy self-criticism and dissatisfaction

- hypersensitivity to criticism - resentful of the critic, and they feel like they're being attacked  if they are criticised at all

- chronic indecision and fear of making mistakes

- excessive will to please

- perfectionism (which can lead to frustration and depression if perfection isn't acieved)

- neurotic guilt (dwelling on, or exaggerting the magnitude of past mistakes)

- floating 'anger' and general defensiveness

- pessimism and a general negative outlook

- they see temporary setbacks as permanent, and intolerable conditions.

A person with high self esteem can show some of the following characteristics: 

- they have a postive self-image (which is deeper and stronger than simply 'body image')

- their self-esteem is not subdued by failures in their pursuits. 

- they have less fear of failure

- appear humble, cheerful, and don't  boast about their achievements

- they work hard to achieve their goals, because if they fail - they can 'bounce back'

- they acknowledge their own mistakes precisely (as their self-image is strong)

- they live with less fear of losing social prestige, more happiness, and general well-being

** But, no level of positive self-esteem is indestructable. And some situations and circumstances in life, can result in an individual falling from this level of positive self-esteem to any other more negative level of self-esteem.

So, self-esteem is vitally important for happiness in life and health.  Abraham Maslow said that psychological health is not possible unless the essential core of a person is fundamentally accepted, loved, and respected by others and by him or herself.

Self-esteem allows people to face life with more confidence, benevolence, and optimism, and more easily reach their goals.

Self-esteem may help people to feel that they deserve happiness in life. It helps people to have more rich interpersonal relationships, and avoid destructive ones.  It is less possible to love others if we don't already love ourselves. 

And, for parents, it is no good to simply tell children that they are 'great'.  They will compare themselves with other children and realise that they aren't 'great' just for existing and being a 'human.  

To improve a child's self esteem it is necessary to be specific about something in particular that is done well.  It is only when a child engages in personally meaningful endeavours, for which they can be justifiably proud, that self-esteem grows.

So, in summary:

There are a number of external factors which can be changed to help prevent  ED's occurring, help find a pathway to recovery, and help avoid relapsing in the future.

The three external factors discussed in this blog - dieting; body-image, and self-esteem are all things which are not set in stone.  They can all be changed and worked on - and with a more positive body-image and self-esteem, and with avoidance of any form of dieting - ever - health and well-being can be found.

I know this has been a long blog - but I hope it can be something to refer back to.  Ideas in each section about how to improve these areas - can be worked on gradually. But at least you'll have a plan.  A map back to health and happiness.

And, as I've said in every blog so far, I would recommend that anyone with an ED seek professional help with a psychologist or psychiatrist and a medical doctor as well.  An ED is a very hard illness to overcome.  However, you can ask for help - and seek it out until you find it - and fight to get better.

You are worth it.  You'll see that in time.  But I will tell you now.  I don't even know you - but I send you my love.  As a fellow human in this life journey -and as someone who had an ED - and recovered, and as the mother of a daughter who also had an ED - and recovered.  With hard work.  But you can do it too!  I promise that you will be so glad that you did the work to recover.

                                               *

Quote:

'I will not die an unlived life … I choose to inhabit my days to allow my living to open me … I choose to risk my significance.'

Dawna Markova

                                               *

Next week I'll discuss the next external factor which will help prevent ED's, and help you to escape from the grasp of an ED:  - The wonderful word: 'average'  (which is anti-perfectionism).  As explained in this blog - accepting being less than perfect, and not needing other people's approval -  is part of developing a more positive self-esteem, and a more positive body-image.

I'll also look briefly at cognitive-behavioural therapy (CBT) thinking styles - which help people to see the world as a much more lovely place.  CBT helps one to see the 'cup half full'.  CBT releases us from perfectionism and brings with it happiness, contentment, and a significant reduction in anxiety and depression.  Even without medication! CBT can get rid of the negative self-talk in your head.

Finally, before I go I have three funny little stories, from events which happened during the past week with my five year old son - Ollie. I will finish every blog in this ED series with a story related to 'anything except food and weight and ED's'!

When I talk later about coping while you recover - I'll mention getting away from the illness.  At least for a while - everyday.  Find life outside the confines of the drab ugly ED illness.  Talk about other things, watch a lovely sun-rise or sun-set or … anything out in the world - beyond the illness.  Get away from it for a while.  And gradually, that life you build away from the illness (and discussions about it) will become the major part of your life.

Anyway, about my five year old Ollie.  Three funny stories from this week:

1.  Ollie had drawn a big picture of a stick-figure person in pen on his left forearm last week.  I asked him what it was for.
He replied, 'It's a picture of you, mum.  I love you so much but I thought I might forget what you looked like when I'm at school.'

He is so sentimental.

                                                    *                

2.  We looked at our house getting built last week.  We were all impressed by the framework and the brickwork.
Ollie squealed with delight, as he climbed over a 2 metre pile of sand, which had been dumped in the front yard - immediately anterior to the future front-door.

'Wow! Great!' he exclaimed. 'They even put in a sand-pit!'

                                                      *

3. Yesterday Ollie's reception-class had a policeman visit them.

The purpose of the visit was to teach the five-year olds about 'stranger-danger,' and to teach the children not to be afraid of police officers - if they were ever in trouble, lost, or needed help.

So, Ollie came home from school with orange ink on his finger tips (the class had been shown how to take finger prints from 'crooks'), and he still wore a name badge on his school-uniform - used to help the policeman talk to the children by name.

I asked Ollie, as I tucked him into bed at the end of the evening, how he liked his day.

'Well,' said Ollie, full of enthusiasm, 'the spy came to visit us at school!'

Ollie had misunderstood the purpose of the policeman's visit, and the exact nature of his job.  But, I let him continue.

'I talked to him, mum!' he continued, breathless with excitement.  'I asked him if he had a van that turned into a Ferrari.  Cause he's a spy.'

'What did he say,' I asked, trying not to laugh.

'He said he did!' Ollie was sitting up in bed, eyes wide as saucers.  'And he telled me it was top secret though … and I can't tell anybody.'

'Did you tell anyone, Ollie?' I asked.

'Yes,' he said softly.  'Just my class … But no-one else, mum.'

OK,' I whispered back.  'I won't tell anyone either.'

Life as a five year old little boy must be so exciting, I thought, as I kissed his forehead and turned out his light. I can imagine his little dreams that night! A spy coming to school - who owns a van which transforms into a ferrari ...

                                                     *

I hope everyone has a lovely week.

And, consider some of the things we talked about here.  Even if you don't have an ED.

A healthy body-image and self-esteem will help you in your life so much - with resilience, happiness, contentment, mental and physical health, and relationships.

And stop dieting!  I'm watching you.  No … put that carrot down.  Go get yourself something to eat if you're hungry.  And make it filling. Proper food. And don't look at the calories on the label.  No numbers.  We'll go into this in more detail later.

Be kind to yourself.  And have a lovely coffee … and a piece of cake.  I've done that at cafes everyday this week - with different friends.  I go to work four days per week as well.  So, I'm unfortunately not a 'lady of complete leisure'. But, again tomorrow morning,  I'm meeting a friend for coffee at our lovely Glenelg Marina.  You could google: Glenelg Marina images. It is a lovely place with great coffee and cheesecake.