INTRODUCTION

This book is about getting over an eating disorder, how we did it, how we helped thousands of others do it, and how we hope to help you do it, too. We took on this project because we want to share what we have learned, provide practical strategies and examples of what really works, and offer our own experience and that of our clients to facilitate your recovery process. 8 Keys to Recovery from an Eating Disorder: Effective Strategies from Therapeutic Practice and Personal Experience is for anyone with an eating or body image problem. You don’t have to meet any formal diagnosis to benefit from this book. If you restrict, binge, purge, excessively diet or weigh yourself, exercise compulsively, or engage routinely and obsessively in any other food- or weight-related behaviors, the eight keys can help you get on, and stay on, the road to recovery. Although 8 Keys is a self-help book intended for those suffering from an eating disorder, it will also be informative and useful for family, friends, and professionals.

This is a personal book for you to use in your recovery process. You can read through the keys in order, skip around, or start with the ones that draw your attention the most. Our goal is to help you understand why you developed your eating disorder, and give you the necessary tools and strategies for change and healing. We do not offer diagnostic criteria, or details of medical complications, nor do we explain the various forms of treatment available. If you would like more information on those aspects of treatment and recovery, see the Resources section at the back of the book where we list suggestions for further reading. This book does not substitute for or replace medical, psychiatric, or therapeutic care. If you have not already done so, we highly encourage you to contact an eating disorder professional for help and obtain a thorough physical, as there are many medical consequences of eating disorders that may not be visible or obvious, but could be dangerous. We are aware that some readers may pick up this book instead of seeking professional help and if that describes you, we hope to help you get started on your path, and perhaps motivate you to seek whatever help is appropriate for you at this time.

Throughout this book you will hear personal accounts from others, including ours (the authors) who have struggled with an eating disorder and recovered. Research shows that working with someone who is recovered is a positive and significant experience for someone suffering with an eating disorder. This does not mean that you have to find a treatment professional who has recovered, but exposure to others who have gone before you and successfully overcome their eating disorder is vital. Revealing to our clients that we are “recovered” is somewhat controversial, as there are those who disagree with this practice. We acknowledge their concerns and understand that this kind of self-disclosure requires a great amount of responsibility and professional astuteness. We have found that our experience of suffering and triumphing over our own eating disorders has given us some of the most useful tools we have for helping others, and we consistently hear from clients that knowing that we recovered is one of the most helpful aspects of their treatment. Although we have chosen to share our own stories exactly as they occurred, some of the quotes and examples from clients are composites or we have changed a detail or two to ensure confidentiality.

In this book, we not only share examples from our personal stories, we also bring the reader into our work together as therapist and client, thus giving readers a glimpse into the process from both sides. Gwen Grabb was a patient at Monte Nido Eating Disorder Treatment Center when it first opened in 1996 and Carolyn Costin was owner, clinical director, and therapist. These narratives are intended to help you understand the therapeutic process, increase insight about your own resistance or fears, clarify issues, enhance your therapy, or provide you with the motivation to seek help if you have been discouraged, or afraid to do so. We hope that reading both of our perspectives will help reduce shame, increase trust, and show that you too can get well and live a normal, full life.

We begin our self-disclosure right here, as we conclude the introduction of the book with an introduction to us. The following is a brief overview to provide you with some needed context as you read though the keys and the personal reflections we provide.

Carolyn’s Story

I developed my eating disorder around the age of 15. It all began with a diet that my friends and I went on in high school. I was the only one who never stopped the diet. At 16, when I was leaving for college (yes, I know, a bit young), I weighed 40 pounds less than I had before I started dieting, and was 40 times more screwed up than anyone knew. I did not know I had an illness. There were no books or television specials or treatment programs advertising help. My mom took me to a doctor to find out what was wrong, but my tests came back normal, validating my belief that I was OK and “Everyone should just leave me alone and let me eat what I want.” I felt proud of my weight loss. It was a sign of success and willpower that I could control my hunger and pass up “fattening” foods, even though, it is more accurate to say that I was obsessed with food and thought about it day and night. Eventually, as often happens with an eating disorder, all foods became fattening in my mind and eventually eating itself felt like a weakness or failure. Still I persisted, due to an intense fear of what would happen to me if I relinquished my rigid control. The best way to describe it now is that I developed a phobia of gaining weight. As I got thinner and thinner, it seemed like I felt fatter. I noticed my stomach sticking out or my thighs looking too big no matter how much weight I lost. To get through the day eating as little as possible was the goal. It became so pervasive that I would not lick postage stamps for fear of the “extra” calories. Once I drank a sip of a regular soft drink that I thought was a diet soda, and when I realized my mistake, I felt panic. I felt like I was a disgrace, and like I had sinned. My mind had been completely taken over by an obsession with calories, weight, and food. I tell clients that it is like being brainwashed, but the good news is, you can be deprogrammed. I want others to know that back then I never would have imagined that I could turn it all around, that someday those behaviors would become old memories of a long-gone illness. I would never have imagined that one day I would be eating pasta and pizza, cake and candy bars, and whatever else I wanted without any hesitation or bother. I would not have believed I would stop counting calories or weighing myself. Yet all of these things are true, and they can be true for you, too.

People always ask, “What made you get better?” or “What turned you around?” Just as there are a myriad of things that come together in the development of an eating disorder, there are many things that have to come together to turn it around as well. There are a few moments that stand out in my mind as important and pivotal. One was an experience I had one morning in my college dorm room. I had been telling myself that I was not going to lose any more weight, but that I just did not want to gain any, either. I was sure that I was eating enough to maintain my weight. When I got on the scale for my routine morning weigh-in, I saw yet another unintended drop in weight. I heard myself say, “I am not in control of it anymore; it is in control of me.” I knew I needed help and I began to look for it, but I could not find anyone who had ever heard of, much less treated, a person with an eating disorder. I was on my own to get better. It was a long hard struggle. I never wanted to gain weight; I wanted a better life, and I had to let weight gain happen as part of that process. When I did gain weight, I began compulsively exercising. This too had to be faced, dealt with, and let go.

There were many ingredients that helped along the way. My studies in psychology helped me to understand my mind, and pushed me to create behavior modification projects that helped me change. The love and unconditional support of my mother made me believe in myself and nourished me in times of desperation. I learned that I could tell people the truth and they would love me more, not less, so I reached out to others to help me. My work as a teacher gave me a sense of purpose. Finally, my exploration into the realm of philosophy and spirituality shifted my focus from the external to the internal, and brought new meaning to my life on a more soulful level. All of this helped me recover and helped make me who I am today. When I became a therapist in 1977, I began immediately disclosing to the few clients who came my way that I too had been there and understood what they were going through. I was “out of the closet” before I knew I was supposed to be in it! As it turned out, disclosing my own eating disorder and eventual recovery became a hallmark of my treatment philosophy. I became a pioneer in two important areas in the field of eating disorders: 1) that you can be fully recovered, and 2) that if you are recovered and you are a therapist, it is useful to share this with your clients, as it is valuable in your arsenal of therapeutic tools and role modeling.

Gwen’s Story

I was only 11 years old when I went on my first diet. Up until that day, I hadn’t thought much about food in relation to my body shape or weight. My mother was always talking about dieting and the social hazards of being overweight. Although her intentions were good, from the moment that I started dieting, my relationship with food and my body changed in very negative and ultimately destructive ways. I would spend the following seven years trying to lose weight and, as I saw it, failing miserably. Each diet failure confirmed my lack of self-discipline and reinforced my feelings of shame and hopelessness. Then, at 18, I moved away to begin college at my heaviest weight ever. Fearful of rejection, I avoided meeting people, joining groups, going to parties, or participating in campus activities. I didn’t really want to be alone, but my decisions kept me that way. I believed that my weight was the root of my isolation and a desperate anger toward myself was brewing inside of me. I didn’t know how to help myself and again my mother (who was extremely loving and truly trying to help) responded to my pain by suggesting I lose weight to improve my self-esteem, and sent me her latest diet. Neither of us could see that the weight was a symptom, rather than the problem itself. Due to my lack of friends and severe depression, this diet took hold of me and took over, leading me into what became a rapid descent into a full-blown eating disorder. I lost a lot of weight very quickly. My meals became more restrictive, rigid, and even ritualized. I started exercising compulsively and chronically weighing myself to make sure I was not gaining weight.

Back then, I had no way of knowing what I was doing to my mind and body, or that what I was doing would change me forever. It was 1980 and there was very little information available about eating disorders at that time. I had never even heard of anorexia or bulimia. Over the next two years, as my eating disorder progressed, I was able to keep it a secret and strongly dismissed any concerns about my weight loss. In fact, when people told me I was too thin, I was ecstatic and sentiments of worry or concern from others felt like a warm hug. That kind of concern felt great to me after years of feeling nothing but shame about my body. Soon, my behaviors started taking a toll on my health. After showing up at the health center weekly with numerous illnesses and ongoing infections, the doctor finally confronted me and used the word “anorexic” to describe me. I was shocked, confused, and thought he was just trying to scare me. After that appointment, I had moments of fear for my health, but my fear of gaining weight was much stronger. Finally, this same doctor recommended that I leave school until I got help and, if I wouldn’t do it voluntarily, he threatened to proceed with a “formal dismissal.” As I had no choice, I returned home and said nothing to my friends or family. I was terrified to stop what I was doing and to gain any weight. When I would try, my anxiety would skyrocket until I found a way to get rid of the food. Thankfully, just being back home around friends helped me feel less isolated and I started eating more and treating myself a little better. I returned to school, but I was far from well.

Shortly thereafter, I met Albert, whom I eventually married. I got pregnant very soon after our wedding, in spite of signs and warnings of possible infertility. Although being pregnant gave me short reprieves from my obsessions, as soon as I had each of my children, I quickly relapsed back into familiar rituals and fears about food and my body. After my third child, I fell back into the behaviors particularly intensively, and one day after running I had a seizure at the gym. This event was the catalyst to me finally seeking help. For the first time, I admitted everything to my husband and allowed him in. There wasn’t very much help available at that time. I had no experience with therapy and didn’t really know what kind of help I needed. Outpatient therapy was unsuccessful and the thought of going somewhere for inpatient treatment terrified me. I was almost ready to give up trying, when someone mentioned Carolyn being a recovered therapist with a house in Malibu where she helped others. The sound of that instilled some hope and I agreed to visit. I was very scared of getting well and all that would entail, but right away Carolyn made me feel safe, understood, and hopeful, and I agreed to treatment. Although I didn’t realize it then, this decision was a major turning point in my life, and the moment when my recovery truly began. Recovery from my eating disorder was a slow process with many setbacks, and twists and turns. There was so much fear to overcome, but I did not give up. It’s hard to say exactly when I got to the place where recovering turned into recovered, but it did. I have a good relationship with myself now, and have authentic and close relationships with the people around me. Having had such a serious illness, and being able to recover from it and heal, has helped me become a stronger and happier person than I ever could have imagined. Becoming a therapist was a natural evolution of this process, and I am very dedicated and passionate about helping others recover. I am honored and excited to bring all of the rich experiences and lessons I have learned along the way to the readers of this book. Through my words, may you find hope and healing.

Writing Assignment:

When you see this icon in the book, it means it is time for you to personalize the information. We strongly suggest that you get a journal and take time to do the assignments in order to make the material personal. Even though it is tempting to just read the assignments and move on, we can’t stress enough how much more you will get out of this book if you do them. Writing in a journal is useful for clarifying your thoughts and feelings, getting to know yourself better, and managing over-whelming emotions associated with an experience. We know that writing down your account of an emotional situation can help you lower your reactivity to it even if you don’t share your writing with anyone else. Recording your thoughts and feelings allows you to get them out and return to them later. You will be able to see your own progress or places when you are stuck. Sharing your journal with someone can also help you get feedback, clarification, and support. Finally, journaling is one of three things that most of our clients who have recovered have in common. The other two are not weighing and reaching out for support at the first sign of a problem. This is meaningful data and we stress the importance of journaling to all of our clients. Not weighing and reaching out for support are addressed thoroughly in the 8 keys.

We have included a number of assignments in each key, but in order to avoid bogging down our readers or disrupting the flow of the reading, we sometimes list one or more of our assignments at the end of each key. Taking the time to do the assignments is important and worth it, but if you are not ready or willing to do this, don’t worry, as you will benefit from the eight keys anyway.