Author Archives: Robyn Kievit

There was a little girl…

There was a little girl 

Who had a little curl
Right in the middle of her forehead
When she was good
She was very, very good
And when she was bad, she was horrid
 

The above nursery rhyme, from what was initially a poem, by Henry Wadsworth Longfellow, feels similar to an eating disorder for me. 

If you’re ‘good,’ you’re amazing. If you’re thin, skinny, starving or purging or over-exercising, you’re fabulous. If you’re horrid, or bad, it’s because you’re eating, thinking about eating anything, even drinking just water. 

This is what I hear from my clients – I learn so much  from their experiences and what they live when they are entrenched with their ED. This is why in every initial session with a client I suggest we don’t use these words around food or our bodies – good, bad, sorry, should, can’t, healthy, clean and diet(ing). 

I have a vivid memory of stepping on the scale in front of my mother when I was young. This is when I was about 14 years old and as a skinny, teenager weighed exactly 100 pounds. I remember standing on the scale, in my parent’s bedroom, in the morning before school.

My mom weighed herself every day. At least this is what I remember. She looked at me that morning – she was still lying in bed – and asked me my weight. When I told her ‘100 pounds,’ her response was, ‘You should always try to stay under 100 pounds, Robyn. Men like thin women.’

At the age of 14 I was not interested in men. Boys, yes, but even so not very much at that time. I was planning to study abroad and was heavily involved with my friends, school, church, and family. That comment stuck with me though.

IMG_6044 FixedThis is a photo of me and my best friend from growing up. We were getting our fall sports team photos done with the rest of the school on this particular day. It was at this age, 14, that I became increasingly body conscious and constantly worried about getting fat. This little girl, with a curling iron curl and a lot of hair spray to keep it stay in all day, was worried about not being good. She was worried she might be horrid if she became fat, ate food(s) with any fat at all, and weighed over 100 lbs.

Everywhere it seemed the adult women in my life at the time were infatuated with their weight. I remember my mom saying things like ‘I shouldn’t eat this I should just tape it to my thighs.’ So many comments about weight gained in three pregnancies and never lost. Then there was ‘I’m just going to eat what Robyn eats because she’s skinny.’ Grown (any age) women trying to look like they are young adolescents is an unwise idea.

When you’re young, these comments stick with you. In fact, there is research to suggest that even infants are learning their parents’ body language and attitudes toward food at this very young age. Other research suggests this all begins in utero.

Hearing, listening, wondering, observing, and even learning (not positively) these thoughts and behaviors around food, weight, and bodies was definitely what drew me to my career. Even as a young teen I knew there absolutely had to be a better way to feel about your body. To think and relate to food. What did the scale matter anyway? But it did. For a long while.

It was not until I got to college and taking advanced nutrition classes that I really began to understand how to position my own nutrition choices and body image around facts. Around science.

I decided the infatuation around food and weight and negative body image was not going to be my life. But it took years and hard work. On my own and with some amazingly talented therapists. Others around me struggled with eating disorders or disordered eating. A college friend passed away, losing her battle with her eating disorder, shortly after graduation.

We do our best as parents. Every single day – even every single hour or minute for that matter. But there are parts of us based on our past and present environments – and our genes play a role, too. Eating disorders are genetically related and more about intergenerational trauma is available now than even five years ago. Science is impassable in this regard. I don’t think my mom knew her comments or thoughts about herself and her relationships with food, her body, and her weight were sitting in my heart. In fact, I know she didn’t. It took a lot of undoing though. I think I am lucky.

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Society and the media have become more accepting of bodies that come in different shapes and sizes. But we still have a long way to go.
When every day can seem harder or every meal can seem like a mountain to climb, don’t give up. Don’t let that boy, girl, friend, mom, dad, sister, brother, parent, or anyone else give up either. There IS way more than the scale, your belly fat (real or perceived?), a ‘thigh gap’, and fitting into a smaller size.

Eating and food can be enjoyable – fun, even. A certain weight to be loved is NOT positive self-esteem. Here’s to the Recovery Warriors and their freEDdom.

Resources for eating disorders awareness week:

Multi-Service Eating Disorders Association
National Eating Disorders Association
The Alliance for Eating Disorders Awareness
One Common Habit Could Have A Lasting Impact On Your Child’s Health
Your Kids Don’t Have to Inherit Your Body-Image Issues
Eating Disorder Hope
Eating Disorders Resource Catalogue
5 Things You Shouldn’t Say to Someone With An Eating Disorder
Representation of the LGBTQ Community in Eating Disorder Recovery: One Perspective

Demystifying and Treating Body Dysmorphic Disorder with Psychotherapy and Medication

Body Dysmorphic Disorder (BDD) is a mental illness in which a person is preoccupied with an imagined physical defect or a minor defect that others can not see. These individuals spend up to eight hours per day focusing on and trying either trying to “fix” or hide their perceived defect.

A few years ago, I (Karen) attended a workshop at the International OCD Foundation on the topic of  BDD for professionals who counsel on BDD, and individuals suffering from the disorder. At the workshop, I was struck by a young man from Europe who raised his hand and stood up to say that he had been suffering from BDD for most of his life. He described his suffering and how he believed he looked like a monster and deformed because of his “defects.” He shared that he was housebound because of his disorder. Being at the conference was the first time in five years that this young man had left his home. He chose to attend as he felt that there would be people and professionals at the conference who would understand his condition and not judge him. What a brave young man to be so vulnerable to share his story!

Last month we presented at the International Association for Eating Disorder Professionals (IAEDP) conference in Palm Desert on the topic of BDD. We had an amazing turnout! Nearly 200 clinicians showed up, all of whom were interested and engaged in our workshop. The following are takeaways from our presentation.

Identifying BDD: Behaviors/ Rituals

Individuals with BDD exhibit certain behaviors referred to as rituals. These rituals are repetitive behaviors that the person engages in to try to lessen their negative feelings about their looks or appearance. Rituals may decrease the individual’s anxiety temporarily. Over time, however, the level of distress the individual experiences will increase, causing more suffering as they continue to engage in rituals such as mirror checking, asking for reassurance from loved ones, camouflaging in order to hide their “defects,” and/or seeking excessive surgical/dermatological procedures.

Often, BDD negatively interferes with one’s social, emotional and occupational functioning. For example, a person with BDD might spend many hours checking themselves in the mirror while neglecting their family or work, often resulting in familial dysfunction or job loss.

Managing Anxiety Related to BDD

While BDD rituals may reduce one’s anxiety in the short term, it will ultimately worsen long term if left untreated. Furthermore, individuals will likely use rituals more frequently in order to manage their anxiety because it feels so uncomfortable and unmanageable. Hence, a significant portion of work that we do with our clients with BDD in therapy is developing tolerance of anxiety.

Interestingly, we generally tell our clients who struggle with the disorder that anxiety is their closest ally in their recovery. The more they accept and befriend their anxiety, the less intense it will feel in the long run. During therapy sessions we invite clients to explore  their level of anxiety through exposure exercises. As they sit with their anxiety, they learn that although the feeling is uncomfortable, it’s not going to hurt them. And, during the course of the exposures, the client’s anxiety inevitably decreases.

During therapy, a clinician may suggest a client see a prescriber to be evaluated for medication that may help alleviate their anxiety symptoms. While the Food and Drug Administration (FDA) has not approved a specific medication for the treatment of BDD to date, typically FDA-approved serotonin reuptake inhibitors (SRI) are prescribed most often to allay symptoms. When incorporating medication management for BDD treatment, it is important to understand that these clients usually need higher doses of medicine, and that the medicine can often take twelve to sixteen weeks before becoming fully effective.

How to Find Help if You or a Loved One has BDD

If any of the issues described above sound familiar, it is important to seek treatment from a team of professionals (therapist and psychopharmacologist) who specialize in BDD. Working with providers who do not understand the disorder can actually fuel and exacerbate BDD symptoms. We have witnessed this firsthand!

Your BDD therapist should employ Cognitive Behavioral Therapy (CBT) for treatment. CBT is the first line of treatment for BDD, and it involves challenging assumptions around beauty and appearance and exposing oneself to situations that may result in anxiety. Working with a psychopharmacologist is equally as important. As noted above, medication in conjunction with psychotherapy is critical as medication targeted for BDD helps clients feel slightly less anxious while undergoing therapy to overcome the disorder.

More information about BDD and CBT can be found at the  International OCD Foundation website https://iocdf.org/ or the BDD Foundation website https://bddfoundation.org/.

As always, please feel free to email us with questions, comments, and/or concerns. If you or a loved one needs support for BDD, please reach out to us directly:

Karen: karen@karenchinca.com
Robyn: robyn@robynkievit.com

We’ll be presenting our talk on BDD again at Carolina House in October 2019. If you are interested in having us present on this topic to a group of clinicians you know or are a part of, please be in touch!

In addition, please visit our Greater Boston Wellness Collaborative website to learn more about our coordinated care services: http://www.gbwellness.com/