Portraits by ChiChi Ubiña
Recovery Coach, Stephanie Hazard sheds light on facing the challenge
There is no one thing that brings about an eating disorder. Often there are multiple factors at play. Although eating disorders are prevalent among teenage girls, they are in fact most common among women between the ages of twelve and thirty-five. However, eating disorders are neither gender specific nor age specific. We also know that 75% of adult female children of alcoholics have eating disorders, and that that there is a correlation between trauma and eating disorders. Research indicates that those who go on a diet are seven to eight times more likely to develop an eating disorder than those who do not diet. (Keel 2006).
My experience with disordered eating began when I went on my first diet at the age of eleven. Growing up, I was teased for being “chubby.” I was on the gymnastics team, and my mother was a model which probably also contributed to my dissatisfaction with my size. So, a friend and I went on a diet together, and I set out to lose ten pounds in ten days. I almost passed out on the last day, but I received a lot of praise for showing so much “self-discipline.” I struggled with my weight on and off, and then when I was at boarding school, the eating disorder really took off. Other friends were “pigging out” and purging (self-induced vomiting, laxative abuse) and I copied them. Copycat behavior among students is a real thing. Some of my guy friends on the wrestling team purged as well to make weight!
As I got older, I discovered that alcohol acted as an appetite suppressant. I relied upon alcohol to help control my weight – or at least I thought it helped. Before I got sober, I would always undereat if I was drinking. I was in bad shape (to put it mildly) in my early thirties living on a diet of no food, white wine, and Dunhill cigarettes. Getting sober, and healing from an eating disorder, resulted in my establishing a renewed and restored relationship with myself where self-care and self-compassion are among my top priorities.
As a trained substance use disorder recovery coach, and a certified eating disorder coach, I work with folks who struggle with one or the other or a combination of both. I would say at least half of my adult female clients have an entangled relationship between drugs, alcohol, and an eating disorder. Clinically speaking, they have co-occurring disorders.
How can you tell if a loved one has an eating disorder?
Eating disorders affect up to 30 million people in the United States – that’s staggering.
Because eating disorders can be hidden in plain sight, it can be very tough to discern if there is a problem until there are glaring symptoms like dramatic weight loss / weight gain, depression, fatigue, or an increase in anxiety and isolation. If food or a preoccupation with food and weight is interfering with physical, psychological, and social well-being then it’s time to get help.
What causes it and what are the types?
Eating disorders have many causes. They may be triggered by stressful life events, including a loss or trauma, relationship difficulties, physical illness, or a life change such as entering one’s teens, starting college, marriage, or pregnancy. An eating disorder may develop in association with another psychiatric illness such as a depressive disorder, obsessive-compulsive disorder, or substance abuse. Many traits and tendencies can make an individual more vulnerable.
Genetics can contribute to an individual’s susceptibility, but environmental factors play a role as well. What we do know is that having certain genetic temperament traits such as anxiety, perfectionism, obsessive-compulsive tendencies, sensitivity to rejection, or lack of impulse control all seem to contribute to developing an eating disorder and can be considered risk factors of a biological or temperamental nature (Strober & Peris, in press). When you combine genetic predisposition with other factors including a culture that reveres thinness, social media, a negative body image, and a stressor like death or divorce, you can have a “perfect storm” coming together that is hard to plan for or prepare for in advance.
There are three main types: anorexia nervosa, bulimia nervosa and binge eating disorder.
For a detailed description, here is an informative link.
What can parents do to prevent eating disorders in their kids?
I don’t think parents can “prevent” an eating disorder, but if a parent is concerned about their child’s weight loss or gain, or eating habits, the parent can support their child by asking if something is troubling them either at home or at school. Coming from a place of curiosity and compassion makes a big difference. For example, a client of mine was getting a divorce, and her daughter lost an extreme amount of weight very quickly. Her daughter began wearing baggy clothes and retreating to her room after school. After several family therapy sessions, it became clear that the daughter was unconsciously trying to bring her parents back together again by giving them something to worry about and bring them all closer.
They are very complicated coping mechanisms. Eating disorders develop over time and evolve into a complex construct for disconnecting from feelings, thoughts, and circumstances that may be too difficult to face, feel or deal with. Although severely detrimental, they are both an outlet, and a way to cope. I highly recommend finding a therapist who specializes in eating disorders (and trauma if possible), and to bring a dietician on board to coordinate with a child’s pediatrician or primary care doctor. Parents are a child’s primary role model, and how a parent talks about weight, and diet, and overall health can be a great opportunity for maintaining an open and constructive dialogue.
Is social media making eating disorders worse?
Yes, I would absolutely agree that social media has contributed to the rise of eating disorders. New research suggests that young people who use social media are more likely to develop an eating disorder. Skipping meals and other behaviors related to eating disorders were reported by 52% of girls and 45% of boys who participated in a study last year. While social media wasn’t cited as a direct cause of eating disorders, according to the study, there is a connection that should be acknowledged and monitored.
COVID also contributed to a huge spike in eating disorders among students. I’ve spoken to the counseling departments at several boarding schools, and they all report that eating disorders among their student population exploded. One school added three eating disorder specialists to their counseling team, and another redeployed school funds to increase their mental health services. Health and wellness are now being taken very seriously, and coaching is being offered as an adjunct to their on-campus services.
Tell us about coaching eating disorder recovery.
Eating disorder recovery coaching is not new, but it’s on the rise thanks to pioneers like Carolyn Costin. Carolyn is a psychotherapist who recovered from anorexia and has been working with clients for over 30 years. She founded the Monte Nido treatment center and developed a curriculum and training for coaches. She and is a huge proponent of the efficacy of coaching. Clients benefit from having a support specialist who goes food shopping with them and eats meals with them and can be there with them in the moment. Therapists and dieticians don’t do that. Coaches share their lived experience and role model what a recovered life looks like instilling hope and providing tools, strategies, and real-time support.
Typically, a coach begins working with a client either once they have discharged from treatment or if there has been a recurrence (relapse) Transitioning home or back to work or back to school is very difficult without support and encouragement. Meeting with a clinician once a week is just not enough support. I have one ED client who has been to treatment twelve times and maintains that the most progress she has every made is when working with coaches. I think Phil Valentine, the Executive Director of CCAR, says it best: “If going to treatment is like having surgery, then having a recovery coach is like working with a physical therapist.” The work post-surgery is critical for healing and strengthening and sustains long-term recovery.
What is the difference between coaching recovery from substance use disorder and coaching eating disorders?
Overall, I find coaching someone with an eating disorder to be much more complicated and intricate than coaching someone with substance use disorder. Healing one’s relationship with food and their body is a complex and protracted process. With substance use disorder recovery, you sever the relationship with a substance. No matter how difficult it may to stop, you are discontinuing that relationship. We are typically meeting twice a week and have daily check-ins. We design a recovery wellness plan and identify short and long-term goals helping the client transition towards a culture and lifestyle of recovery. A recovery support group is identified and typically a client is going to meetings several times a week as well. Someone with an eating disorder can’t sever the relationship with the substance they are using, misusing, or abusing.
You must eat to live and that means reintroducing the substance three to maybe five times a day. You have to navigate and renegotiate your relationship with the substance every day. Coaching can be much more involved where for example I am shopping, prepping, cooking meals, and doing meal planning with the client. Often, I am living in with the client and their family. I also coach virtually and supervise meals via FaceTime. It has been my experience that an eating disorder coaching engagement lasts for at least six months to a year.
In both cases, our focus is on developing and practicing healthy behaviors and growing wellness. We are building an individual’s internal and external recovery capital to provide them with the foundation and support they need to sustain long-term recovery. A broader care team or clinical team is working together in both cases, and with eating disorder cases, there is almost always a dietician or nutritionist and a doctor involved.
How does one stay on track? Does an eating disorder come back?
It varies from person to person. For some that may be not purging, for others it may be maintaining a certain weight range, and for someone else it may be mindfully eating three meals a day. Overall, how you go about maintaining health and wellness is a daily practice unique to you, and “food neutrality” supports your overall well-being. I believe people can be recovered and use Carolyn Costin’s definition as my framework:
“Being recovered is when the person can accept his or her natural body size and shape and no longer has a self-destructive relationship with food or exercise. When you are recovered, food and weight take their proper perspective in your life, and what you weigh is not more important than who you are; in fact, actual numbers are of little or no importance at all. When recovered, you will not compromise your health or betray your soul to look a certain way, wear a certain size, or reach a certain number on the scale. When you are recovered, you do not use eating disorder behaviors to deal with, distract from, or cope with problems.”
There are still times when I may underate or overeat. Yes, I am a sucker for my sister-in-law’s pumpkin cheesecake at Christmas, and I have no appetite before I perform either on stage or on-camera because I’m always filled with nerves then. The difference for me today, however, is that when I have a lapse, it doesn’t dictate the way I feel about myself or compel me to compensate the next day.
A recurrence can happen. Recovery is not linear and it’s not perfect. I am currently working with a client who was weight restored, but over the last seven months lost approximately 50 pounds. She is fighting her way back from that relapse, and every day is a challenge for her to feel her body “getting bigger.” She has a dietician, and a therapist, and a great support group, but continues to struggle.
Does an eating disorder come back in other forms – alcohol, drugs, phone addiction?
Struggling with addiction can sometimes feel like a bad game of whack-a-mole. I have coached clients who have been abusing alcohol, and when that shifts to a better place, other detrimental behaviors pop-up like over shopping or over or undereating. My 25-year-old client who is a ballerina had an eating disorder as a teen, and then her drug use and alcohol abuse really took off once the eating disorder was in a better place. She went to treatment, and I have been coaching her virtually for over a year. Sometimes the ED rears up, but overall, she is learning to see those impulses as an alarm system – helping her to recognize and notice that there might be something else going on that that needs her attention and compassion.
I’m oversimplifying here, but if addictions are coping mechanisms, and attempts at self-soothing, then the work of recovery is to acknowledge that, and pivot toward and adopt new coping skills instead. Much easier said than done. My goal as a coach is to help an individual feel safe enough and supported enough while they do the deeper work of getting to the heart of what’s really causing them so much pain, sadness, and anxiety. Ultimately, I am a mentor, ally and advocate guiding them as they learn to reconnect with themselves and others in life affirming ways.
Carolyn Costin: www.carolyncostin.com
8 Keys To Recovery From An Eating Disorder
8 Keys Workbook
My Dieting Daughter
Geneen Roth www.geneenroth.com
When Food is Love
To reach Stephanie Hazard: www.pathtowardrecovery.com