Decisions make Recovery

1467281_10151815917716868_844971334_n In recovery, it is your
job to get up every day, participate in all life is offering (even
when you don’t want to) and to choose to make decisions differently
than you have in the past. None of these things are an easy feat by
any means. But the real road to recovery is found in one small
decision after another. It is the choice this morning to eat, the
choice tonight to not drink, the choice at 4am to not binge or the
choice at 2pm to not purge. And soon, all those different choices,
each individually made, make up a life that is recovered. SO, do
your job today and someday you can walk recovered.

Level of Care?

Are you getting the level of care that you should be receiving?

The level of care you DESERVE to be getting?

The American Psychological Association has published 5 levels of care for those with an eating disorder. They are as follows:

Level 1: Outpatient (above 85% of a healthy body weight)

Level 2: Intensive Outpatient Program (above 80% of healthy body weight)

Level 3: Partial hospitalization or full-day outpatient care (above 75% of healthy body weight)

Level 4: Residential treatment center (for those who have suicidal thoughts, with no plan)

Level 5: Inpatient Hospitalization (less than 75% of healthy body weight, medically unstable, or suicidal)

What are your thoughts on these levels? What are your experiences with these levels?

Food & Emotions

**Giving credit for this blog in part to the “Food and Feelings Workbook” by Karen R. Koenig, LCSW, M.Ed. Thank you for your amazing work**

The 7 most difficult feelings for disordered eaters:


Have you ever considered that maybe your eating habits affect your emotions and your emotions affect your eating habits?

I highly recommend, if you are noticing that this may be true for you, keeping a food log. Write when you eat, what you eat, the emotions you have when eating, and the emotion you have an hour after eating. **yes, I know, this is time consuming and not easy. but it will give you an idea if how your eating habits are truly affecting every aspect of your life**

For Example:
You may realize that when you are upset you tend to eat a lot if high carbohydrate foods. A few hours later you are fatigued, depressed, or even purging. Another day you may see that eating a certain fruit made you feel happy or energetic an hour later.

Why Does This Help?
If you know that craving carbohydrate foods is likely because you are upset, you can CHOOSE to eat the fruit that tends to make you happy instead. Suddenly, your mood has changed, you are happy, and less likely to indulge in disordered eating behaviors.

Rule of 3’s


I am frequently asked, when should I eat, how often, how much? I tend to refer to the book “Nutrition Counseling in the Treatment of Eating Disorders” by Marcia Herrin and Maria Larkin. Both of whom, are dietitians who have spent their lives dedicated to eating disorder treatment.

They developed and stand by the rule of 3’s.

So what is the rule of 3’s?

3 meals

3 snacks

3 hours apart

What are the Benefits of the rule of 3’s?

*Decreases preoccupation with food

*Decreases binge eating, overeating, emotional eating and under eating

*reduces purging and vomiting

*Decreases negative self-talk and feelings

*Restores hunger and fullness cues

*Manages body weight

*Restores metabolism otherwise lowered by under eating

*Prevents storage of body fat otherwise caused by restrictive eating

*Improves problem-solving abilities and concentration

The RO3s provides your body with all the nutrients it is needing which means you are able to function physically, mentally, and emotionally at your optimal level. It also recalculates your hunger and satation cues so you can trust your body when it says “I’m Hungry” or “I’m full”

Body Dysmorphic Disorder

I am currently working on a class presentation on Body Dysmorphic Disorder for my psychopathology class.

I will post the final powerpoint when it is done (which wont be until march or april) but here are some interesting stats and information I found in my initial search this afternoon.

Phillips, Katharine A (1997) Gender differences in body dysmorphic disorder. Journal of nervous and mental disease 185(9) 570-577

**Women more likely (than man) to be preoccupied with hips and weight, pick their skin and camouflage with makeup, and have comorbid BN.

** Men are more likely to be preoccupied with body build, genitals, and hair thinning, use hat for camouflage, be unmarried, and have alcohol abuse or dependence.

**Suggests that cultural norms and values may influence the content of BDD symptom

Phillips, Katharine A (july 2006). The presentation of body dysmorphic disorder in medical settings. Prim psychiatry, 13(7) 51-59. doi:

  • Commonly misdiagnosed as major depressive disorder, social anxiety disorder, agoraphobia, ocd, trichotillomania, schizophrenia
  • Common is patients with substance abuse and eating disorders
    • Most common disorders are MDD (76: lifetime prevalence) social anxiety disorder (37) and OCD (32%) Substance use (48%)
    • Many will seek nonpsychiatric physicians such as dermatologists and surgeons seeking cosmetic solutions
    • Have unusually high rates of suicidal ideation, suicide attempts and completed suicide
      • 78% experienced suicidal ideations
      • 69% considered suicide as a direct result of BDD
      • 24-28% have attempted suicide
      • Gender ration ranges from 1:1 to 3:2 (female: male)
      • Usually begins during early adolescence however treatment seeking is delayed an average of 11 years after onset
  • Prevalence in community and nonclinical student samples range from 0.7% to 13%
  • On average, excessively preoccupied with non-existent of minimal appearance flaws. Skin is the most common area of concern (acne or scarring). 2nd most common: hair (hair loss, thinning, balding or excessive facial/body hair).
  • Tend to camouflaging with things as body position, clothing makeup, hat
  • Skin picking is found in approximately 1/3 of BDD patient

Case Report: A Young Woman with Body Dysmorphic Disorder

Ms. A was an attractive 28-year-old Hispanic teacher who presented with a chief complaint of “I am obsessed with my appearance, and my plastic surgeon has been trying to get me to see a psychiatrist for 4 years.” Ms. A had undergone 15 cosmetic surgeries, which did not diminish her appearance concerns. These included rhinoplasties, liposuction, a chin implant, collagen implants, and other procedures, some of which were repeated because the patient was dissatisfied with the outcome of previous procedures. Because she thought that her appearance defects were real, she had been reluctant to see a psychiatrist. She believed that her appearance problems would be fixed by “just one more surgery.” However, Ms. A acknowledged that psychiatric treatment might be helpful for the anxiety and depression that her appearance concerns caused. Ms. A said she disliked everything about how she looked, including her supposedly scarred and discolored skin, flat hair, big and bumpy nose, receding chin, thin lips, high forehead, flabby thighs, fat stomach, and stumpy legs. She obsessed about these perceived flaws for 8 hours/day. Because she thought she looked so ugly, Ms. A did not date, avoided many social situations, and often missed work. She also drank excessively to diminish her distress and quell her anxiety in social situations. She was unable to see friends or participate in any social event without first becoming intoxicated, as she felt that this helped her focus less on her appearance flaws and feel more comfortable with the scrutiny that she perceived from other people.

Go to:

Case Report: A Young Man With Body Dysmorphic Disorder

Mr. B, a 23-year-old single white male, was obsessed with his skin. Throughout the day he thought about how his perceived facial acne and scars looked hideous. Because he felt so anxious and depressed over how he looked and thought he was too ugly for other people to see him, he dropped out of college, moved back into his parents’ house, and stayed in his bedroom. He saw no friends and did not leave the house. He felt too anxious about his skin to even eat meals with his family. As a result of his appearance concerns, Mr. B felt severely depressed and considered suicide. Topical and oral agents prescribed by a dermatologist did not diminish his appearance concerns. However, after 12 weeks of treatment with escitalopram, reaching a total dose of 30 mg/day, all of Mr. B’s symptoms were in complete remission. For the first time in years, he ate meals with his family, left the house, ran errands, saw friends, and made plans to return to school.