Archive for the ‘Pyschology’ Category

negative thoughts and behavioursOften we post lots of information about ‘positive’ signs and skills. After all part of recovery is learning to focus on the positive. But what about the negative, how do you recognise negative coping skills. How do you know that the behaviours you are doing are actually harming you or not promoting recovery. We live inside our heads so much that often negative process are so natural as breathing we think this is normal. Continuing negative behaviours can act as triggers for relapse or harming ourselves even more.

As part of a bigger post, I found a great list of negative behaviours and recognising them as such. Put together by Blake Flannery it is an excellent starting point. You can add your own unique negative behaviours to the list. The full article by Blake ‘List of Coping Skills for Anger, Anxiety and Depression’, also gives a lot of positive skills and how they actually help us by adopting them.

Being aware is the starting point for changing any behaviour.

Negative Coping Skills

Here’s a list of things that will cost you in the long run as coping strategies. These do more harm than good in most cases and can make life more stressful.


  1. Procrastination
  2. Abusing drugs or alcohol
  3. Wasting time on unimportant tasks
  4. Shopping (online or malls)

Interpersonal (With Others)

  1. Blaming
  2. Isolating/withdrawing
  3. Mean or hostile joking
  4. Gossiping
  5. Criticizing others
  6. Manipulating others
  7. Refusing help from others
  8. Lying to others
  9. Sabotaging plans
  10. Being late to appointments
  11. Provoking violence from others
  12. Enabling others to take advantage of you

Cognitive (of the Mind)

  1. Denying any problem
  2. Stubbornness/inflexibility
  3. All or nothing/black or white thinking
  4. Catastrophizing
  5. Overgeneralizing

Tension Releasers

  1. Tantrums
  2. Throwing things at people
  3. Hitting people
  4. Yelling at others
  5. Destroying property
  6. Speeding or driving recklessly


  1. Suicide
  2. Self harm
  3. Developing illnesses


  1. Making fun of yourself
  2. Self-sabotaging behaviors
  3. Blaming yourself


  1. Spending too much
  2. Gambling
  3. Eating/drinking too much
  4. Setting dangerous fires
  5. Continually crying

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Although still a fledging in Australia, this treatment is gaining ground as being a better approach the traditional CBT. My daughter was mostly mindfulness and CBT – neither of which was very successful with her. My son is more DBT but because we are in Australia, we only have limited access to full training (unless you live in bloody Sydney) so our professionals in train parts of DBT. Overseas the DBT treatment is showing excellent results and a highly advised must for eating disorder recovery.

The information below comes from the Behaviour Tech website.

What is DBT?


Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

What are the components of DBT?

In its standard form, there are four components of DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.

  1. DBT skills training group is focused on enhancing clients’ capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework for clients to practice using the skills in their everyday lives. Groups meet on a weekly basis for approximately 2.5 hours and it takes 24 weeks to get through the full skills curriculum, which is often repeated to create a 1-year program. Briefer schedules that teach only a subset of the skills have also been developed for particular populations and settings.
  2. DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy and runs concurrently with skills groups.
  3. DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.
  4. DBT therapist consultation team is intended to be therapy for the therapists and to support DBT providers in their work with people who often have severe, complex, difficult-to-treat disorders. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible. Teams typically meet weekly and are composed of individual therapists and group leaders who share responsibility for each client’s care.

What skills are taught in DBT?

DBT includes four sets of behavioral skills.

  • Mindfulness: the practice of being fully aware and present in this one moment
  • Distress Tolerance: how to tolerate pain in difficult situations, not change it
  • Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
  • Emotion Regulation: how to change emotions that you want to change

There is increasing evidence that DBT skills training alone is a promising intervention for a wide variety of both clinical and nonclinical populations and across settings.

What does “dialectical” mean?

The term “dialectical” means a synthesis or integration of opposites. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. For example, DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals. In addition, all of the skills and strategies taught in DBT are balanced in terms of acceptance and change. For example, the four skills modules include two sets of acceptance-oriented skills (mindfulness and distress tolerance) and two sets of change-oriented skills (emotion regulation and interpersonal effectiveness).

How does DBT prioritize treatment targets?

Clients who receive DBT typically have multiple problems that require treatment. DBT uses a hierarchy of treatment targets to help the therapist determine the order in which problems should be addressed. The treatment targets in order of priority are:

  1. Life-threatening behaviors: First and foremost, behaviors that could lead to the client’s death are targeted, including all forms of suicidal and non-suicidal self-injury, suicidal ideation, suicide communications, and other behaviors engaged in for the purpose of causing bodily harm.
  2. Therapy-interfering behaviors: This includes any behavior that interferes with the client receiving effective treatment. These behaviors can be on the part of the client and/or the therapist, such as coming late to sessions, cancelling appointments, and being non-collaborative in working towards treatment goals.
  3. Quality of life behaviors: This category includes any other type of behavior that interferes with clients having a reasonable quality of life, such as mental disorders, relationship problems, and financial or housing crises.
  4. Skills acquisition: This refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors and help them achieve their goals.

Within a session, presenting problems are addressed in the above order. For example, if the client is expressing a wish to commit suicide and reports recurrent binge eating, the therapist will target the suicidal behaviors first. The underlying assumption is that DBT will be ineffective if the client is dead or refuses to attend treatment sessions.

What are the stages of treatment in DBT?

DBT is divided into four stages of treatment. Stages are defined by the severity of the client’s behaviors, and therapists work with their clients to reach the goals of each stage in their progress toward having a life that they experience as worth living.

  1. In Stage 1, the client is miserable and their behavior is out of control: they may be trying to kill themselves, self-harming, using drugs and alcohol, and/or engaging in other types of self-destructive behaviors. When clients first start DBT treatment, they often describe their experience of their mental illness as “being in hell.” The goal of Stage 1 is for the client to move from being out of control to achieving behavioral control.
  2. In Stage 2, they’re living a life of quiet desperation: their behavior is under control but they continue to suffer, often due to past trauma and invalidation. Their emotional experience is inhibited. The goal of Stage 2 is to help the client move from a state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder (PTSD) would be treated.
  3. In Stage 3, the challenge is to learn to live: to define life goals, build self-respect, and find peace and happiness. The goal is that the client leads a life of ordinary happiness and unhappiness.
  4. For some people, a fourth stage is needed: finding a deeper meaning through a spiritual existence. Linehan has posited a Stage 4 specifically for those clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfillment or a sense of connectedness of a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.

How effective is DBT?

Research has shown DBT to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning. For a review of the research on DBT, click here. In this video, DBT Developer and Behavioral Tech founder Dr. Marsha Linehan describes the amazing changes she’s seen in people who have received DBT and gotten out of hell.

Dive Deeper

Philosophy and Principles of DBT

DBT is based on three philosophical positions. Behavioral science underpins the DBT bio-social model of the development of BPD, as well as the DBT behavioral change strategies and protocols. Zen and contemplative practices underpin DBT mindfulness skills and acceptance practices for both therapists and clients. DBT was the first psychotherapy to incorporate mindfulness as a core component, and the Mindfulness skills in DBT are a behavioral translation of Zen practice. The dialectical synthesis of a “technology” of acceptance with a “technology” of change was what distinguished DBT from the behavioral interventions of the 1970s and 1980s. Dialectics furthermore keeps the entire treatment focused on a synthesis of opposites, primarily on acceptance and change, but also on the whole as well as the parts, and maintains an emphasis on flexibility, movement, speed, and flow in the treatment.

The Development of DBT

In the late 1970s, Marsha M. Linehan attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, and non-suicidal injury. Trained as a behaviorist, she was interested in treating these and other discrete behaviors. Through consultation with colleagues, however, she concluded that she was treating women who met criteria for Borderline Personality Disorder (BPD). In the late 1970s, CBT had gained prominence as an effective psychotherapy for a range of serious problems. Dr. Linehan was keenly interested in investigating whether or not it would prove helpful for individuals whose suicidality was in response to extremely painful problems. As she and her research team applied standard CBT, they encountered numerous problems with its use. Three were particularly troublesome:

Learn More

Understand the Underpinnings of DBT: Behavior Therapy

It is essential to have a solid applied understanding of the Behavior Therapy paradigm before venturing into the room with a client to do CBT, DBT, or many other evidence-based treatments. Click here to explore video training segments with teaching from Dr. Marsha Linehan about Behavior Therapy.

Learn the Basics of the Treatment Model

Learn about Potential Adaptations of DBT for Your Setting

Further Learning Opportunities

If you are interested in attending a workshop or want to implement the comprehensive DBT model in your practice, visit the BTECH Training Options page to discover what the right next step is for you or Contact Us with your questions.


Allmon, D., Armstrong, H. E., Heard, H. L., Linehan, M. M., &.Suarez, A. (1991). Cognitive-Behavioral Treatment of Chronically Parasuicidal Borderline Patients. Archives of General Psychiatry, 48, 1060-1064.

Koons, C. R., Robins, C. J., Tweed, J. L., Lynch, T. R., Gonzalez, A. M., Morse, J. Q., Bishop, G. K., Butterfield, M. I., & Bastian, L. A. (2001). Efficacy of Dialectical Behavior Therapy in Women Veterans with Borderline Personality Disorder. Behavior Therapy, 32, 371-390.

Linehan, M. M. (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.

Linehan, M. M., Schmidt, H., Dimeff, L. A., Kanter, J. W., Craft, J. C., Comtois, K. A., & Recknor, K. L. (1999). Dialectical Behavior Therapy for Patients with Borderline Personality Disorder and Drug-Dependence. American Journal on Addiction, 8, 279-292.

Verheul, R., Van Den Bosch, L. M. C., Koeter, M. W. J., De Ridder, M. A. J. , Stijnen, T., & Van Den Brink, W. (2003). Dialectical Behaviour Therapy for Women with Borderline Personality Disorder, 12-month, Randomised Clinical Trial in The Netherlands. British Journal of Psychiatry, 182, 135-140.

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extreme behaviour of eating disordersIn the home environment none of us like confrontation, verbal abuse, violence etc. But this becomes a reality when an eating disorder decides to move in. Normal family relationships become confrontational or violent.

All of us parents/carers will come into contact with this side of an eating disorder. Mostly this abusive side only appears after first treatment is done or serious intervention is tried. Your son or daughter will shout, swear, push, shove, lie blatantly, be secretive, throw things, run away, scream – you name it, it happens. And they sound so real about what they are saying or doing. They look and sound like they mean every single word. The look and emotion that goes into telling you what they think of you is very hurtful and shocking. The other side is they tell you they want to starve to death or they “want to die and you’ll be sorry”. It can be a verbal tidal wave of illogical and dark emotional thoughts. Pretty hurtful stuff when you are the parent of the much loved child.

You wonder as a parent, what the hell you ever did wrong. After all you are the one trying to save them, feeding them, caring for them, taking them to appointments, finding out information and resources. It’s not like you are against them and trying to harm them. And it hurts deep down and you wonder if the relationship between you will ever be the same.

Eating disorders take over the person. It’s uncanningly like having two people living in the same body, but the second person (the real one) never gets to talk or act. The primary person (the ED) takes over everything whilst using the body, mannerisms and emotions of the other. Very surreal and hard to decifer who is saying what. It really does look like your child hates you.

The reason for this intense rage and very out of character behaviour is the ED fighting for it’s corner. Cornered things fight back. It does not want to leave. It’s ability to change and adapt to whatever it needs to is remarkable. Whilst it has the intense control of your child, it changes them. Personality, behaviour, character all changes. The child you once had totally disappears for some time. They don’t have control over this behaviour. They hide, lie, swear, isolate, push you away, get aggressive. It’s all part of the eating disorder illness. IT.IS.NOT.YOUR.CHILD. Take that point on and do not let yourself move away from that. As awful as it can get, your son or daughter cannot control or stop this behaviour whilst the eating disorder is in residence.

Sophie was all of this. She ran away, I chased her in the car to find her. She pushed, hit and shoved. I stared her down. She called me everything she could think of. I heard and hurt. But let me tell you, it took every ounce of my self control to keep calm and firm.

What to do

Learn to separate as early as you can the ED behaviour and your child. From the moment Sophie came home from hospital the first time, we were told to talk to the anorexia as a separate person. I would say “That’s Ana talking, I am not talking to her. I want to talk to Sophie.” and so on. It does work but it takes time for the message to sink in for both of you.

It’s not like your child is using the ED as an excuse to get away with shocking behaviour. And neither are you using the ED as an excuse to be more accepting of this behaviour.  Never trust the ED, it manipulates situations extremely well. Sophie did do this, but she was so far along into stronger recovery she could be told bluntly to not use the ED to gain points for herself.

Brush off the javelins thrown at you. Learn to let it slide. This is not normal behaviour and its not personal. In time, when later recovery stages are happening, you can call the rude behaviour and treat it more like normal teenage stuff. Consequences in other words.

Find vent time for yourself away from your child. Don’t vent at them as it only heightens the scene.

Talk to the support/medical team. Let them know everything that is happening. They can use this in therapy to highlight the ED behaviour and emotions.


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Some of the latest research is focussing on smaller areas of eating disorders. In trying to find understanding which translates into treatment, which translates into health, eating disorders are being taken apart and looked at through every layer.

To get forward movement in research this is a good approach. But when handing down the results of the research we have to be careful. Such small areas of focus does not mean that the results can be shown to be a blanket approach. And we need to be careful the of wording used in the research title and findings.

The below demonstrates this. The latest research caused a lot of comment across blogs with its wording and seemingly blanket approach. It is very good research and is quite correct in saying what it does. It highlights areas and provides understanding of emotions and behaviour that has barely been discussed. We need this kind of research.

However, the word positive conjures up the wrong idea. In today’s society there are so many positive self-esteem approaches, so many positive ideas for health, wealth and life. By aligning ‘positive’ to this research it seems to correlate it to the life we know – those of us who don’t suffer from an eating disorder. For those with an eating disorder, the word positive is not positive at all. Like every other word and behaviour, ‘positive’ has been distorted, maligned and perverted through the eyes of the ED. It is not a ‘positive’ emotion as we know it. Nor does the ‘positive’ emotion last or build-up the person. It is fleeting, drowned in the ever-present, and quick to deny, ED voice. It does not build-up the person, only puts down and is  a destructive force of ‘positivity’. Understand that those with an ED do gain a positive, determined or proud emotion but it is distorted and focussed on tearing themselves apart.

The other thing we need to be mindful of, is that whilst this type of research is great, it must be made clear that not all sufferers will experience these emotions. Eating disorders don’t come as a one-size fits all. That’s what makes them difficult to treat and find a treatment plan that works. Sophie is just one example of many – someone who didn’t find positive or pride to be words to describe her journey. And if they were there in any measure, they were really negative emotions pretending to be positive emotions. Weight lost meant she had failed to lose enough. She failed on every level – no pride, no positive emotion. Only failure and the voice of the anorexia telling her what as failure she was.

In looking for ‘positive’ or ‘pride’ in each sufferer we can overlook other words that can help toward recovery. Negative words they may be, but a negative ALWAYS has a positive. Rigid can be turned into determination. Fear can become guarded (ie protection). By looking in a more positive way for the negative words that describe an eating disorder, you can turn on a light for those in recovery. Just thinking or rewording something in a different way can bring about change that can be harnessed for recovery. It’s something that Sophie’s counsellor did with quite a few of the negative words that come with the diagnosis of an eating disorder. Photographers change their camera lens to get a different view of the same subject, the same can be done with eating disorders to gain precious steps forward for recovery.

The links and summaries of the research findings are below. Worth reading, worth understanding and definitely worth seeing if they describe where you are in the illness.

** http://www.medicalnewstoday.com/articles/280662.php

Past research claims that negative emotions, such as feeling depressed or angry, can fuel anorexia nervosa. But a new study from Rutgers University in New Jersey finds the eating disorder can also be encouraged by “skewed” positive emotions, such as feeling pride after weight loss.

** http://www.scienceworldreport.com/articles/16427/20140804/anorexia-may-be-encouraged-by-pride.htm

A new study conducted by researchers at Rutgers University examines the complications related to the health issue. Study results showed that individuals dealing with this complicated obsession often pride themselves on how much weight they can lose, according to findings published in the journal Clinical Psychological Science.

** http://www.psychologytoday.com/blog/overcoming-self-sabotage/201408/anorexia-nervosa-and-positive-emotion

Although it is well established that many with anorexia experience body dissatisfaction and apprehension about weight gain, the rewarding aspects of weight loss may be particularly pronounced during the development of anorexia and have not been well studied (Walsh, 2013). Many anorexic patients believe their ability to lose weight makes them more attractive and builds self-control and confidence. Another source of positive reinforcement in anorexia may be through exposure to stimuli that promote extreme weight loss, such as content posted on “Pro-Ana” (Pro-Anorexia) websites, which feature images of thin/emaciated women and inspirational quotes for weight loss.


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No matter how good our intentions at times, we can find it very hard to stand alone and not become part of the crowd we hang with. It is so easy to take on mannerisms, beliefs, attitudes, habits etc without even realising. It doesn’t matter whether you are online or in a physical social environment. We become, far too easy, what is around us. We may have the best hope and strength for recovery, but the everyday whittling away from those around us, particularly the online environment, can find us falling back into relapse or struggling more than we need to in our recovery.

Where our mind or thoughts are focussed on, that is where our heart resides.

We might have to rethink our lives, clear things out, stay away from social media, make new friends, look at our spiritual self, make our homes a safe and strong environment. Whatever it takes to continue recovery, to continue health.


If you spend the most time with people who are consumed by calorie-counting and their appearance, you’ll probably start watching your food and nit-picking your body.

If you spend the most time with people who bash their bodies and themselves, you’ll probably start looking at yourself with disappointed, angry eyes.

If you spend the most time with people who consider themselves martyrs, you’ll probably start to feel selfish for practicing any kind of self-care.

If you spend the most time with people who don’t respect your privacy, like to gossip and are very judgmental, you’ll probably feel alone and hesitate to open up to anyone. You may even view humanity with some suspicion and dread.

If you spend the most time with people who have zero boundaries and get upset when you set yours, you might find it hard to have a healthy relationship with both them and yourself.

If you spend the most time with people who have strong boundaries and treat themselves kindly, you’ll probably be inspired to do the same.

If you spend the most time with people who love to laugh, really listen to their loved ones and practice self-care, you’ll probably feel more fulfilled and energised yourself.

If you spend the most time with people who love you for the real you, you might be inspired to turn this love inward and start the process of loving yourself.

It’s the same with the shows we watch, the books we read, the places we go, the things in our homes. We often are our environments. That’s why I suggest recycling diet books and “health” publications and creating a home that nourishes you and helps you feel good about yourself.



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In the starvation of anorexia, the body undergoes severe stress to stay alive. It shuts down many processes, slows others, simplifies functions etc. It’s goal is to survive and to at all costs protect the brain.

In refeeding the body also undergoes a lot of strain. Some things don’t work the same, like digestion and the rest of the lower digestive tract, how it stores and distributes the nutrition. The body takes longer to build up than it took to break down. The amount and type of nutrition is critical and dependent upon how long the body has been in starvation and the strain put on it.

So when the body starts consuming higher levels of food it doesn’t distribute the nutrition the same. It just puts it all (so to speak) in one spot, as it works out what parts need the most building up and nutrition first. The abdomen becomes the storage place. Hence the rounded tummy. It even has a term given to it – fluffy weight gain or fluffy fat. It means that it won’t stay that way, it is a transitional thing. The fat is not a bad word nor a wrong word, our bodies need fat to live. Only our society and culture has made it a bad word.

Your body isn’t going to metabolise or use food the same way as before. It has to relearn how to do this again, and relearn how to digest the food.

The brain and organs are the body’s first priority –
not your ‘need’ for a flat stomach.

Because anorexia has the whole body image and fat psychology in it, everyone literally ‘freaks’ out about the weight gained and the round tummy. The overwhelming fear of being fat and the body image of the flat stomach creates a major level of conflict. Many relapses happen because of this.

Here’s a truth and new concept to think about:

The fear is false and the tummy will flatten out. TRUTH!

And it won’t happen in a month, a few months or even a year. Your body has almost been destroyed, it takes a long, long time for it to heal and work like it did before. And you can’t tell your body which bits to heal first. Your body knows best and is doing exactly the right things.

It comes down to re-programming your mind.

First, remind yourself do you want to live, be healthy or be very sick and miserable and worse die. The choice is yours when it comes to recovery. If a flat stomach means more than your life and health, then there is a problem.

Second, remind yourself the ‘fluffy weight’ will go. It will redistribute properly, your body will work properly. This isn’t a dream or false wish. IT WILL HAPPEN.  The body will not leave your tummy in it’s rounded state. As it heals it will stop using your abdomen as a storage place and send the food nutrition directly to the correct areas.

Third, the fear in your mind about getting fat and putting on too much weight is false. It’s the anorexia giving you this fear and distortion of reality. It’s controlling your mind and making up fears to control you and stop you recovering.It takes a lot to defuse this fear, anorexia feeds and lives on fears. It takes courage to face the anorexia and say, ‘that’s not true and I don’t believe you’. Time will allow you to learn this one. But know it is possible and can be done.

Fourth, follow your meal plan. This helps by giving constant nutrition to the body and starts to stabilise by it’s consistency and regularity. It helps against binge eating which can also emphasise the fluffy weight.

Fifth, it will all take time. You cannot hurry the recovery process. It simply cannot be done. You also cannot measure your recovering body against someone else’s. Everyone recovers at a different rate – metabolism, muscle, body fat, and your other unique body blueprint. In the end you have to choose. What is your goal, what means most. Health, a life free or close to free from anorexia or do you want to be beholden to sickness, control, fears and no/little freedom.

Learn to relive, heal, find a life again. The more you get involved in your life, the less you will notice the stomach. I watched Sophie do the same things. Watched and walked with her all the same fears and rounded tummy. Her body is now normal with a normal abdomen size. She now knows the fears were never real or true.

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“Learn to separate yourself from the eating disorder”

Heard that yet from your therapist? If you are in very early recovery you are not going to understand what they mean. You and the eating disorder are still very much one unit. Are psychiatrist used this image to help Sophie understand.

  • Cover one hand with the other: that’s you and the eating disorder at the beginning. The ED is totally controlling you.
  • Then slowly, gradually start to move the hands apart: As you recover and learn more, you can start to see two separate entities, yourself and the ED.
  • Finally, your two hands are far apart: you are no longer controlled by the ED, you are your own person.

Both carers and sufferers must learn this separation technique. It is critical for recovery. It removes the blame and the idea the person is the problem. It shows that the eating disorder is a separate voice and thinking pattern to you. The eating disorder is the problem, never ever the person.

One of the best ways of becoming aware of the ED and how it is separate to you, is to learn to externalise the eating disorder. Like it is a separate being. It also empowers you to be able to make positive changes and think encouraging thoughts. It disempowers the eating disorder and the control is has on your life.

1. Give it a name

This may sound weird, but it does work. Give the ED a name. Ana, Mia, Ed, anything. This makes the illness separate to you. You address the illness. You see it as a separate entity to yourself. This gives some distance and makes the illness objective rather than personal.

2. You are not a label (or a victim)

Don’t call yourself or others the ‘anorexic’ or  the ‘bulimic’. Doing this ignores the sufferer as a person. They become a label or statistic. You are a person with a mental health illness called anorexia. All the things that made you unique as a person before this illness are still there and still real. The idea that you are a victim, also removes your power as a person. The word makes you feel you are unable to take control of your own life.

3. You still have a voice

It’s just silenced. That’s what the ED does. Learning to exercise your voice and make it strong again, gives you back the control. Just because all you hear at the moment is the loud, negative and destructive ED voice, that that is all there is. Your voice is still there, underneath, and can be developed to be stronger than the ED voice.

4. Make third party statements

When you don’t eat your scheduled meals, or you choose ED behaviour ask questions that don’t point the finger at you.

  • How did the eating disorder make you skip lunch?
  • What did Ana tell you today about yourself?
  • That’s the eating disorder voice I hear, what does (your name) think or feel?
  • Who made that statement, you or Ana?

5. Notice your vulnerable triggers and times

Eating disorders use certain ‘weak’ points, situations, times of the day, certain people to trip you up. ED behaviour and slip-ups are always stronger at these times. Being aware and forewarned can help you beat the ED at it’s own game.

6. Don’t beat yourself up

When you find it too exhausting or too hard to separate from the ED and you just let the ED do it’s thing, be gentle on yourself. It takes a lot of time and learning to get the separation/externalisation happening. You have lived for so long with the ED being often the only voice in your head. Your own voice is rusty from dis-use and like any unused item, takes a while to work.

7. Believe

Yes, externalising the ED is possible. It is a real thing and can happen for anyone and everyone. But it’s not a magic pill or wand. It needs commitment and skills but achieving this is a major step forward in recovery. It opens your eyes to the real character of the eating disorder and it shows you the beauty of your own voice. Therapy with a skilled professional really helps with learning this process.


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