As a therapist specializing in eating disorders and body image issues, I often receive looks of intrigue, bewilderment, and discomfort when people ask me what I do for a living. Why would you want to work with people who have eating disorders? It is so tough! I understand others’ discomfort with my work. The truth is that it IS tough working with people who are struggling with these issues, but my work with Jen reminds me why I am ever inspired by what I do.

A few months ago, Jen (an actor I’ve worked with for 9 months) informed me she was planning to run another marathon in honor of her sister Lindsay, who died tragically young 7 years ago from cancer. Much of our work has been connecting Jen’s eating disorder and body image issues with the loss of her sister. To deal with this loss and pain, Jen unwittingly turned on herself. As a result of her dedication, Jen has overcome her eating disorder. Yet, she is aware that the work continues. So when she said to me she didn’t want to run the marathon this year for the reasons she had in the past (yet she still wanted to honor Lindsay), I encouraged her to instead consider running for herself and all that she has worked on. Here is what Jen is running for now:

Dear Family and Friends,

It has become a bit of a tradition that on April 27th, the day that would have been my sister, Lindsay’s birthday, I register for the NYC Marathon. So, here we are again. Another April 27th. Another marathon. And another year gone by, without my sister.

I run for all the reasons anyone would run to raise money for cancer research. And in past, I have been specific that it is to honor Lindsay. And while all that is completely true, something different has come up for me this year. Something more honest.

This past year I have been going through some of my own health things that some of you may or may not be aware of–in regards to my body image and my eating. Running was a huge factor in that. I was running for all the reasons that are important, AND… to lose weight, to stay fit, to feel thin, to prove something to myself and to others, and to be in control. I was running to run myself down, not always to inspire myself up. And in desperately trying to inspire you all with my story about Lindsay, it continued to be a mask for my own insecurities.

Through this year of fighting with my own demons, I’ve surprised myself with what I have found truly inspires me—fighting for women, and their own confidence in themselves. I’ve realized that what I am most committed to, in my acting, in my bridal consulting, and in my life, is being a person that women can turn to feel better about themselves. AND it starts with me.

This year, I am trying something new.

I am running for early mornings. I am running for thumbs up and fist pumps. I am running for exhausted legs and blistered toes. I am running for the little girl in pig-tails who high-fived me as I ran by, and the father who hugged me as we walked towards the starting line. I am running for all the brides I work with, who want to squeeze into the size below their own. I am running for ponytails. I am running for the graffiti artists on the williamsburg bridge. I am running for all the students who decided to get their degree in the arts this year. I am running for teachers. I am running for the schools who have taken on Jesse’s We Can project. I am running for family. I am running for friends that are family. I am running for Janet and Molly who taught me to be brave. I am running for my mom who is the most brave woman I know. I am running for sisters. I am running for the past I had with Lindsay, the presence she keeps in me always, and the future she has inspired me to see for myself. This year, I am running for ME.

And I need your help. This is my promise, my declaration, that I will fight through all the horrible thoughts we can have about ourselves—and run only for the love of it. Happy Birthday Lindsay. My gift this year to you, is getting your little sister back. The one who used to laugh with you until our belly’s ached, and attacked life with joy and passion and love. See you at the finish line.

Thirty-three years ago, I sat with a psychologist friend, Ellen, at the edge of the water in the Hamptons and said, “I feel fat”.

We were in our twenties and this was (as it still is) the language of girls. We had just eaten a big lunch and were there in our bathing suits deciding whether we dared to go into the water.

“I used to throw up when I felt fat,” Ellen told me (Ellen in later years would be “out” about having been bulimic, so no secrets divulged here). I was stunned. Slowly over the afternoon, Ellen told me what it was like to binge and vomit. She told me that she had been to a therapist at Cornell University, Dr. Marlene Boskind-White, who had discovered that other girls were throwing up too. Ellen had found a way to deal with her eating and thought we should open a center to treat girls in Manhattan who were bingeing and vomiting. I was working at St. Vincents at the time as the head of the Group Therapy Program in the Alcoholism Outpatient Division. We decided that with Ellen’s understanding of this new disorder and my expertise in addictions, we could carry the work that Dr. Boskind-White was doing in Ithaca (with her permission) back to New York City.

My friends thought we were crazy. Surely there weren’t enough girls doing this to run a business. “Everyone sits by the side of the ocean and fantasizes about opening a business,” a friend told me, “but doing it is another thing”. Ellen and I decided to do “another thing”.

By word of mouth (Ellen was in EST at the time and this was a venue where word traveled fast), we were able to find 5 women who were tormented by the way they were eating. We started a group and then sent out a press release (remember, no internet in those days) letting the media know that two NYC psychologists were starting a treatment program for girls who binged and threw up.

We were picked up by a cable TV show in Long Island, aired—and then our visibility exploded. The media loved it—pretty girls who were vomiting. It was a sad statement of the publicity world. The media wanted to know if we could teach people how to throw up in order to lose weight. That clearly wasn’t the point. But the extraordinary exposure in the media (the Today show, 20/20, innumerable national media clips and news articles for years on end) broke the deadened denial of a disorder that was already becoming an underground epidemic. We got thousands of letters from people (many with recognizable names), and, rapid fire, Ellen and I put together the first center ever for the treatment of bulimia, the Bulimia Treatment Associates.

At that time in New York City, Dr. Bill Davis was running the Center for the Treatment of Anorexia. I met with Bill, picked his brain, and Ellen and I ran by the seat of our pants to set up an effective program to treat bulimia. We developed three-day weekend groups (we had a half year waiting list for participation in these Bulimia Workshops) and Ellen and I hired a group of therapists to jump in and learn from our patients what we could do to help.

The time was exciting, inspiring and incredibly frenetic. After about a year, Ellen and I decided to split our partnership. I moved on to work with a good friend and new partner, Dr. Michele Siegel. We relocated from 9th Street to University Place in Manhattan and the Eating Disorder Resource Center was born.

Over the next several years, Michele and I put a center in place that housed 6 offices; we worked with approximately 20 therapists. The field was flying. Centers were opening up throughout the country, the severe extent of eating disorders was revealed. EDRC rapidly grew in size, opening its doors not only to patients suffering from bulimia but to those challenged by anorexia and binge eating disorder as well. During this time, we spoke to so many families that we decided to write down what we were telling family and friends, and Surviving an Eating Disorder: Strategies for Family and Friends was first published. Michele and I wrote, trained and gave talks internationally. These were thrilling times.

Then in 1992, tragedy struck. Michele, mother of four year old Jesse, and pregnant with her second son, developed breast cancer. Months after Michele gave birth to Josh, she, my business partner and incredibly close friend, died. Everything stopped.

That next year, I condensed EDRC, narrowed the scope of what we were doing and stopped to catch my breath and mourn the loss of Michele. Later that year, I also met the man who would become the father of my children and within two years, I would be the mother of twin girls.

Life somehow carried on. But at that time, I redirected my focus, extended my private practice, took care of my children and kept EDRC as a quiet sidebar in my professional life. Thanks to the help of many extraordinary therapists who kept the center vibrant along the way (thanks most recently to Dede Kammerling, Jay Pott and Debra Farbman), for over twenty years EDRC stayed as an anchor in the city for the treatment of eating disorders. Through those years, we kept a steady but low profile as my mainstay attention remained focused on my daughters and my patients.

Recently however, much has changed. Eating disorders have become interwoven into our culture and the field in general has expanded exponentially. EDRC needs to attend to the fact that our patients, the community and families need more. Perhaps as important, I find that my daughters, now full into their teenage years, are as grateful for the time I spend at work as they are for the time I spend at home! For the first time in years, I am able to invest time and energy back into the Center. EDRC is ready to grow again and all of us at EDRC are excited for the expansion of a center that has quietly taken root over the years.

What’s Happening Now…

And so in that spirit, I write to tell you about EDRC. We are growing in size, in program development, and in capacity to handle the ever-expanding needs of the patients and families challenged by an eating disorder in the tri–state area.

Looking back, oddly the moment the center was born was the kind of moment we hope for all our patients. My saying “I feel fat” allowed for a swirl of inspiration that changed my life.

Our mission and goal at EDRC is to turn challenge and struggle, the “I feel fat” moments, into inspiration and opportunity. We thank those of you who have supported EDRC with these goals for the many years along the way. We look forward to continuing the growth of our patients, EDRC and our relationships with you in the years to come.

Oh, those cravings for something sweet!

Is there really anyone who hasn’t known what it’s like to face the siren call of sweets? This is an enchantment compelling and almost impossible to ignore—one that often is met with alarm once you are drawn into its spell.

Is it possible to have that pleasure without feeling as though one has been slammed into a wall after heeding desire? I believe it is.

My mother had a ferocious sweet tooth. She went to one of the finest bakeries in town and brought home perfectly made cakes with butter cream frosting. I am sure all those lovely cakes sweetened my palate and inspired my passion for baking. But Mom—did you do me in here? How can I take on your pleasures without regret?

My patients crave sweets—and so do I. But maybe we all are looking for something that doesn’t really have to do with sugar. What else is sweet that can fill me up when I hear that siren call?

It’s sometimes hard to know what sweet it is we are searching for. Is it a moment of tenderness, listening to a piece of music (how about the voices in 20 Feet from Stardom??), a moment with a close friend, noticing the first crocus to push through the floor of this ice-ridden winter (yes, do look—the crocuses really are now pushing their way to freedom—that is indeed sweet)? What else do you think is sweet?

Our minds are wired from childhood to associate sweet with cookies, that beloved ice cream cone, butter cream frosted cake. You will have to work to think about what else could be sweet in your life.

At the moment the cravings are most intense, assume you are needing something—and likely something sweet. Do the hard work, don’t go to sugar at that moment. Make space for a sweet place in yourself, in a relationship, in your life. One less cookie, one more sweet moment.

When you find that you can have just a little bit of something sweet other than food, how truly sweet it is.

Recently, The Biggest Loser, premiered its season finale and within minutes controversy ensued. On the show, fifteen people had spent nearly four months away from home competing to lose weight. Contestants lost as much as ten pounds in one week. The final three people then had to continue to lose weight for the next three months, home on their own.At the season finale,there was a final weigh in. The person who has lost the most weight would be crowned the winner. The single goal for these contestants was to lose weight.

The latest winner lost a grand total of 155 pounds, which averages to about 5 pounds a week. (Please note that healthy weight loss occurs at 1-2 pounds a week). This winner does not come close to holding the record for greatest weight loss but this time there seemed to be a slight problem. When the finalist made her grand appearance two of the trainers on the show had very concerned looks on their faces. Since the finale last week, audience members and past biggest loser contestants have voiced uneasiness about how thin this particular finalist looked. I am not here to comment on the finalist and her weight loss but I do want to talk about some of my concerns with the show.

NBC says that there are a team of doctors, nutritionists, and trainers who work with the contestants. Any yet, I have never heard the network or past contestants talk about a therapist being on the show, even behind the closed doors. I think it is a problem that talk therapy is not being discussed openly.  Losing and gaining weight is not only about calories or exercise. Weight and how people treat their bodies can also be a reflection of how they feel emotionally. This is something that society often forgets.  When someone feels life is out of control,  food can be used as a way of gaining control amidst chaos. A woman going through a very upsetting breakup may begin to cut back on calories because her body becomes the only thing she feels she can control during this depressed time in her life. On the other hand, someone might feel that he or she has to be perfect in front of others.  Bingeing becomes the only way to lose control—and purging becomes a way of becoming perfect again and regaining control. Eating disorders are complicated and different for each individual.

The above examples might make you think of someone suffering from either Anorexia nervosa or Bulimia but there is another eating disorder not discussed as often, Binge Eating. Sometimes people see a heavy person walking down the street and immediately think they are lazy and simply don’t try or care to lose weight.  Being overweight can be a sign of emotional stress as well as a sign of Binge Eating.  Men and women who have a hard time expressing and managing their feelings may have learned that food could comfort them or help distract them from having to deal with uncomfortable feelings. Once a behavior is learned, it is extremely difficult to unlearn the behavior. The Biggest Loser may help people lose weight, but if people are not looking at the underlying causes related to their weight, they are going to have trouble maintaining their weight loss.  It is crucial that individuals think about their relationship with food, weight, and their body when considering any sort of weight loss.

The Biggest Loser has contestants on the ranch working out for multiple hours of the day and losing an absurd amount of weight in a short amount of time. The show screams unhealthy and unrealistic — yet it is clearly popular because it just ended its fifteenth season.  This brings me to my second point, our obsession with talking and thinking about food, weight, and our bodies. For this part I will speak from a female’s perspective.

Women tend to talk about food and weight all of the time. Women may go to their friends for reassurance about how they look or what they are eating without thinking about their friends’ own struggle with these issues.  Many men and women with eating disorders keep the eating disorder to themselves.   You may think you’re innocently complaining to your friend about how much you just ate without knowing that friend is struggling with his or her own issues around food. The topic of food and weight is so ingrained within women’s language that women are not realizing how much it is actually consuming their conversation.

Try paying attention to conversations you have with your friends over the next week and make note of every time either you or your friend mentions weight or what and how much food they ate.  The number will probably surprise you.  Shows like The Biggest Loser continue to propel these conversations.  How can someone watch a show like this and not comment on someone losing 15 pounds in one week?   I don’t know how we stop these conversations from consistently continuing but I think having awareness is the first step.

She comes to the table saying “I can’t draw.” The critical inner voice is alive and well! I respond, “that’s ok, there are lots of ways to create. Being creative requires experimentation, curiosity, and practicing non-judgment (that can be the hardest part, but it’s a practice.) There are as many ways to create as there are human beings; you can’t do it wrong because it’s an expression of you. You made art when you were a kid, right? Then it didn’t matter what it looked like, it mattered what it felt like. It felt joyful and empowering. We’re going to try to rediscover those feelings. Along the way, we’ll tackle serious subjects, but you’ll be cultivating a new way to handle them.”

In an art therapy session client/therapist relationship is key. There must be safety which allows the client to risk sharing her fears and vulnerabilities. Together we examine the images with curiosity. What was the overall feeling during it’s creation, and afterwards when looking at it? Is there anything the image or characters in the image need? Are there words to describe what’s revealed and how do they relate to the client? As important as curiosity about the image is mindfulness of the process: noticing material choices, feelings evoked by the tactile process, self-critical thoughts, fear of commitment or “messing up”, difficulty with certain emotions. The process of art-making frequently reflects one’s struggles in life. It’s an opportunity to discover, and practice changing patterns.

By the end of the session the critical voice is still there, but a more positive voice is also emerging. “I don’t like that part because it’s too dark.” (We explore darkness; the client’s beliefs and fears.) “I do like the part that was fluid and spontaneous. That part feels good!” One of the most powerful things about the process is that the client is making discoveries about herself. She’s getting to know her strengths, ways of taking care of herself, as well as the sticky places that hold her back. Slowly but surely she begins to cultivate and value all parts of herself, instead of remaining shrouded in a tiny, perfected vision of whom she is supposed to be.

Three years ago, my father passed away. When he was dying, I held tightly the ever fleeting images of him through words. Weeks prior to his death, I wrote the blog below for Gurze Press and the Huffington Post. This was written as a New Year’s Resolution—but I think it is apt for any time of the year—particularly now when we are about to lurch into the rush of the oncoming holidays.

I repost it now as a reminder to myself—and hopefully to you. In the next fast paced weeks of shopping, rushing, partying—and yes, eating—for a moment, STOP.

Crisis as Opportunity: My New Year’s Resolution

December 2011

On May 20 of this year, my father, out of the blue, was diagnosed with a severely aggressive leukemia and was given two to six weeks to live. A quick run to Google (because that’s what we do these days when we’re scared) confirmed that the doctors weren’t being alarmists and that we really had to start saying goodbye now.

In a matter of weeks, life turned on its head. We sold and cleared out the family house, gave away the family dog, spent endless hours, days, weeks at Sloane Kettering and planned a funeral. My father even wrote his own obituary. (My father’s bucket list included anything that could make life easier for my mother—and my mother was not exactly up for planning my father’s death). My father grew weaker, more and more sickly, lost his sense of humor and the twinkle in his eyes. Finally, we all gave in and my father was moved to a residential hospice facility. He only had a week or two left at the most, and we wanted him to be comfortable. We watched him go from a robust 160 lbs down to 150, 140, 130… and finally to 109 lbs. Visiting him felt eerily like I was still at work.

My father said goodbye to everyone, wrote letters and had touching moments of connection with us all. We were grateful that he wasn’t in pain and relieved that he might just slip away gently.

Except it didn’t happen that way.

Right now, my father is on a flight to Florida with my mother, strong enough to plan a trip to their winter retreat. Removed from all medications once he was in hospice, closely monitored by extraordinary nurses and surrounded by the love of his family, my father tentatively has come to life once more.

Two days ago my father left the small room at the hospice facility within which he surely was going to die. It was one of the most extraordinary days of his life, he tells us. He talked about the disbelief, reentering a world he had said goodbye to. He couldn’t believe he was seeing trees again, people, traffic, the stoplight he passed every day of his life.

The stoplight??

I know the stoplight my father is talking about. It’s oddly interwoven into my life as well. But grateful for the stoplight? Pay attention. My father is more alert than the best of us.

These last days, I’ve noticed that I too have a myriad of stoplights in my life. I now am stopped short frequently, finding myself staring at what was, only last week, the background of my life—the lamp on my office table, the tiny oil painting over my desk, the dappled light as it glints through my window in the afternoon. Background has become foreground and I am endlessly moved at the experience of wondering how the details make me who I am. I think of Helen Keller, objects suddenly cascading into her otherwise pitch black night, life found anew. Water.

Of course, I’m ever filled with joy and gratitude for the people I love and for the large, daily events that make up the tapestry of my life. But it is rare that I look so caringly at the details, the Seurat-like blinks that color in the picture at every turn. It is rare that I stop to look at all.

In truth, I don’t know how much longer my father has. I don’t even know if he will make it through the flight to Florida. But as a result of the crisis of his pending death, my father has given me a gift that surpasses any of the holiday presents I’ve received in years’ past. He has reminded me to see.

With every crisis comes the flicker of opportunity. My new year’s resolution is that each time I stop at life’s metaphoric stoplights, instead of impatiently pumping the brake, I’m going to catch my breath, settle in and take a look around. I only hope that, no matter what happens, as crisis evolves into the hushed chaos of quotidian life, that when I see the next stoplight, I actually won’t drive on through.

I (someone who has been known to race through yellow-turning-red lights) hope this resolution lasts longer than any I’ve made before.

Happy new year. jb

(my father died one week after this entry was written)

The Fall season for me is a time when I try to forge ahead in all aspects of my life—family, work, friends and community. I’m pretty likely to take on things that have been brewing but put-off during the summer when even the warm weather seems like permission to unravel. When the cooler weather comes in, I’m “goal-oriented.” This Fall, I began to wonder whether my active focus on goals, while carrying a tilt in the direction of ‘doing’ over ‘being,’ is a mode that could also be applied to getting more clarity on some of the powerful feelings embroiled by an eating disorder.

It’s well-known that identifying and understanding underlying feelings is part of the recovery from an eating disorder. We say, an eating disorder is ‘not about the food, it’s about the feelings.’ But this “about the feelings” is a tricky part. Feelings can be big. Our soul can be a murky place. Our heart can feel turned upside down. This leads us to roll on by, to ‘have a feeling,’ but to not stop, look around, listen in. Because of this, especially with big feelings, what often happens is that we don’t have the feeling, the feeling has us. It may be that with powerful feelings, a deliberate, focused and yes, goal-oriented approach is needed as a tool to begin to get some traction and get back to ourselves. The truth that this may be required is not given voice to in the culture.

So how would I get “goal-oriented” with feelings? First, why not be irreverent and mentally reify the feeling? What about in addition to the naturally human skills of radically accepting the feeling, breathing through the feeling, relaxing into the feeling, distracting from the feeling, what about also using an approach of addressing the feeling, which at first may have to feel something like tackling the feeling. Give it a name, call anger “Maddie,” anxiety “Tornado” or sadness “Poison Ivy”. Give it a place – “down the rabbit hole,” “out to lunch.” Treat the feeling as an object of observation, like a Baroque-period chair.

When a concerted focus on an emotional state is possible more poignant questions can be asked. When did you first have this feeling? Who knows you feel this way? Who doesn’t know? When do you feel this the most? The least? Who has helped you with this feeling? What do they do to help? Do you have that feeling now? These questions of course can change the terms of the problem. Useful distinctions can sometimes be made—self-reproach goes hand in hand with fear of criticism by others, care feels like an attempt to control, insecurity is related to loosing touch with personal an moral convictions, and so on.

“Can Emotional Intelligence be Taught?” a recent article in The New York Times asked about the grade school curriculum (September 11, 2013). The award-winning poet Czeslow Milosz tell us “Love means to learn to look at yourself, The way one looks at distant things” (Love, 1943). Maybe there should be a more deliberate acknowledgment and focus on how to re-introduce ourselves to our feelings, especially powerful ones.

An acquaintance recently spoke about a problem with her healthcare coverage. She listed with dismay how much extra time this problem took: “30 minutes on the phone, 10 minutes finding forms, 20 minutes filling out forms, 10 minutes copying, and 30 minutes to calm down afterward.” 30 minutes to calm down—like 30 minutes at a time addressing ourselves to feelings, may be what it takes.

We hope the summer was long enough for everyone to have had some quiet soulful moments, some wonderful adventures and enough of a lull to be ready to jump back in to a more normal rhythm of work and school.

Over this last month, I’ve had the opportunity to listen to Adam Johnson’s The Orphan Master’s Son, the capacious, stunning Pulitzer Prize winning novel ostensibly about a North Korean spy, but also about identity, love, intimacy and the vacuous space between our two nations’ cultures. I was dragging my iPod and computer from car to apartment, room to room, so compelling (and beware, gritty) was the story.

Throughout the book, the author talks about the pain training that the young spy, Jun Do, has had to learn and endure. When you feel pain in one part of your body, Jun Do is taught, travel to another untortured part of your body. Focus on how that part of you feels, get lost in thoughts or memories that are evoked by the the parts of you that are not broken or in torturous pain. Jun Do wears the scars on his arm from the lit candle held to his skin during the arduous preparation for his life as a spy and kidnapper.

This is a book you live not read. And so throughout the multitude of thoughts it engendered, I found myself wondering if what we do at EDRC each day is “pain training”? Life is tough. Lit candles are held to our skin in endless ways. How do we hold on, be brave and remember that when the pain occurs in one place, there are safe havens to retreat to– other than food, starvation — or yes, even the intense focus of burning or cutting itself. I wondered what place in my body i could go to during “pain training”?

Years ago, when one of my daughters parted from me for her first foray into pre-school, she ran back to me and wordlessly grabbed my leg, right above my knee– and wouldn’t let go. Yes, we slowly pried her hands free; yes, i sat with her until she was quietly engaged in drawing; and yes, i was able to soon leave with the gift of a proudly drawn picture, a warm teacher and a quick-shot view of my daughter smiling, holding the hand of another child as she took her first steps into the world and I was guided out the door.

Maybe for me “pain training” would take me to my leg– a place initially associated with pain but soon lodged with images of connection, relief and love. Maybe if i were a spy in pain training, i would think of that part of my leg, right above the knee, where my daughter’s hands took hold.

What would “pain training” mean to you?

So much for sun and beach and travel and the time to wander while being read to for 20 hours.

Guess it’s time to get back to work…

Despite the recent weather in New York, summer is finally here. The song “Summertime” comes to my mind—and the living is easy.

Or is it?

As we discussed in our newsletter a couple of months ago, summer is a time when it is hard to hide out. During any other season, layers of clothes can distract and camouflage what we really look like. But the living is not so easy when layers of clothes are shed and our bodies are exposed —along with our insecurities about our imperfections (the ones we THINK we have). Who doesn’t look at other’s bodies and compare and contrast (even silently)? I know very few people, men and women, who don’t express some dissatisfaction with their bodies, but generally that doesn’t rule their lives. Like “normal eating”, body dissatisfaction is on a continuum. With eating disorders, body comparison enables the ever present critical voice to get LOUDER and LOUDER!!

It also doesn’t help when popular magazines have whole sections dedicated to the comparison of body parts. For example, People Magazine rates the best beach bodies, the best arms, abs or whatever other body part one tends to notice during these months. Everyone is under a microscope and parts of bodies take on a focus that encourages dissatisfaction, embarrassment and even shame. Most people are able to shrug off their imperfections. But with eating disorders, that critical voice gets so loud that one’s mood can shift rapidly if any excessive skin or fat is detected. Within minutes a person can go from feeling happy to wanting to disappear from the face of the earth because of this critical voice. I recall a patient who reported to me that in the time that it took her to get to my office from her home, her mood shifted from “good” to “anxious and depressed” because she realized that her stomach was not as flat as she wanted it to be when she compared herself to someone she noticed along the way. This young woman wanted to go home and disappear after this encounter.

As the critical voice increases, so does the hiding and avoiding of people. The living is hardly easy. How can we get this critical voice to lose its power and get softer and softer ?

Instead of comparing ourselves to that one, genetically blessed individual who catches our eye on the street, why not also compare ourselves to 5 other individuals at random? New York City is filled with its fair share of well-dressed and in-shape individuals, but it’s also filled with normal, average folks as well.

And remember, when you are happy and smiling and present (enjoying the long summer days and good weather) you are much more attractive—and that can be done without losing 5,10,15 lbs or getting rid of those “fatal flaws”.

Finally, what about highlighting another voice—one that is accepting, a voice that tries to make you feel better not worse, a voice that is kind not abusive.Think about what you could say when the body criticism starts to scream—because when body criticism speaks loudest, it’s time to take care of yourself—not to be punishing

How about something like “Hush little baby, don’t you cry”. (or for those too young to know the lyrics of “Summertime”, let Rhianna speak to you—”we’re beautiful like diamonds in the sky”) .

“Summertime”… and the living can be easy—er!

The new psychiatric diagnostic manual, the DSM-5, is about to be released this month. Many of the new diagnostic categories are being questioned. One of particular interest is that of Binge Eating Disorder. Bingeing, or eating a large quantity of food in a shorter period of time than is typical, is a disordered behavior according to theDSM-5. An individual who has eaten excessively at least 12 times in a period of three months meets criteria for Binge Eating Disorder. That means if you “blow out” once a week, you have an eating disorder. Really??

For many, this may be true, but I’m really curious these days about how women (i’m starting there, at the risk of momentarily losing my male audience) REALLY eat.

I know the usually prescribed base for people struggling to maintain healthy eating is three meals a day, two snacks. But once people slide into the reality of everyday life, is that how we really eat? When I give talks to teens, they tell me they frequently skip breakfast, eat “junk” through the day, “pig out” after school if they have raced through the day without eating much. Are they eating disordered? Harried moms pick at their kids meals before they go out and then worry that they “overdid it” when they finally sat down to dinner, relaxed, eating until they are more than full. Is that a binge? (They will assuredly tell me it was a vast amount of food in a short amount of time—and afterwards they have their laments). Colleagues tell me that when a paper is due, they sit down, make a mess of their notes, their thoughts and their eating as they get their thoughts on paper. Later, they clean up their words, their thoughts, their eating. Is that disordered?

In this culture where most everything is now diagnosed and pathologized, I am wondering what “normal” eating really is. A study of 2000 British women revealed that participants confess to eating two snacks a day—but usually when no one is watching because they are embarrassed about eating the snacks. If women can’t even eat a snack in public, what else are they doing that they are embarrassed about or can’t even report in an anonymous study? My guess is it’s much more than two snacks a day.

Remember how sexuality was spoken about a few decades ago? (Well, maybe you don’t remember—but this is how it was)—Pre-60’s, women all knew what they were supposed to do in bed (missionary position) and no one talked about anything more. Everyone likely assumed there was more to the picture… but no one really knew what people did behind closed doors. This of course all changed with research and literature (think The Joy of Sex). With open discussion about what men and women REALLY did, knowledge, shame and a sense of choice about sexual possibilities radically changed.

In the arena of food, however, we are back where we were in the arena of sex generations ago. We are still in the dark ages, with mystery surrounding what women really eat and shame coloring our ability to even talk about it.

We all know that disordered eating has to do with one’s world being out of balance—food and weight are used to cope with feelings, to withdraw, to protect one’s self. We all have moments of that—sometimes even once a week—Does that mean we are all eating disordered?

A patient of mine once asked me if women REALLY do eat candy if they are not bingeing. Yes, i answered—all the time. But that question prompted my wondering how we can better know what women really do—and what is healthy—and what is not. The new DSM-5 presents many answers. But how can we use the new manual to allow for new questions as well. What do women REALLY eat? When is eating healthy? When is it not?

As fellow EDRC psychologist Lauren Waine notes:

“The cost of not knowing how women really eat may be the continued marginalization of people with normal human behavior, with the net effect being a veil of shame, self-reproach, and the felt need for secrecy and hiding among all people”

I couldn’t say it better.