Anorexia - Coping Yourself

Overview

What is self-help?

Self-help is any activity or lifestyle choice that a person makes in the belief that it will have a therapeutic benefit. Self-help can be something you do by yourself or it can be facilitated by a healthcare worker who will check your progress as you go along. For example, self-help might be recommended for some people with anorexia alongside their usual care but would not usually be recommended by itself as a stand-alone treatment.

Some different types of self-help are listed below:

(1) Bibliotherapy (Guided Self-help)

This is the use of written material to help people understand their psychological problems and learn ways to overcome them by changing their behaviour. This is often based on Cognitive Behavioural Therapy ‘CBT’ principles. This is something you can use at home in your own time and then discuss with your therapist. There are a number of companies providing self-help products, including books, workbooks, CDs and DVDs. Be careful as the quality of these is quite variable so look for ones produced by people with recognised professional qualifications. If you are being seen by a GP or mental health professional you may be given self-help materials by them in addition to your usual care.

For self-help and some practical ways on how to manage thoughts and feelings around eating go to the next tabs, Changing your thoughts and Changing your Behaviour.

(2) CCBT

Cognitive behavioural therapy (CBT) is a popular model of therapy that you may be using with your therapist or support worker. Whereas CBT is often carried out face to face, it can also be delivered via Computerised CBT (CCBT) where you complete similar tasks via an online programme. 

CCBT would not usually be recommended for Anorexia; however there is a CCBT programme for carers of those experiencing Anorexia. ‘Overcoming Anorexia’ is an online course that teaches family or supporters of those with Anorexia the skills necessary to identify the issues surrounding the disorder and how to become expert carers. The carer or family member works through 8 sessions to help them understand the thoughts, feelings and behaviours of the person with anorexia. Topics include effective communication, how to prevent relapse, meal support, self-management in crises, and dealing with binging, purging and other difficult behaviours. Overcoming Anorexia online was developed in partnership with internationally recognised Eating Disorder experts and Beat, the leading UK charity for people with eating disorders and their families. Subscription is currently £45 and can be bought from www.overcominganorexiaonline.com or speak to your GP about access.

(3) Psychoeducational groups

Psychoeducational groups may also be available at your GP surgery or other premises and are another support option for people with Eating Disorders. The group sessions will be delivered by a trained practitioner and may include presentations and use of self-help manuals on eating disorders.

(4) Support Groups

Support groups in your local area can be another source of help. Attending these is often free and you can choose which groups you would like to attend. Support groups may provide face-to-face meetings, telephone conference support groups (which can be based on CBT principles), or additional information on all aspects of eating disorders plus other sources of help. Support groups may be useful to you or for members of your family / friends. Find support groups in Birmingham.

(5) Relaxation

Relaxation is one of the most easily accessible self-help techniques to improve everyday wellbeing and is an effective way to manage difficulties such as stress, poor sleep or anxiety. Stress can build up for any of us and make us feel anxious, tense and wound-up. Learning to relax by doing something you enjoy (having a bath, going shopping, reading a book) usually helps how we feel but not everyone is able to 'switch off' so easily.

Planned relaxation is definitely a skill and takes time to learn so make sure you set aside time to do this. Mastering relaxation techniques can help you to regain a sense of calmness by reducing the severity of any physical symptoms you have (such as heart racing, tension in shoulders etc) and helping you to gradually unwind. Watch our short films on relaxation with instructor Shebina and learn a variety of breathing techniques and deep muscle relaxation. Or if you prefer, download a written information sheet on breathing techniques, the seven-eleven technique and deep muscle relaxation.

 

In the next sections we will look at: 
  • Identifying the problem
  • Changing your thoughts
  • Changing your behaviour 
Overview

Step One – identifying the problem

As you can see, many things may contribute to Anorexia and each person will have an individual experience of the illness. For most people with anorexia the illness will really disrupt their thinking and behaviour, putting constraints on their life and stopping them from feeling free to live how they want to.

These things will all contribute to the illness being maintained by the person and forming a cycle of behaviour which is very difficult to break away from. This exercise may help you to start thinking about your difficulties using psychological techniques. In this exercise you can start to identify the thoughts, feelings and behaviours that appear as well as your body’s reaction to this. Looking into this may help you to understand your eating disorder better but is not something you should undertake entirely alone. The following exercises are best done with a health professional that can support you.

 

Example

Here is an example of how Hannah looked at her difficulties using these techniques. Hannah’s difficulties in this situation were around her body weight and shape. Hannah used this technique to see how her beliefs about her body weight and shape made her think critically of herself, feel worthless, ashamed with a need to control her eating, behave by having strict rules about food intake and restricting food and her body’s reaction to this restricted calorie intake; with weight loss, exhaustion and mood swings.
 

Hannah's cycle of thinking, feeling & behaviour might be broken down like this:


chart

As you can see from the example, finding out how your thoughts, feelings and behaviour are connected can show you how a problem can be maintained through a cycle which is hard to break. You might be able to see from this example how this may be true for you - a health professional can help you do this.

 

The cycle of thoughts, feelings, behaviour & physical symptoms…

Start thinking in a psychological way and identifying the thoughts, feelings and behaviours that appear when you think about food and eating. For example you might get some, several or all of the following:

Thoughts

  • Negative self beliefs:
  • Judge self by what you eat and look like
  • Judge self on your ability to control what you eat and look like.
  • Strict rules about controlling food, shape and weight
  • Focus of attention is taken up with food and eating
  • Strict rules on what you should or shouldn't eat
  • Self-critical thoughts if you don't keep to the rules
  • ‘I failed, I'm useless and weak, I'm worthless’
  • ‘I need to be thin to be in control’
  • ‘Others are trying to make me fat’
  • ‘I'll fall apart if I don't control myself’
  • ‘If I'm not perfect, then I'm a complete failure’

Feelings

  • Depression
  • Guilt
  • Anxiety
  • Irritability
  • Frustration 
  • Shame
  • Fear
  • Failure

Behaviours

  • Strict control of your food intake: when, what, how much.
  • Weighing yourself frequently
  • Skipping meals
  • Hiding food or disguising what eating
  • Not eating
  • Cutting food into tiny pieces
  • Eating alone
  • Vomiting
  • Using laxatives
  • Taking diet or diuretic pills
  • Exercising too much
  • Cooking food for others but denying yourself food
  • Checking your reflection in mirror
  • Attending to websites which promote anorexia as "thin and beautiful"
  • Isolating yourself, not socialising, avoiding social events (especially those that involve meals)

Body’s reaction to this

  • Extreme weight loss
  • Sickness & Bloating
  • Feeling cold
  • Tiredness, weakness & convulsions
  • Brittle nails
  • Dry skin
  • Abnormal heart rhythms
  • Anaemia & kidney damage
  • If you are female your periods may stop
  • Loss of sex drive
  • Sleep problems
  • Cannot concentrate
  • Bowel problems if laxatives are taken.
  • Osteoporosis; having weak bones which break easily due to a lack of calcium
  • Swelling of hands, feet & face (due to fluid disturbances).
  • Tooth decay caused by stomach acid in vomit
  • Hair loss but with extra hair growth on body to keep it warm (lanugo)
  • Diuretics, laxatives & vomiting are an ineffective way to control weight & seriously affect your health.
  • Death by cardiac failure
Once you have identified what happens to you when you think about food and eating you can start to think about the problem bit by bit. This is no easy task and if you need help to achieve this then please contact your GP (find a GP) or one of the agencies listed on the contacts & links page for their expertise and support.

 

 

Overview

Step Two – Changing your thoughts

  • Don’t punish yourself or give yourself a hard time about how much you eat or how much you weigh.
  • You probably feel very afraid of putting on weight. Understand that this fear is part of your illness and try to listen to people when they tell you that you should not be losing any more weight.
  • Don’t compare yourself to other people – you are an individual
  • Imagine what you would say to a friend if they had negative thoughts about themselves?
  • Try to explain to someone you trust what you get from having anorexia. If you feel you need to starve yourself in order to maintain control over your life, or to suppress other emotions you may not feel able to deal with, then tell someone this.
  • Concentrate on and remember the good things about yourself and your life - don’t focus on the bad things - try and keep a diary of things you have enjoyed or achieved during the week to remind yourself of this.
  • Talk yourself better with positive self-talk - when you start to feel down you can try the mind-over-matter approach of self talk to get yourself through any uneasy feelings. You could try saying things like:
    - I can manage. I have been through this before and I managed
    - I am confident and in control of my feelings
    - I don’t need to do this – later I will feel worse if I do
    - I can cope for another hour / 20 minutes / 5 minutes and take it one hour / 20 minutes / 5 minutes at a time.
    - I am doing ok. Right now I am well and ok
    - Today is the first day of the rest of my life and I will take notice of the many positive things this day has to offer
Overview

Step Three – Changing your behaviour

  • Read up on eating disorders and speak to people you trust if you think you have a problem. Download our information booklet on Eating Disorders.
  • Find out what your ideal weight should be for your height. Weight yourself weekly but not more often than this.
  • Try to be honest with yourself and those close to you about what you are or are not eating
  • Keep a diary of what you eat and how you feel when you do and do not eat to help see if there are any connections between the two. Download a food diary or a thought record sheet.
  • Try and change one small thing every week in relation to food, e.g. eating one less thing or one more thing per day or being around food more often and feeling ok with this.
  • Create a simple menu plan (such as 3 meals and 3 snacks per day). Do this with your health care professional.
  • Keep regular meal times daily to create a routine
  • Join a self help group for your eating disorder
  • Consider what your eating disorder has cost you and stopped you from doing. Write a letter to your eating disorder if it helps you to get this down in words.
  • Spend time with family and friends doing things you enjoy
  • Don’t spend longer than you need to looking in the mirror it will only add to any insecurities you may have
  • Avoid websites that encourage starvation or purging - they are damaging & used by people who will encourage you to take on their bad, unhealthy habits. Also avoid celebrity magazines whilst you begin your process of recovery.
  • Treat yourself kindly. Take a relaxing bath, read a book, go to the cinema or listen to your favourite music.
  • Keep a journal, if you don’t feel able to say what you need or want to, try writing it all down and show this to someone who is involved in your care or someone you trust. If you can’t find the words to explain how you are thinking and feeling this is an easier way to express yourself.
  • Write about your life without an eating disorder. Imagine what this would be like and what would be different for you.
  • Watch our short films on Eating Disorders to see how other young people have coped.
  • Take an assertiveness course to build your confidence (contacts & links)
  • List things you can do and the positive qualities about yourself and praise yourself for them
  • Learn a new skill. Develop new aims and goals to work towards. This will help you to focus your energies on achieving positive outcomes.

 

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