Tuesday, January 30, 2007


Eating disorders are serious issues in American society. One of the 3 eating disorders, Anorexia Nervosa affects approximately 0.5% of American women and 0.05% of American men, according to the American Psychological Association (2000). Not only do individuals with Anorexia Nervosa suffer physically, they also suffer mentally as well.

What is Anorexia Nervosa exactly?

The Diagnostic and Statistical Manual of Mental Disorders defines Anorexia Nervosa with these specific criteria:

1. Refusal to maintain a minimal body weight (less than 85% of weight expected for age and height).

2. An intense fear of becoming fat or gaining weight.

3. Denial of unhealthily low weight, basing one's self-evaluation on his/her weight, or a disturbance in the way in which one experiences his/her body shape or weight.

4. Amenorrhea, the absence of menstrual cycles for at least three consecutive months (in postmenarchael women) or the presence of menstruation only when on hormones such as estrogen.

Anorexia Nervosa has two subtypes:

Restricting type - during the current episode of Anorexia the individual has not engaged in any binge-esting or purging behaviors. Binge-eating is classified as consuming significantly more calories in one sitting than what is considered "typical" for that culture. Purging behaviors could include the misuse of laxatives, diuretics, or self-induced vomiting.

Binge-eating/purging type - During the current episode of Anorexia the individual has engaged in binge-eating and/or purging on a regular basis.

Nancy is a college freshman this year. She has difficult adapting to change and misses her friends and family very much. Nancy became concerned about her weight when her roommate said she could stand to lose a few pounds at the gym with her. It has been six months since Nancy's roommate expressed this judgement, but Nancy continues to worry about her weight. Nancy keeps a chart of the food and calories she consumes, eats very little, and exercises multiple hours a day. Yet she manages to keep good grades.

Friends and family have expressed concern for Nancy, telling her she has gotten too thin and that she needs to eat more. Nancy, however, sees herself as extremely fat and feels she needs to lose more weight.

At her last doctor's visit, Nancy admistted that she has not had her menstrual cycle for four months now, but refuses to go into treatment for her eating disorder, insisting that she doesn't have a problem.

Anorexia Nervosa is a serious condition, and those who suffer from it often face serious medical complications and sometimes even death as a resulf of the lack of nutrients being put into the body and dangerously low body weight.

This post is the first of a series of posts on eating disorders. Later this week, I will discuss how to recognize Anorexia Nervosa in family and friends, how to help those who suffer with the condition, and the medical consequences that result from Anorexia.

Tuesday, January 23, 2007

Building trust

I've been talking about trust lately. Last time, I discussed how I believe one can determine whether he/she is able to place increasing amounts of trust in a potential friend. In this post, I'll share my opinions and insights into how one can build trust with another individual.

Relationships are built on trust, so it is important for us, as individuals, to learn how to build trust with other people.

Honesty is the first element in trust I think about when I hear the word "trust". In order for someone to trust you, you have to be honest with that person. And you have to be honest consistently. It's usually easy to be honest about some things while it's difficult to be honest about others. For instance, your new friend asks you if you like the outfit she's wearing. If you love it, you can easily say something like "I love that outfit on you! It really brings out your eyes". However, if you hate the outfit on your new friend, it might be hard to tell her this because you don't want to hurt her feelings.

It is always best to be honest about your feelings, thoughts, and opinions with other people. This doesn't mean that you should be overly critical of others, demean their thoughts, or invalidate their feelings. You can be honest and tactful. In the example above you could say something like "To be honest, I don't think that outfit suits you. The color doesn't bring out your assets the way I've seen colors do for you".

Another aspect of building trust in relationships is consistency. Call every time you need to cancel or reschedule your plans with a friend. Make being late and/or cancelations infrequent. Don't make your friend guess as to how you will react to similar situations. Along with consistency comes consciensiouness, which should be extended to everyone in your life.

You also need to keep the lines of communication open. Openly share and discuss your feelings, thoughts, opinions, and experiences with one another.

Consistency, honesty, and open communication will allow you and the new person in your life to build a solid relationship on trust.

Sunday, January 21, 2007

Trust in friendships

As I discussed in my last post, trust is an essential and difficult aspect of relationships. Trust can be especially difficult for individuals who have been through abuse or trauma.

I know this because I grew up in an abusive household. It wasn't until I went to college that I began to learn the importance of trust in relationships. Whether you are trying to develop a friendship or romantic relationship with another person, trust is the basis on which a relationship is built.

So, how do you know when or even if you can trust a potential friend or partner?

Through my experiences, relationships, and my own therapeutic work, I have learned a great deal about trust in friendships.

First, it is important to realize that trust is built over time. Trust shouldn't be given all at once. Oftentimes survivors of abuse or trauma may let down their guard too easily, allowing others to cross their boundaries too early in a developing friendship.

Don't disclose all of your personal information, background, and/or secrets at once. In fact, you may want to start with "small talk". When first meeting someone, get to know them by asking them what I call surface questions. Examples of these might include:
What is your favorite...?
Where are you from?
What are you studying / what do you do in your current job?
Do you have any siblings?

And so forth. Getting to know someone gradually will allow you to develop a greater sense of trust over time.

Do things you both enjoy. Spending time together will allow you to develop a solid friendship. When you spend time with one another, you also have the opportunity to learn more about each other. When you see a movie, for instance, the movie may inspire you to talk about mutual interests or to bring up things you have not discussed before such as your opinions, thoughts, feelings, or experiences.

Consistency is another factor in trust in my opinion. If your potential friend agrees to meet you at Starbucks at 10AM and she runs into traffic, causing her to arrive late, does she call to let you know she'll be late? Does she offer an apology or explanation for her lateness?

Likewise, does your potential friend call to cancel ahead of time if she can't make your meeting? Are her actions consistent with her words? If she tells you she really wants to get to know you, but then doesn't call, e-mail, or make plans with you for the next three months, her words and actions are not consistent with one another.

There are times when we are ALL late, unable to cancel ahead of time, break someone's confidence accidentally, or neglect to keep good contact with our friends. However if these things are happening consistently, the person in question may or may not be trustworthy.

I believe trust is earned, built over time. If you have concerns about potential friends, talk to the people you trust (long-time friends, counselors, a pastor, etc) to get their take on the situation. Then, you may want to consider talking with your potential friend about your concerns regarding him or her.

The most important thing to remember is to take relationships slowly; don't let new or potential friends cross all your boundaries initially and listen to your instincts!

Tuesday, January 16, 2007


Trust is one of those abstract concepts everyone seems to hold a different opinion about. It appears to be hard to define in any definite terms. But I'd like to share the insights I've gained about trust through my work as a student social worker.

In my first internship in my master's program in social work, I worked in a safe house and transitional housing unit. Not only had many of these women been abused by their former partners, but they had also been abused by family members and friends, people they thought they could trust.

And yet, here I was asking them to trust me, a total stranger. While I have suffered my own significant traumas, I couldn't ethically blurt this out to all the women in the safe house. While the statement might have shown them that I could relate to them, the statement might also make them warier of trusting me. They might feel as if I were too fragile to help them or that they needed to listen to me rather than my doing my job as their counselor.

Thus, I had to figure out different ways of earning their trust, and I did. I built rapport with the mothers and their children by spending a lot of time with them, eating dinner with them, attending their group sessions with them, talking about how their day was, and about their children. I also got to know each child by spending time with them - playing and talking with them, and just allowing them to be the carefree children they deserved to be.

It took two or three months before one mom, which the staff had a particularly hard time connecting with, began to trust me. We took things in baby steps. I got to know her - her likes and dislikes, what she did during the day, her ambitions, and so forth. Eventually, I let her know that if she ever needed to talk that I was available to help her. Opening the therapeutic door for her was an enormous step, one she wasn't ready to take before my internship ended. However, being able to really connect with this woman showed her that there are people out here to support her. I really think the trust she and I built together was monumental considering all that she had been through, and I was truly amazed at how much she accomplished in the short time we had spent together.

So, what is trust exactly? As I said earlier, trust is really difficult to define, but here is what I believe trust is. Trust is being able to count on someone, to know that you can confide in someone and that that someone won't defy your confidence. Trust is being able to share your innermost throughts, feelings, dreams, and ambitions with someone and that same someone should be able to share theirs with you. When you trust someone, you know that person will not judge you based merely on situational circumstances, but rather, they will look past situations and behaviors to seeing your core being.

I believe trust has to built over a period of time. If you have never been through significant trauma, trust might come more easily to you whereas those who have been abused or traumatized might need to take more time to get to know someone before they begin to place any trust in that person.

I believe trust is earned. And when it is broken, you have to re-earn the trust you lost.

If you're having trouble trusting or struggling with the fact that a friend or family member doesn't trust you, tune in later this week to learn how you can cope with these issues.

Monday, January 15, 2007


If you're recovering from any type of addictive behavior, whether it be an eating disorder, self-injury, alcoholism, drug abuse, or smoking, you know how hard it can be to get through even one day without using your coping mechanism. Some days you just feel there is no hope. You don't think you'll ever recover.

Sometimes we just need a little reminder that recovery is possible. Inspirational stories are a great way to remind ourselves of the possibility of recovery. This is a very inspirational story about a young man who suffered from alcoholism and recovered. He's currently five years sober! Go ahead and read for yourself - I think you'll find his experience truly inspiring.

Friday, January 12, 2007


Self-harm has been getting increased attention by the media over the past decade. I wanted to share my experiences as a self-harmer with others in order to help dispel the myths surrounding self-harm. I hope my personal essay sheds light on this topic. If you are a self-harmer, know you are not alone. Family and friends of individuals who hurt themselves may want to read the facts versus myths article I have written on the subject.

Wednesday, January 10, 2007

Coping with trauma anniversaries

As a trauma survivor I know how difficult trauma anniversaries can be. Other people may tell you to “get over it” or just not think about the trauma around the anniversary time, but we, as trauma survivors, know it’s not always that simple. Thus, I have created a list of suggestions that may help you care for yourself during a trauma anniversary as well as the time surrounding it.

Treat yourself to something you love: It is important during tough times that you remind yourself that you deserve good things and that you did not deserve the abuse, rape, or violence you experienced or witnessed. Sometimes it is hard to know what to do for yourself because when you are in this state of mind you feel as if you don’t deserve good things or to treat yourself well. So, here are some suggestions that may help you think of your own!
- Take a hot bath or shower.
- Put on your favorite scented lotion.
- Enjoy something you love to eat or drink. For instance, indulge in a Starbucks coffee, ice cream, chocolate, fruit, yogurt, or whatever you love.
- Wear comfortable clothes.
- Take a walk, run, bike ride, or whatever you enjoy doing.
- Cuddle with your cat or dog.
- Talk with a trusted friend.
- Plan dinner, shopping, a workout, or other activity with someone you enjoy spending time with.

Grounding techniques: Learning grounding techniques will help you if you are experience flashbacks or panic attacks. These techniques focus on the present, so they will bring you back to the present instead of the past.
- Clap your hands together or stomp your feet on the floor.
- Tell yourself you are safe and in the present.
- Touch the things around you and name them aloud or to yourself.
- Name the noises you hear around you or focus on any conversations taking place near you.

Make a safety plan: A safety plan will allow you to stay safe during an anniversary. You might want to notify trusted people of your trauma anniversary and request their support. It is perfectly okay to ask for the support you need. Think about what is helpful for you and tell trusted people so that they can better support you. You might ask trusted people to talk with you, go out to dinner, shop with you, watch a good movie with you, or just be available to listen to you.

If you have a tendency to self-injure, make a list of individuals, hotlines, and hospitals you can call in times of emergencies. Reaching out to someone, whether it is a friend, pastor or priest, family member, counselor, or a trauma related hotline is a healthy way to cope with your feelings.

Remind yourself that it will pass: It is hard to cope with feelings of helplessness, hopelessness, depression, fear, and anger. It’s also difficult to cope with symptoms you may experience from Post-Traumatic Stress Disorder such as nightmares, easily startled, flashbacks, and triggers of the trauma. However, reminding yourself that the feelings and symptoms will pass may help ease the anxiety you feel about them.

Set aside time to relax each day: Setting aside time to relax may ease your symptoms and anxiety. What do you enjoy doing that eases your mind? Here are some suggestions to help you get started.
- Read.
- Write in a journal or a letter to a friend.
- Listen to your favorite music.
- Talk with a friend or other loved one.
- Spend time with your cat or dog.

Pray or meditate: Finally, engaging in prayer or meditation may help you through an anniversary time. If you are religious, pray to your Higher Power for the strength and courage you need to get through this difficult time. Read the Bible to find peace and comfort. Go to church for support from the church community.

If you meditate, make sure you set aside some time everyday to do so. I hear meditation is relaxing to the body, mind, and spirit.

Getting through trauma anniversaries is difficult, but you don’t have to do it alone. The suggestions provided here will help you take care of yourself while struggling through the feelings and symptoms associated with traumatic memories anniversaries often bring to the surface.

Friday, January 5, 2007

How can I help?

Post-Traumatic Stress Disorder is not only hard for the trauma survivor, but oftentimes, for families and friends of the trauma survivor as well.

Here are some things you can do to support a trauma survivor suffering from Post-Traumatic Stress Disorder:

1. Educate yourself: Educating yourself about Post-Traumatic Stress Disorder, its symptoms, causes, and treatments will go a long way in helping you support a trauma survivor. The more you understand about the condition, they better able you are to be supportive of your loved one.

2. Encourage the trauma survivor to seek help: As I mentioned in the post below, there are no "magic pills" to cure PTSD. The only way a trauma survivor can move forward in healing from a traumatic event is by exploring it in detail in counseling. Understandbly, your loved one will be afraid to go through this process. Reliving a traumatic event is not only tough, igoing through the process can bring up feelings of fear, anger, depression, helplessness, and hopelessness.

3. Show active support: If the trauma survivor decides to enter therapy, support him or her. It might be helpful to think of things you can do to support the individual. For instance, you can offer to sit in the waiting room while the individual is in therapy or to be available for support after the appointment. Alternatively, offer to spend quality time with the trauma survivor so that he or she knows he/she is cared about. Letting the trauma survivor know that you are available to listen is also a good idea.

4. Don't push: While it is a good idea to encourage the trauma survivor to seek professional help, it is not a good idea to try to force him/her to do so. Likewise, offer your ear to the trauma survivor, but don't try to coerce or force the individual to talk about the trauma if he/she doesn't want to.

5. Get help yourself: If you are having a hard time handling the trauma or the feelings surrounding it, you should seek therapy, regardless of whether or not the traumatized individual is.

6. Grounding: Individuals with PTSD often experience flashbacks, where one feels like he/she is going through the trauma all over again. It is important that you know some grounding techniques that you can teach the trauma survivor, if he or she is open to learning them. Here are some grounding techniques one can use in the midst of a flashback or panic attack:
-Stamp your feet on the floor
-Clap your hands
-Touch the things around you and name them out loud or look at the things around you and name them out loud
-Pet a pet
-Talk to a trusted person

All of these techniques help focus the mind on the here and now, rather than on the past.

Tuesday, January 2, 2007

Mental Illness Profile

Post-Traumatic Stress Disorder

The criteria for Post-Traumatic Stress Disorder (PTSD) are as follows according to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders IV-TR:

A. The individual was exposed to a traumatic event where both the following were present:
-The individual experienced or witnessed, or was confronted with an event/s that involved actual or threatened death, serious injury, or threat to the physical integrity of the individual or another person.
-The individual's response included intense fear, horror, or helplessness.

B. The traumatic event is persistently reexperienced as evidenced in one or more of the following:
-Psychological distress when presented with internal or external cues that remind the individual about an aspect of the trauma
-Feeling as if one is reliving the traumatic event through hallucinations, illusions, and/or dissociative flashbacks
-Intense and disturbing recollections of the event such as perceptions, thoughts, and/or images

C. Persistently avoiding of stimuli that remind the individual of the trauma or numbing of general responsiveness, that was not present before the traumatic event as exhibited by three or more of the following:
-The individual makes efforts to avoid feelings, thoughts, and/or conversations associated with the traumatic event.
-the individual possesses an inability to recall certain important aspects of the traumatic event.
the individual avoids activities, places, or other people that remind him or her of the traumatic event
-diminished interest or participation in significant activities
-the individual has a feeling of a foreshortened future.
exhibits a restricted range of affect
the individual feels estranged or detached from others.

D. Exhibits increased arousal by two or more of the following:
-Sleeping difficulties
-Exagerated startle response
-Outbursts of anger or irritability
-Concentration difficulties

Symptoms in categories C and D last for more than one month.

What does all of this mean?

Let me give you an example of what a person with post-traumatic stress disorder may look like.

C was raped by an acquaintance three months ago. Ever since, she has not been sleeping well. She cannot seem to get to sleep at night; however, when she does sleep, she has awful nightmares of the rape. She also experiences flashbacks where she feels as if the rape is happening all over again. These are especially triggered by certain things that remind her of the trauma. For instance, a vanilla candle was burning in the living room when she was raped, it was dark in the room, and the phone kept ringing. Thus, when she hears a phone ring, she will immediately go into a dissociative flashback, where she feels the rape happening all over again. Because C was raped in her living room, she tries to avoid spending as much time in there as she can. She also threw the vanilla candle away, but told her mother the glass container had shattered on the floor while she was dusting the coffee table. C has not told her parents what happened that night and while she tries to pretend that nothing is wrong, her parents have noticed changes in their daughter's personality. C was a relatively calm teenager before the trauma. She made straight A's in school. However, since the rape, she has been irritable and has become angry at her parents, seemingly yelling at them for no reason at all. Her grades have also dropped because C has experienced an inability in concentrating on her schoolwork.
C has also become very jumpy. She looks over her shoulder a lot and starts at every little noise. When she hears a car backfire or any other loud noise, she goes into a panic attack.

C's case shows us what one individual with PTSD might experience on a daily basis. However, individuals with PTSD rarely, if ever, experience the same symptoms in the same ways.

While there is currently no medication to treat PTSD in its entirety, anti-anxiety medications such as Xanax, Ativan, or Buspar might help take the edge off the symptoms. The only "cure" for PTSD is for the individual to work through the trauma in therapy.

Tomorrow, I'll discuss how loved ones might help a family member or friend with PTSD.