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By Dr. Cris Haltom
(Part 2, Part 3)
At first, Megan was motivated to come to treatment. She was 18 years old, home from college for the summer, and eager to get on top of the bulimia that plagued her through her freshman year. Many unmotivated young people are mandated by family members to come to treatment after the discovery of their secretive eating disorder. However, Megan was motivated. She and her parents thought, with good reason, Megan would move along quickly in treatment because Megan KNEW she struggled with an eating disorder, and she wanted to get better.
What Megan and her parents hadn't anticipated was the deep and extensive work Megan would have to do to recover. For example, Megan had not eaten cake, pie, french fries, hamburgers, pizza or several other previously loved foods without vomiting afterwards in over one year. When the therapist and nutritionist suggested Megan attempt gradual re-introduction of some of these "fear" foods without purging after eating them, the specter of recovery seemed impossible to Megan.
Megan had difficulty keeping a food journal and made excuses for not completing it when she met with the nutritionist. When Megan did try to eat "forbidden" food she felt anxious and guilty. She was compelled to restrict her food intake at the next few meals to compensate for eating "forbidden" foods. She had difficulty identifying social and emotional triggers that could predict a binge and purge.
Worse yet, with increased attention on her food, exercise and dieting, Megan was having a harder time suppressing and repressing awareness of her symptoms. Throughout treatment she became more acutely aware of the negative consequences of her disordered eating behavior. Like many young people in early stages of treatment, her symptoms worsened as a reaction to increased vulnerability and exposure of her inner issues while in treatment.
Megan and her parents despaired. They were frustrated, angry that treatment seemed to not be working, and saddened that their expectations of a quick recovery were not met.
Cris Haltom has a Ph.D. from Cornell University. She is a licensed psychologist in private practice in Ithaca, N. Y. Cris is an Approved Supervisor (#110) for the International Association of Eating Disorder Professionals. She is available for training, presentations, and workshops. She has published articles, co-edited a text book, appeared on cable television, taught workshops, and taught academic courses as adjunct faculty at Cornell University and other colleges.
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