Understanding Diabulimia

By Michel Harris, MS, RD, LDN, CDE
Imagine a mother watching her five-year-old daughter (we'll call her Lisa) wasting away, despite eating larger than usual amounts of food, and experiencing frequent urination. Unfortunately, those were symptoms of undiagnosed Type I diabetes. While this was not desirable, after receiving education, Lisa was able to return to a healthy state because of daily, multiple insulin injections, a well-balanced meal plan, and participation in sports activities.

Ten years later, Mom noticed that once again, Lisa was consuming larger than usual amounts of food, but she assumed it was just a growth spurt. However, when Mom was changing the sheets on Lisa's bed one morning, she found several vials of unused insulin under the mattress. At this point in time, Lisa had been fully responsible for administering her daily insulin injections and monitoring blood glucose levels. When Mom approached Lisa, she got very defensive but then broke down in tears and admitted that she was only taking one-fourth her usual amount of insulin, and sometimes skipping it altogether.

People with diabetes experience burnout in performing daily self-care to manage their condition. But after much discussion, Lisa admitted that she was not taking her insulin to help control her weight. As a teenager, not only was Lisa having to deal with a chronic condition that required a significant amount of attention each day, but she was also faced with the discomfort of normal weight increases during puberty and the pressure to be thin.

You may have heard of bulimia, a condition in which one eats large quantities of food, then purges the calories via self-induced vomiting, laxative use, excessive exercise, and/or diuretics. Lisa is suffering from a form of bulimia called Diabulimia, and her chosen method of purging is controlling her insulin doses. Without going into too much detail, insulin is a hormone produced by the pancreas that is vital in shuttling glucose (sugar) from the blood into body cells after nutrients are digested and absorbed into the bloodstream. Those with Type I diabetes must inject insulin at meals, snacks, and on occasions when their blood glucose levels may be too high. Failure to do so results in weight loss because the cells cannot use glucose for energy and other vital body functions; that excess of glucose is eliminated in the urine and also builds up to potentially life-threatening levels in the blood.

Diabulimia is a serious condition that requires a treatment team including a psychotherapist, psychiatrist, registered dietitian, medical doctor, and endocrinologist. Symptoms to be aware of are

• Frequent urination
• Weight loss despite eating large quantities of food
• Abnormally high blood glucose levels
• Excessive thirst
• Weakness
• Fatigue
• Inability to concentrate
• Hiding insulin/purposely not taking insulin

In severe cases, the person may develop diabetic ketoacidosis, a potentially fatal condition in which blood glucose levels become dangerously high. People with Type I diabetes are already at risk for several long-term complications that include neuropathy (numbness and tingling of the extremities), cardiovascular disease, retinopathy, kidney disease, and gastroparesis. Since Diabulimia elevates blood glucose levels, this further increases the risk of developing these complications if treatment is not immediately sought.

While most therapists who specialize in eating disorder treatment are equipped to deal with the behaviors associated with Diabulimia, a registered dietitian with eating disorder experience, and who is also a Certified Diabetes Educator (CDE), should be sought after as part of the treatment team.

Michel Harris is the nutritionist at The Awakening Center and believes in the mindful approach to develop a peaceful relationship with food and exercise in the recovery process of eating disorders.

Meditation Monday: Opening the Heart

 By Nancy Hall, MA, NCC, LPC

In an effort to take the “manic” out of “Monday,” this weekly post explores techniques, issues, latest research, and other thoughts on meditation. Nancy facilitates a weekly meditation group at The Awakening Center. For more information, contact her at 773.929.6262, extension 17 or nancyhalltac@gmail.com

Meditation often brings relaxation to the body. Jaws and fists unclench; brows become smooth. And something new experiences can happen when the shoulders loosen--the heart opens up.

We often carry our burdens in our shoulders. Without even realizing it, they creep closer and closer to the ears. This tension-related shrugging also pulls the shoulders forward, drawing the area around the heart back. The shoulders bear our burdens and protect the heart.

At the weekly meditation group at The Awakening Center, before embarking on any guided imagery, I take participants through a progressive relaxation of the body. This is so important because if the body is held in a state of “readiness” and hypervigilance, the meditation experience becomes very narrow. We cannot allow our awareness to expand if we’re in a defended posture. Additionally, important information can be gathered by noticing which body parts don’t soften so easily. What is being communicated? What needs extra kind attention?

When we get to the shoulders, I usually instruct participants to allow them to gently drop down and back. Allowing the shoulders to loosen down releases the burden. Slightly back opens the heart area. While this opening of the heart might be challenging and sometimes downright unsafe in the “real” world, I hope that the group is a safe place to experiment with the experience.

Folks who have experienced hurt and trauma heal through building a sense of safety. Within the group, they can practice opening the heart—even just a little bit—without worrying that it will be stomped. They learn to trust their instincts and can begin opening the heart to loved ones—and even to themselves.

Enjoy your practice.

Meditation Monday: Listening

By Nancy Hall, MA, NCC, LPC

In an effort to take the “manic” out of “Monday,” this weekly post explores techniques, issues, latest research, and other thoughts on meditation. Nancy facilitates a weekly meditation group at The Awakening Center. For more information, contact her at 773.929.6262, extension 17 or nancyhalltac@gmail.com.

The human brain is a wonder. With it, we can do algebra, learn to drive, and figure out how to make cauliflower palatable. But so much of our energy is taken up by the thinking part of the brain. Rumination. Worry. Obsession. Thinking becomes a dream-like state. A trance.

This trance can become a barrier that isolates. Our ability to take in data becomes impeded. Our bodies from the neck down seem separate from our minds.

Meditation can help us awaken from that trance. By breathing and intentionally connecting to the sensations in the body, we begin to gather new information. Your thinking part may tell you that going on that second date is a good idea, but in the meantime, your stomach is in knots.

Psychologist and meditation leader Tara Brach teaches that the first step in opening up the experience is to listen. Listen not only with the ears but with the whole body. Allow yourself to receive the information that is churning through your body from the inside out. 

• Listen to sensations: Is there twisting, tightening, loosening, fluttering, and so forth?
• Listen to emotions: Happy, sad, afraid, angry? How are these emotions expressed in the body?
• Listen to the sounds actually present: What sounds are in the room? Outside the room? Notice the space between sounds. Receive sounds that are actually present instead of listening to the chatter in your head. 

We have so much information available to us if we just listen fully. This is not easy, I know. Thinking and ruminating can be a defense mechanism for some. Trauma or intense emotions can make listening to the body feel unsafe. It’s OK to go at your own pace—start small by checking in with one neutral part of your body. Feel your feet against the floor. Listen to the sounds outside for 60 seconds.

Take these steps with gratitude.

Enjoy your practice.

Meditation Monday: Grappling with Forgiveness

By Nancy Hall, MA, NCC, LPC

In an effort to take the “manic” out of “Monday,” this weekly post explores techniques, issues, latest research, and other thoughts on meditation. Nancy facilitates a weekly meditation group at The Awakening Center. For more information, contact her at 773.929.6262, extension 17 or nancyhalltac@gmail.com

Psychologist and meditation teacher Tara Brach, PhD, writes extensively about forgiveness, a topic I’ve had a hard time really understanding. It’s not that I don’t believe in it or accept its value, I just resist the notion that forgiveness is easy to experience. But Tara’s writings and guided meditations help provide an entry point.

Tara starts with bringing a mindful attention to the heart area. She asks us to become aware of the state of the heart right now—the felt sense and direct experience of sensations at the heart. What is present in that moment? Openness? Tightness? Numbness? The idea is to become aware of the sensations around the heart without judgment.

We can then begin to explore how the heart is connected to our own sense of being and how we feel connected with others. Do we have a sense of belonging?

You can bring to mind a few key people from your life and sense the degree of connectedness or separation that you are aware of. Tara posits that the gateway to unconditional love is to begin to investigate where we’ve created separation in our lives. What allows us to include or exclude others from our hearts?

A path to allowing the heart to open is through forgiveness. A forgiving heart can let go of the armor that sustains separation.

Forgiveness is not saying “what you did was OK.” You might decide to never see someone yet not exclude him or her from your heart. Forgiving is the movement of your own heart from past to present.

After becoming present with the state of the heart, you can then reflect on where you feel unforgiven by others. Whether intentional or unintentional, we have all acted or spoken in ways that left others feeling unseen. In reflecting on these situations, we can give the wound our attention. We can allow the other person’s hurt to register. And then we can ask for forgiveness.

“I see the pain I’ve caused you now and I ask that you forgive me.”

Tune in to whether you will allow yourself to feel forgiven. Is it possible to receive forgiveness? Where are you having a hard time forgiving or accepting yourself for something? See if you can sense underneath whatever feels unforgivable to see what was driving you. Fear? Confusion? Hurt?

See behind the action with perspective. See vulnerability or suffering that might have led you to cause suffering. When you sense that, begin to offer yourself forgiveness in the same way.

“I see and feel the pain I’ve caused myself and I forgive myself.”

Many find that when they stop punishing and blaming themselves, they begin to see the causes and conditions that cause suffering.

Widen the circles of forgiveness to include someone you feel has hurt you. Every one of us has felt betrayed, violated, rejected. Sense where this is true for you and where your heart is feeling armored.

Forgiveness can be a lifelong process, and yet in any moment that we enter with sincere intention, the armor begins to crumble. Depending on the violation or your feelings about it, you might want to work with your therapist so that you feel safe and grounded. But you can allow yourself to see the person and the offense; you can see your wound and lean into that pain with kindness and tenderness.

Sense the compassion that is holding your own heart and then widen your perspective so you can look with clear eyes at the person who hurt you. See if you can look past the mask to see the hurt or fear that might be driving him or her. Your deepest wisdom knows that when we’re not suffering, we don’t cause suffering. Sense the possibility of extending forgiveness.

“I see and feel the pain you’ve caused me and I forgive you now.”

If you’re not quite ready, you might say something like “it’s my intention to forgive you.”

Tara Brach helps explore forgiveness without minimizing or suppressing the wound. We actually have to open our hearts to the pain to create space for forgiveness. And I find comfort in that paradox.

Meditation Monday: Replacing Illusions with Values

By Nancy Hall, MA, NCC, LPC

In an effort to take the “manic” out of “Monday,” this weekly post explores techniques, issues, latest research, and other thoughts on meditation. Nancy facilitates a weekly meditation group at The Awakening Center. For more information, contact her at 773.929.6262, extension 17 or nancyhalltac@gmail.com

When we examine our coping behaviors, how many are truly reliable? Or even actually helpful for that matter? We often take refuge in behaviors or habits that we believe give us control or comfort. But when we can step back and connect to our own clarity, we realize that we’re believing in an illusion.

Instead of giving true comfort or control, many behaviors leave behind shame and regret; self-compassion becomes difficult. The need for comfort and soothing remains present and we turn to our old habits. Then more shame, and the cycle continues

But the short-term rewards of unhealthy coping behaviors seem so great; the desire to numb, distract, disconnect, soothe. The needs at the core of these urges are never quite satisfied. Instead, cravings remain, triggering behaviors, triggering more cravings, and so on.

The urges and cravings take up space in thoughts and feelings. As you begin to connect to your deep wise self, what can you place at the center of your life? What gives you true comfort, soothing, peace?

Take a moment and connect to a behavior or belief that has caused you suffering yet it still takes up a prominent position within you. Perhaps it’s not at the center, but it might be a behavior or belief that seems hard to live without

How have you relied on this behavior? Whether it’s an addiction or compulsion, have you clung to it? What are the consequences?

Check in with your body to notice if any tension or stress has crept back in. Re-engage with your breathing—let it anchor you.

Now, take a moment to ask yourself, what matters to you? What inspires you?

Where are you able to experience stillness…compassion…curiosity…peace?

As you experience the calmness of this moment, ask yourself, what can you truly put your trust in? God as you understand? Nature? Goodness of people? Yourself? A combination?

Whatever that looks like to you, allow yourself to connect to that trust. Where can you turn when you suffer? Where do you go to find your values?

Again, there is no right answer. And the image might not be clear—just let the possibility exist. If you are not sure where you can turn to find values or trust, see what it feels like to turn somewhere…even if you don’t have a clear idea of where that is.

This We Have Now

This we have now
is not imagination

This is not
grief or joy

Not a judging state,
or an elation
or sadness

Those come and go.
This is the presence that doesn’t.
--Rumi

What Does It Mean to Be Recovered?

By Michel Harris, MS, RD, LDN, CDE

With most illnesses, a person is recovered once their symptoms have resolved. However, with eating disorders, it's not this simple.

For safety reasons, many of the medical symptoms associated with eating disorders must be resolved prior to discharge from an in-patient program. However, even though discharge criteria has been achieved, there is still a lot of work to do. All types of eating disorders are composed of an accumulation of misguided beliefs and behaviors associated with food. In most cases, one has suffered with his or her disorder for years, so it stands to reason that a few months of intense therapy before transitioning to out-patient treatment is not enough time to change all of these beliefs and behaviors.

There are several opinions and science-based definitions as to what it means to be "recovered" from an eating disorder. The results of research studies can rarely be applied to a whole population, and this concept applies to our definitions of recovery; they do not apply to every single person with an eating disorder.

So the question still remains: what does it mean to be recovered? Overt signs include:

Being able to accomplish daily tasks and be productive without obsessive thoughts about food
Going to a restaurant and ordering what he or she really wants, not the item that is the healthiest or safest. Exercising without the main goal being weight loss

I can go on and on, but you get the picture. Each person's recovered state is individualized, and a major portion of out-patient therapy is spent exploring and identifying what that means. Some behaviors that are considered disordered for one client may not be so for another. A good example is food choices. A few years ago, I worked with a client who questioned whether she was recovered because she still did not eat desserts. Further probing revealed that prior to her disorder, she did not have a sweet tooth, but she did enjoy savory snacks. Since she was able to enjoy the savory snacks (among other factors), we concluded that yes, she was recovered. However, the client who enjoyed cheesecake before the onset of the eating disorder and still experiences anxiety when trying to eat a small slice is still in the process of recovery.

You might feel frustrated because I have not provided conclusive and specific criteria for what the "recovered" mean; but each client has his or her own unique recovered state that must be patiently pursued with the help of the treatment team.

One last thought. The surfacing of an eating disorder thought or behavior that had been dormant for years does not indicate a relapse. Remember, years of disordered eating–related thoughts and behaviors can be reversed but are likely to surface on occasion. The recovered person is able to acknowledge when this happens and apply coping mechanisms to resolve the issue.

The important point here is that although it might emerge differently for everyone, full recovery is possible. So go for it!

Michel Harris is the nutritionist at The Awakening Center and believes in the mindful approach to develop a peaceful relationship with food and exercise in the recovery process of eating disorders.

Meditation Monday: Embracing Impermanence

By Nancy Hall, MA, NCC, LPC

In an effort to take the “manic” out of “Monday,” this weekly post explores techniques, issues, latest research, and other thoughts on meditation. Nancy facilitates a weekly meditation group at The Awakening Center. For more information, contact her at 773.929.6262, extension 17 or nancyhalltac@gmail.com

Sometimes we feel stuck—convinced our suffering will never end. The fact is, our experience is always changing. And even our worst suffering will not—cannot—stay the same. But there are times when we cling to experiences or feelings—we fight impermanence, not wanting to let go. This also leads to suffering as we simply cannot hold onto things that are always changing.

            Change or impermanence does not necessarily mean things are progressing on a straight line. The reality of change is that it tends to be circular, or there is an ebbing and flowing. Sometimes we believe we are stuck in an unwanted emotion or behavior pattern, but if we examine closely, we’ll see there are slight differences—in the behavior, our emotions, our judgments.

            Accepting impermanence allows us to treasure the present moment. Clinging to an experience we simply don’t want to end or despairing that we may emotionally suffer forever takes us out of our bodies and into the trance of thinking. We churn and ruminate. But the world continues to change and evolve whether we notice it or not.

            I created the following imagery to explore the notion of impermanence a bit further.

• Take a moment and imagine that you are in an orchard of trees—and it is spring time. All the trees are in bloom.    
• Move in to one particular tree—notice its blooms
• Notice any emotions or feelings that arise as you look at this flower
• What does it feel like to enjoy this flower even though you know it will drop and die soon?
• Now imagine time has passed and the flower has withered and fallen to the ground
• What emotions arise in you?
• Does your sense of loss come from worry that you’ll never see another flower as beautiful as this one was? Do you know this to be true?
• While feeling the loss, invite yourself to connect to gratitude for having the experience of observing the flower. Connect to the hope that spring flowers will come again.

       Accepting impermanence can be the route to hope. We can accept our pain and acknowledge that it won’t last forever—hope can stabilize us as we cope with the reality of our pain. But judgment and self-criticism stifles hope. So it’s important to have a mindfulness practice so that you can catch yourself going down that rabbit hole.

            Whether you accept it or not, change is a part of the human existence. Embracing impermanence can help you be fully present in your life.

Nancy Hall, MA, NCC, LPC is a staff therapist and the intake coordinator at The Awakening Center. In addition to seeing clients for individual therapy, she leads the weekly meditation group and co-leads the Somatic-Experience-Informed Trauma Healing Group. Check and subscribe out her blog “All Shapes and Sizes,” which appears on Chicago Tribune’s media partner ChicagoNow.com.