Posts tagged #familytherapy

Understanding Eating Disorders

As warm weather rolls in, so do the commercials for diet plans, liposuction, fat freezing, gym memberships, fat shedding supplements, and on and on. An overwhelming number of advertisements identify aspects of our appearance as flaws and encourage expensive steps to improve those flaws in order to achieve happiness. This message of striving (and starving) for an unrealistic physical appearance is sometimes as blatant as “stop letting that stubborn fat keep you from being happy”. Other times it is the more subtle advertisements and entertainment with portrayals of the happy human with an unrealistic body. The body, they don’t tell the audience, has been enhanced and altered through airbrushing, lighting, and make up (both body and facial).

All of this exposure and how often does the message “these are altered and unrealistic body images” come up in daily life? Look around and we find it is no where near the hundreds of thousands of negative images which are seen over the course of a day or week. Some of these are so subliminal we don’t even realize we are seeing them, they are just running in the background like barely noticeable music played in a mall.

So why is this concerning? These images can contribute to dangerous eating disorders. The Diagnostic and Statistical Manual, the guide to identifying mental health related disorders, even states that the culture of valuing body image is one of the factors which contributes to the development of eating disorders. Such disorders can lead to malnutrition, dehydration, irreversible bone mineral loss, organ damage and other ill effects on health. Mental health related concerns are the continued diminish of self-esteem, neglect of prosocial areas of life due to progressive obsession over food and weight, ongoing negative self-image, increased depression and anxiety, isolation due to fear of being overweight, lack of enjoyment in life, and a number of other mental health related issues. The most common age group in which eating disorders occur is teenage years through the 20’s. This is a critical time related to the development of a healthy body and the development of the brain. Lack of necessary nutrition can negatively impact this process.

One positive aspect is that parental involvement still vey much exists within the age group most afflicted. This offers the opportunity for support in prevention and recovery. Empowering parents with education regarding the signs, and ways to reduce the risk of eating disorders, hopefully, will reduce the rate of these disorders and make for healthier adults.

The following educational piece starts with understanding that each disorder has their own unique distinguishing behaviors. The two main weight related disorders are Anorexia and Bulimia.

Anorexia is the most commonly acknowledged eating disorder. This may be do the shock of the rapid weight loss and sickly appearance of Anorexia. Anorexia has multiple root causes. The most common roots can be an attempt to establish a sense of control, a response to distressing events, or exposure to body shaming or unrealistic expectations of how an attractive body is defined. At first, Anorexia can appear as healthier eating or superficial focus on appearance, which may come with the increased self-awareness accompanying puberty and teenage years. The distinction can be made when:

  • There is rapid and extreme weight loss

  • Inability to see weight loss

  • Obsessive focus on weight (e.g., complaining about body image, pinching of areas to measure how much fat they can grab, constant criticism of body shape)

  • Extreme reduction of food intake

  • Obsessive calorie counting

  • Overuse of laxatives, diuretics, or exercise (differs from Bulimia in there is no binging and are used despite low calorie intake)

  • Detailed food diary

  • Use of diet pills or engagement in fad diets when at a low weight

  • Somatic issues such as stomach pains, constipation, dizziness, headaches, fatigue on a regular basis

  • Lack of engagement of activities, such as swimming, where body shape is more easily observed by others

  • Justification of weight loss due to extracurricular activities (dance, wrestling, gymnastics)

  • Stunted puberty (girls show delayed menstruation or discontinuation of menstruation)

  • Hanging posters (or following on social media) of idealized body types rather than their talent or attraction to the person

  • Struggle to or hiding eating due to shame

  • Consistent use of the bathroom following a meal (indicative of self-induced vomiting)

  • Daily weighing, sometimes multiple times in a day

  • Extreme intolerance to cold

Bulimia is known, but less common. Bulimia is more about not gaining weight than losing weight. It also comes with a fear of being overweight. The distinguishing factor of Bulimia vs Anorexia is that there are bouts of uncontrolled eating of an extreme quantity of food in a short period of time followed by some type of purging to avoid weight gain. This usually does not come with an extreme loss of weight or noticeable change in weight. The lack of change in body shape makes it less noticeable that Bulimia is present. The signs to look for:

  • Times of extreme eating within approximately 2 hours or less, sometimes consuming food they normally would not eat or to the point of being ill

  • Consistent use of the bathroom following a large meal (indicative of vomiting)

  • Excessive use of laxatives, diuretics, diet pills or stimulants

  • Diary of food consumed vs what is purged (extreme versions include weighing what was purged such as vomit, urine and feces excreted)

  • Development of “chipmunk cheeks”, which is due to the swelling of salivary glands

  • Referred to as Exercise Bulimia, obsessive exercise as a form of purging noted by longer than reasonable engagement in one exercise session (e.g., running up and down stairs for hours rather than sets or the use of exercise equipment beyond the standard hour session)

  • Erosion of the esophagus

  • Tooth erosion

  • Constant irritation of the lips

  • Severe acid reflux

Additional tips:

  • In some cases, the use of vomiting can lead to uncontrolled reflexive vomiting upon eating without the intention of purging.

  • There is a trend among those who support the engagement in Eating Disorders to don red beaded bracelets in order to identify themselves to others with eating disorders.

  • Another clear sign is involvement in ProAna or ProMia websites. ProAna are sites dedicated to providing tips and support on how to maintain anorexia. ProMia are sites encouraging Bulimia. Both of these sites maintain the position that eating disorders are a lifestyle choice rather than a disorder. ProAna sites label those with an eating disorder as a “Rexie” or an “Anorexie”. A “Rexie” is someone who defines their Anorexia as achieving success in developing a high level of self-control, power over self, and strength. An “Anorexie” is someone who uses Anorexia for sympathy rather than manifesting the strengths of a “Rexie”.

If you have concerns, exploring your child’s search history may be eye opening regarding these sites and other weight loss sites they have been exploring.

Just like addiction, Eating Disorders can be a lifelong recovery process with the risk of some relapses in the process. Just like addiction, Eating Disorders come with a high level of denial, manipulative behaviors to maintain the disorder, and justification of their behaviors.

There are inpatient and outpatient clinics specific to the treatment of eating disorders. There are support groups, unlike ProAna and ProMia groups, focused on recovery. Eating Disorders can be difficult to watch in the people we care about. It can bring about anger and fears in the loved ones of those struggling with this condition. There is significant information to help understand Anorexia and Bulimia.

This article was broken up into two separate articles; Understanding Eating Disorders and Prevention of Eating Disorders. Click here to read about Prevention

Some quick tips to remember when dealing with the dynamics of an eating disorder:

  • Don’t engage in a power and control struggle as it may increase the severity

  • Remember, the desire for control is one facet feeding their behaviors. Don’t increase their resistance by constantly insisting that they eat.

  • Discussing food with someone who is food obsessed is not the best approach

  • Don’t express anger at them or withdraw; they already carry enough shame

  • Do try to express understanding of how they are feeling, identify the pressure our society unfairly places on them, and work together to find ways to improve their health and begin recovery.

Divorce and Children

The wedding was beautiful. Growing old together sounded like an amazing adventure. Having children was beyond what you could have been imagined and the dreams of growing the family together .... even better. One SNAG. One Mount Everest sized snag. There is a divorce coming. All of this is about to change. Amongst the financial and relationship logistics, there is the potential impact of what all the decisions to come may have on your children. No matter who initiated the decision for divorce, it is a wildly difficult concept with layers of grief to process for both parents. And each child has their own emotional experience and reaction to the news that their life is about to change in a big way. As parents, all that we can do is take steps to minimize the stress surrounding the process of divorce as best as we’re able.

Telling Your Child(ren)

The very first step is to tell your child. Tell... Your... Child... three short words which may carry huge emotional weight and bring up fears and the worst images our brain can conjure up. Sometimes our brain is the movie reel of our own personal horror film.  It is naive to think telling a child their parents are divorcing won’t come with some heartbreaking reactions, whether it be in the immediate moment or after they have had time to process what it means. There may also be reactions after they try to work out all the questions they have about how it will work when their parents no longer live in the same home. However, it is unlikely that the response will be as challenging as the horror film playing in your mind. While telling your child when you have a solid plan is beneficial, it is also okay to tell your child if you don’t know everything just yet.

Once the plan for parenting time and the many other aspects of the separation have been developed, present it to your child(ren) together. Be united in how the plan will occur and present it as a mutual decision. This may help your child not feel like they have to pick sides or that it is someone’s fault. Regardless of the reasons for the divorce, it is an adult decision in which your child should not be included. Divorce planning conversations may include many abstract concepts that children may not be equipped to understand. Their job is to be a child, let them be a child. As the adult, be clear that your child is not responsible for the adults’ feelings. Be clear that it is the parents’ job to help your child manage their emotions and support them in the road ahead. It’s okay for you to be emotional when you tell them. Permit them to cry, be angry, and ask questions. When necessary, it is okay to answer questions with: “Those things are for adults to take care of (discuss, decide, etc) and not something for for us to involve you. We are doing our best to make decisions to keep you safe and take care of you.”


Base your plan on your child’s personal needs. Some important aspects include:

  • Who is moving, when are they moving, and where are they moving?

  • What is the temporary parenting plan?

  • How will they stay connected with one parent while they are with the other? (phone calls, dinners, FaceTime, Skype)

  • What school will they be attending?

  • Where will they keep their belongings?

  • Will there be any changes as far as caregivers (babysitters, daycare,etc)?

  • If your child is moving, will they and how will they see their friends?

  • How will they see family other than their parents?

Your child’s schooling or ability to see friends may seem like things that don’t need to be addressed if they are not changing. However, your child’s daily life is about to change in a big way. They may wonder if EVERYTHING is going to change now. Reassurance of the aspects of their life that will NOT change is helpful. Outlining what will be happening in the near future helps them know what to expect and to trust that the adults will handle how to move forward. Consistency will be the key to reinforcing this trust.

Sticking to the Plan

Make the plan black and white, and stick to the plan without exception. Many co-parents want to be flexible, make exceptions, and assume they will be able to do so with each other without an issue. The reality is, divorce can be an emotionally charged situation, especially when it comes to kids, and things which the two parents were agreeable to prior may become a bone of contention later. Being specific and consistent can take the fight out of little things. This means keeping to a specific parenting time schedule including specific dates and times for exchanging the children, being clear regarding who pays for what costs, etc.  Avoid the fight over little things. The more you can outline in this plan, the less that needs to be discussed in the future. Take the fight out of the future. Create a transition for the kids that is clear and without conflict.


Transition is a difficult event. If your child is moving between two different family dynamics with different sets of rules, they have to re-adjust each time they change places. There are a few things that can help provide some relief during this time. Keep the transition a routine. Include in this routine a run down of the rules of the household. It’s not easy for children to always remember the rules of one house; now they have to shift between two sets of rules, remembering which rules apply to which home. Incorporate a transition item. A transition item is an item of comfort that your child can take back and forth between households. It is usually a blanket, stuffed animal, toy, book, special pajamas or any item that your child can use to self-soothe and maintain a connection to while they’re gone.

The issue regarding your child taking items between homes can be a touchy one for many people. Whether one parent purchased the item or really likes a certain outfit or toy, in the end, your child was given these items and they belong to them. Would you give a friend a gift and tell them they can only use it when they come over or on certain days? Of course not. Yet, many times children of divorce are told they can not bring their belongings to their other home or are pushed to bring certain items back. Moving between homes is hard enough. The additional pressure regarding which home is where the items belong, the feeling of not having ownership of their things, and having to remember what they need to bring back may increase their emotional chaos. Their belongings are their belongings. Period.

 Parenting Time

When considering parenting time, keep in mind that frequency is just as important as length of time. One potential way to maintain frequency is to schedule a mini visit for one parent while the kids are with the other parent. This could look like each parent having a dinner with the kids one night during the time the children are scheduled to be with the other parent. Encourage your children to have phone calls between households.

 Communication between Parents

Keep adult conversations adult conversations. Your child does not need to know the details of the divorce, the faults of the other parent, or current frustrations with the other parent. Venting about the other parent or seeking advice from others to manage difficult interactions should remain amongst adults as well. Hearing negative perceptions or dislike of a parent can inadvertently put your child in a position in which they feel they need to choose and align with one parent. Also, save arguments until another time. (Easier said than done.) When a relationship has reached the point of divorce, it is reasonable to believe there has been a lot of fighting already. Commonly, by the time divorce is an option it is in part due to being tired of fighting, so why fight more? Modeling conflict resolution for your child is important for their future relationships. There is research to support that children have physical distress reactions when exposed to fighting amongst those in their immediate environment. They don’t just hear it and walk away unaffected. It is easy to think a child is so engrossed in their electronics or play date that they aren’t listening. Children are often more perceptive and tuned in to what is happening than we give them credit. Let’s do our best to reduce parent alienation and parent conflict for the sake of our child.

Arguing makes it hard to communicate. This includes communicating about the children. A back and forth book facilitates clear communication and keeps each parent up to date while minimizing the need to navigate a conversation in an emotionally charged situation. A back and forth book is a book in which each parent journals any issues that arose during their parenting time. Pertinent issues may include emotional struggles, medical issues, extracurricular activities, consequences for acting out, and anything else that impacts your child in a way that both parents need to be aware. This helps maintain consistency and also prevents your child from taking advantage of the situation. A back and forth book is significantly important when it comes to medical conditions to document medical concerns, medication given and last dosage given.

Doing Our Best

In the end, whatever your struggles are with your spouse, it is important to remember the impact on your child.  And then do your best at the time.  Remember the first paragraph above? We do the best that we’re able.  It’s possible that you’ll make mistakes just as if you were parenting within a stable marriage. There is no play book to follow. The “best” answer is not always available in each separation or divorce.  For instance, it has been found that children do exceptionally well with divorce when they stay in the same home and the parents transition between homes. This is financially and emotionally difficult for many parents which, more often than not, rules this out as an option. So, we do our best. As long as your children are the primary focus in this situation, they will do as well as possible.

Hopefully, these suggestions provided some guidance for a difficult time.....

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The More “Subtle” Domestic Violence

 The More “Subtle” Domestic Violence

October is Domestic Violence Awareness month. We want to help bring awareness to this topic due to a chronic underestimation of the number of relationships impacted by Domestic Violence and to increase understanding of how to identify Domestic Violence.

This underestimation and need for education of the public is due to a number of dynamics related to this issue, including:

Secrets, Control and The “Subtle” Signs

Due to the heavily secretive nature of the relationship, others may not be aware of the violence. This secret is often maintained by fear of retaliation, shame associated with the victimization, a belief the victim is unable to survive without abuser, or fear the victim will not be believed.

When people are charged with Domestic Violence or a victim discloses, how many times do you hear:

“I couldn’t believe he/she would do such a thing”


“He/she is so kind and laid back, that's impossible”?

Looking beyond the surface, how likely is it one would get involved in a victimizing relationship if they knew the person was violent or they would live with domestic violence? How could the perpetrator avoid interference by those outside the family if they were to outwardly present as someone who was angry, controlling or abusive? Partners who have a pattern of controlling behaviors have a belief system rooted in entitlement, selfishness, superiority, possessiveness, and confusion of love with abuse (i.e. “I am jealous because I love you so much”, “I can’t stand the thought of losing you”). Outside intervention would be unacceptable and would challenge the legitimacy of their belief system. There is a lot about the perpetrator and their self-serving behavior which requires an investment in preventing any knowledge or suspicion they are perpetrating abuse. 

For many victims, abusive behaviors have been normalized for them in the relationship through a slow build up of controlling behaviors. The build up is introduced in such a manner it often goes unnoticed until it is extreme. Initially, there may be abuse followed by a “honeymoon” phase where the abusive partner is apologetic, kind, promises to change, and extremely loving. Overtime, this phase slowly disappears.

The main focus of this article is to SPEAK LOUDLY about the more “subtle” behaviors that may go unnoticed and not recognized as domestic abuse.


Not all abuse is physical, and the presence of Domestic Violence is not only determined by physical abuse. It includes all forms of control and forms of abuse. The Colorado Department of Human Services offers a wonderful training book to their Caseworkers which outlines a variety of forms of abuse which constitute Domestic Violence which are often overlooked.

Below is a shortened list of their comprehensive descriptions (for a checklist identifying the presence of Domestic Violence, see our resource page):

Psychological: unwarranted and persistent jealousy, instills fear with tone or invasion of space, isolation (interference with communication with supports, picking fights before and/or after seeing or communicating with outside supports to make doing so not worth the trouble), humiliation, destruction of property, relentless attempts to prove the victim is crazy or incompetent

Spiritual: misuse of religious text to justify abuse, forceful conversion, degradation of beliefs

Medical: withholding medical care, preventing medical care, withholding necessary medications and medically related assistive devices

Legal Harassment: Threatens CPS or legal reports to maintain compliance with control, threatens removal of custody of the children, threat or actual retaliation to prevent cooperation with the abusers legal involvement, ignoring court orders including child support and contact orders, persistent frivolous legal battles

Deprivation: prevent sleep to argue, denial of basic needs, interference with supports

Sexual: forced sexual contact or unwanted sexual acts, sex in exchange for privileges, withholding of love if sex is not provided, sexual degradation

Economical: restricts or sabotages employment, full control of finances and financial decision making, declared ownership of shared assets

Stalking/monitoring: constant surveillance of electronic devices, monitoring of daily movements (unknowingly or with required check ins and immediate response to their attempts to contact)

Exploitation of Children: put downs of the parent to the children, interference with or undermining ofparenting, threatens harm to children for the purpose of controlling the other parent, use of children to monitor or provide information regarding the other parent


If you or someone you know is impacted by Domestic Violence, safety is priority. Contacting a professional to help formulate a safety plan is imperative. This can be a counselor, victims advocate, child welfare caseworker, or Domestic Violence shelter.

Other resources are:

Family Tree DV Hotline – (303)420-6752

Mountain Peace Shelter – (303)838-8181

National DV Hotline – (800)799-7233

SafeHouse Denver Inc – (303)318-9989

If you know of a child who is being exposed to Domestic Violence, make a report to the Colorado Department of Human Services Child Abuse and Neglect Hotline:




- Alison Atkins, MS, LPCC

Learn more about Alison here

Learn more about Alison here

Posted on October 19, 2017 and filed under awareness.