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Boundaries: This is where I draw the line.

5/12/2019

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Thank you to all who attended and participated yesterday. It was our best attended event to date! I was blown away by the energy, engagement and honesty in that room. Each of you played a role in creating a space where others felt safe enough to get real about their experiences, struggles, and feelings. Great work everyone! 




​As promised, I am going to post some follow up information here about more specific boundary styles, common boundary problems and some simple how-to's on how to start verbalizing boundaries in your own life. 

One of our basic needs is for connection and relationship. Healing takes place in the context of relationships. Without a way to be clear and direct about who we are, what we need, and what we are and are not capable of, our relationships suffer. We feel unseen, unheard, taken advantage of, unsafe, disconnected, resentful, confused, and ultimately hopeless that we will ever understand how to make our relationships work.  

We learned about boundaries very early on, from our families of origin. Growing up in environments  where we did not have a voice (our “no” was not was respected, there was physical, emotional or sexual abuse, or maybe we had no safe space) would teach us certain things about yes and no.
Growing up, I was never taught how to identify my boundaries let alone communicate or enforce them. In my home no one had boundaries. I was never taught how to set a boundary, was never taught that I was allowed to have them and therefore never learned how to keep myself safe (emotionally or physically). This led to decades of violations of my physical, emotional and mental spaces in all kinds of relationships as I grew up. These violations did not magically end when I entered recovery. I did not know how to protect myself. I did not have a voice. I did not who I was, what I valued or how any of this was related.


WHICH TYPE ARE YOU?

Compliants: they melt into the needs and demands of others out of fear - usually of being abandoned - this mimics how it felt for them as a child. They have fear of someone’s anger, fear of being seen as selfish. They take on too much and usually feel taken advantage of. They are internally resentful, and afraid.

Avoidants: withdraw when they are in need, opening up is impossible. They have solid walls instead of a fence with a gate that breathes. Others experience them as impermeable. They experience their own needs as bad/ shameful.
**A combination of these two types looks like taking on the needs of others and never asking for what we need for ourselves.

Controllers: refuse to hear and accept the boundaries of others. They resist taking responsibility for their own lives, so they need to control others. No means maybe and maybe means yes to them. 

Aggressive controllers:  
run over others, use forceful language and tactics to get others to change their No to Yes
 Manipulative controllers:
manipulate and use dishonesty to get others to change their No into a Yes

           Compliants and Avoidants as Controllers:
manipulate others into meeting their needs. Will do a favor or something nice, hoping the other person will read their mind and return the gesture. Everything has a hidden price tag.


How do I set and maintain my boundaries?

Get clear about what you value
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Once we understand the importance of what we are trying to protect, setting, communicating and maintaining boundaries becomes much easier.
​

   Bonding first, boundaries second
We need to find safe places where we can practice setting boundaries and limits inside relationships where we are rooted and grounded in unconditional love (who is this person for you?)


Communicating a boundary
1st time: I will not tolerate/ allow/ accept/ or I do not appreciate etc -  you speaking about women that way, talking about your diet, drinking/ using in front of me, driving that way, yelling at me, looking through my things. I would prefer you not do this around me anymore.  

2nd time: say it again with a consequence (If you choose to continue  ____, I will ____ )
3rd time: remind them of the boundary you set and enforce the consequence


*A note about consequences
In your control, direct, not punishing or manipulative, not passive aggressive, not harmful, something you are capable of following through with.
*A note about maintaining boundaries
    Setting boundaries can come with some guilt, self-doubt, and lots of second- guessing. Sometimes others will react to us with anger or attempts to manipulate us in an attempt to get us to change our limits.
Having support from people that love us enough to hold us accountable for maintaining our values is really helpful. They can also provide  reality checks when our thinking becomes distorted, when we lose perspective, and can provide validation/connection/ unconditional love to offset the guilt and self-doubt that creeps in.
Others who are safe and supportive provide a place for us to start practicing setting and maintaining boundaries.
** Who might these people be for you? How do you know they are your people?




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A board I keep in my home. It reminds me of who I am and what I value.
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Recovery at Risk: Eating Disorders & Addiction

2/16/2019

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now what arizona

Liz Langreck, MS, RDN

Liz has been working to help those struggling with eating disorders since 2011. Liz is a registered dietitian who has worked at all levels of eating disorder care. She is currently pursuing certification as an Certified Eating Disorder Registered Dietitian from the International Association of Eating Disorder Professionals. 

She began her career at Remuda Ranch in Wickenburg, AZ working as a registered dietician. In 2014, Liz joined Dr. Lesley Williams to collaborate at Liberation Center, an outpatient eating disorder center in downtown Phoenix.  
Liz holds a Bachelor’s of Science in Dietetics, and a Master of Science in Food and Nutrition Science from the University of Wisconsin Stout. Liz completed her accredited dietetic internship through the University of Wisconsin Stout.

Liz is a Wisconsin native who enjoys sports, yoga, hiking and the outdoors, cats, and recovery. She has an interest in eastern philosophy and an obsession with the work of Brene Brown. She believes her work in this space is, unquestionably, a calling from her Higher Power. 

** At this event, Liz presented on the ways that undiagnosed / untreated eating disorders impact recovery. We also discussed how prevalent eating disorders (of all types) are for people who have co-occurring substance use disorders. 

 
COMMON SYMPTOMS OF AN EATING DISORDER
Emotional and behavioral
  • In general, behaviors and attitudes that indicate that weight loss, dieting, and control of food are becoming primary concerns
  • Preoccupation with weight, food, calories, carbohydrates, fat grams, and dieting
  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g., no carbohydrates, etc.)
  • Appears uncomfortable eating around others
  • Food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)
  • Skipping meals or taking small portions of food at regular meals
  • Any new practices with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)
  • Withdrawal from usual friends and activities
  • Frequent dieting
  • Extreme concern with body size and shape
  • Frequent checking in the mirror for perceived flaws in appearance
  • Extreme mood swings

Physical 
  • Noticeable fluctuations in weight, both up and down
  • Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)
  • Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a “true” period)
  • Difficulties concentrating
  • Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low white and red blood cell counts)
  • Dizziness, especially upon standing
  • Fainting/syncope
  • Feeling cold all the time
  • Sleep problems
  • Cuts and calluses across the top of finger joints (a result of inducing vomiting)Dental problems, such as enamel erosion, cavities, and tooth sensitivity
  • Dry skin and hair, and brittle nails
  • Swelling around area of salivary glands
  • Fine hair on body (lanugo)
  • Cavities, or discoloration of teeth, from vomiting
  • Muscle weakness
  • Yellow skin (in context of eating large amounts of carrots)
  • Cold, mottled hands and feet or swelling of feet
  • Poor wound healing
  • Impaired immune functioning

Common Diagnoses & Presentations
ANOREXIA NERVOSA
  • Dramatic weight loss (sometimes) 
  • Dresses in layers to hide weight loss or stay warm
  • Preoccupation with weight, food, calories, fat grams, and dieting. Makes frequent comments about feeling “fat"
  • Resists or is unable to maintain a body weight appropriate for their age, height, and build
  • Maintains an excessive, rigid exercise regime – despite weather, fatigue, illness, or injury

BULIMIA NERVOSA
  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics
  • Drinks excessive amounts of water or non-caloric beverages, and/or uses excessive amounts of mouthwash, mints, and gum
  • Has calluses on the back of the hands and knuckles from self- induced vomiting
  • Dental problems, such as enamel erosion, cavities, discoloration of teeth from vomiting, and tooth sensitivity 

BINGE EATING DISORDER
  • Secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating
  • Feelings of disgust, depression, or guilt after overeating, and/or feelings of low self-esteem
  • Steals or hoards food in strange places
  • Creates lifestyle schedules or rituals to make time for binge sessions
  • Evidence of binge eating, including the disappearance of large amounts of food in a short time period or a lot of empty wrappers and containers indicating consumption of large amounts of food 


OTHERWISE SPECIFIED FEEDING OR EATING DISORDER (OSFED)
Because OSFED encompasses a wide variety of eating disordered behaviors, any or all of the following symptoms may be present in people with OSFED.
  • Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting
  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food
  • Self-esteem overly related to body image
  • Dieting behavior (reducing the amount or types of foods consumed)Expresses a need to “burn off” calories taken in
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

AVOIDANT RESTRICTIVE FOOD INTAKE DISORDER (ARFID)
  • Dramatic weight loss
  • Limited range of preferred foods that becomes narrower over time (i.e., picky eating that progressively worsens)
  • Fears of choking or vomiting
  • No body image disturbance or fear of weight gain

ORTHOREXIA 
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • An increase in concern about the health of ingredients; an inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
  • Spending hours per day thinking about what food might be served at upcoming events
  • Body image concerns may or may not be present

COMPULSIVE EXERCISE
  • Exercise that significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or occurs when the individual exercises despite injury or other medical complications
  • Intense anxiety, depression and/or distress if unable to exercise
  • Exercise takes place despite injury or fatigue

DIABULIMIA
  • Increasing neglect of diabetes management; infrequently fills prescriptions and/or avoids diabetes related appointments
  • Secrecy about diabetes management; discomfort testing/injecting in front of others
  • Fear that “insulin makes me fat” Restricting certain food or food groups to lower insulin dosages A1c of 9.0 or higher on a continuous basis 


The above information is from the NEDA website: www.nationaleatingdisorders.org

Here is a link to their online, confidential screening tool: www.nationaleatingdisorders.org/screening-tool

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