"Ours is a culture obsessed with body image. Peruse any fashion magazine and you will see reed thin models embellishing the pages. According to Erica Jong, best-selling author and poet, who was a keynote speaker at the Renfrew Center Foundation’s 16th annual eating disorders conference, Feminist Perspectives and Beyond: Maximizing Change in the Treatment of Eating Disorders, “The average size runway model is 40 percent of the size of the average woman. The average sized woman wears a size 12, and the average sized model wears a double zero.” In her own life, Jong struggled with anorexia. At the age of 13, she “decided to stop eating and even drinking water, because it made my belly stick out.” Her skin erupted in painful boils. Alarmed, her parents took her to see a dermatologist, whom she describes as a tiny German woman “who had blue numbers on her arm, the first I had ever seen,” which marked her as a concentration camp survivor. This doctor informed her that “the skin is the mirror of your soul,” and asked what was troubling Erica emotionally. As she poured her heart out, she unburdened herself of the belief that her newly burgeoning sexuality and the ways in which she and her young boyfriend were expressing it, were somehow shameful. That same fear of sexual development and demonstration of those needs and desires, plagues many women and girls today. Having surrendered hatred of her own body, Jong joyously voiced that she has since learned, “It’s important that your flesh be available for hugging. Hug-ability is more important than how you look in a photograph.”
Take a moment to consider a few startling stats:
* 53% of 13 year old American girls are unhappy with their bodies.
* 78% of 17 year old girls are dissatisfied with their appearance.
* 85% of adult women wake up each day ready to do battle with their weight and size.
* More than 35 million dollars are spent on dieting and diet products each year.
What this amounts to are lost lives, as well as disruption of families because women and girls are literally starving themselves in order to contend with body bias and weight consciousness. It begins with emotional hunger, as we long for acceptance and approval in a society that dispenses messages, both verbal and nonverbal that “thin is in.”
The Renfrew Center has been a beacon in the darkness of the disease/addiction of eating disorders since 1985 when it initially opened its doors in Philadelphia. A pioneer in the field, it was the first freestanding, residential facility treating women and girls with anorexia and bulemia. More than just an accumulation of symptoms (such as restricting food intake, body dysmorphia in which the person views their body as larger than it truly is, binging and purging, obsessive exercise and the overuse of laxatives and diet pills), eating disorders are part of a complex psycho-spiritual-physical triumvirate. With locations in Philadelphia, Bryn Mawr, New Jersey, New York, Connecticut and Florida, Renfrew offers both outpatient and residential treatment and education for clients, families and professionals. To date, they have treated more than 45,000 women. Their methods empower the clients to take charge of their lives by working in partnership with the treatment team. Respect for each individual and a genuine sense of caring and compassion, are hallmarks.
An opportunity for professional edification was presented in the form of this conference held at the Airport Marriott in Philadelphia in November. In the classrooms, hallways and ballroom, therapeutic professionals and speakers gathered nationwide, to bring home portable skills with which they could assist their own clientele. Literature on this important public health issue was abundant. Books with colorful titles such as “Honey Does This Make My Butt Look Big?” by Lydia Manich, “The Woman's Belly Book: Finding Your Treasures Within” by Lisa Sarasohn, “Bodylove” by Rita Freedman and “Running on Empty: A Diary of Anorexia and Bulimia” by Carrie Arnold, all vied for the attention of the attendees with numerous others at the table of Gurze Books, which is located in Carlsbad, California. This company specializes in publishing and distributing texts on eating disorders.
Among the participants of the conference were two women whose practices treat clients in the South Jersey area. Shari Botwin, MSW, LCSW is a licensed clinical social worker with an office in Cherry Hill and Barbara Darcy-Castorina, RD, CDE is a registered dietician who works for Virtua Health in Voorhees.
Nearly ten years ago, Botwin was employed by the Renfrew Center, providing individual and family therapy and in 1997, opened her own practice in which she specializes in eating disorders, trauma and abuse; which she finds often go hand in hand. “I wrote a book that came out in 2004, called ‘Free At Last: The Power of Relationships in Overcoming Trauma, Abuse and Eating Disorders.’ I would say that most of the women I work with had some type of trauma in their past that had manifested into an eating disorder.” Although men do exhibit signs of eating disorders, 90% of her clients are women.
Both Botwin and Darcy-Castorina find that even if it may be under-reported in men, there is a definite prevalence of eating disorders among women. According to Darcy-Castorina, five percent of men say that they have eating disorders. Shari tells the story: “I work with some of the teenagers, and some of the dads, while they won’t acknowledge it, do have symptoms. I was working with one family and the daughter was actually picking up symptoms from the dad. It is less common, but I think that the shame and the stigma of admitting that as a man, are still pretty hard.” A common trait among young men in particular is, the belief, according to Barbara “a bulkier figure is a stronger figure.” In Darcy-Castorina’s practice, she sees men and women in equal measure: “I focus on overeating and binge eating and people with diabetes.” In treating diabetics, she observes, “Their system empties out quickly, so they continue to eat and gain weight and that increases insulin resistance.”
Botwin believes that eating disorders are related to loss; which may include death, divorce, illness and relationship termination. She finds that dysfunctional eating patterns are a way to avoid grieving; so, in one sense, it is symptom-management.
Darcy-Castorina expresses that although she does not treat the psychological impact of the conditions that her clients face, since they are likely to be in treatment by the time they reach her office, she is “enjoying this conference because I can understand that the psychological part is such a strong component. I’ve learned about motivational interviewing. Professionals lob a lot of information at people, when what they need to do is learn to listen to the needs of the patient and not just provide information that they think they need.”
As echoed in the keynote address from Jong, Botwin feels that women are often unaware of their desires and the right to express them. “When I ask, ‘What is it that you want from your mom or what is it that you need from your husband?’ Often they can’t answer, so the big part of the therapy is that they identify it and know that they are deserving of it. Until they get to that point, they will use their eating disorder as a way to speak in a nonverbal way.”
Darcy-Castorina observes, “Women put themselves last.” Botwin carries it a step further as she witnesses within the lives of the abuse survivors she treats, a pattern of attracting people who perpetuate the cycle.
Darcy-Castorina finds that among the primarily middle-aged clients she treats, “There are so many reasons why they are heavy. There is a depressive component at times.” When both take history from clients, they see that at times, people overeat or starve themselves as a way of keeping others at bay, which again continues the cycle of depression and disordered eating.
Although part of the treatment of eating disorders is to help clients feel comfortable with the skin they’re in and learn to love their bodies as is, paradoxically, Darcy-Castorina expresses that because she treats people who in many cases are morbidly overweight: “I try not to have them stay comfortable with the skin they’re in.”
Botwin feels, “In order to be comfortable in your skin, you have to accept who you are and where you come from. You have to know what your experience is and know that this is the impact it had on my life before and this is the impact it has today.” Barbara assists her clients in making healthy choices by educating them about what will happen if they don’t change and the benefits inherent in re-evaluating and taking those necessary steps. Both believe it is quite possible to move beyond eating disorders and live a full life. Darcy-Castorina believes, “You can’t do it alone.” Botwin echoes: “It’s in your connections that you heal.”