Screen Shot 2014-06-04 at 11.01.32 PMAn interview with Jennifer J. Thomas, Ph.D. and Jenni Schaefer, authors of Almost Anorexic: Is My (or My Loved One’s) Relationship with Food a Problem? (The Almost Effect)

In your book, Almost Anorexic; Is My (or My Loved One’s) Relationship with Food a Problem? (The Almost Effect), you describe “almost anorexic,” “diagnostic orphans,” and “subclinical” symptoms of an Eating Disorder as highly significant. Can you please elaborate?

While only 1 in 200 adults will struggle with full-blown anorexia nervosa, at least 1 in 20 (including 1 in 10 teen girls!) will exhibit key symptoms of one or more of the officially recognized DSM eating disorders anorexia nervosa, bulimia nervosa, and binge eating disorder. My coauthor, clinical psychologist Jennifer J. Thomas, and I call this once overlooked category almost anorexic.

Dr. Thomas’ research suggests that almost anorexia can be just as dangerous and impairing as anorexia nervosa. Sadly, many individuals with almost anorexia never get treatment because they don’t fit the specific criteria for anorexia nervosa.

That’s why we wrote Almost Anorexic — to encourage people not to let the number on the scale prevent them from seeking help. Pain and suffering cannot possibly be measured by criteria listed in a diagnostic manual.

What were your individual experiences that motivated you to come together to write Almost Anorexic?

As the Co-Director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital, most of the patients that Dr. Thomas sees do not meet the narrow criteria for anorexia nervosa, even though they have very severe eating disorders. Instead, these individuals are struggling immensely with a subset of the key symptoms of anorexia nervosa, bulimia nervosa, or binge eating disorder—like fluctuating body weight, food restriction, binge eating, purging, or poor body image. I, too, once struggled in this grey area. I didn’t have full-blown anorexia, but I desperately needed help. Unfortunately, I waited many years to get it. We wrote Almost Anorexic so that people will get the help they deserve sooner rather than later.

To Jenni Schaefer – You wrote, “Looking back, I wish people had recognized that my unhealthy eating habits were a sign of a serious problem. I was in a lot of emotional pain, but there wasn’t an avenue to get help.” How have you worked with this insight in your recovery?

My eating disorder stole my voice. I was ashamed and felt guilty about what I was doing with food. Today, I know that no matter how difficult, I need to reach out for help if I am struggling with something. I now know that there is no shame—but rather strength—in getting help for life’s inevitable challenges. In fact, stay tuned for a book that I am currently writing related to this topic!

If you are struggling with the effects of an eating disorder, I encourage you tell someone you trust. To find help in your area, contact the National Eating Disorders Association. You can call their toll free, confidential Helpline, 1-800-931-2237, or Click to Chat online.

A path to recovery, that many find quite useful, is the externalizing technique of separating oneself from the negative voice which accompanies an Eating Disorder. Please tell us how the negative, tormenting voice can sound.

For those who aren’t familiar with my work, in therapy, I learned to treat my eating disorder like a relationship—rather than an illness or a condition. I actually named my “eating disorder,” Ed, which is obviously an acronym.

Ed’s negative voice was mean and berating saying things like, “You’re fat. You don’t deserve to eat today.” Other times, Ed manipulated me in a smooth, seemingly caring tone, “Jenni, I’m sorry that you had a really tough day at work. I’m here to help. Let’s binge.” Ultimately, regardless of the words that came out of Ed’s mouth, I learned to separate and disagree with him. I grew to disobey him. In the end, I realized that what Ed said didn’t really matter at all. What was important was how I responded to him. Ultimately, after lots of hard work in recovery, I “divorced” Ed!

If you are interested in learning more about the externalizing idea, please check out these recent online events that Dr. Thomas and I participated in with both the Academy for Eating Disorders and National Eating Disorders Association:

Voice of Ed: Externalizing the Eating Disorder

Google Hangout: https://www.youtube.com/watch?v=hs9cTJ7CQDg

Tweet Chat: https://storify.com/aedweb/the-voice-of-ed-externalizing-the-eating-disorder

With so many socio-cultural influences challenging a peaceful relationship with one’s body, how does someone who is “almost anorexic” develop an acceptance and love of his/her body?

In dance class at the young age of four-years-old, I remember believing that I was fat. Negative body image was the first part of my eating disorder to come along. So it makes sense that negative body image was also the last part of my eating disorder to go. Because of this, I always encourage people to practice patience and give themselves plenty of time for body image acceptance. In my recovery experience, focusing on what my body does rather than on what it looks like became a key.

Further, I had to get educated about media literacy. Here’s a related excerpt from Almost Anorexic: “Supermodel Cindy Crawford famously told Redbook, ‘Even I don’t wake up looking like Cindy Crawford! What people see on magazine covers is one moment that was perfect—the wind, the light, the hair, the makeup. That’s a two-hour process.’”

As one specific component of body image acceptance, Dr. Thomas writes prescriptions for retail therapy. Most people with almost anorexia have an almost anorexic closet to match, with a wide range of sizes including clothing that only fit them when they were thinner, to baggy shapeless clothes they wear when feeling “fat.”  Dr. Thomas says, “Step away from the skinny jeans. Go out and buy yourself an outfit that fits you now, not 5 pounds from now.”

What recommendations do you have for sufferers specific to a perspective on food and exercise?

In Almost Anorexic, we talk about intuitive eating as well as intuitive exercise. Both involve listening to your body for cues on when and what to eat as well as exercise.

To recover from an eating disorder, it can be helpful to be aware of a cultural phenomenon we call “dieting in disguise.” Here’s a chapter excerpt explaining this important concept: http://www.jennischaefer.com/wp-content/uploads/2013/06/But-I-Dont-Diet.pdf

As members of today’s society, what are some steps we can each take to challenge the “pseudo-prestige” of anorexia?

After repeatedly being told by people who had read my first book, Life Without Ed, “I don’t have an eating disorder, but I do have an Ed in my head,” I decided to name that voice that seemingly everyone was hearing. It was almost like society itself had an eating disorder, so, in my next book, Goodbye Ed, Hello Me, I named the voice “Societal Ed.” Societal Ed lives in so many places—from movies and television to magazines and online advertisements—that you can hardly avoid hearing “his” pervasive message that our bodies aren’t good enough. But we don’t have to listen. If you want to proactively fight Societal Ed and the pseudo-prestige of anorexia, check out the National Eating Disorder Association’s Media Watchdog program:  http://www.nationaleatingdisorders.org/get-involved/media-watchdog. Further, be a positive example of fulfilled and balanced living in your own life.

Your last chapter in Almost Anorexic is entitled “Don’t Settle for Almost Recovered.” Please share your message from this chapter.

I wasn’t born with an eating disorder. I was born with genetic traits that made me vulnerable to developing the illness. Today, rather than using these traits like perfectionism and anxiety in the service of an eating disorder, I apply them to positive endeavors. Genetic traits that make someone susceptible to an eating disorder can actually be utilized in the service of recovery. This is one of the reasons that we believe full recovery is possible.

Dr. Thomas and I encourage people not to settle for “barely recovered.” You can download a table from our book that discusses “barely recovered” versus “fully recovered” here:  http://www.jennischaefer.com/wp-content/uploads/2013/06/AlmostAnorexic_Table15.pdf

If you are currently struggling with an eating disorder, you might find yourself in both columns in the table at any given point on the same day. As we say in Almost Anorexic, “The goal is to move, in all areas listed, more toward ‘fully recovered’ on the right. And, ultimately, if you keep moving, you will find yourself living fully recovered.”

We understand your contributions to the field of eating disorder recovery has recently been enriched by the addition of an audio version of Life Without Ed. Are there any interesting stories you can share about this process?

To create the audio book for the 10th anniversary edition of Life Without Ed, I had to give my husband the silent treatment. Let me explain: reading the book in the studio for hours at a time each day was a big workout for my vocal cords. To stay rested and strong for all of this work, I had to save my voice. So, I literally did not speak to my husband for a couple of weeks. I did write lots of notes to him. Needless to say, we were both excited when the project was complete. People have been requesting the audio book for years, so I am thrilled that it is finally available. It was well worth all of the effort—and silence. You can listen to audio book excerpts here: http://www.jennischaefer.com/resource/audio-book-excerpts/