Dual Disorders
When clinical depression, anxiety, and other emotional disorders coexist with a compulsive eating disorder and obesity

Hi _______,

Here's my take on having both a psychiatric/emotional illness and an eating disorder such as binge eating or compulsive eating disorder. We have two co-occurring primary illnesses. Both of which can affect us physically, emotionally, socially, and spiritually. Both illness interact with one another. They can exacerbate each other. Their symptoms can imitate, overlap, and mask each other. Each disorder makes us vulnerable to relapse or flare-up of the other disease.

Since both illnesses are so intertwined, I believe the only way to approach recovery is to treat both disorders simultaneously. Of course, the Steps can't "heal" a mental illness, but they can be a tool that helps us to both manage our mental illness in a healthy and constructive way, and they are a great tool for living and personal growth for life in general. In the long run, the Steps can help those of us with a psychiatric or emotional illness to function more effectively and effortlessly in our daily lives.

Since many of us use food as a coping tool to sort of "self-medicate" our emotional states, proper symptom management is important to treating both our eating disorder and our mental illness. Finding the right antidepressant, anti-anxiety, or other psychotropic medication when necessary to keep the symptoms of our mental illness in check should be considered part of a healthy and constructive plan of recovery. If we ignore our mental illness we sabotage our chances of recovery from our eating disorder. If we ignore our eating disorder, we sabotage our chances of growing the healthy self-esteem and self-concept required to successfully learn to live and cope with our mental illness.

Some other points to keep in mind:

* Mental illness and mental wellness are part and parcel of the same thing. None of us is 100% mentally ill or 100% mentally healthy. People with a psychiatric diagnosis have an illness — They are not their illness. For example: I have a mental illness, I am not "mentally ill". I hope that someday, the term mental illness falls out of favor as it is stigmatizing and implies a sort of black and white All or Nothing Thinking about those of us with psychiatric disorders.

* Recovery from an eating disorder is not easy for anyone no matter how mentally healthy they may be. It's a disorder that doesn't play favorites. It affects people of all persuasions, color, I.Q., gender, age, education levels, and socio-economic position.

* Paradoxically, those of us who have long dealt with our own emotional issues and psychiatric illnesses in terms of therapy and learning to survive the pain may indeed have a leg up on recovery from an eating disorder. We may have already begun developing our assets for recovery even if we haven't yet recognized that fact. Just as our co-occurring disorders have many similarities, so do many of the assets for recovery, tools, and healthy coping mechanisms required for both of them.

* The 12 Steps are a highly personal experience. Make them your very own tool and figure out how to make them work for you and at your very own pace. Remember that they are worded in a very dated style when the world was use to a more conservative and judgmental style of speech. If it helps, change phrases like "defects of character" to "assets and liabilities for recovery". If abuse and trauma issues might trigger psychiatric problems, save those issues for a future 4th and 5th Step or perhaps work the Steps with the help of a therapist that is familiar with 12 Step recovery and may have worked the Steps themselves. In all, the Steps are a gentle process that unfolds in unique ways before us as we are in the process of working them. There is a lot of ambiguity built into the Steps. Yes, we do "wrestle" with just what they may mean to us and how do we integrate and come to terms with each one. But each step is a moving toward health and wholeness and not a punishment of any sort.

* Remember that we seek progress not perfection. Perfectly healthy eating is desirable, but even without it, we can and do keep growing and learning and putting little pieces into building our recovery. Some days it may only be reading the list and some days going to a meeting or reading literature... prayer, meditation, adding one healthy fresh food you your evening meal, or substituting low-fat frozen yogurt or sorbet for real ice-cream. Eventually all those little pieces and baby steps add up. So instead of beating ourselves up for not being able to be perfect, we can give ourselves credit for each little positive change or thing we are able to make or do.

* As in many healing and growth processes, there is some amount of mourning involved. We do have the right to mourn the loss of our old inappropriate coping mechanisms, our old friend junk food, and those pieces of our self or self-image that we are now outgrowing. Perhaps this mourning could easily be mistaken for or precipitate an episode of clinical depression. I suggest giving ourselves permission... even setting aside certain periods of time now and then, to feel that loss. To really get into it for perhaps half an hour or so. Feelings of loss are not comfortable and it's easy to flip over into depression or binge rather than feel the pain directly. But I believe it is just this grieving process that can open the door to let in new and healthy feelings and behaviors. Sometimes I set my alarm clock to do this and when the alarm rings I go do something else in a different room that is totally unrelated — like the dishes or some gardening. This helps me keep from slipping from doing the work of mourning (feeling the loss) into the realm of self-pity.

Whew! I guess I've gone on long enough. Musta needed to go over these things myself.

Love, Dave 8/28/2003