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Karen's Blogs

Blogs are brief, to-the-point, conversational and packed with information, strategies, and tips to turn troubled eaters into “normal” eaters and to help you enjoy a happier, healthier life.Sign up by clicking "Subscribe" below and they’ll arrive in your inbox. 

That’s So Not Me

As sometimes happens, there’s been a theme cropping in my therapy sessions: “This is not who I am” (said vehemently). This attitude comes from a fixed (versus a growth) mindset ( https://www.karenrkoenig.com/blog/fixed-versus-growth-mindset ) which is the belief that you have an identity and traits you’re stuck with that will never change. This view allows no room for events or insights to impact us that will modify how we think, feel and behave. It’s like never allowing computer updates or uninstalling programs or having a TV that works only on a few channels. We’re all more than our current identity—different at various stages of our lives (childhood, adolescence, young adulthood, middle age, old age). We’re not made to have immutable personas. Naturally, there’s a basic “me” that we recognize as ourselves and a “you” that others recognize as “us,” but it’s the antithesis of growth or healing to say, “That is so...
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Self-objectification is common among people who turn up in my office. It involves internalizing “an observer’s perspective” about ourselves. More specifically, body self-objectification is an unhealthy way of viewing our bodies through the values of others or of society. “Self-objectification is associated with increased risk of poor body image, depression, and eating disorders” and, when studied, “was most consistently and positively associated with neuroticism, perfectionism, and narcissism across multiple studies.” (Carrotte, E., & Anderson, J. R. (2018). “A systematic review of the relationship between trait self-objectification and personality traits.” Personality and Individual Differences, 132, 20-31. DOI:10.1016/j.paid.2018.05.015). Of the three traits listed above, neuroticism and perfectionism are the ones I see in most dysregulated eaters. Neuroticism is seen in a personality tendency toward guilt, shame, anxiety, self-doubt, and self-deprecation. Neurotic clients do a great deal of putting themselves down, feeling insecure about decisions, ruminating about the past, obsessing about the future, worrying...
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Book Review – The Intuitive Eating Workbook for Teens

I wish I’d had The Intuitive Eating Workbook for Teens by Elyse Resch, MS, RDN when I was growing up. My dieting and binge-eating started in adolescence and back then I never gave a thought to these behaviors damaging my mental or physical health. I was ignorant and would have benefitted from knowing about intuitive eating in order to start focusing on appetite cues and valuing my body and stop focusing on weight. The workbook is geared for teens, without talking down to or above them. It covers a wide range of issues beyond what and how to eat. It begins with an explanation of why diets don’t work long-term and the dangerous pattern they set up for young minds and bodies. I love that it links the dynamic of deprivation to rebound eating, of denying ourselves food to rebelling against rules which can generate the desire to overeat. This is...
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But I Hate Taking Medicine, Going to the Doctor, Etc.

I’m flabbergasted when clients adamantly refuse to take medicine, seek medical attention, or get recommended health treatment. This kind of irrationality is what gets people into trouble in the first place. Fortunately, clients come to me to learn how to take better care of themselves, so I am in a position to help them make better decisions. If you’re someone who refuses to go to a doctor, the hospital or take medication, I’d like you to stop and think about whether this is in your long-term best interest. Many clients say, “I hate going to the doctor,” “But I don’t want to go to the hospital,” or “I don’t like dependent on medication.” As if there are actually people out there who enjoy going to the doctor, are happy about going to the hospital, or like the idea of being dependent on medication. Doesn’t your attitude sound a tad silly to...
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Making New Meanings of Full and Satisfied with Food

At dinner celebrating a friend’s birthday, I was full and satisfied by dessert time, while she’d eaten a small dinner just to save room for dessert. She ordered key lime pie which came with a slab of dark chocolate melted on top of it and the waiter brought over a dish of chocolate chip ice cream as well because I’d mentioned that it was her big day. I managed to down a few spoonsful of ice cream, which she insisted I share, then watched her polish off the pie. When she was done, she asked if I wished to take home the remaining ice cream and slab of chocolate and I joyfully took it off her hands. I don’t care for dessert after a meal when I’m usually full. From my diet-binge days, I hate feeling uncomfortably full or too hungry. My habit is to eat seven or eight mini-meals daily,...
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Sorting Out Beliefs Learned from Parents

I’m sometimes amazed at what clients tell me, as if what they’re saying is a provable fact. It’s obvious to me that their thinking isn’t rational and that they have no idea they’re spouting—or, worse, believing—falsehoods. Sometimes these untruths are about eating and sometimes they’re not. Either way, they’ll need to change these beliefs to become “normal” eaters and emotionally healthy people. When we’re children, we believe nearly everything our parents tell us—but that doesn’t mean that all they say is true or that the beliefs we learn from them serve us well in adulthood. Just as you’re probably not still adorning your living quarters with dolls, toy soldiers, miniature tanks, stuffed animals or posters of teen idols, it’s not great mental health to be walking around with outdated, erroneous beliefs in your head. We believe what we learn growing up for several reasons. First, we don’t have the brain capacity...
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What You Need to Know About Suicide

One of the most difficult jobs of a mental health clinician is dealing with someone who is suicidal. Being a layperson with family members, co-workers or friends who want to kill themselves is even scarier. At least we have training in what to do and not do. Here are some things to consider when dealing with people who say they’re suicidal or who you think might be. (“Suicide rates on the rise: know the signs, ask the right questions to help them stem the tide” by Alison Lauria, Social Work Advocates, 10-11/18, pp. 13-20). You may believe that suicide is a rare occurrence, but the fact is that, “Nearly 45,000 Americans age 10 and older died by suicide in 2016, making it one of the leading causes of death in America. And the suicide rate is rising…more than half—54%—of those died by suicide did not have a known mental health condition”...
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Time to Take Down Your Façade

“Sometimes the façade becomes the building,” laments one of the characters in the entertaining and deeply moving novel, Rise and Shine, by Anna Quindlen, a favorite author. How sadly true. I see how that has happened to many of my clients, with and without dysregulated eating, and know that they must tear down that façade to become a whole and healthy person. It’s no mystery how we got to be the way we are. We are built psychologically to survive. That is how the human brain is wired: to adapt to an environment in order to make the best of it. Unfortunately, when this happens, we may think we’re growing toward the light, but end up growing toward the darkness when how we act, believe and feel, which is adaptive in childhood, become maladaptive in adulthood. I have many clients who are Adult Children of Alcoholics (ACOAs) and they have the...
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Sleep, Circadian Rhythms, Eating and Weight

It’s ironic that clients often don’t want to discuss their sleep habits but focus obsessively on their eating habits. In truth, sleep may be a substantial determinant of what and how much we eat, and disruption of our circadian rhythms may have a significant effect on what we weigh. Here’s what science has to say on these subjects. According to “Sleep Longer, Eat Less, Maintain a Healthier Weight” by Mugdha Thakur, MD (Duke Medicine Newsletter, 5/2008, p. 7), “Sleep is a modifiable risk factor in the link between obesity and cardiometabolic diseases…” and “Reduced sleep affects the regulation of appetite hormones such as ghrelin, which increase appetite, and leptin, which decreases appetite.” It is also thought to increase cortisol (a stress hormone) release, which increases eating behavior. Consider the paradigm above: By sleeping less, you’re putting yourself at risk of generating increased stress and appetite. This combination is the perfect storm...
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Neurotic versus Personality Disordered

I remember being fascinated in my social work psychopathology class as my professor described two types of clients we’d be treating. One type would seek us out and the other likely would need to be dragged, kicking and screaming, into our offices. Although I’m not sure after 30-plus years in practice that I’d draw such a sharp distinction between the two types, I do think back to my professor’s description when I meet clients for the first time or listen to them talk about the folks who populate their lives. The first type has what we call a neurotic disorder. To paraphrase my professor, they think that all their problems are their fault. No matter what has happened to them, they brought it on. They made the wrong choice, didn’t see something coming, and berate themselves for staying too long in bad situations. They are mercilessly hard on themselves and shockingly...
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