The Center for Eating Disorders Blog

Photoshop Does Not Cause Eating Disorders – Media & Body Image

Media Literacy Infographic

Click to View (pdf)


National Eating Disorders Awareness Week
(Feb. 23 – March 1, 2014)

Did you know that photoshopped bodies and the unrealistic beauty ideals set forth by the media DO NOT cause eating disorders?  While these unfortunate elements of our society CAN contribute to widespread negative body image and promote an internalization of the “thin ideal”, they cannot be blamed outright for the development of the serious and complex illnesses such as anorexia, bulimia,  binge eating disorder and EDNOS or OSFED.

When it comes to Eating Disorders there are actually a variety of contributing factors, of which the strongest are likely to be genetics and biology. In fact, research suggests 50-80% of a person’s risk for developing an eating disorder is due to genetics which includes factors associated with heritable personality traits such as perfectionism.

That being said, we all stand to benefit from more positive and realistic representations of bodies in the media.  After all, individuals who feel better about their bodies take better care of them, regardless of weight, shape or size.  Additionally, positive body image and media literacy can serve as protective factors against disordered eating.  The infographic above from the National Eating Disorders Association breaks down some of the important elements of the media’s effects on body image. Click on the image to open and join the conversation on our Facebook page.

Read more about the etiology of eating disorders here: Underlying Causes and Contributing Factors

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I Had No Idea…Males and Eating Disorders – National Eating Disorders Awareness Week 2014

This helpful infographic from The National Eating Disorders Association helps to break down some of the key facts. Spread the word and help others by breaking down stereotypes and supporting accurate information about  males and eating disorders.  Join us on Facebook for more information and to join the #NEDAWeek conversation.

Infographic: Males & Eating DisordersThe Center for Eating Disorders at Sheppard Pratt has been treating males affected by eating disorders for over twenty years yet barriers remain for those seeking treatment.  Cultural stigma regarding males and eating disorders can make it more difficult for men to come forward and seek treatment on their own. The good news is that education, support and awareness about eating disorders among males are all improving so that more boys and men are seeking and receiving the treatment they need and deserve.

Perfectly Imperfect: A Special Q&A with JENNI SCHAEFER

Jenni Schaefer
In recognition of National Eating Disorders Awareness Week (Feb. 23 – March 1), we caught up with Life Without Ed author and all-around inspiring person, JENNI SCHAEFER. 

It was about  five years ago that Jenni last visited The Center for Eating Disorders at Sheppard Pratt  and we are thrilled to welcome her back here to the CED blog and back to Baltimore on Saturday, March 1st for a new presentation entitled, Perfectly Imperfect: Eating & Body Image. 

It turns out that a lot can happen in five years.  Armed with a new relationship, a new book and lots of new experiences, Jenni continues to educate, inspire and lead by example both within the eating disorder community and beyond.  We are grateful to Jenni for taking the time to answer our questions and excited to share her responses below with our readers.

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Q & A with JENNI SCHAEFER  

Q: You’ve been a longtime advocate and activist for the National Eating Disorders Association (NEDA) and will be speaking in Baltimore in honor of National Eating Disorders Awareness Week 2014. What does this campaign mean to you and what progress have you seen around the awareness and education of eating disorders since you began this journey?

After struggling for years with an eating disorder, I finally picked up the phone in search of real help. I called 1-800-931-2237, which is NEDA’s Helpline.  NEDA sent me a list of treatment resources (via snail mail back then!), and my healing journey began. It is surreal to me how life has come full circle: I am honored to serve as the Chair of NEDA’s Ambassadors Council today. Working with NEDA and NEDAwareness Week means the world to me. My hope during the week is not only to encourage people to get help but also to prevent some from ever going down the treacherous road of an eating disorder in the first place. If I had participated in a NEDAwareness event years ago, I believe that my journey would have been a lot smoother. Maybe I never would have turned to Ed (aka “eating disorder”) in the first place, or maybe I would have realized that I had a problem and reached out for help sooner. Similar to the 2014 NEDAwareness theme, “I Had No Idea” that I was struggling with a life-threatening illness.

Since I began my recovery journey, I have seen eating disorders awareness and education improve greatly. Back when I was struggling in college, I rarely heard anyone talk about eating disorders. But, today, colleges all across the country ask me to speak at their NEDAwareness events. Again, it is amazing how life can come full circle like that!

Q: In addition to your hugely popular and inspirational books, Life Without Ed and Goodbye Ed, Hello Me, you have a new book out with co-author Jennifer Thomas, PhD called Almost Anorexic: Is My (Or My Loved One’s) Relationship with Food a Problem? What prompted you and Dr. Thomas to write this book, and can you elaborate on what you mean by the term “almost anorexic”?

While 1 in 200 adults will experience full-blown anorexia, at Cover: Almost Anorexicleast 1 in 20 (1 in 10 teen girls!) will struggle with restricting, bingeing and/or purging that doesn’t meet full diagnostic criteria for anorexia nervosa, bulimia nervosa or binge eating disorder. Almost Anorexic, which is the third book in Harvard Medical School’s The Almost Effect™ series, brings attention to the grey area between “normal eating” and an officially recognized eating disorder. Dr. Thomas and I want people to know that, regardless of their eating disorder diagnosis or lack thereof, both help and hope are available. A diagnostic label cannot adequately depict pain and suffering. All who struggle deserve help, and full recovery is possible.

[To learn more about
Almost Anorexic and to read book excerpts, click here. You can also watch a hopeful book trailer (video) or register to attend a professional workshop facilitated by the book's co-authors.]

Q: There has been a lot of discussion within the eating disorder field recently around the conceptualization of eating disorders as brain-based illnesses as opposed to purely psychological or behavioral disorders. You touch on the implications of this in Almost Anorexic How can the words we use to define the disorder impact the recovery process?

When I first received help for my eating disorder, people told me that I would never fully recover. They said that an eating disorder was like diabetes and that it would be with me forever. Believing this, in the end, just served to keep me stuck. I had to change my language, and I had to connect with people who believed that I could get fully better. This made all of the difference.

In relation to brain disorder language, Almost Anorexic explains: “Some people and organizations have found brain-disorder language extremely helpful in explaining to others why individuals with eating disorders can’t just “snap out of it” and in absolving parents of guilt and blame for their child’s illness. Others, however, have worried that brain-disorder language may give sufferers and loved ones alike the hopeless (and false!) impression that eating disorders are lifelong illnesses that cannot be treated and may even provide a handy excuse for the continuation of dangerous symptoms (after all, your brain made you do it). To combat this, parent activist Laura Collins Lyster-Mensh has used the term “treatable brain disorder.” We suggest you use the terminology that works best for you. Words are powerful. Don’t let Ed hijack them.”

Q: Perfectionism is one of the genetically-based personality traits most highly associated with the development of eating disorders and will be the focus of your talk in Baltimore on March 1, 2014. Did perfectionism play a role in the development of your eating disorder? Did it also play a role in recovery?

I was not born with an eating disorder, but I was born with the perfectionism trait. Constantly striving to be perfect certainly made me more vulnerable to having an eating disorder. So did other genetic traits like high anxiety and obsessive-compulsiveness. However, when channeled in a positive direction, these traits played a crucial role in my recovery. I was able to refine perfectionism, for instance, and apply it to things like attending doctors’ appointments and finishing therapy assignments. When taken to the light, our genetic traits absolutely support recovery.

Q: Individuals who are perfectionists often struggle with the urge to compare themselves to people around them. Among individuals with eating disorders these comparisons are often appearance-based or weight-focused but can also be related to one’s career, house, family, wealth or talent. Constant comparison can be very triggering and detrimental to the recovery process. What strategies help you avoid this comparison trap?

My motto, as I originally wrote about in Life Without Ed, is “Compare and Despair.” Early in recovery, I actually displayed “Compare and Despair” on post-it notes throughout my home. These notes reminded me that comparing inevitably leads to despairing, so I did my best to stop setting myself up for this kind of self-loathing. Further, learning that I was not alone in my tendency to compare helped me to change as well.  The Center for Eating Disorders’ survey related to Facebook and comparisons, for instance, has helped people I know to better understand the growing prevalence of comparing (as well as the fall-out of it) and to feel a sense of camaraderie in making positive changes.

Q: In the age of social media, it seems the opportunity for comparing oneself to others has reached an all time high. Do you have any tips for individuals looking to use social media in a healthy way that is supportive of recovery?

In the tenth anniversary edition of Life Without Ed, which was just released, I talk about the fact that Ed surely has a Facebook account! Each time a person with an eating disorder logs in online, Ed does, too. This awareness is key. Further, individuals with eating disorders can change their online settings to block triggering people and ads. Within the anniversary edition of Life Without Ed, I give many tips for how to use technology to support your recovery, including using mobile apps like “Recovery Record” and “Rise Up + Recover.”

Q: You last visited The Center for Eating Disorders at Sheppard Pratt as a guest speaker in 2009 during which you spoke about the concept of being Recovered. from your eating disorder. What new insights about being Recovered. have you gained over the past 5 years, and has any of it surprised you?

I often say that I am recovered from my eating disorder, but not from life. Part of being “recovered.” actually means continual personal growth. Since my visit to Sheppard Pratt, I have blossomed in many areas, especially related to relationships. I have learned how to let more love into my life and have even gotten married. Luckily, my husband’s name is not Ed! Related to freedom from eating disorders, you can click here to download a table that Dr. Thomas and I created comparing “fully recovered” to “barely recovered.”

Q: What are some of the main points you hope to convey during your upcoming talk, Perfectly Imperfect on March 1st in Baltimore? Who do you think could benefit from attending the presentation?

One of the most common comments I receive from audience members is, “I don’t have an eating disorder, but I do have an Ed in my head.” People also relate to my efforts to overcome perfectionism as well as my journey to find happiness in life. We always have fun singing my song, “It’s Okay to be Happy.” That said, my talks are applicable to anyone who calls him or herself a human! On March 1st, I will discuss finding balance with food and weight in a world that is anything but balanced. We will talk about striving simultaneously for both excellence and “perfect imperfection.” And one big goal of my presentations is to laugh—a lot.

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Do you have your own questions for Jenni?  Join us on Twitter @CEDSheppPratt for a special Tweet Chat on Thursday, February 20, 2014 from 1:00-2:00pm EST with Jenni Schaefer (@jennischaefer) and Jennifer J. Thomas, PhD (@drjennythomas).  Use the hashtag #CEDchat to participate and follow along. Send your questions in advance to kclemmer@sheppardpratt.org and we might use them during the chat!

More About Jenni…
Jenni Schaefer’s breakthrough bestseller, Life Without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too, established her as one of the leading lights in the recovery movement. With her second book, Goodbye Ed, Hello Me: Recover from Your Eating Disorder and Fall in Love with Life, she earned her place as one of the country’s foremost motivational writers and speakers. Jenni’s straightforward, realistic style has made her a role model, source of inspiration, and confidant to people worldwide looking to overcome adversity and live more fully. She speaks at conferences, at major universities, and in corporate settings; has appeared on many syndicated TV and radio shows; and has been quoted in publications including The New York Times. She is also chair of the Ambassadors Council of the National Eating Disorders Association. An accomplished singer/songwriter, she lives in Austin, Texas

Want to learn more about NEDAwareness Week Events at The Center for Eating Disorders at Sheppard Pratt?  Click HERE.

 

 

Family-Based Treatment for Adolescents with Anorexia Nervosa: 3 Important Considerations

 

Family-Based Treatment (FBT) is an important evidence-based treatment for anorexia nervosa in adolescents. Originally conceived at the Maudsley Hospital in London, and often referred to as the Maudsley Model, it was further developed by James Lock, MD, PhD and Daniel le Grange, PhD in the United States. FBT is an intensive outpatient treatment involving the entire family whereby parents play a primary and critical role in all of the following tasks:

  • managing the restoration of the child’s weight to a healthy place and supporting the blockade of eating disordered behaviors
  • helping the child to re-establish age-appropriate control and management over their own eating
  • re-focusing the family on healthy adolescent development and relationships separate from the eating disorder

FBT is a highly focused treatment that is presented in three stages. It emphasizes behavioral change and supports a gradual increase in autonomy for the adolescent.  As a psychologist who supports and guides families through this treatment, I thought that it might be helpful for those who are considering FBT to have a primer for the treatment. In thinking about what may be helpful to be aware of when considering FBT, I reflected on the first session I have with each family and thought about all of the crucial messages I try to convey during that time. Below, I’ve decided to share the three messages that, in my perspective, stand as the most important tenets of understanding and implementing FBT.

  1. For adolescents struggling with anorexia nervosa, family support can be the most effective tool for making change. At its core, FBT recognizes that parents are capable of helping their child recover and the therapist’s role is to support them in this goal. When a child is confronted with any serious crisis or illness, investment and nurturing from the family is considered a critical asset and anorexia nervosa is no exception to this. Despite lingering misconceptions about a parental role in the development of eating disorders, FBT is built on the knowledge that parents do not cause eating disorders and that they are, in fact, integral to the recovery process. It is our job as therapists to recognize the strengths and qualities of each family and consider how FBT can be applied within each unique family system. Simply put, the aim of FBT is to empower parents to help their child overcome the eating disorder.  In other words, the therapist serves as a consultant who joins with families as they apply skills they already possess. 
  2. Eating disorders have genetic and biological underpinnings.  As such, adolescents with anorexia nervosa have little control over their illness. Furthermore, periods of malnutrition and starvation can trigger a self-perpetuating cycle of anorexic symptoms that can cause considerable disruption and suffering for the whole family. But to be clear, it is the eating disorder, not the child, which has caused such an interruption in life.  Anorexia nervosa is a devastating illness, the biological, physiological and psychological consequences of which can cause individuals to think and behave in self-destructive ways. It is important that the family works together as a team to help fight the illness and to keep it from embedding further in their child’s life. FBT therapists assist parents in distinguishing between their child and their child’s illness. This distinction helps the family to avoid blaming the child for disruption and stress that is actually a result of the illness, and also makes it easier for parents to take action when they realize they can nurture their child while simultaneously battling against the illness. As a result, energy can be better spent fighting the anorexia, not fighting with their child who is likely already suffering a great deal.
  3. Because of #1 and #2, FBT requires serious hard work and commitment. I am very upfront with families involved in FBT that they will be their child’s primary support AND that eating disorders are insidious and overwhelming illnesses. FBT is not easy. Fighting a devastating illness that has convinced your loved one they are not sick and that they don’t need help, is going to be a lot of hard work. And while it can be grueling, it is also worth it. When we hosted author Harriet Brown as a guest speaker in 2010, we asked her to share her family’s experience in doing FBT with her daughter, and she spoke to this difficulty and to the benefits of this tenet:When we took on FBT, we took on both the responsibility and the power to intervene. That was a tremendously liberating step. The worst part of my daughter’s illness for me was standing by helplessly, watching her suffer and starve. The notion that my husband and I could help her required a huge mental paradigm shift—but once we made it, we were much more effective.” 

In the beginning, FBT will require a lot of energy- energy to monitor your child’s behaviors, energy to learn different behavioral responses, energy to deal with the emotional and interpersonal changes that may come about through this work. I warn my families about the commitment that it takes and I’m honest about the dedication needed. But I also talk to families about the benefits of short-term work to outweigh the devastating long-term effects of an eating disorder and I share with them the facts.  I talk to them about the serious and significant risks of anorexia- physically, emotionally, cognitively- and I have found that families most often agree that avoiding these risks is worth putting in the work. I tell them that FBT has been shown in research (and in my office) to be the most efficacious treatment for adolescents with anorexia that we know about today.

After committing to and sticking with the treatment, I see families eventually begin to talk about “having [their] child back.” I hear families talk about their child’s increased energy, sense of humor returning, interest in friendships again, and reestablishment in the family. I hear the satisfaction when parents talk about receiving feedback from others who approach them just to say that they have recognized a positive change in their child. Over time, I hear families talk about feeling confident that they helped their child recover. They share that they can once again trust their child to make healthy food choices, and they feel a sense of relief that they no longer have to live with the constant presence of the illness. I hear families tell me that the “fight” with the eating disorder gets easier and less demanding, and eventually they don’t need to engage in the battle at all. 

If you think your family member, or someone you know may benefit from family-based treatment, I would recommend starting by talking to a professional about this option, either your current treatment provider or, if you are not currently in treatment, finding a family therapist who is trained specifically in FBT. The Center for Eating Disorders has several FBT therapists in our outpatient department, and we are happy to answer any questions you may have about this treatment modality. You can email us at EatingDisorderInfo@sheppardpratt.org or call (410) 938-5252. Additionally, we encourage all of the families we work with to utilize the book, Help Your Teenager Beat an Eating Disorder (Lock & Le Grange, 2005) as an educational and supportive resource throughout the FBT process. You can also access an extensive selection of journal articles regarding clinical research on FBT courtesy of Maudsley Parents organization.

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 Written by Laura Sproch, PhD
Individual and Family Therapist
The Center for Eating Disorders at Sheppard Pratt

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Seasonal Depression: Fall-ing into Winter

Fall on the SP Campus...
Does the idea of darkness during your 5pm commute home from work get you down? You’re not alone if you’ve noticed that it’s not just the flowers in your garden but also your mood that has “wilted” with the cooler temperatures. During the fall and winter months, people may experience a shift in their mood as we collectively adjust to less sunshine and more cold weather. But it might be more than just “the blues” if it is a persistent sadness that feels present most days and is interfering with your ability to function or engage in day-to-day life. If this is a pattern that’s occurred for at least two years in a row and impacts you at the same time each year, it might be Seasonal Affective Disorder.

Seasonal Affective Disorder (SAD)
Many people around the world suffer from SAD, now identified in the DSM-5 as Depressive Disorder with seasonal pattern. It is suspected that seasonal depression is, in part, caused by a reduced exposure to sunlight resulting in disruption to our natural circadian rhythm (the body’s “internal clock”), as well decreased levels of the hormones serotonin and melatonin which help to regulate mood, sleep and appetite. Not surprisingly, populations living farther from the equator experience higher rates of seasonal depression than places closest to it. Thus, this type of depression occurs more frequently in populations throughout the northern rather than southern parts of the United States. In fact, one study found prevalence rates to be 1.4% in Florida and a much higher 9.7% in New Hampshire. (1)  Much of the research also indicates younger people and women tend to be at higher risk for winter depressive episodes.

People who already struggle throughout the year with clinical depression or bipolar disorder may also experience worsening symptoms during specific seasons. For those with seasonal depression, the episodes of depression that occur in the fall/winter are significantly greater than those episodes that occur throughout the remainder of the calendar year. In any case, it’s important to pay attention to seasonal patterns in your mood so that you can prepare and seek appropriate treatment and support as needed.

Common symptoms of seasonal depression
Seasonal depressive episodes generally set in during late fall or early winter. Some of the most common signs and symptoms include:

  • decreased energy, lethargy
  • increased sleep, difficulty waking
  • social withdrawal and loss of interest in activities previously enjoyed
  • increased appetite, unintended weight gain
  • persistent sadness, hopelessness
  • difficulty concentrating or focusing on tasks

(Though less common, some people experience spring/summer depressive episodes and those symptoms can look a little different, more often encompassing sleeplessness, irritability, decreased appetite and weight loss, etc.)

How might seasonal depression affect people with eating disorders?
A depressive episode can impact eating patterns and thus, impact eating disorder recovery efforts.  Individuals suffering from seasonal depression often report increased appetite. Specific studies have indicated that individuals with SAD tend to experience more cravings for foods that are higher in carbohydrates and rich in starch and report increased consumption of carbohydrates when depressed, anxious or lonely. (2)  Combined with decreased energy and declining mood, these cravings can place one at higher risk for binge eating behaviors.

Other research has shown a seasonal component to depression especially for those individuals suffering from Bulimia Nervosa. (3)  The research revealed that patients with Bulimia Nervosa tended to experience seasonal patterns of mood and appetite similar to those described by many with SAD. (4)  Some research has further speculated with regard to a possible genetic link between eating disorders and susceptibility to changes in mood related to the season. (5)

Treatment Options for Individuals affected by seasonal depression
So what can you do when the light outside your window has turned to darkness and, perhaps, this has added fuel to the eating disorder fire as well? The good news is that there are many different treatment approaches that are helpful to those suffering from seasonal depression.

  • Light therapy or Phototherapy is a commonly prescribed treatment for individuals suffering from seasonal depression. In light therapy individuals sit in front of a “light box” for approximately thirty minutes daily or per their doctor’s recommendation. Research has shown that light therapy can relieve the symptoms of seasonal depression in as many as 70% of cases. (6)
  • Anti-depressant medications can also be helpful in treating winter depression and have been shown to improve mood, energy and sleep patterns. One of the ways in which these medications work is by increasing serotonin levels in the brain.
  • Evidence-based therapies for depression such as Cognitive Behavioral Therapy (CBT) can also be helpful for seasonal depression.
  • Behavioral interventions in your daily life can also be helpful in reducing symptoms of seasonal depression. Consider trying to incorporate some or all of these:
    1. Engage in activities with friends and family each day to ward off feelings of lonliness or isolation.
    2. Make a point to get outside in the sunlight for at least a portion of the day if possible. Schedule a walk with your colleague during break or sit outside instead of inside while you do your daily perusing of Facebook, however…
    3. Be mindful about whether online social networks make you feel worse instead of better OR if they take up large amounts of time that could be better spent connecting with people in person (see #1 above).
    4. Plan to get plenty of sleep on a consistent schedule; do your best to go to bed and wake up at the same times each day, and aim for 7-8 hours of sleep/day.
    5. Avoid the use of alcohol or other substances which can worsen depressive symptoms, complicate eating disorder symptoms and disrupt sleep.

Focus on the highlights of the changing season.
If you struggle with seasonal depression, a long autumn and the approaching winter can feel daunting. Holiday stress, can make things even more difficult for individuals who are triggered by tense family dynamics, elaborate meals and social gatherings. This year, Instead of focusing on the doldrums of the season or annual stressors, consider looking for positive seasonal activities in which to get involved. Now is the perfect time to go to a holiday parade, paint a room in your house a new color, volunteer for a new cause, plan a weekend getaway, attend a recovery event, build a snowman or read a winter-themed book. It could also be a great opportunity to finish your summer vacation scrapbook or try a new activity like snow tubing or ice skating. You can even practice guided imagery or meditation – just because there is snow outside it doesn’t mean you can’t imagine yourself relaxing on a warm beach.

Try not wish away the winter season.  Each season comes with its own set of challenges for individuals with eating disorders – just think of the onslaught of diet pressures throughout spring or the bathing suit saga of summer.  So the key is not to just “get through” each season (there will be a new set of stressors on the next calendar page after all) but to learn to live mindfully in each season and find ways you can enjoy what it has to offer.

Above all else remember to ask for help when you need it. Talk to your treatment providers about your seasonal mood changes and they can help to devise an individualized treatment plan that works for you. If you are seeing a Registered Dietitian now is the time to talk with them about the food cravings you might be experiencing and devise an approach to cope and integrate more variety into your meal plan. Remember to open up and involve your support system– let your friends or family be a part of the process by sharing with them what you are going through. With help and support, you’ll be celebrating the Vernal Equinox in no time and reflecting on a well-spent, memorable winter.

For questions about treatment for co-occurring depression and eating disorders, please visit our website at www.eatingdisorder.org

Written by Amy Scott, LCPC

 

References:

  1. Friedman, Richard A. (December 18, 2007) Brought on by Darkness, Disorder Needs Light. New York Times’’.
  2. Krauchi, K., Reich, S.,& Wirz-Justice, A. (1997). Eating style in seasonal affective disorder – who will gain weight in winter? Compr Psychiatry, Mar-April, 38 (2). 80-87.
  3. Lam, R.W, Goldner, E.M., & Grewal, A. Seasonality of symptoms in anorexia and bulimia. International Journal of Eating Disorders. 1996. Jan 19 (1): 34-44.
  4. Fornari, V.M, Braun, D. L., Sunday, S.R., Sandberg, D.E., Matthews, M, Chen, IL, Mandel, F.S., Halmi, KA & Katz, JL (1994) . Seasonal Patterns in Eating Disorder Subtypes.Compr Psychiatry. Nov /Dec; 35 (6): 450-456.
  5. Sher, L. (2001). Possible Genetic Link Between eating disorders and seasonal changes in mood and behavior. Med Hypothesis, Nov 57 (5): 606-608.
  6. Wein, Harrison ed. (2013). Beat the winter blues shedding light on seasonal sadness. NIH News in Health. Retrieved from http://newsinhealth.nih.gov/issue/Jan2013/Feature1.

 

Body Image & ACT: Q&A with Author and Psychologist Emily Sandoz, PhD


The collective response to negative body image often includes an attempt to convince people to love their bodies, to embrace every imperfection and to do away with all negative thoughts.  These can be difficult, if not impossible, tasks for most people, particularly amidst the backdrop of a culture that encourages body bashing and a very narrow ideal of “beauty”.  For many individuals, negative thoughts about their bodies are so deeply entrenched that it feels too big of a leap to move from hating their bodies to falling madly in love with them. So if you’re not ready to love your body, what’s left to do?  Emily Sandoz, PhD, along with co-author Troy DuFrene, propose a different path in their new book, Living With Your Body & Other Things You Hate: How to Let Go of Your Struggle with Body Image Using Acceptance & Commitment Therapy. 

In anticipation of our upcoming Fall Community Event, we conversed remotely with Dr. Sandoz to find out more about her work with body image, Acceptance & Commitment Therapy (ACT), and of course, the soon-to-be-released book.  Read on to learn more about ACT and don’t forget to RSVP for Dr. Sandoz’s free presentation in Baltimore on November 17th, 2013, or download the event invitation (pdf).

 

Q & A with Emily Sandoz, PhD

Q: What was your  motivation for writing Living With Your Body & Other Things You Hate: How to Let Go of Your Struggle with Body Image Using Acceptance & Commitment Therapy (due out Jan. 2013)?

ES: Well, a couple of things. First, I find myself more and more aware of how body conscious we are.  At a very early age, people begin evaluating themselves in terms of their body’s appearance or functioning. For many, this can become a primary means of self-evaluation, becoming more of a focus than other things that person really values or strives for.  Further, I think the general public receives mixed messages about what they are supposed to do with those evaluations.  Are they wrong evaluations? Should they always evaluate themselves positively, always love the body? Should they change their bodies? Is it our responsibility to look good, to be strong and physically capable?  This book suggests that all that struggle to manage our thoughts and feelings about our bodies, or even manage our bodies themselves, can just lead to more and more struggle. We suggest that healthy body image is about body image flexibility – being able to receive our experiences of our bodies, good and bad, and to relate to ourselves and the world meaningfully, regardless of those body experiences.

Q: Many people engage in deep and serious battles with body image on a daily basis.   What are the possible repercussions of going through life hating your body? 

ES:It stands in the way of other things that are more important. You can’t help being critical of the way your body is.  That’s what minds do – they are critical.  They have to be!  But hating is getting entrenched in those self-criticisms.  Letting them drive your behavior, so you end up living your life more about managing your self-criticisms than about your relationships, or your career, or your spirituality – whatever is most important to you.

Q: What are the main tenets of Acceptance & Commitment Therapy?

ES: ACT (said as the word “act”) is based on the idea that healthy living is characterized by psychological flexibility, or the ability to experience ourselves, others, and the world fully and without defense, while taking action toward the things we care about, even when it is painful or scary. Not having this psychological flexibility is actually a driving factor in creating psychological stress and problems such as depression, anxiety and eating disorders.  It’s not our experiences (our thoughts or feelings) that are problematic, it’s all the things we do to try to get rid of them.  Those things interfere with the life worth living.

[Psychological flexibility spans a wide range of human abilities to: recognize and adapt to various situations; shift mindsets or behavior to preserve personal or social functioning; maintain balance among important life domains; and commit to behaviors that are congruent with our values. source: Kashdan & Rottenberg, 2009]

Q: What does the research say about the effectiveness of ACT for body image and eating disorders?

ES: This is a relatively new area, to be sure, but preliminary data coming from a number of different labs are largely supportive of the application of ACT to body image and eating disorders.  My own work in this area has recently moved to basic research, focusing on the nature of body image inflexibility, how it develops, and how flexibility can be trained. My hope is that this work can complement the treatment research by promoting continued development based on better understandings of body image flexibility and inflexibility.

Q: Many people are familiar with Cognitive Behavior Therapy (CBT) and Dialectic Behavior Therapy (DBT) but may be less knowledgeable about ACT.  What are the main differences between ACT and other evidence-based treatments for eating disorders and body image such as CBT and DBT? 

ES: Well ACT is a cognitive behavior therapy, but it differs from many CBT’s in that it challenges the idea that thinking must change for observable behavior to change.  In this area, ACT posits that healthy body image and eating does not depend on challenging critical thoughts about the body. It depends on learning to engage in meaningful, values-based action regardless of what thoughts are coming up.

Q: “Acceptance” can be a difficult concept for people to really understand and put into practice.  Why is this?  And what’s the most effective way to define or describe acceptance as it relates to body image?

ES: It’s tough because we sometimes think acceptance means liking or tolerating tough experiences.  Applied to body image, acceptance simply means making room for all thoughts and feelings about the body, whether we like them or not.

Q: What are the potential barriers to “letting go” of one’s struggle with body image? To that same point, what are the possible benefits?

ES: We are trained from a very early age that things that hurt are wrong, that we are responsible for managing our feelings.  In the case of body image, we are also taught that managing our bodies is our responsibility.  We are taught that it’s right to struggle, that we should feel good and look good, and we should be willing to struggle to get there. Because of this, considering letting go of that struggle is hard to even imagine. We find ourselves wondering what would happen to our experiences of our bodies if we stopped struggling. Would our bad feelings about the body completely overwhelm us if we weren’t managing them?  And what about our bodies themselves? If we weren’t struggling – Would we suddenly become grotesque? Would our bodies become completely disabled?  Of course, letting go of the struggle does mean that we expose ourselves to all kinds of hurt that we don’t like having.  Only letting go of that struggle frees us up to do other things that are more important – to allocate all those resources to the things we really care about, even when it hurts. And we know it’s going to hurt because we feel most vulnerable when we’re going after the things we want. So in ACT, we practice doing that, in the presence of the worst kinds of body hurt.  It’s not just hurt anymore, though, it’s hurt with a purpose.

Q: You talk in your new book about the idea that acceptance “isn’t something you do once”.  Can you elaborate on that notion?

ES: Well, it’s not like we pass through some portal where suddenly we are all-accepting and the work is done. It takes practice.  We think we’re doing great, then we suddenly notice all these new ways of inflexibility showing up, these new scary or painful thoughts coming up.  It’s just human nature.  Working on body flexibility is a lifetime commitment to making the things that matter to you more important than managing your experience of your body.

Q: Where does the element of “Commitment” come into play when working on body image struggles?

ES: Building a lifelong pattern of flexibility takes commitment. From an ACT perspective, commitment means noticing when we are being inflexible, when we are working to move away from ourselves and our own experiences, and simply turning back.

Q: What are some of the other areas in life in which the principles of ACT might be beneficial?

ES: Any area of life that is, for you, characterized by attempts to manage your experiences instead of managing the meaning in your life is an area of life that might benefit from the ACT principles.  And the ACT community provides a wealth of resources for people looking to do this kind of work. The Association for Contextual Behavioral Science website has a whole section for folks who are looking for support applying these principles in their lives, and New Harbinger publishes a number of self-help books for a range of difficulties people experience.

Q: On November 17, 2013 you will be in Baltimore speaking about How to Let Go of Your Struggle with Body Image.  What do you hope people will take away from this event and who could benefit from attending?

My main hope is that people may leave curious. Curious about how they struggle with their body image and what costs that has in their lives. Curious about how their lives might look different if they let go of the struggle with body image and embraced their experiences of their body, painful or pleasurable.  Curious about how they might use the time and energy if they weren’t spending it on the body image struggle.

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Emily K. Sandoz, PhD, is assistant professor of psychology at University of Louisiana at Lafayette, LA. She is a therapist who specializes in treating clients using acceptance and commitment therapy. Sandoz is coauthor of Acceptance and Commitment Therapy for Eating Disorders and The Mindfulness and Acceptance Workbook for Bulimia. She received her doctorate from the University of Mississippi, and she lives and works in Lafayette, LA.

On November 17th, Dr. Sandoz will be the featured guest speaker at The Center for Eating Disorders at Sheppard Pratt‘s fall event, How to Let Go of Your Struggle with Body Image.  Click on the link to find out more about the FREE event and to reserve your seats.

The Center for Eating Disorders at Sheppard Pratt offers outpatient therapists trained in Acceptance & Commitment Therapy. If you’re interested in this type of therapy and would like to find out more about starting treatment for an eating disorder and/or body image, please call us at (410) 938-5252.

 

Recovery Word Cloud

As part of our {Saturdays} {Sharing} {Support} series, we recently asked our Facebook followers to share the ONE word they would use to provide motivation and encouragement to other individuals or families in the recovery process.  This word cloud is a compilation of the wonderful responses we received both online and in groups here at CED. We’re thinking it might not be such a bad thing to have your head in the clouds after all.

  Thank you to everyone who participated on Facebook and shared your recovery motivation.  If you’re new to the CED blog, join us on Facebook and Twitter for ongoing recovery motivation and education about eating disorders and body image.

What is ARFID?

In the last few months, you may have heard people talking about the “DSM-5” which was just published in May 2013 – this is the latest edition of the manual that mental health clinicians use for diagnosing psychiatric disorders. Formally, the DSM-V is The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.  The newest addition includes several changes to the way eating disorders are categorized and diagnosed.  This post will delve into one of those changes, specifically a new diagnosis called Avoidant / Restrictive Food Intake Disorder (also known as ARFID).

When a person is diagnosed with any type of mental health disorder by a treatment professional, it essentially means they meet a certain number of diagnostic criteria set forth by the DSM-V, in much the same way that someone would meet criteria and be diagnosed with a medical ailment such as heart disease or diabetes. The goal of diagnosing specific disorders is not to label or stigmatize a person but to capture their specific struggles and unique characteristics. This allows treatment providers to develop the best possible treatment plan and apply evidence-based interventions.

The DSM-V provides the following diagnostic criteria for ARFID:

A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

1.  Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
2.  Significant nutritional deficiency.
3.  Dependence on enteral feeding or oral nutritional supplements.
4.  Marked interference with psychosocial functioning.

B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.


So what does all this mean in plain English?

Individuals who meet the criteria for ARFID have developed some type of problem with eating (or for very young children, a problem with feeding). As a result of the eating problem, the person isn’t able to eat enough to get adequate calories or nutrition through their diet. There are many types of eating problems that might arise – difficulty digesting certain foods, avoiding certain colors or textures of food, eating only very small portions, having no appetite, or being afraid to eat after a frightening episode of choking or vomiting.

Because the person with ARFID isn’t able to get enough nutrition through their diet, they may end up losing weight. Or, younger kids with ARFID might not lose weight, but rather may not gain weight or grow as expected. Other people might need supplements (like Ensure or Pediasure or even tube feeding) to get adequate nutrition and calories. And most of all, individuals with ARFID may have problems at school or work because of their eating problems – such as avoiding work lunches, not getting schoolwork done because of the time it takes to eat, or even avoiding seeing friends or family at social events where food is present. A good example would be a young boy who almost choked on a hot dog one time, but now refuses to eat any type of solid food and can’t eat school lunches or even enjoy a taste of his own birthday cake. Another example might be a young girl who seems to have no interest in food, complains that “I’m just not hungry” and, as a result, eventually ends up losing weight.

What ARFID is not

It is important to be sure that the person’s problem with eating is not due to a lack of food or “food insecurity”. In other words, children living in poverty who don’t get enough to eat (and as a result are not growing as expected) would not be given the diagnosis of ARFID. An individual living in a famine (who loses weight because they are starving) would not be given the diagnosis of ARFID. It is also important to remember that the eating issues in ARFID are not related to a normal cultural or religious practice. For example, a person who is fasting during a religious holiday (such as Lent or Ramadan) would not be given the diagnosis of ARFID.

We know that individuals with anorexia or bulimia struggle with distortions in how they see their bodies and that they have significant concerns about their weight. But this type of thinking does not occur in ARFID – kids with ARFID typically don’t fear weight gain and don’t have a distorted body image. Also, in ARFID, the problems that people have with eating are not related to underlying medical problems. For example, a child going through cancer treatment might lose her appetite and avoid food because of chemotherapy – but this child would not be given a diagnosis of ARFID. Another example might be a teenager who is obsessed with a fear that he is going to ingest germs and get sick, and therefore refuses to eat any uncooked foods – this teenager would probably be given a diagnosis of obsessive-compulsive disorder rather than ARFID.

Filling in the gaps

Although ARFID is being presented as a new diagnosis, it might be more useful to simply consider it as a way of describing symptoms more specifically. A lot of patients with eating disorders don’t “fit” perfectly into a diagnosis of anorexia nervosa or bulimia nervosa – and so, prior to the release of the DSM-V, clinicians would often give those folks the diagnosis of Eating Disorder, Not Otherwise Specified (EDNOS). Unfortunately, if you say that someone has EDNOS, it doesn’t really give us much information about the person’s symptoms, other than that they have some kind of eating disorder.

In the past, before the DSM-V, kids with ARFID might have been diagnosed with EDNOS. They also could have been given another diagnosis called “Feeding Disorder of Infancy or Early Childhood” (although most clinicians didn’t use that diagnosis especially since one of its requirements was that the age of onset has to be before age six). But what about those kids or adults who have restrictive eating not related to fear of weight gain, who may or may not be a normal weight, and whose lives are severely impacted by their symptoms? This is where ARFID can fill in the gaps and help us to better understand those individuals.

As ARFID is officially still a new diagnostic category, there is little data available on its development, disease course, or prognosis. We do know that symptoms typically present in infancy or childhood, but they may also present or persist into adulthood. It is possible that some individuals with ARFID may go on to develop another eating disorder, such as anorexia nervosa or bulimia nervosa, but again, no research is available yet to give a clear picture of what happens down the road for these individuals. We also are still learning about effective treatments for individuals with ARFID. Although research is just beginning, we believe that behavioral interventions, such as forms of exposure therapy, may be useful. And of course, as in other eating disorders like anorexia or bulimia, treatment of underlying conditions such as anxiety or depression is crucial.

Many kids develop different or strange patterns of eating at some point in their life – refusing to eat vegetables for a few months, or wanting to eat only chicken nuggets for dinner – but for most individuals, those patterns eventually resolve on their own without intervention. For the small subset of individuals who have persistent or worsening problems with food intake, however, the introduction of ARFID means we are now able to better diagnose and describe their symptoms, which should ultimately result in better clinical outcomes.

The most important takeaway point in all of this? Eating disorders come in all shapes, sizes, and symptoms, and if you have questions or concerns, just ask.

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References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association, 2013.

Kenney L, Walsh B. Avoidant/Restrictive Food Intake Disorder (ARFID) – Defining ARFID. Eating Disorders Review, Gurze Books, 2013; Vol 24, Issue 3.

 Written by Heather Goff, M.D., Child & Adolescent Psychiatrist

 

Yoga for Body Awareness & Acceptance

Yoga is defined as a “union” or the coming together of our separate aspects – body, mind and spirit – into one harmonious relationship.  It is often described as the experience of finding balance, or existing in the place between doing and being.

Eating Disorders & Yoga

In the midst of an eating disorder this balance, or union, between body and mind is often upset. Individuals with eating disorders often experience negative body image, and typically have significant difficulty embracing or nurturing their bodies in nonjudgmental ways.  Furthermore, the mind is often exhausted with negative thoughts about altering the body.  The mind may also be preoccupied with rigid and relentless food rules or thoughts about acting on symptoms which are harmful to the physical body.  Some might say that eating disorders represent the antithesis of a body-mind union as the two parts are often at war with each other.

Yoga room

CED’s new yoga room

Individuals with anorexia (AN), bulimia (BN), binge eating disorder (BED) and other specified eating disorders commonly suffer from co-occurring anxiety and/or depression.   These illnesses can further complicate one’s ability to practice mindfulness or establish a mind-body union.  Given that body awareness and mindfulness can be such powerful tools in the journey towards eating disorder recovery, individuals may benefit from trying new and enjoyable ways to incorporate them into their lives.  One of these ways is through a practice of yoga.

Yoga as an Adjunct to Evidence-Based Eating Disorder Treatment

The practice of yoga is well-suited to provide a number of specific benefits for individuals with eating disorders because of its gentle use of the body and the incorporation of mindfulness skills.  Other therapies that incorporate a mindfulness component, like DBT, have been shown to be beneficial to eating disorder recovery.

It has long been accepted, and a number of formal studies have shown, that practicing yoga can help reduce stress and anxiety. It can also enhance your mood and overall sense of well-being.  Yoga has been utilized in the treatment of various conditions including chronic pain, depression, and heart disease.  While there is limited research on the specific effects of yoga for individuals with eating disorders, initial findings are promising but more randomized controlled trials are needed. Many of the research studies on yoga for eating disorders thus far have been fairly small.  In general, those small studies seem to support the efficacy of yoga as an adjunct treatment for anorexia, bulimia and binge eating disorder but more research is needed.

Nourishing Body and Mind at The Center for Eating Disorders

At the Center for Eating Disorders patients explore and develop many coping skills through individual therapy, family therapy, group therapy, art therapy, occupational therapy and CED Leafnutritional counseling.  Through the application of evidence-based treatments such as Cognitive Behavioral Therapy, Dialectical Behavior Therapy and Family-Based Treatment, our patients learn to utilize tools like symptom blocking, grounding skills, deep breathing, emotion regulation, relaxation,  goal setting, leisure exploration and communication. Our goal is to teach the individual to nourish and nurture the body, through proper nutrition as well as through holistic care and attention.

In addition to these existing modalities, The Center for Eating Disorders is now offering Yoga for Body Awareness and Acceptance as an additional way for patients to work on healing their bodies and calming their minds.  Within the context of the group setting, our qualified yoga instructor will guide patients through Asana (poses), Meditation, Guided imagery, Pranayama (breath work), and a cultivation of a nonjudgmental attitude towards the physical body.  Through yoga, patients will experience gratitude for a body that is healthy enough to carry them through life.

Yoga for Body Awareness and Acceptance

In this particular yoga practice, patients will utilize asana to bring awareness to the physical body while connecting breath to movement.  The instructor will help individuals utilize meditation to cultivate mindfulness and a compassionate awareness of what is occurring in the present moment in the physical body without judgment of that moment. Standing postures will be used to promote stability, strength, and balance cultivating an outward focus as well as seated postures to promote internal focus, healing and flexibility.  Groups will also include positive affirmations.  Yoga for Body Awareness and Acceptance will encompass elements of both restorative yoga and gentle yoga, each of which are described below:

Restorative Yoga
Brings recuperation to the organs, nervous system and consciousness. Using long holds to soothe the mind and encourages the student to have an inward focus. With more description and commentary accompanying the postures.  The slower pace of practice will awaken and encourage deeper openings in the physical body. This class is appropriate for all levels of practitioners. Typically utilizing props like blankets and blocks. Most if not all poses are seated or reclined poses. Poses are held for 3-4 minutes, while the teacher reads to the student, or plays music.

Gentle Yoga
Focuses on deep relaxation, rejuvenation, and healing. It promotes physical and mental fitness through poses, breathing exercises, readings, guided imagery, relaxation, and meditations. Appropriate for all levels and ages, especially those new to yoga or seeking a soothing practice. Includes standing and seated postures as well as some vinyasa (flow).

It’s important for individuals to know that yoga is not a standalone treatment for eating disorders. Utilizing Yoga as a complementary eating disorder treatment involves specific elements of yoga practice and should be facilitated by a qualified professional who is familiar with the unique mental and physical aspects of eating disorders.  Yoga for body awareness should not incorporate excessive exercise. Rather, the physicality of yoga should be a means through which the therapist or yoga instructor can supervise a patient’s meditation.    Given the potential medical consequences of eating disorders, individuals should never engage in yoga or other forms of physical movement without prior consent from their treatment providers.

Meet CED’s Yoga Instructor

SZ - yoga instructor

Sarah Ziemann  RN, BSN, RYT 500, Certified Yoga Instructor 

Sarah’s love for Yoga began in 2003 when she received the Book “The Heart of Yoga” in which yoga is explored specifically with adapting to the individual at any age, lifestyle and current state of health. Sarah has worked as a Registered Nurse at the Center for Eating Disorders since 2009. She completed her advanced yoga training at Baltimore’s own Charm City Yoga Center, studying under Kim Manfredi Blades. 

More, More, More: The Dangers of Excessive Exercise

There is such a thing as too much exercise

Media messages encouraging us to exercise away our “flaws” are rampant, particularly in these summer months when many people are self-conscious about wearing bathing suits and dressing for warmer weather.   We’re nearly halfway through summer but the seasonal cultural pressures to attain the “perfect” beach body are still in full swing. The relentless marketing often focuses on incorporating the most strenuous new workouts, squeezing in more time at the gym, pushing just a little bit harder and faster every step of the way.  When it comes to exercise, the message almost always seems to be more, more, more.

It’s true that staying active and engaging in exercise is a positive activity that can have long-lasting benefits for physical and mental health.  However, it becomes increasingly important in our “faster, longer, harder, more” exercise culture to ask ourselves, can you have too much of a good thing? The Answer:  Absolutely.

 

More is not always better.

Exercise can quickly become unhealthy when taken to extremes or when the body is not equipped with proper nourishment.  Individuals who struggle with perfectionism, rigidity, obsessive/compulsive behavior, addiction or eating disorders are particularly at-risk for engaging in over-exercise (also referred to as exercise abuse or obsessive exercise.)  These individuals often start out with moderate exercise goals in an attempt to change their weight/body shape but can easily slip into patterns that become compulsive.

Often, the same messages that promote extreme exercise also encourage people to ignore their body’s cues – to push past pain and exhaustion in order to reach goals.  But when you override your body’s need for rest, healing, or even medical attention, it can have long-term negative consequences on health, not to mention on overall fitness and athletic performance. Furthermore, exercise and weight loss goals may gradually become more and more extreme, and thus more and more dangerous. It’s important to note that even individuals who do not appear underweight, may be exercising obsessively or working out beyond what is healthy for their body.  Even high caliber athletes are at risk.

“It is no secret among athletes that in order to improve performance you’ve got to work hard. However, hard training breaks you down and makes you weaker. It is rest that makes you stronger. Physiologic improvement in sports only occurs during the rest period following hard training.” [Overtraining Syndrome]

 

Signs & Symptoms of Excessive Exercise
Because exercise is such a socially acceptable and culturally applauded behavior, it can be difficult to identify when someone is engaging in healthy activity and when they may have crossed the line to over-exercise.  It’s particularly important for coaches, trainers, fitness instructors and other professionals in the exercise industry to be aware of the warning signs and red flags that someone may be struggling with obsessive exercise.  These are just some of the signs that an individual may have an unhealthy relationship with exercise:

  • Exercises above and beyond what would be considered a normal amount of time (For athletes, prolonged training above and beyond that required for the sport)
  • Refusal to build in days of rest or recovery; Exercises despite injury or illness
  • Athletic performance plateaus or declines (Overtraining Syndrome)
  • Rigidity, inflexibility regarding exercise schedule
  • Excessive concern with body aesthetic
  • Withdrawal effects (sleep/appetite disturbance, mood shifts, intense anxiety) and feelings of depression or guilt when exercise is withheld
  • Exercise is prioritized over family, work, school or relationships (sometimes to the point of neglecting important responsibilities or obligations)
  • Exercise is the person’s only way of coping with stress
  • Deprives self of food if unable to exercise (feels he/she has not “earned” or “does not deserve” the calories)
  • Defines overall self-worth in terms of exercise performance
  • After workouts, is plagued by thoughts like “I didn’t do enough” or “I should have done more”
  • Rarely takes part in exercise for fun. Activities like hiking, paddle boarding, etc, don’t seem like “good enough” exercise.

If you or someone you know identify with this list, it may be time to step back and take an honest assessment of the exercise relationship.
Excessive exercise not only interferes with an individual’s daily life and interpersonal relationships, but it is also dangerous. Excessive exercise can easily result in overuse injuries and stress fractures which could be temporary or permanent.  Women may have menstrual irregularity and men may experience a decrease in testosterone.  Among the many other potential consequences, exercising too much can lead to decreased immunity and frequent colds or illnesses.  Over-exercise is often a sign of an underlying eating disorder.  Furthermore, recent research found that the frequency of over-exercise predicted suicidal gestures/attempts and concluded that excessive exercise should be noted as a potential warning sign of suicidality among individuals with bulimia. [source: Eating Disorders Review,  May/June 2013]

If your body is telling you that it needs a rest…
You should never exercise when you are sick or injured. When you have a fever, fatigue or muscle injuries, take the day off to help your body heal.  Even a very healthy body needs adequate rest in between workouts.  It’s recommended that you take at least two days off a week to allow your body time for healing and recovery.  Also, make sure that you are properly providing your body with enough carbohydrates, dietary fats, proteins and water to fuel your workouts. Proper hydration is critical when working out.  Dehydration can lead to overheating, muscle fatigue, headache, nausea and it impairs your body’s ability to transport oxygen.

Maintain a Healthy Relationship with Exercise
There are many ways to have a healthy relationship with exercise. First, it is extremely important that you have spoken to your doctors and they have all cleared you for exercise. Just like many things in life, moderation is the key to success.  Focus on establishing a balance between working out and other experiences, relationships and responsibilities in your life.  Consider combining a variety of activities that you enjoy and are convenient to your lifestyle instead of becoming overly attached to one type of exercise for a specific amount of time each day.  Hiking, golfing, dancing, biking, tennis, kayaking and taking your dog for that much needed walk are great ways to be active in different ways. Remember that the goal of healthy exercise is not to change your body but to care for your body so that it will allow you to enjoy your life.

If you think you may be struggling with excessive exercise, we encourage you to talk with someone close to you and seek help to establish a healthier relationship with exercise. You can also visit www.eatingdisorder.org or call us (410) 938-5252.

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Additional Resources:

The Exercise Balance: What’s Too Much, What’s Too Little, and What’s Just Right for You! By Pauline Powers M.D. and Ron Thompson Ph.D.

In response to Dr. Drew ~ Exercise bulimia is not a mild mental health issue (on the CED blog)

 Blog contributions by Amy Gooding, Psy.D., CED Therapist