The Center for Eating Disorders Blog

Connecting with EMME on Body Image, Beauty and Balance…

The Center for Eating Disorders at Sheppard Pratt is gearing up for a week of free community events in recognition of National Eating Disorder Awareness Week 2013. To help us kick things off, supermodel and positive body image advocate, Emme will provide a special keynote presentation in Baltimore entitled “Connecting BODY+MIND+SPIRIT” on February 24th, 2013. In advance of this free event, we asked Emme to share her unique insights into the current cultural ideals regarding beauty and to comment on some of the key elements that have helped her establish a positive, balanced relationship with her body, mind and spirit throughout her career.

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Q & A with Emme Aronson:

Q: Through your development of EmmeNation and your role as an Ambassador for the National Eating Disorder Association, you have become a powerful advocate for positive body image. What does the term body image mean to you and how did it come to be such a significant part of your overall message of self-acceptance?

Emme: Body image is the framework for the house where our soul resides. If the foundation is weak, the house crumbles and the soul cannot fully exhibit its magnificence. How we live day-to-day depends on whether or not we have a connective or disassociated connection with our soul and our body.

Often we live from the neck up in a constant, not fully self-accepting state so to speak. By not breaking this chain of self loathing, body bashing, and guilt, dis-ease within one’s self grows and negativity cycles infinitum. At the same time a select few get richer at the cost of millions being diseased or disconnected each day, even each hour if engaging in large doses of media/TV.

It has always been my opinion that only by taking responsibility for one’s health and well-being of the mind, body and spirit, all parts moving in unison together as a befriended system, will we ever be set free from the onslaught of purely capitalistic influences. Our vitality of health, not to mention our culture and the imminent sustainability of our environment,depends on this effort.

Q: What would you say are some of the biggest pressures facing women and girls today that impact the way they experience their bodies and their inner selves?

Emme: I feel it’s the “capitalism-at-all-costs” mentality which, sadly, gets carried on the backs of women starting at an early age. This constant reminder of inadequacy plants insecurity where there once was none, or the seeds may get passed down generationally from mothers to daughters. With the hypersexualized advertising culture in full swing today, these dormant seeds are watered and the negative impact on body image, self-esteem, goal setting, visualization, and accomplishments rolls on, eroding the cornerstone of our society – women and children.

Q: What has your modeling career taught you about your relationship with your body?

Emme: Coming from a news media background, I immediately saw the lack of body diversity in the reporting of beauty. The story was loud and clear that natural body diversity was not to be discussed in mainstream media, and if it was, you were not to highlight it or shoot beautiful, size diverse models side-by-side. This was due to pressures caused by astounding amounts of money being dumped into diet related advertising (based on products with a 98% failure rate). The diet industry today probably makes well over a hundred billion dollars a year. (Psychology Today stated 50 billion in 1997, up from 30 billion in 1987). Understandably, a conflict of interest precedes that kind of money, especially when in uninformed hands. So its my job, and the job of other NEDA ambassadors, to reach out to the media as best we can to share best practices in reporting on body and eating related issues via the protocol presented to networks, women’s magazines and online outlets. An informed media gives them the opportunity to do good and make a choice, which is the best case scenario.

Q: The fashion and beauty industries often receive a lot of criticism for the role they play in pressuring women (and men) to look better, thinner, different, “perfect”, etc. How have you managed to balance your interests in fashion and beauty with your message of self-acceptance and inner beauty.

Emme: Having regularly been involved in the beauty, fashion, TV and clothing industries during different parts of my 20+ year career, I work on maintaining a balance between all the influences. I’m sure I have ruffled a few feathers when I’ve refused to say a line for a commercial, submitted a suggested rewritten line for a show, or refused commercial opportunities worth a lot of money because they didn’t align with my brand. I know a few people thought I was too righteous or full of myself but at the end of the day, I realized I didn’t need to defend myself but instead, had to go by the feeling I had in my gut. Your gut is a wonderful guide, if it’s tight and constricted, wait on whatever is in front of you. If you feel ease and grace, move forward. You may not understand what’s holding you back but listen to that innate guide that’s been with us since the beginning of time. That sensation doesn’t lie. It sometimes takes a lifetime to be still and feel it but, more times than not, it’s right.

Q: At various points in your life you’ve been faced with significant challenges, including a cancer diagnosis, which have surely tested you emotionally and physically. How have you managed to maintain a gratitude-driven existence and a positive relationship with your body throughout these ups and downs?

Emme: If I didn’t have the hearty body that I have, my cancer and treatments during chemo would have wrecked me. I feel today that cancer was one of my best teachers on so many levels.

However, where I gained the most appreciation for my curvaceous body was when I was pregnant. I absolutely loved being able to carry a child and know I was holding this new life in me. Regardless of the fact that my body gained 70 pounds and I was very large, I felt, without a doubt, that this was what my body was meant to do and I embraced myself at every stage. I even did a photo shoot (with all my bits covered but pretty much nude) and it’s one of my favorite shots.

Q: What is your favorite or most useful piece of advice for individuals who still struggle to find peace with their bodies on a daily basis?

Emme: Develop your list of gratitude and concentrate on that list until the anxiety of not being perfect subsides. This stops me before negative self speak rears it’s angry head. (Granted this sometimes takes years to work, but never giving up breeds success). After repeating this often enough like a trained dog, you come to realize you are much more than the empty shell we call our body. Instead of value being based on shape or size, a person’s true value has a chance to rise and nourish the individual and those around them, shining light on personal character traits like: helpfulness, friendliness, playfulness, bravery, courageousness and so on. Once again, take away the soul and you’ve got nothing, just bones, tendons, muscle and fat.

Q: In addition to your work in the U.S., you’ve been active globally with efforts to help women develop positive relationships with their bodies. Can you tell us more about some of these international efforts?

Emme: I’ve been so blessed to have been given the chance to travel a great deal domestically as well as internationally for my work. As a model I got to represent curvy women on three continents, and today I speak out in national and international press on issues relating to self-acceptance, the tricky issues around body image and how important achieving a healthy balance is to sustainability. Recently I was nominated as a Green Apple Ambassador by the Center for Green Schools, a program of the United States Green Building Council (USGBC) (@mygreenschools). I’m being asked to co-create a K-12 curriculum with the CGS showing the correlation between the following: positive body image + environment = sustainability. Not only in the confines of the ED community are these issues being worked on but in the corporate world, educational systems, and in architectural environments. What is now being discussed in many professional circles is this: If you don’t feel good about yourself, you will not reach for better, think better, act better, eat better, do better, and ultimately may not care about anything beyond your immediate grasp, thus disconnecting you from the world in which you live. Not a great scenario overall.

So there’s clearly a lot of work to be done in the here and now with children, parents, grandparents, schools and the professional community to take responsibility for what we say, think and do to ourselves, to others and to the environment. And guess what? It boils down to such a simple notion:everything rolls from the source!

Q: Do you think we, as a culture, are making progress moving towards “body peace” instead of body bashing as our norm? What have you noticed?

Emme: We’re certainly speaking more about our bodies in print and online, and women are more reflected ethnically, in more various shapes/sizes and in a wider age range, thankfully. All are very important for our culture to see what exists beyond sterile, digitalized images and corporate projections of beauty. However, the more we seem to make progress and move forward toward diverse representations, the corporate push for a more restrained image pops back in again. So education is key and awareness is paramount. An educated and positively engaged mind, body and spirit can help filter what we see, hear and absorb. Indeed, buyer-be-aware of what we “buy into”. Our dollars can be spent in much better ways and can send a bigger message if we really put our heads together for real change in corporate America. I’ve learned, slow change is lasting change.

Q: Who could benefit from attending your presentation in Baltimore on February 24th? What message or skill do you most hope people will take away with them after hearing your talk?

Emme: I hope to connect with those who want to feel less alone and those seeking answers. No need to suffer in silence or bump along life’s journey by yourself. There’s no right or wrong when seeking out one’s truth. So my only message is this: Come with an open heart, you never know what may inspire, inform or ignite you. There’s only one you, and you are perfect just as you are!

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Many thanks to Emme for taking the time to respond to our questions and for sharing her strength and insight with our readers. If you’d like more information about Emme’s presentation on February 24th, you can visit www.eatingdisorder.org/events or download the event flyer. The event is free to attend but pre-registration is required to reserve seats.

Interested in more on this topic with Emme? Join us for a special Twitter Chat with her on Thursday, February 21, 2013 from 1:00-2:00 EST. Follow @CEDatSheppPratt and @EmmeNation for details and reminders.

All photos of Emme courtesy of EmmeNation.com

Published By Kate Clemmer

February 14th, 2013 in Body Image, CED Events, Celebrity Topical News, Diets, Editor's Picks, Guest Blogger, In the News, NEDAWeek, Perfectionism, Q & A

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Ringing in the New Year without your old Cognitive Distortions

As the winter holidays pass by and our thoughts turn to the New Year, it can be an exciting time to reflect on 2012 or to make a fresh start in areas of life that could use some extra attention ~ friends, family, self-care, school or work? Unfortunately, the changing of the calendar year (and the co-occurring mass marketing of new year’s resolutions) can also stimulate increased cognitive distortions. We’ve addressed cognitive distortions on our blog before and defined them as a pattern of thinking or “self-talk” that consistently shifts life events into a negative framework.

There are different types of cognitive distortions including “all-or-nothing“ thoughts that force experiences, relationships and feelings into categorical extremes of all good or all bad. There’s also “filtering” in which a person’s thoughts magnify negative aspects of a situation while simultaneously ignoring important positive information. Many people deal with cognitive distortions occasionally but some people, including those with eating disorders, depression or anxiety, may struggle with more frequent or more intense negative thoughts. The danger lies not with the distorted thought in and of itself but in one’s tendency to believe that the thought is 100% true when it most likely is not.

Holiday advertisements and New Year’s promotions tend to add fuel to the cognitive distortion fire, strengthening one’s beliefe that false and negative thoughts are actually reality. Three types of distortions stand out in the holiday media frenzy…

Shoulds, Shouldn’ts & Have-Tos: Based on Christmas catalogs and holiday specials, the list of holiday “have-tos” is endless – I have to decorate my house like Martha Stewart, I have to find the perfect gift for everyone on my list, I have to fit into that dress I bought three years ago. The arrival of New Year’s Eve often brings with it even more pressure: I shouldn’t eat that dessert, I should go to every family gathering t

Jumping-to-Conclusions & Comparisons: Assuming you know exactly how other people are thinking and feeling or creating assumptions about someone else’s life from limited observations can make it difficult to focus on yourself in any positive way. Have you ever received a pristine holiday card in the mail only to fantasize about that person’s supposedly perfect life while putting yourself down for not measuring up? Just because he/she is in one picture with a spouse and three children in matching holiday outfits doesn’t mean they necessarily have a blissful marriage, are happy at their jobs, or that they have never struggled with health, mental health or addiction problems. It’s important not to compare yourself to a one-second snapshot of someone else’s life.

Magical Thinking: New Year’s weight-loss resolutions are the ultimate cognitive distortions when it comes to magical thinking. Pick up any magazine, listen to any commercial and peruse any social network to find businesses, entire industries, or even family and friends touting the message that weight loss = happiness and fulfillment. This is usually financially motivated. Remember that the weight loss industry (and many others) zero in on the things people are looking for most out of life and repeatedly pair them with weight loss when marketing their products. They know that people will pay money if they think there’s a magical road to happiness, friends, confidence and success. If you find yourself thinking that fitting into a particular size or changing your body in some way will ”fix” everything that you think is wrong in your life or change who you are, take a step back. Not only does the research show that chronic dieters are more likely to be depressed but dieting itself has been linked to weight gain and increased risk for disordered eating behaviors.

This year, if you’re tempted to make a New Year’s Resolution, you may want to assess your options. First make sure your goals are not the result of “shoulds” or “have-tos” generated by external sources like the media or even family and friends. Then, consider starting off your resolutions with something more focused on creating positive moments in your life during 2013. Here’s a couple possibilities:

“This year I think I would find fulfillment in…”
“This year, I would really enjoy…”.
“I’ve been wanting to spend more time with…”

Finally, turn off the TV and put away your fashion magazines or anything else that tempts you to compare yourself to other people or seek happiness through the shape or size of your body. This year, allow your focus to be on building yourself up emotionally, putting a stop to the cognitive distortions, and establishing self-acceptance in the present moment, in the present body.

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If you’re interested in moving towards mindfulness and learning more about self-acceptance, please save-the-date for our 2013 National Eating Disorder Awareness Week events, including a keynote address by Emme, global advocate for positive body image. Find out more here.

photos via Pinterest.com

Published By Kate Clemmer

December 27th, 2012 in Cognitive Distortions, Comparisons, Filtering, Magical Thinking, Shoulds / Have-To's

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Decoding the Road to Eating Disorder Recovery

Everyone’s recovery journey looks different. Recovery may take some individuals longer or shorter and involve various combinations of treatment providers, treatment modalities and sources of motivation. Different people may rely more or less on specific support people and utilize different and diverse coping skills. Aside from just being different, no one’s recovery will be perfect. That’s a good thing. The ups and downs are necessary opportunities for growth and learning during the healing process. In the midst of that, it can be hard to imagine recovery until you see that others have been where you are and have come out stronger and more fulfilled on the other side.

Over the years many individuals have come here to speak about how, why and with what tools they’ve established their recovery from various eating disorders. In 2010 speaker Jenni Schaefer shared what recovery means to her and why she kept pushing through what she calls the ”mediocre stages of recovery” to reach a state of being “Recovered.”. In 2011 recovery advocate Johanna Kandel also visited to provide insight on her past fears about recovery like “what if I can’t recover?” and “what if I hate being recovered?” She also addressed the challenge of envisioning yourself without the eating disorder and why it’s never too late to find hope and begin the recovery process.

Most recently we hosted author, scientist and recovery advocate, Carrie Arnold for a talk entitled Hope Through Science. Carrie’s presentation was an honest depiction of her own challenges and triumphs in recovery. She also shared about her exploration of eating disorders through the lens of a scientist, joking with the crowd that she may be the only one to “read PubMed [journal articles] like its sort of a contact sport.” During her talk, Carrie provided a glimpse at some of this science and talked about how it impacted her understanding of the illness while also working to propel her forward in recovery.

Hope Through Science attendees responded to Carrie’s down-to-earth, science-minded and very realistic view of her own healing process. Her discussion about the science and biology behind eating disorders also goes a long way in helping to break through much of the stigma that surrounds eating disorders so that people begin to understand that they are not to blame for their suffering, but they can be responsible for, and capable of, taking the steps to recover. Lessening this stigma and misunderstanding about what causes eating disorders is also helpful for friends and family who may be struggling to support a loved one in the recovery process.

“Loved her personal story and clarification of what an eating disorder is; definitely provided more of an idea for my family.” ~ Event Attendee

“It was interesting to hear information about how science can affect the development and progression of an eating disorder and how knowing the ‘science behind an eating disorder’ could potentially help to unlock a successful recovery process.” ~ Event attendee

As noted above, everyone has different strengths to share and different lessons they learn throughout recovery. Carrie’s distinctive position as both a recovered individual and a science writer, allows her to add a unique perspective to the host of hopeful stories out there. If your journey to recovery is similar to Carrie’s, and the insight into the biology of eating disorders informs and empowers you personally, we highly reccommend picking up a copy of her most recent book: Decoding Anorexia: How Breakthroughs in Science Offer Hope for Eating Disorders. Carrie Arnold can also be found blogging about eating disorders, science and recovery over at Ed Bites.

Regardless of which path you take to get there, recovery can often feel like an uphill battle, and its not uncommon for individuals to feel hopeless at various points along the way. That being said, it becomes very important for individuals and their families to be exposed to the many different stories of healing and recovery that do exist. In order to believe that recovery is possible, sometimes you have to see it and hear it. This is one of many reasons why we at the Center for Eating Disorders find it important to offer recovery-focused events for the community and our patients. These events provide a platform for recovered individuals to share their stories and their strength while also reminding us all that the process of recovery looks different for everyone.

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If you or a loved one are struggling with an eating disorder or have questions about treatment, please visit www.eatingdisorder.org or call us at (410) 938-5252. You can also follow CED on Facebook.

Published By Kate Clemmer

December 17th, 2012 in Anorexia Nervosa, Books, CED Events, Celebrity Topical News, eating disorders, Perfectionism, Recovery, Video Clips

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Tried & True Strategies for a Recovery-Focused Holiday, Part III: AFTER Thanksgiving has Come and Gone

Post-holiday time can be filled with mixed emotions. Some people experience RELIEF that it wasn’t as difficult as they had predicted, others struggle with post-holiday FRUSTRATION or GUILT related to eating disorder behaviors or holiday meal challenges. Still others head out of the holiday week EXCITED to return to the familiar structure and schedule of school or work. There may have been HAPPY times or SAD emotions woven throughout your Thanksgiving holiday as relationships and expectations for the holiday were tested. Maybe you tried some of the tips we suggested in Part I and Part II of our holiday blog series with a lot of success…or perhaps with a lot of struggle. No matter how things went or how you’re feeling now its important to honor your emotions and continue on from this point in a recovery-focused way. Here are some tips that can help you make the most of your week-after-Thanksgiving (and beyond).

1. Change your filter. So often, the eating disorder voice shines such a powerful spotlight on everything negative that it can be easy to get caught up in what went “wrong” on Thanksgiving day and ignore everything that was positive. This is an example of a cognitive distortion called filtering. In the days and weeks that follow, try not to allow your eating disorder to dictate how you will remember this holiday. Instead, sit down with positive intention and make a point to reflect on what went well, what worked and who was integral to those successes.

2. Don’t skip therapy. (Sound familiar?) If you had a hard time during the holiday and find yourself feeling frustrated or ashamed that you acted on symptoms, do not cancel appointments with providers. Right after slip-ups is the ideal time to meet with a therapist or dietitian to process what happened, what the trigger was and how to prevent a holiday-induced downward spiral. If your first appointment with a provider won’t be for another few days, take some time to jot down your observations and feelings about the holiday and what you want to remember to discuss with your therapist or dietitian.

3. Accept post-holiday compliments gracefully. Individuals with eating disorders often have a hard time accepting positive feedback, especially when it clashes with their own negative beliefs about themselves or their abilities. If someone is genuinely telling you that you did a good job with something, before you refute them, consider how your reaction will affect you and them. When Aunt Martha calls you this week and says “Thanks for hosting us this weekend. Your house looked beautiful all decorated for the holiday and the meal was just great,” your instinct might be to say ”Oh please, the turkey was dry and the house was a mess! I just didn’t have time to clean it the way I wanted to.” When you completely reject a compliment it sends a message to the other person that you may be overly critical in general or that their opinion is not valued. Additionally, if you deflect compliments from the same people repeatedly, they may be conditioned not to give them at all. Most importantly, when you reject compliments you deny yourself the opportunity to absorb a positive belief which could go a long way in helping to boost your self-esteem and overall self worth. Even if you’re struggling to believe that a compliment is true, allow yourself to receive it and entertain the idea that it just might have some validity. Instead of deflecting, consider simple statements, such as “Thank you so much – that means a lot to me” or even, “Thanks” will work just fine.

4. Move On. If this holiday wasn’t what you had hoped for, let it go. Don’t continue to blame yourself for things that may have been beyond your control. Assess what can be changed in similar situations in the future and make note of them, then allow your mind to move on. Getting stuck in thoughts about how disastrous/boring/disappointing/etc. your Thanksgiving was is not going to help you make today the best it can be. Remember that non-holidays are just as important in the long run of recovery. Make today a good day; do the best thing for you and your recovery in this moment.

5. Keep the gratitude going. Thanksgiving does a great job in helping to promote gratitude. Even if you haven’t yet jumped on the #thanksvember bandwagon via Twitter or Facebook, it’s not too late to start. Take some time tonight to be grateful and send a genuine “thank you” to the support people that helped you enjoy the holiday…

If your mom changed the subject at dinner when a relative was harping on you for not taking seconds of her casserole, tell your mom later how much you appreciated her speaking up. (If you live close by, give her a hug while you’re at it.)
If your friend answered frantic text messages you were sending on Thanksgiving day, let him know how much that meant to you that he was available for support in the thick of the holiday.
If your little nieces and nephews forced you into hysterical laughter with their impromptu Thanksgiving skit, send them little notes in the mail to let them know you can’t wait for their Christmas or Hanukkah performances too.
When it comes to gratitude, remember to use your voice. It’s an excellent opportunity to nourish the positives and create more of what you need for your recovery.

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Is there someone you relied on this Thanksgiving to help you through? If you have feedback or comments about positive ways in which your support people helped out this holiday, we’d love to hear. Share in the comments below or join the conversation on our Facebook page.

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Tried and True Strategies for a Recovery-Focused Holiday – Part I: BEFORE the Holiday

Tried and True Strategies for a Recovery-Focused Holiday – Part II: The Day OF Thanksgiving

Above photo courtesy of psychcentral.com (click on the photo to link to interesting research about the benefits of gratitude on health and wellness)

Published By Kate Clemmer

November 27th, 2012 in Celebrity Topical News, Cognitive Distortions, eating disorders, Editor's Picks, Emotions & Coping, Holidays, Recovery, Support

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Tried and True Strategies for a Recovery-Focused Holiday – Part II

Each year we see many individuals with eating disorders, and even those in strong recovery, become increasingly anxious as the holidays approach. Being on high alert for triggers or signs of relapse can be an effective way of staying recovery-focused and keeping yourself well. However, it’s also important to relax into the holiday and not allow the anxiety to overshadow what could be a very positive experience.

Yesterday in Part I, we shared strategies to help you plan ahead for a recovery-focused holiday. Today in Part II, our staff share their top tips for making it through the actual day of a holiday with health and recovery intact.

Part II: The Day OF Thanksgiving…

RELAX - Focus on your breath, meditate, or listen to soothing music on your way to he festivities so you start off the celebration in a positive place. If you show up in an anxious or negative mood right off the bat, it’s likely to affect those around you and be intensified.

Try to enjoy the holiday, not just survive it! Focus on what you would like to do and who you would like to do it with. Shift your attention from body image, food, and self-criticism and focus on what you want the meaning of the holiday to be for you.

~Kim Anderson, Ph.D., Therapist and Director of Psychology

Check in with yourself about body comparisons. Believe it or not, we hear a lot about patients not liking family gatherings because they are comparing their bodies to other family members. For many people, these inter-family comparisons can be the most triggering or most intense body comparisons they face. If you find yourself going down that road, hit the pause button. Rewind, reconnect and consider engaging the person in conversation instead. See if you can find out something positive about them you never knew before. Remember that they are more than just their body and you are more than just yours.
Get grounded. If you feel your thoughts drifting to food, body or weight, re-connect to something positive in the moment. Sometimes wearing a special bracelet or keeping a special item in your pocket that you can reach for and touch/hold can help to ground you. Connecting physically to an item can help you stay in the moment and tune out the eating disorder voice.
Cross generational boundaries. Be mindful of the different support each generation of your family can offer. Hanging out with siblings, cousins and others of a similar age to you can be a nice way to connect around common developments and gives you a chance to get support/empathy on specific life stage issues like being away at college, parenting stress, job hunting, retirement, etc. On the other hand, reaching out to older generations, like grandparents, is an opportunity to get outside of your own concerns, to see how priorities can shift throughout life and also to collect some family history. Consider sitting down with an older relative and asking them an open-ended question about their most memorable Thanksgiving. Even the youngest generations have something to offer you in your recovery-focused holiday…

Spending time with the young children in your family during large family gatherings could be a good distraction from “grownup conversation”. Hang out with the kids, play games with them and ask them about themselves. You might even consider eating with the children and think about being a good role model for them.

~Lisa McCathran, LCPC, CED Outpatient Therapist

Be the family photographer. Grab your camera and put yourself in charge of documenting the day. Many extended families only have rare opportunities to spend time together. Catching family memories on film will not only keep you focused on something other than the ED, it will give people around you a reason to smile and be mindful of the special moments throughout the day.
Hors d’oeuvres. Food is often present at holiday gatherings long before the actual holiday meal is set on the table. Be prepared. When eating appetizers/munchies, instead of continually grazing and walking around with food, you may want to put all of your choices on a plate together at once so that you can see a total of what you are eating. Then allow yourself to sit down and mindfully enjoy eating it.
Structure your time before and after the meal by preemptively volunteering to help out in ways you are most comfortable with. For example, ask if you could set the table instead of helping around the food in the kitchen. Instead of packing up the leftovers, consider offering to load the dishwasher or get the kids in their pajamas.
Be assertive in making sure you get seated next to your most supportive family member at the dinner table.
Use your support. If you took the effort to connect with a “safe person” in advance of the holiday, now you have to be sure to utilize them. It can be hard to ask for help in the moment but it will be worth it.

[Editors note: When we asked our dietitians to chime in on the "eating part" of the holiday and their best piece of advice, they all said the same thing...which means it's probably pretty important. That's why we've included all of their input below without consolidating. Even though it's repetitive, it's one of the most important things you can do to have a happy, safe and recovery-focused holiday while recovering from an eating disorder.]

Take the time to eat your three meals during the holiday. Breakfast will be particularly important as it sets the stage for your hunger and fullness cues over the rest of the day.
Eat regularly!!! It’s the most important thing to do. This is not the best time to try a new eating schedule.
Do not skip meals! Do not plan to compensate for overeating later by skipping meals in advance.
Stick to the meal plan especially the day before the holiday and on Thanksgiving Day.

Have an adequate meal at each meal time prior to the Thanksgiving meal so that you’re able to enter the holiday meal hungry, but not ravenous. When you skip meals or restrict during the day and then enter a meal ravenous, you’re much more likely to eat past fullness. On the other hand, entering a meal with a natural level of hunger means you will be more likely to stop when you’re properly nourished and comfortably full.

~ Hannah Huguenin, MS, RD, LDN, CED Dietitian

Everyone needs a little alone time. Remember to take time by yourself to journal or relax during the day. If you’re staying with relatives and can’t find space inside the house to be alone, grab your coat, a cup of hot tea and step outside for fresh air, or consider volunteering to run an errand for your host
Play games. Don’t assume that your host will be prepared with distraction techniques for you - he or she will probably be pretty busy with holiday hosting tasks – so bring your own games to the party. Grab a holiday-themed puzzle or some of your favorite board games that will encourage interaction. Need something quicker and easier? Simply bring a deck of cards that you can use to play all sorts of different games with others or even by yourself.

Many people with eating disorders, especially those who’ve experienced trauma, may experience very intense emotions around the holidays. These strong feelings and stressors can be overwhelming but they don’t need to ruin or disrupt your holiday. Consider using a “containment strategy”. Write down the unpleasant thought or feeling on paper and put it “away” inside a designated containment box to be opened later when feeling safer such as in a therapist’s office or when the feeling has decreased in intensity.

~ Irene Rovira, Ph.D., Therapist & CED Psychology Coordinator

If you are not attending a family gathering it’s still important to plan a recovery-focused holiday. In fact, it may be even more important to create structure and social opportunities that will keep you focused on the bigger picture and engaged in positive activities. This could include volunteering your time to other causes like a soup kitchen or a homeless shelter or it might mean finding another friend without plans and going out to a movie together.
You made a list, now check it twice. If you took the advice in Part I of this holiday blog series, then you should have a list of the top 3 most useful coping skills for you (this will be different for everyone). If you’re going through the day and you’re struggling with eating disorder thoughts or urges to act on symptoms, refer back to your list and work through them again, making tweaks if necessary. For example, if you called or texted a friend who never replied, do it again but try someone else this time. Just because the first person didn’t get back to you, doesn’t mean you have to give up.
RELAX and end your day with SELF-CARE. Just as we suggest starting off the day with relaxation techniques, allow more time for yourself to decompress from the holiday as it comes to a close. Breathe deeply, put on your favorite music playlist for the ride home, or take a few minutes to journal when you arrive home. Regardless of how the day went, do something nice for yourself before you go to bed on Thanksgiving night. For some people, that might be taking a nice hot bath, reading a book, writing a supportive email to yourself, watching a favorite movie with your spouse or a best friend, or cuddling with your pet. Whatever it is, allow yourself to enjoy it. Accept that you are deserving of self-care and able to bring your day to a close in a positive way.

We know this is a long list, and you can’t do every single thing on here ( and we don’t want you to overwhelm yourself by trying). Just choose the ones that speak to you and that you think will be most helpful on your holiday. Chat with support people and get their feedback regarding how these tips can fit into your specific family’s traditions and holiday schedules.

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Did you miss Part 1? You can still go back and read the holiday planning and preparation tips here: Tried and True Strategies for a Recovery-Focused Holiday, Part I: BEFORE the Holiday…

Find Part III here: Tried & True Strategies for a Recovery-Focused Holiday, Part III: AFTER Thanksgiving has Come and Gone

Have a good tip that we missed? Share your support and feedback on our Facebook page.

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Many thanks to the following CED providers who’ve contributed to this blog series:

Samantha Lewandowski, MS, RD, LDN
Hannah Huguenin, MS, RD, LDN
Jennifer Moran, Psy.D.
Kim Anderson, Ph.D.
Laura Sproch, Ph.D.
Irene Rovira, Ph.D.
Amy Scott, LCPC
Lisa McCathran, LCPC
Anne Holman, LCSW-C
Kate Clemmer, LCSW-C
Jennifer Lane, MS, OTR/L

Published By Kate Clemmer

November 20th, 2012 in Celebrity Topical News, Editor's Picks, Holidays, Nutrition, Recovery, Support

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Tried and True Strategies for a Recovery-Focused Holiday – Part I

Holiday gatherings and celebratory feasts can pose some significant challenges, regardless of where you’re at in treatment or recovery. Being aware of them, planning for them and setting yourself up for an enjoyable holiday is important. That’s why we asked all of our clinical staff at CED to share their best advice for having a safe and successful holiday while maintaining or working towards recovery from an eating disorder. They had so much to share that we couldn’t fit it all in just one post so this is just the first of a 3-part series to help you through the before, during and after of the holidays.

Through the years, these are some of the strategies and suggestions that our therapists have seen the most success with and we hope you will too. Happy Thanksgiving from all of us here at the Center for Eating Disorders at Sheppard Pratt.

Part I: BEFORE the Holiday…

Plan, Plan, Plan…..with your treatment team and with your primary supports. Develop a very specific, detailed plan for managing all the stressors that come along with the holidays.
Challenge predictable thoughts before the holiday. If you notice you have predictable patterns of negative thinking pop up at family gatherings or the same triggering thoughts sneak up on you every Thanksgiving day, take time to identify them in advance. Write them down and work on challenging the thoughts ahead of time (on your own or with a therapist) so you’re better prepared to defend against these specific negative/irrational thoughts on the actual day. You might even consider keeping a list of your positive affirmations or challenge statements with you on Thanksgiving for easy access. (If you know you’ll have your phone handy, you could even send a text to yourself the day before).
Identify one or two major positives about the holiday. No matter how anxious or depressed you may feel about an approaching holiday, there IS a positive hidden somewhere, even if it’s as simple as getting time off from school or work.
Make a list of your top 3 most reliable coping strategies and keep it handy in a notebook or on your phone.

Decrease stress and increase relaxation. Only say “yes” to events that you would like to attend and believe you can attend with success. Keep your daily schedule of activities and gatherings manageable.

~ Kim Anderson, Ph.D., Therapist and CED Psychology Coordinator

RSVP with a time limit. For example, “Thanks so much for inviting me. I’ll be able to be there from 3:00 to 5:00.” This provides you with some boundaries and an opportunity to leave the situation if it’s becoming detrimental to your recovery. However, if things are going better than expected (which often happens) and you want to stay longer, then you can.
Choose a worry chair. If the anxiety is overwhelming or interfering with life, set up an appointment for yourself to “worry” about your concern at a specified time, date and place- this allows you to “delay” the worry and frees you up to take care of business at hand until then.

I really try to highlight for my patients that they are not alone in experiencing high stress around the holidays and that other members of their family are likely struggling with similar anxieties and negative thoughts. Some are able to manage extra stressors in healthy ways like talking about how they’re feeling, getting enough sleep, setting limits, or adding in extra self-care. Other family members may turn to unhealthy management strategies like drinking too much, getting into arguments, withdrawing, avoiding, hiding their feelings, or eating too much/too little. I try to use this to help my patients see that the problem isn’t the food itself, it is ultimately the thoughts and feelings, that can lead to intensified eating disorder urges. Being aware of this can free you up to move forward and choose more constructive and beneficial ways to cope.

~Laura Sproch, Ph.D., Individual and Family Therapist and CED Research Coordinator

Identify a “safe person” you can go to that is aware of your struggle and will support, distract, and protect you on the day of the holiday gathering. Talk with that person ahead of time so they know exactly how to support you during the meal and in specific situations. These things are not always obvious and support people may need a little “coaching” in advance. Some people even like to arrange a “code word” with their support person that they can say when they’re feeling really triggered and need an opportunity to remove him or herself from the situation.
A day ahead, you may want to plan out the timing for your meals, especially if Thanksgiving meal is falling at an atypical meal time. Refuse to use that timing issue as an excuse to skip meals or go off your meal plan. Simply juggle around your mealtimes a bit so that you can still fit in breakfast, lunch, dinner and one or two snacks. If you don’t do this in advance, it probably won’t happen.
Create a holiday project that will provide you with some distraction and also give you something positive to look forward to on the day of the holiday. Consider creating a scrapbook of past family holidays or a hand-made gift for your host/hostess.
Set realistic expectations. Work on decreasing expectations about decorations, food, family time, and any other areas in which you’re feeling pressure to be perfect.

Real-life holidays, like many things, will not resemble the advertisements and commercials that portray them. Holiday gatherings will not be perfect…someone will spill their drink all over the carpet, your relatives will arrive late (or unexpectedly early!), kids will have tantrums, arguments may occur, and at least some of the food will get overcooked. The great thing is, that’s all okay and normal. If you find yourself expecting a picture perfect Thanksgiving, take time to adjust your vision and agree to embrace the day in all its imperfection. Ultimately, that is exactly what will make it memorable.

~ Kate Clemmer, LCSW-C, CED Community Outreach Coordinator

Focus on the bigger picture. Research causes or charities that interest you where you might be able to volunteer during the holiday season; focus on the meaning of the holiday rather than the food specifically.
Don’t skip therapy appointments. With all of the preparations and traveling and extra time committments, many people find themselves tempted to cancel pre-holiday meetings with therapists and dietitians or skip regular support groups. We’ve encountered this many times before and unfortunately, it rarely results in positive outcomes. This is exactly the time when extra support is crucial. Instead of cancelling, consider other options like adjusting your appointment time to an earlier slot before you leave town.
Begin a daily practice of gratitude. Start each day by reflecting on something you are grateful for. You could write them each down in a journal or even post them on Facebook. This is a great way to head into the holiday with a fresh and positive outlook.

Stay tuned for tomorrow’s post with more insight and suggestions from our therapists and dietitians in Tried and True Strategies for a Recovery-Focused Holiday, Part 2: The Day Of Thanksgiving.

[UPDATE]: Part II is now live here.

[UPDATE]: Part III is available here: Tried & True Strategies for a Recovery-Focused Holiday, Part III: AFTER Thanksgiving has Come and Gone

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You might also be interested in these posts from past holidays…

Tips for Overcoming Holiday Stress and Anxiety – Part I: The Food

Tips for Overcoming Holiday Stress & Anxiety – Part II: The Stress

Nutrition Tips for a Healthy and Happy Holiday!

Thanksgiving with an Eating Disorder: 10 Tips to Help You Get Through the Holiday

Photo courtesy of examiner.com

Published By Kate Clemmer

November 19th, 2012 in Celebrity Topical News, Cognitive Distortions, eating disorders, Editor's Picks, Emotions & Coping, Holidays, Perfectionism, Recovery, Support

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A First Look at CED’s 2013 Professional Symposium ~ “Eating Disorders: State-of-the-Art Treatment”

A Professional Symposium sponsored by The Center for Eating Disorders at Sheppard Pratt

Saturday, April 6, 2013
Baltimore, MD

Learn from five international experts in one intensive training day.

Keynote Presentations:

Nature & Nurture in Eating Disorders: The Science Every Clinician Needs to Know
Cynthia Bulik, Ph.D.

Making a Difference in Body Image
Carolyn B. Becker, Ph.D.

Adapting Dialectic Behavior Therapy (DBT) for Binge Eating & Bulimia
Debra Safer, M.D.

Children & Adolescents with Eating Disorders are Not Mini-Adults: Challenges in Diagnosis and Treatment
Bryan Lask, M.D.

More Similar Than Strange: The Power of “Normal” Explanations in the treatment of Eating Disorders
Kelly Vitousek, Ph.D.

Breakout Sessions:

Mirror Mirror on the Wall: Reflections on the Treatment of Adult Women with Body Image Disturbances
Cynthia Bulik, Ph.D.

Addressing PTSD in the Context of Eating Disorder Treatment: An Evidence-Based Case Formulation Approach
Carolyn B. Becker, Ph.D.

The Application of Distress Tolerance Skills for Binge Eating and Bulimia
Debra Safer, M.D.

Communicating with Children and Adolescents who have Eating Disorders: Being on their Wavelength
Bryan Lask, M.D.

The Use and Abuse of Externalizing in Therapy for Eating Disorders
Kelly Vitousek, Ph.D.

Registration:

Registration for this event is not yet open. If you’d like to receive a reminder when registration becomes available, please subscribe to our mailing list and indicate that you are a treatment professional.

More info:

The Center for Eating Disorders’ annual symposium is designed to bring cutting-edge, innovative treatment knowledge to the professionals caring for people with eating disorders. Hear from five international eating disorder experts on a variety of treatment topics designed to strengthen your knowledge of comprehensive eating disorder treatment, and help improve patient outcomes.

The symposium will be of interest to all professionals who make up the treatment team, including psychiatrists, internists, family practitioners, psychologists, registered nurses, social workers, registered dietitians and expressive arts therapists. Application has been made for 7.5 CME/CEU credits.

QUESTIONS?

Call (410) 427-3886 or email kclemmer@sheppardpratt.org

Published By Kate Clemmer

October 26th, 2012 in Celebrity Topical News

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Hope Through Science: CARRIE ARNOLD Talks About Decoding Eating Disorder Recovery

On November 4th, 2012 The Center for Eating Disorders at Sheppard Pratt will welcome Carrie Arnold to Baltimore for a special community event entitled, Hope Through Science: Decoding Eating Disorders. Carrie Arnold is a trained scientist, science writer and also the creator of the popular eating disorder recovery blog, EdBites. After her own decade-plus long battle with an eating disorder, Carrie recently released a new book designed to share the science of eating disorders in a user-friendly way that not only educates readers but empowers recovery. In the book, she discusses how delving into the biology behind anorexia helped her to overcome her own illness.

In advance of her presentation, we asked Carrie to share a little bit about the new book, the recovery journey, and why science is for everyone. Read on to see Carrie’s responses, and don’t forget to click on the image at the bottom of the post for details on how to RSVP for her upcoming presentation.

Q: As a scientist, science writer and someone who has dealt with an eating disorder yourself, you have a unique perspective about some of the most critical aspects of the disorders and the science behind them. What would you say is the one piece of scientific knowledge about eating disorders that everyone should know?

CA: I think the most important thing for someone to know about eating disorder science is that EDs are real, treatable illnesses. They are not choices–sufferers aren’t choosing to starve, binge eat, purge, and over-exercise. Rather, they are symptoms of a potentially deadly illness that requires rapid, intensive, and evidence-based treatment to bring about full recovery.

Q: Can you list some of the potential benefits to learning about and understanding the biology of eating disorders?

CA: For me, learning about science was a way to start moving forward rather than continually looking at my past to try and figure out what might have caused my disorder. Insight didn’t bring recovery. Learning my triggers was important, but trying to get to the “root cause” of my eating disorder wasn’t helpful because there really wasn’t a root cause. Rather, it was a perfect storm of events that tripped my predisposition to anorexia. Malnutrition and ED behaviors were perpetuating the disorder, and the first step in recovery was weight and nutritional rehabilitation.

Q: What role did this knowledge play in your recovery process?

CA: Focusing on nutritional restoration as the first step of recovery was probably the most important. As much as I hated it (and believe me, I hated having to gain weight and stop ED behaviors!), I could think much clearer when I was at a healthy weight for me, and eating regularly. Studies have shown that reaching and maintaining a biologically appropriate weight is one of the best predictors of recovery, and having a treatment team and family that insisted upon this was probably the most important thing in my recovery.

Q: Your new book focuses primarily on the science of anorexia but research gains have been made for all eating disorders in recent years. Can individuals with bulimia, binge eating disorder and eating disorder NOS also benefit from uncovering the science behind their eating disorders?

CA: Absolutely. I primarily discussed anorexia in my book because that was the disorder with which I had the most personal experience, and because the amount of research out there is so massive that I couldn’t tackle everything in just one book. Understanding what eating disorders are and what causes them (often, individuals have a biologically-based predisposition to EDs that are frequently triggered by an energy imbalance in the form of dieting, an attempt to “eat healthy,” growth spurts during puberty, increased training for sport, etc) can free the sufferer from blaming themselves and their families for past events and instead focus on moving forward.

Q: Will your talk be applicable to individuals struggling with all types of eating disorders or just those with anorexia?

CA: This talk is definitely for people with any type of eating disorder. Even much of what we know about anorexia can be applied to other disorders–the importance of regular eating, addressing co-occurring conditions, understanding triggers, and relapse prevention. These things are universal.

Q: While the focus of your book is on the biology and genetics of eating disorders, you make it a point to communicate that environment is still important and does influence behavior. Why is this an critical reminder for readers?

CA: Many people hear the word “biology” or “genetics” and believe that if an eating disorder is related to either of those two things, then recovery is impossible. Their eating disorder was fate and there is nothing they can do. Which is the furthest thing from the truth! We can’t change our genes, but we can change our environment. Genes don’t act in a vacuum; environment is also important. Psychotherapy, for example, can physically change the brain and help you learn better coping strategies. I have to make sure to eat 3 meals and 2-3 snacks each day to maintain my recovery, as well as taking steps to prevent undue stress and sleep deprivation, all of which can trigger ED thoughts.

Q: It can be helpful for individuals who are struggling with eating disorders to hear from other people in recovery, to know that it is possible, and that it’s worth it to keep moving forward. What advice would you give to others who may still be struggling or are trying to find the motivation to pursue recovery?

CA: It was really hard for me to believe in recovery after years of illness, ineffective treatment, and failed attempts at recovery. Ultimately, I couldn’t sustain motivation on my own, especially in the face of overwhelming anxiety and depression. I needed other people in my life to believe in my own recovery until I was strong enough and well enough to believe it myself. It’s one of the most ironic features of my recovery- I didn’t have motivation to get better and sustain recovery behaviors until I was well on my way to wellness. It’s why support from friends, family, and treatment providers is so important.

Q: What would you say has been the most meaningful or most worthwhile part of your own recovery?

CA: Not being so scared of everything. I can relax at times. I can laugh. I can be myself.

Q: Who could benefit from coming to your talk, “Hope Through Science” in Baltimore on November 4^th? What would you say to people who might initially be turned off or intimidated by the word “science”?

CA: Eating disorders are so misunderstood that I think anyone touched by an eating disorder (sufferers, friends, family, and clinicians) could benefit from learning more about the subject. Our culture likes to portray science as something that’s just for geeks and eggheads. In reality, lots of people are interested in science, even if they don’t always know it. This won’t be like high school science class – I promise!

Q: As someone who understands the suffering of an eating disorder and the hard work of recovery, what do you hope attendees will take away with them on November 4^th after hearing your presentation?

CA: That recovery is hard work, takes a long time, and requires lots of support, but it’s possible with the right treatment.

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Many thanks to Carrie Arnold for taking the time to share her insight and knowledge for this blog. Click on the image below for details about her upcoming presentation in Baltimore. The event is FREE to attend but space is limited so be sure to RSVP. If you have questions, please don’t hesitate to call us at (410) 938-5252.

Published By Kate Clemmer

October 22nd, 2012 in At-Risk Populations, CED Events, Diets, eating disorders, Guest Blogger, Professional Education, Q & A, Recovery

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An open letter to Dr. Drew Pinsky…

Earlier this week, Dr. Drew Pinsky made some misleading comments about “exercise bulimia” in a video featured on CNN iReport. The comments sparked concern because of the implications they could have for individuals who are struggling with excessive exercise and for those who may be at-risk. Dr. Harry Brandt, CED Director, was motivated to reach out to Dr. Drew in hopes of opening a public conversation that will shed light on eating disorders and spread accurate information regarding just how serious excessive exercise can be. The letter is published below:

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Dear Dr. Pinsky:

By way of introduction, I am the Director of the Center for Eating Disorders at Sheppard Pratt, and former Director of the Unit on Eating Disorders of the National Institutes of Health. While generally, I think you have done an excellent job of increasing awareness of major mental illnesses to the population at large, I was concerned about your recent video comments regarding “exercise” bulimia. I felt compelled to blog about it on our website, and have received many responses from patients. Here is a link to the blog: In response to Dr. Drew ~ Exercise bulimia is not a mild mental health issue.

I would be most appreciative if you would consider following up on this issue publicly to raise awareness about the seriousness of bulimia nervosa, with particular attention to those individuals that use compulsive exercise as their means of purging.

I would welcome the opportunity to discuss this with you further.

With best regards,

Harry A. Brandt, M.D.

Director, Center for Eating Disorders
Sheppard Pratt Health System

Head, Department of Psychiatry
St. Joseph Medical Center

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Published By Kate Clemmer

August 8th, 2012 in advocacy, At-Risk Populations, binge eating disorder, Bulimia Nervosa, Celebrity Topical News, eating disorders

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In response to Dr. Drew ~ Exercise bulimia is not a mild mental health issue

Recently the well-known celebrity internist, Dr. Drew Pinsky, shot this video for CNN iReport. During the segment he answers viewers’ questions about mental and physical health, including one about healthy exercise and another regarding diet pill addiction in which he references underlying eating disorders as a serious concern. What seems to be warranting concern is not the answers he’s giving to the viewers so much but the opening statement of the video in which he lightheartedly discloses his own struggle with something he refers to as a “mild” mental health issue called exercise bulimia. Dr. Drew’s remarks were as follows:

I got a whiff of exercise bulimia. You sort of exercise too much, and if you miss it you freak out. You have to constantly exercise. I don’t feel right if I don’t do it. But, you know, a little whiff of mental health issue never hurt anybody.

In actuality, “exercise bulimia” is not a formal diagnosis but is a popular term often used to describe a subset of individuals with anorexia or bulimia diagnoses who feel compelled to engage in excessive exercise as a form of compensation for calories. Some of the signs and symptoms associated with excessive exercise include:

Engaging in exercise even when sick or injured
Becoming seriously depressed if you can’t get a workout in
Exercising above and beyond what would be considered a normal amount of time
Refusing to build in any days of rest or recovery days
Inflexibility as to time of day and mode of exercise
Prioritizing exercise over social dates, family functions, work, or school
Intense fear at states of rest
Intense anxiety at situations where preferred method of exercise is unavailable
Intense guilt when forced to stray from exercise routine
Refusal to eat if unable to exercise
Defining self-worth in terms of exercise performance

Upon seeing the video above, The Center for Eating Disorders’ Director, Harry Brandt, M.D., had serious concerns regarding Dr. Drew’s statement about exercise bulimia and specifically the public interpretations that would follow.

“In the age of the internet and personal blogs there will always be misinformation out there, but it’s particularly concerning to see high profile medical professionals, in this case an internist, minimizing what is a very serious disorder for a lot of people” said Dr. Brandt. He went on to say that “eating disorders are difficult to identify and treat partly because they are a socially normative disease. Common symptoms like weight loss, dieting, negative body image and excessive exercise are all reinforced in our society. This can make it very difficult for people with serious eating disorders to recognize their behaviors as problematic and part of a more significant mental health problem. Statements like Dr. Drew’s trivialize a dangerous behavior and unfortunately make it more difficult for individuals to justify getting help.”

Dr. Drew’s opinion that, “a little whiff of mental health issue never hurt anyone“ is actually far from true. Something that may seem minor or mild could actually be indicative of a full-blown eating disorder or might represent the first signs that one is developing. Eating disorders have the highest mortality rate of any mental illness. Without treatment anywhere from 5-20% of individuals with eating disorders may eventually die from complications related to their illness. Individuals with eating disorders who struggle with excessive exercise in particular are at risk for the following health problems:

Increased injuries such as stress fractures, strains and sprains
Possible permanent damage to bones, muscles, joints, ligaments and tendons
Increased susceptibility to infections, fatigue and exhaustion
Muscle wasting (the body begins breaking down muscle mass as a source of energy)
Fatigue
Dehydration
Osteoporosis (bone loss)
Arthritis
Menstrual irregularities and reproductive problems, including infertility
Heart problems

Excessive or compulsive exercise does not always occur alongside an eating disorder but when it does, it can provide some of the first signs that someone is struggling with food and eating. We encourage influential health professionals like Dr. Drew to be mindful of the messages they share with the public and to take great care not to normalize or trivialize behaviors that could indicate someone is suffering from a serious mental health problem.

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If you are concerned that you are a loved may have an unhealthy relationship with exercise, please call us at (410) 938-5252 or visit our website at www.eatingdisorder.org .

Published By Kate Clemmer

August 8th, 2012 in At-Risk Populations, Athletes, Celebrity Topical News, In the News, Television

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The Center for Eating Disorders Blog

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Q & A with Emme Aronson:

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Part II: The Day OF Thanksgiving…

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Part I: BEFORE the Holiday…

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Saturday, April 6, 2013 Baltimore, MD

Keynote Presentations:

Breakout Sessions:

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Thank you for subscribing!

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Saturday, April 6, 2013
Baltimore, MD