As we mentioned in our last few Q&A posts, we hosted our Annual Symposium on Saturday, April 18. The beautiful weather and gathering of accomplished eating disorder professionals made for an extremely enjoyable day. Our symposium was designed to bring cutting edge, innovative treatment knowledge and options to the professionals caring for people with eating disorders. And, we are happy to report that more than 135 people were in attendance!

Below is a list of speakers, topics and a few pictures from our exciting event:

• Steven Wonderlich, Ph.D., spoke about trauma as it relates to eating disorders and the impact this trauma may have on diagnosis and treatment. 

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• Stewart Agras, M.D., discussed empirically-based treatments for Bulimia Nervosa, including Guided Self Help, Cognitive Behavioral Therapy and the use of antidepressants in the treatment of bulimia.

• Judith Banker, MA, LCP, FAED, talked about the gap between research and practice and the concern that research findings and clinical observations become lost in this gap. She went over the proposed guidelines for Research-Practice Integration and the benefits to patients, researchers and clinicians in this exchange.

• Dr. Kathryn Zerbe created a beautiful artwork backdrop to help illustrate her description of interventions with eating disorders based on their specific life stage. Throughout her discussion of transferance and countertransferance, she continued to provide fantastic works of art to help solidify her concepts.  

• Michael Levine, Ph.D., who returned to the symposium after postive feedback from his presentation last year, revisited the ideas around prevention efforts and the ways in which media and culture can shape individual’s views on beauty and cultural norms. He exhorted the audience to use courage to fight against the pervasive messages within our culture, not just in reference to beauty but in reference to gender, class, race and the ideas of power, as well.

Keep checking back as we will post select video footage from the symposium soon!

• Be sure to start your holiday off right by giving your body what it needs at breakfast.  People are often tempted to skip breakfast when they anticipate a large meal later in the day, but depriving yourself of breakfast will potentially set you up for a binge at the holiday meal.

• There are often multiple food options available at holiday meals which can be very overwhelming when preparing your plate.  Remind yourself that you are not obligated to try every dish or to take one of everything.  Instead, plan to choose 1-2 items from each food group to create a balanced meal.

• In preparing your plate, it can be helpful to remember appropriate portion sizes as suggested by the Food Guide Pyramid. One easy way to size up portions is to use your hand.  A clenched fist is about a cup, and a cup is the amount recommended for a portion of pasta, rice, cereal, vegetables, and fruit. A meat portion should be about as big as your palm. For more information on portion sizes, visit: http://www.mypyramid.gov/.

• Plan to allow yourself to eat “treats” and “extras”.  This is socially and psychologically healthy!

• Listen to your body!  During the holiday season, meals are often frenzied and fast-paced, and it becomes very easy to neglect your hunger and fullness signals.  Plan several ways to remind yourself to pause and be mindful of your body’s natural cues before, during and after the meal.

• It can be helpful to call the host or hostess ahead of time to find out what will be on the holiday menu.  Knowing the menu in advance can help you plan your meal and ensure that there will be options that you feel comfortable eating.  If necessary, you can offer to bring a dish that will increase your comfort level with the meal.

• Plan for how you will deal with possible discomfort around feelings of fullness; distract yourself by engaging in a positive coping activity such as playing a game, walking the dog, writing in a journal or enjoying the company of friends and family.

• Talk to other family members in advance about not pushing food or commenting on diets, calories, or weight loss.  Asking a parent or another supportive family member to spread this request can also be helpful.

• Don’t forget about the day after your holiday meal!  Plan to meet a friend for your meals the next day to help you resist the urge to skip meals or compensate for any slip-ups that occurred during the holiday.

• For additional tips on how to handle holiday stress, check out our previous blog, Thanksgiving with an Eating Disorder: 10 Tips to Help You Get Through the Holiday.
  

  Remember to relax, BREATHE, and enjoy the holiday as best you can!  From all of us at The Center for Eating Disorders, have a very happy holiday season!

 Photo courtesy of http://www.dsmivtr.org

Sarah Blake, Social Worker and Outreach Coordinator at the Center for Eating Disorders at Sheppard Pratt, offers insight on EDNOS, Eating Disorder Not Otherwise Specified.

So many of my patients have grappled with having the diagnosis of EDNOS. Eating Disorder Not Otherwise Specified is a classification for disordered eating that the DSM-IV lists as a category “for disorders of eating that do not meet the criteria for any specific Eating Disorder.  Keep reading though, before making a judgment call about this diagnosis.  In the rigid thinking of some of the patients I have worked with who have had eating disorders, having this diagnosis can initially mean to that individual that they have failed –  to be a person who has a “real” eating disorder.  This type of thinking can lead to a variety of other thoughts that can impede their recovery process.

The diagnosis of EDNOS can mean a wide range of things. It can mean you meet the criteria for Anorexia Nervosa, but you have maintained a menstrual cycle. It could mean that you struggle with severely restricting your food intake and have lost significant weight, but are currently at a fairly normal weight for your height. It could mean that you meet the criteria for Bulimia Nervosa but binges occur less then twice a week or that the cycles have occurred for less then a duration of 3 months.  It could mean that you eat small amounts of food and then do something to compensate for having ingested the food.  It could mean that you engage in a recurrent pattern of binge eating without any compensatory behaviors.

What is important to note here is that just because a person does not fit the exact criteria for Anorexia or Bulimia, does not mean they do not have a serious illness that requires attention.  Countless individuals who are diagnosed with EDNOS are at risk for the same medical complications as those individuals who are diagnosed with Anorexia and Bulimia. These include (but are not limited to) dehydration, electrolyte imbalance, heart attack, and death.  These are still eating disorders requiring necessary medical attention and psychological support.

EDNOS is a widespread problem. According to Eating Disorders: The Journal of Treatment and Prevention, EDNOS develops in 4-6% of the general population, and 50% of the individuals who come in for treatment for an eating disorder are given the diagnoses of EDNOS.  There must be a reason that so many individuals are in this diagnostic category and it is most certainly not, that 50% of the people who come in to treatment are not “good enough” at their disordered eating, to get an “official diagnosis”!

No matter how extreme your eating issues are, they are taking away from the fullness of life you could be experiencing. The eating disorder may seem as if it provides comfort or security,  but it does not allow you to feel a full range of emotions including:  joy,  surprise,  love and even sadness and acceptance to name a few.  Only by seeking help will you have the opportunity to truly begin to experience the fullness of life you desire.

*****Eating Disorder Not Otherwise Specified, Anorexia, Bulimia, and Binge Eating are all serious illnesses.  If you or someone you know is struggling with an eating disorder – help is available! Contact us at 410-938-5252 or via the web http://www.eatingdisorder.org/get_help/ to talk to someone confidentially about your concerns.*****

 photo courtesy of http://www.maternalwisdom.org/

In recent years a handful of unofficial terms have seeped into the existing eating disorder vocabulary.  From “wannarexia” to “manorexia”, these trendy expressions have been popping up in articles and blogs across the internet.  More recently, “pregorexia” has made appearances.  This word attempts to diagnose the intersection of pregnancy and eating disorders.  The term has been unofficially coined in response to the growing awareness of pregnant women acting on ED (eating disorder) symptoms in an attempt to avoid the weight gain and body changes that take place in normal, healthy pregnancies.  Some propose that the trend is a result of the media’s increasing coverage of celebrities’ unrealistic pregnant and post-baby bodies.

The Center for Eating Disorders agrees that the media can play a role in the development and maintenance of people’s eating disorders but it does not cause eating disorders in and of itself.  It is also important to point out that most women who would be described as having “pregorexia” have had body image problems and disordered eating (if not full-fledged eating disorders) long before they were pregnant.

Eating disorders are exacerbated by stress, and pregnancy is an intense physical and emotional stressor. It is no surprise that some women experience an intensification or return of ED symptoms during pregnancy. The “pregorexia” label is concerning because it distracts from the real and very serious eating disorder and implies that the problem will go away after nine months when the label no longer applies. It can also stigmatize a population of woman who already notoriously underreport their ED symptoms to doctors due to the guilt associated with having an ED during pregnancy.

Very simply put, a pregnant woman who is simultaneously suffering from anorexia, bulimia or any other eating disorder, needs support and professional treatment to ensure her health and the health of her unborn baby.  What she doesn’t need is a fictitious label to disguise, excuse or further stigmatize the real problem.

The Center for Eating Disorders does not encourage the use of “pregorexia” or any other terms that make light of eating disorders.  It can be very dangerous to replace official diagnoses with unofficial labels that could minimize, mask or distract from the underlying illness and might reduce one’s motivation to seek treatment.  These invented terms do not exist as independent diagnoses for a reason and cannot, and should not, take the place of professional assessments and official diagnoses.

*****Eating Disorders during pregnancy can be particularly dangerous for both mother and child.  Some of the risks include miscarriage, birth defects or abnormalities, premature or low birth weight babies, and an increased risk of post-partum depression.  If you or someone you know is struggling with an eating disorder and need treatment, please contact the Center for Eating Disorders at Sheppard Pratt at (410) 938-5252 or email us at EatingDisorderInfo@sheppardpratt.org .*****

It is not often that young people are given the chance, much less encouraged, to reflect kindly or positively on their bodies.  The Center for Eating Disorders’ Love Your Tree poster campaign creates this opportunity by inviting all of Maryland’s middle school, high school, and college students to create a poster that celebrates their body and promotes a positive dialogue about the diversity of beauty.The Love Your Tree poster campaign was developed three years ago by The Center’s senior art therapist, Julia Andersen.  She adapted the concept from a play written by Eve Ensler in which she travels the world and talks with different people about how we view our bodies.  One of those people is Leah, a Masai woman in Africa who is puzzled by Ensler’s negative attitude toward her own body.  In the play, Leah says:

“Eve, look at that tree? Do you see that tree? Now, look at that tree (pointing to another one). Do you like that tree? Do you hate that tree ’cause it doesn’t look like that tree? Do you say that tree isn’t pretty cause it doesn’t look like that tree? We’re all trees. You’re a tree. I’m a tree. You’ve got to love your body, Eve. You’ve got to love your tree.” (excerpt from The Good Body, 2004 by Eve Ensler).

The ‘Call for Posters’ encourages participants to respond to the phrase “Like a tree, my body is…” by creating a 2-dimensional design that celebrates their body and conveys a positive message about body image.  Please be sure to submit a completed Registration Form and artist statement when you submit your poster design.

The 3^rd annual Love Your Tree poster campaign began in September and will run through December which means students have less than one month to submit their posters!  All posters must be received by December 12^th, 2008.   Maryland teachers are also invited to get involved by working with their classes and students to submit posters.  Teachers can request a free workshop to help educate students about body image and engage them in the creation of Love Your Tree posters.  All participating students and teachers will be invited to attend the Love Your Tree reception and Poster Exhibit in February 2009.  Several artists from each age group will be recognized with awards totaling $1200. One poster will be chosen for reproduction and used by the Center for Eating Disorders’ to promote positive body image throughout the year.

Please call Kate Clemmer at (410) 427-3386 for more information about submitting a poster or to request a Love Your Tree workshop for your school or organization. Details are also available on our Events page at http://www.eatingdisorder.org/events.php

photo courtesy of www.everythingentertainment.com

The deaths of at least two runway models in 2006 from complications associated with anorexia drew heated attention to the unhealthy culture associated with modeling and with the fashion industry in general.  It may have taken two years, but a recent article on Today’s website reports that some positive changes were apparent on the runway at New York Fashion Week this year.  The article states that the body sizes of the models at Fashion Week had clearly increased from previous years.  Despite this progress, the modeling industry still supports a body size significantly smaller then the average American woman. As a result, there is still a lot of work to be done before what is put out by the media is a message that can make us all feel good about the skin we are in.

The fashion industry is being encouraged to take greater strides to protect the health of its models.  Currently, these efforts, described as “modest”, include workshops on eating disorders, age limitations for the runway, healthier snacks, and professional help for models identified as having an eating disorder.  We hope that continued efforts by the fashion industry will not only help to produce healthier models but healthier role models for the young girls and women who admire them.

To find out more about this topic, read the full article, Not-quite-so-thin is in for Fashion Week models, at http://www.msnbc.msn.com/id/26662601/

Following the presentation: CED staff shared a relaxing moment with the keynote speaker, Dr. Trisha Gura.  Left to Right: Steven Crawford, M.D., Kate Clemmer, LGSW, Sarah Blake, LCSW, Dina Wientge, LCSW-C, Trisha Gura, Ph.D., Paula Goldberg, R.N., Julia Andersen, ATR-BC
.

The Center for Eating Disorders’ 2008 fall outreach event was a great success with more than 100 attendees! This year’s event featured a keynote presentation by Dr. Trisha Gura, medical journalist and author of the acclaimed book, Lying in Weight: the Hidden Epidemic of Eating Disorders in Adult Women.

During Dr. Gura’s presentation, she mixed anecdotes from her book, her own experiences with anorexia, and a solid message of hope. The audience was diverse, filled with those struggling with eating disorders, their family and friends, and eating disorder professionals. Gura leveled with her audience by describing her own struggles with disordered eating and drawing from stories of women she interviewed for her book, Lying in Weight. She described eating disorders through all of life’s stages and also outlined the major influences that cause disordered eating.

Dr.Gura left her audience inspired by encouraging people with disordered eating to conquer their fears and seek treatment. She assured attendees that it is never too late to get help.

After the presentation, a Q & A session gave the audience a chance to ask Trisha their own questions such as how to help a family member with an eating disorder, the best types of treatment and her opinions on the term “recovered.” The Center for Eating Disorders would like to thank everyone who attended this event!

In addition to speaking at Sheppard Pratt, Dr. Gura hosted a chat on the Center for Eating Disorders online forum. This chat gave participants the opportunity to ask Dr. Gura any questions that they had regarding eating disorders. To view the chat click here: Dr. Gura online chat

Want more information about Trisha Gura or her book, read the Center for Eating Disorders blog entry Eating Disorders in Adult Women: A Q&A with Dr. Trisha Gura or go to her website, www.trishagura.com

1.)  In your book, Lying in Weight: The Hidden Epidemic of Eating Disorders in Adult Women, you talk about the fact that the subject of eating disorders among adult women does not get the attention it deserves. Why do you think this is?

The media perpetuates a myth: that eating disorders happen only to teenagers who want to look like fashion models. Society at large accepts that myth and doesn’t realize the older women suffer too, in fact doubly. Older women feel like two-time losers 1. Because they have an eating disorder and 2. Because they think they should know better due to age.

Finally, older women are less reluctant to seek help for the reasons above. Until recently, fewer were coming forward for treatment because they either were so embarrassed and/or did not realize they could have an eating disorder in the 40s, 50s even 70s.(The oldest women with anorexia in Lying in Weight was 92). The less that came forward, the less attention the issue received.

2)  What do you want the audience to take away from your talk at Sheppard Pratt on Oct. 5?

Anyone male or female of an ethnicity or race can get an eating disorder. But at the same given the right treatment and support, anyone can heal.

3)  What makes your talk at Sheppard Pratt relevant to everyone, not just those with disordered eating or those prone to developing eating disorders?

In only one instance have I met a woman who did not have some issue with her body size or image. Cindy Bulik’s group at the University of North Carolina found 75 percent of all American women endorse some unhealthy thoughts, feelings or behaviors related to food or their bodies. Men, particularly athletes and those involved in professions that value appearance, are joining the ranks of their female counterparts. Thus, a discussion of body image and food and exercise behaviors is relevant to a much larger group than those who have eating disorders.

4)  In your book, you say that midlife events can trigger disordered eating. What types of events are you referring to and what role do they play in developing eating disorders?

In midlife there are no less than 15 major transitions that can affect a person’s life i.e. divorce, an empty nest, menopause. Those life changes pile up in midlife, much like the physical, emotional and hormonal changes of adolescence cumulate in teenagers to cause overall tumult. The sense of everything coming apart is what prompts many latent eating disorders to ripen.

5) What advice would you give to someone who thinks they may be at risk for developing an eating disorder as a result of midlife events?

Know that you are not alone. Early statistics show that the number of women in their 40s and 50s seeking treatment have tripled and quadrupled, respectively, in the last decade.

Reach out for help. Your body is not that of a teenager and will not bounce back from unhealthy behaviors as quickly. Also, if you have children and/or loved ones, they will suffer from your lack of attention to the problem and benefit beyond words from your courage in undertaking a journey toward healing.

Eating disorders have long been recognized as a disease that only affects white, adolescent girls.  And while those are often the faces you will see in documentaries and after school specials on the topic, it’s important to know that anorexia, bulimia, binge eating and other eating disorders can, and often do, transcend this stereotype.  Not only do eating disorders cross racial, ethnic and gender boundaries, they can also occur outside of the teenage years, developing or recurring during adulthood, mid-life and older adulthood. This may not be surprising considering the “fifty is the new thirty” cultural attitude which seems to keep extending the unrealistic physical demands placed on females by the media.

Adult women struggling with eating disorders can face a unique set of stressors and risks associated with the disease.  Whether they are still battling an untreated eating disorder from adolescence, have had a recurrence of one that was previously under control or have developed one for the first time, the repercussions for themselves and their families can be overwhelming. Marriage, divorce, career, finances, or the death of a loved one can be contributing stressors in an adult woman’s life.  The stress of pregnancy and parenting can be especially triggering, and yet, it is more important than ever at this time in a woman’s life that she is taking care of her body and modeling healthy behavior.  Criticizing herself in the mirror or refusing to eat certain foods, or entire meals, will likely be observed and emulated in the attitudes and behavior of her own children.  Wanting to break this cycle of negative self image and disordered eating can be a significant factor in motivating adult women to seek treatment.

Health complications associated with eating disorders are also likely to catch up with a woman in later adulthood and could motivate her to pursue treatment.  Infertility, osteoporosis and severe tooth decay caused by years of acting on eating disorder symptoms are no longer just warnings from doctors but become painful realities as women age.

In the United States it is estimated that about 10 million women, throughout all ages, struggle with an eating disorder.  Eating disorders can negatively impact all areas of adult life including intimacy, decision-making, social relationships and parenting competence.  The good news is that more and more adult women are reaching out for help and getting the treatment they need to recover.

Want to find out more about this topic? Come hear Trisha Gura the acclaimed author of Lying in Weight: The Hidden Epidemic of Eating Disorders in Adult Women, speak during a special symposium at Sheppard Pratt on Sunday, October 5^th from 1:00 – 3:00 pm.  Admission is free but pre-registration is required.  Please call Iris Fisher at (410) 938-3157 to register.

Want to interact with Trisha Gura online? Chat with her live at the Center for Eating Disorders online discussion forum on Sept. 30th at 8 p.m. Check back soon for more details

Written by Kate Clemmer, Outreach Coordinator at The Center for Eating Disorders at Sheppard Pratt