Knitting Together Skills for Eating Disorder Recovery

April is National Occupational Therapy Month ~ #OTMonth 


If you’ve had an eating disorder yourself, or you know someone who has, you might know all-too-well that one of the side effects of these illnesses is decreased engagement in meaningful, fun or productive activities. Eating disorders have a way of overtaking a person’s energy and time, even altering the way the brain works.

As more time is spent obsessing about food and weight, and engaging in symptomatic behaviors, there tends to be less and less mental energy available for activities unrelated to meals, food or thoughts  of body dissatisfaction.  By no fault of their own, individuals who develop eating disorders often don’t realize how much the eating disorder shifts their focus and leads them away from people, events, and activities they once enjoyed.  This is one of the reasons The Center for Eating Disorders (CED) at Sheppard Pratt has always incorporated Occupational Therapy into our treatment options for individuals with eating disorders.An individual’s “occupation” is any activity that occupies his or her time.  Thus, Occupational Therapists (OTs) fcus on enabling people to participate in meaningful and purposeful activities of daily life. At CED, our OTs work to provide individuals with a setting where the behavioral changes made through Cognitive Behavior Therapy (CBT) and insights learned in other psychotherapies can be converted into new behaviors that become part of the long-term healing process. We’ve written before about some of the ways our OT Department does this through Horticulture Groups.  Similar work is done throughout the year in different ways – including through mindful knitting groups.

Knitting is a craft that requires both physical and cognitive skills and thus engages both mind and body simultaneously. Knitting has the advantage of engaging the senses with the sound of the needles, touch of the yarn and movement of the hands that, together, hold the attention of the mind in the present moment. Repetitive action can be calming, textures can provide grounding opportunities and hand movements offer engagement for mind and body. This can be a much-needed relief for persons with eating disorders whose thoughts are constantly being pulled to the last meal or to the next one, or to persistent negative beliefs about their body, weight or size.

Over the last two years since our knitting program began, the OTs in The Center for Eating Disorders’ Partial Hospital Program (PHP) facilitated two therapeutic knitting groups, running twice a week for 8 months a year as an addendum to our core CBT protocols and additional evidence-based therapies. Participants could join for one session or many and were reminded frequently that each contribution is part of the whole. In these groups, patients who were veteran knitters joined beginners, learning new skills and sharing experiences. The groups were an opportunity for individuals to practice mindfulness and socialize with peers while, as one participant put it, “focus on calming,repetitive activity that also produces a tangible result” completely separate from anything related to one’s eating disorder.  The tangible result? Mindful knitting participants worked to create a collage of knitted squares which, when knitted together, became finished baby blankets.

When asked about the impact of the groups, individuals indicated  they “became more centered, distracted from my negative thoughts”  and “my anxiety level changed”.  Others shared that “the knitting was calming; the repetitiveness of the knitting felt good.” The power of knitting as a therapeutic tool has been documented outside the individual experiences of our patients. According to Corkhill et al., (2014), knitting in groups can impact perceived happiness, improve social confidence and feelings of belonging.

The knitting group, like many of our other OT groups, offers a safe environment to explore a new hobby (or rekindle interest in an old one), challenge perfectionistic tendencies, relax in recovery-focused ways, and stay in the moment with the flow of the needles and yarn.  This opportunity to engage the mind and the body also allowed for reflection on the healing and recovery process. When our most recent group of participants were asked how to apply the skills learned in knitting group to their broader recovery goals, responses included all of the following:

  • “ I can look at each of my new coping skills as accomplishments and enjoy the state of calmness.”
  • “I didn’t give up. I can remember not to give up so quickly.”
  • “I was able to feel good about myself. I can definitely use that for self-esteem issues.”
  • “[I’m] very excited to go home and knit. It’s so helpful to practice being in the moment.

The knitting groups provided a healing experience, new mindfulness skills and a variety of powerful reflections for participants. They also provided participants with an outcome they could feel good about. Upon completion, the group’s resulting baby blankets were donated to newborns at Mt.Washington Pediatric Hospital where they can continue to promote healing in new and important ways.

Would you like to find out more about OT and other treatment options at The Center for Eating Disorders? Call us today at (410) 938-5252.


Blog Contributor: Christine Brown, MS, OTR/L is an Occupational Therapist at The Center for Eating Disorders. Christine received her Masters of Science degree from Virginia Commonwealth University in 1999. Prior to joining the team at The Center for Eating Disorders, Christine spent time providing community-based services as an intensive case manager and worked in a general psychiatric inpatient and partial hospital program.  In her current role at The Center, Christine provides occupational therapy for adults and adolescents in our inpatient and partial hospital programs. She assists patients in increasing engagement in valued roles and meaningful occupations through group and individual interventions. In addition to the knitting group and other OT groups, Christine facilitates the sensory awareness and horticulture specialty groups.

 


Reference:

Corkhill, Betsan & Hemmings, Jessica & Maddock, Angela & Riley, Jill. (2014). Knitting and Well-being. Textile: The Journal of Cloth and Culture. 12. 10.2752/175183514×13916051793433.

 

32 Ways to Stay Recovery-Focused During a Snow Storm

If you are one of the many people on the east coast dealing with this most recent winter storm, you might be struggling to cope with loneliness, boredom or the stress of being stuck at home in heavy snow and cold temperatures. Snow days can certainly be fun but they can also present some challenges for individuals who struggle with mental health issues and eating disorders in particular. That’s why we put together this list of activities and strategies for maintaining a recovery-focused snow day. You can print or bookmark this post and refer back as need for coping skills and ideas for staying recovery-oriented on any unexpected days off throughout the year.


32 Recovery-Focused Activities, Tips & Strategies:

  1. First things first. Review what food you have available and write down a plan for your remaining meals and snacks for the day that is aligned with recommendations from your treatment providers. Post your plan in the kitchen or somewhere you will see it throughout the day. Set up reminders to take the breaks you need to prepare and eat each meal.
  2. Call or text a friend to check-in. 
  3. Paint something.
  4. Start a new knitting or craft project. 
  5. Read an old book that you loved the first time around.
  6. Record your observations about the storm in a journal.
  7. FaceTime with a family member that might be feeling lonely in the storm.
  8. Try this breathing exercise.
  9. Catch up on THANK YOU cards. 
  10. Watch funny videos on YouTube.
  11. Create a gratitude list and add to it throughout the snow storm. When the storm is over, hang it up somewhere where you can admire it and refer back to it.
  12. If you know you tend to get sucked in to social comparisons, limit your time on social media to specific hours each day. Block or hide accounts that you notice only leave you feeling negatively. Follow one or two new accounts that are #bodypositive or recovery-focused. We recommend @NEDAstaff, @LindaBaconHAES and @MelissaDToler to get started.
  13. Look up and print information about eating disorder support groups in your area and make plans to attend once the roads are cleared. Add it to your calendar with an alert so you don’t forget.
  14. Challenge your perfectionism. Do something in a mediocre way and be okay with it. If you don’t consider yourself an artist, it’s okay. Just grab a pencil and start sketching or start tearing up some old magazines for a collage project and get to work. Accept imperfection. Celebrate imperfection.
  15. Make a snow day music playlist full of upbeat classics that warm your heart. 
  16. Go through your closet and gather old or uncooperative clothes that are not serving you or your recovery. Bag them up and get them ready to donate when the snow clears.
  17. Do research on countries and tourist attractions you might like to visit someday.
  18. If you’re an essential employee and need to be at work during the storm, remember that your well-being is also essential. Be assertive about your need for meals, breaks and sleep. 
  19. Throw in a load of laundry you’ve been putting off. When it comes out of the dryer, fold it right away. It’s a great way to keep your hands busy and it’ll be warm too.
  20. Watch a favorite movie and just be present with the movie instead of being on your computer or phone at the same time.
  21. If you’re feeling like the walls are closing in on you, get bundled up and check on elderly neighbors.
  22. Listen to the snow falling and do a 3-minute mindfulness exercise.
  23. Have LEGOs and/or kids in the house? Invite your kids to build something with you.
  24. Send a picture of yourself smiling to someone who has been having a rough time and might need a smile.
  25. Water all of your indoor plants
  26. Drink some hot tea and read the paper
  27. Once the snow passes, put on your boots, explore the outdoors and take some photos; look for people and animal tracks in the snow.
  28. Do a puzzle.
  29. Make a list of compliments you’ve received in the past and honor them, even if you couldn’t accept or believe them at the time they were given.
  30. Make plans for next week. Schedule a meal with a supportive friend or buy tickets online for a show or event you’d like to see.
  31. Make a meal plan and grocery shopping list for the coming week. Email it to a dietitian or therapist on your treatment team.
  32. Don’t have a treatment team?  Call (410) 938-5252 for a free phone assessment and to be connected with an Intake Coordinator at The Center for Eating Disorders who can talk with you about available options.

What else would you add to the list? How are you planning to make your snow day more memorable and recovery-focused? Share your ideas with us on Facebook and Twitter.


www.eatingdisorder.org

8 Tips for Raising Body Positive Kids (Who are also Competent Eaters)


If your goal is to raise kids with high levels of self-esteem, eating competence, body satisfaction and a healthy weight (which is different for everyone) then join the chorus of advocates saying #wakeupweightwatchers and ditch the diet mentality for yourself and your family.  We know weight-loss diets don’t work. We also know they can cause serious harm, especially when introduced to kids and teens.  Let’s prevent the weight loss industry from profiting off our children’s generation.

So if dieting doesn’t work to help kids maintain a healthy weight, what is a parent to do?  These 8 tips are a great place to start.

  1. Make a commitment to having family meals together as often as you can within your family’s schedule. Having regular sit-down meals as a family has been shown to be a protective factor against a range of health and mental health problems including disordered eating.1,2,3,4 
  2. Introduce and incorporate a variety of foods from different food groups at every meal. This doesn’t assume your kid will actually eat them but it’s important to expose them, even if it’s just on someone else’s plate.
  3. Teach and model body acceptance (as opposed to body criticism or body comparison). Kids are always listening and watching how the adults around them relate to their own bodies.
  4. Support your child’s natural ability to regulate hunger and satiety. Promote trust in their ability to self-regulate. We recommend learning more about Ellyn Satter’s Family Feeding Model and the Division of Responsibility in feeding.

Research has shown that size acceptance and learning to use hunger and fullness cues produces sustainable improvements in blood pressure, cholesterol levels, physical activity, self-esteem, and depression compared to dieting.” 5

 

  1. Engage in physical movement as a family with the goal of adventure, fun, coordination and social connection. Try not to frame exercise as punishment, as a way to gain permission to eat or as a means to an end (i.e. weight-loss).
  2. Incorporate all foods without fear or mixed messages. Food is energy and fuel but it’s also okay for it to be enjoyable too. Don’t forbid specific foods or categories of foods (unless there is an allergy of course). Refrain from using food as a reward at home and in the classroom as this can confuse kids, encourages them to eat in the absence of hunger or may lead to a pattern of rewarding oneself with food.6
  3. Refrain from labeling foods as “good foods” vs “bad foods”. Connecting foods with negative labels like bad, toxic or junk foods, can send kids a message that food is related to morality. Even young kids may internalize these labels. Ex) I ate a bad food, therefore I must be bad or I should feel badly. This can trigger strong feelings of guilt or shame related to eating as well as increased emotional eating.
  4. Support healthy sleep habits. Kids who don’t get enough sleep, or have chaotic sleep schedules, show changes in hormones that regulate hunger and appetite. Not getting enough sleep can also impact the way a child’s body metabolizes certain foods.7

While these tips are meant to be a very basic place to start, they might still feel overwhelming since we live in a culture of toxic messages about food and weight. It’s hard to let go of anxiety about our kids’ eating behavior and weight. These can also be difficult to implement if you have your own history of body image struggles, eating disorders or dieting.

If you’re worried that your own relationship with food or weight might be complicating the way you approach these issues with your kids or teens you’re not alone. It can be helpful to get support from a therapist with eating disorder expertise or other non-diet practitioners. At The Center for Eating Disorders at Sheppard Pratt we provide a number of services that can help, including:

If you’re interested in any of these services, please call (410) 938-5252 for more information. 

Previous Post: 10 reasons NOT to introduce dieting during childhood & adolescence


References:

  1. Losing weight won’t make you happy
  2. Are Family Meal Patterns Associated with Overall Diet Quality during the Transition from Early to Middle Adolescence?
  3. Family meals during adolescence are associated with higher diet quality and healthful meal patterns during young adulthood.
  4. BENEFITS OF FAMILY DINNERS
  5. 10 Reasons to Stop Dieting Now
  6. Secrets of Feeding a Healthy Family: how to eat, how to raise good eaters, how to cook
  7. The connection between sleep and growth

Additional Recommended Reading: Weight Science: Evaluating the Evidence for a Paradigm Shift

 

10 reasons NOT to introduce dieting during childhood & adolescence


Weight Watchers recently announced that it will offer free memberships to teens starting this summer. This announcement led to parents, physicians, dietitians and therapists around the world speaking out – and rightfully so – about the harmful effects of encouraging dieting in our kids. Why? Weight-loss diets have not been shown to provide any long-term health benefits.  Furthermore, dieting remains a major predictor for the development of eating disorders and worsens negative body image.

If you have kids or teens in your life that are feeling the pressure to diet or lose weight,  here are ten important facts and considerations to bear in mind.


1. Restrictive diets negatively impact children’s normal stages of growth and development. 

“Dieting is associated with potential negative physical health consequences. Nutritional deficiencies, particularly of iron and calcium, can also pose short- and long-term risks. In growing children and teenagers, even a marginal reduction in energy intake can be associated with growth deceleration1

2. Dieting is a major risk factor for the development of eating disorders. It can be hard to recognize eating disorders in teens or children, as many harmful attitudes about weight and food have become normalized in our culture. However, the problem is very real. And eating disorders don’t discriminate by gender, body type, ethnicity, or social status. According to Dianne Neumark-Sztainer, Ph.D., in the U.S. alone, more than 50% of adolescent girls and 33% of adolescent boys have used unhealthy weight control behaviors. Even when such behaviors don’t develop into clinical eating disorders, they can still have a significant negative impact on physical and mental health.

3. Dieting disrupts children’s innate ability to eat intuitively. Dieting teaches kids to override natural hunger and fullness cues which can have lifelong effects.

4. Diets often rely on externally mandated measures of food or fullness which  undermine our innate ability to feed ourselves well. Using external systems such as “points” or other charts and arbitrary ways of monitoring food intake teaches kids to shut down or ignore their own internal regulatory systems (including hunger and satiety cues) and to mistrust their own bodies.

5. Focusing on weight is problematic as it is not a reliable measure of health. Furthermore, weight-focused discussion in and of itself is a risk factor for obesity and eating disorders.

“Several studies have found that parental weight talk, whether it involves encouraging their children to diet or talking about their own dieting, is linked to overweight and EDs.” 2

6. Dieting teaches kids to associate eating with feelings of guilt and shame as opposed to viewing food as fuel and energy.

7. Dieting negatively impacts body image. Weight fluctuations, common with dieting behaviors, often end up fueling the cycle of body dissatisfaction and disordered eating.

8. Findings clearly indicate that dieting and unhealthy weight control behaviors predict significant weight gain over time.3 Weight loss diets are actually associated with higher lifetime BMI.

9. Weight loss diets are associated with decreased metabolism, food preoccupation, and binge eating.4

10. Weight loss diets are associated with increased rates of depression and decreased self-esteem.5,6

Once we all understand the facts about how diets actually impact children (and adults), we can help families focus on implementing actual evidence-based strategies that we know are more likely to result in positive outcomes and healthier kids.

The question becomes: How can family members and friends best support our nation’s youth towards a peaceful relationship with food and positive body image without introducing potentially harmful diet routines?

Check out our next post, 8 Tips for Raising Body Positive Kids (Who are also competent eaters) for some basic ideas and strategies.

References:

  1. Dieting in adolescence
  2. Preventing Obesity and Eating Disorders in Adolescents
  3. Dieting and Unhealthy Weight Control Behaviors During Adolescence: Associations With 10-Year Changes in Body Mass Index
  4. Intuitive Eating Category: Studies
  5. Risk and protective factors for depression that adolescents can modify: a systematic review and meta-analysis of longitudinal studies.
  6. Losing weight won’t make you happy 

Contributors:
Rebecca Hart, R.D.
Caitlin Royster, R.D.
Rebecca Thomas, R.D.
Kate Clemmer, LCSW-C
Hannah Huguenin, R.D.

Transition and Recovery with Ryan Sallans: A Reflection on TU’s Eating Disorder Awareness Week Event


What does it mean to live authentically? 

Honoring your truth.

In other words, understanding, accepting, and nurturing your various, intersecting identities, to live your best life. This was a major theme throughout a special event held in February at Towson University (TU) to help recognize National Eating Disorders Awareness Week.At the event, speaker Ryan Sallans shared his personal experience of gender identity development and eating disorder recovery with the TU community. Organized by TU’s Counseling Center, the event was well-attended and brought together various university and local organizations, including The Center for Eating Disorders at Sheppard Pratt, TU’s Center for Student Diversity and The TU Body Image Peer Educators (BIPE). Sallans is a well-known public speaker, author, and health educator, and has been featured on Larry King Live, NPR, The Advocate, and many other news and popular media outlets.

 

Documenting Self-Discovery through Transition and Recovery

Throughout his talk, Sallans highlighted the delicate balance between taking care of oneself and navigating important relationships that often change throughout transition. Of course, each individual’s experience is different and Sallans did well to emphasize his is only one story among many.

Despite transgender and gender non-binary identities being discussed more openly than ever, there remains a stark deficit in information regarding the intersection of body image, gender identity development, and eating disorders. Studies have suggested the prevalence of eating disorders is higher among transgender individuals when compared to the general population (Reisner et al., 2016; Watson, Veale, & Saewyc, 2016). This health disparity is likely influenced by the pervasive effects of transphobia in our society, which sets the stage for inequality and discrimination at home and beyond, creating unique risk factors for the trans community (Bockting, Miner, Swinburne-Romine, Hamilton, & Coleman, 2013; Watson et al., 2016).

Pair this with the fact that no one is immune to the influence of the multi-billion dollar beauty industry consistently sending a message that, in order to be happy, we must look a certain way. Each one of us, regardless of gender, is sold (to some extent) on the idea that by controlling our bodies, we can achieve happiness, wealth, and popularity. Those working in the eating disorder field have historically referred to this as the internalization of the “thin ideal” or the acceptance of unrealistic or narrow beauty standards (Thompson & Stice, 2001). Transgender individuals are not immune from this culturally normative body dissatisfaction.  But people with eating disorders who identify outside of the restrictive gender binary may also experience amplified body dissatisfaction because their gender identity and their sex assigned at birth do not match (Algars, Alanko, Santtila, & Sandnabba, 2012; Strandjord, Ng, & Rome, 2015).

Furthermore, adjusting to a changing body and gender expression (for those who opt for cosmetic, hormonal, and other gender-affirming interventions), as well as the public commentary this process often evokes, presents its own unique challenges that impact body image and self-esteem (Couturier, Pindiprolu, Findlay, & Johnson, 2014).

 

How does one survive, and thrive, when faced with such challenges?

Sallans encouraged everyone in the room that night to stay hopeful and connected, which for him means sharing life stories to better understand those that are different. His comments suggested tremendous patience and empathy for his loved ones’ process of arriving at a place of acceptance with his transition, while also emphasizing the need to disconnect at times to protect oneself. Sallans identified a number of strategies and resources he has found useful, starting with a non-judgmental awareness of his needs, his boundaries, and his triggers. He explored the role of psychotherapy, as well as self-guided research on lesbian, gay, bisexual, and transgender issues, in helping him to turn towards his inner truth and wisdom.

Consistent with national guidelines on psychotherapy with LGBTQ individuals, Sallans benefited tremendously from collaborating with an affirmative therapist; someone he was able to confide in during times of confusion and fear surrounding gender identity, at a time when very few were even considering gender outside of the binary. The trust and respect he built with his therapist created a safe space to discuss gender issues and eating disorders, which provided the platform for recovery and ultimately allowed for closer and more authentic connections with family and friends. Outside of therapy, Sallans said he found it incredibly useful to communicate about his emotions and take time out for himself. He acknowledged the need to unplug from negative relationships (and social media) and engage in routine self-care, which for him often includes going for walks and being in nature.

Self-care, use of coping skills for managing negative emotions, positive sense of identity and community, and feeling like you can count on those closest to you are universal factors associated with resiliency (Rutter, 2012). These factors are even more relevant for those who identify outside of the gender binary (Hill & Gunderson, 2015; Watson et al., 2016). If you or a loved one is struggling with an eating disorder and questioning gender identity, see the resource links below to gather information, find community, and get professional support.

 

For information regarding affirming and evidence-based treatment options and programs at The Center for Eating Disorders at Sheppard Pratt, please contact us at (410) 938-5252 or email us at eatingdisorderinfo@sheppardpratt.org.

 

Additional Resources:
https://www.ryansallans.com (Ryan Sallans’ Official Website)
www.genderspectrum.org
www.glaad.org
www.pflag.org
www.thetrevorproject.org
https://www.chasebrexton.org/our-services/lgbt-health-resource-center


Written By: Andrea Castelhano, PsyD, Outpatient Therapist – Dr. Castelhano is a licensed clinical psychologist in the outpatient department at The Center for Eating Disorders at Sheppard Pratt. She earned her doctorate in Clinical Psychology at the American School for Professional Psychology at Argosy University, DC where she received training in cognitive behavioral therapy and mindfulness-based approaches to psychotherapy. She also received specialized training in eating disorders, anxiety disorders, and co-occurring self-harm and suicidality. Additionally, she has provided affirmative therapy to individuals in the LGBTQ+ community throughout her training and professional career. Affirmative therapy is a therapeutic approach that respects individuals of all sexual orientations and genders, recognizes the impact of intersectionality on identity development and life experience, and addresses issues including discrimination and heterosexism as they relate to the individual’s broader treatment goals. Dr. Castelhano joined The Center for Eating Disorders in 2018 and brings her experience from a variety of clinical rotations, including a year-long practicum at Children’s National Medical Center Outpatient Eating Disorders Clinic,  APA-accredited clinical internship at Laureate Psychiatric Clinic and Hospital, and post-doctoral fellowship with the University of Tulsa Counseling and Psychological Services Center. She provides individual, family, and couples therapy, as well as psychological testing services. She is fluent in Spanish and Portuguese.


References

Algars, M., Alanko, K., Santtila, P., & Sandnabba, N.K. (2012). Disordered eating and gender identity disorder: A qualitative study. Eating Disorders: The Journal of Treatment & Prevention, 20, 300-311.

Bockting, W.O., Miner, M.H., Swinburne-Romine, R.E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943-951.

Couturier, J., Pindiprolu, B., Findlay, S., & Johnson, N. (2014). Anorexia nervosa and gender dysphoria in two adolescents. International Journal of Eating Disorders, 48, 151-155.

Hill, C. A., & Gunderson, C. J. (2015). Resilience of lesbian, gay, and bisexual individuals in relation to social environment, personal characteristics, and emotion regulation strategies. Psychology of Sexual Orientation and Gender Diversity, 2, 232-252.

Reisner, S.L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, … Baral, S.D. (2016). Global health burden and needs of transgender populations: A review. The Lancet, 388, 412-436.

Rutter, M. (2012). Annual research review: Resilience – clinical implications. The Journal of Child Psychology and Psychiatry, 54, 474-487.

Strandjord, S.E., Ng, H., Rome, E.S. (2015). Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: Lessons learned. International Journal of Eating Disorders, 48, 942-945.

Thompson, J.K. & Stice, E. (2001). Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science, 10, 181-183.

Watson, R.J., Veale, J.F., & Saewyc, E.M. (2016). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders, 50, 515-522.

Q & A with Kitty Westin – National Eating Disorders Awareness Week 2018


Kitty Westin is an advocate for people affected by eating disorders and has become a nationally and internationally recognized authority on the impact mental illness has on individuals, their families and the community. She is also a licensed psychologist. Following the death of her daughter, Anna, from anorexia in 2000, Kitty founded the Anna Westin Foundation (now known as The Emily Program Foundation) a Minnesota-based 501c3 on a mission to eliminate eating disorders. She is past president and a current board member. She is also recently retired from the board of the  Eating Disorders Coalition, a national advocacy organization based in Washington D.C. after nearly two decades of service. 

In honor of National Eating Disorders Awareness Week, Kitty will give a special presentation in Baltimore called Shattering Stigma, Advocating for Change.  In advance of this free community event, we asked Kitty to reflect on her advocacy work, her resilience, and her hopes for future eating disorder activism.


Q & A with Kitty Westin

Before your own family experienced the pain and suffering of an eating disorder
firsthand, what did you know about these illnesses? What was your perception of eating disorders in general?

I am a trained psychologist and I knew very little about eating disorders. I think I had no more than an hour of lecture about eating disorders when I was in my graduate studies. I don’t ever remember being cautioned to notice early warning signs when my 3 daughters were growing up.


What gives you the courage and hope to continue telling your daughter Anna’s story at events like the one coming up in Baltimore?

When Anna died it felt like my world was blown apart and I had no idea how to put it back together. Her death was like losing a limb – I am aware of the loss every day and the pain never truly goes away but you learn how to live without it. In the beginning, I somehow knew that telling our story without guilt or shame could possibly help someone else and we could transform the horror of Anna’s death into something positive.


Over the past twenty years, the scientific understanding of eating disorders has
evolved significantly but we’re still missing important information about the impact of eating disorders.  Why is that?  What do we need to know to move forward

Shame and stigma get in the way all the time! People who are struggling with eating disorders or any mental health condition often feel stigmatized and judged and that very often prevents them from seeking treatment, talking with their family and friends, or speaking out against the injustices they face. And, we don’t have enough research dollars or NIMH funding to encourage researchers to study eating disorders. NIMH spends approximately $28 million per year on eating disorders and $505 million on Substance Abuse disorders


What do you think is the biggest or most enduring misperception regarding eating disorders and who they impact? What can we do to continue to try to combat the misinformation?

Many people think eating disorders are behavior problems or a choice as opposed to a serious mental disorder. We need to talk openly and honestly about eating disorders. We must address our toxic culture ofthinness.


What does it mean to fight for “health parity” for
people with eating disorders?  What are the current challenges and opportunities?

Mental Health parity is the law of the land. It is a violation of the law for insurance companies to refuse to cover treatment of eating disorders “on par” with any medical/surgical issue. However, insurance companies often find loopholes and refuse to cover eating disorder treatment, especially higher levels of care like intensive day programs, inpatient  and residential care.


What are some of the ways that stigma can impact individuals and families dealing with eating disorders and mental illnesses in general?

Stigma prevents people from the very things that define quality of life; such as healthy relationships, meaningful work, homes and respect.


Many of us in the eating disorders community have watched and admired your hard work for nearly two decades, and it’s abundantly clear that you embody the definition of RESILIENT. How can we all – activists, clinicians, individuals with mental illness, caregivers and support people – work on cultivating more resiliency in our own lives?

Everyone who is in the “war” against eating disorders needs support and I think it helps to join an “army” made up of people fighting the same issue. There is power in numbers. Nobody can do this alone and there is no need to try to do it alone. There are numerous ways to find support and be an advocate.


Though you recently announced your retirement from a leadership position at The
Eating Disorders Coalition (EDC), when you think to the future where do you see potential successes in the fight against eating disorders?

The EDC definitely had a huge victory when language from the Anna Westin act was passed as part of the 21st Century Cures Act in 2016! However, there is much still to do. One very important thing is to make sure that the Cures Act is implemented correctly. And, we are working with agencies like HHS and DOD. We are asking CDC to add questions designed to address eating disorders into National Health Surveys.


Who do you think could benefit from attending “Shattering Stigma, Advocating
for Change” on February 25 in Baltimore?

My message is designed to reach a wide audience including people who are struggling with mental health issues, their family and friends, professionals and providers and anyone interested in learning about stigma and the impact  it has on individuals and the community.


What do you most hope attendees will take away from listening to your presentation in Baltimore on February 25th?

My hope is that my words will encourage people to stand up and use their voices to affect change. There is no hope without action.

 


Kitty Westin has received numerous awards for her advocacy work and has written several book chapters and articles related to eating disorders advocacy and the impact they have on society. An important milestone for Kitty was being present on December 13, 2016 when President Obama signed into law the ground-breaking health care initiative, the 21st Century Cures Act. The Cures Act includes extensive language from the Anna Westin Act, a bill that will improve access to treatment for eating disorders and education of all health care professionals.

Many thanks to Kitty Westin for her time and responses above. If you’re interested in attending her keynote presentation on February 25, click the image below to find out more and be sure to RSVP.

 

12 Tried and True Ways People Upheld a Recovery-Focused Holiday


Looking back on this holiday season, it’s safe to say that social gatherings and celebratory feasts posed some significant challenges for anyone trying to develop a more peaceful relationship with food – including those in recovery from an eating disorder. That’s why The Center for Eating Disorders at Sheppard Pratt launched a social media campaign called the “12 Days of Eating Disorder Recovery.” The initiative shared tips on how to maintain healthy relationships with food through the holiday season and beyond. These are summarized below – one for each day of the 12 days – so you can use them to navigate future holiday seasons and get a little help finding the joy and peace within the hustle and bustle.


#12DaysofEDRecovery

Day 1: Keep expectations realistic and set manageable goals that will help you stick to your plan.

Regardless of where you’re at in recovery, celebrations, holiday feasts and schedule changes can pose challenges. Planning ahead and setting realistic expectations can help you stay focused on what truly matters.


Day 2: Grab a notebook or journal and write down all the reasons why recovery is important to you.

While you’re at it, make another list of support people. Figure out in advance who you will call if things get overwhelming or if you simply need to get out of your own head. Things that help you cope daily are still needed during the holidays.

If you’re headed out of town, pack your suitcase with your notebook along with other recovery tools. This could be tangible things like a fidget cube, fun book, art supplies or a favorite essential oil.


Day 3: Connect in safe and meaningful ways with others in recovery.

Recovery from an eating disorder is a journey that requires support, encouragement and ongoing motivation. Individuals with eating disorders and their loved ones can find hope and help in others who understand what they’re going through. Support groups and therapy groups can be a great way to strengthen recovery skills and help remind you that you are not alone.


Day 4: Set a goal today that has nothing to do with food, weight or your eating disorder.

It’s common for social gatherings to revolve around food in our culture, especially during the holidays. These celebrations often lead to an intensified emphasis on meals and eating for those working on recovery from an eating disorder. Keep doing what you need to do to fuel your body in recovery, but try also setting a goal for yourself that has nothing to do with food or your eating disorder.


Day 5: Don’t let your eating disorder make decisions for you in the grocery store. Use price or brand to inform decisions instead of reading nutrition labels.

Whether we like it or not, grocery shopping is part of adulthood. But for the millions of individuals living with an eating disorder, this everyday task feels overwhelming and becomes a significant barrier to recovery. If you are worried about buying items for upcoming gatherings or celebrations, this tip can help make grocery shopping more manageable.


Day 6: Defuse grocery shopping stress by bringing a friend, avoiding crowds and shopping at smaller stores in off-peak hours.

If you’ve had negative experiences with grocery shopping, you can start developing more positive associations. A Registered Dietitian may provide some easy steps for managing your grocery list.

Ask your dietitian for support, or consider adding one to your treatment team if you haven’t done so. You can also go with a friend or support person the first few times to help distract from any eating disorder thoughts and avoid being triggered by diet products.


Day 7: Infuse your New Year with body positivity and gratitude.

Be prepared to see your newsfeed flooded with New Year’s resolutions, gym memberships and diet plans in the coming weeks. To balance triggering and unhealthy messages, remember to reality check all the bogus weight-loss ads and surround yourself online and IRL with body-positive people and organizations.

Pay attention to which images and messages contribute to your feeling badly about yourself or your body and do what you can to remove them from your daily life. When you notice them, remove them (unsubscribe, throw them away, etc.) or challenge them.

Focus on gratitude for the functionality of the breath in your body, the ability to move, see, hear, taste or touch. Try to elevate those in your mind as you go through your day.

Create your own New Year’s goals with body positive thoughts. Work to set aside unhealthy ideals and embrace your body.


Day 8: Tackle eating disorder stigma by dispelling myths among friends and family.

Major misconceptions about eating disorders are widespread, even among those closest to us. Family can be a key component to recovery success. Unfortunately, some family and friends may still subscribe to ED myths that lead to stigma and might make it harder to ask for help or to seek treatment. Help educate and increase awareness about eating disorders among your loved ones.


Day 9: Friends and family can be a great support network. Be open with the people closest to you about how they can best support you.

Holiday conversations often revolve around what people are eating or not eating, who’s eating too much or too little and even criticism or praise about body weight and size.  Did this happen for you during Chanukah or Christmas this year?

The start of a new year can be a great time to enlist family members as allies by being open about your needs and boundaries. Set the stage for healthier gatherings in the new year by having a post-holiday conversation with them about how their words impacted you and what they can do instead to support you at the table and in other stressful situations.


Day 10: Meditate or listen to soothing music to start your day in a positive place.

It’s not just about food and body image. Incorporating mindfulness in the new year can be a way to care for your overall mental health. If you’re heading back to work or school after winter break, find a way to change up your routine to build in mindfulness practices.  Even just three minutes of meditation can help you set a positive intention for the day.

You can be mindful in your social connections too. Cultivate awareness about the different support each generation of your family can offer. Hanging out with cousins can be a nice way to connect and get support on specific life stage issues like being away at college, parenting stress, job hunting, etc. On the other hand, reaching out to older generations, like grandparents, is an opportunity to see how priorities can shift throughout life. Even the youngest generations have something to offer you in your recovery-focused festivities.


Day 11: Aim for balance and flexibility rather than perfection.

Individuals who are perfectionists often struggle with the urge to compare themselves to people around them. Research has shown perfectionism to be a significant risk factor for the development of eating disorders.

Constantly striving to be perfect with food or appearance during the holidays can lead to tension and stress. Even those holiday photo cards hanging around your house can trigger negative social comparisons. Try making some small changes to help ease perfectionist tendencies this time of year.


Day 12: Support is essential to your wellbeing. Recovery is possible with treatment and support.

Whether you are an individual working on recovery, or a loved one who is close to someone in recovery during this time of year, it’s important to remember that support is essential to wellbeing.

Remember, you don’t have to go through this alone.

Ask for help.

 

If you are experiencing symptoms of an eating disorder and you’re not connected to a therapist or receiving treatment, don’t wait any longer.  There is no reason to go through this alone. Call (410) 938-5252 for a free phone assessment today.


This holiday season, and year-round, carry these tips with you. Recovery is possible and recovery is worth it.

Looking Back: One Mom’s Words of Hope


We recently received a note from a family who started the hard work of recovery three years ago. Her words were reflective and resonated with our staff who know that it can feel quite overwhelming for patients and families at the beginning of treatment. Knowing how isolating it can be to go through recovery as an individual and as a caregiver, we asked this parent if we could share her note so that other families might know they are not alone and that it does get better.  She graciously agreed and we are honored to share her words with you below.

You can read more patient and family testimonials here.

If you or a loved one are in need of treatment, support or resources please call us at (410) 938-5252.

 

Easing Anxiety About Grocery Shopping During Eating Disorder Recovery

Image

 


Easing Anxiety About grocery Shopping - Woman with Shopping Cart [IMAGE]Whether we like it or not, grocery shopping is a necessary task of adulthood. It can be annoying or simply unenjoyable for anyone who is living a busy life or just doesn’t enjoy shopping or cooking. Most adults however, make it in and out of the grocery store regularly without significant disruption, problems or stress. But for the millions of individuals living with an eating disorder, an everyday task like buying food for themselves or their families feels completely overwhelming. Just thinking about going food shopping can trigger intense anxiety and may result in avoidance or elevated eating disorder symptoms. Actually going to the store and getting out before the milk gets warm seems impossible at times.

Since having consistent, structured and fulfilling meals are such a fundamental part of eating disorder recovery, being able to source and purchase the food for those meals then becomes a primary part of treatment.  If someone is too anxious to step foot in the store, obsesses over the label on every item or finds they just wander aimlessly, it can really inhibit their ability to bring home the foods they need to meet their nutritional goals. As a result, difficulties with grocery shopping can become a significant barrier to recovery. That’s why our Outpatient Nutritional Coordinator put together these tips to help individuals with eating disorders (or anyone really) navigate the grocery experience and become more confident in your shopping ability.

Plan, Plan, Plan: This is one of the most impactful tips! Planning your meals ahead saves you time and money. It can also decrease anxiety at meal times since you know that you have something in place and what to expect. In order to maintain stable meals, you must have a menu planned and food available to meet that plan; remember to incorporate foods from all food groups. Set aside one hour, one day a week for meal planning. Planning ahead also cuts down on the amount of trips to the store you need to take during the week.  One to two trips to the grocery store per week is reasonable

Organize your list: Based on your planned menu, create a grocery list. Breaking it down into the sections of the grocery store can cut down on time spent in the store. People that “wing it” end up wandering too long or revisiting the same aisle two or three times. Keep a pad of paper in your kitchen or a list on your phone where you can write down food staples that you run out of during the week; add them to your main grocery list before you go.

Be realistic: Set realistic expectations when you plan your meals. What do you have going on this week?  Which nights will you have more time to cook?  Which nights do you need something easy to assemble?  At which meals would it make sense to use leftovers?   Pick up a variety of foods that require different levels of preparation.

Mission possible: Set a time limit and stick to it.  Make it your mission to be at the register in 30 minutes or less.

Add support: Go with a friend or support person for the first few times. Whether they know you have an eating disorder or not, this will help distract from any eating disorder thoughts in your head and will keep you more on task.  Letting your support person know your goal of being at the register in 30 minutes or less can also help hold you accountable to not wasting time wandering aisles or compulsively comparing items.

Stick with what you pick: If you find yourself spending too much time reading labels or comparing similar products, try to make the decision based on which one is on sale that week. Choosing the item based on price can also help expose you to different brands and allows you to discover which one your taste buds truly prefer.  Another way to decrease label reading is to view the grocery store ad online before going to the store when making your list.  This allows you to view items without being able to read their labels and to commit to having them on your grocery list based on what is on sale.  This is helpful for reducing time comparing products, getting exposure to trying different products out, and can save you money!

Shrink the store: Sometimes it’s fun to shop at a large grocery store and to have a lot of options, but for some people more options = more anxiety. If that’s the boat you’re in, try shopping at a smaller store such as Aldi, Eddie’s, or the grocery section at Target.   It’s a lot easier to decide which yogurt to buy when you have three options instead of thirty!  Having less options of yogurt, cereal, bread, crackers, etc, can reduce time spent in the aisles and will help you get out of the store faster.

Ditch the diet products:
Avoid being lured into fat free, sugar free, “diet products.”  They do not satisfy and will only leave you feeling hungry and stuck in the “diet mentality.”  Normalized eating incorporates regular products that are more satisfying and enjoyable.

Avoid the crowds: Try to shop at times when the grocery store is not as busy. Typically during the week, 3-6pm tends to be the busiest time at the grocery store.  Sundays are also very busy days.  Try to go in the morning, later in the evening, or on Saturday.   You can also look your grocery store up on google maps and look at their “popular times” bar graph to see less busy times to shop.

Check your status:
Be mindful of your vulnerability factors.  Are you tired? Stressed? Hungry? If the answer is yes, plan on engaging in some self-care first and going to the grocery store when you are feeling more rested, stable and satiated.

Ask an RD: If you need help planning meals, making grocery lists, expanding variety, and setting goals for improving your confidence with grocery shopping, ask your dietitian for support. If you do not have a dietitian, consider adding one to your treatment team if you are working through an eating disorder.

Remember that with learning any new skill, it takes practice and time.   If you have negative experiences with grocery shopping in your past, try some of these tips to begin developing more positive associations with going to the grocery store. Over time, this will help decrease your anxiety around grocery shopping. Plus, having food available for meals will help you stay on track on your journey to recovery.


The Center for Eating Disorders is excited to announce the launch of a brand new Grocery Shopping Support Program designed to aid individuals working on recovery from eating disorders including anorexia, bulimia and binge eating disorder. Parents/Caregivers of children and adolescents are also eligible for participation. Program components and goals include:

  • Snack/meal/menu planning
  • Grocery list development
  • Incorporation of challenging foods
  • Efficiently utilizing time spent in stores
  • Managing impulsive food purchases
  • Identifying triggers and coping skills
  • Decreasing anxiety around food and food purchases
  • Exposure to food-based environment
  • Individualized treatment goals

If you’re interested in scheduling a grocery support appointment, please call (410) 938-5252.  If you have questions about the program you can also email Hannah Huguenin.


Written By: Hannah Huguenin MS, RD, LDN
Outpatient Nutrition Coordinator

Hannah has been an integral part of The Center for Eating Disorders’ staff since 2008, and provides individual nutritional counseling for the outpatient population. In her role at The Center, she manages the outpatient nutrition team and leads program development. She was instrumental in building the Center’s new Grocery Shopping Support Program. Hannah also provides ongoing support to help patients decrease eating disorder behaviors, meet their nutritional goals and improve their relationship with food through nutrition education.

How to Stay Recovery-Focused When Interacting with Triggering Media

In our previous post we discussed a variety of reasons that individuals with eating disorders, especially those in the early stages of recovery, may choose not to watch the Netflix film To The Bone or other films they know could create roadblocks in their continued recovery.

With that said, triggering media has always been around and will always be a part of our society so it’s helpful to know how to navigate it.  Many individuals in long-term recovery or later stages of treatment might feel prepared to watch a film or read a book about eating disorders, despite triggering content. Many of our clinicians have helped to shape such exposure into therapeutic experiences for patients who are ready.  For example, during periods of strong recovery, seeing a film like To The Bone can be an opportunity to reflect on one’s own experience, see things from a new perspective, process lingering eating disorder thoughts or channel anger towards the eating disorder in productive ways.

If you’ve considered all of the options and decide you do want to watch a film about eating disorders, these are a few things to consider that can help you do so in safe and productive ways.

  1. Don’t watch alone. Watch with a support person you can trust and communicate openly with them about how it is impacting you in the moment. You might even consider pausing the show periodically to breathe, reflect and talk.
  2. Time it right. Only watch it when you know you’ll be attending a therapy session or support group within a few days so you can explore your reactions and get help challenging any distorted thoughts or concerns about what you see on screen. If you currently have a lot of other life stressors or you’re in a time of transition (moving, starting school, going through a divorce, etc.) you may want to consider waiting to watch until things settle down.
  3. Challenge the ED thoughts. Consider journaling about aspects of the movie that you find triggering and then refute and challenge the inaccurate, negative or distorted thoughts.
  4. Be an activist. Write a letter to the director of the film or to the editor of a local newspaper regarding what you liked or didn’t like, what was helpful vs. not helpful or what you’d like to see more of when it comes to films about eating disorders. For example, while To The Bone features one person of color and one male in supporting roles, the movie’s star and protagonist is a young, white, upper-middle class woman with anorexia. This doesn’t help to dismantle stereotypes about who is and isn’t impacted by eating disorders. Consider writing a letter that advocates for greater diversity in eating disorder representation or about another aspect of recovery that feels important to you.
  5. Create an escape clause. Allow yourself the option to stop watching at any point throughout the film. Eating disorders can be associated with all-or-nothing thinking so it may feel like once you start the movie you have to finish it, but remember it’s not so black and white. At any point, if you feel triggered or uneasy about what you’re watching, turn it off.
  6. Plan ahead. Decide in advance upon an alternative show to watch or a self-care activity you can do when the film is over (or if you stop watching early) that will help you sustain a more recovery-focused mindset.

Do you use these strategies or have other ideas for navigating triggering media safely?  Tweet them to us @CEDSheppPratt and we’ll add to the list. 


You may also be interested in reading: 
To Watch or Not to Watch: That is the Question, Navigating “To The Bone” and other potentially triggering movies about eating disorders