Moving Past Resistance & Finding the Motivation to Change

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“Getting over a painful experience is much like crossing monkey bars.
You have to let go at some point in order to move forward.”
~C.S. Lewis

Change is hard. You’ve likely heard this statement before. It’s also likely you’ve experienced it firsthand because, well, we all have. It’s one of those universal truths. Perhaps you’ve gone through the end of a relationship, relocated to a different city, started a new job, or maybe even changed careers completely. It’s never easy, even when it is exciting. Inherent to every change, including those that are ultimately positive, are feelings omonkey barsf discomfort and fear. Why? It can be uncomfortable, even painful, to do things in a new way, particularly if you’ve been doing them the old way for a very long time. Given that we as humans are naturally programmed to avoid pain and discomfort, it can also mean we find ourselves unmotivated to change.

Deciding to pursue recovery from an eating disorder after several years or even decades of illness is extremely hard. Doing the work of recovery after years of using eating disordered behaviors can, for many individuals, invoke a lot of fear. Eating disorder behaviors and thoughts may have become so entrenched that ceasing these behaviors will require change to all other parts of life as well…rekindling old interests, developing new hobbies, re-building relationships around recovery instead of the disorder, possibly getting new clothes, implementing new routines and learning new coping skills. Knowing that change can be perceived as danger, even when it’s actually beneficial, can help individuals understand their resistance to it. More importantly, this knowledge can help individuals to move past it.

“Fear, Uncertainty and discomfort are
your compasses towards growth.”
~Celestine Chua

Eating Disorders, The Brain & Change

Understanding change is particularly relevant in the field of eating disorders because of the various factors that drive the disorders. Many people already understand that certain social and cultural pressures (like our diet-obsessed culture or excessively retouched advertising) can impact thoughts about food and weight and may serve to maintain eating disorder thoughts and behaviors. It can, however, be just as important to understand the biological pressures that maintain symptoms and decrease motivation to recover. For example, malnourishment and low body weight are biological markers that can impact the brain’s ability to react to new or changing situations. In other words, when someone is not nourished well, they are more likely to struggle with rigidity of thoughts, otherwise known as “cognitive inflexibility” or “poor set shifting”. Research has found that, even at healthy weights, individuals with eating disorders are more likely to be wired for cognitive inflexibility which can mean more resistant to change.

“This characteristic rigidity or inflexible way of thinking and behaving can act as a real hindrance to those who exhibit it. For example, an inflexible thinking style is likely to mean that an individual relies on strict habits and rules to order his/her life. This rule-bound way of living can impede the individual’s involvement in new opportunities and experiences, monopolize time that could be used more productively, and result in relationship difficulties if the rules become extremely rigid. (2010, Tchanturia & Hambrook)

When it comes to eating disorders, there are daily consequences of being set in your ways since those ways are ultimately harmful. When faced with a decision to pursue change or not, it can be helpful to take a closer look at the specific psychological, sociocultural, and biological barriers keeping you stuck or unmotivated. Only then can you make an informed decision.

Motivation to Change- A Model for Understanding How and Why Change Happens

Motivation to Change is a theoretical model that explores the process of behavior change – from wearing sunscreen to smoking cigarettes, drinking excessively to eating disorders. The model proposes that we all participate in the stages of change whenever we are about to make a change in our lives. Research has shown that when therapeutic intervention is matched to a patient’s stage of change and the therapy is conducted within that stage, a more positive and long-lasting result is more likely.

The Motivation to Change model is divided into the following 5 Stages of Change:

  1. Precontemplation – a lack of awareness of the problem; no intention to change
  2. Contemplation – awareness of the problem but uncertainty about making a change; someone is thinking about change, but is not committed
  3. Preparation – intending to take action; there is a desire to make a change and some planning prior to making the change
  4. Action – the actual time spent making the change and modifying behavior
  5. Maintenance – life once the change has been made, including relapse prevention

This is not a linear model. It is expected that individuals may move backward and forward through these stages and that there will be an ebb and flow of motivation. Even during the action phase, individuals will experience indecision and ambivalence. Understanding this process, and having the support of a therapist along the way, is important in reducing discouragement and increasing long-term success. After all, change is hard. But despite the fear and discomfort, change can also be a very beautiful thing.

“Your life does not get better by chance,
it gets better by change.”
~Jim Rohn

Motivation to Change at The Center for Eating Disorders

opposing arrowsThe Center for Eating Disorders incorporates the motivation to change model and concepts in individual therapy at all levels of care and in specialized treatment groups throughout our inpatient, partial hospital and intensive outpatient programs. This summer we are announcing the addition of an outpatient, once weekly, Motivation to Change Therapy Group for individuals with eating disorders. From the first to last session, group members will be asked to participate in discussion and homework activities designed to explore where they are in the model and how ready they feel to move to the next stage. The group will be offered on Saturdays from 4:00-5:00 PM beginning in June 2014.

Anyone interested in participating can contact Rachel Hendricks at (410) 427-3862 or rhendricks@sheppardpratt.org. The group is offered as a complete module, and participants will be encouraged to participate in each session as the sessions will be progressive.

While the Motivation to Change groups at The Center are exclusively for people with eating disorders, anyone can benefit from understanding motivation to change and using the principles to assess, prepare, and make change in their own lives.

Find details about the Motivation to Change group and a long list of other outpatient groups offered at The Center for Eating Disorders by clicking here.

“By changing nothing, nothing changes.”

~Tony Robbins

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References:

Tchanturia, K. & Hambrook, D. (2010). Cognitive Remediation Therapy for Anorexia Nervosa. In C.M. Grilo & J.E. Mitchell (Eds.), The Treatment of Eating Disorders: A clinical handbook ( pp. 130-149). New York, NY: Guilford.

Monkey Bars Image courtesy of photostock / FreeDigitalPhotos.net
Arrows image courtesy of Naypong / FreeDigitalPhotos.net

 

This Week in #MediaLiteracy | 2 Campaigns You Should Know About

The world of social media presents an interesting dichotomy.  The challenges of existing in an online community are ever increasing.  Concerns about safety and security are high on the list of course (particularly for parents with tech savvy kids) but additional risks to overall well-being and self-esteem are lingering close behind.  Dangers include online bullying, exposure to harmful imagery or media, and the less sensationalized, yet still problematic, body bashing and body comparison often experienced within sites like Facebook and Pinterest.

Yet while these risks exist, these same online communities also provide a great opportunity for social change and grassroots organizing.  We’ve seen two such examples of powerful social media campaigns this week that we thought were worth sharing.  If you struggle with the body toxic environment online OR offline, perhaps these are opportunities for you to help create change for yourself and for others.   Take a look, find out more, get involved.  Just think, every minute you spend advocating for media literacy, body positivity and truth is one less minute you have to engage in the alternatives.

#TruthInAds

The Truth in Advertising Act of 2014 (HR4341) was introduced earlier this week with bipartisan support from Representatives in Florida and California and with collaboration from several great organizations including The Eating Disorders Coalition and The Brave Girls Alliance.

The groundbreaking bill calls on the Federal Trade Commission to develop a legislative framework for advertisements that alter the human body (i.e. shape, size, proportion, color, etc.) and asks for recommendations and remedies for photoshopped ads that are determined to be false/deceptive and which may contribute to a series of emotional, psychological and physical health issues, and economic consequences – particularly affecting, but not limited to, girls and women.” (via Brave Girls Alliance).  If this is something you support, its easy to get involved in any of the following ways:

  • Add your name to the Change.org petition by Seth Matlins
  • Read this great write-up about the Truth in Advertising Act by Matt Wetsel over at his blog, …Until Eating Disorders are No More.  He makes it easy to  find your representative in Congress and how to let them know you support the bill.
  • Take to Twitter, Facebook, Google+ and any other social media site with the hastag #TruthInAds to help spread the word. You can even stop by The Brave Girls Alliance for toolkits, images and talking points for the campaign.

#AdoptTheIllusionists

The Illusionists is a 90 minute documentary about the body as the “finest consumer object” and the pursuit of ideal beauty around the world. Or: how corporations are getting richer by making us feel insecure about the way we look. 

The hard thing for most people about speaking out against society’s narrow ideals of beauty is that it can feel like you’re a fish swimming upstream in a strong current of Photoshopped bodies, fat talk, and dieting.  Taking a stand can mean you’re up against some pretty powerful forces like the beauty and fashion industries, the diet and weight loss industries and even the larger television and film media that rely on funding from these sources. This pressure compounds when you’re an independent filmmaker working to expose the stories and financial benefits behind the WORLD’S beauty ideals.  That’s what filmmaker, Elena Rossini is doing with her documentary The Illusionists and it’s why The Center for Eating Disorders has been a supporter of the film since it first launched via a Kickstarter campaign in 2011.

Now that the film is almost complete, Elena is swimming against that cultural current once more, and has taken to Twitter with the #AdoptTheIllusionists campaign to help the film, and its message, get the widest possible circulation. On her blog, Elena writes, “My passion for the project stems from its potential to incite activism: I strongly believe that The Illusionists can ignite important conversations about consumer culture, mass media, and the epidemic of body image dissatisfaction around the world. It only takes one person to believe in The Illusionists for the fate of the film to change. It could be a producer. An actress. A writer. An activist with the right connections. It could be you.”

The film has already caught the eye of accomplished artists and activists including Geena Davis and Stephen Fry.  If YOU want to see the first 4 minutes of the film and then show your support for the film, visit Elena’s post, It Only Takes One Person or go straight to the #AdoptTheIllusionists campaign page for supportive statements that are ready-to-tweet.

Let us know how you’ve supported the above campaigns and other ways you engage in media literacy activism.  Leave a comment below or join us on Facebook and Twitter.

Perfectly Imperfect: A Special Q&A with JENNI SCHAEFER

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

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

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

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Q & A with JENNI SCHAEFER  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

Seasonal Depression: Fall-ing into Winter

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Written by Amy Scott, LCPC

 

References:

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

 

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


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

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

 

Q & A with Emily Sandoz, PhD

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

What is ARFID?

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

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

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

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

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

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

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

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


So what does all this mean in plain English?

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

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

What ARFID is not

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

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

Filling in the gaps

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

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

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

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

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

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References:

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

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

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

 

Yoga for Body Awareness & Acceptance

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

Eating Disorders & Yoga

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

Yoga room

CED’s new yoga room

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

Yoga as an Adjunct to Evidence-Based Eating Disorder Treatment

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

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

Nourishing Body and Mind at The Center for Eating Disorders

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

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

Yoga for Body Awareness and Acceptance

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

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

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

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

Meet CED’s Yoga Instructor

SZ - yoga instructor

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

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

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

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.

 

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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.

 

 

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

GratitudePost-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)