Body Respect Q&A with Linda Bacon, Ph.D. ~ Part I


Linda Bacon, Ph.D. is an internationally recognized authority on weight and health.  She will stop by Baltimore this fall for two events aimed at dispelling long held myths about weight and health within the medical community and in our society at large. A nutrition professor and researcher, Dr. Bacon holds graduate degrees in physiology, psychology, and exercise metabolism, with a specialty in nutrition. She has conducted federally funded studies on diet and health, and  published in top scientific journals. Dr. Bacon’s advocacy for Health at Every Size (HAES) has generated a large following on social media platforms and the international lecture circuit. Her book, Health at Every Size: The Surprising Truth About Your Weight, called the “Bible” of the alternative health movement by Prevention Magazine, ranks consistently high in Amazon’s health titles. Her latest book, Body Respect: What Conventional Health Books Get Wrong, Leave Out, or Just Fail to Understand, co-authored by Lucy Aphramor, is a crash course in all you need to know about bodies and health.

We recently had the pleasure of corresponding with Dr. Bacon to get answers to some of your most popular questions about HAES, the work she does dispelling diet myths and her newest book, Body Respect.  You can find Part I of her responses below, and Part II is available here.

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Q & A with LINDA BACON, Ph.D.

Q: What led you to pursue writing about and researching health and weight science?

LB: My journey began from own personal pain: in my adolescence and early twenties, I believed that I was fat, that there was something wrong with being fat, and if only I lost weight, everything in my life would be better: my parents would be more proud of me, I’d be more popular… Those thoughts sent me on the painful journey of fighting my weight, and included an academic search for a solution. What I found along that academic journey surprised me: the research contradicted many of the commonly accepted beliefs I held about weight. I developed a critical lens through my work first as a psychotherapist, next as an exercise physiologist and later a nutritionist. And that critical lens has been so valuable in re-learning how to look at myself, and my own relationship with food and my body, and come to a sense of peace and contentment. The war that was originally waged against my self – the fat on my body – was more appropriately waged against oppressive attitudes about fat. I’m now on a mission to share what I’ve learned, both to support others in their personal journeys and to support social change. Our culture plays a huge role in fueling our disconnection with self and it’s critical we move towards a more just and compassionate world so that this struggle isn’t so normative. No one should experience the pain and body shame that I – and many others – routinely do.

Q: What are the most important tenets of Health at Every Size (HAES)?

LB: I see three aspects as being most important: 1) RESPECT, including respect for body diversity; 2) CRITICAL AWARENESS – challenging cultural and scientific assumptions; valuing people’s lived experience and body knowledge; and acknowledging social injustice as a hazard to health and well-being; and 3) COMPASSIONATE SELF-CARE – in eating, movement, and other areas. There’s a lot packed into those words, so here’s the simpler response: HAES is all about supporting people in moving towards greater acceptance and improved self-care, and advocating for the institutional and social change necessary to support that.

Free event in Baltimore on November 8th. Click image for details.

Q: Why do you think so many people continue to rely on dieting when the data isn’t there to back it up as an effective remedy for weight loss or improved health?

LB: I have a lot of compassion for dieters. The dieting belief system is so strongly a part of our culture and medical belief system, it makes sense that many people would buy into it and believe they are doing the right thing. And there is so much fantasy imbued in the results: the belief that one will be seen as attractive and successful, and that it will ameliorate disease. It makes sense many people grab onto it, and get a sense of hope when they try. And we’re taught to believe the “experts” rather than to trust our own experience. So when the diet fails to give them lasting results, the dieter blames him or herself, rather than the diet.

The diet is the problem and it’s the diet that fails, not the dieter. It takes courage to take our power back and recognize that the problem is out there, not in ourselves, that we have a system inside us well-designed to help us manage our weight, if only we trust it. The HAES journey is about helping people to understand that the source of their pain is not the weight itself – but the weight prejudice, and to reclaim their power to know what, when, how to eat, and a new attitude towards other self-care behaviors.

Not long ago, I had a very poignant experience of the damages of the diet mentality. I attended a wedding reception where there was a beautiful buffet of gourmet food. At one end of the buffet was the proud father of one of the brides. (I’m in California, where it’s legal for lesbians to marry.) He had helped plan this party; to him, sharing food was part of the ritual that brought his daughter’s friends and family together. At the other end, three women approached. One looked at the display and said, “Oh, I really shouldn’t.” Her friend commiserated, saying, “It really is tempting, isn’t it?” They all looked on sadly. This is the world we have created. These women are “good” dieters. For them, virtue lies in confronting the temptations of good food, exerting their willpower, and overcoming their desire.

This saddens me. I want a world where food is about nourishing us, body and soul, where we can celebrate with the shared ritual of eating. Where you eat what you want without guilt… and without bingeing. Where eating is uncomplicated by weight concerns.

Fortunately, that world is possible and the Health at Every Size movement helps to articulate it. I live in it myself, and I’ve tested it in a randomized controlled clinical trial. And my results have been reproduced by others. We have shown that people – yes, even “obese” people who are experienced dieters – can learn to dump the diet mentality and celebrate food, and that it results in improved nutritional choices and improved health outcomes. And that it does not result in that feared weight gain.

Q: In your new book, Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight, you and your co-author Lucy Aphramor write a lot about the influence of social justice on weight and health. What’s the most important thing you think people should understand about the impact of inequality and social differences on weight and health?

LB: I can sum it up in three words: “our stories matter.” Our experiences in the world get lodged in us on a cellular level. The experience of oppression, for example, triggers a chronic stress response, which in turn leads to weakened immunity and increased risk for many diseases. When we focus solely on an individual’s weight or health habits, we miss these structural and political inequities, and it stops us from addressing the policies and systems that have a far greater impact on our health. It also supports a culture of blaming individuals for their disease: e.g., “it’s your fault for getting diabetes; if only you ate better.”

How we get treated in the world has a huge impact on our health. Acknowledging the power of social status in determining health can help take the blame off of the individual and will have more significance for tackling health disparities than getting more people to stop smoking, or to be more active, or to eat more nutritiously. This doesn’t mean that we need to stop talking about behavior change: helping someone take better care of themselves is valuable. But it needs to be put in context. Once we understand this, it opens up new avenues for self-care and for how health care gets practiced.

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Interested?  Want to learn more about Dr. Bacon’s research and how the focus on weight can obstruct us from achieving health?  Read more in Body Respect Q&A with Linda Bacon: Part II.

Then join us in Baltimore on November 7th and 8th to see her speak. Visit our Events Page to reserve your seats.


 

Body Respect Q&A with Linda Bacon, Ph.D. ~ Part II

Welcome to Part II of our discussion with internationally acclaimed author and researcher, Linda Bacon, Ph.D.  If you missed Part I, you can find it here

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Q&A with Linda Bacon, Ph.D. ~ Part II

 

Q: What are some of the repercussions of evaluating a person’s health by their weight?

LB: One key repercussion is misdiagnosis. Some thin people get the diseases we blame on weight – and they often don’t get diagnosed until later when they’re more advanced and harder to treat – and many heavier people never get the diseases we blame on weight. And then of course, it introduces the nocebo effect: tell someone they’re going to get sick and they probably will. So it’s just bad medicine. (And expensive! Those excessive costs attributed to “obesity” can be better attributed to weight bias.) Fat or thin, the conflation of weight and health imbues people with a fear of fat and distracts us from what really matters. It brings stigma, a problem of social justice, into health care. It’s both ineffective AND damaging.

 

Q: How could a focus on weight, or on weight loss, get in the way of effective healthcare? Can you give a specific example?

LB: My knee has been bothering me a lot lately, and that provides for an easy example. My father suffered from similar knee problems. However, he was fat (I use that as a descriptive term, stripped of pejorative connotations) and I’m not, resulting in very different treatment from our orthopedists.

My doc told me to first try physical therapy, that stretching and strengthening the muscles around the joint can help. Surgery was also presented as an option.

But what did my father’s doctors recommend? They put him on diets – over and over again. He never developed a regular exercise habit and struggled with weight cycling and disordered eating his whole adult life.

Carrying more weight may have aggravated my dad’s joint problems; no doubt there are ways it’s hard to be in a fatter body. (I should add parenthetically, that there are also ways it confers health advantage, but that’s a much longer blog post.) But trying to lose that weight is no kind of solution. I can assure you, my father – almost all heavier people – they’ve tried already.

My dad went to his death with knee pain. That’s just not effective healthcare. Even if fat is a causative factor and weight loss may be helpful in reducing symptoms, that doesn’t mean that prescribing weight loss is an effective or helpful solution. (Note also that it’s well documented in the literature: prescribing weight loss is more likely to result in health-damaging weight cycling than sustained weight loss.)

My advice in training health care professionals in respectful care with larger people is to start by considering how they would treat someone in a thinner body. Appropriate exercise? Meds? Surgery? Then do what you can to support your patients in implementing your advice and handling the challenges posed by their particular body.

It’s important to remember that good health habits benefit everyone, across the weight spectrum. And that you can’t diagnose someone’s health habits by looking at them. My father – and people of all sizes – could also have benefited from eating disorders screening. Appropriate eating disorders treatment may – or may not – have a side effect of weight change.

 

Q: On November 7 and 8 you will be speaking at two events in Baltimore, one for the community and another specifically for health professionals. What are some of your main goals for each of those talks and who do you think could benefit from attending?

LB: More than anything else, I want to inspire people. For the general community, I want attendees to leave with a sense of hope, that they can lose the guilt and shame and instead take pleasure in eating, that they can look at their bodies kindly. And I want the health care professionals to leave with a greater sense of agency, feeling empowered that they know how to be helpful for people. I want all of us to walk away with a stronger sense of community, feeling that we’re part of a committed group of people helping to make this a more just and compassionate world.

 

Q: Are you hopeful that our medical community, or even our society in general, will be able to make a paradigm shift away from a focus on weight? What helps you stay focused on and inspired by this goal?

LB: I do feel quite hopeful. I’ve watched the transition that’s been happening over the years, how my message resonates with the medical community, once exposed. Most professionals are feeling disillusioned with the old system, and I’m frequently told that coming to hear me talk is a relief. It allows them to take their disquiet seriously and they feel empowered to be presented with solutions that make sense.

But I’m not naïve. As much as I’d like to have faith in the inevitability of justice being done, and the old paradigm being tossed by the wayside, I’m just not confident that’s going to happen large-scale in the mainstream anytime soon. But I find it very liberating to consider that maybe the point isn’t victory, as much as we would like to see that done. Maybe the real issue is that by speaking my truth, I sleep better at night and it gives me hope.

Desmond Tutu offered this advice as rationale for the work of a freedom fighter: You don’t do the things you do because others will necessarily join you in doing them, nor because they will ultimately prove successful. You do the things you do because the things you do are right.

Dr. Linda Bacon

So I try to let go of the preoccupation with outcome, and find fulfillment in my involvement in something worthwhile, and being a part of this greater community. I look forward to being at Sheppard Pratt soon, and connecting with more people committed to a more just and respectful world.

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Many thanks to Dr. Linda Bacon for sharing her time, expertise and compassion with our online communities.  Please join us November 7th in Baltimore when Dr. Bacon will offer an in-depth training for health professionals and then again on November 8th for an inspiring free community event. Find out more and register for both events here.

See Also: BODY RESPECT Q&A with Linda Bacon: Part I

Understanding Hopelessness & Cultivating Hope: Discussing Suicide and the Death of Robin Williams

As the world feels and reacts to the news of Robin Williams’ death, the national conversation has turned quite rapidly to suicide and suicide prevention. Unfortunately, to those of us in the field of mental health, these headlines require daily observance. In general, individuals struggling with eating disorders are more likely than those without eating disorders to think about and attempt suicide. One study found that risk for suicide is approximately 23 times higher in those with eating disorders than in the general population of the same age (Harris and Barraclough, NSPL_Logo_home1997).

While we feel strongly that the details surrounding Williams’ death are a private matter, it has been publicly acknowledged that he was battling severe depression and had a long history of substance abuse.  Among a multitude of public reactions to the news, there is a pervasive feeling of shock that a person whose public life was built around laughter and joy could simultaneously be experiencing so much pain. People far and wide are wondering how this hilarious and much-loved person could actually be feeling so hopeless?

Hopelessness is a difficult topic, particularly for individuals who are not in the midst of feeling it and, perhaps as a result, have a difficult time conceptualizing how anyone else could ever get to a point that they feel completely unable to be helped. But understanding hopelessness is at the core of every discussion about suicide. Discussing it honestly and compassionately can make a difference for those who struggle. Carrie Arnold, a former guest speaker here at the Center, wrote openly about this on her blog after receiving the news about Williams. A poignant account of her own experience with depression and attempted suicide, Arnold captures the importance of striving to understand and develop compassion for individuals in a state of despair.

“We talk of people who complete suicide as being ‘selfish’ that they couldn’t sense their loved one’s pain. Yet when those feelings of utter despair washed over me, all I could think about was the pain I was causing others.”

Arnold goes on to talk about the venture back from despair and the rebuilding of hope, desire and gratitude, writing:

“Then you figure out that you have started living life again without even realizing it. There’s no miracle moment, here, just the slow stringing together of small moments into a narrative called your biography.”

Carrie Arnold’s story is extremely important to tell because it reflects the stories of so many others that don’t make headlines and rarely get told. This is the story of traveling to the brink of hopelessness and continuing right on through. This is the story of hope. The message to people struggling with eating disorders, depression or addiction is that you can prevail.  You can feel hopeless and still not be hopeless.

Almost every single guest speaker we’ve hosted to speak about recovery through the years have shared that they felt hopeless a lot and that they fully believed recovery was impossible for them. They were sure of it. Yet there they are, years later, standing on a stage telling their incredible story of recovery.  Rest assured, many people living full,  meaningful lives without their eating little tree growingdisorders today were once sitting there in front of a computer screen thinking about how recovery was impossible for them too. Too many lives have been lost to suicide, there is no question about that. Yet so many others have been to the depths of hopelessness and traveled back. In fact, according to the Action Alliance for Suicide Prevention, “the vast majority of people who face adversity, mental illness, and other challenges—even those in high risk groups—do not die by suicide, but instead find support, treatment, or other ways to cope.” This is where we can begin to cultivate hope. Do not listen to any voice that says you can’t recover. YOU CAN.

The news of Robin Williams’ death is a reminder to each of us that hopelessness rarely puts itself on parade. Hopelessness hides; it isolates and it often masquerades as your neighbor, friend or coworker trudging quietly through the thickness of depression all while posting exciting status updates on Facebook or volunteering at their child’s school with a fresh smile. If we take something from the tragic passing of a beautiful person and talented actor, let it be this:

Depression does not discriminate.  A well-polished public life – house, career, car, body, wardrobe, etc – is not an accurate reflection of a person’s private life or emotional experience. Check-in with friends if you know they’ve struggled with depression in the past, and never assume that someone is okay based on outward appearance alone.

ASK FOR HELP.   It is not shameful to struggle out loud. Be honest with those around you about how you’re feeling and do not allow your hopelessness to hide.  Talk to friends, family or call the Suicide Prevention Lifeline at 1-800-273-TALK (8255) if you are in crisis.

Depression, eating disorders and substance abuse are treatable illnesses. If you’ve traveled through hopelessness and back again, share with others about that experience of healing so they know it’s possible and that hopelessness is not a one-way street. Encourage others to get treatment.

Know the signs and symptoms that someone is in immediate danger for suicidal behavior and become educated about underlying risk factors for suicide. For example, adolescent boys and girls engaging in multiple unhealthy weight control behaviors are at greater risk for experiencing suicidal thoughts (Kim, et al, 2009).

For more information about the risks of suicide associated with eating disorders, please visit Medical Complication of Eating Disorders.

If you are interested in getting treatment for an eating disorder and co-occurring issues such as depression, anxiety, trauma or substance abuse, please call us right away at (410) 938-5252.  You are not alone.

www.eatingdisorder.org

*Tree image courtesy of Just2shutter and FreeDigitalPhotos.net

 

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.

*    *    *

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.