3 Basic Recovery Tips for Moms & Moms-to-be with Eating Disorders

Pregnancy and motherhood can be extremely daunting. The “what-ifs?”, “can I manage it all?” and “what will my body do?” internal dialogue often begins quite early in the process of parenthood, even among women without eating disorders.  When a woman struggles with body dissatisfaction and disordered eating, normal concerns throughout pregnancy and parenting can escalate into major anxiety. They may also fuel a new or renewed focus on weight and shape that can lead to harmful behaviors like restriction, purging, bingeing or obsessive exercise. Co-occurring depression – or postpartum depression – can also be risk factors for disordered eating.

According to data from the CDC, the average age at which women have their first child is 28 and this has been steadily rising for decades. As of 2016 however, the demographic with the highest birth rates are actually women in their early thirties (ages 30-34).1 This holds true across all fifty states as well as all racial and ethnic groups.

Interestingly, women between the ages of 30 and 40 are also increasingly seeking treatment for eating disorders. Eating disorders affect about 10% of women during their reproductive years and this number may be growing.  With this in mind, it has become exceedingly apparent that there is a need to tailor treatment to mothers and mothers-to-be in order to effectively assist women during this stage of life.

Pregnancy-related body image concerns combined with the extra stressors of parenting – and feeding – young children can complicate eating disorder recovery efforts. But there are also opportunities and strengths in this new role and certain things moms-to-be can do to stay recovery-focused during the adventures of pregnancy and parenthood. Below are three very basic tips to help provide a starting point for a healthy transition.

 

1. BE HONEST.

If you’re currently pregnant, tell your OB or midwife that you have a history of an eating disorder and about your current or past symptoms.

Some women say they feel shame or guilt in expressing feelings of body-dissatisfaction or disclosing ED symptoms to their medical providers, especially during pregnancy and post-partum. If you find yourself battling these thoughts, it’s helpful to remember that eating disorders thrive on silence and secrecy. Keeping symptoms a secret usually means things get worse, not better. Being open with your OB or midwife allows them to better care for you and more accurately monitor the health of your baby. When your providers know about the eating disorder they can also do more to support your recovery efforts; this could include connecting you with a local support group or tailoring discussions about food and exercise appropriately. Remember, eating disorders are serious illnesses – not simply a choice or lifestyle. It’s okay to let go of the guilt and shame so you can move forward with help.

 

2. EMBRACE IMPERFECTIONS.

You can’t do it all perfectly—nobody can (even if it looks like they do on social media).

More mothers than ever are raising their children while managing full-time careers outside of the home and trying to keep up with ever-increasing expectations for the always perfect outfit, an exquisitely clean house and an expertly planned family vacation.On top of it all, posting finely tuned photos on social media to prove it all happened can almost feel mandatory.Moms who internalize this pressure are understandably overwhelmed because perfection is a race that no one wins. Remember, even the people who look like they have it all together online, are only sharing what they want people to see. It’s essentially a person’s curated highlight reel; the behind-the-scenes shots may not be so picture perfect.

Given that the trait of perfectionism is an established genetic risk factor for the development of eating disorders, it’s easy to see how these increasing expectations and media pressures can create extra challenges for pregnant and parenting moms working on eating disorder recovery. If you find yourself constantly comparing your house, your body, your parenting or your life in general to people you see on TV or friends on social media it’s important to discuss these influences with a therapist or treatment team. You can also do a self-audit of your feed and make some changes to ensure you are cultivating a body positive presence across your social media platforms.

 

3. PRIORITIZE RECOVERY

Self-care isn’t selfish.

There’s a reason why the flight crew on every plane instructs parents flying with children to put on their own oxygen masks in an emergency before putting one on their child.  It might feel counterintuitive or even selfish to do so but we know it’s not. Why? Because it’s much harder to take care of other people – especially infants and toddlers – if you’re not caring for yourself.  When it comes to mental health and eating disorders, you may need to prioritize your recovery efforts now so that you have the physical ability and mental clarity to prioritize your family in the long-term. Seeking therapy, keeping up with appointments and staying connected to other moms who talk openly and authentically about the challenges of motherhood are integral to recovery.

 


At The Center for Eating Disorders, we recently launched an outpatient therapy group to help pregnant and parenting moms with eating disorders do the hard Kristen Norris, LCPCwork of prioritizing recovery while caring for their families. The group, which meets weekly, focuses on skills for balancing recovery and motherhood, addressing body image concerns and strategies for feeding the family. In addition to building recovery skills, this group can also be a way to help moms recharge and gain support. It is open to pregnant women and parenting moms of any age and stage.

The Moms’ group is held on Thursdays at 10 a.m. at outpatient department in Physician’s Pavilion North, Suite 300. Please contact Kristen Norris for additional information or to enroll in the group. She can also be reached by phone at 410-427-3904.


References:

  1. Mathews TJ, Hamilton BE. (2016). Mean age of mothers is on the rise: United States, 2000–2014. NCHS data brief, no 232. Hyattsville, MD: National Center for Health Statistics.

Self-Care Resources & Coping with Mass Tragedy


Daily self-care is extremely important for individuals with existing physical and mental health diagnoses including eating disorders, depression, anxiety, PTSD and bipolar disorder. It can be even more crucial during times of high stress, uncertainty or exposure to traumatic events. Even indirect, or secondhand exposure, to violence or disasters can have detrimental effects on one’s mental health. Research conducted by Dr. Pam Ramsden in 2015 found that “viewing violent news events via social media can cause people to experience symptoms similar to post-traumatic stress disorder (PTSD).”

In the wake of several national and international acts of violence over the past month, most recently the attack in Nice, France, it’s important to assess your own self-care practices and media use and to seek additional help when needed.

Below is a list of resources we’ve compiled that may help you and your loved ones cope in the aftermath of such tragedies.

 

RESOURCES FOR ADULTS:

RESOURCES TO HELP CHILDREN:

If you are experiencing intense or prolonged stress in the wake of violence you’ve experienced firsthand or via exposure through news outlets and social media please do not hesitate to seek help. Speak with a therapist if you have one. You can also seek more immediate assistance via the SAMHSA Disaster Distress Helpline at 800-985-5990. 

A more comprehensive list of hotlines and articles is available in this article by Skyler Jackson, MS of The University of Maryland: 100+ Resources for the Aftermath of the Orlando Mass Shooting Tragedy.


 

"Look for the helpers." - Fred Rogers

 

 

 

 

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Body Positive Summer STEP 1: Stop critiquing your body. Start critiquing the thin ideal.


The myth that the size or shape of your body determines what kind of swimsuit you can wear or how much fun you’re allowed to have is entrenched in a culture that profits off of our insecurities. These insecurities may be related to weight or size but also extend to just about every aspect of our bodies – skin, body hair, nails and refuse to miss out on this season of lifemore.  Businesses know that anxious, sad or insecure individuals are better consumers.1  In other words, a person who feels badly about herself is likely to pay more for products she thinks may help her feel, look or be better. The farther she experiences herself to be from the culture’s thin ideal, the greater risk for body dissatisfaction.

The reality is that the answer to all of life’s struggles are not solved by dropping a pant size and cannot be found inside a tanning bed or by embarking on a juice cleanse. Marketers know that the key to their success lies not in creating a product that actually “works” but by keeping people dissatisfied and, thus, poised to keep paying for each new product or weight loss gimmick that comes along next.

Sadly, a focus on weight and appearance is introduced and reinforced quite early.  Recently, Discovery Girls Magazine, aimed at 8-12 year old kids, ran an article suggesting girls choose bathing suits based on “body type” and how they might look in their suit (as opposed to, perhaps, the child’s color and pattern preferences or simply, how comfortable the suit is while playing). Its unfortunate foreshadowing in a culture that tells adults a “bikini body” is something we must attain before engaging in life at the pool on a hot summer day. This is a culture that wants us to prioritize how we appear to others above our own need for comfort or functionality, and in many cases above health or well-being.

So what can we do?

  • Begin to pay conscious attention to the advertisements you are exposed to as the summer heats up. This includes ads on social media, magazine headlines and commercials during your favorite TV show.  But it also includes messages you might hear directly from friends, coaches or via favorite brands on Instagram. Take note of fat talk and body shaming messages that might usually seep into your self-evaluation without you even noticing.  For example, some television shows or swimsuit catalogs simply erase the natural diversity of bodies by choosing models or actors who all look quite similar (or have been photoshopped to appear that way).  As you create an awareness of this flow of information you can begin to consciously object to it AND celebrate the organizations and companies who actually do a good job of representing real and diverse bodies.
  • Each time you find yourself directing negative attention to your body, flip the switch and look outward. Pay attention to whether there are images and messages surrounding you that might be contributing to your feeling badly about yourself or your body. If you notice them, take some sort of opposite action. Remove them (unsubscribe, physically thrown them away, etc.) or challenge them. It could be as simple as blocking a particular kind of ad on your Facebook newsfeed, writing a letter to a magazine editor, or just venting to a friend about a misleading diet advertisement.

Even small acts can be empowering. Once your start, you may be surprised to see who responds or joins you in your efforts.  Self-acceptance and body acceptance may not be profitable for the beauty industries but you and your summer stand to benefit a great deal from these acts.

 

 

Need a little inspiration? Check out this great video from MTV’s Laci Green about the bikini body. Then, let others know how you are removing or challenging the negative or body shaming messages in your life using the #bodypositivesummer hashtag on Twitter or Instagram

Read more #bodypositivesummer posts here:

 

References

1. Cryder CE1, Lerner JS, Gross JJ, Dahl RE. (2008) Misery is not miserly: sad and self-focused individuals spend more. Psychol Sci. Jun;19(6):525-30. http://www.ncbi.nlm.nih.gov/pubmed/18578840

 

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5 things that might surprise you about eating disorders, weight and food

5 Things That Might Surprise You VENDITTA

Despite how widespread eating disorders are, many, many misconceptions remain about these illnesses and the people affected by them.  These misconceptions are hosted and maintained by a variety of sources including the popular media, opinions of people around you, outdated information online and in textbooks, and by stigma that prevents open and honest conversations that could lead to greater understanding on a more personal level.  As a society, it’s important that we move past the stereotypical thinking, not just about eating disorders but about eating and health in general so that we can shift towards non-judgmental attitudes and practices that truly promote well-being.  After my time as a Community Outreach intern at The Center for Eating Disorders at Sheppard Pratt, these are the five most surprising facts I thought would be important for my peers and the community to know.

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1. Anorexia and bulimia are not the only eating disorders, nor are they the most prevalent. There are more than just the eating disorders that we hear about through the media.  Binge eating disorder, atypical anorexia nervosa, bulimia nervosa of a low frequency and/or limited duration, and Avoidant Restrictive Food Intake Disorder (ARFID) are just a few examples.  Some of these diagnoses fall within the category of Other Specified Feeding or Eating Disorder (OSFED), but it is also possible to have an Unspecified Feeding or Eating Disorder.  In all of these cases though, eating disorders can take a significant toll on a person’s health and quality of life.  It seems the lack of awareness, the sensitivity of these disorders, and the confusing nature of diagnosis for eating disorders have all contributed to the fact that only 1 in 10 people with an eating disorder will get treatment.  This is a sobering statistic given that eating disorders have the highest mortality rate of any mental illness and are rarely resolved without professional help.  Raising awareness of all the different types of eating disorders and wide variety of symptoms might make it a little easier for individuals who are struggling to see themselves represented and to seek help.

2. Up to 30 million people of all ages and genders suffer from eating disorders. It is true that adolescent females make up a large part of the treatment seeking population, but it’s important to note the role that bias and misinformation, even among medical professionals, can play here.  If a person is struggling with an eating disorder and they fall outside of the white, adolescent female stereotype, they are actually less likely to be screened for, correctly diagnosed with, or referred to specialized treatment for an eating disorder.  The truth is that eating disorders do not discriminate; people of any race, ethnicity, sexual orientation or socioeconomic status may be affected.  These illnesses affect men, women, children, and the elderly.  It’s important that health and mental health professionals know this and don’t overlook warning signs in their patients.

3. There is no such thing as a “bad food.” Most of us learn throughout our lifetimes that certain foods are “bad” and others are “good” based on any number of analyses – fat content, calories, food group, process by which it was made, etc.  These messages reach us through social pressures, peer groups, family attitudes, commercials, magazines, and just about everywhere we look online.  When we’re surrounded by these messages, it is easy to forget that food is just food and gives us energy and can be enjoyed– it doesn’t have to be assigned a moral value.  Despite what we are told by the healthy lifestyle bloggers, it is okay, even necessary, to eat bread and pasta.  It is okay to get ice cream that isn’t sugar free and to go for the full fat lattes.  None of these things influence our self-worth or intrinsic goodness.  Disordered thoughts about food are everywhere and will likely continue to be everywhere.  Take away the “good” and “bad” labels from the food and you’re one step closer to creating a healthy attitude toward food whether you’re working on recovery from an eating disorder or not.

4. Fat talk is harmful for everyone. Body dissatisfaction can be a significant risk factor for the development of eating disorders.  Negative thoughts about one’s body are not easily extinguished and most people with eating disorders continue to struggle with these thoughts during their recovery process. Talking about diets, comparing body sizes, complimenting weight loss, or just generally talking negatively about body shape or weight can be very triggering and can even contribute to relapse.  But it’s not just people with eating disorders who are harmed by fat talk.  Whether it is self-directed or directed at a friend or a stranger, focusing on weight/size as a measure of worth or beauty brings everyone down.   It probably seems completely normal for someone to say “you look great, have you lost weight?” or for a co-worker to mention she’s not eating carbs because she’s afraid it will make her fat.  But it doesn’t have to be normal. When fat talk happens, consider how you might turn it around to be positive and helpful instead of feeding into the negativity.  Could you change the subject completely, educate your friend about the dangers of fat talk, or simply model mindful eating behaviors?  You can also remind your friends of all the reasons why you care about them that have nothing to do with what size they wear.

5. You really can’t tell whether or not someone has an eating disorder simply by looking at them. People with eating disorders look very much like everyone else – completely diverse.  As stated earlier, this includes diversity in age, gender and race but also diversity in weight and size.  The phrase, “you don’t look like you have an eating disorder” is not only misleading but also can be extremely detrimental to individuals seeking support.  Eating disorders can affect low weight, average weight, and high weight individuals.  Unfortunately, many people delay seeking treatment based on an assumption that their health is not at risk unless they are drastically under or overweight.   In general, weight is a very poor predictor of one’s current health.  If you are engaging in disordered eating behaviors and experience frequent negative thoughts about your body, it doesn’t matter what size you are, your health is at risk and you deserve support and treatment.

For more information about different types of eating disorders and treatment visit eatingdisorder.org.

If you’re concerned that you or a loved one may be exhibiting signs of an eating disorder,  you can take the confidential online self-assessment to find out more.

Emily VENDITTA croppedWritten by: Emily Venditta
Towson University Graduate
CED Community Outreach Intern
Spring 2016

 

Simple solutions for holiday (and everyday) conversations about food and weight


dining room
As we head into the holidays, it can be helpful to have a very simple plan for responding to family and friends drawn to the very topics that may be most troubling during recovery from an eating disorder.  Depending on how you spend your holiday this year, one or all of these suggestions may come in handy when the conversation takes a turn toward triggering language regarding bodies, food or weight.


Step 1:
Obstruct or change the conversation if you notice someone is heading into a discussion that makes you uncomfortable.

Remember people generally like to talk about themselves and their interests. If Aunt Marie is pressuring everyone to eat more pie or is gushing over a family member’s weight loss, use that as an opportunity to reflect the attention back to her. So who taught you how to bake? What are you up to at work Aunt Marie? How was that vacation you went on?

If you’re comfortable staying on the topic but exerting your power into the conversation you could try something like this: I’ve actually been learning a lot about how weight is not a good determinant of overall health. I’m focusing on my work-life balance and healthier ways to deal with stress. I’m thinking about meditation…have you ever tried it?


Step 2: Set boundaries
if someone continues to target you with questions or comments about your body or what you’re eating.

Here are some simple examples with varying levels of intensity.  You can choose which ones you think would work well for you, or create your own.

  • I try not to get involved in discussions about dieting and weight loss.
  • I’d prefer not to talk about my weight today.
  • I am so happy to be here with everyone, I don’t want to waste our time together talking about food/weight.
  • Please don’t comment on my body.
  • Let’s find something else to do or talk about.
  • I’d much rather tell you about school / work / hobby
  • It’s really stressful to me when people make comments about what I’m eating.
  • It’s actually not helpful for me to talk about calories or exercise.
  • I’m choosing to focus on other things this year.
  • It is not beneficial for me to feel badly about my body or guilty about what I ate.

The great thing about practicing these responses with other people is that you’ll be more likely to use them when struggling with negative self-talk or eating disorder thoughts in your own head too.


Step 3:
Step away & seek support.

If stressors persist or you find you just need a break from the crowd, locate your holiday ally or text a friend. Take some time to vent about what’s bothering you, take 3 very deep breaths, and then re-focus on the positive parts of the day.  Sounds simple but it can make a big difference.

You are deserving of a happy and healthy holiday. How you choose to create that is up to you.  Just remember that one insensitive comment from one person does not have to ruin your entire holiday. At anytime, you can choose to re-engage in both the celebration and your recovery.

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Read more about healthy holiday coping…


 Concerned that you or a loved one may have an eating disorder?  Call us at (410) 938-5252 for a free and confidential phone assessment or visit www.eatingdisorder.org for more information about treatment options.

 

Photo credit: freedigitalphotos.net / digidreamgrafix

 

 

 

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Why Providers Must Stand Up and Join the March Against ED

This post was written by our Community Outreach Coordinator as a guest blog for the March against eating disorders.  It was originally posted on marchagainsted.com and has been cross posted here with their permission.


Teacher
Nurse
Barista
Artist
Accountant
Grandmother
Student
CEO
Musician
Author
Mom
News Anchor
Military Officer
College Athlete
Dad

They care for you, entertain you and bring you joy.  They protect you and teach you, create things for you.  They help you and mentor you. They are varied. They are diverse. They are important.

They are people you might see every day.

And they are people we might see every day in the course of providing care and treatment for individuals and families impacted by eating disorders.

MOM March 2014At The Center for Eating Disorders at Sheppard Pratt, we see numerous people each day struggling with anorexia, bulimia, binge eating disorder, ARFID and other feeding and eating disorders.  These individuals with eating disorders are varied.  They are diverse. They are important.

This is why we were proud to participate in the inaugural March Against Eating Disorders on Capitol Hill last fall and why we are eager to return this year on October 27th for an even larger and more impactful event. As physicians, therapists, dietitians and nurses specializing in the treatment of people with eating disorders, we see the daily struggle, the medical repercussions, the fear and the impact of eating disorders on relationships, careers and families.  But we also see the hope, the healing and comfort that comes with treatment and recovery.  That is why it’s so important for those of us in the field to stand up and share our voices too.

Why do we march?  

  • We march because eating disorders continue to be stigmatized, sensationalized, overlooked and underfunded despite having the highest mortality rate of any mental illness.
  • We march because no one chooses to have an eating disorder.  Eating disorders are highly heritable illnesses, meaning 50-80% of a person’s risk for developing an eating disorder is genetic. Additional causes are varied and complex.
  • We march because no family should hear “it’s just a phase, she’ll grow out of it.” from a medical professional before they make it through our doors. A lack of specialized eating disorder training for physicians delays detection and appropriate referrals. Delaying treatment delays recovery.
  • We march because 20-30% of our patients are men who thought they were the “only one” and suffered in silence for a long time. Eating disorders don’t discriminate and treatment shouldn’t either.
  • We march because parents do not cause eating disorders but eating disorders can cause heartache for parents and family members. Guilt, blame, stigma and outdated stereotypes can prevent families from getting the help they deserve. Current research supports an understanding that caregivers can play a positive and integral role in helping a loved one to heal from their eating disorder.
  • We march because eating disorders can be deadly but they can also be overcome.  Early intervention and evidence-based treatment makes a difference.
  • We march because no one should have to get sicker before they can get well. Insurance coverage for eating disorders must not be a barrier to quality care.
  • We march because we live together in a culture that equates weight loss with health, yet we work every day with individuals whose weight loss is associated with osteopenia, hair loss, fatigue, cardiac arrhythmia and infertility.  We support a movement that embraces health-focused goals for our schools and communities instead of weight-focused goals.

These are just some of the reasons why we are excited to stand with The Alliance for Eating Disorders Awareness, The Eating Disorder Coalition, and MAED – Mothers Against Eating Disorders at The #MarchAgainstED in our nation’s capitol.  Join us on October 27th to take a stand and help increase awareness about eating disorders.

Why will you march?  

Register now at www.MarchAgainstED.com

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Clemmer.2015.final

 

Written by Kate Clemmer, LCSW-C, Community Outreach Coordinator at The Center for Eating Disorders at Sheppard Pratt for www.MarchAgainstED.com

The original posting of this blog is available at: http://www.marchagainsted.com/blog/why-providers-must-stand-up-and-join-the-march-against-ed

 

THE ILLUSIONISTS Film Screening – Meet the panel of experts…

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On June 7th, hundreds will gather in Baltimore to be among the first to see an exclusive screening of the much-anticipated international documentary The Illusionists. In addition to viewing the full-length film, event attendees will have a unique opportunity to ask questions and converse with a panel of experts including the film’s director.  Meet the panel members below and be sure to reserve your seat for the event.

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Panel Members:

elena_headshotELENA ROSSINI
Writer & Director of ‘The Illusionists’

Elena Rossini is an Italian filmmaker and multimedia producer. Notable film projects include DOVE SEI TU, a feature-length narrative film set in between Milan, the documentary DIRECTION, and IDEAL WOMEN, an experimental short film juxtaposing beauty ideals in the art world vs. mass media, commissioned by ARTE Web and the Louvre Museum. In 2009, Elena launched a multimedia platform – No Country for Young Women – whose aim is to promote the visibility of professional women and to provide real role models for young girls from entrepreneurs to NASA engineers, illustrators, architects, filmmakers, non-profit directors, award-winning novelists, and more.

Since 2011 when The Illusionists was funded through a crowdfunding campaign, Elena has worked tirelessly as writer, producer, cinematographer and director. Elena is also a photographer and a blogger. Her photos and articles have appeared in Jezebel, indieWIRE, Adios Barbie and Gender Across Borders.  Elena will travel from her home in Paris to be a part of this exclusive advance screening and panel discussion.

 

tmaronickThomas Maronick, JD, DBA
Professor of Marketing
Towson University

Dr. Maronick is a Professor of Marketing in the College of Business and Economics at Towson University in Towson, Maryland.  He holds a BA in Philosophy from St. Thomas Seminary, an MBA from the University of Denver, and a Doctorate in Business Administration (DBA) from the University of Kentucky with a major in Marketing. It also includes a JD from the University of Baltimore, School of Law. Dr. Marnonick is also an inactive member of the Maryland Bar. At Towson University he teaches undergraduate and graduate courses in strategic marketing and marketing research and has also taught graduate and executive development courses in marketing, consumer behavior, and marketing research at a number of universities in the Baltimore and Washington DC area. In addition to his role as professor, Dr. Maronick’s professional background includes serving as Director of the Office of Impact Evaluation in the Bureau of Consumer Protection at the Federal Trade Commission (FTC) from 1980 – 1997 where he served as the in-house marketing expert for all divisions of the Bureau, advising attorneys and senior management on marketing aspects of cases being considered or undertaken by Commission attorneys. Dr. Maronick was also responsible for the evaluation of research submitted by firms being investigated by the Commission and for the design and implementation of all consumer research undertaken by the Bureau during that period. Since leaving the Commission in 1997, Dr. Maronick has served as an expert witness in marketing-related cases and has testified in Federal and State courts.  His areas of expertise include: marketing, deceptive advertising, public policy, research, and expert witness/litigation support.

 

Laura.Sproch.2015a_portraitLaura Sproch, PhD
Psychologist & Research Coordinator
The Center for Eating Disorders at Sheppard Pratt

Dr. Laura Sproch is a licensed clinical psychologist who serves as the Research Coordinator and outpatient individual, family, and group therapist at the Center for Eating Disorders. Currently, Dr. Sproch is initiating treatment outcome studies, managing quality improvement projects, and developing novel research projects in an effort to contribute to the field’s understanding of effective eating disorder treatment methods. Dr. Sproch received her Ph.D. in Clinical/School Psychology from Hofstra University in Hempstead, NY where she completed her dissertation examining cognitive similarities between differential eating disorder diagnoses. Dr. Sproch originally joined the CED team in 2011 as a postdoctoral fellow on the inpatient and partial hospitalization units acting as a family, individual, and group therapist. She has also worked with adolescents and adults struggling with disordered eating at a variety of levels of care, including at Friends Hospital in Philadelphia, PA and ‘Ai Pono: The Anorexia and Bulimia Center of Hawaii in Honolulu, HI. Her professional interests also include cognitive behavioral therapy, family-based treatment, behavioral modification, and school psychology.

 

Panel Moderator:

Dr. Crawford headshot_portrait

Steven Crawford, M.D.
Co-Director
The Center for Eating Disorders at Sheppard Pratt

In addition to his leadership role at The Center for Eating Disorders, Dr. Steven Crawford serves as Assistant Chief of Psychiatry at St. Joseph Medical Center, University of Maryland and as an Associate Professor at The University of Maryland where he helps to train medical students on effective screening and care for individuals with eating disorders. As an extension of this commitment to professional training, Dr. Crawford also serves as Director for Eating Disorders fellowship at The Center for Eating Disorders. He is Past President of the Maryland Psychiatric Society and Chair for the Committee on Scientific Activity for MedChi.  Dr. Crawford has participated in numerous research studies including NIMH federally funded research for an international collaborative study on the genetics of Anorexia Nervosa as well as the Family Therapy Treatment of Adolescents with Anorexia Nervosa. His numerous publications include the chapter on Eating Disorders and Substance Use Disorders for the fifth edition of Substance Abuse: A Comprehensive Textbook. After more than 25 years of specializing in the field of eating disorder treatment, Dr. Crawford has become a trusted resource for his patients, colleagues and the community.

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Questions about the panel or the event?  Call (410) 427-3886 or email kclemmer@sheppardpratt.org

 

 

 

FOOD LOGS: How they can help with eating disorder recovery (& why you might still be avoiding them)

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coffee-writing-stuart-milesFood logs are one of a variety of therapeutic tools used during treatment for an eating disorderFood logs – also referred to as food records or food journals – can take many forms.  Some people prefer to jot things down free form in a personal notebook while others do best filling out the prepared charts provided by their dietitian.  Many others have gone tech-friendly and use an app on their phone to track info and share it with providers. Regardless of the form it takes, a food log does much more than track your food.  A helpful format for food logs will include the time of day, a description of the meal or snack, actual food and beverage intake, location/setting of the meal and, most importantly, an individual’s thoughts and feelings before, during and after eating. Completing food logs and subsequently reviewing them with a registered dietitian can be a pretty powerful part of the recovery process. Not surprisingly, and perhaps because they can be so powerful, many individuals also experience some resistance to using them.  If you’ve ever been encouraged to complete food logs as part of your treatment for an eating disorder but had trouble starting or committing to the process, we thought it might help to know why a dietitian would recommend doing them and the specific ways in which they can aid in the recovery process.

Completing food logs throughout the week maximizes time spent in session with your providers. Weekly nutrition counseling sessions are often 30 minutes long.  It could potentially take up the most of that half hour to do a 24 or 48-hour verbal recall of your meals during the session. It’s easier to get down to business if the logs are already done. Plain and simple.

Food logs are like x-rays. If you hurt your arm and asked your doctor to put a cast on it, she would require you to get an x-ray first to see if, how and where it was broken. If you refused, she broken-armwould only be able to give you broad advice, like “take a Tylenol and get some rest.”  (If you’ve broken a bone before you probably know that wouldn’t help a whole lot). On the other hand, if your doctor could look at the x-ray of your arm she could fit you for the exact type of splint or cast needed, assign the proper amount of physical therapy, and provide individualized prescriptions for your pain.  In much the same way, food logs allow the dietitian to give you tailored advice and individualized strategies, rather than simply relying on a general, one-size-fits-all nutrition goal.

Food logs provide insight into your bigger picture. Sure, your food logs communicate specific details from each meal, but they also show trends and patterns over the course of the week related to meal times, location, hunger/satiety  cues, situational triggers and thoughts. Dietitians can often see connections on the food logs that patients don’t always see themselves. Seeing “the forest for the trees”  allows the dietitian to offer the most useful and beneficial feedback to the patient. Let’s say you arrived home from work late and ate an entire large pizza. Looking back on the food log we may see that you had an 8-hour gap without a meal that caused you to feel extremely hungry. Perhaps a goal would be set to have an afternoon snack available for those situations to help you get to dinner hungry, but not ravenous. On the other hand, maybe you had a stable breakfast, lunch, and afternoon snack, but your dietitian notices you hadn’t allowed yourself pizza in six months despite the fact that it’s one of your favorite foods. A more appropriate goal in that situation would be to practice food habituation with pizza (exposure to a food over time makes the food less compelling) and having a support person around when you’re eating it for a while. The bottom line: It’s harder to learn from the incident when we only see it from one angle. Food logs help us both have more perspective on why things happen, to know whether the set-up was physical or emotional and how to address the physical and emotional needs going forward.

Food logs provide a way to monitor progress. Nutrition therapy is about making changes that improve your relationship with food and your health. We tend to set small weekly goals that create momentum towards overarching goals and bigger changes over time. How will either of us know if the goals are met if we don’t keep track of them? Keeping a food log provides an objective look at progress from week to week and month to month.  It also takes the pressure off of you and your dietitian to recall from memory all of the details of your food and symptom use from the past month.  Rest assured, as you heal from your eating disorder you will have many more important things to use your brain for!

Returning to a normal and healthy relationship with food means appropriately responding to hunger and fullness signals. It’s impossible to do that if your signals are broken from chaotic or disordered eating. The best thing to get your digestive system and metabolism back on track is structured eating – meaning adequate amounts of food with adequate frequency.  Food logs aid in structured eating accountability, and structured eating over time sharpens your signals. Food logs and structured eating can provide the training wheels to help you get to a place of intuitive eating.

Food logs help connect your mind with your body.  Putting your pen to paper before, during or after a meal increases mindfulness with eating which can decrease mindless eating. Logging intake with your thoughts improves your ability to tell the difference between emotional hunger and physical hunger.  This practice also increases awareness to how certain foods make your body feel – energy, mood, mental clarity, digestive happiness, etc. Being aware of how foods make your body feel is important in working towards more sustainable and fulfilling eating practices.

Keeping up with food logs can help prevent relapse during transitions.  If you’ve ever received care for an eating disorder in an inpatient or partial hospital setting, you know the transition into outpatient or even intensive outpatient treatment can be difficult as you are once again responsible for completing more meals on your own. One way to help maintain the stability or progress you made in the higher level of care is to continue to self-monitor your intake and associated emotions during that transition and promptly discuss any specific challenges you encounter with your outpatient providers.  If you’re completing food logs, it’s easier to catch a slip-up before it becomes a full-blown relapse.

As mentioned earlier it’s not uncommon for individuals to question the benefit of food logs or to experience some resistance to the idea of completing them. A common reaction from patients is that, “writing down everything I eat makes things worse“ or “I don’t like doing food logs because it reminds hands with pen.africa and freedigitalphotosme of acting on my eating disorder.” As providers, we completely understand that rigidly tracking food and exercise can often be a symptom of the eating disorder.  That being said, there is a big difference between keeping a detailed, private food diary and collaborating with a dietitian to complete food logs during treatment. For one, the end goals are very different. If you tracked your food before it was probably to monitor strict adherence to dangerous eating disorder behaviors or dieting techniques. Those logs probably involved weighing, measuring, and counting calories and were done to benefit the distorted rules of the ED, not to honor or nourish your body. Conversely, the goal for food logs in treatment is to monitor weekly goals, help normalize eating behavior and to improve your relationship with food. When doing food logs with a dietitian, there is no good vs. bad, no shaming, no judgement. The role of the dietitian is not to be the food police waiting to condemn you. Rather, their role is that of a supportive detective. To examine the data, to see if there is something that is setting you up for problematic eating behaviors and then provide you with education and ideas to help make improvements going forward.

Still not sure? Here are a few additional tips for those of you who may have lingering fears about food logs…

For those that are embarrassed to show anyone… Does it make you nervous or uncomfortable to think about showing someone else a record of your daily eating behaviors? If you are worried that your dietitian will be shocked, grossed out, alarmed, or otherwise disturbed by your food log it can be helpful to think of the dietitian like any other specialist.  Take a dermatologist for example. You might feel nervous or uncomfortable during an annual skin check but to the dermatologist, that’s what they do everyday – they look at freckles and moles all day long.  Food logs and weights can be things that feel vulnerable to share, but remember, those are just pieces of data that the dietitian analyzes and they’ve seen and heard it all before. It’s their job to look at meal patterns and associated thoughts/behaviors. Vulnerability takes courage, but being courageous can lead to positive change. If you’re feeling shameful about sharing your food logs, remember this quote from AA – “secrets thrive in the dark and die in the light.” Being honest with your dietitian and allowing him or her to see your food logs is one of the first steps in moving away from the pain of the eating disorder.

For those who struggle with perfectionism… Food logs aid in improving nutrition behaviors just like practicing an instrument aids in learning the skill of playing an instrument. Writing down logs is intended to keep you in the mindset of practicing your nutrition goals for the week. The more often you practice a particular skill, the more it becomes a habit over time. That progression will not be perfect, and that’s a good thing. Even when you have a rough week and the goals aren’t met, food logs are still very helpful!  As providers, we actually learn more from the rough days than we do from the stable days. The logs allow us to see and discuss what some of the barriers might have been to meeting the goal, so we know what to try or be mindful of the following week. Portraying a “perfect” day of eating when it’s not what actually happened is not helpful.  Recording struggles or slip-ups in a food log allows us to work together to correct the focus and try again. Just like it takes practicing a song on the piano before you can play it without looking at the music – food logs keep you intentional in your practice of positive nutrition behaviors before you can naturally engage in the behaviors without the logs.

For those who don’t want to be stuck doing food logs for the rest of their lives (a.k.a. everyone)… Food logs are used to benefit an individual’s relationship with food and establish normal eating.  To that end, the goal is never for someone to be reliant on tracking their intake or completing food logs for the rest of time.  Rather, this is a temporary tool to help bridge the gap between eating disordered and eating intuitively. It might seem counter intuitive to spend your time tracking food in an effort to heal from a disorder that caused you to obsessively focus on food.  But if your goal is to one day be free from disordered eating, it can help to remember this: learning a new behavior often requires focusing on it more before you can focus on it less.

If a dietitian has recommended that you try doing food logs and you were never quite ready to give it a try but you continue to struggle with your ED, it might be worth taking some time for self-reflection. Would it be worth trying something new?  Consider what you would do if your car was stuck in the mud and the first two tow trucks to the scene couldn’t pull you out because they didn’t have the right tools. What would you say to a third one that came along with a different towing device?  Trying something new can sometimes help you to get unstuck. Even if you have tried food logs before and just couldn’t commit to the process, perhaps approaching an old tool with a new perspective or deeper understanding of how it works, could make all the difference.

CED-2014-19334-Mandala-FINALNot wanting to try food logs or other therapeutic tools suggested by your team, can be a form of avoidance. Consider whether you might be avoiding an awareness of particular behaviors or feelings.  Are you trying to avoid being accountable to make changes?  Are you avoiding acknowledgement of your body’s basic needs?  If any of these resonate with you, try being honest with your dietitian or therapist about why you may have been resistant to doing food logs in the past.  Ask for some strategies to make them more manageable or less anxiety-producing. Food logs do take time and you may not always like doing them, but there’s no denying that they can play an important role in facilitating positive change with the support of your treatment team. At the end of the day, doing food logs is temporary. A healthy relationship with food and your body lasts a lifetime.

Written by Hannah Huguenin, R.D. and Kate Clemmer, LCSW-C

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Are you struggling with an eating disorder but you’re not sure where to go for help? Contact The Center for Eating Disorders at Sheppard Pratt at (410) 938-5252 to do an initial phone assessment or visit eatingdisorder.org to learn more.  You may also want to check out our upcoming free events and workshops.

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Hannah Huguenin MS, RD, LDN

Registered Dietitian

Hannah Huguenin received her Bachelor of Science degree in Dietetics with a minor in Chemistry from Olivet Nazarene University in Illinois. She received her Masters degree from the University of Kansas Medical Center in Kansas City where she also completed her Dietetic Internship. During this internship, Hannah completed a rotation on an acute care eating disorder unit at the Research Medical Center in Kansas City. She has been with The Center for Eating Disorders since 2008, and provides individual nutritional counseling for the outpatient population. In her role at the Center, she provides ongoing support to help patients decrease eating disorder behaviors, meet their nutritional goals and improve their relationship with food through nutrition education.
 
 
Kate Clemmer, LCSW-C
Community Outreach Coordinator

Kate Clemmer earned her Master of Social Work degree from the University of Maryland, Baltimore in 2005 with a focus on Management & Community Organization and a specialization in Child, Adolescent & Family Health. Before joining the Center for Eating Disorders in 2008, Kate provided school-based therapy to adolescents and families in Baltimore City and coordinated a multi-school health education and prevention program. As the CED’s Outreach Coordinator, Kate currently facilitates trainings and workshops in the community, provides outreach to individuals interested in the Center’s services and coordinates the Center’s annual community events. These events include an annual Symposium for health professionals, the Love Your Tree Body Image Campaign, and National Eating Disorders Awareness Week. Kate also facilitates the Center’s community support group for individuals with eating disorders and their friends/family, held on Wednesday evenings.

 

Photo credit: freedigitalphoto.net and (in order) Stuart Miles, Boaz Yiftach, Africa

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 has shared that he or she felt hopeless often and 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