Archive for the 'Editor's Picks' Category

Utilizing Transference & Countertransference to Deepen the Treatment of Eating Disorders, with Kathryn Zerbe, M.D.

Following an incredibly positive response to her April 2009 presentation on integrated treatment for eating disorders, we are thrilled to welcome Kathryn Zerbe, M.D. back to Baltimore for our 2010 annual professional symposium.  Dr. Zerbe will present, along with 5 other distinguished experts, at Eating Disorders: State of the Art Treatment on Saturday September 25th, 2010.  Her much anticipated  presentation will focus on psychodynamic approaches and the use of transference and countertransference to enhance clinical practice in the treatment of individuals with eating disorders.

Kathryn Zerbe, M.D. is a Professor of Psychiatry and Obstetrics & Gynecology at Oregon Health & Science University.  She also serves as the Director of the Oregon Psychoanalytic Institute and has authored over 60 clinical papers and four books including, Integrated Treatment for Eating Disorders: Beyond the Body Betrayed.  Dr. Zerbe is a Distinguished Fellow of the American Psychiatric Association and a Fellow of the Academy of Eating Disorders. She has been repeatedly selected as one of “America’s Top Doctors” and is a highly sought after speaker both in the united states and internationally.

Find out more about Dr. Zerbe’s work and her upcoming presentation in Baltimore by reading her insightful and thought provoking responses to our questions below.  And don’t miss your chance to attend all six expert presentations on September 25th, 2010. (This event has been approved for 7 CME/CEUs). REGISTER soon!  Space is limited. 

Q & A with Kathryn Zerbe, M.D.

The title of your upcoming talk in Baltimore is “Resiliency, Vulnerability and Growth: Utilizing Transference and Countertransference Reactions to deepen the Treatment of Eating Disorders”.  What specific role does vulnerability play in this process?

KZ: Bewilderment, boundaries, and burnout — these are just a few of the concerns that clinicians are liable to struggle with when treating patients with an eating disorder.  Recognizing that in our quest to be helpful to our patients, we also face a potential undertow because the work to preserve life is taxing in the short run and often takes a commitment of time, energy, and sacrifice in the long run.  Clinicians ‘in the trenches’ know these facts, but what do we do to help ourselves to deal with the hurt feelings that arise when tenacious negative transferences arise, or when we are in a seemingly unwinnable battle with 3rd parties, or experience powerlessness when the patient refutes our counsel?  Awareness to these vulnerabilities, and others, are the first line of defense in staying attuned, steadfast, and nimble in robust clinical practice.

What would you say is the biggest barrier clinicians may face in trying to implement improved strategies for utilizing transference and countertransference in the clinical setting?

KZ: “To know thyself’ and “To be true to thyself’ have been laudable goals since the time of Socrates and Shakespeare, respectively, but such ideals are easier to write about in the abstract than to achieve in real time.  With the daily challenge of managing a lively practice and tending to one’s busy personal life, it is easy to put one’s own needs on the back burner.  Taking a small amount of time weekly to think about the impact of clients is enormously helpful.  In this way, one works on the feelings and clinical formulation one has about each specific person in practice but is simultaneously humbled by what each person teaches us by sharing their unique history and viewpoints.

 

What are the potential consequences of ignoring or ineffectively addressing transference and countertransference issues in the therapeutic process?

KZ: Like most clinicians, I feel extraordinarily blessed to be working in this field where one has the opportunity to witness individuals grow and change over time.  However, burnout is a formidable foe to contend with because change is often difficult, slow, and painful for the patient.  Sensitive clinicians pick up on, or in technical parlance, “contain,” these feelings.  To avoid burnout and to keep the work fresh, invigorating, and growth promoting, the therapist  who ‘knows himself or herself’ best is in a better position to assist the patient, and this is a ‘work in progress’  that is never done until one retires from practice altogether.

In your upcoming presentation, you will discuss strategies for managing “cultural countertransference”. Can you briefly define this term in the context of treating individuals with eating disorders?

KZ: Therapists as well as patients are prone to having conscious and unconscious reactions to media stereotypes, idealized body images, and culture norms as a whole.  We clinicians are in a better position to help our patients by becoming more aware of these potential ‘blind spots’ to  the  prevailing cultural  in ourselves and thinking them through.  Recovery can be enhanced by a timely discussion and critique of noxious cultural norms in therapy.  Both patient and clinician can make use of reading, media, movies, self-scrutiny, and ongoing dialogues with peers or consultants to become more cognizant of our largely unconscious idealization and overvaluation of beauty.   However, as Dr. Catherine Steiner Adair of Harvard University pointed out when she defined the term ‘cultural countertransference,’ in the early 1990s, we must also be wary that too much focus on the culture can be a defense to deepening the patient’s treatment.

Overall, what do you hope symposium attendees will take away from your presentation at The Center for Eating Disorders on September 25th?

KZ: If participants emerge from my talk (which will use art history slides to demonstrate concepts and to provide encouragement for each therapist to bring his/her unique creativity and tenacity to the therapy hour) with permission to ‘take care of yourself’ as you take care of the patient, I will be very happy, indeed.  Perhaps there will be an idea or two that will be new to the ear, but more likely the listener will simply take more seriously the need for ‘time outs’ and the pragmatic and psychodynamic reasons that undergird that need and recommendation.  One of my heroines, Eleanor Roosevelt, said “Do something that is scary everyday!”  I keep that saying on my desk as a reminder that our daily work as clinicians presents us with mysteries and a summons for personal growth that we can’t predict when we get to the office in the morning.  The more tools that we have in our therapeutic hip pocket, the better!  So, I’m looking forward to gaining wisdom from the other speakers who come first and hearing the comments and questions from the audience to, very selfishly, enhance my individual practice!

Our enduring thanks to Dr. Zerbe for taking time out of a busy schedule to provide such thorough answers. Be sure to join us on September 25th for what is sure to be an engaging and enlightening presentation.  Download the Eating Disorders: State of the Art Treatment PROGRAM BROCHURE (pdf) for registration details and deadlines.

If you’d like to order or find out more about Dr. Zerbe’s publications, please click on the links below.  These titles will also be available for purchase at the upcoming symposium.

Published by Kate Clemmer
August 20th, 2010 in CED Events, Editor's Picks, Enhancing Clinical Practice, In the News, Professional Education, Q & A, Therapies, Treatment Providers
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Baby Steps in the Wrong Direction? Increased Anxiety About Weight in the Very Young Child

Have we as a country gone too far in conjuring up a fear of fat?  Most eating disorder specialists and body image advocates would say we hit that milestone long ago – the proof being in our country’s continued and desperate reliance on dieting despite its 95-98% failure rate.  However, recent research seems to suggest a new low – one that we are concerned may spike unnecessary anxiety in new parents and could further distort our country’s relationship with food and eating, beginning with our youngest and most fragile generations.  That being said, we felt it was important to address this topic within our Nurture blog series.

This relatively new research, out of Eastern Virginia Medical School, proposes that a progression toward obesity begins as early as three months old.  Researchers have referred to their findings as a “tipping point”, suggesting we further scrutinize weight during the earliest months of life.  The study’s online abstract states, “that the critical period for preventing childhood obesity in this subset of identified patients is during the first 2 years of life and for many by 3 months of age.”

This raises a lot of serious concerns about how we might be encouraged to interpret these results.  Should worried parents or concerned childcare providers cut down on or restrict breast milk and formula out of fear for an infant’s future weight category?  Will parents of healthy, naturally larger babies be inclined to panic during weigh-ins at the pediatrician’s office or be made to feel they need to enforce low calorie diets to help their baby or toddler lose weight?  Not only do these things not work to prevent children from becoming overweight, they are also incredibly dangerous and can disturb a young body’s natural hunger and fullness cues, setting the groundwork for a harmful relationship with food later in life. The same disruption can happen when infants or children are persuaded to eat when not hungry or made to eat significantly past the point of fullness.  Ellyn Satter, a family therapist, registered dietitian and internationally recognized authority on eating and feeding speaks to this process on her website, stating,

“Children who eat and grow at the extremes make their parents so nervous that they often interfere. It backfires. In our weight-obsessed culture, parents may try to restrict a robust child with a hearty appetite because they assume that enjoying food and eating a lot means she will get fat. It doesn’t, and it doesn’t work. Children who don’t get enough to eat—or fear they won’t—become preoccupied with food and tend to overeat when they get a chance…

…Pressure on children’s eating always backfires. Trying to get a child to eat more than she wants makes her eat less. Trying to get her to eat less than she wants makes her eat more.”

Understanding the paradoxical outcome of restricting early feedings leads us to question the messages sent by this research study as well as those introduced by most childhood obesity prevention campaigns today.  As a country, we should pause and ask ourselves if increasing anxiety about infant and childhood weight might be hurting more than it is helping?  Promoting an even earlier vigilance and stigma around weight and bodies seems only to be muddying the water further, adding to the very “problem” that studies such as this one seem to be trying to address.

Negative messages about food and weight passed from our culture to our infants and children can lead to strained feeding and food relationships, a diet mentality, low self-esteem and negative body image.  All of these things are also risk factors for the development of disordered eating and eating disorders, including anorexia, bulimia and binge eating disorder which is the most prevalent and is often associated with obesity.  For most adults concerned about a child’s weight or well being, the obvious next question would be, “well than what am I supposed to do?”

Consider moving away from a hyper-focus on weight, body type, BMI or any other calculator of weight. Like most efforts involved in parenting, it’s not an easy task to accomplish particularly when it seems like every newspaper article, concerned relative, or public service campaign is telling you to do the opposite.  Do your best to focus instead on your child’s overall health (remembering that weight does not = health).  Honor and accept your child’s natural body size and shape.  Create positive goals around eating that involve paying attention to your baby’s or child’s internal hunger and fullness cues instead of relying on external messages about how much is “too much”.  Positive goals might also include taking steps to decrease the stress related to feeding a family by learning about and adopting Satter’s Division of Responsibility (DOR) in feeding which can be utilized from the earliest stages of infancy throughout adolescence. As  stated on EllynSatter.com, our goals as parents and as a culture with regards to feeding should be to:

“emphasize competency rather than deficiency: providing rather than depriving: and trust rather than control.” *

We would add that providing education rather than stigma; positive goals rather than “tipping points”: and fostering tools rather than anxiety will go a long way in helping to nurture a culture that cares more about health and less about size.

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*Quotes are copyright © 2010 by Ellyn Satter. Published at www.EllynSatter.com. For more about raising children who eat as much as they need and get bodies that are right for them (and for research backing up this advice), see Ellyn Satter’s Your Child’s Weight: Helping Without Harming, Kelcy Press, 2005. Also see www.EllynSatter.com/shopping to purchase books and to review other resources.

photo courtesy of  pediatrics.about.com

Published by Kate Clemmer
August 13th, 2010 in Body Image, Editor's Picks, In the News, Nurture. Blog Series, Nutrition
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“Brave Girl Eating” – Q & A with Harriet Brown, Part I

On August 25th, 2010, The Center for Eating Disorders will welcome Harriet Brown – journalist, professor and parent of a child who almost died from an eating disorder.  Harriet Brown will be traveling to Baltimore to speak about her oldest daughter, Kitty’s difficult struggle with anorexia and  how their family used love, persistence and Family-Based Treatment (FBT) to help her recover.  In anticipation of her presentation and the upcoming release of her new book (left), we asked Harriet to share a little bit about her family’s experience in this three-part blog series. Her strikingly honest and insightful responses are sure to resonate with and empower countless other families who’ve been impacted by an eating disorder.

Harriet Brown’s presentation on Aug. 25th at The Center for Eating Disorders is FREE and open to the public. More information is available on our Events Page.


Q & A with Harriet Brown: Part I

Before your family went through this very personal experience with anorexia nervosa, what knowledge did you have of eating disorders and the treatment process?

HB: Probably about what most people know, which is basically nothing. I bought into all the usual myths: Anorexia affected white girls from rich families. Anorexia was a bid for attention, a way to act out in a dysfunctional family. I had no idea what I thought about treatment—I probably never gave it a thought, honestly.

When and how did you first become aware that your daughter was struggling with an eating disorder?  What were your initial reactions?

HB: We’d been aware of the possibility for a while—Kitty was a gymnast, and she’d always been on the thin side. I’d even asked her pediatrician about six months before she was diagnosed whether Kitty was maybe too thin; she’d grown half an inch and not gained any weight in a year, at age 13. The pediatrician reassured us, which in retrospect was a mistake; all adolescents need to be growing and gaining weight, and failure to gain can be as much a symptom as losing weight.

My husband and I first noticed an uptick in anxiety, but no weight loss. That’s why I was confused—I thought there had to be sudden dramatic weight loss. Kitty developed some obsessive tendencies around food and other areas, and her anxiety bloomed to the point of interfering with daily life. By now my husband and I were very alarmed. Around then Kitty lost a few pounds—4 or 5—and suddenly we put 2 and 2 together and realized we were dealing with anorexia.

Our first reaction was to push her to eat. That’s when we began to understand what we were dealing with. The harder we pushed her to eat, the more she resisted, and that was not like Kitty. By the time she was formally diagnosed, three weeks later, we were in a state of utter shock and panic. That sense of panic persisted for several months as we tried and failed to get her to eat, as her physical condition deteriorated; she landed in the hospital for dehydration and bradycardia at one point. That hospitalization was a turning point for all of us. We’d been trying to get her to eat, and failing; she was insisting she wasn’t hungry, she’d already eaten, her stomach hurt, all the excuses an individual with an eating disorder offers up. And part of us believed her, because we’d always been able to believe her. I think I was in denial. I know I was, actually. There was a moment, in the hospital, when after 4 hours of re-hydration, her heart rate still didn’t come up. The doc transferred her to the peds ICU. I remember distinctly running alongside the bed and arguing with the doctor about why she didn’t need to be in the ICU. I look back on that moment with horror, because it shows how much in denial I was that this was a life-threatening illness. No parent really wants to think that. And in retrospect I think all families pass through a stage of denial like this, and the best thing you can do is hurry them through it so they can get to the hard work of helping their child recover.

We flailed around unsuccessfully from June to August, when we stumbled on the notion of family-based treatment and decided immediately to try it. That’s when we started to make progress.

…to be continued.

Check back to read more of Harriet’s incredibly poignant account of her daughter’s illness and recovery.  In part II, Harriet talks about the most important thing she learned in the process of parenting a child with anorexia and the critical steps her family took along the way.

If you’d like to comment on this blog, or you want to receive updates when Parts II and III of this blog are posted, please join in the discussion and become a fan of CED’s Facebook page.

You can learn more about Harriet Brown and the upcoming release of her book, Brave Girl Eating: A Family’s Struggle With Anorexia, by visiting her website, www.harrietbrown.com.


Published by Kate Clemmer
August 9th, 2010 in CED Events, Celebrity Topical News, Editor's Picks, In the News, Nutrition, Recovery
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In Search of…

One of the most frequently used phrases in marketing to mothers is “How to get your body back… .” The ending varies and generally goes something like, “How to get your body back…after pregnancy…after baby…after having children…,” but the specific ending is less important than the underlying message.  When women are told repeatedly that they will need to “get their bodies back” after pregnancy doesn’t that seem to imply that their bodies are lost, damaged or missing as a result of the pregnancy?

The truth is, a pregnant body does not represent a loss of one’s body or even a damaging of it (despite a recent celebrity comment which seems to suggest this).  To the contrary, pregnancy can actually be a very visible expression of the body’s resourcefulness, strength and utility, and that is beautiful. You’ve owned your body the whole time, and it’s been doing important things for you and your baby.  During pregnancy, the body does go through changes, albeit sometimes difficult or painful ones that are a necessary part of pregnancy and childbirth, but it is still your body – the same one that climbed the jungle gym when you were five years old, the same one that walked up on stage during graduation and the same one that embraced a friend when they needed a hug.  Bodies are not lost; they don’t disappear because they change size or shape or because they’ve accumulated stretch marks or c-section scars.  Bodies work hard and deserve to be cared for, respected and appreciated.

It can be very easy to fall into a pattern of rebelling against weight gain and other physical changes that accompany pregnancy and childbirth.  That is after all, the strategy most often proposed by our image-obsessed media, a relentless diet industry, and even sometimes further encouraged by well-intentioned family members or friends.  But in reality, it’s not helpful to spend significant time and energy in search of a body you’ve been told you lost.  This quest too often ends up spiraling into years of yo-yo dieting, excessive exercise, negative body image or even serious eating disorders – all of which can be detrimental to physical and emotional well-being.  Too much time spent focused on “getting your pre-baby body back” can also have the unfortunate and undesired consequence of interfering with important bonding time between mom and baby.  This might be one reason why authors, Claire Mysko and Magali Amadei, named the phrase “get your body back” to their list of the top 5 most detrimental tabloid catch phrases for new and pregnant moms.

Search no more.  Trust your body’s natural changes and processes, including hunger and fullness cues and your unique set-point.  Nourish yourself appropriately.  Respect your body’s journey and its accomplishments; appreciate your body for what it allows you to do, not solely for how it looks.  Remind yourself that nurturing your body with enjoyable movement, adequate rest and unconditional kindness is the best way to be a healthy and beautiful mom.

If you enjoyed this blog, you may want to read these previous entries from CED’s Nurture Blog Series:

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Published by Kate Clemmer
July 9th, 2010 in Body Image, Celebrity Topical News, Editor's Picks, Glossary Definitions, Nurture. Blog Series
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Motivational Mini-Clips from Jenni Schaefer!

Each year, The Center for Eating Disorders sponsors a Fall Outreach Event to help promote messages about eating disorder recovery, awareness and prevention within the community.  Last October, we were proud to host best-selling author, advocate and recovery role model, Jenni Schaefer.  Jenni spoke about her own experience with an eating disorder and about her latest book Goodbye Ed, Hello Me: Recover from Your Eating Disorder and Fall in Love with Life.  While its been almost eight months since Jenni’s presentation here in Baltimore, we know that the summer season can offer specific challenges related to eating disorder recovery, and so it seemed like a good opportunity for us to share some motivational moments from the presentation.  Check out these short, inspirational clips from Jenni’s talk – we hope that watching them might help others to stay focused on saying “Goodbye to Ed” too! 

Are you or someone you love working hard on recovery from an eating disorder?  Jenni speaks about “mediocre stages of recovery” in this clip and offers a little perspective on why its worth it to keep going. 

http://eatingdisorder.org/blog/wp-content/uploads/2010/06/schaefer1.flv

Have you ever felt that you have to be unhappy or that you were “born to be miserable”?   You certainly aren’t alone.  In this clip Jenni talks about breaking away from this belief and adding joy back into life. 

http://eatingdisorder.org/blog/wp-content/uploads/2010/06/schaefer2.flv

What is recovery about for you? 

For everyone who could use a little ongoing motivation - check out Jenni Schaefer’s Recovery Support Blog  as well as her regular blog contributions to The Huffington Post  which often span the topics of eating disorders, recovery and dating.  And if you’re curious about that guitar she was talking about or the song she sang later in her presentation- check out her website for the lyrics.

Many thanks to Jenni Schaefer for continuing to inspire so many people and for being a role model not just in recovery but in living a balanced and joyful life. 

Appointed to the Ambassador Council of the National Eating Disorders Association, Jenni Schaefer is a singer/songwriter, speaker, and author of Life Without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too(McGraw-Hill) and Goodbye Ed, Hello Me: Recover from Your Eating Disorder and Fall in Love with Life(McGraw-Hill 2009). She is a consultant with Center For Change in Orem, Utah. For more information: www.jennischaefer.com

If you’d like to receive updates about future community events at The Center for Eating Disorders at Sheppard Pratt, please visit our website and sign-up on our mailing list.

Published by Kate Clemmer
June 11th, 2010 in CED Events, Celebrity Topical News, Editor's Picks, Recovery
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Adding Up, Weighing In, and Counting Down: Five Ways to Cope with the Numbers Game of Pregnancy

 

The Center for Eating Disorders is honored to be able to feature Claire Mysko and Magali Amadei as guest bloggers in our Nuture series for moms and mothers-to-be.   Their book, Does This Pregnancy Make Me Look Fat? The Essential Guide to Loving Your Body Before and After Baby, offers a refreshingly realistic and healthy perspective on body image during pregnancy. Recently, we asked Claire and Magali to offer their best advice to women, especially those who have struggled with eating disorders or disordered eating, on how to navigate the adventures of pregnancy without over-focusing on weight and size.

This is what they had to say…

 

 

Pregnancy is a time of great anticipation. It’s also a time that is measured meticulously from start to finish—in weeks on the calendar, milestones on the sonograms, and numbers on the scale. And for those with histories of disordered eating, all that counting can be dangerous territory. Here are five tips to help every expectant mother get beyond the numbers game.

 Tip # 1:

Take weight out of the equation. This might seem like a radical suggestion considering that pregnancy weight gain and post-baby weight loss are such hot topics of conversation among mothers-to-be and new moms. To add fuel to the fire, weigh-ins are often the center of every visit to the doctor. But truthfully, there really isn’t any reason you need to keep track of your weight. If you know that it could become an unhealthy fixation, tell your OB or midwife that you prefer not to discuss the number unless it becomes a medical issue. Step on the scale backwards and remind the physician’s assistant that you don’t want to be told your weight. Then enjoy the looks on people’s faces when they ask you how much you’ve gained and you respond, “I don’t know.” As a bonus, you’ll soon discover that there are plenty of other interesting—and more substantive–things about becoming a mother that you can talk about.

Tip # 2:

Choose a health care provider who is sensitive to food, weight and body image issues. Women who have struggled with poor body image and/or disordered eating need to find prenatal healthcare providers who are knowledgeable and compassionate when it comes to these issues. We’ve heard from many women who ended up in the examination room—and sometimes even the delivery room—feeling belittled and unsupported by their own doctors. The best way to avoid this scenario is to push through whatever shame you might be feeling and be upfront with your OB or midwife about your history and your pregnancy-related body image fears. If you’re met with criticism or any other reaction that makes you feel uncomfortable, remember that you are well within your rights to walk out that door and find another doctor who will treat you with more respect. Of those we surveyed, 73% of pregnant women with body image issues and histories of eating disorders and disordered eating said they had not discussed this history with their OBs or midwives. It’s time to break that dangerous silence.  

Tip #3:

Clean out your closet. One of the kindest things you can do for yourself is to pack up anything in your wardrobe that would qualify as “form-fitting” as soon as you see that plus sign on the pregnancy test. You will start gaining weight before you start showing, so this is a surefire way to avoid the agony of trying to squeeze into something that’s too small. And we’re not kidding about packing it up. Put those clothes in a box, and seal it up tight. Personally, we advise you not to open it again until a year after you’ve given birth. You know what they say about nine months to gain the weight, nine months to take it off? Well, we’re adding a few extra months for good measure. That’s a lot of seasons in fashion-speak, so chances are good that you won’t even be interested in some of those clothes once you dig that box out again. For sanity’s sake, pregnancy is a time when you must let go of your attachment to a specific clothing size. As someone who is about to become a mother, your sense of self-worth cannot hinge on whether you can fit into whatever size you think is “ideal” for you. Is that a belief you would want your child to absorb? What’s really ideal is to find clothes that are flattering, comfortable, and versatile. Sizes vary from store to store, so don’t have a heart attack if you end up wearing sizes that seem beyond what you imagined you would wear. That goes for pregnancy and it applies for after delivery, too. The number on the scale doesn’t define any of us, and neither does the number on the tags of our clothes. If it’s making you that miserable, take a pair of scissors and cut those labels out of sight and out of mind.

Tip #4

Be aware of the triggers of pregnancy. The incessant counting, comparing, and measuring that happens during those nine months and beyond can tap into some of the very vulnerabilities that are linked to eating disorders and food and weight obsessions. Perfectionism, loss of control, feelings of isolation, and memories of childhood often bubble right to the surface. But if you’re getting the support you need, you’ll have a better chance of weathering those storms without resorting to self-destructive habits. Resist the urge to shut down or close off.  Remember that there is nothing shameful about asking for help. It’s the most courageous thing you can do for yourself and your baby. Look at your recovery as an ongoing process that will help you reach your full potential as an individual and as a mother.

Tip #5

Break the cycle of body hatred. Allow yourself to celebrate the fact that your body is working some serious magic right now. Before you get stymied by stretch marks or focused on flabby skin, take time to reflect on how you will teach your child—in your words and in your actions—that you appreciate your body because it brought them into the world. We have the power to help future generations grow up placing a higher value on good health than on weight and physical appearance. But before we can pass along those positive attitudes, we must first embrace them for ourselves.

Make your commitment now by signing the  Healthy Beauty Pledge for Mothers and Mothers-to-Be.

Visit Claire Mysko’s website  for more empowering and encouraging blogs about body image.

* * *

Adapted from Does This Pregnancy Make Me Look Fat? The Essential Guide to Loving Your Body Before and After Baby by Claire Mysko and Magali Amadei

Published by Kate Clemmer
June 4th, 2010 in Body Image, Editor's Picks, Glossary Definitions, Nurture. Blog Series
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Body Image in a Bathroom

It’s no surprise that we appreciate initiatives aimed at promoting positive body image.  We often post about documentaries or books that teach youth (and adults) about the importance of focusing on health over weight and shape.  We even sponsor an annual arts-based, positive body image campaign called Love Your Tree, that helps to teach students about the diversity of beauty.  But recently one of our staff members was traveling out-of-state and came across a powerful message of body acceptance in what is, quite possibly,  the least likely of places – an airport bathroom. 

In the everyday world, we are constantly inundated with idealized images of the female body that promote thinness – magazine covers, department store windows, internet ads, and TV commercials just to name a few of the sources.   How nice to stumble upon something when you least expect it, that makes you stop and remember that people naturally and beautifully come in all sizes and shapes.  

Photo courtesy of Hannah Huguenin, RD, taken at the entrance to the women’s bathroom in the Jacksonville airport

Published by Kate Clemmer
May 14th, 2010 in Body Image, Editor's Picks
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Speaking the Same Language – Nurturing a Common Understanding

 

Over the course of the next few months the Nurture blog series  will explore the central theme of motherhood involving various topics such as fertility, pregnancy, childbirth and parenthood as they relate to body image, and overall wellness.  Several of these topics, in addition to being potentially sensitive subject matter, also have a language all their own.  As we approached these blogs, we thought it was important to make sure that everybody is speaking the same language – hence, the glossary page. 

Many of the terms used in this blog series get tossed around a lot in our society with the assumption that everyone knows what they mean, but that isn’t always the case as we will point out in future blogs entries regarding the term “body image”.  We also wanted to provide clarification for terms that are sometimes used in two different ways (i.e. “going on a diet” vs. “a balanced diet”).  Additional terms, like “low birth weight” or “amenorrhea” are more technical and so we thought it couldn’t hurt to provide a little refresher for these more medically-based terms as well. Throughout this series of blogs the glossary will grow and terms will be added, feel free to use it as a reference when reading specific blog entries and refer back to it as often as needed.  If you have any questions or suggestions for terms that should be added let us know!

*** 

Nurture. GLOSSARY

Amenorrhea: Amenorrhea is the absence of menstrual bleeding. Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in a girl by age 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years. Secondary Amenorrhea is the absence of menstrual bleeding in a woman who had been menstruating normally but later stops menstruating for 3 or more months and its occurrence is not a result of pregnancy, lactation, systemic hormonal birth control pills, or menopause. (source: emedicinehealth.com) Amenorrhea can be a symptom of disordered eating, over exercise or an eating disorder.

 Body Image: Body image is… how you see yourself, how you feel about your body and shape, and what you believe about your body.  Body image is made up of memories and assumptions about your body and the feelings you have when you think about or visualize your own body. Body image is also how you feel in your body as you move and control it.  Body image is not dependent on how much you weigh, how tall you are, or your personal style.  A person’s body image can exist anywhere on a continuum – from a very positive and healthy body image to a very poor or negative body image.   

Diet (noun): The customary amount and kind of food and drink taken by a person from day to day; i.e. a balanced diet:  one containing foods which furnish all the nutritive factors in proper proportion for adequate nutrition. (Dorland’s Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.)

Diet (verb): A Reduction of caloric intake or manipulation of food and drink with the intent to lose weight.

Disordered Eating: A significant deviation from normalized eating patterns that may include dieting, fasting, bingeing, or skipping meals. Disordered eating disregards internal regulation of hunger and fullness and provides the body with much more or much less than the body needs to function properly.  Instead of feeling good after a meal, someone who has disordered eating will often experience feelings of guilt, shame, discomfort, fear or discontent.

Infertility:  The inability to become pregnant after persistent attempts over a given period of time, usually determined to be one year in humans. 

Low Birth Weight: Babies born weighing less than 5 pounds, 8 ounces (2,500 grams) are considered low birth weight. Low birth weight babies are at increased risk for serious health problems as newborns, lasting disabilities and even death. About 1 in every 12 babies in the United States is born with low birth weight. (March of Dimes Foundation)

Normal Eating: Eating in response to the body’s natural hunger and fullness cues, with a variety of food choices that offer balance, diverse foods and moderation.  Normal eating generally involves eating three regular meals per day and 1-2 additional snacks in response to hunger. Normal eating involves nourishing the body for the purpose of providing energy and maintaining well-being and should result in feeling good afterwards.

Over Exercise / Excessive Exercise: 1. Repeatedly exercising beyond the requirements for good health; when an individual engages in strenuous physical activity to the point that is unsafe and unhealthy. 2. The Diagnostic Manual, the DSM-IV-TR, defines excessive exercise as exercise that “significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications.”  3. Some of the physical dangers that may become an issue for someone exercising too much can be: dehydration, stress fracture and osteoporosis, degenerative arthritis, amenorrhea, reproductive problems, and heart problems.

Set-Point / Set-Point Theory: 1. Set point is the weight range in which your body is programmed to weigh and will fight to maintain that weight. Set point is often referred to as an internal “thermostat” that regulates weight. 2. According to the set-point theory, there is a control system built into every person dictating how much body fat he or she needs to maintain homeostasis. Some individuals are genetically programmed to have a high setting, others have a low one. According to this theory, body fat percentage and body weight are matters of internal controls that are set differently in different people. 3. The set point theory suggests that despite dieting efforts, the body eventually tends to return to its set point weight or will adjust metabolism and other mechanisms in an attempt to do so.

Published by Kate Clemmer
April 13th, 2010 in Body Image, Editor's Picks, Glossary Definitions, Nurture. Blog Series
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Do I Really Have Binge Eating Disorder?

Q: A close friend of mine recently told me that she believes I may have a binge eating disorder.  Some weeks I don’t binge at all and other weeks I binge daily.  Do I really have a binge eating disorder?

A: You ask a very interesting, and common, question.  It also happens to be a complicated one!  First off, are you really binge eating?  Some people may feel like they’ve binged after eating one candy bar, a handful of peanuts or a single ice cream cone.  For these people, a binge involves eating any amount of something they consider to be a “bad” or “dangerous” food.  Technically, this is referred to as a SUBJECTIVE binge because it relies on each individual’s own, sometimes inaccurate, definition of how much food is “too much”.  On the other hand, while difficult to precisely define, a formally defined, or OBJECTIVE, binge consists of 1) eating a significantly larger amount of food than an average person might eat,  2) doing so in a relatively brief period of time (less than two hours) and 3) sensing a loss of control over eating during the episode.  Distinguishing between a subjective binge and an objective binge is an important part of helping you to answer the question about whether you have a binge eating disorder (BED). 

That being said, episodic, or occasional binge eating alone does not constitute BED.  Current diagnostic criteria indicates that an individual is bingeing at least twice a week for six months and experiences that “out of control” feeling during the binge in order to be diagnosed as having BED.* 

People with BED tend to eat quite rapidly, binge even though they’re not hungry, and often eat until they are feeling exceptionally full.  At the emotional core of BED is a sense of shame, and possibly disgust, about one’s eating behavior and, consequently, binges are apt to occur secretively.  Around 2-3% of the general population meets the criteria for BED and interestingly, women are somewhat more likely to have BED than men.  Some research suggests that upwards of 50% of people with BED are not obese, contrary to what people may assume.  

Its important to point out that even if you don’t think you meet full criteria for BED, it doesn’t mean you don’t have an eating disorder or that you shouldn’t seek help.  Any problematic disordered eating behaviors, including infrequent binges, could be symptoms of an eating disorder.  Regardless of the specific diagnosis, early assessment and intervention will significantly help to improve your chances for recovery.

Blog answer contributed by David Roth, Ph.D. 

Dr. Roth is a psychologist and therapist at The Center for Eating Disorders.  He specializes in the treatment of individuals with Binge Eating Disorder. 

* It is important to note that new diagnostic criteria for BED and its inclusion as a separate disgnosis is currently being developed and will likely be updated in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, scheduled to be released in May of 2013.

Published by Kate Clemmer
March 23rd, 2010 in Editor's Picks, Glossary Definitions, Nutrition, Therapies
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Should People With Binge Eating Disorder Try to Lose Weight?

Many people with binge eating disorder (BED) are obese and may have health problems related to their eating disorder.  Often times, people who are obese attempt to lose weight by joining a weight loss program or trying various diets; they may even be urged to do so by a medical professional who is unfamiliar with appropriate treatment for eating disorders.  While weight loss can sometimes be a by-product of recovery from BED, it should not be the primary goal.  In fact, attempts at controlling one’s weight through dieting, can exacerbate the binge eating symptoms by triggering a deprivation-binge cycle that ultimately results in weight gain and decreased metabolism. 

At The Center for Eating Disorders we recognize that the health problems which can accompany BED are a result of behaviors, not a direct effect of one’s weight.   Additionally, we find it of great importance to acknowledge and remind others that people can be healthy at every size and shape.  In fact, research shows that focusing on improving health behaviors – without regard to weight or the number on the scale –consistently leads to better physical health outcomes1.

That being said, people with BED, whether they are obese or not, can benefit physically and emotionally from seeking treatment for their eating disorder.  Treatment for BED includes working towards self-acceptance and focusing on the normalization of eating patterns.  This involves incorporating a wide variety of foods from all food groups and working through detrimental beliefs about food and eating.  People in recovery often find that once they are able to maintain a balanced pattern of eating and incorporate a healthy amount of physical activity that they enjoy, their body will naturally find and settle at its own appropriate set point.  This set point – the weight range at which one’s body is genetically programmed for optimal functioning - is different for every individual.  Focusing on balance and stability, rather than a specific weight or pant size, honors the health and well-being of the individual above all else. 

Questions about BED?  Join in the discussion on our Facebook page or visit our website for more information about BED and treatment options.

 

References:

1 Bacon, L., et al., (2005). Size Acceptance and Intuitive Eating Improve Health for Obese, Female Chronic Dieters.

Published by Kate Clemmer
March 19th, 2010 in Body Image, Editor's Picks, Nutrition, Therapies
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