What is ARFID?

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

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

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

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

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

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

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

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


So what does all this mean in plain English?

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

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

What ARFID is not

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

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

Filling in the gaps

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

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

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

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

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

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References:

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

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

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

 

Connecting with EMME on Body Image, Beauty and Balance…

 

The Center for Eating Disorders at Sheppard Pratt is gearing up for a week of free community events in recognition of National Eating Disorder Awareness Week 2013.  To help us kick things off, supermodel and positive body image advocate, Emme will provide a special keynote presentation in Baltimore entitled “Connecting BODY+MIND+SPIRIT” on February 24th, 2013. In advance of this free event, we asked Emme to share her unique insights into the current cultural ideals regarding beauty and to comment on some of the key elements that have helped her establish a positive, balanced relationship with her body, mind and spirit throughout her career.

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 Q & A with Emme Aronson:

Q: Through your development of EmmeNation and your role as an Ambassador for the National Eating Disorder Association, you have become a powerful advocate for positive body image. What does the term body image mean to you and how did it come to be such a significant part of your overall message of self-acceptance?

Emme: Body image is the framework for the house where our soul resides. If the foundation is weak, the house crumbles and the soul cannot fully exhibit its magnificence. How we live day-to-day depends on whether or not we have a connective or disassociated connection with our soul and our body.

Often we live from the neck up in a constant, not fully self-accepting state so to speak. By not breaking this chain of self loathing, body bashing, and guilt, dis-ease within one’s self grows and negativity cycles infinitum. At the same time a select few get richer at the cost of millions being diseased or disconnected each day, even each hour if engaging in large doses of media/TV.

It has always been my opinion that only by taking responsibility for one’s health and well-being of the mind, body and spirit, all parts moving in unison together as a befriended system, will we ever be set free from the onslaught of purely capitalistic influences. Our vitality of health, not to mention our culture and the imminent sustainability of our environment,depends on this effort.

Q: What would you say are some of the biggest pressures facing women and girls today that impact the way they experience their bodies and their inner selves?

Emme: I feel it’s the “capitalism-at-all-costs” mentality which, sadly, gets carried on the backs of women starting at an early age. This constant reminder of inadequacy plants insecurity where there once was none, or the seeds may get passed down generationally from mothers to daughters. With the hypersexualized advertising culture in full swing today, these dormant seeds are watered and the negative impact on body image, self-esteem, goal setting, visualization, and accomplishments rolls on, eroding the cornerstone of our society – women and children.

Q: What has your modeling career taught you about your relationship with your body?

Emme: Coming from a news media background, I immediately saw the lack of body diversity in the reporting of beauty. The story was loud and clear that natural body diversity was not to be discussed in mainstream media, and if it was, you were not to highlight it or shoot beautiful, size diverse models side-by-side. This was due to pressures caused by astounding amounts of money being dumped into diet related advertising (based on products with a 98% failure rate). The diet industry today probably makes well over a hundred billion dollars a year. (Psychology Today stated 50 billion in 1997, up from 30 billion in 1987). Understandably, a conflict of interest precedes that kind of money, especially when in uninformed hands. So its my job, and the job of other NEDA ambassadors, to reach out to the media as best we can to share best practices in reporting on body and eating related issues via the protocol presented to networks, women’s magazines and online outlets. An informed media gives them the opportunity to do good and make a choice, which is the best case scenario.

Q: The fashion and beauty industries often receive a lot of criticism for the role they play in pressuring women (and men) to look better, thinner, different, “perfect”, etc. How have you managed to balance your interests in fashion and beauty with your message of self-acceptance and inner beauty.

Emme: Having regularly been involved in the beauty, fashion, TV and clothing industries during different parts of my 20+ year career, I work on maintaining a balance between all the influences. I’m sure I have ruffled a few feathers when I’ve refused to say a line for a commercial, submitted a suggested rewritten line for a show, or refused commercial opportunities worth a lot of money because they didn’t align with my brand. I know a few people thought I was too righteous or full of myself but at the end of the day, I realized I didn’t need to defend myself but instead, had to go by the feeling I had in my gut. Your gut is a wonderful guide, if it’s tight and constricted, wait on whatever is in front of you. If you feel ease and grace, move forward. You may not understand what’s holding you back but listen to that innate guide that’s been with us since the beginning of time. That sensation doesn’t lie. It sometimes takes a lifetime to be still and feel it but, more times than not, it’s right.

Q: At various points in your life you’ve been faced with significant challenges, including a cancer diagnosis, which have surely tested you emotionally and physically. How have you managed to maintain a gratitude-driven existence and a positive relationship with your body throughout these ups and downs?

Emme: If I didn’t have the hearty body that I have, my cancer and treatments during chemo would have wrecked me. I feel today that cancer was one of my best teachers on so many levels.

However, where I gained the most appreciation for my curvaceous body was when I was pregnant. I absolutely loved being able to carry a child and know I was holding this new life in me. Regardless of the fact that my body gained 70 pounds and I was very large, I felt, without a doubt, that this was what my body was meant to do and I embraced myself at every stage. I even did a photo shoot (with all my bits covered but pretty much nude) and it’s one of my favorite shots.

Q: What is your favorite or most useful piece of advice for individuals who still struggle to find peace with their bodies on a daily basis?

Emme: Develop your list of gratitude and concentrate on that list until the anxiety of not being perfect subsides. This stops me before negative self speak rears it’s angry head. (Granted this sometimes takes years to work, but never giving up breeds success). After repeating this often enough like a trained dog, you come to realize you are much more than the empty shell we call our body. Instead of value being based on shape or size, a person’s true value has a chance to rise and nourish the individual and those around them, shining light on personal character traits like: helpfulness, friendliness, playfulness, bravery, courageousness and so on. Once again, take away the soul and you’ve got nothing, just bones, tendons, muscle and fat.

Q: In addition to your work in the U.S., you’ve been active globally with efforts to help women develop positive relationships with their bodies. Can you tell us more about some of these international efforts?

Emme: I’ve been so blessed to have been given the chance to travel a great deal domestically as well as internationally for my work. As a model I got to represent curvy women on three continents, and today I speak out in national and international press on issues relating to self-acceptance, the tricky issues around body image and how important achieving a healthy balance is to sustainability. Recently I was nominated as a Green Apple Ambassador by the Center for Green Schools, a program of the United States Green Building Council (USGBC) (@mygreenschools).  I’m being asked to co-create a K-12 curriculum with the CGS showing the correlation between the following: positive body image + environment = sustainability. Not only in the confines of the ED community are these issues being worked on but in the corporate world, educational systems, and in architectural environments. What is now being discussed in many professional circles is this: If you don’t feel good about yourself, you will not reach for better, think better, act better, eat better, do better, and ultimately may not care about anything beyond your immediate grasp, thus disconnecting you from the world in which you live. Not a great scenario overall.

So there’s clearly a lot of work to be done in the here and now with children, parents, grandparents, schools and the professional community to take responsibility for what we say, think and do to ourselves, to others and to the environment. And guess what? It boils down to such a simple notion:everything rolls from the source!

Q: Do you think we, as a culture, are making progress moving towards “body peace” instead of body bashing as our norm? What have you noticed?

Emme: We’re certainly speaking more about our bodies in print and online, and women are more reflected ethnically, in more various shapes/sizes and in a wider age range, thankfully. All are very important for our culture to see what exists beyond sterile, digitalized images and corporate projections of beauty. However, the more we seem to make progress and move forward toward diverse representations, the corporate push for a more restrained image pops back in again. So education is key and awareness is paramount. An educated and positively engaged mind, body and spirit can help filter what we see, hear and absorb. Indeed, buyer-be-aware of what we “buy into”. Our dollars can be spent in much better ways and can send a bigger message if we really put our heads together for real change in corporate America. I’ve learned, slow change is lasting change.

Q: Who could benefit from attending your presentation in Baltimore on February 24th? What message or skill do you most hope people will take away with them after hearing your talk?

Emme: I hope to connect with those who want to feel less alone and those seeking answers. No need to suffer in silence or bump along life’s journey by yourself. There’s no right or wrong when seeking out one’s truth. So my only message is this: Come with an open heart, you never know what may inspire, inform or ignite you. There’s only one you, and you are perfect just as you are!

 

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Many thanks to Emme for taking the time to respond to our questions and for sharing her strength and insight with our readers.  If you’d like more information about Emme’s presentation on February 24th, you can visit www.eatingdisorder.org/events or download the event flyer.  The event is free to attend but pre-registration is required to reserve seats.

Interested in more on this topic with Emme?  Join us for a special Twitter Chat with her on Thursday, February 21, 2013 from 1:00-2:00 EST.  Follow @CEDatSheppPratt and @EmmeNation for details and reminders.   

All photos of Emme courtesy of EmmeNation.com

In response to Dr. Drew ~ Exercise bulimia is not a mild mental health issue

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Recently the well-known celebrity internist, Dr. Drew Pinsky, shot this video for CNN iReport. During the segment he answers viewers’ questions about mental and physical health,  including one about healthy exercise and another regarding diet pill addiction in which he references underlying eating disorders as a serious concern.  What seems to be warranting concern is not the answers he’s giving to the viewers so much but the opening statement of the video in which he lightheartedly discloses his own struggle with something he refers to as a “mild” mental health issue called exercise bulimia.  Dr. Drew’s remarks were as follows:  

I got a whiff of exercise bulimia. You sort of exercise too much, and if you miss it you freak out. You have to constantly exercise.  I don’t feel right if I don’t do it.  But, you know, a little whiff of mental health issue never hurt anybody. 

In actuality, “exercise bulimia” is not a formal diagnosis but is a popular term often used to describe a subset of individuals with anorexia or bulimia diagnoses who feel compelled to engage in excessive exercise as a form of compensation for calories.  Some of the signs and symptoms associated with excessive exercise include:  

  • Engaging in exercise even when sick or injured
  • Becoming seriously depressed if you can’t get a workout in
  • Exercising above and beyond what would be considered a normal amount of time 
  • Refusing to build in any days of rest or recovery days
  • Inflexibility as to time of day and mode of exercise
  • Prioritizing exercise over social dates, family functions, work, or school
  • Intense fear at states of rest
  • Intense anxiety at situations where preferred method of exercise is unavailable
  • Intense guilt when forced to stray from exercise routine
  • Refusal to eat if unable to exercise
  • Defining self-worth in terms of exercise performance

Upon seeing the video above, The Center for Eating Disorders’ Director, Harry Brandt, M.D., had serious concerns regarding Dr. Drew’s statement about exercise bulimia and specifically the public interpretations that would follow. 

“In the age of the internet and personal blogs there will always be misinformation out there, but it’s particularly concerning to see high profile medical professionals, in this case an internist, minimizing what is a very serious disorder for a lot of people”  said Dr. Brandt.  He went on to say that “eating disorders are difficult to identify and treat partly because they are a socially normative disease.  Common symptoms like weight loss, dieting, negative body image and excessive exercise are all reinforced in our society.   This can make it very difficult for people with serious eating disorders to recognize their behaviors as problematic and part of a more significant mental health problem.  Statements like Dr. Drew’s trivialize a dangerous behavior and unfortunately make it more difficult for individuals to justify getting help.”       

Dr. Drew’s opinion that, “a little whiff of mental health issue never hurt anyone“ is actually far from true.  Something that may seem minor or mild could actually be indicative of a full-blown eating disorder or might represent the first signs that one is developing.   Eating disorders have the highest mortality rate of any mental illness.  Without treatment anywhere from 5-20% of individuals with eating disorders may eventually die from complications related to their illness.  Individuals with eating disorders who struggle with excessive exercise in particular are at risk for the following health problems: 

  • Increased injuries such as stress fractures, strains and sprains
  • Possible permanent damage to bones, muscles, joints, ligaments and tendons
  • Increased susceptibility to infections, fatigue and exhaustion
  • Muscle wasting (the body begins breaking down muscle mass as a source of energy)
  • Fatigue
  • Dehydration
  • Osteoporosis (bone loss)
  • Arthritis
  • Menstrual irregularities and reproductive problems, including infertility
  • Heart problems

Excessive or compulsive exercise does not always occur alongside an eating disorder but when it does, it can provide some of the first signs that someone is struggling with food and eating. We encourage influential health professionals like Dr. Drew to be mindful of the messages they share with the public and to take great care not to normalize or trivialize behaviors that could indicate someone is suffering from a serious mental health problem.

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If you are concerned that you are a loved may have an unhealthy relationship with exercise, please call us at (410) 938-5252 or visit our website at www.eatingdisorder.org .

LOVE YOUR TREE: A Special Community Exhibit of Student Artwork ~ August 2012

 

 

 

 

  

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“LOVE YOUR TREE”  ~ Community Art Exhibit 

August 9-12th, 2012 

Thurs, Fri, Sat: 10am-9pm / Sunday: 10am-5pm 

The Shops at Kenilworth in Towson, MD 

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Join us by the fountain at The Shops at Kenilworth for a unique look at six years of student artwork celebrating positive body image, the diversity of beauty, and self-acceptance.   This open exhibit is a kick-off for the Center for Eating Disorders’ 7th annual Love Your Tree campaign  which is currently accepting new artwork submissions from middle school, high school and college students.  Be sure to browse the exhibit, be a part of body positivity…and get a some shopping done while you’re at it!    

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To find out more about Love Your Tree, or to set-up a free art workshop for your school or youth organization, visit us during the exhibit at The Shops at Kenilworth or email the Love Your Tree program coordinator at kclemmer@sheppardpratt.org.

   You can also visit our website at www.eatingdisorder.org.  

  

What’s Really Going On with Facebook & Body Image?

The results of our recent survey regarding the intersection of Facebook use and body image have been highlighted by various news outlets over the past two weeks.  We discussed the implications of the survey results here (and as a guest post over at The Illusionists), drawing attention to the fact that 51% of the 600 survey respondents said they often compare themselves to others while on Facebook and that seeing photos on Facebook makes them more self-conscious about their own body and weight.  Additionally, 32% endorsed feelings of sadness when they compare their body to other people’s photos on Facebook which, for most people, is at least once a day if not more.

Facebook: Body Image Friend or Foe? at The Illusionists.org

We originally set out to do this survey because we were finding that patients with eating disorders were meeting with great difficulty in the recovery process when it came to logging into their Facebook accounts.  In fact, before we released the full survey results, one user on our Facebook page left the following comment:

Facebook definitely played a role in fueling my eating disorder symptoms and behaviors.  Most people only post pictures that glamorize their bodies and social life…There have been multiple times throughout my recovery that I have deactivated my account because the things I was seeing online were fogging my view of reality.  Realizing that the site was doing more harm than good for me has made me more aware of the things I post on my account.  I think it’s important to make sure we are trying to foster a safe and healthy community and we can only do that if we first change the way we act… .” -  Facebook User

While some media outlets have gone as far as to say that Facebook is a cause of negative body image and eating disorders, others have dismissed the significance of the results as par for the course in our  image and weight-obsessed culture.  Others, including this editorial assistant over at Allure Magazineonline, have spoken up in a personal, and humorous, way about the modern realities of  this pressure-to-be-perfect in Facebook photos. Despite the varied reactions, one thing became clear to us following the survey;   Individuals with eating disorders are not alone in their battle with body-obsession on Facebook.   

Since the survey, we’ve been asked multiple times about how body-pressure from online social media differs from the toxic messages we’ve been getting for decades from fashion magazines, commercials and weight-focused friends?   The answer: the content itself is nothing new to us as a society - conversations that are hyper-focused on weight loss, diets, bikini bodies, and who looks ”hot or not” – but the delivery and dissemination of it is new.  We’ve noticed the following characteristics of online communities are unique in how they can potentially affect the relationship we have with our bodies: 

  • Accessibility - Online social networks never turn off.  Even when you’re by yourself you’re often not far from your laptop, iPad or Smartphone and the lure of logging in to Facebook.  In the past, waiting in line at the store might have included…waiting in line.  With a smartphone it could easily be spent browsing Facebook pics from your old college roomate’s beach vacation or reading about Aunt Sally’s 37th time going on a diet.  For better or worse, we have a lot more visual information at our fingertips than ever before. 
  • Immediacy – your status update or photo can literally be seen (and commented on) around the world in a matter of seconds.
  • Lack of control over what other people post and how people comment on it.
  • Two-way street- unlike with magazines or commercials, Facebook not only allows you to see photos of other people, but allows them to see photos of you.  Maybe even more importantly, YOU are seeing public photos of you which can sometimes create the most body anxiety, especially if your instinct is to zero in on all of your supposed “imperfections” in each picture.
  • Business or Pleasure? – there’s a unique mix between the personal and business realms on Facebook.  Users often use one account to stay connected with friends/family but also occasionally promote a product or business in their posts and photos.  This means we get advertisement-like messages about beauty, exercise and weight-loss products from people we like and/or trust.  Confusing? Definitely.     
  • The sheer number of people you are connected to on Facebook is more than you would ever casually socialize with on a Friday night. The thought of hundreds or even thousands of people zeroing in on what you imagine to be “imperfections” can be overwhelming when it comes to body insecurities.  (It’s important to remember that no one else is ever looking at you or your body in photos as closely as you are!) 
  • Body Comparisons while on Facebook take on new meaning because you’re seeing real people.  Unlike magazines and advertisements which feature [heavily photoshopped]models and celebrities, photos of Facebook friends may, unfortunately, feel like a more realistic or welcoming comparison.  

The truth is, when you get caught up in comparing yourself and your body to other people (online or off) you can’t win.  Blogger, Margarita Tartakovsky, shares her journey out of this comparison trap in How To Stop Comparing Yourself To Others, in which she reflects:  

When you’re rarely satisfied with yourself, your self-worth is shaky, and you see others’ lives as almost perfect – or definitely better than your own. You  constantly search outside yourself, and as a result, you knock yourself down. For many of us, comparing ourselves just changes stripes from time to time. One day, we want someone else’s abs, biceps or hips. Another day, we want their smarts or style. A few days later, we want their family life or financial situation.  Until we can truly believe in ourselves, the comparisons will swirl and sabotage…It’s interesting that now that I accept, appreciate and believe in my body, the physical comparisons have mostly quieted.

The trap of body negativity and comparisons on Facebook can certainly be difficult to avoid, especially if your online social atmosphere includes a lot of people who place a high value on appearance-only qualities or happen to be caught up in the diet mentality themselves.  The impact can feel much more powerful if your body image is already in a fragile state as is often the case for individuals with eating disorders and those recovering from eating disorders.  

The great news is that you can mold a more positive online experience for yourself.  If you’ve reflected on your Facebook use,  assessed its impact on your body image and realized that too much of your social networking time is spent feeling worried or sad about how you look, than it may be time to set some changes in motion.

You can start by vowing to maintain a body positive Facebook profile - this means not engaging in fat talk, self-criticism, diet discussion or body snarking while on Facebook. Once you’ve made the decision to do so, you can find tips and suggestions for incorporating body positivity in our post, Social Networks ~ Building a Body Positive Presence Online.

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Related Posts:

You may also be interested in:

Body Image Friend or Foe? How is Facebook affecting the way you feel about your Body?

ABC-2 News Interview - Does Facebook Make You Feel Fat?

Over the last year, major social networking and blog sites have taken steps to protect users from  dangerous Pro-ana and Pro-mia communities online.  These are sites that promote eating disorders as a way of life, instead of a genuine mental illness, and create an atmosphere that normalizes and encourages extremely dangerous weight-loss behaviors.  Most recently the popular photo sharing site, Pinterestupdated their policies regarding inappropriate content to include Pinners and boards that feature “thinspo” or “thinspiration” – images of dangerously thin bodies meant to motivate or inspire users to pursue greater weight loss.   While banning this content won’t cure eating disorders, it can certainly help to protect vulnerable individuals from tapping into these dangerous websites. 

Though somewhat hidden in “underground” niches across the web, the dangers of online pro-eating disorder sites have been well-documented, and we commend Pinterest, Facebook, and Tumblr for taking a stand to protect their users from these sites.  But perhaps more unsuspecting in their effects, are mainstream social network communities: general sites like Facebook that we all use everyday to keep in touch with friends and family across the world, to post pictures of our kids and pets, to share birthday wishes or follow favorite organizations.  

Have you ever thought about how Facebook use is affecting your relationship with your body? 

Recently, The Center for Eating Disorders commissioned a public survey of Facebook users age 16-40 and found that, for most Facebook users, the answer to this questions is actually quite concerning.  In response to the survey we found:

  • 51% of respondents said that seeing photos of themselves on Facebook makes them more conscious about their own body and their weight
  • 32% said they feel SAD when comparing Facebook photos of themselves to their friends’
  • 44% spend time wishing they had the same body or weight as a friend when looking at photos on Facebook
  • 37% said they feel that they need to change specific parts of their body when comparing their bodies to a friend’s body in Facebook photos

Now consider that 80% of the respondents in our survey reported that they log on to Facebook at least once a day and more than half of them log on several times each day.   Thus, we see the set-up  for a daily stream of negative body image thoughts which could potentially impact one’s self-esteem.

Recent articles on CNN.com and NYTimes.com have drawn attention to the heightened role that online social networks play in adolescents’ relationship with their bodies, specifically with regards to the sexualization of teens’ online photos.  Most recently, the self-esteem website Proud2BMe.org  featured a collection of sobering quotes  from real teens regarding their body image and Facebook use, a few of which are excerpted below:

“People get positive attention in the world by losing weight. And you can do it to an even greater extent on Facebook.”-Anika, 18

“It’s only the ‘standard beauty’ who gets the ‘likes’ I feel like to be the hot girl, you have to be like that, or wear your shirt too low and your skirt too high.” -Kirby, 18

“When looking at images of girls in a magazine almost all us know that they are altered electronically to appear perfect. When it comes to social media such as Facebook, most believe that they are looking at raw pictures, or ‘real girls.’ Whether this is true or not, they are ultimately used as a standard of comparison.    -Mary

What may be even more sobering is the reality that this mindset is not unique to adolescents. Survey results indicate that this is not just a phase we pass through or something teens will necessarily grow out of.   Respondents included adults in their 20s, 30s and 40s confirming that they experience similar patterns of body negativity and weight obsession when using Facebook.   

Body negativity on Facebook is not to be considered just a women’s issue either.  In this survey commissioned by CED, 40% of the male respondents agreed that they sometimes write negative comments about their own body in photos posted on Facebook (whereas 21% of females agree to doing so).

What do we gain from publicly, or privately, criticizing our bodies and constantly comparing our bodies to one another?  Does anyone really benefit from congratulating or praising people when they post about weight loss or diets in their Facebook updates?  Weight obsession and body shaming certainly isn’t new, but online social networks are creating a new frontier that seems to be publicizing our body insecurities while magnifying society’s love affair with diets and weight loss. CED’s associate director Dr. Steven Crawford had this to say in response to the survey results:

As people spend more time thinking about what’s wrong with their bodies, less time is spent on the positive realm and engaging in life in meaningful and fulfilling ways.  When people become more concerned with the image they project online and less concerned with holistic markers of health in real life, their body image may suffer and they may even turn, or return, to harmful fad diets or dangerous weight-control behaviors. We hope the results of this survey encourage people to really look at how their online behavior affects their outlook, and we caution them against being overly critical of their own bodies or other people’s bodies while on Facebook and other social networking sites.

Consider reflecting on your own Facebook use and how it could possibly be affecting your relationship with your body.   We suggest asking yourself the following questions to discern whether certain online behaviors or patterns are harming your self-esteem or body image:

  • How often do you publicly or privately criticize your own body while online?
  • How much time do you spend comparing your body to other people’s bodies online?
  • What percentage of your status updates focus on weight, diets or exercise? 
  • Do your comments on other people’s photos regularly focus on weight or appearance in a negative or positive way?  
  • How do you feel when you look through friends’ online albums? Do you ever get overwhelmed by this?  

It’s important to remember that Facebook, and social networking in general, is a wonderful way to stay in touch with and connect to other people and organizations.  Facebook certainly doesn’t cause negative body image in and of itself.  It does however, provide lots of fuel for the weight-obsession and body criticisms that already burn out of control in our larger culture.  This can be particularly worrisome for individuals who already struggle with severe negative body image or eating disorders.  During a recent interview with ABC-2 News regarding the survey results, CED Director, Dr. Harry Brandt added that,     

Facebook may be another step in our culture that promotes self-consciousness about appearance and feelings of low self-worth around [the] body, and those are significant factors in the proliferation of eating disorders.

If you find that you’re using Facebook as an outlet for feeling badly about your body, comparing yourself to others physically, or hyperfocusing on appearance and weight in your posts, it may be time to renovate your page.  Check out these follow-up posts:

Do you have suggestions? Want to share about you own experience?  Join the conversation, and start the movement towards online body positivity on our Facebook page.

You can findmore information about The Center for Eating Disorders at Sheppard Pratt on our website, www.EatingDisorder.org

Making a Difference ~ Fat Talk Free Week 2011

This is the 6th post in an 8-part blog series  about eating disorders on campus.

Fat Talk Free Week 2011

“I’m having a fat day.”

“Does this outfit make me look fat?”

“I can’t go on that date until I lose more weight – I’m so disgusting.”

Have you ever uttered these words? Have you thought them? Heard other people say them? These types of statements have become far too acceptable as part of our every day speech and social conversation. In an effort to combat this way of speaking to ourselves and others, Tri Delta Sorority launched their fourth annual Fat Talk Free Week going on right now, October 16-22, 2011.

The following description of this initiative is posted on their website:

Fat Talk describes all of the statements made in everyday conversation that can contribute to women’s dissatisfaction with their bodies by reinforcing the thin ideal. Examples of fat talk may include: “I’m so fat,” “Do I look fat in this?” “I need to lose 10 pounds” and “She’s too fat to be wearing that.” Statements that are considered fat talk don’t necessarily have to be negative; they can seem positive yet also reinforce the need to be thin –“How do you stay so skinny?” or  “You look great! Have you lost weight?”

Fat Talk Free Week, our cause campaign in support of Reflections, is an annual week-long event to raise awareness about the damaging effects of Fat Talk. We’re encouraging everyone to change the conversation to create a more positive body image for women everywhere!

Negative body image is one of the most persistent symptoms of an eating disorder. In fact, for many people, their eating disorder symptoms will be well under control before their body image begins to improve. This is a frustrating experience that can also be very triggering, leading some, unfortunately, to revert to their eating disorder behaviors. Fortunately, there are some steps you can take to actively work on nurturing and accepting your body. There’s still time to enlist some friends or family members to take part in Fat Talk Free Week to support you in creating a world less focused on appearance and unrealistic body ideals.

Stop Fat Talk: Instead of talking with others about your appearance, start conversations about which classes you are taing, your weekend plans or how you are feeling that day. Compliment others on their accomplishments, style, or humor instead of highlighting their appearance or weight. If others are engaging in fat talk, politely redirect the conversation or let them know about your goal for the week and encourage them to join in.  You can connect with others on the End Fat Talk Facebook Page.

Make a List, Don’t Check it Twice: On one half of a piece of paper, write a list of the things you dislike about your body. On the other half write the things that you like about your body, you accomplishments and your personality. Tear off the half that details the negatives and rip it up into pieces. Throw it in the trash where it belongs! Put the positive half somewhere that you can look at it frequently to remind yourself of your great qualities.

Treat Your Body: This would be a great week to schedule a massage or a pedicure. Strapped for cash? Check out local spas that might have student discounts or get some friends together and swap accessories that emphasize your favorite feature. Sometimes, it is a treat to simply take a nice, long shower at home and actually take time to enjoy the scents of the shampoos and soaps that you use.

Apologize: It may seem silly, but every time you catch yourself thinking a negative thought about your body, pause and apologize to your body for being so harsh. Instead, try to express your gratitude for what your body does for you. For example, if you are thinking your thighs are too big, stop and thank your legs for giving you the ability to walk from place to place.  You might even want to write your body an apology letter for having been so critical in the past. Then write your resolutions for how you will treat it better in the future.

Get Creative: Tap into your inner artist and create a poster for CED’s 6th Annual Love Your Tree positive body image and poster campaign.  Colleges and  student organizations in the state of Maryland can even request a free Love Your Tree creative workshop for your campus facilitated by the program’s creator, Julia Andersen.  More details here.

Out with the old, In with the new: This would be a great week to do your body a favor and get rid of any old clothes that don’t fit or simply don’t make you feel great when you wear them. What is the point of holding onto jeans that don’t cooperate with your body? They’re only taking up space in your closet, and you could be focusing on the jeans that fit you and flatter you now. Host a clothing drive in your dorm or with your friends; donate those clothes to Goodwill or take them to a consignment shop. Everyone wins!

We at The Center for Eating Disorders encourage you to sign the Fat Talk Free Week Pledge.  Over 3,000 other people have already made the commitment to befriend their bodies, will you?

Remember, Fat Talk Free doesn’t have to end on Friday.  See how much better you feel when you focus on life outside of clothing sizes, diet goals and the media’s harmful messages about beauty. You may find that you want to make it a daily commitment.  Need a little extra motivation?  Check out Positive Body Image is Always In Season: 7 Tips for Year-Round Body Image Boosting and join us on Facebook.

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Written by Jennifer Moran, PsyD. as part of CED’s 8-part college blog series for students struggling with disordered eating and body image concerns on campus.

Momentum of Positive Change: The AMA’s Photoshop Policy & Beyond

On its website, the American Medical Association (AMA) states that its mission is to “help doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues.”  It speaks volumes then, that in their most recent press release, the AMA announced the adoption of a new policy to discourage the rampant use of photoshopping and American Medical Association Logophoto editing by advertisers.  In the policy, AMA cites the connection between unrealistic/altered images and adolescent health problems, particularly body image and eating disorders. A press release about the new policy included the following statement:

Advertisers commonly alter photographs to enhance the appearance of models’ bodies, and such alterations can contribute to unrealistic expectations of appropriate body image – especially among impressionable children and adolescents. A large body of literature links exposure to media-propagated images of unrealistic body image to eating disorders and other child and adolescent health problems. The AMA adopted new policy to encourage advertising associations to work with public and private sector organizations concerned with child and adolescent health to develop guidelines for advertisements, especially those appearing in teen-oriented publications, that would discourage the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image.

Its important to note that eating disorders are biological illnesses with a myriad of  genetic, hormonal and neurobiological factors.  Just as parents do not cause eating disorders, nor do airbrushed magazine ads. (In fact, Carrie Arnold over at Psychology Today’s Body of Evidence does a great job of examining this aspect of the AMA’s statement).  But our hope is that this new policy is not just focused on removing a risk factor for those who may be genetically more susceptible to the “thin ideal”.  A society saturated with computer-generated images portrayed as real bodies is unhealthy and harmful whether it contributes to an eating disorder or not.   Its harmful to females and males.  Its harmful to kids and adults.  Its harmful for anyone that struggles with negative self-esteem or body image.  In this way, the issue of photoshop and media ethics is more than an eating disorder prevention issue but one that addresses self-esteem and body image on a societal level.

While some will say the policy doesn’t accomplish enough, its encouraging to see a well-respected, national organization like the AMA acknowledging the issue and prompting further attention to it. What’s most encouraging isGirl Scouts of America logo that this recent action by the AMA, seems to be part of a larger momentum of change including the Girl Scouts’ announcement of its’ project, Healthy MEdia: Commission for Positive Images of Women and Girls which is being co-launched by the National Association of Broadcasters (NAB), the National Cable & Telecommunications Association (NCTA), and The Creative Coalition.

The new policy also arrives amidst several specific wins in the fight against harmful media practices surrounding weight, food, beauty ideals and sexualization.  Most recently, the Federal Trade Commission (FTC) won a settlement against Beiersdorf, Inc. (parent company of Nivea) Inc. that prohibits them from making continued false claims that its Nivea My Silhouette! skin cream can reduce consumers’ body size.  In June, the National Eating Disorders Association (NEDA) publicly applauded Yoplait for agreeing to pull a troubling ad campaign after being warned by NEDA that it normalized dangerously disordered thoughts around food and weight.  And thanks to international body image advocates Sharon HaywoodMelinda Tankard Reist and more than 5,000 signatures on a petition at Change.org, major networks MTV and VH1 both agreed to ban a violent and misogynistic music video starring Kanye West and other high profile music stars.

Lots of individuals and organizations are pushing back against the tide of false bodies, diet myths, weight prejudice and general negativity in the media.  They’re making great strides in the promotion of positive body image, self-esteem and overall health (vs. weight).  In addition to those we mentioned above, here are just a few more organizations and individuals that are doing good and speaking out for change:

When it comes to body image and media literacy, what other successful campaigns and positive social changes have you noticed lately? 

Join the discussion and check us out on Facebook & Twitter.

Bathing Suit Blues?

Summer is a season of many perks…beach vacations, picnics, holiday weekends,  longer days, blooming gardens, swimming pools, lightning bugs and flip flops, just to name a few.  But for males and females who struggle with their body image, this otherwise pleasant season can be overshadowed by anxiety and dread.  Like clockwork, every spring we are bombarded by messages telling us to “Shape Up for Summer” or “Shed those Extra Winter Pounds”.  As weather gets warmer and clothes get skimpier, even people who coasted through winter without worry, suddenly become more aware of their body weight and shape. And for those who struggle on a daily basis with negative body image or eating disorders, summer offers added challenges along the journey towards finding body confidence.  Pressure to conform can be overwhelming when surrounded by friends or family on that illusive search for the “perfect” beach body – a fruitless and unrealistic ideal sold to us by advertisers, often with complete disregard for health. For some, just the thought of purchasing a bathing suit can trigger enough worry and self doubt to allow these harmful media messages to seep in.  From crash diets to tanning beds, summer can quickly become a minefield of dangerous behaviors and deteriorating health.

So what can you do if summertime stress has you low on body confidence?  Can you make it through the barrage of destructive messages this summer and still come out okay?  Better yet, can you use it as an opportunity to gain confidence, positivity and strength?  We say yes, you can! Here are some suggestions:

Talk back. Okay, maybe this goes against everything your parents ever told you but certainly they won’t mind a little attitude if directed at the media and not at them.  Dispute harmful summer body myths with positive self-talk, and say it like you mean it…

“No one can tell me what I can and can’t wear; I will find and wear a swimsuit that fits and flatters my body JUST AS I AM instead of trying to change my body to fit into a pre-determined size or style.”

 “I refuse to miss out on fun opportunities in my life because some magazine tells me I’m not skinny enough, tan enough or muscular enough to be seen in a bathing suit.”

Stop and smell the roses…literally and figuratively.  Grow a garden, plant a tree, feel the grass between your toes, and breathe in the sweet summer air.  Sit outside and read a good book feeling the warm sunshine upon your face.  Look up in the night sky and gaze at the stars.  Be mindful of the scenery and sounds around you this summer. Sail on a boat, take a nature walk, listen to the rain on the roof during a thunder storm.  Enjoy all of your five senses with gratitude, and remember to give your body credit for allowing you to do all of these awesome things.

Accessorize. It can be fun to sport a great sun hat or trendy sunglasses that make you feel great and don’t have a size on their tag.  And while those accessories are eye-catching, we’d argue that the best beach bodies are those adorned with confidence and a smile.  If authentic confidence is hard for you right now, practice the “fake it until you make it” technique consistently, especially if you are going to be around young kids or adolescents who will be modeling your body image behaviors.

Teach others about a healthy lifestyle and show them the power of your positive energy.  Refrain from reading articles focused on weight, and talk often about how good health has nothing to do with the number on a scale.  Remind yourself and others that pressures from society regarding body size are unrealistic, unhealthy and dangerous.  Spend extra time with supportive friends and loved ones who also understand, appreciate, and embrace a diverse definition of beauty.

Change it up! Wear a different color, try a new sport or connect with a new friend.  Take a day trip somewhere you’ve never been or try a hobby you were always curious about.  Relish in the extra hours of sunlight and remember that a changing of the seasons is not about how you look in a bathing suit, but rather how you live your life.

Be kind. Treat your body, and other people’s bodies, with respect and dignity.

We’ve said it before… and we’ll say it again: Dieting does not work.  In fact, dieting damages your physical and mental well being. Chronic dieters are more likely to be depressed, have low self-esteem and most will end up at higher weights than they started. There’s a reason counting calories and adding up meal points were not included in our list of fun things about summer.   Summer is bound to go by quickly… try spending your time and energy on activities that are actually enjoyable and beneficial.  Dieting is neither of those things.

Let’s welcome summer and bid farewell to any lingering anxiety.  We hope you can spend time appreciating where you and your body are in this moment.

What are you doing to make the best of your summer and to turn the bathing suit blues into body confidence? Share your strategy on our Facebook page!

Find out more about The Center for Eating Disorders at Sheppard Pratt at www.eatingdisorder.org.

Blog contributions by Amy Scott, LCPC

20 Ways to Celebrate “International No Diet Day”

Today is the 9th annual International No Diet Day (INDD).  The campaign was started in 1992 by an author in Britain who had gone through her own recovery from anorexia. What started as a gathering in her living room has grown into a celebration of beauty and health across the globe.

Here are 20 ways you can get involved with the international celebration of INDD...

1. The obvious: Take the No Diet Pledge (Don't forget to print it out as a reminder.)

2. Review the facts.  Dieting rarely works. 95% of all dieters regain their lost weight and more within 1 to 5 years.

3. Do some research.  Next time you see a diet ad, read the extra fine print under the before/after pictures.

4. Throw out your scale.  While physically chucking that bathroom scale out a second-story window and watching it break into pieces below sounds exciting, there are obvious risks with that tactic.  Consider these alternative methods:

  • Donate it to a thrift store (bonus = tax write-off for donations!)
  • Hand it over at your next therapy or nutrition appointment
  • Wait by the road on trash day and hand it directly to your Garbage Collector

5. Use the money you planned to spend on diet products to get a massage, visit a museum,  send a gift to an out-of-town friend, OR deposit it in a savings account.  We promise it will be more fulfilling.

6. Check out some of our favorite websites and bloggers that advocate a non-diet approach to healthy living for people of every size.

7. Recycle any weight-loss magazines or diet cookbooks.  Get creative and turn them into crafts, rip-out the pages and use them as packing paper for breakables.  Or simply thrown them in the recycling bin.

8. Better yet: cancel any ongoing subscriptions to diet-laden publications.

9. Do a spring cleaning of your closet.  Donate clothes that don’t fit or don’t make you feel good in your body.  Remember,clothes are meant to fit your body, not the other way around.

10. Start living.  Do the thing you’ve been putting off until you lose X pounds. Go to the beach, take a salsa dancing lesson, go mountain climbing.

11. Reach out for support. If chronic dieting and an intense focus on weight loss has led to serious problems with eating disorders, dangerous weight-loss attempts or feelings of depression,  seek professional help.  (Not sure if you really need help?  You can start with this confidential, self-assessment quiz to find out).

12. Are you a parent, pediatrician, educator or childcare provider?  Help cultivate a new generation of non-dieters by teaching children to be competent eaters from the start.  Check out these great feeding resources:

13. Make a list of 10 positive things your body does for you. Hang it on your mirror.

14. Wear something you love and feel comfortable in

15. Spread the word. Copy the picture above and post to your Facebook profile.

16. Connect to nature.  Find some beautiful scenery, sit, relax and be inspired by the natural ability of living things to nourish themselves without external cues from diet companies.   You have the same ability.

17. Feeling crafty? Instead of trashing the bathroom scale, consider taking it apart and turning it into an art project representing your freedom from dieting.  (Side note: If you do this, PLEASE send us a pic and we will post on our facebook page!)

18. Compliment a friend on a quality not related to appearance OR tell someone you love what makes them beautiful without using words that describe body size, weight or appearance.

19. Add up all of the time you usually spend weighing yourself, counting calories, reading weight-loss articles, feeling badly about your body, or thinking about food.  Make a list of all the things you'd rather be doing with that time.  Start doing them.

20. Keep on going.  Just in case 20 ideas wasn't enough for you, here's a list of "50 Ways to Lose the 3 Ds: Dieting, Drive for Thinness, and Body Dissatisfaction" from The National Eating Disorders Association.

The Center for Eating Disorders at Sheppard Pratt fully supports the goals and values of International No Diet Day on May 6th and all year long.   We hope you have a chance to try at least one of the ideas today, but remember that they don't expire.   These 20 ideas represent steps you can take at any time to start changing your relationship with food and weight.

If you or someone you love is struggling with an eating disorder, please visit our website at www.eatingdisorder.org or call us at (410) 938-5252 for information about treatment and support.