In our previous post we discussed a variety of reasons that individuals with eating disorders, especially those in the early stages of recovery, may choose not to watch the Netflix film To The Bone or other films they know could create roadblocks in their continued recovery.
With that said, triggering media has always been around and will always be a part of our society so it’s helpful to know how to navigate it. Many individuals in long-term recovery or later stages of treatment might feel prepared to watch a film or read a book about eating disorders, despite triggering content. Many of our clinicians have helped to shape such exposure into therapeutic experiences for patients who are ready. For example, during periods of strong recovery, seeing a film like To The Bone can be an opportunity to reflect on one’s own experience, see things from a new perspective, process lingering eating disorder thoughts or channel anger towards the eating disorder in productive ways.
If you’ve considered all of the options and decide you do want to watch a film about eating disorders, these are a few things to consider that can help you do so in safe and productive ways.
- Don’t watch alone. Watch with a support person you can trust and communicate openly with them about how it is impacting you in the moment. You might even consider pausing the show periodically to breathe, reflect and talk.
- Time it right. Only watch it when you know you’ll be attending a therapy session or support group within a few days so you can explore your reactions and get help challenging any distorted thoughts or concerns about what you see on screen. If you currently have a lot of other life stressors or you’re in a time of transition (moving, starting school, going through a divorce, etc.) you may want to consider waiting to watch until things settle down.
- Challenge the ED thoughts. Consider journaling about aspects of the movie that you find triggering and then refute and challenge the inaccurate, negative or distorted thoughts.
- Be an activist. Write a letter to the director of the film or to the editor of a local newspaper regarding what you liked or didn’t like, what was helpful vs. not helpful or what you’d like to see more of when it comes to films about eating disorders. For example, while To The Bone features one person of color and one male in supporting roles, the movie’s star and protagonist is a young, white, upper-middle class woman with anorexia. This doesn’t help to dismantle stereotypes about who is and isn’t impacted by eating disorders. Consider writing a letter that advocates for greater diversity in eating disorder representation or about another aspect of recovery that feels important to you.
- Create an escape clause. Allow yourself the option to stop watching at any point throughout the film. Eating disorders can be associated with all-or-nothing thinking so it may feel like once you start the movie you have to finish it, but remember it’s not so black and white. At any point, if you feel triggered or uneasy about what you’re watching, turn it off.
- Plan ahead. Decide in advance upon an alternative show to watch or a self-care activity you can do when the film is over (or if you stop watching early) that will help you sustain a more recovery-focused mindset.
Do you use these strategies or have other ideas for navigating triggering media safely? Tweet them to us @CEDSheppPratt and we’ll add to the list.
You may also be interested in reading:
To Watch or Not to Watch: That is the Question, Navigating “To The Bone” and other potentially triggering movies about eating disorders
Navigating “To the Bone” and other Potentially Triggering or Inflammatory Movies about Eating Disorders
Like most things in life there are benefits and risks that come with exposure to media, especially media that depicts sensitive or potentially life-altering subject matter such as eating disorders, suicide or mental health. As you may have already noticed from the controversial conversations about it, the Netflix movie, To the Bone is no different. The film depicts a young woman, Ellen, in the throes of her eating disorder and follows her through the recovery process which the synopsis points out, includes
help from a “non-traditional doctor” played by Keanu Reeves. It may come as no surprise that the main character, Ellen, is a young, white, very thin, upper middle-class woman, and that the particular eating disorder she is dealing with is anorexia nervosa. Hollywood tends to over-rely on this stereotyped depiction of eating disorders, despite the fact that in reality, eating disorders and the people they impact are much more diverse.
As one of the nation’s longest-running providers of evidence-based treatment for children, adolescents and adults with eating disorders we’ve been asked by numerous patients and families in the previous weeks how to handle such a film. And while To The Bone may be a new film, this is far from a new question. Over the last several decades, similar questions have been raised in response to documentaries, blogs, fictional books and memoirs written by individuals recovering from eating disorders.
Decades of observing the impact of this type of media has reinforced our recommendation that individuals who are currently struggling with an eating disorder or those who are in the early stages of treatment and recovery don’t typically benefit from watching movies or reading books that display any of the following characteristics:
- extremely graphic depictions of people engaged in eating disorder symptoms such as bingeing, purging, chewing/spitting, body checking, over-exercising, self-harming or abusing drugs and alcohol
- detailed descriptions of ED thoughts and behaviors that are left unchallenged, unexplained or are not paired with sufficient education regarding the consequences
- conversations that include specific numbers such as weights, clothing sizes, calorie counts or repetitions of exercise.
If you notice any of these characteristics in a movie, show or book, it should be a red flag that it might not be a beneficial resource or recovery-focused activity for someone who is currently struggling.
We always look to support popular media that finds a way to raise awareness and stimulate meaningful discussions about eating disorders in safe and non-triggering ways. With that in mind, we went into our own viewing of this newest movie with high hopes and an open mind. Unfortunately, what we found was that To The Bone ultimately ticks off all three of the red flags mentioned above. Furthermore, the film’s depiction of treatment methods and treatment protocols are far from helpful, safe, or accurate. As a team of specialized professionals, many of whom have spent their entire careers learning about, researching and utilizing evidence-based treatments for eating disorders, this film was, quite frankly, disappointing and at times difficult for our staff to watch.
On the flip side, it did do a good job of illustrating the immense pain and struggle faced by those who are impacted by these illnesses. It also got people talking about an issue that is usually hushed in society despite the fact that eating disorders impact 20-30 million people. Our hope would be that some viewers of the film gain insight or information that could help them check in with a friend or loved one who is showing warning signs and needs help.
Taking into account both perspectives and the possibility for all the positive and negative impacts, it’s crucial to think critically about the media introduced to us as communities, families and individuals.
If you are a therapist, a parent, educator or friend of someone with an eating disorder…
It’s really important to empower anyone considering watching a film about eating disorders to feel like they can disengage safely and with your support. Let them know it’s okay to decide not to watch because it has the potential to be harmful for them and their recovery. This can be a hard but powerful decision because it builds confidence and sets a precedent for recovery-focused decision-making. How? Today, it might be saying no to a Netflix film that “everyone else is watching and talking about” but tomorrow it could be saying no to a dangerous cleanse that a favorite celebrity is promoting on social media or saying no to a friend that encourages you to step on her bathroom scale. Learning how to say no to such things, even when the societal pressure and internal urges are strong, is imperative for long-term recovery.
If you have an eating disorder or are in recovery from an eating disorder…
If you’re like a lot of our patients, seeing a trigger warning at the start of a film or hearing in advance that it might be detrimental isn’t always a deterrent and might even make the content more intriguing. We’ve heard from some of our patients that they choose to watch the film despite their own reservations and knowledge of the content. Most of the reactions included versions of the following:
- I found myself comparing my body to the actress in the film and thinking that maybe I wasn’t deserving of or didn’t really need treatment since I wasn’t as thin as her.
- I found myself wishing I could go back to my eating disorder.
- I was tempted to use “a little bit of my ED behaviors” and was reassuring myself I wouldn’t let it get that bad.
- If she [the actress Lily Collins] can “lose weight safely” for this role after recovering from an eating disorder in real life than maybe I can too.
Despite what may be positive intentions for this film, it’s important to be realistic about how it actually plays out for the millions of people with eating disorders who watch it. While not everyone will have reactions like these, we think it’s important for individuals and support people to know it’s a possibility that the person who is struggling with an eating disorder may overlook the negative aspects of the eating disorder on screen and only see the perceived positive or glamorized aspects.
If you are struggling with whether or not to watch this film, or engage with any other eating-disorder focused media, remember that it’s okay to say no. At the very least, we encourage you to discuss your decision with a treatment provider or trusted support person. If you decide together that watching this type of film might actually be beneficial at certain stages of recovery, check out these guidelines for watching safely.
Some of the most important ways to enhance recovery and prevent relapse include: continuing regular contact with treatment providers, following evidence-based recommendations, engaging in regular self-care and creating a home environment that is conducive to your continued healing and recovery. In this case, that might also include creating a Netflix watchlist that doesn’t have anything to do with eating disorders.
Do you have thoughts on the film or the media surrounding it? Join the discussion on our Facebook page.
Written by Kate Clemmer, LCSW-C, Community Outreach Coordinator, The Center for Eating Disorders at Sheppard Pratt
These are just a few of the typical headlines that can be seen on fitness and “health” magazines geared towards men. While there has been fairly widespread awareness cultivated around the media’s negative impact on women’s body image, not as much attention has been paid to how the media targets men and boys with similar body shaming tactics.
Our culture in general, and the media specifically, often pushes women to lose, lose, lose so they can be smaller, thinner and closer to an elusive definition of “perfect” but the opposite message is often being pushed towards men; most advertising and traditional media suggests the male quest for perfection requires they be bigger, stronger and more muscular. Products previously peddled exclusively towards women – hair removal items, weight loss diets, tanning products, and plastic surgery – are expanding their markets by making men take a harder, longer and much more critical look at their own appearance.
A 2016 review of five national studies found that 20 to 40 percent of men were unhappy with some aspect of their looks, including physical appearance, weight, and muscle size and tone. An earlier study found that college aged men who viewed media images of muscular men showed a significantly greater discrepancy between their own perceived muscularity (what they think they look like) and their ideal body (what they feel they should look like). The researchers suggested their results could show that even brief exposure to such idealized images can increase body dissatisfaction in men.
Despite this ongoing push for men to get bigger and stronger, over the last decade we’ve also seen the juxtaposition of thinner versions of masculinity. You can see it when looking at modern male mannequins with impossibly small waists and very slim – yet sculpted – abdomens and legs. Conflicting body ideals abound. So what is the message after all…get bigger, but stay lean? Be muscular, but still fit in those trendy skinny jeans? It’s mind numbing to try and understand, and even more impossible to attain, yet these are the messages that boys are forced to decipher from a very young age and often continue to wrestle with into adulthood and middle age.
Given all of this, it isn’t that surprising a 2014 study of more than five thousand males aged 12 to 18 years found nearly 18 percent of boys are highly concerned about their weight and physique. Of the boys who were highly concerned with their weight, about half were worried only about gaining more muscle, and approximately a third were concerned with both thinness and muscularity simultaneously.
It’s important to note that, as is also the case with females, photoshopped advertisements and a general lack of diversity in the media’s representation of bodies does not in and of itself cause eating disorders. Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder are complex illnesses with genetic and biologic underpinnings. However, environmental triggers such as narrow or unrealistic body ideals in the media can contribute to increased levels of body dissatisfaction which has been identified as a risk factor for eating disorders.
Dealing with unhealthy media messages is something that almost every man will have to deal with. As is also the case with girls and women, the dangers lie in the drastic steps some boys and men may take to try to manage increasing body image anxiety. Guys who are more dissatisfied with their bodies may be more likely to engage in risky weight loss, bulking or sculpting behaviors such as extremely restrictive diets, cleanses, steroids, supplements or excessive exercise. These are unhealthy and potentially dangerous behaviors for anyone. However, in boys and men who are genetically at risk for eating disorders, these types of behaviors can set the stage for an eating disorder, triggering changes in the brain, disrupting metabolic functioning, dysregulating hunger/fullness cues and often worsening body image, mood and anxiety symptoms. Boys and men who have a history of trauma, are involved in sports or careers that promote weight loss and perfection, and those with close family members with a history of an eating disorder are also at higher risk for developing one themselves.
Eating disorders have long been miscategorized as purely a women’s issue, even by some healthcare professionals. As a result it’s quite common for major warning signs like excessive exercise or drastic changes to diet to be overlooked or even congratulated in men. Stigma and stereotypes in the eating disorders combine to make it difficult for men who are stuck in the cycle of disordered eating to break out of it and get help. It is suggested that 25-40% of people with eating disorders are men, yet they only make up about 10% of people seeking treatment.
Talking openly about eating disorders can help minimize shame and embarrassment for males struggling with these issues. At The Center for Eating Disorders at Sheppard Pratt, we’ve been treating men with eating disorders for more than twenty-five years and we’re encouraged by the changes we hear in the conversations more recently. More men have been speaking out locally and using national platforms to raise awareness. In just the last year, Zayn Malik of the band One Direction discussed his struggle with an eating disorder and anxiety, performer/songwriter Matthew Koma wrote a poignant blog about his recovery from anorexia, and Joey Julius, a football player at Penn State, made a series of public statements regarding his decision to seek treatment for binge eating disorder. Their messages all point to a resounding hopefulness stemming from the reality that treatment is available and men can heal from their eating disorders and body dissatisfaction.
So what can you do to help the men in your life?
Start by checking in with them. The Let’s Check In campaign is all about empowering individuals, families and communities to talk openly about eating disorders and to strengthen support for individuals of all genders who might feel alone. When it comes to eating disorders, early identification and prompt help-seeking can make a big difference. You can play a role in supporting prevention and recovery from eating disorders simply by educating and preparing yourself.
Know the risk factors and pay attention to any sudden shifts in diet, exercise routine or increased negative comments about themselves or their body. If you’re unsure, the confidential online assessment is a quick tool that can help you gauge whether someone you love might be at risk. Second, if you are seeing increasing warning signs plan to check in with your friend or loved about your concerns and provide them with compassion and resources. A fact sheet, conversation guide and additional resources are available at www.letscheckin.com/.
Regis Aguglia, LCSW-C,
Family Therapist at The Center for Eating Disorders at Sheppard Pratt
Regis Aguglia earned his Masters in Social Work from the University of Maryland in 2010. Prior to joining The Center for Eating Disorders in 2014, Regis provided individual, family and group therapy in outpatient and school-based settings and gained experience treating individuals struggling with substance abuse. As a Family Therapist in The Center’s inpatient and partial hospital programs, Regis works with families to understand the impact of an eating disorder on the family system and helps to strengthen communication, coping skills, nutritional stability and recovery-focused support. Regis also facilitates a number of inpatient therapy groups including dual diagnosis groups for patients with co-occurring substance abuse and a specialty group for boys and men with eating disorders.
Bailey Webber is a student investigative journalist, writer, and co-director of The Student Body. Her story of courage and activism has been featured in numerous newspaper and online articles. She has been honored by the National Association of University Women for her advocacy work, is an ambassador for the National Eating Disorders Association as well as Proud to Be Me with which she has written several articles, blogs, and has participated in panel discussions. Bailey is the daughter of Michael Webber, a motion picture producer and renowned documentary filmmaker. As such, she has grown up around movie making and has storytelling in her blood. The Student Body is her directorial debut.
In advance of the upcoming Baltimore Premiere of her film, we had the pleasure of asking Bailey about the film and her experience co-directing it alongside her father. Part 1 of here responses are shared here.
Q&A with Bailey Webber – Part 1
In your own words, can you tell us what The Student Body is about and why you feel people should see the film?
BW: For me, The Student Body is a story of empowerment and finding your voice. Learning to stand against something that you feel is wrong, even when nobody else seems to be standing with you. That’s the example we see in the beginning of the film with my friend, Maddy, which then empowered me to find my own voice, to step outside of my comfort zone, and to combat something that I felt was unjust. Little did I know the giants I would face along the journey!
I hope people will watch the film for a couple reasons. For one, I want young people to realize that their opinion does matter, their voice can be powerful, and they can help to bring about change in their world. But it starts with being willing to learn, to work hard, and to be persistent. And for adults, I hope they will see the film and learn as I did, that obesity is so much more complicated than we are led to believe, and shaming and blaming kids for this epidemic of obesity is wrong on so many levels.
I also want people to know that this is a very positive film and it’s even filled with a lot of humor! People are surprised at how funny and entertaining the film is and they come away from with a sense of hope and encouragement, as well as being better informed and energized about the progress that can be made. I’ve had both students and adults tell me seeing the film has changed their life!
Can you share a little bit about the evolution of The Student Body? What drew you to the topic of BMI report cards and body shaming in the schools?
BW: Believe it or not, this film actually started off as a small, summer project when I was a sophomore in high school. I wanted to make a documentary about the “fat letters” that were being handed out to students at my school and my dad, who is a filmmaker, agreed to mentor me through the process.
Early on in my investigation, it became clear that this was more than just a local story, this was happening all over our state. And by the end of the summer, I found myself in the middle of a heated national debate! This was much bigger than I could have imagined and I wanted to take my investigation all the way. So, my dad agreed to drop his other films and help me see this through to the end. The father/daughter filmmaking duo was born! I then spent the next two years in production, traveling the country and taking my story to its conclusion.
I am so thankful to have been able to learn and work alongside my dad. I had my own obstacles to overcome and I really needed someone like him to give me the confidence and encouragement to keep going all the way. It was an amazing journey and I learned so much about myself through the experience.
Was there one interview you did for the film that really moved you or was particularly powerful? If so, with whom was it and what made it stand out to you?
BW: As I began investigating this issue I read that these “fat letters” are being sent to students of all ages, even as young as kindergartners. I didn’t know how awful and detrimental this really was to young kids until I talked to them myself. One of the most powerful interviews I did was with a group of 4th graders in New York who were brave enough to speak on camera. These sweet little kids each received “fitness grams” from their school, telling them that they were overweight and were devastated by it. They cried when they got home. They saw themselves differently than before. And they were not alone; kids and parents all over the country have had similar experiences but just would not agree to talk about it on camera because it was humiliating.
The short time I spent with these kids changed me forever. It gave me the energy I needed to keep pressing forward and to be a voice for them and also caused me want to focus my future on working more with youth.
What was your personal knowledge/perception of BMI testing in schools before the film and how did it evolve throughout your filming of The Student Body?
BW: One of my favorite things about documentary filmmaking is how much I learn through the journey. When I started this film I didn’t know much about BMI or obesity. I simply wanted to tell a personal story about a girl at my school and shed light on what seemed like government profiling and bullying. But this led me to connect with top experts around the country who were willing to talk to me about BMI and obesity. I learned so much through this process and the neat thing is the audience gets to come along with me as we take this journey together.
Can you share the most surprising thing you learned in the process of creating this film?
BW: The most surprising, and maybe most controversial thing I learned, is that all of the experts that I spoke to said pretty much the same thing – obesity is a disease and the cause in many people may not be as simple as we once believed. Research is showing that it’s not as simple as calories in versus calories burned and that obesity is not only caused by poor diet and exercise. The research is finding all of these other factors that play a big role in the obesity epidemic and yet we still are pointing our finger at kids and telling them they have done something wrong. The experts talked with me about the disconnect between what their research is showing and what the general public believes.
Read Part 2 of our interview with Bailey Webber HERE.
Who’s bringing a dessert? Can someone help with appetizers? Here, have some more! Are you really taking another helping? I wish I could eat like you. Ugh, my diet must start tomorrow!
Sound familiar? It’s not unusual for pre-Thanksgiving talk between family members to focus on food and food-related tasks. It’s also not uncommon for holiday conversation to revolve around what people are eating or not eating, who’s eating too much or too little and, in some cases, criticism or praise regarding weight and size. To be clear, making sure there’s enough food to feed everyone at a gathering is important, but it doesn’t need to be the center of everyone’s day.
When an individual is struggling with an eating disorder, or working hard to maintain recovery from one, these topics can activate disordered thoughts about food, trigger negative body image and impact a person’s ability to be emotionally or physically present at the gathering. Intentionally steering the day towards gratitude and connection instead of food and weight can take a bit of work in our diet-obsessed culture but it stands to benefit many, not just those with eating disorders.
Where to start? These are just a few suggestions from our therapists and dietitians. Feel free to share your ideas and recommendations on our Facebook page.
1. Offer roles for family and friends who want to contribute something but may not want to bring food. Not everyone enjoys cooking and some people, especially those with eating disorders, might feel incredibly anxious around food. There are definitely other ways to help and have a meaningful connection to the day that don’t involve preparing food. For example:
- Planning activities or bringing a craft for the kids (or adults!) to work on.
- Pet duty. Someone might really love to take the dogs out for a walk while everyone else is distracted in the kitchen or watching the football game.
- Helping with clean-up and dish-washing (Yes, some people enjoy washing dishes!)
- Ask the musicians of the family to bring their instruments.
- See if anyone would be willing to put together a slideshow of past Thanksgiving photos for after-dinner viewing.
Quick Tip: Tap into everyone’s strengths. If your brother has taken up a recent interest in photography ask if he’d be willing to document the day and capture different positive interactions. How great would it be to have a beautiful photograph of a grandparent rocking a new baby or all the cousins playing football outside? These are, after all, the moments you’d choose to remember about a holiday, not how many calories you ate or an offhanded remark someone made about your weight gain/loss.
2. Give in to the gratitude trend. Gratitude might seem like a big social media gimmick right now but the truth is it does have the power to shift your attitudes and perceptions. The moment dinner is served and everyone sits down to eat can be a moment of peak anxiety if you have an eating disorder. In anticipation of this, Google “gratitude quotes”, pick your favorites and write them on small cards to place at each table setting. Depending on how willing your family is, you could also give everyone a chance to go around and verbally share something for which they are grateful.
3. If you’re hosting, do a quick assessment of reading material around your house. Put away (or better yet, recycle) any magazines that are overly focused on appearance, diet or beauty. Studies show even just 3 minutes of looking at fashion or “fitness” magazines can negatively impact self-esteem and trigger feelings of sadness and guilt. Do you really want your 7 year-old nephew to practice his reading skills with a fitness magazine full of photoshopped bodies? Do yourself and your guests a favor by instead stocking your coffee table with photo albums, short stories written by your kids, or some photography books by a favorite artist. (If you really want to make a body positive impact, you could leave a copy of Intuitive Eating or Health At Every Size laying around as well.)
4. Identify an ally (or two). Many of us look forward to holidays with great anticipation because we get to spend time with family members we don’t often see. Some of us experience dread and stress for the very same reason. It’s no secret that family dynamics can be complicated. Instead of focusing on family members who are particularly difficult to handle, focus on the ones who can help. If you have a grandparent, cousin or significant other who knows you’re struggling with recovery, have a conversation with them in advance about the ways in which they can support you at the gathering, at the table, and in specific situations throughout the day.
5. Step away from the bathroom scale. If you’re hosting and you have a scale in your house, move it out of sight temporarily, or permanently. If you are a guest in someone else’s house, consider asking them if they can stash it in a closet for the day. As a parent, spouse or support person of someone in recovery, this would be a great thing to take care of in advance as a way to advocate for your loved one.
6. Whatever you spend time focusing on will be what you spend time focusing on. If you’re in recovery you likely going to need to think about meal plans and meeting nutritional needs and that’s okay, but make sure you also have holiday intentions that don’t involve food, eating or weight. Why? Because if all your goals that day revolve around what you’re eating you will be hyper-focused on food just like you were with the eating disorder. Prioritize your nutritional goals, talk them over with your dietitian and then consider adding some non-food goals like these:
- I will record an interview with a grandparent. (Check out The Great Thanksgiving Listen)
- I would love to cuddle with a relative’s new baby.
- I’d like to sneak off to do a 3-minute mindful meditation before dinner
- I’m going to talk with each family member about their favorite songs, then compile a playlist to share after the holiday.
- I will give at least 3 non-appearance related compliments to other people on Thanksgiving day.
Quick Tip: Whatever you choose, make sure your goals are easy, achievable and positively worded. Think about adding good things into your experience, instead of avoiding a negative. For example, instead of saying “I won’t go on Facebook during our Thanksgiving get together” say “I look forward to taking a break from social media so I can catch up with my loved ones.” Remember, whatever you focus on will be what you’re focused on.
7. Remember that you cannot control everyone else. We live in a food and weight-obsessed society, so it’s likely some of this conversation will make it’s way into your holiday despite your best efforts. If and when it does, be prepared with ways you can change the conversation, set boundaries and seek support.
8. Give Back – Identify a local charity and ask all the Thanksgiving guests to bring a donation for the cause. Even if the day is hard for you and your recovery you will be left with a visual reminder of everyone’s generosity, (even if they couldn’t stop mentioning how many calories were in the appetizer all day).
Thanksgiving can be a truly beautiful holiday that reminds us all to give thanks and reflect upon the positives in life. Taking the focus off food might not only benefit those with an eating disorder but anyone struggling with negative thoughts, low self-esteem or loneliness this holiday season.
When we lift the food frenzy and body angst we are better able to focus on gratitude and authentic connection with others and ourselves.
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You may also be interested in reading:
Questions about treatment for an eating disorder? Call us at (410) 427-3886 or visit eatingdisorder.org
Photo Credit: freedigitalphotos.net / bugtiger
This post was written by our Community Outreach Coordinator as a guest blog for the March against eating disorders. It was originally posted on marchagainsted.com and has been cross posted here with their permission.
They care for you, entertain you and bring you joy. They protect you and teach you, create things for you. They help you and mentor you. They are varied. They are diverse. They are important.
They are people you might see every day.
And they are people we might see every day in the course of providing care and treatment for individuals and families impacted by eating disorders.
At The Center for Eating Disorders at Sheppard Pratt, we see numerous people each day struggling with anorexia, bulimia, binge eating disorder, ARFID and other feeding and eating disorders. These individuals with eating disorders are varied. They are diverse. They are important.
This is why we were proud to participate in the inaugural March Against Eating Disorders on Capitol Hill last fall and why we are eager to return this year on October 27th for an even larger and more impactful event. As physicians, therapists, dietitians and nurses specializing in the treatment of people with eating disorders, we see the daily struggle, the medical repercussions, the fear and the impact of eating disorders on relationships, careers and families. But we also see the hope, the healing and comfort that comes with treatment and recovery. That is why it’s so important for those of us in the field to stand up and share our voices too.
Why do we march?
- We march because eating disorders continue to be stigmatized, sensationalized, overlooked and underfunded despite having the highest mortality rate of any mental illness.
- We march because no one chooses to have an eating disorder. Eating disorders are highly heritable illnesses, meaning 50-80% of a person’s risk for developing an eating disorder is genetic. Additional causes are varied and complex.
- We march because no family should hear “it’s just a phase, she’ll grow out of it.” from a medical professional before they make it through our doors. A lack of specialized eating disorder training for physicians delays detection and appropriate referrals. Delaying treatment delays recovery.
- We march because 20-30% of our patients are men who thought they were the “only one” and suffered in silence for a long time. Eating disorders don’t discriminate and treatment shouldn’t either.
- We march because parents do not cause eating disorders but eating disorders can cause heartache for parents and family members. Guilt, blame, stigma and outdated stereotypes can prevent families from getting the help they deserve. Current research supports an understanding that caregivers can play a positive and integral role in helping a loved one to heal from their eating disorder.
- We march because eating disorders can be deadly but they can also be overcome. Early intervention and evidence-based treatment makes a difference.
- We march because no one should have to get sicker before they can get well. Insurance coverage for eating disorders must not be a barrier to quality care.
- We march because we live together in a culture that equates weight loss with health, yet we work every day with individuals whose weight loss is associated with osteopenia, hair loss, fatigue, cardiac arrhythmia and infertility. We support a movement that embraces health-focused goals for our schools and communities instead of weight-focused goals.
These are just some of the reasons why we are excited to stand with The Alliance for Eating Disorders Awareness, The Eating Disorder Coalition, and MAED – Mothers Against Eating Disorders at The #MarchAgainstED in our nation’s capitol. Join us on October 27th to take a stand and help increase awareness about eating disorders.
Why will you march?
Register now at www.MarchAgainstED.com
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Written by Kate Clemmer, LCSW-C, Community Outreach Coordinator at The Center for Eating Disorders at Sheppard Pratt for www.MarchAgainstED.com
The original posting of this blog is available at: http://www.marchagainsted.com/blog/why-providers-must-stand-up-and-join-the-march-against-ed
As the world feels and reacts to the news of Robin Williams’ death, the national conversation has turned quite rapidly to suicide and suicide prevention. Unfortunately, to those of us in the field of mental health, these headlines require daily observance. In general, individuals struggling with eating disorders are more likely than those without eating disorders to think about and attempt suicide. One study found that risk for suicide is approximately 23 times higher in those with eating disorders than in the general population of the same age (Harris and Barraclough, 1997).
While we feel strongly that the details surrounding Williams’ death are a private matter, it has been publicly acknowledged that he was battling severe depression and had a long history of substance abuse. Among a multitude of public reactions to the news, there is a pervasive feeling of shock that a person whose public life was built around laughter and joy could simultaneously be experiencing so much pain. People far and wide are wondering how this hilarious and much-loved person could actually be feeling so hopeless?
Hopelessness is a difficult topic, particularly for individuals who are not in the midst of feeling it and, perhaps as a result, have a difficult time conceptualizing how anyone else could ever get to a point that they feel completely unable to be helped. But understanding hopelessness is at the core of every discussion about suicide. Discussing it honestly and compassionately can make a difference for those who struggle. Carrie Arnold, a former guest speaker here at the Center, wrote openly about this on her blog after receiving the news about Williams. A poignant account of her own experience with depression and attempted suicide, Arnold captures the importance of striving to understand and develop compassion for individuals in a state of despair.
“We talk of people who complete suicide as being ‘selfish’ that they couldn’t sense their loved one’s pain. Yet when those feelings of utter despair washed over me, all I could think about was the pain I was causing others.”
Arnold goes on to talk about the venture back from despair and the rebuilding of hope, desire and gratitude, writing:
“Then you figure out that you have started living life again without even realizing it. There’s no miracle moment, here, just the slow stringing together of small moments into a narrative called your biography.”
Carrie Arnold’s story is extremely important to tell because it reflects the stories of so many others that don’t make headlines and rarely get told. This is the story of traveling to the brink of hopelessness and continuing right on through. This is the story of hope. The message to people struggling with eating disorders, depression or addiction is that you can prevail. You can feel hopeless and still not be hopeless.
Almost every single guest speaker we’ve hosted to speak about recovery through the years has shared that he or she felt hopeless often and they fully believed recovery was impossible for them. They were sure of it. Yet there they are, years later, standing on a stage telling their incredible story of recovery. Rest assured, many people living full, meaningful lives without their eating disorders today were once sitting there in front of a computer screen thinking about how recovery was impossible for them too. Too many lives have been lost to suicide, there is no question about that. Yet so many others have been to the depths of hopelessness and traveled back. In fact, according to the Action Alliance for Suicide Prevention, “the vast majority of people who face adversity, mental illness, and other challenges—even those in high risk groups—do not die by suicide, but instead find support, treatment, or other ways to cope.” This is where we can begin to cultivate hope. Do not listen to any voice that says you can’t recover. YOU CAN.
The news of Robin Williams’ death is a reminder to each of us that hopelessness rarely puts itself on parade. Hopelessness hides; it isolates and it often masquerades as your neighbor, friend or coworker trudging quietly through the thickness of depression all while posting exciting status updates on Facebook or volunteering at their child’s school with a fresh smile. If we take something from the tragic passing of a beautiful person and talented actor, let it be this:
Depression does not discriminate. A well-polished public life – house, career, car, body, wardrobe, etc – is not an accurate reflection of a person’s private life or emotional experience. Check-in with friends if you know they’ve struggled with depression in the past, and never assume that someone is okay based on outward appearance alone.
ASK FOR HELP. It is not shameful to struggle out loud. Be honest with those around you about how you’re feeling and do not allow your hopelessness to hide. Talk to friends, family or call the Suicide Prevention Lifeline at 1-800-273-TALK (8255) if you are in crisis.
Depression, eating disorders and substance abuse are treatable illnesses. If you’ve traveled through hopelessness and back again, share with others about that experience of healing so they know it’s possible and that hopelessness is not a one-way street. Encourage others to get treatment.
Know the signs and symptoms that someone is in immediate danger for suicidal behavior and become educated about underlying risk factors for suicide. For example, adolescent boys and girls engaging in multiple unhealthy weight control behaviors are at greater risk for experiencing suicidal thoughts (Kim, et al, 2009).
For more information about the risks of suicide associated with eating disorders, please visit Medical Complication of Eating Disorders.
If you are interested in getting treatment for an eating disorder and co-occurring issues such as depression, anxiety, trauma or substance abuse, please call us right away at (410) 938-5252. You are not alone.
*Tree image courtesy of Just2shutter and FreeDigitalPhotos.net
The world of social media presents an interesting dichotomy. The challenges of existing in an online community are ever increasing. Concerns about safety and security are high on the list of course (particularly for parents with tech savvy kids) but additional risks to overall well-being and self-esteem are lingering close behind. Dangers include online bullying, exposure to harmful imagery or media, and the less sensationalized, yet still problematic, body bashing and body comparison often experienced within sites like Facebook and Pinterest.
Yet while these risks exist, these same online communities also provide a great opportunity for social change and grassroots organizing. We’ve seen two such examples of powerful social media campaigns this week that we thought were worth sharing. If you struggle with the body toxic environment online OR offline, perhaps these are opportunities for you to help create change for yourself and for others. Take a look, find out more, get involved. Just think, every minute you spend advocating for media literacy, body positivity and truth is one less minute you have to engage in the alternatives.
The Truth in Advertising Act of 2014 (HR4341) was introduced earlier this week with bipartisan support from Representatives in Florida and California and with collaboration from several great organizations including The Eating Disorders Coalition and The Brave Girls Alliance.
The groundbreaking bill calls on the Federal Trade Commission to develop a legislative framework for advertisements that alter the human body (i.e. shape, size, proportion, color, etc.) and asks for recommendations and remedies for photoshopped ads that are determined to be false/deceptive and which may contribute to “a series of emotional, psychological and physical health issues, and economic consequences – particularly affecting, but not limited to, girls and women.” (via Brave Girls Alliance). If this is something you support, its easy to get involved in any of the following ways:
- Add your name to the Change.org petition by Seth Matlins
- Read this great write-up about the Truth in Advertising Act by Matt Wetsel over at his blog, …Until Eating Disorders are No More. He makes it easy to find your representative in Congress and how to let them know you support the bill.
- Take to Twitter, Facebook, Google+ and any other social media site with the hastag #TruthInAds to help spread the word. You can even stop by The Brave Girls Alliance for toolkits, images and talking points for the campaign.
The Illusionists is a 90 minute documentary about the body as the “finest consumer object” and the pursuit of ideal beauty around the world. Or: how corporations are getting richer by making us feel insecure about the way we look.
The hard thing for most people about speaking out against society’s narrow ideals of beauty is that it can feel like you’re a fish swimming upstream in a strong current of Photoshopped bodies, fat talk, and dieting. Taking a stand can mean you’re up against some pretty powerful forces like the beauty and fashion industries, the diet and weight loss industries and even the larger television and film media that rely on funding from these sources. This pressure compounds when you’re an independent filmmaker working to expose the stories and financial benefits behind the WORLD’S beauty ideals. That’s what filmmaker, Elena Rossini is doing with her documentary The Illusionists and it’s why The Center for Eating Disorders has been a supporter of the film since it first launched via a Kickstarter campaign in 2011.
Now that the film is almost complete, Elena is swimming against that cultural current once more, and has taken to Twitter with the #AdoptTheIllusionists campaign to help the film, and its message, get the widest possible circulation. On her blog, Elena writes, “My passion for the project stems from its potential to incite activism: I strongly believe that The Illusionists can ignite important conversations about consumer culture, mass media, and the epidemic of body image dissatisfaction around the world. It only takes one person to believe in The Illusionists for the fate of the film to change. It could be a producer. An actress. A writer. An activist with the right connections. It could be you.”
The film has already caught the eye of accomplished artists and activists including Geena Davis and Stephen Fry. If YOU want to see the first 4 minutes of the film and then show your support for the film, visit Elena’s post, It Only Takes One Person or go straight to the #AdoptTheIllusionists campaign page for supportive statements that are ready-to-tweet.
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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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