Hidden Risks for the LGBTQ+ Community, and How You Can Help

 


Every June, Pride month provides an opportunity to share awareness, knowledge and recognition of important issues facing the LGBTQ+ community. It’s a time to celebrate progress while recommitting to challenges that lie ahead. One such challenge among the LGBTQ+ community too often stays hidden: eating disorders.

While eating disorders may happen to anyone, current research suggests that those in the LGBTQ+ community may be at higher risk,1  beginning as early as age twelve.2  In a study of over 35,000 students, gay males were 28 percent more likely to report poor body image, 25 percent more likey to engage in binge eating, and 9 percent more likely to diet frequently compared to heterosexual males.3  What’s important to highlight is how outside influences can act as a trigger for these unhealthy and dangerous behaviors in marginalized populations. For example, daily discrimination among lesbians is associated with increased binge eating.

Let’s take a closer look at stressors that may be unique to the LGBTQ+ community, including those listed by NEDA (The National Eating Disorders Association)and others identified by our patients and therapists.


Unique Stressors Faced by LGBT+ Individuals

  • Fear of rejection after coming out to one’s friends, family, classmates, co-workers and the public
  • Bullying, violence or threats at school, work or online, in some cases resulting in Post Traumatic Stress Disorder (PTSD)
  • Discrimination based on gender identity or sexual orientation
  • Hardship or stress related to identification with a gender that is different than the one assigned at birth
  • Internalized stigma where one begins to believe, internalize and/or act upon negative messages about oneself
  • Homelessness or unsafe homes occur among the LGBTQ+ population, with 42 percent of homeless youth identifying as such6
  • Unrealistic Body ideals within LGBTQ+ peers/community
  • Double minority status wherein one person experiences oppression as a member of more than one minority group (i.e. related to orientation, gender, religion, race or otherwise).


The Transgender Community

Specifically among transgender youth, a 2017 study reported that as many as one in four youths report engaging in at least one disordered eating behavior, with 35 to 45 percent engaging in binge eating or fasting. Experiences of discrimination, harassment, and violence – or enacted stigma – were often linked to greater levels of eating disorder behaviors among trans youth.7

This same study also indicated that there are some protective factors that help buffer enacted stigma from influencing eating habits in trans youth. Social support from family, friends and peers was associated with a lower percentage of trans youth engaging in binge eating. In other words, when family and school connectedness are present in the youth’s life the likelihood of binge eating decreases. In particular, the presence of family support drove the lowest probability of disordered eating.


Showing Support to the LGBTQ+ Community – 8 Ways to Help

Everyone can do their part to help lower risk factors associated with eating disorders in the LGBTQ+ community. The common thread is championing less violence and discrimination and more support and acceptance. Here are eight way you can help:

  1. Know the signs and symptoms of disordered eating and be able to recognize them in a friend, family or peer. Watch this video for an example of how everyday conversations can be a chance to check in and offer support.
  2. Be a listening ear to your LGBTQ+ friends, family and peers and be someone who they can talk to when they are upset or distressed
  3. Respect identity by using preferred gender pronouns (i.e., he/she/they), name, and other terms – when in doubt, use neutral words (i.e., they, partner) or ask about preference
  4. Ask early and specifically about the presence of eating disorder symptoms if you are a health or mental health provider working with LGBTQ+ youth. Early intervention  leads to more positive recovery outcomes but many people don’t disclose disordered eating behaviors unless explicitly asked about them.
  5. Start an LGBTQ+ club at your school or workplace to demonstrate your support and to help spread awareness
  6. Volunteer for LGBTQ+ hotlines, such as the GLBT National Help Center or The Trevor Project
  7. Educate yourself on the relationship between stigma, discrimination and eating disorders and help spread the word about common myths and facts
  8. Remember the power of family connectedness as a protective factor. Create a welcoming home for your family members of all genders and orientations.

If you are a member of the LGBTQ+ community and you think that you may have disordered eating, or just want a judgement-free space to talk, call any of the following hotlines or visit https://www.eatingdisorder.org/letscheckin to take a free online self-assessment and get connected with treatment.


LGBTQ+ and Related Hotline Numbers

  • National Eating Disorder Hotline 1-800-931-2237
  • LGBT National Youth Talkline 1-800-246-PRIDE (7743)
  • LGBT National Hotline 1-888-843-4564
  • Sage LGBT Elder Hotline 1-888-234-SAGE (7243)
  • The Trevor Project (24/7) 1-866-488-7386
  • TrevorText (M-F 3pm-10pm) Text “Tevor” to 1-202-304-1200
  • The National Runaway Safeline 1-800-RUNAWAY (800-786-2929)
  • The True Colors Fund (homelessness) 1-212-461-4401

For more information about eating disorders and treatment options in Baltimore, visit eatingdisorder.org or call (410) 938-5252 for a free phone assessment.


Blog contributions by Catherine Pappano, CED Research Assistant 

You may also be interested in reading:

 


References

  1. Watson, R. J., Adjei, J., Saewyc, E., Homma, Y., & Goodenow, C. (2017). Trends and disparities in disordered eating among heterosexual and sexual minority adolescents. International Journal of Eating Disorders, 50(1), 22-31.

  2. NEDA: Eating disorders in LGBTQ+ populations. https://www.nationaleatingdisorders.org/learn/general-information/lgbtq. Accessed June 22, 2018

  3. French, S.A., Story, M., Remafedi, G., Resick, M.D., & Blum, R.W. (1996). Sexual orientation and prevalence of body dissatisfaction and eating disordered behaviors: A populationbased study of adolescents. International Journal of Eating Disorders, 19(2), 119-126.

  4. Mason, T.B., Lewis, R.J., & Heron, K.E. (2017). Daily discrimination and binge eating among lesbians: a pilot study. Psychology & Sexuality, 8(1-2), 96-103.

  5. NEDA: Eating disorders in LGBT (gay/lesbian/bisexual/transgender) populations. https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/LGBTQ.pdfAccessed October 31st, 2017.

  6. NEDA: Eating disorders in LGBT (gay/lesbian/bisexual/transgender) populations. https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/LGBTQ.pdfAccessed October 31st, 2017.

  7. Watson, R. J., Veale, J. F., & Saewyc, E. M. (2017). Disordered eating behaviors among transgender youth: probability profiles from risk and protective factors. International Journal of Eating Disorders, 50,515-522.

Transition and Recovery with Ryan Sallans: A Reflection on TU’s Eating Disorder Awareness Week Event


What does it mean to live authentically? 

Honoring your truth.

In other words, understanding, accepting, and nurturing your various, intersecting identities, to live your best life. This was a major theme throughout a special event held in February at Towson University (TU) to help recognize National Eating Disorders Awareness Week.At the event, speaker Ryan Sallans shared his personal experience of gender identity development and eating disorder recovery with the TU community. Organized by TU’s Counseling Center, the event was well-attended and brought together various university and local organizations, including The Center for Eating Disorders at Sheppard Pratt, TU’s Center for Student Diversity and The TU Body Image Peer Educators (BIPE). Sallans is a well-known public speaker, author, and health educator, and has been featured on Larry King Live, NPR, The Advocate, and many other news and popular media outlets.

 

Documenting Self-Discovery through Transition and Recovery

Throughout his talk, Sallans highlighted the delicate balance between taking care of oneself and navigating important relationships that often change throughout transition. Of course, each individual’s experience is different and Sallans did well to emphasize his is only one story among many.

Despite transgender and gender non-binary identities being discussed more openly than ever, there remains a stark deficit in information regarding the intersection of body image, gender identity development, and eating disorders. Studies have suggested the prevalence of eating disorders is higher among transgender individuals when compared to the general population (Reisner et al., 2016; Watson, Veale, & Saewyc, 2016). This health disparity is likely influenced by the pervasive effects of transphobia in our society, which sets the stage for inequality and discrimination at home and beyond, creating unique risk factors for the trans community (Bockting, Miner, Swinburne-Romine, Hamilton, & Coleman, 2013; Watson et al., 2016).

Pair this with the fact that no one is immune to the influence of the multi-billion dollar beauty industry consistently sending a message that, in order to be happy, we must look a certain way. Each one of us, regardless of gender, is sold (to some extent) on the idea that by controlling our bodies, we can achieve happiness, wealth, and popularity. Those working in the eating disorder field have historically referred to this as the internalization of the “thin ideal” or the acceptance of unrealistic or narrow beauty standards (Thompson & Stice, 2001). Transgender individuals are not immune from this culturally normative body dissatisfaction.  But people with eating disorders who identify outside of the restrictive gender binary may also experience amplified body dissatisfaction because their gender identity and their sex assigned at birth do not match (Algars, Alanko, Santtila, & Sandnabba, 2012; Strandjord, Ng, & Rome, 2015).

Furthermore, adjusting to a changing body and gender expression (for those who opt for cosmetic, hormonal, and other gender-affirming interventions), as well as the public commentary this process often evokes, presents its own unique challenges that impact body image and self-esteem (Couturier, Pindiprolu, Findlay, & Johnson, 2014).

 

How does one survive, and thrive, when faced with such challenges?

Sallans encouraged everyone in the room that night to stay hopeful and connected, which for him means sharing life stories to better understand those that are different. His comments suggested tremendous patience and empathy for his loved ones’ process of arriving at a place of acceptance with his transition, while also emphasizing the need to disconnect at times to protect oneself. Sallans identified a number of strategies and resources he has found useful, starting with a non-judgmental awareness of his needs, his boundaries, and his triggers. He explored the role of psychotherapy, as well as self-guided research on lesbian, gay, bisexual, and transgender issues, in helping him to turn towards his inner truth and wisdom.

Consistent with national guidelines on psychotherapy with LGBTQ individuals, Sallans benefited tremendously from collaborating with an affirmative therapist; someone he was able to confide in during times of confusion and fear surrounding gender identity, at a time when very few were even considering gender outside of the binary. The trust and respect he built with his therapist created a safe space to discuss gender issues and eating disorders, which provided the platform for recovery and ultimately allowed for closer and more authentic connections with family and friends. Outside of therapy, Sallans said he found it incredibly useful to communicate about his emotions and take time out for himself. He acknowledged the need to unplug from negative relationships (and social media) and engage in routine self-care, which for him often includes going for walks and being in nature.

Self-care, use of coping skills for managing negative emotions, positive sense of identity and community, and feeling like you can count on those closest to you are universal factors associated with resiliency (Rutter, 2012). These factors are even more relevant for those who identify outside of the gender binary (Hill & Gunderson, 2015; Watson et al., 2016). If you or a loved one is struggling with an eating disorder and questioning gender identity, see the resource links below to gather information, find community, and get professional support.

 

For information regarding affirming and evidence-based treatment options and programs at The Center for Eating Disorders at Sheppard Pratt, please contact us at (410) 938-5252 or email us at eatingdisorderinfo@sheppardpratt.org.

 

Additional Resources:
https://www.ryansallans.com (Ryan Sallans’ Official Website)
www.genderspectrum.org
www.glaad.org
www.pflag.org
www.thetrevorproject.org
https://www.chasebrexton.org/our-services/lgbt-health-resource-center


Written By: Andrea Castelhano, PsyD, Outpatient Therapist – Dr. Castelhano is a licensed clinical psychologist in the outpatient department at The Center for Eating Disorders at Sheppard Pratt. She earned her doctorate in Clinical Psychology at the American School for Professional Psychology at Argosy University, DC where she received training in cognitive behavioral therapy and mindfulness-based approaches to psychotherapy. She also received specialized training in eating disorders, anxiety disorders, and co-occurring self-harm and suicidality. Additionally, she has provided affirmative therapy to individuals in the LGBTQ+ community throughout her training and professional career. Affirmative therapy is a therapeutic approach that respects individuals of all sexual orientations and genders, recognizes the impact of intersectionality on identity development and life experience, and addresses issues including discrimination and heterosexism as they relate to the individual’s broader treatment goals. Dr. Castelhano joined The Center for Eating Disorders in 2018 and brings her experience from a variety of clinical rotations, including a year-long practicum at Children’s National Medical Center Outpatient Eating Disorders Clinic,  APA-accredited clinical internship at Laureate Psychiatric Clinic and Hospital, and post-doctoral fellowship with the University of Tulsa Counseling and Psychological Services Center. She provides individual, family, and couples therapy, as well as psychological testing services. She is fluent in Spanish and Portuguese.


References

Algars, M., Alanko, K., Santtila, P., & Sandnabba, N.K. (2012). Disordered eating and gender identity disorder: A qualitative study. Eating Disorders: The Journal of Treatment & Prevention, 20, 300-311.

Bockting, W.O., Miner, M.H., Swinburne-Romine, R.E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943-951.

Couturier, J., Pindiprolu, B., Findlay, S., & Johnson, N. (2014). Anorexia nervosa and gender dysphoria in two adolescents. International Journal of Eating Disorders, 48, 151-155.

Hill, C. A., & Gunderson, C. J. (2015). Resilience of lesbian, gay, and bisexual individuals in relation to social environment, personal characteristics, and emotion regulation strategies. Psychology of Sexual Orientation and Gender Diversity, 2, 232-252.

Reisner, S.L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, … Baral, S.D. (2016). Global health burden and needs of transgender populations: A review. The Lancet, 388, 412-436.

Rutter, M. (2012). Annual research review: Resilience – clinical implications. The Journal of Child Psychology and Psychiatry, 54, 474-487.

Strandjord, S.E., Ng, H., Rome, E.S. (2015). Effects of treating gender dysphoria and anorexia nervosa in a transgender adolescent: Lessons learned. International Journal of Eating Disorders, 48, 942-945.

Thompson, J.K. & Stice, E. (2001). Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science, 10, 181-183.

Watson, R.J., Veale, J.F., & Saewyc, E.M. (2016). Disordered eating behaviors among transgender youth: Probability profiles from risk and protective factors. International Journal of Eating Disorders, 50, 515-522.

Body Comparison: An Olympic Sport?


When cheering on the elite athletes at the Rio Olympics and in other high-profile sporting events, it can be easy to lose perspective and you may find yourself comparing your physical body to those at the peak of their sport careers. Lost in these comparisons, we too often become self-critical and forget the long journeys, support communities, financial resources, sacrifices and sheer hard work that comes with being an Olympic athlete.

Olympic bodiesEngaging in body comparison not only hurts you but serves to fuel the overall toxic culture of body shaming. After all, even Olympic athletes are subject to mean-spirited remarks about their appearance. In the most recent summer games, Ethiopian swimmer Nobel Kiros Habte faced some harsh comments for not matching the “look” of his peers, as did Mexican gymnast Alexa Moreno. Many others have faced similar backlash through the years.
Just as athletes are not immune from body shaming, it’s important to remember the “perfect” athletic body does not equate to perfect health. Making snap judgments about someone’s fitness or health based on their appearance is misleading – it’s rarely possible to tell, for example, if someone has an eating disorder just by looking at them. Athletes are not immune to eating disorders or struggles with body image. American cyclist and two-time national champion Mara Abbott has been open about her experience with anorexia. In a candid column for a cycling blog, she reflected on how it affected her performance: “Personally, having taking a hiatus from sport in 2012 due to an eating disorder, I can attest that my thinnest was definitely not my strongest. I really mean that. Please read that sentence more than once.”

As we gather around the television with our friends and families to celebrate athletic achievement, we can support the competitors, ourselves and each other by focusing less on physical appearance and more on the hard work and powerful accomplishments of these world-class athletes.  After all, Olympic bodies can be powerful, graceful, tough and resilient but they are also diverse.  From gymnastics to archery, swimming to shot put, let’s allow our athletes to be inspirations, not because of or in spite of their looks but for the attitude and spirit they project in aiming for their goals.  Let’s enjoy watching all sporting events – whether it’s a World Cup game or a pee wee soccer league – from a place of body appreciation and as part of a body positive summer.

*     *     *

You might also be interested in reading:

Faking It: Sunless Tanning and the Risks You May Not Have Considered

Faking It_ SunlessTanning_SORENSENSkin cancer is among the most common forms of cancer in the United States. In fact, over the past three decades, there have been more cases of skin cancer than all other forms of cancers combined.1  Furthermore, a 2014 study published in the Journal of the American Medical Association-Dermatology estimated that more than 400,000 cases of skin cancer each year in the United States may be the result of indoor tanning, with approximately 6,000 of these cases being melanoma, the most deadly form of skin cancer.2

Most people are aware of these risks. Warnings of cancer and other related health problems are broadcast widely, and reminders to slather on sunscreen can be heard from all corners of our pools and beaches. At the same time though, the pressure to acquire the media’s ideal body is strong, and this culturally defined ideal frequently includes obtaining a “luxurious summer glow” or becoming a “bronzed beauty”. For some, the perceived benefits of tanning via sun exposure, or tanning bed, seemingly outweigh those severe health risks and they continue tanning despite the danger. In research on UV exposure, some excessive tanning behavior has even been described as an addiction. Many other people, including 1 in 10 adolescents, opt for what is promoted as the safer option – sunless tanning.

Body image avoidanceSunless tanning products (creams, foams, sprays, stains, etc.) are heavily promoted as a viable option for someone looking to achieve a summer glow without assuming the health risks of tanning beds or sun exposure. But is it completely without risk? If we know UV exposure is unhealthy, then why are we spending time and money trying to fake it? It’s a million dollar question with a million dollar answer, or more accurately, a $763 million answer; that’s how much the fast-growing sunless tanning industry was worth in 2014.

Like the bikini body, the elusive summer glow represents an unfair and unrealistic expectation that can contribute to an individuals’ experience of body dissatisfaction. Additionally, trying to change skin color with the use of sunless tanning products can be viewed as a form of body image avoidance. An inability to achieve the tan ideal, or the time and mental resources spent focused on one’s perceived inadequacies, simply magnify negative feelings towards the body.  Thus, sunless tanner may help dodge the bullet, so to speak, by avoiding UV rays, but it is not completely harmless. Body dissatisfaction, body image avoidance, and low self-esteem are some of the most well documented risk factors in the development and presentation of eating disorders.  Furthermore, studies have found links between general tanning behaviors and unhealthy weight control practices. Consider the following associations:

  • Steroid use and unhealthy weight loss strategies were 4x and 2.5x more likely, respectively, among high school males who used indoor tanning, compared to their non-tanning counterparts.3
  • Boys who tan were more likely to be trying to lose or gain weight than non-tanners.4
  • Female students who engaged in indoor tanning were also more likely to engage in unhealthy weight control practices.5
  • A belief that a tan improves appearance is one of the strongest predictors of UV exposure behaviors.6

We know that body dissatisfaction can drive both tanning and unhealthy weight control behaviors. These correlations underscore the point that, despite a lower skin cancer risk, promoting sunless tanning may still be problematic, especially in individuals who struggle or have struggled with body image. Promoting or validating the quest for a tan body has the potential to reinforce negative body image thoughts and perpetuate appearance related obsessions.

It is important to keep in mind that any beauty ideal is carefully crafted and enforced by #bodypositivesummer_TANNINGan industry that profits from the body dissatisfaction it’s “standards” create. Tanning is no different. In fact, it’s important to point out that the tan ideal is just one way that westernized beauty ideals promote insecurity or dissatisfaction across the spectrum of skin colors. The media’s pressure on Caucasian women to be tan occurs concurrently with tactics like whitewashing and digitally lightening the skin (and hair) of women of color in prominent advertisements. Writers at Beauty Redefined unpack the cultural implications of those practices in the post: Beauty Whitewashed: How white ideals exclude women of color.

By creating the narrowest possible margin for beauty, the media essentially convinces everyone their skin is either too light, too dark or some other shade of inadequate. As a result, people who internalize the cultural definitions of beauty feel ‘required’ to purchase some sort of product or service to achieve the ideal, or risk being invisible. As Director Elena Rossini reveals in her masterful documentary The Illusionists, the very same company that promotes tanning products in the U.S., profits off of skin-whitening creams in India.

Media influencing what we perceive as beauty is not exactly a new conversation, but sometimes these ideals become so much a cultural norm that we cease to question them. Just think how often the phrase “you look so tan!” is thrown around as a compliment or “I’m so pale” is delivered as a self-criticism.  Great diversity of skills, skin colors, body shapes and sizes is a natural and healthy part of life. Any group who tries to change that, especially for profit, should be met with critical speculation. Just as we attempt to challenge the thin ideal, we should seek to debunk tanning myths and push back against unrealistic or unhealthy expectations. One way to do that is by helping to build families and peer groups that prioritize body positivity and body acceptance.

As individuals, we can push back by refusing to buy-in to a heavily marketed tanning industry that includes outdoor tanning, indoor tanning or pre-packaged tanning. Perhaps the money, time, and mental resources devoted to the quest for a perfect summer glow could be better used elsewhere?

Find out just how much money you could save by expanding the infographic on the right.  Then head on over to Twitter or Instagram to tell us what you would do with your savings and how you intend to finish out your #bodypositivesummer free from the grip of body dissatisfaction.

 

About the Author:
t_sorenson_headshotTaylor Sorensen is a rising senior at Trinity College in Hartford, CT where she is majoring in Neuroscience.  At Trinity, Taylor is involved in research focusing on the neuronal underpinnings of Autism Spectrum Disorder.  She joined The Center for Eating Disorders as a summer intern in both the Research and Community Outreach Departments.


 

References:
  1. Stern, RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol 2010; 146(3):279-282.
  2.  Wehner, MR. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol. 2014 Apr;150(4):390-400. doi: 10.1001/jamadermatol.2013.6896.
  3. Miyamoto J, Berkowitz Z, Jones SE, Saraiya M. Indoor tanning device use among male high school students in the United States. Journal of Adolescent Health. 2012;50:308–310. doi:10.1016/j.jadohealth.2011.08.007. [PubMed]
  4. Demko CA, Borawski EA, Debanne SM, Cooper KD, Stange KC. Use of indoor tanning facilities by white adolescents in the United States. Archives of Pediatriac and Adolescent Medicine. 2003;157:854–860. doi:10.1001/archpedi.157.9.854. [PubMed]
  5. Guy, GP. Et al. Indoor Tanning Among High School Students in the United states, 2009 and 2011. JAMA Dermatol. 2014 May; 150(5):501-511.
  6. Pagoto, SL, Hillhouse, J.Not All Tanners Are Created Equal: Implications of Tanning Subtypes for Skin Cancer Prevention. Arch Dermatol. 2008 Nov; 144(11): 1505–1508.

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From Collegiate Athlete to Pregnant Mom, ERIN MANDRAS talks summer body image pressures {Guest Post}

 


mandrassoccer2 Erin Mandras Erin Chooses body positivity

 

 

 


I went to pick a magazine off the rack the other day at the store, and, just like most people, I am automatically drawn to the headlines highlighted in big, bold capital letters on the front covers.

“Flat Abs, Lean Legs, Firm Butt.”
“Drop XX lbs. Fast.”
“Flat Belly Now!”
“Drop A Jeans Size In XX Days.”
“Sexy Abs Fast.”

You get the point. It is only natural for me, or anyone, to assume that these characteristics are being promoted because they depict beauty, and that sexy is defined as thin, lean, flat, and firm. As we are right in the thick of summer season, and attaining a “bikini body” is at the forefront of peoples’ minds, I picked up one of the magazines and skimmed through it. Thankfully, those magazine headlines don’t effect me in the same way they once did.

I suffered from an eating disorder at the age of twenty. My desire to appear attractive, and be physically fit fully dominated my ability to focus on being healthy. My initial attempt at losing “a few pounds” turned into an obsession with food restriction and excessive exercise. And, it all began in the summertime when I knew I would be in a swimsuit with my friends, and my body was more exposed than in the winter season. Little did I know that my drive to be thin and sexy would lead me down a deep, dark path of depression and anxiety.

I am an athlete. I have always been active and competitive in sports, particularly soccer. Short in height, I needed to have strength in my upper and lower body to be successful. At the time of my eating disorder, however, I lacked size, power, and personality–all attributes that had contributed to my successes on the field. I quickly realized these qualities I once possessed had dissipated and what I thought was making me better, sexier and more confident was actually making me weaker and more insecure.

Fast forward thirteen years.

I am now 23-weeks pregnant with my third child, and summer has begun once again. My body is larger than it has ever been in my whole life.  But so is my heart. I have two little Erin Mandras hits the beach with her kidsboys, who love to go swimming at our neighborhood pool. It is in this environment that I am forced to make a decision: embrace my features and my body, and enjoy myself and my children; or turn back to my eating disorder and disengage from life and from my family.

Love, family, and happiness now far outweigh a desire to be a certain body type. And, for me, who is not happy, joyful, or lively when I am dieting or focusing on dissatisfaction with my body, I choose to live life.

Life is too short to focus solely on my appearance or socially constructed beauty ideals. I much prefer to enjoy myself, exercise healthily, and concentrate on being the best person, mom, wife, daughter, and friend I can be. That is far sexier than any number on the scale or what I look like in a bikini.

 

Erin Mandras is a blogger and inspirational speaker at Kick The Scale.  She’s also a youth soccer coach in the Baltimore, MD area, and cares for her two young kids (Levi, 4 1/2 and Austin, 2 1/2). Prior to these roles, Erin was a college soccer coach at Michigan State University, Towson University, and Loyola University Maryland, and a former women’s soccer player at Michigan State University. She was born and raised in West Bloomfield, MI, is now married to her wonderful husband, Jon Mandras, and resides in Baltimore.   


Wondering how can you start to build a body positive summer for yourself and the people you care about?

Put the magazines down.  Better yet, don’t even pick them up. Create your own headlines.

Local Woman chooses body positivity!What do you want your summer headline to be?

Share with us on Twitter using the hashtag #bodypositivesummer and find out more about the campaign here.

 

 

 

 

 

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Surviving & Thriving through Mid-Terms & Finals

It seems like many colleges and universities have moved away from the standard exam schedule. In fact, it can seem like you are constantly studying for exams or writing papers, with no downtime or lull in the semester at all. Midterms and finals just mean a heightened level of existing anxiety or stress. Unfortunately, for many college students, that means there comes a point in the semester when it seems like there are way too many obligations and way too little time to manage them all.  If you are simultaneously working on recovery from an eating disorder this can be incredibly frustrating, particularly if everything seems to be equally important on your to-do list. While it can be easy to lose sight of how critical your recovery is in the midst of these academic priorities, its crucial to remember the potential consequences.  Turning to your eating disorder behaviors will only intensify the stress you’re body is under, making it mentally and physically harder to concentrate, harder to interact and connect with other people (i.e. study groups, roommates, support people) and much harder to accomplish that long list of study tasks.

Self-care, nourishing your body, following treatment recommendations and practicing your new healthy coping skills is what will eventually get you through the stress of mid-term or final exams.  While the hectic nature of college academics can’t be completely avoided, we can offer some tips to help make it feel more manageable and less likely to derail your progress in recovery.

Prioritize: Make a list of all of your upcoming responsibilities. Pull out the larger projects and see if you can break these down into smaller, more achievable tasks. For example, break down “10 page research paper” into: print articles; read articles; write an outline; write the rough draft; write the bibliography; and revise the paper. Write deadlines next to each item on your list and then organize your to-do list by due-date or high priority items. Don’t forget to breathe.

Eliminate unnecessary responsibilities: Do you really have to do everything on your list? You might have some things on there that are optional projects, or possibly some student organization meetings that are not imperative for you to attend. Perhaps you can ask for less hours at work during exam weeks. Remember that you can also always talk to your professor; if you have 3 exams scheduled on one day, one of your professors may actually be willing to allow you to take the exam for their class on a different day. If you just can’t adjust your schedule, know that this stress is temporary. Focus on the end point and plan a reward for yourself after big assignments are turned in.

Don’t give up on the basics: As tempting as it may be, you still need to prioritize sleeping, eating and self-care. In fact, it is even more important that you take care of yourself during this stressful time. Always strive to get as close to 8 hours of sleep each night as possible, remembering that lack of sleep can have a significant effect on hunger and eating patterns.  Make sure you are scheduling times to eat your meals and snacks and that you are thinking ahead. If you know you won’t have time to go back to your room for a meal, remember to pack your food with you or bring money to eat while you are out.

“The time to relax is when you don’t have time for it.”   

~Sydney Harris

Relaxation is vital. Take some time every day to take a deep breath and be still. Enjoy what the season has to offer.  Consider setting aside 30 minutes or an hour during your busy time to catch up with a friend or roommate – no multi-tasking or studying allowed during that time.

Keep your appointments: When things get hectic, it may be tempting to cancel your therapy or nutrition appointments so that you can spend more time studying.  This often makes sense in a moment of panic or stress but can easily lead towards losing sight of  recovery’s importance.   Cancelling appointments during high stress or high pressure times can be a risk  factor for relapse.  Consider a rock climber choosing to take off her safety harness right when she gets to the highest and steepest part of the cliff.  You’d probably question that decision right?  The same applies to your “safety harness” and your support system during difficult times.  If you are struggling to get to your appointments, speak to your therapist about this and decide together what is the best way to balance your responsibilities with your recovery in mind.

Reach Out:  Recovery can feel like a full-time job sometimes, and college is a full-time job for many students.  You may be realizing that you are struggling so much with both that you just can’t focus on your academics the way that you want to. You may have missed a number of classes, gotten behind in lectures or just feel too overwhelmed to truly focus. Don’t be afraid to talk with your professor and see if there is any way that you can catch up, delay some deadlines, or work with a tutor to help you in that class.  You don’t have to go through this on your own.  Ask for help and explore your options for support on campus. If you think you need to withdraw from a class and have missed the Drop/Add deadline, or if you are thinking about taking a medical leave of absence, schedule an appointment with the Dean of Students, an Academic Advisor, or someone at the Counseling Center – that is what they are there for!

While academics and exam stress can be overwhelming, just remember that you have options regarding how you handle that stress and how you let it affect you. You have already accomplished so much this semester.  Reflect on what has been working well so far and praise yourself for a job well done. If there are things that have been a struggle, now is a good time to evaluate what aspects of your self-care and stress tolerance could be improved.  Try  coming up with a reasonable plan to put into action for the rest of the semester and continue reflecting on it to see what is working and what isn’t. If you are stumped as to how to do this, reach out to others for support and additional ideas.

CED wishes you a memorable semester of academic success, balance and self-care.  For more insight on the intersection between college and eating disorder recovery, check out our whole blog series at: Battling Body Image Concerns & Disordered Eating on Campus .

If you are struggling with an eating disorder and need help or support, please call The Center for Eating Disorders at (410) 938-5252.  You can also reach us by email at EatingDisorderInfo@sheppardpratt.org.

 

Written by Jennifer Moran, PsyD, CED Therapist & College Liaison

Originally published on 11/11/2011

Reaching Out for Recovery Resources on Campus

As the newness of the school year starts to fade, you might be realizing that you or a loved one may need more support to maintain or re-focus on recovery while on campus.  It might feel discouraging to recognize that you are not doing as well as you had hoped, but you do not have to suffer alone.  Most colleges and universities provide a full Students on GC campusrange of services to their students, and it would be worthwhile to look into what is available on your campus. While every campus is unique, the following services are typically available at every school.

Student Health Center: The Health Center has physicians and nurses that are on site and specialize in working with college students. Many schools have at least one member of the staff that is familiar with working with people who have been diagnosed with eating disorders and will be able to help facilitate your care and make appropriate referrals on and off campus. Sometimes a dietitian is on staff to work with college students who need nutritional counseling.

Campus Counseling Center: The Counseling Center may be part of the Student Health Center, or it may be a completely separate department. At most schools, therapists are available to see students in individual therapy for a wide array of emotional and psychological concerns. The best part is that many of these services are free or very low-cost. The Counseling Center may also offer group therapy, which allows you to connect with others on campus who are facing some of the same concerns that you are. Some counseling centers may also work with a psychiatrist that can prescribe and monitor medications, if appropriate.

Peer Counselors: If the idea of speaking to a counselor is overwhelming, you may feel more comfortable initially meeting with a peer who has been trained to provide support. While a peer counselor is not qualified to do therapy, they can be a great support in supplementing your ongoing care or helping you to access the appropriate level of treatment for you.

Resident Advisors: Your RA is very knowledgeable about life on campus and can help direct you to the people in your community that can best assist you. They typically have gone through training to mediate conflict between roommates, to listen supportively to their residents and to help students access services on campus.

Dean of Students/Academic Advising: If your school work is starting to suffer because of your eating disorder or mood, you can speak to the Dean of Students or your Academic Advisor to explore your options. They will be prepared to help you with administrative concerns such as adding/dropping classes, communicating with your professors, adjusting your schedule to accommodate treatment, taking a medical leave of absence, and directing you to tutors and academic support programs.

Campus Ministries: If you are spiritually connected to your faith, you might feel more comfortable reaching out to the school’s chaplain. The chaplain is available to meet with students and can assist you in locating a place of worship consistent with your beliefs or can help direct you to more spiritually based counselors.

Off-Campus Treatment & Support: If you prefer to access services off campus or would like more specialized outpatient treatment, find out whether there are any treatment centers located close to your school.  The Center for Eating Disorders at Sheppard Pratt always welcomes students from surrounding colleges and universities during the school year. The Center is actually within walking distance to Towson University and is located within 5 miles of all of the following campuses:

Students who attend school a bit farther away from their treatment team, may be able to schedule classes in a way that frees up a particular day of the week for fitting in outpatient appointments with various providers.

The Center for Eating Disorders provides a wide array of treatment options including individual therapy, medication management, nutritional counseling, and a free support group every Wednesday night from 7:00-8:30 PM. If you need help finding outpatient treatment services close to your campus, you can visit The National Eating Disorder Association’s Treatment & Support Finder and search by state or zip code.

In the end, where you seek support is not as important as whether you seek support.  Remember that you are not alone and asking for help is a sign of strength.  If you are struggling, please reach out to a trusted friend, loved one, treatment provider or one of the campus supports listed above.

If you have any questions about the resources or services discussed above,please email Jennifer Moran, PsyD, CED’s College Liaison at jmoran@sheppardpratt.org or call (410) 938-5252.

***

Written by Jennifer Moran, Psy.D.

Originally published 9/13/11

Balancing Act: Back-to-School Basics of Self-Care on Campus

It’s that time of year again! While it was just a few months ago that everyone was so excited for the start of summer break, there is also something very exciting about the start of a new school year: new school supplies, new classes, new back-to-school clothes and maybe even new friends. Notice a theme? The start of a school year offers the opportunity for new beginnings. For some, they will be making a major transition to living on a new campus where every aspect of the experience is, in fact, new. For others, returning to school or starting a new semester offers a chance to improve upon their earlier efforts at balancing school, their social life and self-care. For everyone, this new beginning is a time to pause and reflect on what your goals are for the semester and how you would like to achieve them.

Here at the Center for Eating Disorders , we often work with students who are struggling tocar breakdown balance all of their responsibilities during the very hectic semester. When mounting pressure and too many commitments forces something to be let go, too often people opt to give up sleep, meals, relaxation, or time for self-care. These basic needs are sometimes even viewed as a luxury. While the thought of failing to meet deadlines or getting poor grades can be very stressful, people tend to underestimate just how important the “luxury” of taking care of yourself is in the grand scheme of your overall ability to function. It would be similar to draining a car battery without ever recharging it; eventually, the battery is not going to work and the car won’t start!

Fortunately, this scenario can be prevented with a little foresight and some planning. The start of the semester is a great time to create a plan to help keep things balanced throughout the next couple of months. Here are some tips for creating a good plan.

  1. Write out your schedule for the semester. Once your classes, work schedules and social engagements are in the calendar, go back through and make sure that there are times for all three meals each day. Schedule them in so that they will not be forgotten!
  2. Plan accordingly. Do you have a work shift or a class that goes from 11-2? Plan to pack your lunch so that you can have something to eat during your break.  Look at your syllabi and put important deadlines and exam dates on your calendar. If you notice one week is going to be packed with things to do, plan ahead so you are not overwhelmed.
  3. Get connected to your safety net. Its the first week of school and everything might still be feeling new and  exciting and maybe even easy.   But even if you don’t feel like you need the extra support right now, take a moment while things are slow to identify the phone numbers and locations on campus for the student health center and the counseling center.  Save the info in your phone.  If a time comes later in the semester when you need to reach out for help, you will have made it a little easier for yourself to quickly connect with your campus support system.
  4. Choose a bedtime. School schedules can be erratic. You might start each day at different times based on your class schedule, and you might stay up very late on the weekends or during exam times.   But resist the urge to maintain this erratic sleep schedule throughout your entire college career.  Whenever possible, do your best to go to sleep and wake-up around the same time every day in an effort to get 7-8 hours of sleep each night, especially if you are working on recovery from an eating disorder.  Why? Balanced sleep can help you maintain balance in other areas of life as well, such as your mood and your eating.  This is partially because sleep helps your body regulate hormone levels, including those that stimulate feelings of hunger and fullness. When hormones are dysregulated it can set you up for overeating or  bingeing.   When you are tempted to pull those all-nighters during midterm week, remember that studies show a sleep deficit of 3-4 hours a night over the course of even just one week can interfere with the body’s ability to process nutrients from food, manage stress, and maintain a proper balance of hormones. (source: American Thoracic Society, International Conference, News release, San Diego, May 19-24, 2006.)
  5. Schedule “me” time. It is very important that you take time to check in with yourself. Try to find time to journal or do something you enjoy for even just a few minutes every day. If you know that you will struggle to fit this into your schedule, try signing up for a yoga class, a book club or another fun, relaxing activity to make sure that you stick with it.  This is also a great way to meet people with similar interests.
  6. Stay True to Yourself. It can be easy to feel pressured or rushed into making as many new friends as possible, sometimes by altering yourself and your priorities to fit in lest you risk being all alone. You may want to pause every so often and reflect on whether the company you are keeping is raising you up or is dragging you down. Are the new friendships you’re building helping you commit to self-care and positive self-worth or are they contributing to greater body/food anxieties? Listen carefully to your inner voice and let it guide you to make the best decisions for you.

We at the Center wish all of you a happy first semester at school!  Stay connected with this back-to-school blog series and other body image and eating disorder resources by liking CED’s Facebook Page or following @CEDatSheppPratt on Twitter.

Written by Jennifer Moran, PsyD, College Liaison, The Center for Eating Disorders at Sheppard Pratt

Originally published 9/6/11

Photo Credit: Freedigitalphotos / Naypong

Mindful Eating on Campus ~ Part 1

college student at laptopFew things are more stressful for a student who is in recovery from their eating disorder than trying to negotiate eating on campus. College living is full of obstacles to eating consistently and mindfully: buffets in the dining halls; eating between classes and on the go; staying up until 4 AM; social events involving food; and limited access to the grocery store or a working kitchen. While many students in treatment are given guidelines as to how to eat in a healthy manner, it is often difficult to implement those strategies in a campus setting but it is possible.  A great resource for this task is the book, Mindful Eating 101: A Guide to Healthy Eating in College and Beyondby Dr. Susan Albers which we will reference throughout this post.

Mindfulness is an old concept that has, more recently become somewhat of a cultural catch phrase. Standing at a coffee shop bulletin board, you may notice advertisements for mindful meditation classes or yoga classes that promise skill development in the art of mindfulness or even magazine covers that stress the importance of mindful living. So, what is mindfulness?  Mindfulness refers to the ability to bring one’s awareness completely to the present moment.  In contrast, mindlessness, refers to behaving or doing things without much attention.

Consider that you are eating dinner in your dorm in front of the TV during your favorite night of Mindful Eating 101television. As you laugh along with the show and get intrigued by products during the commercials, you occasionally pick up your phone and make plans for the evening and attempt to skim a chapter in your text book for tomorrow’s quiz.  All the while, you also continue to go through the motions of eating your dinner…mindlessly. In this situation, your attention is likely focused on the characters and themes in the TV show and not on your food or your body’s response to the food.  When this happens, it is common for people to eat more than they normally would because they aren’t really enjoying their food, and they aren’t in touch with the mechanisms in the body that tell us when we want to stop eating. In contrast, when you choose a meal from the dining hall and sit at a table to enjoy it with a friend but without other distractions, you may find that you eat more slowly, you savor the tastes of the food, and you have an increased awareness of your hunger/satiety cues, which allow you to stop when you feel full. This style of eating would be considered mindful eating.

Individuals who’ve struggled with an eating disorder or have chronically dieted often lose touch with their body’s natural ability to regulate food and eating processes.  Sometimes they may need help establishing normal eating patterns again and re-connecting to their bodies.  In eating disorder treatment, mindfulness is a concept that is used frequently in helping people to develop awareness of their thoughts, emotions, patterns, triggers, and hunger/fullness cues.

Eating mindfully is an important skill because it allows you to eat exactly what your body wants in just the right amounts. Restricting your food intake or dieting is not mindful because it denies your body of the food that it needs for fuel and nourishment.  Bingeing is also not mindful eating because it exceeds the amount of food that your body wants or needs and may cause you to feel uncomfortably full or even pained.  Mindfulness involves trusting your body to maintain a balance.  Learning to eat mindfully can take time, so be gentle with yourself as you practice the steps that will allow you to eat intuitively in response to your own body’s needs.

Dr. Albers outlines the seven habits of mindful eaters in her book.  These habits are the key components of learning to eat mindfully.

  1. Awareness: Use your senses to gather information about the world. By using sight, sound, hearing, touch and taste, you can become attuned to what is going on around you at any moment. Turning this inward, you can better recognize your hunger, fullness and thirst cues to help guide your eating choices.
  2. Observation: Simply notice your thoughts and feelings as an impartial observer. The key is to do this without judgment. For example, if you have the thought “I am fat,” simply notice that it is there, label it as a negative thought, and move on.
  3. Shifting out of autopilot: Some of our routines become so mundane that it is difficult to pay close attention to the details. These routines sometimes enable mindless eating or skipping meals completely, and so you may want to change the routine or bring awareness to it in order to be more mindful. Try waking up a few minutes earlier to fit in breakfast or consider meeting a classmate someplace for lunch that you’ve never been before.
  4. Finding the gray area: Black and White thinking refers to thinking in extremes. Food is good or bad. Someone is fat or skinny. Clearly, life is not that simple. To be mindful, one must be flexible and avoid operating in extremes. An example of this is someone who is on a diet that forbids bread; even if a person wants bread they will deprive themselves of it because of the diet. Sometimes, this deprivation can lead to the person bingeing on bread. In contrast, a mindful eater would recognize the particular craving and allow herself to have an appropriate serving of bread at the time when she wants it.
  5. Be in the moment:  As a college student, you may find yourself frequently eating in class, while cramming for a test, or even while walking or driving across campus. Multi-tasking like this is not considered mindful because you cannot use your senses to enjoy the food or to stay aware of your hunger and fullness cues. Ideally, a mindful eater would sit with their meal on a plate at a table and devote their full attention to eating. However, this is not always a realistic goal for a college student.  Try making small changes that help you stay present during meals, such as always sitting down to eat and turning off your phone to remind yourself to stop texting and posting on Facebook until you finish your lunch.
  6. Non judgmental: Notice judgmental thoughts and proceed with compassion instead of criticism. Often at the campus dining halls, various stations offer different types and categories of food. If you notice yourself judging a particular food station ( “I can’t order from that section, everything is full of fat.”) notice the criticism attached to the food and label it (“there I go thinking of foods in good and bad categories again.”) Practice compassion and focus on truthful statements (“this food may have fat in it, but I need some fat to help me protect my organs”).  Try to incorporate different foods from each of the various food stations at the dining hall throughout the course of the week.
  7. Acceptance: Accept things for how they are as opposed to how you think they should be. Dr. Albers gives a great example in her book of accepting your shoe size, even if you wish it were different, because there really is nothing that you can do about it. As much as you may wish to have smaller or larger feet, eventually you must let go and accept that your feet are the size that they are.

If you’ve struggled with disordered eating, it may be easier to practice mindfulness at first with something that is not related to food. Try this simple exercise to practice the aforementioned skills. Close your eyes and simply count how many sounds you can hear in the room. When you think you have counted the sounds in the room, push yourself to try to hear beyond the room. Can you hear sounds from outside? In the hallway? What about the sounds closest to you…can you hear your own breathing? The sounds that you hear are happening in the here and now; congratulations…you have been successful at being mindful of the present moment! Now you might want to try doing a similar exercise with your food, using your senses to guide your eating.

For more information and tips on healthy eating during college, read Mindful Eating on Campus: Part 2 HERE…

 

Written by Jennifer Moran, PsyD, Therapist and College Liaison at The Center for Eating Disorders at Sheppard Pratt; Originally published on 10/11/11

 Photo Credit:
1. Vichaya Kiatying-Angsulee and freedigitalphotos.net
2. Susan Albers / mindfuleatingcafe.com

For more information about Dr. Albers and her Mindful Eating series, visit her website at www.mindfuleatingcafe.com.

Understanding Hopelessness & Cultivating Hope: Discussing Suicide

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

www.eatingdisorder.org

*Tree image courtesy of Just2shutter and FreeDigitalPhotos.net