At some point during treatment for an eating disorder, most individuals will meet with a Registered Dietitian. One of the many important things you’ll do during those sessions is identify and discuss your personal list of fear foods. This is an important step that allows the dietitian to individualize treatment, help you plan for and overcome obstacles, and work alongside the rest of the treatment team to empower you in your recovery.
What are fear foods?
A fear food, or challenge food, is a term for foods that one finds difficult to incorporate into everyday eating. This term is used for foods that feel scary to eat, often because of negative thoughts or feelings related to the food’s nutrient content. Fear foods can be items or categories of food that one perceives to be “bad” and which, when consumed, might trigger feelings of intense guilt or shame. As a result, people with eating disorders often completely avoid or restrict their fear foods. Sometimes, just being around a particular food or being faced with the possibility of eating it can result in increased anxiety.
For people with anorexia, bulimia or binge eating disorder, these fears and the perception of certain foods as “bad” are often related to anxiety about anticipated weight gain and/or an inability to stop eating the food once they begin. In other words, there tends to be a strong belief that eating a fear food will instantly make you fat or that eating a certain food will make you lose control and overeat.
A person’s list of fear foods might be specific, like ice cream or peanut butter. For others, their fear foods might encompass a whole category like all desserts or fried foods. Someone else’s fear food list might include an entire nutrient group such as carbohydrates. Common fear foods are also items considered by many to be tasty, but may also be labeled as “junk food” in our current culture.
Where do fear foods come from?
Fear foods develop from personal values, attitudes, feelings and even memories associated with a certain food. Messages from the people close to you – family, friends, coaches, teachers, healthcare providers – all play a significant role in determining your thoughts about food and can ultimately influence your (dis)comfort with particular food items.
Fear foods may also stem from a variety of impersonal sources including trending cultural ideas about food, media messages, advertisements or even nutrition information intended to be educational and beneficial. For example, there are multitudes of articles and news stories that include lists of supposedly good vs. bad foods, or foods that are better/worse for health.
Another frequent source of fear or shame related to food is dieting. Given that most diets limit or cut out certain foods, dieters start to believe that the eliminated food is bad. The more diets a person goes on, the more fear foods they are likely to have.
What are some consequences of avoiding fear foods?
- Limited variety and lack of enjoyment in meals
- Social isolation
- Obsessive thoughts about the feared food
- Worsening anxiety
- Increased eating disorder symptoms and heightened risk of relapse
- Prolonged negative relationship with food
People without eating disorders may have fear foods too but the consequences for those with eating disorders are much steeper since we know that limiting variety and continuing to avoid specific foods during recovery raises one’s chances for relapse. Two of our CED dietitians recently wrote in more detail about this topic for our friends at Eating Disorder Hope in a post entitled, The Importance of Incorporating Fear Foods and Challenge Foods in Recovery.
Remember, no single food has the power to make you thin or fat. And, ironically, the avoidance of a food is typically what leads a person to overeat it.
If you think you might need assistance reintegrating fear foods or overcoming negative thoughts about food and eating in general, please call The Center for Eating Disorders at (410) 938-5252 for a free phone consultation.
In individuals with different eating disorder diagnoses, or those with co-occurring disorders, fear foods might manifest differently. For example, in individuals with ARFID, anxiety may be related to a fear of choking or to a perceived health consequence of eating the food item. In individuals with PTSD, fear foods may stem from associations with the traumatic experience. In both cases, treatment methods may differ, and the treatment team should take into account the origin and underpinnings of each fear food when providing education and support.
Hannah Huguenin, MS, RD, LDN
Samantha Lewandowski, MS, RD, LDN
Kate Clemmer, LCSW-C
Daily self-care is extremely important for individuals with existing physical and mental health diagnoses including eating disorders, depression, anxiety, PTSD and bipolar disorder. It can be even more crucial during times of high stress, uncertainty or exposure to traumatic events. Even indirect, or secondhand exposure, to violence or disasters can have detrimental effects on one’s mental health. Research conducted by Dr. Pam Ramsden in 2015 found that “viewing violent news events via social media can cause people to experience symptoms similar to post-traumatic stress disorder (PTSD).”
In the wake of several national and international acts of violence over the past month, most recently the attack in Nice, France, it’s important to assess your own self-care practices and media use and to seek additional help when needed.
Below is a list of resources we’ve compiled that may help you and your loved ones cope in the aftermath of such tragedies.
RESOURCES FOR ADULTS:
- Managing Traumatic Stress: Coping with Terrorism – American Psychological Association (APA)
- Tips for Survivors: COPING WITH GRIEF AFTER COMMUNITY VIOLENCE – SAMHSA
- Building Resilience to Manage Indirect Exposure to Terror – American Psychological Association (APA)
- 5 Digital Self-Care Tips Black People Can Use While Coping with Trauma – Taryn Finley, Black Voices Associate Editor
- Acts of Violence, Terrorism, or War: Triggers for Veterans – U.S. Department of Veterans Affairs
- Media Coverage of Traumatic Events – U.S. Department of Veterans Affairs
- 11 Ways to Feel Less Helpless this Week – Annie Wright, Upworthy
RESOURCES TO HELP CHILDREN:
- Helping Children Cope With Terrorism – Tips for Families and Educators – National Association of School Psychologists
- Tips for Parents on Media Coverage – The National Child Traumatic Stress Network
- Explaining the News to Our Kids – CommonSenseMedia.org
- How to talk to children about difficult news and tragedies – American Psychological Association (APA)
- Helping Your Children Manage Distress in the Aftermath of a Shooting – American Psychological Association (APA)
If you are experiencing intense or prolonged stress in the wake of violence you’ve experienced firsthand or via exposure through news outlets and social media please do not hesitate to seek help. Speak with a therapist if you have one. You can also seek more immediate assistance via the SAMHSA Disaster Distress Helpline at 800-985-5990.
A more comprehensive list of hotlines and articles is available in this article by Skyler Jackson, MS of The University of Maryland: 100+ Resources for the Aftermath of the Orlando Mass Shooting Tragedy.
Despite how widespread eating disorders are, many, many misconceptions remain about these illnesses and the people affected by them. These misconceptions are hosted and maintained by a variety of sources including the popular media, opinions of people around you, outdated information online and in textbooks, and by stigma that prevents open and honest conversations that could lead to greater understanding on a more personal level. As a society, it’s important that we move past the stereotypical thinking, not just about eating disorders but about eating and health in general so that we can shift towards non-judgmental attitudes and practices that truly promote well-being. After my time as a Community Outreach intern at The Center for Eating Disorders at Sheppard Pratt, these are the five most surprising facts I thought would be important for my peers and the community to know.
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1. Anorexia and bulimia are not the only eating disorders, nor are they the most prevalent. There are more than just the eating disorders that we hear about through the media. Binge eating disorder, atypical anorexia nervosa, bulimia nervosa of a low frequency and/or limited duration, and Avoidant Restrictive Food Intake Disorder (ARFID) are just a few examples. Some of these diagnoses fall within the category of Other Specified Feeding or Eating Disorder (OSFED), but it is also possible to have an Unspecified Feeding or Eating Disorder. In all of these cases though, eating disorders can take a significant toll on a person’s health and quality of life. It seems the lack of awareness, the sensitivity of these disorders, and the confusing nature of diagnosis for eating disorders have all contributed to the fact that only 1 in 10 people with an eating disorder will get treatment. This is a sobering statistic given that eating disorders have the highest mortality rate of any mental illness and are rarely resolved without professional help. Raising awareness of all the different types of eating disorders and wide variety of symptoms might make it a little easier for individuals who are struggling to see themselves represented and to seek help.
2. Up to 30 million people of all ages and genders suffer from eating disorders. It is true that adolescent females make up a large part of the treatment seeking population, but it’s important to note the role that bias and misinformation, even among medical professionals, can play here. If a person is struggling with an eating disorder and they fall outside of the white, adolescent female stereotype, they are actually less likely to be screened for, correctly diagnosed with, or referred to specialized treatment for an eating disorder. The truth is that eating disorders do not discriminate; people of any race, ethnicity, sexual orientation or socioeconomic status may be affected. These illnesses affect men, women, children, and the elderly. It’s important that health and mental health professionals know this and don’t overlook warning signs in their patients.
3. There is no such thing as a “bad food.” Most of us learn throughout our lifetimes that certain foods are “bad” and others are “good” based on any number of analyses – fat content, calories, food group, process by which it was made, etc. These messages reach us through social pressures, peer groups, family attitudes, commercials, magazines, and just about everywhere we look online. When we’re surrounded by these messages, it is easy to forget that food is just food and gives us energy and can be enjoyed– it doesn’t have to be assigned a moral value. Despite what we are told by the healthy lifestyle bloggers, it is okay, even necessary, to eat bread and pasta. It is okay to get ice cream that isn’t sugar free and to go for the full fat lattes. None of these things influence our self-worth or intrinsic goodness. Disordered thoughts about food are everywhere and will likely continue to be everywhere. Take away the “good” and “bad” labels from the food and you’re one step closer to creating a healthy attitude toward food whether you’re working on recovery from an eating disorder or not.
4. Fat talk is harmful for everyone. Body dissatisfaction can be a significant risk factor for the development of eating disorders. Negative thoughts about one’s body are not easily extinguished and most people with eating disorders continue to struggle with these thoughts during their recovery process. Talking about diets, comparing body sizes, complimenting weight loss, or just generally talking negatively about body shape or weight can be very triggering and can even contribute to relapse. But it’s not just people with eating disorders who are harmed by fat talk. Whether it is self-directed or directed at a friend or a stranger, focusing on weight/size as a measure of worth or beauty brings everyone down. It probably seems completely normal for someone to say “you look great, have you lost weight?” or for a co-worker to mention she’s not eating carbs because she’s afraid it will make her fat. But it doesn’t have to be normal. When fat talk happens, consider how you might turn it around to be positive and helpful instead of feeding into the negativity. Could you change the subject completely, educate your friend about the dangers of fat talk, or simply model mindful eating behaviors? You can also remind your friends of all the reasons why you care about them that have nothing to do with what size they wear.
5. You really can’t tell whether or not someone has an eating disorder simply by looking at them. People with eating disorders look very much like everyone else – completely diverse. As stated earlier, this includes diversity in age, gender and race but also diversity in weight and size. The phrase, “you don’t look like you have an eating disorder” is not only misleading but also can be extremely detrimental to individuals seeking support. Eating disorders can affect low weight, average weight, and high weight individuals. Unfortunately, many people delay seeking treatment based on an assumption that their health is not at risk unless they are drastically under or overweight. In general, weight is a very poor predictor of one’s current health. If you are engaging in disordered eating behaviors and experience frequent negative thoughts about your body, it doesn’t matter what size you are, your health is at risk and you deserve support and treatment.
For more information about different types of eating disorders and treatment visit eatingdisorder.org.
If you’re concerned that you or a loved one may be exhibiting signs of an eating disorder, you can take the confidential online self-assessment to find out more.
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
Does the idea of darkness during your 5pm commute home from work get you down? You’re not alone if you’ve noticed that it’s not just the flowers in your garden but also your mood that has “wilted” with the cooler temperatures. During the fall and winter months, people may experience a shift in their mood as we collectively adjust to less sunshine and more cold weather. But it might be more than just “the blues” if it is a persistent sadness that feels present most days and is interfering with your ability to function or engage in day-to-day life. If this is a pattern that’s occurred for at least two years in a row and impacts you at the same time each year, it might be Seasonal Affective Disorder.
Seasonal Affective Disorder (SAD)
Many people around the world suffer from SAD, now identified in the DSM-5 as Depressive Disorder with seasonal pattern. It is suspected that seasonal depression is, in part, caused by a reduced exposure to sunlight resulting in disruption to our natural circadian rhythm (the body’s “internal clock”), as well decreased levels of the hormones serotonin and melatonin which help to regulate mood, sleep and appetite. Not surprisingly, populations living farther from the equator experience higher rates of seasonal depression than places closest to it. Thus, this type of depression occurs more frequently in populations throughout the northern rather than southern parts of the United States. In fact, one study found prevalence rates to be 1.4% in Florida and a much higher 9.7% in New Hampshire. (1) Much of the research also indicates younger people and women tend to be at higher risk for winter depressive episodes.
People who already struggle throughout the year with clinical depression or bipolar disorder may also experience worsening symptoms during specific seasons. For those with seasonal depression, the episodes of depression that occur in the fall/winter are significantly greater than those episodes that occur throughout the remainder of the calendar year. In any case, it’s important to pay attention to seasonal patterns in your mood so that you can prepare and seek appropriate treatment and support as needed.
Common symptoms of seasonal depression
Seasonal depressive episodes generally set in during late fall or early winter. Some of the most common signs and symptoms include:
- decreased energy, lethargy
- increased sleep, difficulty waking
- social withdrawal and loss of interest in activities previously enjoyed
- increased appetite, unintended weight gain
- persistent sadness, hopelessness
- difficulty concentrating or focusing on tasks
(Though less common, some people experience spring/summer depressive episodes and those symptoms can look a little different, more often encompassing sleeplessness, irritability, decreased appetite and weight loss, etc.)
How might seasonal depression affect people with eating disorders?
A depressive episode can impact eating patterns and thus, impact eating disorder recovery efforts. Individuals suffering from seasonal depression often report increased appetite. Specific studies have indicated that individuals with SAD tend to experience more cravings for foods that are higher in carbohydrates and rich in starch and report increased consumption of carbohydrates when depressed, anxious or lonely. (2) Combined with decreased energy and declining mood, these cravings can place one at higher risk for binge eating behaviors.
Other research has shown a seasonal component to depression especially for those individuals suffering from Bulimia Nervosa. (3) The research revealed that patients with Bulimia Nervosa tended to experience seasonal patterns of mood and appetite similar to those described by many with SAD. (4) Some research has further speculated with regard to a possible genetic link between eating disorders and susceptibility to changes in mood related to the season. (5)
Treatment Options for Individuals affected by seasonal depression
So what can you do when the light outside your window has turned to darkness and, perhaps, this has added fuel to the eating disorder fire as well? The good news is that there are many different treatment approaches that are helpful to those suffering from seasonal depression.
- Light therapy or Phototherapy is a commonly prescribed treatment for individuals suffering from seasonal depression. In light therapy individuals sit in front of a “light box” for approximately thirty minutes daily or per their doctor’s recommendation. Research has shown that light therapy can relieve the symptoms of seasonal depression in as many as 70% of cases. (6)
- Anti-depressant medications can also be helpful in treating winter depression and have been shown to improve mood, energy and sleep patterns. One of the ways in which these medications work is by increasing serotonin levels in the brain.
- Evidence-based therapies for depression such as Cognitive Behavioral Therapy (CBT) can also be helpful for seasonal depression.
- Behavioral interventions in your daily life can also be helpful in reducing symptoms of seasonal depression. Consider trying to incorporate some or all of these:
- Engage in activities with friends and family each day to ward off feelings of lonliness or isolation.
- Make a point to get outside in the sunlight for at least a portion of the day if possible. Schedule a walk with your colleague during break or sit outside instead of inside while you do your daily perusing of Facebook, however…
- Be mindful about whether online social networks make you feel worse instead of better OR if they take up large amounts of time that could be better spent connecting with people in person (see #1 above).
- Plan to get plenty of sleep on a consistent schedule; do your best to go to bed and wake up at the same times each day, and aim for 7-8 hours of sleep/day.
- Avoid the use of alcohol or other substances which can worsen depressive symptoms, complicate eating disorder symptoms and disrupt sleep.
Focus on the highlights of the changing season.
If you struggle with seasonal depression, a long autumn and the approaching winter can feel daunting. Holiday stress, can make things even more difficult for individuals who are triggered by tense family dynamics, elaborate meals and social gatherings. This year, Instead of focusing on the doldrums of the season or annual stressors, consider looking for positive seasonal activities in which to get involved. Now is the perfect time to go to a holiday parade, paint a room in your house a new color, volunteer for a new cause, plan a weekend getaway, attend a recovery event, build a snowman or read a winter-themed book. It could also be a great opportunity to finish your summer vacation scrapbook or try a new activity like snow tubing or ice skating. You can even practice guided imagery or meditation – just because there is snow outside it doesn’t mean you can’t imagine yourself relaxing on a warm beach.
Try not wish away the winter season. Each season comes with its own set of challenges for individuals with eating disorders – just think of the onslaught of diet pressures throughout spring or the bathing suit saga of summer. So the key is not to just “get through” each season (there will be a new set of stressors on the next calendar page after all) but to learn to live mindfully in each season and find ways you can enjoy what it has to offer.
Above all else remember to ask for help when you need it. Talk to your treatment providers about your seasonal mood changes and they can help to devise an individualized treatment plan that works for you. If you are seeing a Registered Dietitian now is the time to talk with them about the food cravings you might be experiencing and devise an approach to cope and integrate more variety into your meal plan. Remember to open up and involve your support system– let your friends or family be a part of the process by sharing with them what you are going through. With help and support, you’ll be celebrating the Vernal Equinox in no time and reflecting on a well-spent, memorable winter.
For questions about treatment for co-occurring depression and eating disorders, please visit our website at www.eatingdisorder.org
Written by Amy Scott, LCPC
- Friedman, Richard A. (December 18, 2007) Brought on by Darkness, Disorder Needs Light. New York Times’’.
- Krauchi, K., Reich, S.,& Wirz-Justice, A. (1997). Eating style in seasonal affective disorder – who will gain weight in winter? Compr Psychiatry, Mar-April, 38 (2). 80-87.
- Lam, R.W, Goldner, E.M., & Grewal, A. Seasonality of symptoms in anorexia and bulimia. International Journal of Eating Disorders. 1996. Jan 19 (1): 34-44.
- Fornari, V.M, Braun, D. L., Sunday, S.R., Sandberg, D.E., Matthews, M, Chen, IL, Mandel, F.S., Halmi, KA & Katz, JL (1994) . Seasonal Patterns in Eating Disorder Subtypes.Compr Psychiatry. Nov /Dec; 35 (6): 450-456.
- Sher, L. (2001). Possible Genetic Link Between eating disorders and seasonal changes in mood and behavior. Med Hypothesis, Nov 57 (5): 606-608.
- Wein, Harrison ed. (2013). Beat the winter blues shedding light on seasonal sadness. NIH News in Health. Retrieved from http://newsinhealth.nih.gov/issue/Jan2013/Feature1.
Published By Kate Clemmer
November 25th, 2013 in Anxiety, binge eating disorder, Bulimia Nervosa, Celebrity Topical News, Cognitive Behavior Therapy, Depression, Diagnoses, eating disorders, Emotions & Coping, Glossary Definitions, Holidays, Recovery, Seasonal Affective Disorder, Support