Seasonal Depression: Fall-ing into Winter

Fall on the SP Campus...
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:
    1. Engage in activities with friends and family each day to ward off feelings of lonliness or isolation.
    2. 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…
    3. 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).
    4. 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.
    5. 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

 

References:

  1. Friedman, Richard A. (December 18, 2007) Brought on by Darkness, Disorder Needs Light. New York Times’’.
  2. 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.
  3. 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.
  4. 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.
  5. Sher, L. (2001). Possible Genetic Link Between eating disorders and seasonal changes in mood and behavior. Med Hypothesis, Nov 57 (5): 606-608.
  6. 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.

 

Body Image & ACT: Q&A with Author and Psychologist Emily Sandoz, PhD


The collective response to negative body image often includes an attempt to convince people to love their bodies, to embrace every imperfection and to do away with all negative thoughts.  These can be difficult, if not impossible, tasks for most people, particularly amidst the backdrop of a culture that encourages body bashing and a very narrow ideal of “beauty”.  For many individuals, negative thoughts about their bodies are so deeply entrenched that it feels too big of a leap to move from hating their bodies to falling madly in love with them. So if you’re not ready to love your body, what’s left to do?  Emily Sandoz, PhD, along with co-author Troy DuFrene, propose a different path in their new book, Living With Your Body & Other Things You Hate: How to Let Go of Your Struggle with Body Image Using Acceptance & Commitment Therapy. 

In anticipation of our upcoming Fall Community Event, we conversed remotely with Dr. Sandoz to find out more about her work with body image, Acceptance & Commitment Therapy (ACT), and of course, the soon-to-be-released book.  Read on to learn more about ACT and don’t forget to RSVP for Dr. Sandoz’s free presentation in Baltimore on November 17th, 2013, or download the event invitation (pdf).

 

Q & A with Emily Sandoz, PhD

Q: What was your  motivation for writing Living With Your Body & Other Things You Hate: How to Let Go of Your Struggle with Body Image Using Acceptance & Commitment Therapy (due out Jan. 2013)?

ES: Well, a couple of things. First, I find myself more and more aware of how body conscious we are.  At a very early age, people begin evaluating themselves in terms of their body’s appearance or functioning. For many, this can become a primary means of self-evaluation, becoming more of a focus than other things that person really values or strives for.  Further, I think the general public receives mixed messages about what they are supposed to do with those evaluations.  Are they wrong evaluations? Should they always evaluate themselves positively, always love the body? Should they change their bodies? Is it our responsibility to look good, to be strong and physically capable?  This book suggests that all that struggle to manage our thoughts and feelings about our bodies, or even manage our bodies themselves, can just lead to more and more struggle. We suggest that healthy body image is about body image flexibility – being able to receive our experiences of our bodies, good and bad, and to relate to ourselves and the world meaningfully, regardless of those body experiences.

Q: Many people engage in deep and serious battles with body image on a daily basis.   What are the possible repercussions of going through life hating your body? 

ES:It stands in the way of other things that are more important. You can’t help being critical of the way your body is.  That’s what minds do – they are critical.  They have to be!  But hating is getting entrenched in those self-criticisms.  Letting them drive your behavior, so you end up living your life more about managing your self-criticisms than about your relationships, or your career, or your spirituality – whatever is most important to you.

Q: What are the main tenets of Acceptance & Commitment Therapy?

ES: ACT (said as the word “act”) is based on the idea that healthy living is characterized by psychological flexibility, or the ability to experience ourselves, others, and the world fully and without defense, while taking action toward the things we care about, even when it is painful or scary. Not having this psychological flexibility is actually a driving factor in creating psychological stress and problems such as depression, anxiety and eating disorders.  It’s not our experiences (our thoughts or feelings) that are problematic, it’s all the things we do to try to get rid of them.  Those things interfere with the life worth living.

[Psychological flexibility spans a wide range of human abilities to: recognize and adapt to various situations; shift mindsets or behavior to preserve personal or social functioning; maintain balance among important life domains; and commit to behaviors that are congruent with our values. source: Kashdan & Rottenberg, 2009]

Q: What does the research say about the effectiveness of ACT for body image and eating disorders?

ES: This is a relatively new area, to be sure, but preliminary data coming from a number of different labs are largely supportive of the application of ACT to body image and eating disorders.  My own work in this area has recently moved to basic research, focusing on the nature of body image inflexibility, how it develops, and how flexibility can be trained. My hope is that this work can complement the treatment research by promoting continued development based on better understandings of body image flexibility and inflexibility.

Q: Many people are familiar with Cognitive Behavior Therapy (CBT) and Dialectic Behavior Therapy (DBT) but may be less knowledgeable about ACT.  What are the main differences between ACT and other evidence-based treatments for eating disorders and body image such as CBT and DBT? 

ES: Well ACT is a cognitive behavior therapy, but it differs from many CBT’s in that it challenges the idea that thinking must change for observable behavior to change.  In this area, ACT posits that healthy body image and eating does not depend on challenging critical thoughts about the body. It depends on learning to engage in meaningful, values-based action regardless of what thoughts are coming up.

Q: “Acceptance” can be a difficult concept for people to really understand and put into practice.  Why is this?  And what’s the most effective way to define or describe acceptance as it relates to body image?

ES: It’s tough because we sometimes think acceptance means liking or tolerating tough experiences.  Applied to body image, acceptance simply means making room for all thoughts and feelings about the body, whether we like them or not.

Q: What are the potential barriers to “letting go” of one’s struggle with body image? To that same point, what are the possible benefits?

ES: We are trained from a very early age that things that hurt are wrong, that we are responsible for managing our feelings.  In the case of body image, we are also taught that managing our bodies is our responsibility.  We are taught that it’s right to struggle, that we should feel good and look good, and we should be willing to struggle to get there. Because of this, considering letting go of that struggle is hard to even imagine. We find ourselves wondering what would happen to our experiences of our bodies if we stopped struggling. Would our bad feelings about the body completely overwhelm us if we weren’t managing them?  And what about our bodies themselves? If we weren’t struggling – Would we suddenly become grotesque? Would our bodies become completely disabled?  Of course, letting go of the struggle does mean that we expose ourselves to all kinds of hurt that we don’t like having.  Only letting go of that struggle frees us up to do other things that are more important – to allocate all those resources to the things we really care about, even when it hurts. And we know it’s going to hurt because we feel most vulnerable when we’re going after the things we want. So in ACT, we practice doing that, in the presence of the worst kinds of body hurt.  It’s not just hurt anymore, though, it’s hurt with a purpose.

Q: You talk in your new book about the idea that acceptance “isn’t something you do once”.  Can you elaborate on that notion?

ES: Well, it’s not like we pass through some portal where suddenly we are all-accepting and the work is done. It takes practice.  We think we’re doing great, then we suddenly notice all these new ways of inflexibility showing up, these new scary or painful thoughts coming up.  It’s just human nature.  Working on body flexibility is a lifetime commitment to making the things that matter to you more important than managing your experience of your body.

Q: Where does the element of “Commitment” come into play when working on body image struggles?

ES: Building a lifelong pattern of flexibility takes commitment. From an ACT perspective, commitment means noticing when we are being inflexible, when we are working to move away from ourselves and our own experiences, and simply turning back.

Q: What are some of the other areas in life in which the principles of ACT might be beneficial?

ES: Any area of life that is, for you, characterized by attempts to manage your experiences instead of managing the meaning in your life is an area of life that might benefit from the ACT principles.  And the ACT community provides a wealth of resources for people looking to do this kind of work. The Association for Contextual Behavioral Science website has a whole section for folks who are looking for support applying these principles in their lives, and New Harbinger publishes a number of self-help books for a range of difficulties people experience.

Q: On November 17, 2013 you will be in Baltimore speaking about How to Let Go of Your Struggle with Body Image.  What do you hope people will take away from this event and who could benefit from attending?

My main hope is that people may leave curious. Curious about how they struggle with their body image and what costs that has in their lives. Curious about how their lives might look different if they let go of the struggle with body image and embraced their experiences of their body, painful or pleasurable.  Curious about how they might use the time and energy if they weren’t spending it on the body image struggle.

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Emily K. Sandoz, PhD, is assistant professor of psychology at University of Louisiana at Lafayette, LA. She is a therapist who specializes in treating clients using acceptance and commitment therapy. Sandoz is coauthor of Acceptance and Commitment Therapy for Eating Disorders and The Mindfulness and Acceptance Workbook for Bulimia. She received her doctorate from the University of Mississippi, and she lives and works in Lafayette, LA.

On November 17th, Dr. Sandoz will be the featured guest speaker at The Center for Eating Disorders at Sheppard Pratt‘s fall event, How to Let Go of Your Struggle with Body Image.  Click on the link to find out more about the FREE event and to reserve your seats.

The Center for Eating Disorders at Sheppard Pratt offers outpatient therapists trained in Acceptance & Commitment Therapy. If you’re interested in this type of therapy and would like to find out more about starting treatment for an eating disorder and/or body image, please call us at (410) 938-5252.

 

Tried & True Strategies for a Recovery-Focused Holiday, Part III: AFTER Thanksgiving has Come and Gone

GratitudePost-holiday time can be filled with mixed emotions.  Some people experience RELIEF that it wasn’t as difficult as they had predicted, others struggle with post-holiday  FRUSTRATION or GUILT related to eating disorder behaviors or holiday meal challenges.  Still others head out of the holiday week EXCITED to return to the familiar structure and schedule of school or work. There may have been HAPPY times or SAD emotions woven throughout your Thanksgiving holiday as relationships and expectations for the holiday were tested. Maybe you tried some of the tips we suggested in Part I and Part II of our holiday blog series with a lot of success…or perhaps with a lot of struggle.  No matter how things went or how you’re feeling now its important to honor your emotions and continue on from this point in a recovery-focused way. Here are some tips that can help you make the most of your week-after-Thanksgiving (and beyond).

 

1. Change your filter.  So often, the eating disorder voice shines such a powerful spotlight on everything negative that it can be easy to get caught up in what went “wrong” on Thanksgiving day and ignore everything that was positive.  This is an example of a cognitive distortion called filtering.  In the days and weeks that follow, try not to allow your eating disorder to dictate how you will remember this holiday.  Instead, sit down with positive intention and make a point to reflect on what went well, what worked and who was integral to those successes.

2. Don’t skip therapy. (Sound familiar?)  If you had a hard time during the holiday and find yourself feeling frustrated or ashamed that you acted on symptoms, do not cancel appointments with providers.  Right after slip-ups is the ideal time to meet with a therapist or dietitian to process what happened, what the trigger was and how to prevent a holiday-induced downward spiral.  If your first appointment with a provider won’t be for another few days, take some time to jot down your observations and feelings about the holiday and what you want to remember to discuss with your therapist or dietitian.

3. Accept post-holiday compliments gracefully.  Individuals with eating disorders often have a hard time accepting positive feedback, especially when it clashes with their own negative beliefs about themselves or their abilities.  If someone is genuinely telling you that you did a good job with something, before you refute them, consider how your reaction will affect you and them. When Aunt Martha calls you this week and says  “Thanks for hosting us this weekend.  Your house looked beautiful all decorated for the holiday and the meal was just great,”  your instinct might be to say “Oh please, the turkey was dry and the house was a mess! I just didn’t have time to clean it the way I wanted to.”   When you completely reject a compliment it sends a message to the other person that you may be overly critical in general or that their opinion is not valued.  Additionally, if you deflect compliments from the same people repeatedly, they may be conditioned not to give them at all.  Most importantly, when you reject compliments you deny yourself the opportunity to absorb a positive belief which could go a long way in helping to boost your self-esteem and overall self worth.  Even if you’re struggling to believe that a compliment is true, allow yourself to receive it and entertain the idea that it just might have some validity.  Instead of deflecting, consider simple statements, such as “Thank you so much – that means a lot to me” or even, “Thanks” will work just fine.

4. Move On. If this holiday wasn’t what you had hoped for, let it go.  Don’t continue to blame yourself for things that may have been beyond your control.  Assess what can be changed in similar situations in the future and make note of them, then allow your mind to move on. Getting stuck in thoughts about how disastrous/boring/disappointing/etc. your Thanksgiving was is not going to help you make today the best it can be.  Remember that non-holidays are just as important in the long run of recovery.  Make today a good day; do the best thing for you and your recovery in this moment.

5. Keep the gratitude going.  Thanksgiving does a great job in helping to promote gratitude.  Even if you haven’t yet jumped on the #thanksvember bandwagon via Twitter or Facebook, it’s not too late to start. Take some time tonight to be grateful and send a genuine “thank you” to the support people that helped you enjoy the holiday…

  • If your mom changed the subject at dinner when a relative was harping on you for not taking seconds of her casserole, tell your mom later how much you appreciated her speaking up.  (If you live close by, give her a hug while you’re at it.)
  • If your friend answered frantic text messages you were sending on Thanksgiving day, let him know how much that meant to you that he was available for support in the thick of the holiday.
  • If your little nieces and nephews forced you into hysterical laughter with their impromptu Thanksgiving skit, send them little notes in the mail to let them know you can’t wait for their Christmas or Hanukkah performances too.
  • When it comes to gratitude, remember to use your voice.  It’s an  excellent opportunity to nourish the positives and create more of what you need for your recovery.

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Is there someone you relied on this Thanksgiving to help you through?   If you have feedback or comments about positive ways in which your support people helped out this holiday, we’d love to hear.  Share in the comments below or join the conversation on our Facebook page.

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Tried and True Strategies for a Recovery-Focused Holiday – Part I: BEFORE the Holiday

Tried and True Strategies for a Recovery-Focused Holiday – Part II: The Day OF Thanksgiving

Above photo courtesy of psychcentral.com (click on the photo to link to interesting research about the benefits of gratitude on health and wellness)

Tried and True Strategies for a Recovery-Focused Holiday – Part I

 

plan-ahead-sunsetHoliday gatherings and celebratory feasts can pose some significant challenges, regardless of where you’re at in treatment or recovery. Being aware of them, planning for them and setting yourself up for an enjoyable holiday is important. That’s why we asked all of our clinical staff at CED to share their best advice for having a safe and successful holiday while maintaining or working towards recovery from an eating disorder. They had so much to share that we couldn’t fit it all in just one post so this is just the first of a 3-part series to help you through the before, during and after of the holidays.  

Through the years, these are some of the strategies and suggestions that our therapists have seen the most success with and we hope you will too.  Happy Thanksgiving from all of us here at the Center for Eating Disorders at Sheppard Pratt.

Part I: BEFORE the Holiday…

  • Plan, Plan, Plan…..with your treatment team and with your primary supports. Develop a very specific, detailed plan for managing all the stressors that come along with the holidays.
  • Challenge predictable thoughts before the holiday. If you notice you have predictable patterns of negative thinking pop up at family gatherings or the same triggering thoughts sneak up on you every Thanksgiving day, take time to identify them in advance. Write them down and work on challenging the thoughts ahead of time (on your own or with a therapist) so you’re better prepared to defend against these specific negative/irrational thoughts on the actual day.  You might even consider keeping a list of your positive affirmations or challenge statements with you on Thanksgiving for easy access.  (If you know you’ll have your phone handy, you could even send a text to yourself the day before).
  • Identify one or two major positives about the holiday. No matter how anxious or depressed you may feel about an approaching holiday, there IS a positive hidden somewhere, even if it’s as simple as getting time off from school or work.
  • Make a list of your top 3 most reliable coping strategies and keep it handy in a notebook or on your phone.

Decrease stress and increase relaxation. Only say “yes” to events that you would like to attend and believe you can attend with success. Keep your daily schedule of activities and gatherings manageable.

~ Kim Anderson, Ph.D., Therapist and CED Psychology Coordinator

  • RSVP with a time limit. For example, “Thanks so much for inviting me. I’ll be able to be there from 3:00 to 5:00.” This provides you with some boundaries and an opportunity to leave the situation if it’s becoming detrimental to your recovery. However, if things are going better than expected (which often happens) and you want to stay longer, then you can.
  • Choose a worry chair.  If the anxiety is overwhelming or interfering with life, set up an appointment for yourself to “worry” about your concern at a specified time, date and place- this allows you to “delay” the worry and frees you up to take care of business at hand until then.

I really try to highlight for my patients that they are not alone in experiencing high stress around the holidays and that other members of their family are likely struggling with similar anxieties and negative thoughts. Some are able to manage extra stressors in healthy ways like talking about how they’re feeling, getting enough sleep, setting limits, or adding in extra self-care. Other family members may turn to unhealthy management strategies like drinking too much, getting into arguments, withdrawing, avoiding, hiding their feelings, or eating too much/too little. I try to use this to help my patients see that the problem isn’t the food itself, it is ultimately the thoughts and feelings, that can lead to intensified eating disorder urges. Being aware of this can free you up to move forward and choose more constructive and beneficial ways to cope.

~Laura Sproch, Ph.D., Individual and Family Therapist and CED Research Coordinator

  • Identify a “safe person” you can go to that is aware of your struggle and will support, distract, and protect you on the day of the holiday gathering. Talk with that person ahead of time so they know exactly how to support you during the meal and in specific situations. These things are not always obvious and support people may need a little “coaching” in advance. Some people even like to arrange a “code word” with their support person that they can say when they’re feeling really triggered and need an opportunity to remove him or herself from the situation.
  • A day ahead, you may want to plan out the timing for your meals, especially if Thanksgiving meal is falling at an atypical meal time. Refuse to use that timing issue as an excuse to skip meals or go off your meal plan. Simply juggle around your mealtimes a bit so that you can still fit in breakfast, lunch, dinner and one or two snacks. If you don’t do this in advance, it probably won’t happen.
  • Create a holiday project that will provide you with some distraction and also give you something positive to look forward to on the day of the holiday. Consider creating a scrapbook of past family holidays or a hand-made gift for your host/hostess.
  • Set realistic expectations. Work on decreasing expectations about decorations, food, family time, and any other areas in which you’re feeling pressure to be perfect.

Real-life holidays, like many things, will not resemble the advertisements and commercials that portray them. Holiday gatherings will not be perfect…someone will spill their drink all over the carpet, your relatives will arrive late (or unexpectedly early!), kids will have tantrums, arguments may occur, and at least some of the food will get overcooked. The great thing is, that’s all okay and normal. If you find yourself expecting a picture perfect Thanksgiving, take time to adjust your vision and agree to embrace the day in all its imperfection. Ultimately, that is exactly what will make it memorable.

~ Kate Clemmer, LCSW-C, CED Community Outreach Coordinator

  • Focus on the bigger picture. Research causes or charities that interest you where you might be able to volunteer during the holiday season; focus on the meaning of the holiday rather than the food specifically.
  • Don’t skip therapy appointments. With all of the preparations and traveling and extra time committments, many people find themselves tempted to cancel pre-holiday meetings with therapists and dietitians or skip regular support groups.  We’ve encountered this many times before and unfortunately, it rarely results in positive outcomes.  This is exactly the time when extra support is crucial.  Instead of cancelling, consider other options like adjusting your appointment time to an earlier slot before you leave town.
  • Begin a daily practice of gratitude. Start each day by reflecting on something you are grateful for. You could write them each down in a journal or even post them on Facebook. This is a great way to head into the holiday with a fresh and positive outlook.

Stay tuned for tomorrow’s post with more insight and suggestions from our therapists and dietitians in Tried and True Strategies for a Recovery-Focused Holiday, Part 2: The Day Of Thanksgiving

[UPDATE]: Part II is now live here

[UPDATE]: Part III is available here: Tried & True Strategies for a Recovery-Focused Holiday, Part III: AFTER Thanksgiving has Come and Gone

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You might also be interested in these posts from past holidays…

 Tips for Overcoming Holiday Stress and Anxiety – Part I: The Food

Tips for Overcoming Holiday Stress & Anxiety – Part II: The Stress

Nutrition Tips for a Healthy and Happy Holiday!

Thanksgiving with an Eating Disorder: 10 Tips to Help You Get Through the Holiday

Photo courtesy of examiner.com

 

When Someone You Love Has an Eating Disorder

CED LeafThis is a special blog in advance National Eating Disorders Awareness Week (Feb 26th – March 3rd) and an upcoming free workshop, When Your Loved One has an Eating Disorder: Helping Them Heal on the Road to Recovery. You can find details about all of our upcoming NEDAWeek events at the end of the post.

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Guilt.  Shame.  Frustration.  Sadness.  Fear.  Anger.  These are just some of the emotions commonly experienced and expressed by support people when someone they love is struggling with an eating disorder (ED).  While each family experiences an ED, and the recovery process, in a unique way, there can be some commonalities that are important to talk about. Attending support groups, information sessions, and community workshops facilitated by treatment professionals are all great ways for support people to gain understanding and insight into the difficult journey their loved one is on.  It’s also a great way for family and friends to get feedback and support around their own feelings while they help their loved one navigate their way back to health.   A few of the most common struggles faced by family members are discussed below.    

Often times, parents and caregivers feel guilty and express concern that they may be to blame for their loved one’s eating disorder.

It can be terrifying for caregivers to find out that their loved one has an ED, especially as they begin to understand the level of suffering that comes with that.  A common reaction among parents is self-blame or intense guilt over the possibility that they may have contributed to their daughter’s or son’s illness.  This guilt can understandably create resistance or defensiveness and can be paralyzing for loved ones in the treatment process.  As long as the focus remains on “It’s all my fault.” it can be difficult to move towards “How can we as a family work together to support our loved one’s recovery?” 

While these illnesses have a complex combination of contributing factors, research has found them to be highly heritable, meaning 50-80% of one’s risk for developing an ED is dependent upon genetic factors. It’s important for families to receive reassurance that they are not to blame for their loved one’s illness while understanding that there are important ways they can help in the recovery process.  In fact, evidence-based treatment of EDs suggests educating family members and involving them in the treatment process greatly improves outcomes.  By identifying ways in which the ED has affected the family functioning and discussing dynamics that may be maintaining some of the person’s symptoms, families can work together towards improved communication, positive interactions and healing that extends far beyond the eating disorder.

Support people often feel anxious or frustrated about what to say vs. what not to say to a loved one with an eating disorder.  This can lead to fear that they are making their loved one worse because they don’t know how to respond in difficult situations involving food or body image.  Support people report that they often feel that they are “walking on eggshells” around their friend or family member with the eating disorder.

One of the most common examples of this dilemma occurs during the recovery process when support people may say something like “You look so much healthier,” but it is interpreted as “You look fat”.  Anyone who has been through an ED will tell you that they often feel irritable, and so much of their energy and time is spent thinking about weight and food that most comments people make about their appearance will automatically be construed in a negative way, even when they come from a place of care and concern.  Alternative comments that may be easier for your loved one to hear as they recover might be, “I’ve noticed you have a lot more energy lately” or “It is so nice to see you smiling today.”  One of the most helpful things support people can do is to communicate with their loved one by asking for a specific list of things that they can say or do that would be helpful to them when they are struggling.  Examples of things that are triggering or are not helpful to recovery could be useful as well.  Keep in mind that these lists may change at various points in the recovery process; communicate and revise often.

Also important to note: supporting someone through recovery from an ED is uniquely difficult compared to some other illnesses because of the cultural environment we live in.  Our society encourages and applauds hyper vigilance around weight, food and perfection yet recovery from an ED involves giving up some level of control over all three of those things.  Learning to filter unhelpful information and help your loved one resist damaging cultural messages about weight/food can feel like an uphill battle.  However, it does get easier with continued education about media literacy and guidance from therapists and registered dietitians who specialize in treating individuals with EDs.    

Support people are often so worried about the individual with the eating disorder that they focus 100% their energy on their loved one’s safety and recovery.   It becomes very easy to forget to seek their own support, neglect to keep up with their own self-care or let other personal priorities fall to the wayside. This can lead to mounting  feelings of exhaustion, depression or hopelessness.

Helping a loved one through the process of recovery from an ED can feel all-encompassing, especially when it’s your child or a spouse.   It often must become the family’s priority to get them back to a place of safety and stability, both physically and mentally.  However, support people can only offer stable, strong support when they are caring for themselves and staying stable, strong and rested themselves.  It’s important for caregivers to stay connected to their own friends, to seek out their own support and to set aside time to replenish themselves emotionally.  It could be as simple as sending a quick email to a friend every night before bed or scheduling a day trip to a favorite place. Whatever it is, remember the advice you get when you fly…you have to put on your own oxygen mask before you can effectively help those around you.

The truth is recovery can be a challenging process for all involved.  Even as progress is made, there are often set-backs or plateaus that can be confusing and frustrating .   Can you relate to the experiences discussed above?  Did you encounter other difficulties and roadblocks while learning to support a loved one in recovery?  Leave us a comment below or join in the discussion on our Facebook page.

At the Center for Eating Disorders, we recognize that there is a special need for education and support for the supporters themselves.  When Your Loved One Has an Eating Disorder: Helping Them Heal on the Road to Recovery is a FREE workshop designed to help family members and friends receive specialized education about EDs and their treatment, as well as insight into various care giving tools that can help facilitate the recovery process. Check out the details below, and don’t forget to RSVP by calling (410) 427-3886.

MARCH 1st, 2012  ~ When Your Loved One Has an Eating Disorder: Helping Them Heal on the Road to Recovery [download the event flyer]7:00 – 8:30 pm in  Baltimore, MD

 

 

Visit our Events Page for a full listing of upcoming events, including our NEDAWeek kick-off event, Invisible Victory: An Athlete’s Story of Hope & Triumph in Eating Disorder Recovery.

 

Invisible Victory

 

 

 www.eatingdisorder.org

“What if I hate being recovered?”…and other fears that get in the way of eating disorder recovery.

Each time we face our fear, we gain strength, courage, and confidence in the doing. ~anonymous

Fear is a powerful emotion.   At it’s best, fear can serve to alert and protect us from legitimate danger.  At it’s worst, fear is debilitating and it can prevent us from taking any action at all, especially in the direction of our goals.  When individuals with eating disorders (EDs) are faced with the possibility of  recovery,  fear can quickly become a primary motivation to maintain the status quo of symptoms and the illness.  Often the fears are so strong and so many, that there’s a feeling of being paralyzed in a place of chaos and discontent.

To want to recover but to simultaneously be afraid of recovery is a common sentiment.   Many people fear the physical changes of recovery…what will my body look like if I recover?… How will it change?… Can I tolerate the physical discomfort? And while these are often the fears most verbally expressed, many of the most paralyzing fears occupy more significant arenas… Who am I without the ED?… What will happen to my relationships if I recover?… What if I can’t recover? When author and recovery advocate, Johanna Kandel visited The Center for Eating Disorders she touched on the topic of fear in her talk and found the answers to these questions on her own journey to recovery…

“What happens if I do this thing called recovery and it’s not worth it?…What if I hate being recovered?” The work of recovery is hard – that’s no secret – but when it comes down to it, you’d be hard-pressed to find anyone who has recovered from an ED and wishes they hadn’t.  Its much easier to find people who wish they had sought help earlier and yearn to make up for time they spent in the grips of the ED.

“Ultimately we know deeply that the other side of every fear is freedom.” ~ Marilyn Ferguson

It can be hard to push through the fear of the unknown and the uncertainty of what recovery will look like, but you can’t get past a fear you don’t acknowledge.  Tune into your fears, become aware of what they are, and then you can begin to address them one-by-one.   Talk about them out loud with a friend or loved one.  Write them down in a journal or share them anonymously on our discussion board.  Find a support group where you can listen to other people process similar fears about recovery from an ED.  Most importantly, don’t let fear keep you from becoming the best and most authentic version of yourself.

Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us. We ask ourselves, who am I to be brilliant, gorgeous, talented, and fabulous? Actually, who are you not to be? ~Marianne Williamson

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This was the fourth of several recovery blogs inspired by the February 2011 presentation by Johanna Kandel at The Center for Eating Disorders at Sheppard Pratt. Follow CED on  Facebook to stay tuned as we continue to post additional recovery-focused blogs and video clips.  Johanna shares more about her own recovery journey in her highly influential book, Life Beyond Your Eating Disorder,  and continues to support others through her role as the Executive Director of The Alliance for Eating Disorders Awareness, a non-profit organization based in Florida. You can learn more about Johanna and her incredible book in these previous blogs as well: