Speaking the Same Language – Nurturing a Common Understanding


Over the course of the next few months the Nurture blog series  will explore the central theme of motherhood involving various topics such as fertility, pregnancy, childbirth and parenthood as they relate to body image, and overall wellness.  Several of these topics, in addition to being potentially sensitive subject matter, also have a language all their own.  As we approached these blogs, we thought it was important to make sure that everybody is speaking the same language – hence, the glossary page. 

Many of the terms used in this blog series get tossed around a lot in our society with the assumption that everyone knows what they mean, but that isn’t always the case as we will point out in future blogs entries regarding the term “body image”.  We also wanted to provide clarification for terms that are sometimes used in two different ways (i.e. “going on a diet” vs. “a balanced diet”).  Additional terms, like “low birth weight” or “amenorrhea” are more technical and so we thought it couldn’t hurt to provide a little refresher for these more medically-based terms as well. Throughout this series of blogs the glossary will grow and terms will be added, feel free to use it as a reference when reading specific blog entries and refer back to it as often as needed.  If you have any questions or suggestions for terms that should be added let us know!



Amenorrhea: Amenorrhea is the absence of menstrual bleeding. Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in a girl by age 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years. Secondary Amenorrhea is the absence of menstrual bleeding in a woman who had been menstruating normally but later stops menstruating for 3 or more months and its occurrence is not a result of pregnancy, lactation, systemic hormonal birth control pills, or menopause. (source: emedicinehealth.com) Amenorrhea can be a symptom of disordered eating, over exercise or an eating disorder.

 Body Image: Body image is… how you see yourself, how you feel about your body and shape, and what you believe about your body.  Body image is made up of memories and assumptions about your body and the feelings you have when you think about or visualize your own body. Body image is also how you feel in your body as you move and control it.  Body image is not dependent on how much you weigh, how tall you are, or your personal style.  A person’s body image can exist anywhere on a continuum – from a very positive and healthy body image to a very poor or negative body image.   

Diet (noun): The customary amount and kind of food and drink taken by a person from day to day; i.e. a balanced diet:  one containing foods which furnish all the nutritive factors in proper proportion for adequate nutrition. (Dorland’s Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.)

Diet (verb): A Reduction of caloric intake or manipulation of food and drink with the intent to lose weight.

Disordered Eating: A significant deviation from normalized eating patterns that may include dieting, fasting, bingeing, or skipping meals. Disordered eating disregards internal regulation of hunger and fullness and provides the body with much more or much less than the body needs to function properly.  Instead of feeling good after a meal, someone who has disordered eating will often experience feelings of guilt, shame, discomfort, fear or discontent.

Infertility:  The inability to become pregnant after persistent attempts over a given period of time, usually determined to be one year in humans. 

Low Birth Weight: Babies born weighing less than 5 pounds, 8 ounces (2,500 grams) are considered low birth weight. Low birth weight babies are at increased risk for serious health problems as newborns, lasting disabilities and even death. About 1 in every 12 babies in the United States is born with low birth weight. (March of Dimes Foundation)

Normal Eating: Eating in response to the body’s natural hunger and fullness cues, with a variety of food choices that offer balance, diverse foods and moderation.  Normal eating generally involves eating three regular meals per day and 1-2 additional snacks in response to hunger. Normal eating involves nourishing the body for the purpose of providing energy and maintaining well-being and should result in feeling good afterwards.

Over Exercise / Excessive Exercise: 1. Repeatedly exercising beyond the requirements for good health; when an individual engages in strenuous physical activity to the point that is unsafe and unhealthy. 2. The Diagnostic Manual, the DSM-IV-TR, defines excessive exercise as exercise that “significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications.”  3. Some of the physical dangers that may become an issue for someone exercising too much can be: dehydration, stress fracture and osteoporosis, degenerative arthritis, amenorrhea, reproductive problems, and heart problems.

Set-Point / Set-Point Theory: 1. Set point is the weight range in which your body is programmed to weigh and will fight to maintain that weight. Set point is often referred to as an internal “thermostat” that regulates weight. 2. According to the set-point theory, there is a control system built into every person dictating how much body fat he or she needs to maintain homeostasis. Some individuals are genetically programmed to have a high setting, others have a low one. According to this theory, body fat percentage and body weight are matters of internal controls that are set differently in different people. 3. The set point theory suggests that despite dieting efforts, the body eventually tends to return to its set point weight or will adjust metabolism and other mechanisms in an attempt to do so.

Do I Really Have Binge Eating Disorder?

Q: A close friend of mine recently told me that she believes I may have a binge eating disorder.  Some weeks I don’t binge at all and other weeks I binge daily.  Do I really have a binge eating disorder?

A: You ask a very interesting, and common, question.  It also happens to be a complicated one!  First off, are you really binge eating?  Some people may feel like they’ve binged after eating one candy bar, a handful of peanuts or a single ice cream cone.  For these people, a binge involves eating any amount of something they consider to be a “bad” or “dangerous” food.  Technically, this is referred to as a SUBJECTIVE binge because it relies on each individual’s own, sometimes inaccurate, definition of how much food is “too much”.  On the other hand, while difficult to precisely define, a formally defined, or OBJECTIVE, binge consists of 1) eating a significantly larger amount of food than an average person might eat,  2) doing so in a relatively brief period of time (less than two hours) and 3) sensing a loss of control over eating during the episode.  Distinguishing between a subjective binge and an objective binge is an important part of helping you to answer the question about whether you have a binge eating disorder (BED). 

That being said, episodic, or occasional binge eating alone does not constitute BED.  Current diagnostic criteria indicates that an individual is bingeing at least twice a week for six months and experiences that “out of control” feeling during the binge in order to be diagnosed as having BED.* 

People with BED tend to eat quite rapidly, binge even though they’re not hungry, and often eat until they are feeling exceptionally full.  At the emotional core of BED is a sense of shame, and possibly disgust, about one’s eating behavior and, consequently, binges are apt to occur secretively.  Around 2-3% of the general population meets the criteria for BED and interestingly, women are somewhat more likely to have BED than men.  Some research suggests that upwards of 50% of people with BED are not obese, contrary to what people may assume.  

Its important to point out that even if you don’t think you meet full criteria for BED, it doesn’t mean you don’t have an eating disorder or that you shouldn’t seek help.  Any problematic disordered eating behaviors, including infrequent binges, could be symptoms of an eating disorder.  Regardless of the specific diagnosis, early assessment and intervention will significantly help to improve your chances for recovery.

Blog answer contributed by David Roth, Ph.D. 

Dr. Roth is a psychologist and therapist at The Center for Eating Disorders.  He specializes in the treatment of individuals with Binge Eating Disorder. 

* It is important to note that new diagnostic criteria for BED and its inclusion as a separate disgnosis is currently being developed and will likely be updated in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, scheduled to be released in May of 2013.

Application Awareness

Dr. Harry Brandt, Director at the Center for Eating Disorders, was recently quoted in a blog entry on ChicagoTribune.com.  The article discussed the negative impact that some smart phone applications can have on those individuals who are suffering from or are at-risk for developing an eating disorder. In light of this article, we’re re-posting an earlier entry we wrote on the subject in an attempt to generate awareness about this potentially dangerous trend.


They can navigate you safely to your destination, identify a song playing in the background, and keep you busy with endless games while riding the bus to work or school, but some Smart Phone applications are not so helpful and could become harmful to their users.  Eating disorder experts have observed that new handheld applications, designed to aid users in reaching weight loss goals, can easily perpetuate a serious eating disorder (ED) or become the catalyst for the development of an ED in those who are at-risk.  

One of these weight monitoring applications boasts in an advertisement that it is, “a tool for people who are serious about tracking their weight…you can’t control your weight unless you are aware of how it is changing.”  This ability to track minute details of nutritional intake 24 hours a day from the palm of your hand, and the desire to establish, the always elusive, “control” over one’s eating and weight could be easily abused by anyone with disordered eating patterns.  In fact, many of the application’s features promote or even mimic actual signs and symptoms of a serious ED.  Frequent weighing, micromanaging food intake, and excessive monitoring of calories spent during exercise are all signs that someone may have an ED.  These potentially dangerous actions are encouraged by the applications which assign technical names to the disordered eating patterns such as the setting of a “daily caloric budget” and the use of a “nutritional database”.        

What may be most dangerous about these applications is the illusion they create that this level of excessive monitoring of food, weight, and exercise represents a normal, healthy lifestyle.  At the Center for Eating Disorders, we strive to help people develop healthy relationships with food and an appreciation for their bodies, regardless of weight or size.  Unfortunately, applications such as the ones described above, seem to be doing the exact opposite.

Tools like this may be benign, although time-consuming and unnecessary, in the hands of people who are not vulnerable to EDs.  However, the thoughts and behaviors they encourage could be life threatening to someone with an ED or to someone who is at-risk for developing one.  It is increasingly important that we, as a community and as individuals, are aware of the risks associated with our ever-expanding world of technology and the effects it may be having on the people in our lives. 

If you are concerned about a friend or loved one who is struggling with disordered eating or you would like more information about eating disorders, please call us at (410) 938-5252 and explore our website at www.eatingdisorder.org .

Our Photoshop Culture


Being a “critical viewer of the media” includes building up your resistance to negative body image messages projected by magazines, billboards, television — all forms of media.  Seeing the truth behind these messages, and being aware that things are not always as they seem in pictures, is part of this critical viewing process.   For parents, it is particularly important to talk to your kids about how magazine covers and other media outlets don’t actually portray real bodies.  Recently, the LA Times published an article which highlights our cultural obsession with Photoshop and how it is constantly used by the media to create an unrealistic definition of beauty and perfection.  Read the LA Times article , Photoshopped images: the good, the bad and the ugly, and then join in a discussion about it on our Facebook page or our discussion board.

Above image courtesy of blogocrats.files.wordpress.com

Cognitive Distortions: Define, Discover & Disprove

Cognitive distortion is a term used to describe a pattern of thinking, or “self-talk”, that consistently shifts life events into a negative framework.  When automatic thoughts continually send us negative messages, we often begin to believe they are true.  This can lead to feelings such as sadness, anger, shame, hopelessness, and anxiety which can perpetuate a depressed mood and may trigger disordered eating.  The first step in overcoming negative thoughts is learning to identify them.  There are many different types of cognitive distortions; some of these are described below:

  • All-or-Nothing Thinking:  Also known as “black & white thinking”, this occurs when things are thought of in extremes with no middle ground or grey zone.  Ex) “I woke up late and now my whole day is ruined.”
  • Discounting: Downplaying or disregarding the positive elements of a situation.  Ex) “I shouldn’t have gotten an award for that project, anyone could have done that.” OR  “She only told me I looked beautiful because she’s my friend and she was trying to make me feel better.”
  • Filtering: Focusing on and magnifying the negative aspects while ignoring important positive information  Ex)  “My boss chose to publish the article I wrote but he made so many changes and edits to it – he must have thought it was awful.”
  • Overgeneralization: the assumption that one small negative event is a continually occurring problem; often includes words such as “never”, “always”, and “every”.  Ex) “I never win anything.” OR “I always mess everything up.” OR “Everyone thinks I am annoying”
  • Fortune Telling: making a prediction about how something will turn out as though it is already a fact  Ex) “I just know there is going to be terrible weather on my wedding day and nothing will turn out the way I planned.”   
  • Mind Reading:  making assumptions about what other people are thinking  Ex)  “Everybody thinks I’m too young and inexperienced to do this job.” OR “He would never even consider going out on a date with me.” 

Once you can identify the cognitive distortions you are struggling with, you can begin to challenge the thoughts and substitute them with more accurate facts and/or positive thoughts.  The best way to overcome cognitive distortions is to work with a therapist who can help you learn to process and restructure thinking patterns that are causing you distress.  However, you can begin to undo cognitive distortions by challenging your own automatic thoughts.  Next time you’re feeling  triggered or are tempted to act on symptoms, write down the thoughts you are having, and ask yourself the following questions: 

What’s the evidence? 

Am I confusing a thought with a fact? 

Am I thinking in all-or-nothing terms? 

What’s the source of my information? 

Am I confusing a rare occurrence with a common one? 

What difference will this make in a week, a year, or ten years? 

Am I overlooking my strengths?

Am I assuming every situation is the same? 

These may sound like simple questions with obvious answers but you may find out a lot about your thoughts when you begin to challenge them.  In fact, you might find that some of the difficult feelings you experience are triggered by thoughts that you didn’t even realize you were having.  It takes time and effort, but eventually it is possible to turn off these automatic negative thoughts and “turn on” a more positive soundtrack for your life.  Why not try it today?

If you are struggling with negative thoughts and are interested in seeking treatment for an eating disorder, please call our admissions counselors at (410) 938-5252.

  Above photo courtesy of papergoods.com


Anorexia & Autism


In our previous blog, The Science of Eating Disorders, we discussed the importance of ongoing research regarding the genetic origins of eating disorders.  This focus has many implications for improving prevention, identification and treatment efforts.  One example of this topic was highlighted in a recent Time Magazine article focusing on new research that uncovered possible genetic links between anorexia and autism.  Autism is a brain development disorder that develops prior to age three and affects boys at a much higher rate than girls.  In comparison, anorexia nervosa (AN) affects females at a higher rate than males, and the average age of onset is between 14 and 18.  While on the surface these two disorders may seem like unlikely partners, recent research and clinical observations may prove differently.  In fact, according to the article, research suggests that approximately 15% to 20% of patients with AN may also have Asperger’s syndrome, which is on the Autism Spectrum.  The Time Magazine article addresses possible explanations for the underlying similarities between autism and AN and elaborates on further connections between the two disorders.  Several of these main points are summarized and excerpted below:  

  • Emotion regulation is a common trait among individuals with autism and in those with AN.
  • “There is evidence that the ‘repetitive thoughts and behaviors, rigid routines and rituals and perfectionism’ that characterize both autism and AN may be traced to the same regions in the brain.”
  • It’s possible that the development of autism and the development of AN actually rely on the same genetic predisposition but it may manifest differently depending on an individual’s gender.
  •  “Starvation itself intensifies autistic characteristics like rigidity and obsession.”
  • Underweight individuals with AN performed poorly on a test of interpreting other people’s emotions.  The test was originally developed to study impaired social interactions in people with autism-spectrum disorders.
  • “The theory is that hunger focuses the brain so sharply on the task of getting food that it shuts down higher cognitive functions, like reading other people’s emotions.”

To find out more about this topic, read the full length article, A Genetic Link Between Anorexia and Autism? and post your comments about this topic on our discussion board.

EDNOS – Is it an Eating Disorder or Not?


 Photo courtesy of http://www.dsmivtr.org

Sarah Blake, Social Worker and Outreach Coordinator at the Center for Eating Disorders at Sheppard Pratt, offers insight on EDNOS, Eating Disorder Not Otherwise Specified.

So many of my patients have grappled with having the diagnosis of EDNOS. Eating Disorder Not Otherwise Specified is a classification for disordered eating that the DSM-IV lists as a category “for disorders of eating that do not meet the criteria for any specific Eating Disorder.  Keep reading though, before making a judgment call about this diagnosis.  In the rigid thinking of some of the patients I have worked with who have had eating disorders, having this diagnosis can initially mean to that individual that they have failed –  to be a person who has a “real” eating disorder.  This type of thinking can lead to a variety of other thoughts that can impede their recovery process.

The diagnosis of EDNOS can mean a wide range of things. It can mean you meet the criteria for Anorexia Nervosa, but you have maintained a menstrual cycle. It could mean that you struggle with severely restricting your food intake and have lost significant weight, but are currently at a fairly normal weight for your height. It could mean that you meet the criteria for Bulimia Nervosa but binges occur less then twice a week or that the cycles have occurred for less then a duration of 3 months.  It could mean that you eat small amounts of food and then do something to compensate for having ingested the food.  It could mean that you engage in a recurrent pattern of binge eating without any compensatory behaviors.

What is important to note here is that just because a person does not fit the exact criteria for Anorexia or Bulimia, does not mean they do not have a serious illness that requires attention.  Countless individuals who are diagnosed with EDNOS are at risk for the same medical complications as those individuals who are diagnosed with Anorexia and Bulimia. These include (but are not limited to) dehydration, electrolyte imbalance, heart attack, and death.  These are still eating disorders requiring necessary medical attention and psychological support.

EDNOS is a widespread problem. According to Eating Disorders: The Journal of Treatment and Prevention, EDNOS develops in 4-6% of the general population, and 50% of the individuals who come in for treatment for an eating disorder are given the diagnoses of EDNOS.  There must be a reason that so many individuals are in this diagnostic category and it is most certainly not, that 50% of the people who come in to treatment are not “good enough” at their disordered eating, to get an “official diagnosis”!

No matter how extreme your eating issues are, they are taking away from the fullness of life you could be experiencing. The eating disorder may seem as if it provides comfort or security,  but it does not allow you to feel a full range of emotions including:  joy,  surprise,  love and even sadness and acceptance to name a few.  Only by seeking help will you have the opportunity to truly begin to experience the fullness of life you desire.

*****Eating Disorder Not Otherwise Specified, Anorexia, Bulimia, and Binge Eating are all serious illnesses.  If you or someone you know is struggling with an eating disorder – help is available! Contact us at 410-938-5252 or via the web http://www.eatingdisorder.org/get_help/ to talk to someone confidentially about your concerns.*****

The Truth Behind “Pregorexia”


 photo courtesy of http://www.maternalwisdom.org/

In recent years a handful of unofficial terms have seeped into the existing eating disorder vocabulary.  From “wannarexia” to “manorexia”, these trendy expressions have been popping up in articles and blogs across the internet.  More recently, “pregorexia” has made appearances.  This word attempts to diagnose the intersection of pregnancy and eating disorders.  The term has been unofficially coined in response to the growing awareness of pregnant women acting on ED (eating disorder) symptoms in an attempt to avoid the weight gain and body changes that take place in normal, healthy pregnancies.  Some propose that the trend is a result of the media’s increasing coverage of celebrities’ unrealistic pregnant and post-baby bodies.

The Center for Eating Disorders agrees that the media can play a role in the development and maintenance of people’s eating disorders but it does not cause eating disorders in and of itself.  It is also important to point out that most women who would be described as having “pregorexia” have had body image problems and disordered eating (if not full-fledged eating disorders) long before they were pregnant.

Eating disorders are exacerbated by stress, and pregnancy is an intense physical and emotional stressor. It is no surprise that some women experience an intensification or return of ED symptoms during pregnancy. The “pregorexia” label is concerning because it distracts from the real and very serious eating disorder and implies that the problem will go away after nine months when the label no longer applies. It can also stigmatize a population of woman who already notoriously underreport their ED symptoms to doctors due to the guilt associated with having an ED during pregnancy.

Very simply put, a pregnant woman who is simultaneously suffering from anorexia, bulimia or any other eating disorder, needs support and professional treatment to ensure her health and the health of her unborn baby.  What she doesn’t need is a fictitious label to disguise, excuse or further stigmatize the real problem.

The Center for Eating Disorders does not encourage the use of “pregorexia” or any other terms that make light of eating disorders.  It can be very dangerous to replace official diagnoses with unofficial labels that could minimize, mask or distract from the underlying illness and might reduce one’s motivation to seek treatment.  These invented terms do not exist as independent diagnoses for a reason and cannot, and should not, take the place of professional assessments and official diagnoses.

*****Eating Disorders during pregnancy can be particularly dangerous for both mother and child.  Some of the risks include miscarriage, birth defects or abnormalities, premature or low birth weight babies, and an increased risk of post-partum depression.  If you or someone you know is struggling with an eating disorder and need treatment, please contact the Center for Eating Disorders at Sheppard Pratt at (410) 938-5252 or email us at EatingDisorderInfo@sheppardpratt.org .*****

Night Eating Syndrome – Q&A with James Mitchell

 Dr. James Mitchell, an internationally renowned expert in eating disorders, discusses the two most common types of night eating syndrome.  He will be presenting this topic at the upcoming symposium on April 12, 2008, hosted by The Center for Eating Disorders at Sheppard Pratt.

What is night eating syndrome? 

There exist at least two forms of night eating syndrome, or NES. The first, most commonly referred to as NES, involves people who overeat late in the day and/or get up during the night to eat. These people also have marked problems with insomnia and are fully aware of what they are doing when they wake up to eat. The other form of night eating is usually related to a sleep-related eating disorder. Those individuals wake up and eat during the night, but many times are amnestic for it and are only partially aware of what they are doing. This type of night eating is a parasomnia, much like sleepwalking. 

How does an individual identify that they are struggling with this issue?

People with NES are usually fully aware of their problem. Those with a sleep-related eating disorder may be amnestic for the eating episodes, but may discover evidence the following day that they have been eating during the night; such as food that has been left out, or that the oven has been left on.

Is there effective treatment available for NES? 

There is a structured form of counseling which has been manualized and is available as a self-help manual by Allison & Stunkard for NES.  For sleep related eating disorder, medications are usually indicated and can be quite effective.

Read more about Dr. James Mitchell.

If you are a mental health professional and are interested in hearing Dr. Mitchell speak on this subject, you can register for the April 12th symposium online at www.eventville.com/sheppardpratt

Borderline Personality Disorder – Q&A with Randy A. Sansone

Dr. Randy A. Sansone, an internationally renowned expert in eating disorders, talks about borderline personality disorder and the unique challenges those who suffer from it may face.  He will discuss this topic at the upcoming symposium on April 12, 2008, hosted by The Center for Eating Disorders at Sheppard Pratt.

What is borderline personality disorder? 

Borderline personality is a longstanding dysfunction in personality that is characterized by three fundamental features: (1) a superficially intact social facade or veneer; (2) longstanding difficulties in self-regulation (i.e., an inability to effectively regulate oneself, which might emerge as eating disorders, alcohol/drug problems, promiscuity, difficulty regulating money, chronic pain syndromes); and (3) chronic self-harm behavior (e.g., self-mutilation such as cutting, hitting, burning, or scratching oneself; suicide attempts; engagement in abusive relationships; high-risk hobbies/behaviors with the intent of gambling with death).

How frequent does this co-occur in individuals with eating disorders? 

The data indicate that about one-quarter to about one-third of individuals with eating disorders have co-morbid borderline personality disorder. The disorder is less common among those with restricting anorexia nervosa and more common among eating disorder syndromes characterized by impulsivity (such as anorexia nervosa, binge-purge type; bulimia nervosa, purging type).

What unique challenges face this population in learning to manage their eating disorder? 

While standard eating disorder treatment is helpful, it must be augmented with psychotherapy intervention for the personality disorder. In many cases, the function of the eating disorder symptoms extends beyond food/body/weight issues and may relate, in addition, to self-harm behavior. In addition, there are oftentimes adjunctive self-regulatory and self-harm issues that must be addressed in treatment (e.g., substance abuse, suicide attempts). Because borderline personality is oftentimes associated with early developmental trauma, these issues must be taken into account, as well. 

**Some data suggests that individuals with eating disorders and borderline personality may have more severe symptoms as well as less robust treatment outcomes, compared to individuals with eating disorders, alone. Other data suggests that the treatment response to the eating disorder symptoms may improve equally well, but the individual’s overall functionality is less.

Read more about Dr. Randy A. Sansone, M.D.

If you are a mental health professional and are interested in hearing Dr. Sansone speak on this subject, you can register for the April 12th symposium online at www.eventville.com/sheppardpratt.