Eating disorders in film: Important reminders during awards season #popcultureED

 


Over 13 percent of teen girls suffer from an eating disorder by the age of 20. It’s not just girls either: disordered eating is almost as common in males as females and can extend long into adulthood. When we get right down to it, eating disorders are serious and people living with them have a higher risk of dying compared to same-aged peers. Still, disordered eating is often joked about and normalized in pop culture. This ‘awards season’, we’re nominating moments from popular movies of the past that show just how common distorted ideas about bodies, diet and food are in our culture. We still love some of these classic comedies, but let’s be careful to challenge unhealthy behaviors as we watch.

GIPHY Video Audience Giving a STanding Ovation

Unfortunately, some movie scenes can be quite triggering for folks with eating disorders and those in recovery. It’s not uncommon to see detailed ED thoughts and behaviors in films that that are never challenged or paired with appropriate education. So, we’ve taken a few movie examples below and added important reminders and fact-checking opportunities.

It’s possible to enjoy films while also thinking critically about their messaging. You might also want to actively decide whether to watch or not to watch before engaging with specific films that you know will normalize or showcase disordered eating.

First up on our #popcultureED tour is…


“THE DEVIL WEARS PRADA”

This movie, starring 2019 SAG awards winner Emily Blunt, reminds us that no goal is ever worth starving for. Emily Blunt’s character frequently makes comments about her restrictive eating and undeniable pursuit of a thinner body.

Nourishing your body consistently is a better way to keep yourself healthy enough to reach your career goals and be present to enjoy them. If you’re struggling to overcome thoughts that equate thinness with success, you’re not alone. Take a step and ask for help before things get worse. Whether you’re a fashion designer, a father, a teacher, or an artist, you deserve to be free of food and weight obsession.

 


“ROMY AND MICHELLE’S HIGH SCHOOL REUNION”

Romy and Mishelle share all sorts of diet obsessed banter in this movie, including this extremely dangerous quip. Reality Check: Candy is delicious, but it doesn’t provide nearly enough energy on its own for everything your amazing body does each day. All foods can fit in a healthy pattern of eating but one type of food on its own – whether candy or kale – can never meet all your nutritional needs. Incorporating a variety of fun and nourishing foods is best.

 


“MEAN GIRLS”

Did you know that some of the most common side effects of dieting are mood changes, depression and irritability. That could be one reason why Regina was always so negative and, quite frankly, pretty nasty to the people around her. Luckily, this movie does teach us that trying to be “perfect” can take its toll.

Did you know that perfectionism is a risk factor for the development of eating disorders?  Perfectionism can also cause you to miss out on opportunities to learn from mistakes and may ultimately get in the way of living a balanced, rewarding life.

 


“A CINDERELLA STORY”

Our bodies need different nutrients to fuel them. Cutting out entire food groups or sources of energy can cause major problems for your body (and really limit your options when eating out). One of the side effects often noted by people with eating disorders is that they begin to isolate from friends and family since they no longer feel comfortable eating around other people or they literally can’t find anything on the menu that fulfills the “rules”.

Social isolation can lead to all sorts of other diffculties and can worsen depression and anxiety. If you’ve noticed that you or a friend are retreating from meals or other previously enjoyed activities it might be time to seek support.

 


“ZOOLANDER”

Derek and Hansel are misinformed when it comes to losing weight. The fact is, purging is not an effective way to lose weight or prevent weight gain. In fact, over time, purging behaviors are associated with weight gain (and a whole host of serious medical consequences). On top pf being misinformed, the characters explode in laughter when Matilda opens up to them about her own history with bulimia.

This is obviously a comedy but it’s still important to remind ourselves while watching that purging is NEVER funny and purging is never a safe behavior. Don’t be like Derek and Hansel. If a friend shares with you that she or he is struggling, take it seriosly. If you need resources to help a friend, check out the Let’s Check In Discussion Guide.

 


“CLUELESS”

Cher and her friends engage in awful lot of weight shaming, diet talk and appearance bashing throughout this movie. (It’s actually hard to find a single scene without it).

Critical body talk and weight shaming – even when self-directed – has a lot of negative consequences. When you criticize your own body, it impacts you and the people around you negatively, making everyone more distracted by and less accepting of their own appearance.

Our thoughts affect our feelings and behaviors so it’s important to learn how to curb negative self-talk and practice saying kind things to yourself. Remember, your vibe attracts your tribe. Work on body acceptance and you’ll be more likely to attract friends who are body positive too.

 


“BRING IT ON” 

Sports have the power to promote self-esteem but not with a coach like Sparky Polastri who flat out disparages bodies and encourages restrictive eating disorders among his athletes.  Any coach who puts an emphasis on weight is bad news for the whole squad.

Not eating enough to fuel your workout can reduce strength, speed, and stamina and lead to increased risk of injury from things like stress fractures, fainting and muscle cramps – not what you want when you’re on top or bottom of the pyramid!

Sparky’s advice is way off; athletes burn a lot of energy through their training, so they actually need to eat more than non-athletes to properly fuel their bodies. Never be afraid to get a second opinion if a coach is steering you wrong.

 


“PITCH PERFECT”

Food shaming is ALL AROUND US in the movies and in real life so we get pretty used to hearing stuff like this. Something you think is a harmless joke about what someone is eating might actually have major repercussions for them.

We never know how the people around us feel about food or their bodies, so it’s best not to make offhand comments about what they should or shouldn’t be eating. Also, burgers are great and can be enjoyable and nourishing at any age!

 


“LITTLE MISS SUNSHINE”

Did anyone else’s heart break a little when Richard told Olive that ice cream would make her fat? In real life, instilling a fear of fatness does not keep kids (or adults for that matter) from gaining weight, but it can contribute to negative body image and disordered eating, including bingeing on foods that are deemed by adults to be forbidden or off-limits.

A better message for kids? All bodies are good bodies and it’s OK to enjoy a variety of different foods. You might also want to check out these other 8 tips for raising body positive kids (who are also competent eaters).

 


The Oscars

As you watch the Oscars and other awards shows this season, let’s cheer on the great acting and fun story lines while also keeping in mind how popular films – even comedies and parodies – can influence our own thoughts and expectations regarding food, weight and eating.

Join the conversation with us on social media using #popcultureED.

If you’ve had an eating disorder in the past or are in the early stages of recovery, sometimes it helps to have a specific support plan for watching potentially triggering or body shaming movies. Read more about that here: How to stay recovery-focused when interacting with triggering media

Don’t forget, eating disorders are serious and risky if untreated. The first step is awareness; If you suspect that you or someone you know has an eating disorder, visit  eatingdisorder.org or call 410-938-5252 for a free phone assessment.

NEDA Congressional Briefing on Eating Disorders

CED Co-Director, Dr. Steven Crawford, among panelists to speak on Capitol Hill

The National Eating Disorders Association (NEDA) in conjunction with the Congressional Mental Health Caucus hosted a Congressional Briefing on Capitol Hill on October 2, 2018. This briefing was held to educate representatives and legislative aides about eating disorders in overlooked populations. Panelists at the briefing included Chevese Turner (moderator), Mike Marjama, Claire Mysko, Janell Mensinger, PhD, and Steven Crawford, M.D.

Dr.Crawford, co-director at The Center fo Eating Disorders at Sheppard Pratt, began by discussing the different eating disorders and the risks and causes associated with them. He explained the differences in each disorder and the ways someone can help if they notice symptoms of an eating disorder in someone they care about. These include, seeking more information on the subject, locating resources, not focusing on weight, and encouraging the person to seek specialized treatment.

Dr. Janell Mensinger, an Associate Research Professor at Dornsife School of Public Health at Drexel University, presented on eating disorders and population weight. Her presentation focused on people in higher weight bodies and she explained how weight-related harassment is over four times more common than bullying. She stressed that we, as a society, need to shift focus from weight to health and provided research that shows eating disorders and extreme dieting are increasing among people in higher weight bodies.

The next panelist Claire Mysko, CEO of NEDA, spoke about a prevention program called the Body Project. The Body Project is a group-based intervention that helps decrease eating disorder symptoms and body dissatisfaction in high school girls. There are currently 388 trained facilitators for this program across the United States. Mysko also mentioned how NEDA is working on a similar program for young men.

The final panelist was former Seattle Mariners Catcher Mike Marjama who now serves as a NEDA Ambassador. Marjama presented his personal struggle with body dissatisfaction and an intense desire to change his body, which led to extreme behaviors around food and exercise, an eating disorder diagnosis and eventually hospitalization. His treatment and recovery however, led him to a baseball career and renewed appreciation for mindfulness and balance. After retiring he decided to speak openly about his disorder and his story has since been featured on Good Morning America. As an Ambassador for NEDA his goal is to help boys and men see through outdated stereotypes about eating disorders so they can get the help they need.

Eating disorders are one of the most dangerous mental health issues and should not be taken lightly. Unfortunately, they are too often overlooked in people with higher weight bodies, in athletes of all calibers and in traditionally marginalized populations. Our hope is that the information shared in the Oct 2nd hearing will assist legislators in creating policies that not only support prevention and treatment for eating disorders but improve overall public health.

Additional Advocacy Resources:

  • Get involved, learn about state-specific legislative actions and become a NEDA advocate.
  • Read summaries of current legislative actions, read about current initiatives and get involved with advocacy days on Capitol Hill with the Eating Disorder Coalition.
  • You can find out more about The Center for Eating Disorders’ recent advocacy work here.

Written by: Julie Seechuk, Social Work Intern 

Testimony on The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools


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The following written testimony was provided by Steven Crawford, M.D. in advance of the Maryland State Medical Society House of Delegate’s vote on the matter of advocating for the inclusion of eating disorder questions in state and national health monitoring tools. 

Additional information on the position of Dr. Crawford and The Center for Eating Disorders at Sheppard Pratt can be found by reading the following articles: 

Data Collection Critical to Understanding Eating Disorders – Baltimore Sun

30 million people will experience eating disorders — the CDC needs to help – The Hill

More detailed information about resolution 10-18 is linked in the testimony below.

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Testimony of

Steven F. Crawford, M.D., Co-Director
The Center for Eating Disorders at Sheppard Pratt

Before the

MEDCHI, THE MARYLAND STATE MEDICAL SOCIETY HOUSE OF DELEGATES

April 29, 2018

Resolution 10-18 – The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools

My name is Dr. Steven Crawford, and I am pleased to appear today on behalf of The Center for Eating Disorders at Sheppard Pratt.  For nearly 30 years, on a daily basis, I have been involved in clinical care, teaching, and research of life-threatening eating disorders including anorexia nervosa and bulimia. I started my career in at Mercy Center for Eating Disorders, and subsequently I have held leadership positions in psychiatry at St. Joseph Medical Center, and currently, with Dr. Harry Brandt, I co-direct one of the largest hospital based eating disorders programs in the United States at Sheppard Pratt Health System.  I am a member of the Academy For Eating Disorders, a Distinguished Fellow the American Psychiatric Society, and a faculty member of the University of Maryland School of Medicine.

I come before you asking your support of Resolution 10-18 which asks for the “The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools.”

In the United States there are an estimated 20 to 25 million people who suffer from anorexia nervosa, bulimia nervosa and related eating disorders.  These illnesses destroy lives and devastate families throughout Maryland.  Anorexia nervosa has the highest death rate and the highest suicide rate of any psychiatric illness.   Further, the eating disorders are unique in that virtually every major organ system in the body can be affected by starvation, poor nutrition, and the dangerous behavioral patterns associated with eating disorders.  Sudden death is not uncommon.

After over two decades of mandatory surveillance of eating disorders signs and symptoms under the CDC’s Youth Risk Behavioral Surveillance System, the Centers for Disease Control (CDC) and state stakeholders voted to remove the mandatory eating disorders surveillance questions in 2015. The questions were removed under the pretense of changing public health priorities.  This, despite growing prevalence of eating disorders, an increasing awareness of their impact and the knowledge that every 62 minutes, someone dies as a direct result of an eating disorder.  Eating disorders should be among the top priorities of CDC because of their high death rate and the evidence that early identification and treatment are essential.

In this resolution, we request support of Med-Chi in advocating to the Maryland Department of Health for the immediate re-instatement of eating disorder questions in any current and future statewide Youth Risk Behavior Surveys (YRBS).  These efforts, if successful, would position Maryland as a national leader in tracking, assessing and mitigating the negative medical, social and financial burdens caused by eating disorders.

Additionally, we are working with the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), the National Eating Disorders Association (NEDA), and The Eating Disorders Coalition (EDC) to ensure the eating disorder questions are reinstated on a national level through the CDC surveillance systems.  This resolution additionally asks the MedChi’s American Medical Association (AMA) Delegation ask our AMA to advocate that the CDC reinstate the eating disorder questions into the YRBSS.

It is our hope that the House of Delegates will support this critical initiative by passing resolution 10-18.


UPDATE: On April 29, 2018, the MedChi House of Delegates voted to adopt resolution 10-18.

 

Knitting Together Skills for Eating Disorder Recovery

April is National Occupational Therapy Month ~ #OTMonth 


If you’ve had an eating disorder yourself, or you know someone who has, you might know all-too-well that one of the side effects of these illnesses is decreased engagement in meaningful, fun or productive activities. Eating disorders have a way of overtaking a person’s energy and time, even altering the way the brain works.Knitted squares in blue, grey and white; the beginning stages of a blanket

As more time is spent obsessing about food and weight, and engaging in symptomatic behaviors, there tends to be less and less mental energy available for activities unrelated to meals, food or thoughts  of body dissatisfaction.  By no fault of their own, individuals who develop eating disorders often don’t realize how much the eating disorder shifts their focus and leads them away from people,  events, and activities they once enjoyed.  This is one of the reasons The Center for Eating Disorders (CED) at Sheppard Pratt has always incorporated Occupational Therapy into our treatment options for individuals with eating disorders.An individual’s “occupation” is any activity that occupies his or her time.  Thus, Occupational Therapists (OTs) focus on enabling people to participate in meaningful and purposeful activities of daily life. At CED, our OTs work to provide individuals with a setting where the behavioral changes made through Cognitive Behavior Therapy (CBT) and insights learned in other psychotherapies can be converted into new behaviors that become part of the long-term healing process. We’ve written before about some of the ways our OT Department does this through Horticulture Groups.  Similar work is done throughout the year in different ways – including through mindful knitting groups.

Knitting is a craft that requires both physical and cognitive skills and thus engages both mind and body simultaneously. Knitting has the advantage of engaging the senses with the sound of the needles, touch of the yarn and movement of the hands that, together, hold the attention of the mind in the present moment. Repetitive action can be calming, textures can provide grounding opportunities and hand movements offer engagement for mind and body. This can be a much-needed relief for persons with eating disorders whose thoughts are constantly being pulled to the last meal or to the next one, or to persistent negative beliefs about their body, weight or size.

Over the last two years since our knitting program began, the OTs in The Center for Eating Disorders’ Partial Hospital Program (PHP) facilitated two therapeutic knitting groups, running twice a week for 8 months a year as an addendum to our core CBT protocols and additional evidence-based therapies. Participants could join for one session or many and were reminded frequently that each contribution is part of the whole. In these groups, patients who were veteran knitters joined beginners, learning new skills and sharing experiences. The groups were an opportunity for individuals to practice mindfulness and socialize with peers while, as one participant put it, “focus on calming,repetitive activity that also produces a tangible result” completely separate from anything related to one’s eating disorder.  The tangible result? Mindful knitting participants worked to create a collage of knitted squares which, when knitted together, became finished baby blankets.

When asked about the impact of the groups, individuals indicated  they “became more centered, distracted from my negative thoughts”  and “my anxiety level changed”.  Others shared that “the knitting was calming; the repetitiveness of the knitting felt good.” The power of knitting as a therapeutic tool has been documented outside the individual experiences of our patients. According to Corkhill et al., (2014), knitting in groups can impact perceived happiness, improve social confidence and feelings of belonging.

The knitting group, like many of our other OT groups, offers a safe environment to explore a new hobby (or rekindle interest in an old one), challenge perfectionistic tendencies, relax in recovery-focused ways, and stay in the moment with the flow of the needles and yarn.  This opportunity to engage the mind and the body also allowed for reflection on the healing and recovery process. When our most recent group of participants were asked how to apply the skills learned in knitting group to their broader recovery goals, responses included all of the following:

  • “ I can look at each of my new coping skills as accomplishments and enjoy the state of calmness.”
  • “I didn’t give up. I can remember not to give up so quickly.”
  • “I was able to feel good about myself. I can definitely use that for self-esteem issues.”
  • “[I’m] very excited to go home and knit. It’s so helpful to practice being in the moment.

The knitting groups provided a healing experience, new mindfulness skills and a variety of powerful reflections for participants. They also provided participants with an outcome they could feel good about. Upon completion, the group’s resulting baby blankets were donated to newborns at Mt.Washington Pediatric Hospital where they can continue to promote healing in new and important ways.

Would you like to find out more about OT and other treatment options at The Center for Eating Disorders? Call us today at (410) 938-5252.


Christine Brown, MS, OTR/L

Blog Contributor: Christine Brown, MS, OTR/L is an Occupational Therapist at The Center for Eating Disorders. Christine received her Masters of Science degree from Virginia Commonwealth University in 1999. Prior to joining the team at The Center for Eating Disorders, Christine spent time providing community-based services as an intensive case manager and worked in a general psychiatric inpatient and partial hospital program.  In her current role at The Center, Christine provides occupational therapy for adults and adolescents in our inpatient and partial hospital programs. She assists patients in increasing engagement in valued roles and meaningful occupations through group and individual interventions. In addition to the knitting group and other OT groups, Christine facilitates the sensory awareness and horticulture specialty groups.

 


Reference:

Corkhill, Betsan & Hemmings, Jessica & Maddock, Angela & Riley, Jill. (2014). Knitting and Well-being. Textile: The Journal of Cloth and Culture. 12. 10.2752/175183514×13916051793433.

 

32 Ways to Stay Recovery-Focused During a Snow Storm

If you are one of the many people on the east coast dealing with this most recent winter storm, you might be struggling to cope with loneliness, boredom or the stress of being stuck at home in heavy snow and cold temperatures. Snow days can certainly be fun but they can also present some challenges for individuals who struggle with mental health issues and eating disorders in particular. That’s why we put together this list of activities and strategies for maintaining a recovery-focused snow day. You can print or bookmark this post and refer back as need for coping skills and ideas for staying recovery-oriented on any unexpected days off throughout the year.


32 Recovery-Focused Activities, Tips & Strategies:

  1. First things first. Review what food you have available and write down a plan for your remaining meals and snacks for the day that is aligned with recommendations from your treatment providers. Post your plan in the kitchen or somewhere you will see it throughout the day. Set up reminders to take the breaks you need to prepare and eat each meal.
  2. Call or text a friend to check-in. 
  3. Paint something.
  4. Start a new knitting or craft project. 
  5. Read an old book that you loved the first time around.
  6. Record your observations about the storm in a journal.
  7. FaceTime with a family member that might be feeling lonely in the storm.
  8. Try this breathing exercise.
  9. Catch up on THANK YOU cards. 
  10. Watch funny videos on YouTube.
  11. Create a gratitude list and add to it throughout the snow storm. When the storm is over, hang it up somewhere where you can admire it and refer back to it.
  12. If you know you tend to get sucked in to social comparisons, limit your time on social media to specific hours each day. Block or hide accounts that you notice only leave you feeling negatively. Follow one or two new accounts that are #bodypositive or recovery-focused. We recommend @NEDAstaff, @LindaBaconHAES and @MelissaDToler to get started.
  13. Look up and print information about eating disorder support groups in your area and make plans to attend once the roads are cleared. Add it to your calendar with an alert so you don’t forget.
  14. Challenge your perfectionism. Do something in a mediocre way and be okay with it. If you don’t consider yourself an artist, it’s okay. Just grab a pencil and start sketching or start tearing up some old magazines for a collage project and get to work. Accept imperfection. Celebrate imperfection.
  15. Make a snow day music playlist full of upbeat classics that warm your heart. 
  16. Go through your closet and gather old or uncooperative clothes that are not serving you or your recovery. Bag them up and get them ready to donate when the snow clears.
  17. Do research on countries and tourist attractions you might like to visit someday.
  18. If you’re an essential employee and need to be at work during the storm, remember that your well-being is also essential. Be assertive about your need for meals, breaks and sleep. 
  19. Throw in a load of laundry you’ve been putting off. When it comes out of the dryer, fold it right away. It’s a great way to keep your hands busy and it’ll be warm too.
  20. Watch a favorite movie and just be present with the movie instead of being on your computer or phone at the same time.
  21. If you’re feeling like the walls are closing in on you, get bundled up and check on elderly neighbors.
  22. Listen to the snow falling and do a 3-minute mindfulness exercise.
  23. Have LEGOs and/or kids in the house? Invite your kids to build something with you.
  24. Send a picture of yourself smiling to someone who has been having a rough time and might need a smile.
  25. Water all of your indoor plants
  26. Drink some hot tea and read the paper
  27. Once the snow passes, put on your boots, explore the outdoors and take some photos; look for people and animal tracks in the snow.
  28. Do a puzzle.
  29. Make a list of compliments you’ve received in the past and honor them, even if you couldn’t accept or believe them at the time they were given.
  30. Make plans for next week. Schedule a meal with a supportive friend or buy tickets online for a show or event you’d like to see.
  31. Make a meal plan and grocery shopping list for the coming week. Email it to a dietitian or therapist on your treatment team.
  32. Don’t have a treatment team?  Call (410) 938-5252 for a free phone assessment and to be connected with an Intake Coordinator at The Center for Eating Disorders who can talk with you about available options.

What else would you add to the list? How are you planning to make your snow day more memorable and recovery-focused? Share your ideas with us on Facebook and Twitter.


www.eatingdisorder.org

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


What does it mean to live authentically? 

Honoring your truth.

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

 

Documenting Self-Discovery through Transition and Recovery

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

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

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

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

 

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

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

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

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

 

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

 

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


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


References

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

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

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

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

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

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

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

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

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

Easing Anxiety About Grocery Shopping During Eating Disorder Recovery

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Easing Anxiety About grocery Shopping - Woman with Shopping Cart [IMAGE]Whether we like it or not, grocery shopping is a necessary task of adulthood. It can be annoying or simply unenjoyable for anyone who is living a busy life or just doesn’t enjoy shopping or cooking. Most adults however, make it in and out of the grocery store regularly without significant disruption, problems or stress. But for the millions of individuals living with an eating disorder, an everyday task like buying food for themselves or their families feels completely overwhelming. Just thinking about going food shopping can trigger intense anxiety and may result in avoidance or elevated eating disorder symptoms. Actually going to the store and getting out before the milk gets warm seems impossible at times.

Since having consistent, structured and fulfilling meals are such a fundamental part of eating disorder recovery, being able to source and purchase the food for those meals then becomes a primary part of treatment.  If someone is too anxious to step foot in the store, obsesses over the label on every item or finds they just wander aimlessly, it can really inhibit their ability to bring home the foods they need to meet their nutritional goals. As a result, difficulties with grocery shopping can become a significant barrier to recovery. That’s why our Outpatient Nutritional Coordinator put together these tips to help individuals with eating disorders (or anyone really) navigate the grocery experience and become more confident in your shopping ability.

Plan, Plan, Plan: This is one of the most impactful tips! Planning your meals ahead saves you time and money. It can also decrease anxiety at meal times since you know that you have something in place and what to expect. In order to maintain stable meals, you must have a menu planned and food available to meet that plan; remember to incorporate foods from all food groups. Set aside one hour, one day a week for meal planning. Planning ahead also cuts down on the amount of trips to the store you need to take during the week.  One to two trips to the grocery store per week is reasonable

Organize your list: Based on your planned menu, create a grocery list. Breaking it down into the sections of the grocery store can cut down on time spent in the store. People that “wing it” end up wandering too long or revisiting the same aisle two or three times. Keep a pad of paper in your kitchen or a list on your phone where you can write down food staples that you run out of during the week; add them to your main grocery list before you go.

Be realistic: Set realistic expectations when you plan your meals. What do you have going on this week?  Which nights will you have more time to cook?  Which nights do you need something easy to assemble?  At which meals would it make sense to use leftovers?   Pick up a variety of foods that require different levels of preparation.

Mission possible: Set a time limit and stick to it.  Make it your mission to be at the register in 30 minutes or less.

Add support: Go with a friend or support person for the first few times. Whether they know you have an eating disorder or not, this will help distract from any eating disorder thoughts in your head and will keep you more on task.  Letting your support person know your goal of being at the register in 30 minutes or less can also help hold you accountable to not wasting time wandering aisles or compulsively comparing items.

Stick with what you pick: If you find yourself spending too much time reading labels or comparing similar products, try to make the decision based on which one is on sale that week. Choosing the item based on price can also help expose you to different brands and allows you to discover which one your taste buds truly prefer.  Another way to decrease label reading is to view the grocery store ad online before going to the store when making your list.  This allows you to view items without being able to read their labels and to commit to having them on your grocery list based on what is on sale.  This is helpful for reducing time comparing products, getting exposure to trying different products out, and can save you money!

Shrink the store: Sometimes it’s fun to shop at a large grocery store and to have a lot of options, but for some people more options = more anxiety. If that’s the boat you’re in, try shopping at a smaller store such as Aldi, Eddie’s, or the grocery section at Target.   It’s a lot easier to decide which yogurt to buy when you have three options instead of thirty!  Having less options of yogurt, cereal, bread, crackers, etc, can reduce time spent in the aisles and will help you get out of the store faster.

Ditch the diet products:
Avoid being lured into fat free, sugar free, “diet products.”  They do not satisfy and will only leave you feeling hungry and stuck in the “diet mentality.”  Normalized eating incorporates regular products that are more satisfying and enjoyable.

Avoid the crowds: Try to shop at times when the grocery store is not as busy. Typically during the week, 3-6pm tends to be the busiest time at the grocery store.  Sundays are also very busy days.  Try to go in the morning, later in the evening, or on Saturday.   You can also look your grocery store up on google maps and look at their “popular times” bar graph to see less busy times to shop.

Check your status:
Be mindful of your vulnerability factors.  Are you tired? Stressed? Hungry? If the answer is yes, plan on engaging in some self-care first and going to the grocery store when you are feeling more rested, stable and satiated.

Ask an RD: If you need help planning meals, making grocery lists, expanding variety, and setting goals for improving your confidence with grocery shopping, ask your dietitian for support. If you do not have a dietitian, consider adding one to your treatment team if you are working through an eating disorder.

Remember that with learning any new skill, it takes practice and time.   If you have negative experiences with grocery shopping in your past, try some of these tips to begin developing more positive associations with going to the grocery store. Over time, this will help decrease your anxiety around grocery shopping. Plus, having food available for meals will help you stay on track on your journey to recovery.


The Center for Eating Disorders is excited to announce the launch of a brand new Grocery Shopping Support Program designed to aid individuals working on recovery from eating disorders including anorexia, bulimia and binge eating disorder. Parents/Caregivers of children and adolescents are also eligible for participation. Program components and goals include:

  • Snack/meal/menu planning
  • Grocery list development
  • Incorporation of challenging foods
  • Efficiently utilizing time spent in stores
  • Managing impulsive food purchases
  • Identifying triggers and coping skills
  • Decreasing anxiety around food and food purchases
  • Exposure to food-based environment
  • Individualized treatment goals

If you’re interested in scheduling a grocery support appointment, please call (410) 938-5252.  If you have questions about the program you can also email Hannah Huguenin.


Written By: Hannah Huguenin MS, RD, LDN
Outpatient Nutrition Coordinator

Hannah has been an integral part of The Center for Eating Disorders’ staff since 2008, and provides individual nutritional counseling for the outpatient population. In her role at The Center, she manages the outpatient nutrition team and leads program development. She was instrumental in building the Center’s new Grocery Shopping Support Program. Hannah also provides ongoing support to help patients decrease eating disorder behaviors, meet their nutritional goals and improve their relationship with food through nutrition education.

How to Stay Recovery-Focused When Interacting with Triggering Media

In our previous post we discussed a variety of reasons that individuals with eating disorders, especially those in the early stages of recovery, may choose not to watch the Netflix film To The Bone or other films they know could create roadblocks in their continued recovery.

With that said, triggering media has always been around and will always be a part of our society so it’s helpful to know how to navigate it.  Many individuals in long-term recovery or later stages of treatment might feel prepared to watch a film or read a book about eating disorders, despite triggering content. Many of our clinicians have helped to shape such exposure into therapeutic experiences for patients who are ready.  For example, during periods of strong recovery, seeing a film like To The Bone can be an opportunity to reflect on one’s own experience, see things from a new perspective, process lingering eating disorder thoughts or channel anger towards the eating disorder in productive ways.

If you’ve considered all of the options and decide you do want to watch a film about eating disorders, these are a few things to consider that can help you do so in safe and productive ways.

  1. Don’t watch alone. Watch with a support person you can trust and communicate openly with them about how it is impacting you in the moment. You might even consider pausing the show periodically to breathe, reflect and talk.
  2. Time it right. Only watch it when you know you’ll be attending a therapy session or support group within a few days so you can explore your reactions and get help challenging any distorted thoughts or concerns about what you see on screen. If you currently have a lot of other life stressors or you’re in a time of transition (moving, starting school, going through a divorce, etc.) you may want to consider waiting to watch until things settle down.
  3. Challenge the ED thoughts. Consider journaling about aspects of the movie that you find triggering and then refute and challenge the inaccurate, negative or distorted thoughts.
  4. Be an activist. Write a letter to the director of the film or to the editor of a local newspaper regarding what you liked or didn’t like, what was helpful vs. not helpful or what you’d like to see more of when it comes to films about eating disorders. For example, while To The Bone features one person of color and one male in supporting roles, the movie’s star and protagonist is a young, white, upper-middle class woman with anorexia. This doesn’t help to dismantle stereotypes about who is and isn’t impacted by eating disorders. Consider writing a letter that advocates for greater diversity in eating disorder representation or about another aspect of recovery that feels important to you.
  5. Create an escape clause. Allow yourself the option to stop watching at any point throughout the film. Eating disorders can be associated with all-or-nothing thinking so it may feel like once you start the movie you have to finish it, but remember it’s not so black and white. At any point, if you feel triggered or uneasy about what you’re watching, turn it off.
  6. Plan ahead. Decide in advance upon an alternative show to watch or a self-care activity you can do when the film is over (or if you stop watching early) that will help you sustain a more recovery-focused mindset.

Do you use these strategies or have other ideas for navigating triggering media safely?  Tweet them to us @CEDSheppPratt and we’ll add to the list. 


You may also be interested in reading: 
To Watch or Not to Watch: That is the Question, Navigating “To The Bone” and other potentially triggering movies about eating disorders

 

 

 

 

 

To Watch or Not to Watch: That is the Question

Navigating “To the Bone” and other Potentially Triggering or Inflammatory Movies about Eating Disorders

Like most things in life there are benefits and risks that come with exposure to media, especially media that depicts sensitive or potentially life-altering subject matter such as eating disorders, suicide or mental health. As you may have already noticed from the controversial conversations about it, the Netflix movie, To the Bone is no different. The film depicts a young woman, Ellen, in the throes of her eating disorder and follows her through the recovery process which the synopsis points out, includes
help from a “non-traditional doctor” played by Keanu Reeves. It may come as no surprise that the main character, Ellen, is a young, white, very thin, upper middle-class woman, and that the particular eating disorder she is dealing with is anorexia nervosa. Hollywood tends to over-rely on this stereotyped depiction of eating disorders, despite the fact that in reality, eating disorders and the people they impact are much more diverse.

As one of the nation’s longest-running providers of evidence-based treatment for children, adolescents and adults with eating disorders we’ve been asked by numerous patients and families in the previous weeks how to handle such a film.  And while To The Bone may be a new film, this is far from a new question.  Over the last several decades, similar questions have been raised in response to documentaries, blogs, fictional books and memoirs written by individuals recovering from eating disorders.

Decades of observing the impact of this type of media has reinforced our recommendation that individuals who are currently struggling with an eating disorder or those who are in the early stages of treatment and recovery don’t typically benefit from watching movies or reading books that display any of the following characteristics:

  • extremely graphic depictions of people engaged in eating disorder symptoms such as bingeing, purging, chewing/spitting, body checking, over-exercising, self-harming or abusing drugs and alcohol
  • detailed descriptions of ED thoughts and behaviors that are left unchallenged, unexplained or are not paired with sufficient education regarding the consequences
  • conversations that include specific numbers such as weights, clothing sizes, calorie counts or repetitions of exercise.

If you notice any of these characteristics in a movie, show or book, it should be a red flag that it might not be a beneficial resource or recovery-focused activity for someone who is currently struggling.

We always look to support popular media that finds a way to raise awareness and stimulate meaningful discussions about eating disorders in safe and non-triggering ways. With that in mind, we went into our own viewing of this newest movie with high hopes and an open mind. Unfortunately, what we found was that To The Bone ultimately ticks off all three of the red flags mentioned above. Furthermore, the film’s depiction of treatment methods and treatment protocols are far from helpful, safe, or accurate.  As a team of specialized professionals, many of whom have spent their entire careers learning about, researching and utilizing evidence-based treatments for eating disorders, this film was, quite frankly, disappointing and at times difficult for our staff to watch.

On the flip side, it did do a good job of illustrating the immense pain and struggle faced by those who are impacted by these illnesses. It also got people talking about an issue that is usually hushed in society despite the fact that eating disorders impact 20-30 million people.  Our hope would be that some viewers of the film gain insight or information that could help them check in with a friend or loved one who is showing warning signs and needs help.

Taking into account both perspectives and the possibility for all the positive and negative impacts, it’s crucial to think  critically about the media introduced to us as communities, families and individuals.

If you are a therapist, a parent, educator or friend of someone with an eating disorder

It’s really important to empower anyone considering watching a film about eating disorders to feel like they can disengage safely and with your support.  Let them know it’s okay to decide not to watch because it has the potential to be harmful for them and their recovery.  This can be a hard but powerful decision because it builds confidence and sets a precedent for recovery-focused decision-making.  How? Today, it might be saying no to a Netflix film that “everyone else is watching and talking about” but tomorrow it could be saying no to a dangerous cleanse that a favorite celebrity is promoting on social media or saying no to a friend that encourages you to step on her bathroom scale. Learning how to say no to such things, even when the societal pressure and internal urges are strong, is imperative for long-term recovery.

If you have an eating disorder or are in recovery from an eating disorder…

If you’re like a lot of our patients, seeing a trigger warning at the start of a film or hearing in advance that it might be detrimental isn’t always a deterrent and might even make the content more intriguing. We’ve heard from some of our patients that they choose to watch the film despite their own reservations and knowledge of the content.  Most of the reactions included versions of the following:

  • I found myself comparing my body to the actress in the film and thinking that maybe I wasn’t deserving of or didn’t really need treatment since I wasn’t as thin as her.
  • I found myself wishing I could go back to my eating disorder.
  • I was tempted to use “a little bit of my ED behaviors” and was reassuring myself I wouldn’t let it get that bad.
  • If she [the actress Lily Collins] can “lose weight safely” for this role after recovering from an eating disorder in real life than maybe I can too.  

Despite what may be positive intentions for this film, it’s important to be realistic about how it actually plays out for the millions of people with eating disorders who watch it. While not everyone will have reactions like these, we think it’s important for individuals and support people to know it’s a possibility that the person who is struggling with an eating disorder may overlook the negative aspects of the eating disorder on screen and only see the perceived positive or glamorized aspects.

If you are struggling with whether or not to watch this film, or engage with any other eating-disorder focused media, remember that it’s okay to say no. At the very least, we encourage you to discuss your decision with a treatment provider or trusted support person.  If you decide together that watching this type of film might actually be beneficial at certain stages of recovery, check out these guidelines for watching safely.

Some of the most important ways to enhance recovery and prevent relapse include: continuing regular contact with treatment providers, following evidence-based recommendations, engaging in regular self-care and creating a home environment that is conducive to your continued healing and recovery. In this case, that might also include creating a Netflix watchlist that doesn’t have anything to do with eating disorders.

Do you have thoughts on the film or the media surrounding it? Join the discussion on our Facebook page.


Written by Kate Clemmer, LCSW-C, Community Outreach Coordinator, The Center for Eating Disorders at Sheppard Pratt

A Focus on Body Image & Eating Disorders in Boys & Men for #menshealthmonth

“Get Lean in 2017”
“Shrink Your Gut,”
“Add Bulk To Your Arms”
“Get Rock Hard Abs,”

These are just a few of the typical headlines that can be seen on fitness and “health” magazines geared towards men. While there has been fairly widespread awareness cultivated around the media’s negative impact on women’s body image, not as much attention has been paid to how the media targets men and boys with similar body shaming tactics.

Our culture in general, and the media specifically, often pushes women to lose, lose, lose so they can be smaller, thinner and closer to an elusive definition of “perfect” but the opposite message is often being pushed towards men; most advertising and traditional media suggests the male quest for perfection requires they be bigger, stronger and more muscular.  Products previously peddled exclusively towards women – hair removal items, weight loss diets, tanning products, and plastic surgery – are expanding their markets by making men take a harder, longer and much more critical look at their own appearance.

A 2016 review of five national studies found that 20 to 40 percent of men were unhappy with some aspect of their looks, including physical appearance, weight, and muscle size and tone. An earlier study found that college aged men who viewed media images of muscular men showed a significantly greater discrepancy between their own perceived muscularity (what they think they look like) and their ideal body (what they feel they should look like). The researchers suggested their results could show that even brief exposure to such idealized images can increase body dissatisfaction in men.

Despite this ongoing push for men to get bigger and stronger, over the last decade we’ve also seen the juxtaposition of thinner versions of masculinity.  You can see it when looking at modern male mannequins with impossibly small waists and very slim – yet sculpted – abdomens and legs.  Conflicting body ideals abound. So what is the message after all…get bigger, but stay lean? Be muscular, but still fit in those trendy skinny jeans? It’s mind numbing to try and understand, and even more impossible to attain, yet these are the messages that boys are forced to decipher from a very young age and often continue to wrestle with into adulthood and middle age.

Given all of this, it isn’t that surprising a 2014 study of more than five thousand males aged 12 to 18 years found nearly 18 percent of boys are highly concerned about their weight and physique. Of the boys who were highly concerned with their weight, about half were worried only about gaining more muscle, and approximately a third were concerned with both thinness and muscularity simultaneously.

It’s important to note that, as is also the case with females, photoshopped advertisements and a general lack of diversity in the media’s representation of bodies does not in and of itself cause eating disorders. Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder are complex illnesses with genetic and biologic underpinnings. However, environmental triggers such as narrow or unrealistic body ideals in the media can contribute to increased levels of body dissatisfaction which has been identified as a risk factor for eating disorders.

Dealing with unhealthy media messages is something that almost every man will have to deal with. As is also the case with girls and women, the dangers lie in the drastic steps some boys and men may take to try to manage increasing body image anxiety. Guys who are more dissatisfied with their bodies may be more likely to engage in risky weight loss, bulking or sculpting behaviors such as extremely restrictive diets, cleanses, steroids, supplements or excessive exercise. These are unhealthy and potentially dangerous behaviors for anyone.  However, in boys and men who are genetically at risk for eating disorders, these types of behaviors can set the stage for an eating disorder, triggering changes in the brain, disrupting metabolic functioning, dysregulating hunger/fullness cues and often worsening body image, mood and anxiety symptoms. Boys and men who have a history of trauma, are involved in sports or careers that promote weight loss and perfection, and those with close family members with a history of an eating disorder are also at higher risk for developing one themselves.

Eating disorders have long been miscategorized as purely a women’s issue, even by some healthcare professionals. As a result it’s quite common for major warning signs like excessive exercise or drastic changes to diet to be overlooked or even congratulated in men. Stigma and stereotypes in the eating disorders combine to make it difficult for men who are stuck in the cycle of disordered eating to break out of it and get help. It is suggested that 25-40% of people with eating disorders are men, yet they only make up about 10% of people seeking treatment.

Talking openly about eating disorders can help minimize shame and embarrassment for males struggling with these issues. At The Center for Eating Disorders at Sheppard Pratt, we’ve been treating men with eating disorders for more than twenty-five years and we’re encouraged by the changes we hear in the conversations more recently. More men have been speaking out locally and using national platforms to raise awareness. In just the last year, Zayn Malik of the band One Direction discussed his struggle with an eating disorder and anxiety, performer/songwriter Matthew Koma wrote a poignant blog about his recovery from anorexia, and Joey Julius, a football player at Penn State, made a series of public statements regarding his decision to seek treatment for binge eating disorder. Their messages all point to a resounding hopefulness stemming from the reality that treatment is available and men can heal from their eating disorders and body dissatisfaction.

So what can you do to help the men in your life?

Start by checking in with them. The Let’s Check In campaign is all about empowering individuals, families and communities to talk openly about eating disorders and to strengthen support for individuals of all genders who might feel alone. When it comes to eating disorders, early identification and prompt help-seeking can make a big difference. You can play a role in supporting prevention and recovery from eating disorders simply by educating and preparing yourself.

Know the risk factors and pay attention to any sudden shifts in diet, exercise routine or increased negative comments about themselves or their body. If you’re unsure, the confidential online assessment is a quick tool that can help you gauge whether someone you love might be at risk.  Second, if you are seeing increasing warning signs plan to check in with your friend or loved about your concerns and provide them with compassion and resources.  A fact sheet, conversation guide and additional resources are available at www.letscheckin.com/.


Regis Aguglia, LCSW-C

Written by:
Regis Aguglia, LCSW-C,
Family Therapist at The Center for Eating Disorders at Sheppard Pratt
Regis Aguglia earned his Masters in Social Work from the University of Maryland in 2010. Prior to joining The Center for Eating Disorders in 2014, Regis provided individual, family and group therapy in outpatient and school-based settings and gained experience treating individuals struggling with substance abuse. As a Family Therapist in The Center’s inpatient and partial hospital programs, Regis works with families to understand the impact of an eating disorder on the family system and helps to strengthen communication, coping skills, nutritional stability and recovery-focused support. Regis also facilitates a number of inpatient therapy groups including dual diagnosis groups for patients with co-occurring substance abuse and a specialty group for boys and men with eating disorders.