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

 


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

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

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


Unique Stressors Faced by LGBT+ Individuals

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


The Transgender Community

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

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


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

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

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

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


LGBTQ+ and Related Hotline Numbers

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

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


Blog contributions by Catherine Pappano, CED Research Assistant 

You may also be interested in reading:

 


References

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

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

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

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

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

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

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

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


What does it mean to live authentically? 

Honoring your truth.

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

 

Documenting Self-Discovery through Transition and Recovery

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

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

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

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

 

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

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

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

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

 

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

 

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


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


References

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

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

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

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

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

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

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

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

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

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.

Body Comparison: An Olympic Sport?


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

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

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

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You might also be interested in reading:

Adventures in Self-Care with Melissa Fabello, Part II

 

MF 003
In honor of National Eating Disorders Awareness Week 2016 (Feb. 21-27), we asked body acceptance activist and eating disorder recovery advocate, Melissa Fabello to share her thoughts on some essential eating disorder awareness topics.  If you missed it, you can find her thoughts on self-care, perfectionism and dieting in Part I.

Below, in part II she opens the door to important conversations about body neutrality and intersectionality, and she also shares the one thing she wants people struggling with eating disorders to know about recovery.

 


Q & A with MELISSA FABELLO: Part II

 

Q: You recently wrote an awesome list of 50 body acceptance resolutions for 2016. In that list you introduce body neutrality as an alternative goal when body positivity feels like too much pressure. What did you mean by that?

MF: There are so many aims of the body acceptance or body positivity movement that I love. I have found so much comfort, joy, and support within those communities, and I am forever grateful to them for that. I’ve also found some missteps that I think need correcting, one of which being the push for everyone to feel beautiful and to love their bodies. I think that’s a lovely goal, and I also think it’s too lofty for reality.

Because the truth is that no one loves their body every single day – no one. Part of how body image works is that it can shift and that we all have good days, and we all have bad days. Mostly, when we have healthy body image, we simply see our body for what it is without ascribing any meaning to it whatsoever, and we exist, full of acceptance, in that body. To me, that’s what body neutrality is about. It’s about acknowledging and accepting our body as is, rather than pushing ourselves to have extreme feelings about it either way.

And I like to think of it as an option – not an alternative to the mainstream body acceptance movement. I like to think of it as something that someone can choose to work toward, if that goal feels more realistic than one of unconditional love. Perhaps, even, I like to think of it as a stop on the train toward a more loving relationship with our bodies. I just think that pushing people to love their bodies can backfire if it creates another standard to live up to.

 

Q: In all of your writing and in advocating for individuals with eating disorders, you take great care to acknowledge the true diversity of those who are impacted. From gender to age to race and socioeconomic status, why is it so important to you to highlight these marginalized voices in your work?

MF: Intersectionality – the understanding that intersecting social identities exist, a term that was coined by Kimberlé Crenshaw – is an absolute must in any and all work, I believe, but especially in work that stems from feminism. The ways in which we’re impacted by society differ, based on our identities. As a queer woman, for example, I experience life differently than a straight woman or a queer man. As a white woman, I experience life differently than a woman of color or a white man. Our positionality within the complicated web of identity matters because it affects how we move through this world. This is true in regards to body image and eating disorders, too.

We talk a lot about the thin ideal in our work – and that’s a very real, valid concern. We talk less, though, about how our beauty ideals are also centered on whiteness, on a heteronormative idea of gender roles, on access to money, on youth, and many other intersections. The further that we get away from the ideal, the more suffering we may experience as a result, and the more pressure we may feel to approximate those ideals. And I think that when we center the most marginalized – the people furthest from that ideal – in our work, then we help more people. When our work focuses on white, middle class, cis women, for example, then those are the only people that we help.

The eating disorder field has long focused its efforts on a very specific population, and I think it’s far past time to admit that and to work actively to eradicate the ways that that focus perpetuates systems of oppression like white supremacy and classism, among others. Different voices need to be centered because different 670_06_NEDAW_TWITTER_01_2016_P12experiences exist and have been ignored.

 

Q: Who do you think could benefit from attending your presentation, Adventures in Self-Care: Everyday strategies for nurturing an imperfect recovery in the real world?

MF: I think that anyone could, honestly! It’s been my experience that conversations around self-care can be difficult to have because so few people practice it. I’m going to talk a lot about what self-care means and why it’s important, but I’m also going to give ideas on how to start cultivating more self-care practices in your life – in ways that are easy and practical. I think that anyone who feels like sometimes life is overwhelming and they need some “me” time could benefit from this conversation – and isn’t that everyone?

 

Q: Lastly, what is the one thing you would want to tell someone who is struggling with an eating disorder and may be feeling ambivalent, hopeless, overwhelmed by or resistant to the prospect of recovery?

MF: I want them to know that those are very real and valid feelings to have. I want them to know that we’ve all come up against that at some point or another. And I want them to know that one of the biggest obstacles to recovery is believing that it’s one huge accomplishment that looks a certain way. It’s not. Recovery is about a whole bunch of tiny successes that lead you to a healthier, happier place – defined by you. Recovery is in your reach because you get to decide what it looks like and how to get there. But first, you need to take the first step of believing (even skeptically!) that it’s a possibility. And it is. I promise you that it is.

 

Continue the conversation with us on Facebook and Twitter using the hashtag #bmoreselfcare. 


Many thanks to Melissa Fabello for taking the time to share her passionate and thoughtful responses. If you’d like to hear more from Melissa, join us in Baltimore on February 21 to help kick-off National Eating Disorders Awareness Week. Don’t forget to RSVP. Space is limited. 

Download an Event Flyer to share or post:
Adventures in Self-Care…Everyday strategies for nurturing an imperfect recovery in the real world (PDF)

You can find Part I of our Q&A with Melissa here.

 



 

A Reason to Smile ~ A Featured #NEDAwareness Q&A with Benjamin O’Keefe

Ben-headshot-2nd

 

BENJAMIN O’KEEFE is an actor, activist, and writer.  Besides working as a performer, Ben has been an emerging leader in activism work focused on LGBT rights, Youth Rights, and Body Image. In this role, Ben has been responsible for creating many major movements of change – most notably, an International movement against size discrimination by Abercrombie & Fitch. Benjamin will speak about his recovery from an eating disorder at a free event on February 22 in Baltimore where he will also co-facilitate a workshop looking at how individual and collective cultural experiences shape the treatment and recovery process.


Today on the blog, Ben shared with us his answers to some of our questions about the recovery journey so that we could share them with you.  Please feel free to leave a comment here on the blog or head over to our Facebook page to thank Ben for his inspiring responses.

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Q & A with Benajamin O’Keefe

 Q: What is one fact about eating disorders that you think is most important for people to know and understand?

Ben: I think the most important thing to know about eating disorders is that they affect no two people the same. They don’t discriminate–even though many people’s opinions on them do. I think that the way we discuss eating disorders needs to fundamentally change. We need to break down the taboo around eating disorders, and start talking about the ways that these disorders affect people from all walks of life and of all cultural make up.

Q: What is one thing you learned about yourself during your experience with an eating disorder and/or the recovery process?

Ben: I learned that I could make it through it anything. Back when I was sick, I never thought that I would make it out of the dark hole that was my disorder. And I certainly never thought that I would make it out to become a person who loves himself so thoroughly–and helps encourage others to do the same.

I learned that, not only am I good enough, but I am great just the way I am.

I learned to surround myself with love, whether that be in the people I spend time with or the environments in which I put myself.

I learned to love my reflection, but more importantly to love what that mirror can’t show me. I am more than a number on a scale, I am a person that deserves love and happiness.

Q: Did you face any specific challenge during the recovery process and what helped you overcome it?

Ben: The road to recovery is so different for every person, but one thing that I think everyone can relate to is the isolation that comes with an eating disorder. It’s so easy to feel like we are alone, in fact it’s Ben-headshot-1024x683exactly what the eating disorder wants you to feel, but it’s just simply not the case. There are people that love you, people you don’t even know.

For me, finding a community of people; whether it be people currently struggling, recovered, or just allies, helped me to see that I truly wasn’t alone in my fight, and that we could get through it together.

Q: What are some day-to-day differences between life with an eating disorder and living life in recovery/recovered from an eating disorder?

Ben: I think the biggest difference is my relationship with food. It’s no longer an enemy. I eat when I’m hungry, I stop when I’m full. If I feel like having a cookie, then I eat a cookie. It’s seems simple, but for someone who is struggling with an eating disorder, it’s not.

For me, I now know that food gives life, and that I shouldn’t fear it, but enjoy it. I make healthy choices, and exercise regularly, but it’s no longer about a number on scale, but instead about being the healthiest person that I can be.

Q: What feedback would you give to the support people – friends and family – of individuals struggling with eating disorders? How can they best help to aid in the recovery process?

Ben: First of all I say THANK YOU. This is a journey for you too, and sometimes we don’t think to say thank you to the people supporting us.

Second, I think that my feedback would be to find patience. It’s easy for support people to become frustrated when they see their loved ones taking actions that don’t make sense to them, but it’s important to remember that this is a mental disorder. It’s not a choice.

With patience, love, and support your loved one can make it through. They need you—and your strength and love.

Q: Everyone defines recovery differently. What does recovery mean to you?

Ben: Recovery to me means regaining my reason to smile. When I struggled with anorexia I felt like I was never happy. No matter what I did, how thin I got, what compliment I received on my appearance, it was never enough.

Now, it’s hard to find me without a smile on my face. I love life, and I do my best to take whatever comes my way—good or bad—with a smile on my face. To me that is the biggest indication of my recovery.

 Benjamin Okeefe SMILEYou can find Ben smiling over on Twitter @benjaminokeefe.

 Leave your comments below and head over to RSVP for Ben’s upcoming talk at Recovery in Real Life.  You can also view a video invitation from Benjamin here.

I Had No Idea…Males and Eating Disorders – National Eating Disorders Awareness Week 2014

This helpful infographic from The National Eating Disorders Association helps to break down some of the key facts. Spread the word and help others by breaking down stereotypes and supporting accurate information about  males and eating disorders.  Join us on Facebook for more information and to join the #NEDAWeek conversation.

Infographic: Males & Eating DisordersThe Center for Eating Disorders at Sheppard Pratt has been treating males affected by eating disorders for over twenty years yet barriers remain for those seeking treatment.  Cultural stigma regarding males and eating disorders can make it more difficult for men to come forward and seek treatment on their own. The good news is that education, support and awareness about eating disorders among males are all improving so that more boys and men are seeking and receiving the treatment they need and deserve.

More, More, More: The Dangers of Excessive Exercise

There is such a thing as too much exercise

Media messages encouraging us to exercise away our “flaws” are rampant, particularly in these summer months when many people are self-conscious about wearing bathing suits and dressing for warmer weather.   We’re nearly halfway through summer but the seasonal cultural pressures to attain the “perfect” beach body are still in full swing. The relentless marketing often focuses on incorporating the most strenuous new workouts, squeezing in more time at the gym, pushing just a little bit harder and faster every step of the way.  When it comes to exercise, the message almost always seems to be more, more, more.

It’s true that staying active and engaging in exercise is a positive activity that can have long-lasting benefits for physical and mental health.  However, it becomes increasingly important in our “faster, longer, harder, more” exercise culture to ask ourselves, can you have too much of a good thing? The Answer:  Absolutely.

 

More is not always better.

Exercise can quickly become unhealthy when taken to extremes or when the body is not equipped with proper nourishment.  Individuals who struggle with perfectionism, rigidity, obsessive/compulsive behavior, addiction or eating disorders are particularly at-risk for engaging in over-exercise (also referred to as exercise abuse or obsessive exercise.)  These individuals often start out with moderate exercise goals in an attempt to change their weight/body shape but can easily slip into patterns that become compulsive.

Often, the same messages that promote extreme exercise also encourage people to ignore their body’s cues – to push past pain and exhaustion in order to reach goals.  But when you override your body’s need for rest, healing, or even medical attention, it can have long-term negative consequences on health, not to mention on overall fitness and athletic performance. Furthermore, exercise and weight loss goals may gradually become more and more extreme, and thus more and more dangerous. It’s important to note that even individuals who do not appear underweight, may be exercising obsessively or working out beyond what is healthy for their body.  Even high caliber athletes are at risk.

“It is no secret among athletes that in order to improve performance you’ve got to work hard. However, hard training breaks you down and makes you weaker. It is rest that makes you stronger. Physiologic improvement in sports only occurs during the rest period following hard training.” [Overtraining Syndrome]

 

Signs & Symptoms of Excessive Exercise
Because exercise is such a socially acceptable and culturally applauded behavior, it can be difficult to identify when someone is engaging in healthy activity and when they may have crossed the line to over-exercise.  It’s particularly important for coaches, trainers, fitness instructors and other professionals in the exercise industry to be aware of the warning signs and red flags that someone may be struggling with obsessive exercise.  These are just some of the signs that an individual may have an unhealthy relationship with exercise:

  • Exercises above and beyond what would be considered a normal amount of time (For athletes, prolonged training above and beyond that required for the sport)
  • Refusal to build in days of rest or recovery; Exercises despite injury or illness
  • Athletic performance plateaus or declines (Overtraining Syndrome)
  • Rigidity, inflexibility regarding exercise schedule
  • Excessive concern with body aesthetic
  • Withdrawal effects (sleep/appetite disturbance, mood shifts, intense anxiety) and feelings of depression or guilt when exercise is withheld
  • Exercise is prioritized over family, work, school or relationships (sometimes to the point of neglecting important responsibilities or obligations)
  • Exercise is the person’s only way of coping with stress
  • Deprives self of food if unable to exercise (feels he/she has not “earned” or “does not deserve” the calories)
  • Defines overall self-worth in terms of exercise performance
  • After workouts, is plagued by thoughts like “I didn’t do enough” or “I should have done more”
  • Rarely takes part in exercise for fun. Activities like hiking, paddle boarding, etc, don’t seem like “good enough” exercise.

If you or someone you know identify with this list, it may be time to step back and take an honest assessment of the exercise relationship.
Excessive exercise not only interferes with an individual’s daily life and interpersonal relationships, but it is also dangerous. Excessive exercise can easily result in overuse injuries and stress fractures which could be temporary or permanent.  Women may have menstrual irregularity and men may experience a decrease in testosterone.  Among the many other potential consequences, exercising too much can lead to decreased immunity and frequent colds or illnesses.  Over-exercise is often a sign of an underlying eating disorder.  Furthermore, recent research found that the frequency of over-exercise predicted suicidal gestures/attempts and concluded that excessive exercise should be noted as a potential warning sign of suicidality among individuals with bulimia. [source: Eating Disorders Review,  May/June 2013]

If your body is telling you that it needs a rest…
You should never exercise when you are sick or injured. When you have a fever, fatigue or muscle injuries, take the day off to help your body heal.  Even a very healthy body needs adequate rest in between workouts.  It’s recommended that you take at least two days off a week to allow your body time for healing and recovery.  Also, make sure that you are properly providing your body with enough carbohydrates, dietary fats, proteins and water to fuel your workouts. Proper hydration is critical when working out.  Dehydration can lead to overheating, muscle fatigue, headache, nausea and it impairs your body’s ability to transport oxygen.

Maintain a Healthy Relationship with Exercise
There are many ways to have a healthy relationship with exercise. First, it is extremely important that you have spoken to your doctors and they have all cleared you for exercise. Just like many things in life, moderation is the key to success.  Focus on establishing a balance between working out and other experiences, relationships and responsibilities in your life.  Consider combining a variety of activities that you enjoy and are convenient to your lifestyle instead of becoming overly attached to one type of exercise for a specific amount of time each day.  Hiking, golfing, dancing, biking, tennis, kayaking and taking your dog for that much needed walk are great ways to be active in different ways. Remember that the goal of healthy exercise is not to change your body but to care for your body so that it will allow you to enjoy your life.

If you think you may be struggling with excessive exercise, we encourage you to talk with someone close to you and seek help to establish a healthier relationship with exercise. You can also visit www.eatingdisorder.org or call us (410) 938-5252.

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Additional Resources:

The Exercise Balance: What’s Too Much, What’s Too Little, and What’s Just Right for You! By Pauline Powers M.D. and Ron Thompson Ph.D.

In response to Dr. Drew ~ Exercise bulimia is not a mild mental health issue (on the CED blog)

 Blog contributions by Amy Gooding, Psy.D., CED Therapist

Invisible Victory: An Athlete’s Story of Hope & Triumph in Eating Disorder Recovery ~ Q & A with Whitney Post

In observance of National Eating Disorders Awareness Week 2012, The Center for Eating Disorders at Sheppard Pratt in Baltimore is excited to offer a special community event to raise awareness about the serious nature of eating disorders, the importance of treatment and support, and to help shed some light on the surprising place where eating disorders often hide – on sports teams and among athletes.  On February 26th, former World Champion rower, Whitney Post, will be speaking about her own identity as an elite athlete and how she ultimately used it to her advantage while recovering from an eating disorder.  Today, Whitney is the President and Co-Founder of Eating for Life Alliance and spends much of her time educating college students, professionals, athletes and coaches about eating disorder prevention and treatment.   

In advance of her talk, we asked Whitney to comment on this important topic and provide our readers with a glimpse into her February 26th presentation entitled, Invisible Victory: An Athlete’s Story of Hope & Triumph in Eating Disorder Recovery. 

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Q & A with Whitney Ladd Post:

Why do you think it is important to address the intersection between sports and disordered eating? What are the benefits to creating awareness and spreading education about this particular topic?

WP: For starters, we live in a culture that is incredibly rewarding of the goal-oriented, driven, take-responsibility, and perfectionistic qualities of athletes.  In addition, the media sensationalizes athletic bodies, not just athletic performances. In athletes, the body can become an obsessive focus as well as a tool for athletic success. Many of the traits that make people successful and driven athletes, can also be easily misdirected towards disordered eating and an overly-critical body image. In one study of college female athletes, 88 % felt they were overweight or needed to lose weight. Another challenge is that some athletic cultures perpetuate the myth that weight loss improves performance, and athletes may be reluctant to acknowledge a problem or seek treatment. In short, it can be very easy for athletes to hide a serious and dangerous eating disorder because they often appear, from the outside, to be excelling at their sport and may look incredibly fit and healthy.

My goal is for everyone, athletes in particular,  to understand the physical and emotional consequences of eating disorders and disordered eating in the short and long term.  Weight loss in athletics can often be presented as the magical elixir, but if it compromises health it will ultimately compromise performance.  I want athletes to know that it is a highly treatable disorder with early and proper interventions, and I want to address their reluctance to seek treatment. In my experience an eating disorder never gets better if left untreated, only worse.

Research tells us that eating disorders are biologically-based illnesses but that a variety of other factors can also play a role in how and when the illness is expressed in different individuals.  Did being an athlete affect your struggle with the eating disorder?  What role did it play in your recovery?

WP: When people ask me if lightweight rowing gave me an eating disorder, I say absolutely not. I loved being on the water, I loved the sense of team, and I loved working hard to win. Yet, I also had an attraction to the grueling process of making weight for the sport, as part of my willingness to put my body through extremes for the sake of weight loss.  Lightweight rowing offered me a mechanism to play out my unhealthy relationship with food and my body.  My years as a lightweight further entrenched my eating disordered mentality.

Yet, there are many features of athletics that can be applied to recovery if the right goals are set.  The sense of team, commitment, step-by-step training toward a goal, and positive self-coaching as well as support and guidance from others can be applied to the treatment of an eating disorder.  Part of my message is that some of the same liabilities of competition and training can be redirected toward recovery.

Your blog about eating disorder recovery is called “Invisible Victory” – why do you refer to this victory as invisible?

WP: Great question.  For me, all my goals in my sports career involved getting noticed, recognized, and praised.  There was always a teammate or a coach or spectator to witness when my hard work resulted in success.  The situation was very different with my eating disorder recovery.  I had to be my own cheer leader, because so many of my victories were not even perceptible to anyone else.  Monitoring and changing my thoughts, behaviors, and reactions were crucial to creating a new relationship with food and my body.  I had to learn to both accept the invisible nature of my new quest, and celebrate the victories big and small with or without witnesses.

When you were struggling with an eating disorder, did you ever reach a point where you didn’t think recovery was possible?  If so, what helped you push past it and what message would you give to other individuals who may be feeling that way now?

WP: Recovery felt very much the way many of my lofty athletic goals felt.  At times I faced feeling totally devastated, discouraged, and depressed, but I never stopped working in the direction of my goal.  So of course there were many times when I wasn’t sure I would ever find my way out of my little prison in which I was both warden and prisoner, but I never stopped trying.

How has your definition of health changed throughout your life as you were struggling with an eating disorder and now, as an advocate for recovery?

WP: The biggest tangible change over the years has been that my self-worth and self-image are no longer tied to exercise. Exercise is still very important to me, but now I workout mainly for the health, mood, and social benefits (I love working out with a friend).   I believe the best way to advocate for health and recovery is to live it.  I continue to place a high priority on physical, spiritual and emotional health.  Without that, nothing else works very well.

It’s clear from your bio at Eating for Life Alliance (ELA) that you’ve accomplished a great number and variety of personal and professional goals.  What would you say you are most proud of today and why?

WP: I am so happy to be freed up from the narrow vision of the world that defines eating disorders.  Instead of all the daily struggles faced when I defined myself by my body, I am now free to channel my energies to so many things.  For me, recovery from my eating disorder was a gateway to an easier and more fulfilling life.  I have a wonderful marriage and a new family, great friendships, and the opportunity to work professionally on something I am passionate about.  Before recovery these things seemed to always belong to other people, not me.

What do you hope is the take-home message for those who attend your presentation on February 26th?  Who could benefit from attending?

WP: My message is one that can benefit anyone who has been affected by an eating disorder themselves or has had a loved one with an eating disorder.  It is also important information for any parent, professional, educator, coach or friend who will likely be in a position to help someone someday if they know what to look for and how to respond.

One practical message I plan to get across to athletes and those who work with them is this: although athletes have a unique set of factors that make them more susceptible to eating disorders, they also have impressive assets that can be enlisted in helping them recover.  Eating disorders are common in athletes, and I don’t want anyone to be isolated and without the help she or he needs.

I want to offer education and encouragement to everyone who attends and wants to know more about eating disorders as they pertain to exercise and athletics, as well as to anyone out there who is looking for more hope.

Download the event flyer (pdf)

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Many thanks to Whitney Post for taking the time to provide these responses and for having the courage to share her story so that so many others may know they are not alone. 

If you would like to hear more about Whitney’s story of recovery, please join us on Sunday, February 26th at 2:00 pm for our NEDAWeek kick-off event, Invisible Victory: An Athlete’s Story of Hope & Triumph in Eating Disorder Recovery.  All are welcome to attend this FREE event.  We strongly encourage athletes, coaches, athletic trainers and athletic directors from surrounding schools and colleges to attend,  as well as any individual who has been personally affected by an eating disorder, their parents, friends, educators, and health professionals.  Please download an event flyer for details.  Attendance is free but seats are limited so pre-registration is encouraged by emailing: RSVP@sheppardpratt.org

This is just one of several special events to be offered over the course of NEDAWeek.  Find out more on our Events Page

You can also request a mailing of event flyers or posters for your organization by emailing  kclemmer@sheppardpratt.org.  

 

Bathing Suit Blues?

Summer is a season of many perks…beach vacations, picnics, holiday weekends,  longer days, blooming gardens, swimming pools, lightning bugs and flip flops, just to name a few.  But for males and females who struggle with their body image, this otherwise pleasant season can be overshadowed by anxiety and dread.  Like clockwork, every spring we are bombarded by messages telling us to “Shape Up for Summer” or “Shed those Extra Winter Pounds”.  As weather gets warmer and clothes get skimpier, even people who coasted through winter without worry, suddenly become more aware of their body weight and shape. And for those who struggle on a daily basis with negative body image or eating disorders, summer offers added challenges along the journey towards finding body confidence.  Pressure to conform can be overwhelming when surrounded by friends or family on that illusive search for the “perfect” beach body – a fruitless and unrealistic ideal sold to us by advertisers, often with complete disregard for health. For some, just the thought of purchasing a bathing suit can trigger enough worry and self doubt to allow these harmful media messages to seep in.  From crash diets to tanning beds, summer can quickly become a minefield of dangerous behaviors and deteriorating health.

So what can you do if summertime stress has you low on body confidence?  Can you make it through the barrage of destructive messages this summer and still come out okay?  Better yet, can you use it as an opportunity to gain confidence, positivity and strength?  We say yes, you can! Here are some suggestions:

Talk back. Okay, maybe this goes against everything your parents ever told you but certainly they won’t mind a little attitude if directed at the media and not at them.  Dispute harmful summer body myths with positive self-talk, and say it like you mean it…

“No one can tell me what I can and can’t wear; I will find and wear a swimsuit that fits and flatters my body JUST AS I AM instead of trying to change my body to fit into a pre-determined size or style.”

 “I refuse to miss out on fun opportunities in my life because some magazine tells me I’m not skinny enough, tan enough or muscular enough to be seen in a bathing suit.”

Stop and smell the roses…literally and figuratively.  Grow a garden, plant a tree, feel the grass between your toes, and breathe in the sweet summer air.  Sit outside and read a good book feeling the warm sunshine upon your face.  Look up in the night sky and gaze at the stars.  Be mindful of the scenery and sounds around you this summer. Sail on a boat, take a nature walk, listen to the rain on the roof during a thunder storm.  Enjoy all of your five senses with gratitude, and remember to give your body credit for allowing you to do all of these awesome things.

Accessorize. It can be fun to sport a great sun hat or trendy sunglasses that make you feel great and don’t have a size on their tag.  And while those accessories are eye-catching, we’d argue that the best beach bodies are those adorned with confidence and a smile.  If authentic confidence is hard for you right now, practice the “fake it until you make it” technique consistently, especially if you are going to be around young kids or adolescents who will be modeling your body image behaviors.

Teach others about a healthy lifestyle and show them the power of your positive energy.  Refrain from reading articles focused on weight, and talk often about how good health has nothing to do with the number on a scale.  Remind yourself and others that pressures from society regarding body size are unrealistic, unhealthy and dangerous.  Spend extra time with supportive friends and loved ones who also understand, appreciate, and embrace a diverse definition of beauty.

Change it up! Wear a different color, try a new sport or connect with a new friend.  Take a day trip somewhere you’ve never been or try a hobby you were always curious about.  Relish in the extra hours of sunlight and remember that a changing of the seasons is not about how you look in a bathing suit, but rather how you live your life.

Be kind. Treat your body, and other people’s bodies, with respect and dignity.

We’ve said it before… and we’ll say it again: Dieting does not work.  In fact, dieting damages your physical and mental well being. Chronic dieters are more likely to be depressed, have low self-esteem and most will end up at higher weights than they started. There’s a reason counting calories and adding up meal points were not included in our list of fun things about summer.   Summer is bound to go by quickly… try spending your time and energy on activities that are actually enjoyable and beneficial.  Dieting is neither of those things.

Let’s welcome summer and bid farewell to any lingering anxiety.  We hope you can spend time appreciating where you and your body are in this moment.

What are you doing to make the best of your summer and to turn the bathing suit blues into body confidence? Share your strategy on our Facebook page!

Find out more about The Center for Eating Disorders at Sheppard Pratt at www.eatingdisorder.org.

Blog contributions by Amy Scott, LCPC