3 Basic Recovery Tips for Moms & Moms-to-be with Eating Disorders

Pregnancy and motherhood can be extremely daunting. The “what-ifs?”, “can I manage it all?” and “what will my body do?” internal dialogue often begins quite early in the process of parenthood, even among women without eating disorders.  When a woman struggles with body dissatisfaction and disordered eating, normal concerns throughout pregnancy and parenting can escalate into major anxiety. They may also fuel a new or renewed focus on weight and shape that can lead to harmful behaviors like restriction, purging, bingeing or obsessive exercise. Co-occurring depression – or postpartum depression – can also be risk factors for disordered eating.

According to data from the CDC, the average age at which women have their first child is 28 and this has been steadily rising for decades. As of 2016 however, the demographic with the highest birth rates are actually women in their early thirties (ages 30-34).1 This holds true across all fifty states as well as all racial and ethnic groups.

Interestingly, women between the ages of 30 and 40 are also increasingly seeking treatment for eating disorders. Eating disorders affect about 10% of women during their reproductive years and this number may be growing.  With this in mind, it has become exceedingly apparent that there is a need to tailor treatment to mothers and mothers-to-be in order to effectively assist women during this stage of life.

Pregnancy-related body image concerns combined with the extra stressors of parenting – and feeding – young children can complicate eating disorder recovery efforts. But there are also opportunities and strengths in this new role and certain things moms-to-be can do to stay recovery-focused during the adventures of pregnancy and parenthood. Below are three very basic tips to help provide a starting point for a healthy transition.

 

1. BE HONEST.

If you’re currently pregnant, tell your OB or midwife that you have a history of an eating disorder and about your current or past symptoms.

Some women say they feel shame or guilt in expressing feelings of body-dissatisfaction or disclosing ED symptoms to their medical providers, especially during pregnancy and post-partum. If you find yourself battling these thoughts, it’s helpful to remember that eating disorders thrive on silence and secrecy. Keeping symptoms a secret usually means things get worse, not better. Being open with your OB or midwife allows them to better care for you and more accurately monitor the health of your baby. When your providers know about the eating disorder they can also do more to support your recovery efforts; this could include connecting you with a local support group or tailoring discussions about food and exercise appropriately. Remember, eating disorders are serious illnesses – not simply a choice or lifestyle. It’s okay to let go of the guilt and shame so you can move forward with help.

 

2. EMBRACE IMPERFECTIONS.

You can’t do it all perfectly—nobody can (even if it looks like they do on social media).

More mothers than ever are raising their children while managing full-time careers outside of the home and trying to keep up with ever-increasing expectations for the always perfect outfit, an exquisitely clean house and an expertly planned family vacation.On top of it all, posting finely tuned photos on social media to prove it all happened can almost feel mandatory.Moms who internalize this pressure are understandably overwhelmed because perfection is a race that no one wins. Remember, even the people who look like they have it all together online, are only sharing what they want people to see. It’s essentially a person’s curated highlight reel; the behind-the-scenes shots may not be so picture perfect.

Given that the trait of perfectionism is an established genetic risk factor for the development of eating disorders, it’s easy to see how these increasing expectations and media pressures can create extra challenges for pregnant and parenting moms working on eating disorder recovery. If you find yourself constantly comparing your house, your body, your parenting or your life in general to people you see on TV or friends on social media it’s important to discuss these influences with a therapist or treatment team. You can also do a self-audit of your feed and make some changes to ensure you are cultivating a body positive presence across your social media platforms.

 

3. PRIORITIZE RECOVERY

Self-care isn’t selfish.

There’s a reason why the flight crew on every plane instructs parents flying with children to put on their own oxygen masks in an emergency before putting one on their child.  It might feel counterintuitive or even selfish to do so but we know it’s not. Why? Because it’s much harder to take care of other people – especially infants and toddlers – if you’re not caring for yourself.  When it comes to mental health and eating disorders, you may need to prioritize your recovery efforts now so that you have the physical ability and mental clarity to prioritize your family in the long-term. Seeking therapy, keeping up with appointments and staying connected to other moms who talk openly and authentically about the challenges of motherhood are integral to recovery.

 


At The Center for Eating Disorders, we recently launched an outpatient therapy group to help pregnant and parenting moms with eating disorders do the hard Kristen Norris, LCPCwork of prioritizing recovery while caring for their families. The group, which meets weekly, focuses on skills for balancing recovery and motherhood, addressing body image concerns and strategies for feeding the family. In addition to building recovery skills, this group can also be a way to help moms recharge and gain support. It is open to pregnant women and parenting moms of any age and stage.

The Moms’ group is held on Thursdays at 10 a.m. at outpatient department in Physician’s Pavilion North, Suite 300. Please contact Kristen Norris for additional information or to enroll in the group. She can also be reached by phone at 410-427-3904.


References:

  1. Mathews TJ, Hamilton BE. (2016). Mean age of mothers is on the rise: United States, 2000–2014. NCHS data brief, no 232. Hyattsville, MD: National Center for Health Statistics.

8 Tips for Raising Body Positive Kids (Who are also Competent Eaters)


If your goal is to raise kids with high levels of self-esteem, eating competence, body satisfaction and a healthy weight (which is different for everyone) then join the chorus of advocates saying #wakeupweightwatchers and ditch the diet mentality for yourself and your family.  We know weight-loss diets don’t work. We also know they can cause serious harm, especially when introduced to kids and teens.  Let’s prevent the weight loss industry from profiting off our children’s generation.

So if dieting doesn’t work to help kids maintain a healthy weight, what is a parent to do?  These 8 tips are a great place to start.

  1. Make a commitment to having family meals together as often as you can within your family’s schedule. Having regular sit-down meals as a family has been shown to be a protective factor against a range of health and mental health problems including disordered eating.1,2,3,4 
  2. Introduce and incorporate a variety of foods from different food groups at every meal. This doesn’t assume your kid will actually eat them but it’s important to expose them, even if it’s just on someone else’s plate.
  3. Teach and model body acceptance (as opposed to body criticism or body comparison). Kids are always listening and watching how the adults around them relate to their own bodies.
  4. Support your child’s natural ability to regulate hunger and satiety. Promote trust in their ability to self-regulate. We recommend learning more about Ellyn Satter’s Family Feeding Model and the Division of Responsibility in feeding.

Research has shown that size acceptance and learning to use hunger and fullness cues produces sustainable improvements in blood pressure, cholesterol levels, physical activity, self-esteem, and depression compared to dieting.” 5

 

  1. Engage in physical movement as a family with the goal of adventure, fun, coordination and social connection. Try not to frame exercise as punishment, as a way to gain permission to eat or as a means to an end (i.e. weight-loss).
  2. Incorporate all foods without fear or mixed messages. Food is energy and fuel but it’s also okay for it to be enjoyable too. Don’t forbid specific foods or categories of foods (unless there is an allergy of course). Refrain from using food as a reward at home and in the classroom as this can confuse kids, encourages them to eat in the absence of hunger or may lead to a pattern of rewarding oneself with food.6
  3. Refrain from labeling foods as “good foods” vs “bad foods”. Connecting foods with negative labels like bad, toxic or junk foods, can send kids a message that food is related to morality. Even young kids may internalize these labels. Ex) I ate a bad food, therefore I must be bad or I should feel badly. This can trigger strong feelings of guilt or shame related to eating as well as increased emotional eating.
  4. Support healthy sleep habits. Kids who don’t get enough sleep, or have chaotic sleep schedules, show changes in hormones that regulate hunger and appetite. Not getting enough sleep can also impact the way a child’s body metabolizes certain foods.7

While these tips are meant to be a very basic place to start, they might still feel overwhelming since we live in a culture of toxic messages about food and weight. It’s hard to let go of anxiety about our kids’ eating behavior and weight. These can also be difficult to implement if you have your own history of body image struggles, eating disorders or dieting.

If you’re worried that your own relationship with food or weight might be complicating the way you approach these issues with your kids or teens you’re not alone. It can be helpful to get support from a therapist with eating disorder expertise or other non-diet practitioners. At The Center for Eating Disorders at Sheppard Pratt we provide a number of services that can help, including:

If you’re interested in any of these services, please call (410) 938-5252 for more information. 

Previous Post: 10 reasons NOT to introduce dieting during childhood & adolescence


References:

  1. Losing weight won’t make you happy
  2. Are Family Meal Patterns Associated with Overall Diet Quality during the Transition from Early to Middle Adolescence?
  3. Family meals during adolescence are associated with higher diet quality and healthful meal patterns during young adulthood.
  4. BENEFITS OF FAMILY DINNERS
  5. 10 Reasons to Stop Dieting Now
  6. Secrets of Feeding a Healthy Family: how to eat, how to raise good eaters, how to cook
  7. The connection between sleep and growth

Additional Recommended Reading: Weight Science: Evaluating the Evidence for a Paradigm Shift

 

10 reasons NOT to introduce dieting during childhood & adolescence


Weight Watchers recently announced that it will offer free memberships to teens starting this summer. This announcement led to parents, physicians, dietitians and therapists around the world speaking out – and rightfully so – about the harmful effects of encouraging dieting in our kids. Why? Weight-loss diets have not been shown to provide any long-term health benefits.  Furthermore, dieting remains a major predictor for the development of eating disorders and worsens negative body image.

If you have kids or teens in your life that are feeling the pressure to diet or lose weight,  here are ten important facts and considerations to bear in mind.


1. Restrictive diets negatively impact children’s normal stages of growth and development. 

“Dieting is associated with potential negative physical health consequences. Nutritional deficiencies, particularly of iron and calcium, can also pose short- and long-term risks. In growing children and teenagers, even a marginal reduction in energy intake can be associated with growth deceleration1

2. Dieting is a major risk factor for the development of eating disorders. It can be hard to recognize eating disorders in teens or children, as many harmful attitudes about weight and food have become normalized in our culture. However, the problem is very real. And eating disorders don’t discriminate by gender, body type, ethnicity, or social status. According to Dianne Neumark-Sztainer, Ph.D., in the U.S. alone, more than 50% of adolescent girls and 33% of adolescent boys have used unhealthy weight control behaviors. Even when such behaviors don’t develop into clinical eating disorders, they can still have a significant negative impact on physical and mental health.

3. Dieting disrupts children’s innate ability to eat intuitively. Dieting teaches kids to override natural hunger and fullness cues which can have lifelong effects.

4. Diets often rely on externally mandated measures of food or fullness which  undermine our innate ability to feed ourselves well. Using external systems such as “points” or other charts and arbitrary ways of monitoring food intake teaches kids to shut down or ignore their own internal regulatory systems (including hunger and satiety cues) and to mistrust their own bodies.

5. Focusing on weight is problematic as it is not a reliable measure of health. Furthermore, weight-focused discussion in and of itself is a risk factor for obesity and eating disorders.

“Several studies have found that parental weight talk, whether it involves encouraging their children to diet or talking about their own dieting, is linked to overweight and EDs.” 2

6. Dieting teaches kids to associate eating with feelings of guilt and shame as opposed to viewing food as fuel and energy.

7. Dieting negatively impacts body image. Weight fluctuations, common with dieting behaviors, often end up fueling the cycle of body dissatisfaction and disordered eating.

8. Findings clearly indicate that dieting and unhealthy weight control behaviors predict significant weight gain over time.3 Weight loss diets are actually associated with higher lifetime BMI.

9. Weight loss diets are associated with decreased metabolism, food preoccupation, and binge eating.4

10. Weight loss diets are associated with increased rates of depression and decreased self-esteem.5,6

Once we all understand the facts about how diets actually impact children (and adults), we can help families focus on implementing actual evidence-based strategies that we know are more likely to result in positive outcomes and healthier kids.

The question becomes: How can family members and friends best support our nation’s youth towards a peaceful relationship with food and positive body image without introducing potentially harmful diet routines?

Check out our next post, 8 Tips for Raising Body Positive Kids (Who are also competent eaters) for some basic ideas and strategies.

References:

  1. Dieting in adolescence
  2. Preventing Obesity and Eating Disorders in Adolescents
  3. Dieting and Unhealthy Weight Control Behaviors During Adolescence: Associations With 10-Year Changes in Body Mass Index
  4. Intuitive Eating Category: Studies
  5. Risk and protective factors for depression that adolescents can modify: a systematic review and meta-analysis of longitudinal studies.
  6. Losing weight won’t make you happy 

Contributors:
Rebecca Hart, R.D.
Caitlin Royster, R.D.
Rebecca Thomas, R.D.
Kate Clemmer, LCSW-C
Hannah Huguenin, R.D.

Self-Care Resources & Coping with Mass Tragedy


Daily self-care is extremely important for individuals with existing physical and mental health diagnoses including eating disorders, depression, anxiety, PTSD and bipolar disorder. It can be even more crucial during times of high stress, uncertainty or exposure to traumatic events. Even indirect, or secondhand exposure, to violence or disasters can have detrimental effects on one’s mental health. Research conducted by Dr. Pam Ramsden in 2015 found that “viewing violent news events via social media can cause people to experience symptoms similar to post-traumatic stress disorder (PTSD).”

In the wake of several national and international acts of violence over the past month, most recently the attack in Nice, France, it’s important to assess your own self-care practices and media use and to seek additional help when needed.

Below is a list of resources we’ve compiled that may help you and your loved ones cope in the aftermath of such tragedies.

 

RESOURCES FOR ADULTS:

RESOURCES TO HELP CHILDREN:

If you are experiencing intense or prolonged stress in the wake of violence you’ve experienced firsthand or via exposure through news outlets and social media please do not hesitate to seek help. Speak with a therapist if you have one. You can also seek more immediate assistance via the SAMHSA Disaster Distress Helpline at 800-985-5990. 

A more comprehensive list of hotlines and articles is available in this article by Skyler Jackson, MS of The University of Maryland: 100+ Resources for the Aftermath of the Orlando Mass Shooting Tragedy.


 

"Look for the helpers." - Fred Rogers

 

 

 

 

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Why Providers Must Stand Up and Join the March Against ED

This post was written by our Community Outreach Coordinator as a guest blog for the March against eating disorders.  It was originally posted on marchagainsted.com and has been cross posted here with their permission.


Teacher
Nurse
Barista
Artist
Accountant
Grandmother
Student
CEO
Musician
Author
Mom
News Anchor
Military Officer
College Athlete
Dad

They care for you, entertain you and bring you joy.  They protect you and teach you, create things for you.  They help you and mentor you. They are varied. They are diverse. They are important.

They are people you might see every day.

And they are people we might see every day in the course of providing care and treatment for individuals and families impacted by eating disorders.

MOM March 2014At The Center for Eating Disorders at Sheppard Pratt, we see numerous people each day struggling with anorexia, bulimia, binge eating disorder, ARFID and other feeding and eating disorders.  These individuals with eating disorders are varied.  They are diverse. They are important.

This is why we were proud to participate in the inaugural March Against Eating Disorders on Capitol Hill last fall and why we are eager to return this year on October 27th for an even larger and more impactful event. As physicians, therapists, dietitians and nurses specializing in the treatment of people with eating disorders, we see the daily struggle, the medical repercussions, the fear and the impact of eating disorders on relationships, careers and families.  But we also see the hope, the healing and comfort that comes with treatment and recovery.  That is why it’s so important for those of us in the field to stand up and share our voices too.

Why do we march?  

  • We march because eating disorders continue to be stigmatized, sensationalized, overlooked and underfunded despite having the highest mortality rate of any mental illness.
  • We march because no one chooses to have an eating disorder.  Eating disorders are highly heritable illnesses, meaning 50-80% of a person’s risk for developing an eating disorder is genetic. Additional causes are varied and complex.
  • We march because no family should hear “it’s just a phase, she’ll grow out of it.” from a medical professional before they make it through our doors. A lack of specialized eating disorder training for physicians delays detection and appropriate referrals. Delaying treatment delays recovery.
  • We march because 20-30% of our patients are men who thought they were the “only one” and suffered in silence for a long time. Eating disorders don’t discriminate and treatment shouldn’t either.
  • We march because parents do not cause eating disorders but eating disorders can cause heartache for parents and family members. Guilt, blame, stigma and outdated stereotypes can prevent families from getting the help they deserve. Current research supports an understanding that caregivers can play a positive and integral role in helping a loved one to heal from their eating disorder.
  • We march because eating disorders can be deadly but they can also be overcome.  Early intervention and evidence-based treatment makes a difference.
  • We march because no one should have to get sicker before they can get well. Insurance coverage for eating disorders must not be a barrier to quality care.
  • We march because we live together in a culture that equates weight loss with health, yet we work every day with individuals whose weight loss is associated with osteopenia, hair loss, fatigue, cardiac arrhythmia and infertility.  We support a movement that embraces health-focused goals for our schools and communities instead of weight-focused goals.

These are just some of the reasons why we are excited to stand with The Alliance for Eating Disorders Awareness, The Eating Disorder Coalition, and MAED – Mothers Against Eating Disorders at The #MarchAgainstED in our nation’s capitol.  Join us on October 27th to take a stand and help increase awareness about eating disorders.

Why will you march?  

Register now at www.MarchAgainstED.com

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Clemmer.2015.final

 

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

The original posting of this blog is available at: http://www.marchagainsted.com/blog/why-providers-must-stand-up-and-join-the-march-against-ed

 

Erin Matson on Eating Disorders & “Recovery in Real Life” A Special #NEDAWawareness Guest Blog

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ERIN MATSON (@Erintothemax) is a writer and organizer for reproductive justice, equality for women, and social change. An activist and strategist, Erin has led local, state, and national advocacy campaigns and has appeared in a variety of publications and frequently on television, including ABC World News, BBC World News, and MSNBC. She served as an Editor at Large for RH Reality Check, and previously held a variety of positions in the National Organization for Women, including serving as the youngest state NOW president in the country (Minnesota NOW), a founding member of the national Young Feminist Task Force, and a national executive officer (NOW Action Vice President). One of her responsibilities was leading the national organization’s Love Your Body campaign. Erin is an anorexia survivor, and for many years said that recovering from an eating disorder was the coolest thing she’d ever done. That changed when she became a mom. 

We asked Erin to reflect on the experience of living with and recovering from an eating disorder and she graciously allowed us to share her thoughts and ideas with our readers. This is what she had to say…

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

EM: Recovery is possible! When I was most struggling with anorexia, I wish I had known there were people who do go on to recover. An eating disorder means there is hard work ahead but it definitely doesn’t mean that your life is doomed forever. I had an eating disorder and things were terrible, but today my life is terrific. That possibility didn’t get through to me while I was struggling.

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

EM: I am. It sounds strange, but one of the most profound things I learned through the recovery process is that I deserve to take up space without relying upon external validators like accomplishments, or roles, or size.

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

EM: Bad days and bad moments happen. Accepting them when they happen, rather than viewing them as failures or reasons to give up, is the first step to overcoming them. During the more difficult phases of my recovery I tried to observe a mental wall of separation between meal and snack and physical activity times; no matter what happened earlier in the day or the day before, I was going to focus on following my recovery plan during the moment in front of me.

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

EM: Cue the music and rainbows! Seriously, the difference is amazing. I am able to enjoy life, a depth of thought, and the company of others in a way that was impossible when I was preoccupied with my eating disorder. Recovery has made me more compassionate toward others and the struggles they may be going through. In the super-awesome category, recovery made it possible for me to have a baby.

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?

EM: Patience. Patience and unconditional love are the best gifts you can give to an individual in recovery. What I didn’t need was people to fix my problem; what I most needed was people who I could count on, no matter what.

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

EM: Recovery means living without my eating disorder. It means accepting myself, and allowing myself the freedom to be human. At a macro level, it has come to mean for me actively resisting sexism and eating disorder culture, and working so that people treat each other (and themselves) better.

Want to hear more from Erin Matson on recovery from her Eating Disorder?  Be sure to RSVP for the event Recovery in Real Life and register for her breakout session entitled The Gifts & Challenges of Recovery during Pregnancy, Post-Partum & Parenting. 

Before the event, you can catch Erin chatting about the gifts of recovery in this short YouTube video: What Has Recovery Given You? Erin Matson on Eating Disorder “Recovery in Real Life” 

She also blogs about pregnancy and eating disorders, reproductive justice and other important issues over at erintothemax.com.  

Meet the rest of the #RecoveryinRealLife speakers here.

Family-Based Treatment for Adolescents with Anorexia Nervosa: 3 Important Considerations

 

Family-Based Treatment (FBT) is an important evidence-based treatment for anorexia nervosa in adolescents. Originally conceived at the Maudsley Hospital in London, and often referred to as the Maudsley Model, it was further developed by James Lock, MD, PhD and Daniel le Grange, PhD in the United States. FBT is an intensive outpatient treatment involving the entire family whereby parents play a primary and critical role in all of the following tasks:

  • managing the restoration of the child’s weight to a healthy place and supporting the blockade of eating disordered behaviors
  • helping the child to re-establish age-appropriate control and management over their own eating
  • re-focusing the family on healthy adolescent development and relationships separate from the eating disorder

FBT is a highly focused treatment that is presented in three stages. It emphasizes behavioral change and supports a gradual increase in autonomy for the adolescent.  As a psychologist who supports and guides families through this treatment, I thought that it might be helpful for those who are considering FBT to have a primer for the treatment. In thinking about what may be helpful to be aware of when considering FBT, I reflected on the first session I have with each family and thought about all of the crucial messages I try to convey during that time. Below, I’ve decided to share the three messages that, in my perspective, stand as the most important tenets of understanding and implementing FBT.

  1. For adolescents struggling with anorexia nervosa, family support can be the most effective tool for making change. At its core, FBT recognizes that parents are capable of helping their child recover and the therapist’s role is to support them in this goal. When a child is confronted with any serious crisis or illness, investment and nurturing from the family is considered a critical asset and anorexia nervosa is no exception to this. Despite lingering misconceptions about a parental role in the development of eating disorders, FBT is built on the knowledge that parents do not cause eating disorders and that they are, in fact, integral to the recovery process. It is our job as therapists to recognize the strengths and qualities of each family and consider how FBT can be applied within each unique family system. Simply put, the aim of FBT is to empower parents to help their child overcome the eating disorder.  In other words, the therapist serves as a consultant who joins with families as they apply skills they already possess. 
  2. Eating disorders have genetic and biological underpinnings.  As such, adolescents with anorexia nervosa have little control over their illness. Furthermore, periods of malnutrition and starvation can trigger a self-perpetuating cycle of anorexic symptoms that can cause considerable disruption and suffering for the whole family. But to be clear, it is the eating disorder, not the child, which has caused such an interruption in life.  Anorexia nervosa is a devastating illness, the biological, physiological and psychological consequences of which can cause individuals to think and behave in self-destructive ways. It is important that the family works together as a team to help fight the illness and to keep it from embedding further in their child’s life. FBT therapists assist parents in distinguishing between their child and their child’s illness. This distinction helps the family to avoid blaming the child for disruption and stress that is actually a result of the illness, and also makes it easier for parents to take action when they realize they can nurture their child while simultaneously battling against the illness. As a result, energy can be better spent fighting the anorexia, not fighting with their child who is likely already suffering a great deal.
  3. Because of #1 and #2, FBT requires serious hard work and commitment. I am very upfront with families involved in FBT that they will be their child’s primary support AND that eating disorders are insidious and overwhelming illnesses. FBT is not easy. Fighting a devastating illness that has convinced your loved one they are not sick and that they don’t need help, is going to be a lot of hard work. And while it can be grueling, it is also worth it. When we hosted author Harriet Brown as a guest speaker in 2010, we asked her to share her family’s experience in doing FBT with her daughter, and she spoke to this difficulty and to the benefits of this tenet:When we took on FBT, we took on both the responsibility and the power to intervene. That was a tremendously liberating step. The worst part of my daughter’s illness for me was standing by helplessly, watching her suffer and starve. The notion that my husband and I could help her required a huge mental paradigm shift—but once we made it, we were much more effective.” 

In the beginning, FBT will require a lot of energy- energy to monitor your child’s behaviors, energy to learn different behavioral responses, energy to deal with the emotional and interpersonal changes that may come about through this work. I warn my families about the commitment that it takes and I’m honest about the dedication needed. But I also talk to families about the benefits of short-term work to outweigh the devastating long-term effects of an eating disorder and I share with them the facts.  I talk to them about the serious and significant risks of anorexia- physically, emotionally, cognitively- and I have found that families most often agree that avoiding these risks is worth putting in the work. I tell them that FBT has been shown in research (and in my office) to be the most efficacious treatment for adolescents with anorexia that we know about today.

After committing to and sticking with the treatment, I see families eventually begin to talk about “having [their] child back.” I hear families talk about their child’s increased energy, sense of humor returning, interest in friendships again, and reestablishment in the family. I hear the satisfaction when parents talk about receiving feedback from others who approach them just to say that they have recognized a positive change in their child. Over time, I hear families talk about feeling confident that they helped their child recover. They share that they can once again trust their child to make healthy food choices, and they feel a sense of relief that they no longer have to live with the constant presence of the illness. I hear families tell me that the “fight” with the eating disorder gets easier and less demanding, and eventually they don’t need to engage in the battle at all. 

If you think your family member, or someone you know may benefit from family-based treatment, I would recommend starting by talking to a professional about this option, either your current treatment provider or, if you are not currently in treatment, finding a family therapist who is trained specifically in FBT. The Center for Eating Disorders has several FBT therapists in our outpatient department, and we are happy to answer any questions you may have about this treatment modality. You can email us at EatingDisorderInfo@sheppardpratt.org or call (410) 938-5252. Additionally, we encourage all of the families we work with to utilize the book, Help Your Teenager Beat an Eating Disorder (Lock & Le Grange, 2005) as an educational and supportive resource throughout the FBT process. You can also access an extensive selection of journal articles regarding clinical research on FBT courtesy of Maudsley Parents organization.

*     *     *

 Written by Laura Sproch, PhD
Individual and Family Therapist
The Center for Eating Disorders at Sheppard Pratt

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New Collaborative Care Programs for parents, caregivers and loved ones

The Center for Eating Disorders at Sheppard Pratt has long urged the participation and inclusion of family members in the treatment process for both adolescent and adult patients with eating disorders.  In addition to all of our family treatment components, parents and family members have been able to access our community support group as well as a weekly family psychoeducation group.  We are excited to announce that, beginning in July 2012, family members and caregivers of our patients will be provided with an additional level of support and engagement in the recovery process.

The Collaborative Care Workshops are designed to help provide education and support for the friends and family members who are most central to the patient’s recovery process.

Building from the strengths of the family based model, Janet Treasure and her colleagues have developed a series of workshops for caregivers of loved ones who have been diagnosed with eating disorders as a way of meeting the needs of the carers.  The workshops are designed to educate carers on the key skills that clinicians have in treating eating disorders so that there is more continuity in care between the treatment setting and at home. The workshops are designed to address the most universal needs of the carers: connection with other carers; support; and skills training. Sessions reflect an adult learning modality in which skills are taught and then there is ample time for participants to practice these skills experientially. Key skills taught include motivational interviewing, communication, the trans-theoretical model of change, self-care and behavior analysis. Research suggests that participation in these workshops, leads to benefits for both the carers and the patient. (Treasure, Sepulveda, Whitaker, Todd and Lopez).

 ~ Outpatient Collaborative Care Workshops at CED ~

The 6-week Collaborative Care workshop series will be offered to parents, significant others and primary caregivers of individuals who are stepping down from our higher levels of care (inpatient or partial hospital programs). Typically, participation in the workshop series will begin the week following a loved one’s discharge from the eating disorder unit.  [UPDATE: As of July 2013, CC Workshops are open to all family members and support people during any stage of a loved one’s treatment and recovery.] Participation in the program will provide caregivers with the following resources, skills and opportunities:

  1. Provide basic eating disorder education, including current research findings about treatment recommendations, course of illness and treatment, prognosis, and basic understanding of how eating disorders are maintained.
  2. Define and recognize symptom substitution behaviors and strategies for managing these should they arise.
  3. Analyze carer needs and learning to implement self-care strategies, including mindfulness techniques.
  4. Learn effective communication skills to improve communication with their loved one who has an eating disorder.
  5. Recognize caregiver styles and learning to maximize strengths while working towards the most effective caregiver style.
  6. Define the different stages of change in the trans-theoretical model of change and understand how these stages can impact a loved one’s motivation throughout the treatment process.
  7. Learn how to help increase their loved one’s motivation towards recovery.
  8. Improve emotional intelligence by learning basic emotion regulation skills.
  9. Learn the basic theoretical model of cognitive behavioral therapy, as well as basic CBT techniques.
  10. Learn how to analyze how caregiver behaviors may inadvertently contribute to the maintenance of eating disorder behaviors in the family context.

Additionally, caregivers will learn about the interventions most commonly used by the Center for Eating Disorders.  Providing carers with education on the basic theoretical underpinnings of cognitive behavioral therapy and dialectical behavioral therapy will ensure that carers understand the skills that their loved ones have been taught in treatment. This will allow carers to be more fully able to support their loved one in attempts to challenge and/or block eating disorder cognitions and behaviors when they are at home. For more information about this program please email the Collaborative Care group facilitator, jmoran@sheppardpratt.org.

The Center for Eating Disorders has also added a 4-weekend Collaborative Care workshop series exclusively for family members  of current CED inpatients and partial hospital patients.  Please call us at (410) 938-5252 for more information.

Visit our website: www.eatingdisorder.org

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 References & Additional Resources:

Lock, J; Couturier, J; and Agras, W.S. (2006)Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy. Journal of American Academy of Child and Adolescent Psychiatry, 45(6), 66-72.

Lock, J.; Le Grange, D.; Agras, W.S. and Dare, C. (2001) Treatment Manual for Anorexia Nervosa: A Family Based Approach. New York: Guilford.

Silverman, J. Anorexia Nervosa: Historical Perspective on Treament (1997). In D.M. Garner & P.E. Garfinkel (Eds), Handbook of treatment for eating disorders, 2nd edition(pp 3-10) New York: Guilford Press.

Treasure, J., Schmidt, U. & Macdonald, P. (Eds). (2010) The Clinician’s Guide to Collaborative Caring in Eating Disorders: The New Maudsley Method. New York: Routledge.

Treasure, J., Sepulveda, A., Whitaker, W., Todd, G. & Lopez, C. (2010) Family and Carer workshops. In Treasure, J., Schmidt, U. & Macdonald, P. (Eds). (2010) The Clinician’s Guide to Collaborative Caring in Eating Disorders: The New Maudsley Method.(pp167-173) New York: Routledge.

Treasure, J.; Smith, G.; and Crane. A. (2007) Skills-based learning for caring for a loved one with an eating disorder: The new Maudsley method. New York: Routledge.

Nurturing a Positive Pregnancy…Lessons Learned from Eating Disorder Recovery

Several months ago, The Center for Eating Disorders had the pleasure of hosting former World Champion rower, Whitney Post, as a keynote speaker during National Eating Disorders Awareness Week.  In her talk, Invisible Victory, she spoke about her identity as an elite athlete and how she ultimately used it to her advantage in recovering from her eating disorder (ED).  During her visit to Baltimore, Whitney also shared that she was expecting a baby this June, and that  her work in ED recovery had provided a unique perspective and helpful skills for navigating the ups, downs and body image challenges of pregnancy.  In honor of Mother’s Day,  we asked Whitney if she would help us re-introduce our Nurture blog series for moms and mothers-to-be, and she graciously agreed.  The result is this insightful and delightfully down-to-earth Q&A  post about her ongoing journey through pregnancy and recovery. 

 Q & A with Whitney Post

Q: Have you noticed any similarities or parallels between the pregnancy experience and the recovery process?

WP: I remember early on in pregnancy lying in bed and trying to take stock of all the changes that were going on in my work, my body, my energy, and my identity.  It felt overwhelming to say the least, but what occurred to me was that I was so glad I had all the training of recovery to help me navigate this new journey.  I already knew how to surrender large areas of my life for the sake of something new and different.  I think both recovery and pregnancy are about building new life.  In each the process is long, full of uncertainty and discomfort, and full of hope.  There is a great demand for outside support and people who have been through the process before, and the ability to surrender to what the process is asking of you vs. having things exactly the way you want them.

Q: Can you describe how the process of recovering from an ED has helped you prepare for the experience of pregnancy, particularly as it relates to your body image?

WP: I wanted to be one of those women who remained toned and just grew a big round belly out front.  I am not.  I wanted to be one of those women who stayed true to her satisfying workout regimes.  I am not.  And I wanted to be one of those women who seemed to get more stylish as her belly grew, with cool accessories and funky outfits.  I am not. 

But what I am is one of those women who is putting the health of the child growing inside me first, and doing my best with all the rest.  I just do it while wearing clogs, and in between very moderate (“lame” would be another term) workouts.  As the weight started to come on, I could feel two sides of my brain at work.  One said, “this is a miracle and weight gain is part of the process.  This is healthy and natural.”  Meanwhile, another, old part of my brain shouted, “Hello!!!! You are gaining weight!!  Remember how unhappy you were last time this happened?  Do something about it now!!!”  Every time another round of clothes has to be retired because it becomes snug, a part of me feels an old tug to feel bad about myself.  But recovery taught me the skills of being able to recognize these two different voices and gave me the ability to make a choice, vs. listening to whichever voice is scarier.  I am pleased to say that, “this is normal and natural” now wins easily over “go on a diet!”

At my OB office when they check you in for each visit they hand you a cup to pee in and ask you to weigh yourself.  They leave the room and come back in about ten minutes.  For several months I would worry about having to weigh myself, as part of my recovery has involved not knowing how much I weigh.  I could have asked them to weigh me and just looked away, that would have been totally valid, but I just chose to do the drill and let them decide if I was gaining too much or too little.  As long as I’m not trying to control my weight, but rather trust that to the doctors, and manage healthy meals and appropriate workouts, I feel I am on track.

Q: How can pregnancy positively or negatively impact recovery? 

WP: I have found that I have had to work pretty hard at taking care of my recovery because my needs changed suddenly.  I had to find a new way to eat when everything made me nauseated.  I had to find a new way to work the tools of the program when I was too tired to go to 12-step meetings I normally went to.  I had to find women who were in recovery who had been pregnant to learn from them.  So suddenly, the little world of my recovery resources needed to be updated and shifted, and that has been a big investment on my part.  So I think if you let the things that sustain you in recovery slide because you have less energy or those resources don’t fit as well, you can be on a slippery slope, because you may also find yourself (as I often have) more emotionally vulnerable than normal.  But if you look at it as a time to invest in a new phase of recovery and build a community around you, it can strengthen you.

Q: Can you share some concrete steps women can take during pregnancy to help them nurture a positive relationship with their changing bodies?

  • Recognize you may have conflicting feelings and impulses but make sure your actions reflect your goals and values.  (for example – I want to diet because I don’t like gaining weight but my goal is to have a healthy baby and pregnancy, and so I will accept that gaining weight is part of the process and is temporary).
  • Talk to other women who have been through it and speak honestly about your experience.  You can be a wonderful mother and still not enjoy every aspect of pregnancy – they are not mutually exclusive.
  • Ensure from the outset that you have an OB who is supportive of prioritizing health vs. weight.  Then, trust your doctors when it comes to monitoring weight, exercise, etc., and get someone (nutritionist or physician) to work with you on the food and eating part, if you struggle with it, so you aren’t alone.
  • Focus on the positive parts – go to birthing classes, pay attention to the baby kicks, pick out baby clothes, prepare the house, etc.
  • Go with your body’s intuition about when it needs a rest, a snack or a cry.  You may not be able to keep up with your old self, or your old standards, and that’s okay.  It’s important to accept that your body now has a whole new task to prioritize; supporting the physical growth and development of your baby requires a lot of energy.

Q: As an eating disorder treatment professional, a recovery advocate and now a pregnant woman yourself, what are your thoughts on the mainstream media’s representation of pregnant and post-pregnancy bodies? 

WP: Mainstream media has never been helpful when it comes to figuring out how my body should look, and a pregnant body is no different.  The women chosen to be pregnancy models or on the covers of magazines are a very select group of pregnant women who all look much the same, and are all captured in about their fifth or sixth month of pregnancy when the belly is often cute and round.  If you go to a prenatal yoga class and look at all the bodies (as I often did – I was barely able to focus on the poses) you will see all the different shapes and sizes of bellies regardless of the phase of pregnancy.  Some of them seem pretty wacky looking as we are just not accustomed to seeing really pregnant women!  I find it much healthier to see these real live pregnant women than to look at the models.

As for “after the baby” the media is obsessed with how fast a woman can “get her body back.”  I’m happy Heidi Klum made it her goal to be a sexy Victoria secret model within weeks of giving birth, but I don’t think that is helpful for most women.  I am really looking forward to being able to run and do a sit up and move my body with greater ease and speed after the baby is born.  But the reality is I will be sleep deprived and in a very demanding phase of feeding, soothing, and getting to know a new baby, and at that time, I don’t need to be preoccupied with how quickly I can lose weight.  Focusing on eating well and getting in some sleep and exercise will be my goal for good self-care.

Q: Is there one piece of advice that has been particularly helpful for you in terms of staying focused on wellness and body positivity during pregnancy?

WP: Trust your body and stay connected ~ not that different from recovery, right? : )  Pregnancy can make you tired and moody, and both of those things can make socializing less appealing. I have found that I need to push myself to stay connected to old pals and to reach out to start to create a new community of moms-to-be. 

Q: Are there any lessons you’ve learned through ED recovery that you think may also be helpful for individuals as they venture into the day-to-day life of motherhood with a new baby?

WP:In recovery I spent a lot of time learning how to figure out what I needed, and how to stand up for that need while being kind and respectful of others.  But I still need to fight a part of me that is stuck in the habit of  “people pleasing.”  In pregnancy part of my job is to avoid putting myself in bad situations (being around people who have contagious colds or flus, overdoing myself with social/work demands), even though I might have been fine with these situations when not pregnant. This means I have to say “no” to things more often.  I learned early on that if I went against an instinct about my limits of comfort, I was really uncomfortable. I imagine some of the same will be true with an infant.  So my lesson that I am learning over again is that I need to respect my instincts and boundaries, and while I may inconvenience people in the process, we will all survive.

Whitney Post 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. The Center for Eating Disorders is incredibly grateful to Whitney for sharing her insights, experiences,  and advice about pregnancy and recovery for this post We wish her well as she ventures into motherhood!  If you’d like to share your own ideas on this topic, please leave your thoughts in the comments section below or join the discussion on our Facebook Page

If you enjoyed this blog, you may want to read these previous entries from CED’s Nurture Blog Series:

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*Significant health risks (for mom and baby) are associated with eating disorders during pregnancy.  It is recommended that the eating disorder be significantly resolved before a pregnancy is attempted.  If pregnancy does occur prior to recovery, it is imperative that you receive appropriate medical and psychological support. If you are struggling with an eating disorder during pregnancy, or are working hard to maintain your recovery during pregnancy, we would like to remind you how important it is to be honest with your OB and other medical providers during this time.  It’s critical that your providers are aware of your medical history and any current and past ED symptoms so that they can provide the best possible health care for you and your baby.  

When Someone You Love Has an Eating Disorder

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

 

Invisible Victory

 

 

 www.eatingdisorder.org