4 social media changes you can make for the New Year…in 5 minutes or less


The pressures of resolutions and new beginnings after the holiday season can be overwhelming. So why not make a change that will help free up time and headspace while also improving body image?  Your social media life may be an area to evaluate…

Social media has undoubtedly become more and more prominent in our lives. On the one hand, these sites have showcased benefits, such as maintaining social connections and sharing meaningful content and life experiences with others1. On the other hand, problematic social networking site use (or SNS), such as commenting on others’ pictures and “lurking,” have been shown to have negative consequences on body image, self-esteem, and eating disorder symptoms. Even taking selfies, and excessively editing and manipulating these images, has been associated with greater body-related and eating concerns2.

As you reflect on the past year, think about how much time you spent scrolling through social media and comparing likes. What if you could start the new year off with a healthier and more productive approach to care for yourself and your self-esteem? These four simple tips can help you change social media behaviors in the new year.

 

1. Limit Overall Social Media Use


On average, we use social networking sites for over an hour a day3. While some of this social media time may be used in productive ways, maladaptive use of these sites for over an hour a day could lead to significant negative thoughts and feelings. Think about unplugging and limit time spent scrolling!

  • Set aside a specific time every day to use your favorite sites.
  • Delete the apps off your phone, limiting access to social media only from your computer.
  • Use digital reminders or post-it notes on your computer to remind you of other activities you might enjoy more than scrolling through a social media feed. Texting a friend? Planning a vacation? Registering for a class?

 

2. Think Critically About Social Media


For some, it might seem impossible to remove social media entirely in a world where use is growing rapidly. So, while we can limit use overall, it can be greatly beneficial to change the way we perceive what we are exposed to when we are using social media. While scrolling through Facebook and Instagram and viewing everyone’s carefully selected and manipulated “best-self”, be sure that you are thinking critically about what you are seeing and posting.

  • Remind yourself that images are often edited and re-edited!
  • Be mindful of comparing yourself with peers or celebrities’ photos on social media.
  • Notice if you are starting to feel poorly about yourself when scrolling and decide if it would be a good time to log off.

 

3. Remove or Block Negative Content


Exposure to content that promotes the “thin ideal”, or the promotion of a desire to be skinny or fit, is more common now than ever in a world of body-altering photo applications and “photoshopping” in the media. Many individuals with an eating disorder are prone to participate in negative social comparisons and are more likely to internalize the “thin ideal,” making them more susceptible to the negative effects of this type of imagery. Take some time to go through your social media and analyze what you are being exposed to and how it makes you feel.

  • Are anyone’s photos making you feel poorly about yourself?
  • Is a celebrity promoting disordered eating or dangerous products (like cleanses or detox teas) to maintain a “perfect figure?”
  • If images or accounts are not helping you work towards recovery, hide the posts or block photos.

 

4. Follow More Positive Accounts


While the negative effects of social media have been the focus here, there are many reasons why these platforms have skyrocketed in recent years. Sites such as Facebook and Instagram can be great to share accomplishments, keep in contact with distant friends, or even see what your favorite musician or politician is up to. We can help to control what kind of messages and content we are exposed to by changing who we follow on social media.

  • Fill your feed with positive role models, quotes, and positive peers to help create a body-positive environment that focuses on more than appearance to achieve self-worth.

Below are just a few examples of body positive or recovery-focused Instagram accounts you can choose to follow in the new year!

 


 

Written By:

Ava Sardoni, Research Assistant
The Center for Eating Disorders at Sheppard Pratt 

Ava is currently pursuing her Master’s in Clinical Psychology at Loyola University Maryland, with intent to graduate in May of 2019. She also earned her Bachelor of Arts in Psychology at Loyola University Maryland, graduating in May of 2018. Her past research projects include researching the relationship between specific personality traits and motivations for using online dating applications.


References:

  1. Cohen, R., Newton-John, T., & Slater, A. (2018). ‘Selfie’-objectification: The role of selfies in self-objectification and disordered eating in young women. Computers in Human Behavior, 79. 68-74. https://doi.org/10.1016/j.chb.2017.10.027
  2. McLean, S.A., Wertheim, E.H., Masters, J., Paxton, S.J. (2016). A pilot evaluation of a social media literacy intervention to reduce risk factors for eating disorders. International Journal of Eating Disorders, 50. 847-851. doi: 10.1002/eat.22708
  3. Uhls, Y.T., Ellison, N.B., & Subrahmanyam, k. (2017). Benefits and Costs of Social Media in Adolescence. Pediatrics, 140(Supplement 2, S67-S70. Retrieved from http://pediatrics.aappublications.org/content/140/Supplement_2/S67.long

Telemental Health: Using Technology to Overcome Barriers to Eating Disorder Recovery


The highly specified nature of eating disorder care lends an important fact about treatment: Evidence-based eating disorder treatments are as complex as the disorders themselves and require well-trained and experienced clinicians to provide such specialized care. However, the complex and specialized nature of treatment yields one of the main challenges facing the field of eating disorder care today: There simply aren’t enough available providers to meet the needs of patients, and those qualified to offer evidence-based treatment tend to be concentrated in urban areas.1,2

Barriers to Quality Care

Eating disorders, on average, affect at least 30 million Americans of all ages and genders.3 Several effective treatments for eating disorders exist that have been shown to greatly improve physical health and mental wellbeing in a majority of patients. Evidence-based treatments such as cognitive-behavioral therapy, interpersonal therapy, and family-based therapy are designed to target specific concerns within particular eating disorder diagnoses and populations.4 But for patients with eating disorders living in rural areas, there are few treatment options. As a result, they are often forced to make difficult decisions, choose between less than optimal options, and deal with potentially negative consequences such as:

  • Traveling far distances to available specialty providers
  • Sacrificing excessive time away from school or work
  • Paying for travel in addition to treatment
  • Receiving lower level care from a provider with no experience or specialized training in the treatment of eating disorders
  • Opting to not get treatment at all and continuing to suffer with the serious consequences of an eating disorder.
One potential solution to the lack of readily accessible care for eating disorders is telemedicine, also known as telepsychology or telemental healthcare. 

Telemedicine allows clinicians to deliver specialized care to patients in a remote location via videoconferencing. In the field of general health care, telemedicine has existed for decades as a means to provide treatment to patients who could not travel to qualified providers. In this format, a patient can receive the same high-quality care they would from a specialist treatment center remotely in the comfort of their own home. Telemedicine is a relatively new method for eating disorder treatment, but research studies have shown its effectiveness to be practically equivalent to that of traditional face-to-face therapy.5

Though more research is needed to support this method of delivering therapy, the existing studies show that eating disorder treatment delivered through telemedicine can lead to positive outcomes such as:

  • The establishment of a healthy weight1,6
  • Decreased concerns about shape and weight1,2
  • Positive relationships with the providing clinician5

Disadvantages of telemedicine typically include technological difficulties,7 though rapid improvements in communication technology will likely combat issues found in past telemedicine research.8

Telemental Health offers a path to high-quality treatment for individuals affected by eating disorders who otherwise might not have access to it.

The Center for Eating Disorders at Sheppard Pratt now offers telemental health services for patients who live far distances from our offices. Dr. Jennifer Moran and Dr. Ekaterina Amarando are trained and licensed to provide psychotherapy for patients located in the state of Maryland, and Dr. Meghan Gaare is trained and licensed to provide psychiatric care for patients in the states of Maryland and Virginia.

For inquiries related to receiving telemedicine care, please call (410)-938-5252, or visit CED Telemental Health Program.

 


Written by: 
PHOTO Jacquelyn PattonJacquelyn Patton, Research Assistant
Jacquelyn is a graduate student currently pursuing her Masters in Clinical Psychology at Towson University, with the intent to earn her degree in May 2020. She received her Bachelors of Science in Psychology from the University of Maryland, College Park in 2017. As an undergraduate, Jacquelyn served as a research assistant for the Center for Addiction, Personality, and Emotions Research where she conducted a study examining the impact of racism and racial/ethnic identity formation on health-risk behaviors, including disparate patterns of substance use. She joined the research team at CED as a volunteer research assistant in 2018, working under the supervision of Dr. Sproch. In this role, Jacquelyn is currently researching the utility and efficacy of telemedicine in the treatment of eating disorders.

 


References

1. Anderson, K. E., Byrne, C. E., Crosby, R. D., & Le Grange, D. (2017). Utilizing telehealth to deliver family-based treatment for adolescent anorexia nervosa. International Journal of Eating Disorders, 50, 1235-1238. doi:10.1002/eat.22759

2. Simpson, S., Bell, L., Britton, P., Mitchell, D., Morrow, E., Johnston, A. L., & Brebner, J. (2006). Does video therapy work? A single case series of bulimic disorders. European Eating Disorders Review, 14, 226-241. doi:10.1002/erv.686

3. Eating Disorder Statistics. (2018). National Association of Anorexia Nervosa and Associated Disorders. Retrieved from http://www.anad.org/education-and-awareness/about-eating-.disorders/eating-disorders-statistics/

4. Yager, J., Devlin, M. J., Halmi, K. A., Herzog, D. B., Mitchell, J. E., Powers, P., & Zerbe, K. J. (2006). Practice guidelines for the treatment of patients with eating disorders. (3rd ed.) Retrieved from https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guideline s/eatingdisorders.pdf

5. Mitchell, J. E., Crosby, R. D., Wonderlich, S. A., Crow, S., Lancaster, K., Simonich, H., … & Myers, T. C. (2008). A randomized trial comparing the efficacy of cognitive–behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behaviour research and therapy46, 581-592. doi:10.1016/j.brat.2008.02.004

6. Goldfield, G. S., & Boachie, A. (2003). Delivery of family therapy in the treatment of anorexia nervosa using telehealth. Telemedicine Journal and E-Health, 9, 111–114.  doi:10.1089/153056203763317729

7. Chakrabarti, S. (2015). Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World Journal of Psychiatry, 5, 286-304. doi:10.5498/wjp.v5.i3.286

8. Waugh, M., Voyles, D., & Thomas, M. R. (2015). Telepsychiatry: Benefits and costs in a changing health-care environment. International Review of Psychiatry27, 558–568. doi:10.3109/09540261.2015.1091291

 

 

NEDA Walk: There are many ways to make a difference


Despite their increasing prevalence, eating disorders receive significantly less funding than other major mental illnesses, and a lot of misinformation still exists about who is impacted and just how serious eating disorders can be. As treatment providers we know that for every person who walks through our doors and receives treatment, many others never get the help they need. We are participating in a NEDA Walk this year to try to help change that. As NEDA shares on their website, there are 30 million great reasons to participate in a walk. If you’re wondering why you should walk, consider the following.

To help raise awareness & restore hope…
Eating disorders are widely misunderstood illnesses, and old stereotypes and myths often prevent people from seeking help. Help fight stigma and shine a light on eating disorders as a serious public health issue.

To help save lives…
Eating disorders are associated with many different short-term and long-term health consequences, some of which are very serious and others that can be fatal. By participating in the NEDA Walk, you’ll be raising funds that support life-saving programs, advocacy efforts, and research initiatives.

To feel less alone…
Eating disorders can be extremely isolating illnesses. When you’re struggling or supporting a loved one with an eating disorder, it’s easy to feel like you’re the only one in the world who is going through it but we promise, you’re not. Participating in a NEDA Walk is a great way to come together as a recovery-focused group and engage as a community in positive change.

While there are countless reasons to participate in a Walk, it’s also extremely important to consider that there may be reasons not to walk too. Given that eating disorders often involve energy deficits and an unhealthy relationship with exercise, it’s important to remind potential walkers that your safety and recovery always need to come first.

Typical NEDA walks are 1- 2 miles in distance but for someone with an eating disorder, significant movement or walking – even a short distance – could be unsafe or contrary to treatment goals. Definitely check in with your treatment providers prior to participation if you’re having any of these symptoms:

  • recent fatigue, weakness or dizziness
  • episodes of fainting, falling or near falls (tripping) in past month
  • muscle cramps, numbness or paresthesia’s (limb falling asleep) in your extremities
  • recent dehydration and electrolyte abnormalities
  • inability to complete a meal without acting on symptoms the morning of the walk

Furthermore, even if you haven’t had the physical symptoms listed above, ask yourself the following questions:

  • Is your motivation to attend the walk driven primarily by a desire to engage in exercise?
  • Have your thoughts about the walk included calculations of distances, steps, calories, etc.?
  • Do your current treatment goals include taking a break from exercise or restrictions on movement?

If the answer to any of those questions is yes, be sure to set parameters with your treatment team around the best and safest way for you to participate. For example, it is important to remember that you can attend a NEDA Walk without doing the walk portion of the event! Bring a lawn chair, listen to the keynote speakers, and cheer on your team. You can also bring a buddy who can help you stay focused on the important aspects of the walk and who can help ensure you’re well-fueled before the event, symptom-free during the event and full of hope throughout the day.

Lastly, it’s 100% OKAY if you can’t attend a walk right now because you’re taking care of yourself. Sometimes self-care means saying no to some things so you can say yes to treatment or recovery. You can always participate by sharing about the cause online – or – use the event day as a catalyst for your own recovery. Locate a local support group, read a book about recovery, or make that call to a therapist you’ve been putting off.

However you choose to participate, remember that you are worth it and you are not alone.

………………

The Center for Eating Disorders at Sheppard Pratt will be joining NEDA and a host of other eating disorder and body image organizations for the Baltimore NEDA Walk on September 30 at Goucher College. Find out more here.

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.

Knitting Together Skills for Eating Disorder Recovery

April is National Occupational Therapy Month ~ #OTMonth 


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

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

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

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

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

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

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

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

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


Christine Brown, MS, OTR/L

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

 


Reference:

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

 

32 Ways to Stay Recovery-Focused During a Snow Storm

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


32 Recovery-Focused Activities, Tips & Strategies:

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

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


www.eatingdisorder.org

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


What does it mean to live authentically? 

Honoring your truth.

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

 

Documenting Self-Discovery through Transition and Recovery

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

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

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

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

 

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

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

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

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

 

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

 

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


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


References

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

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

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

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

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

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

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

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

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

12 Tried and True Ways People Upheld a Recovery-Focused Holiday


Looking back on this holiday season, it’s safe to say that social gatherings and celebratory feasts posed some significant challenges for anyone trying to develop a more peaceful relationship with food – including those in recovery from an eating disorder. That’s why The Center for Eating Disorders at Sheppard Pratt launched a social media campaign called the “12 Days of Eating Disorder Recovery.” The initiative shared tips on how to maintain healthy relationships with food through the holiday season and beyond. These are summarized below – one for each day of the 12 days – so you can use them to navigate future holiday seasons and get a little help finding the joy and peace within the hustle and bustle.


#12DaysofEDRecovery

Day 1: Keep expectations realistic and set manageable goals that will help you stick to your plan.

Regardless of where you’re at in recovery, celebrations, holiday feasts and schedule changes can pose challenges. Planning ahead and setting realistic expectations can help you stay focused on what truly matters.


Day 2: Grab a notebook or journal and write down all the reasons why recovery is important to you.

While you’re at it, make another list of support people. Figure out in advance who you will call if things get overwhelming or if you simply need to get out of your own head. Things that help you cope daily are still needed during the holidays.

If you’re headed out of town, pack your suitcase with your notebook along with other recovery tools. This could be tangible things like a fidget cube, fun book, art supplies or a favorite essential oil.


Day 3: Connect in safe and meaningful ways with others in recovery.

Recovery from an eating disorder is a journey that requires support, encouragement and ongoing motivation. Individuals with eating disorders and their loved ones can find hope and help in others who understand what they’re going through. Support groups and therapy groups can be a great way to strengthen recovery skills and help remind you that you are not alone.


Day 4: Set a goal today that has nothing to do with food, weight or your eating disorder.

It’s common for social gatherings to revolve around food in our culture, especially during the holidays. These celebrations often lead to an intensified emphasis on meals and eating for those working on recovery from an eating disorder. Keep doing what you need to do to fuel your body in recovery, but try also setting a goal for yourself that has nothing to do with food or your eating disorder.


Day 5: Don’t let your eating disorder make decisions for you in the grocery store. Use price or brand to inform decisions instead of reading nutrition labels.

Whether we like it or not, grocery shopping is part of adulthood. But for the millions of individuals living with an eating disorder, this everyday task feels overwhelming and becomes a significant barrier to recovery. If you are worried about buying items for upcoming gatherings or celebrations, this tip can help make grocery shopping more manageable.


Day 6: Defuse grocery shopping stress by bringing a friend, avoiding crowds and shopping at smaller stores in off-peak hours.

If you’ve had negative experiences with grocery shopping, you can start developing more positive associations. A Registered Dietitian may provide some easy steps for managing your grocery list.

Ask your dietitian for support, or consider adding one to your treatment team if you haven’t done so. You can also go with a friend or support person the first few times to help distract from any eating disorder thoughts and avoid being triggered by diet products.


Day 7: Infuse your New Year with body positivity and gratitude.

Be prepared to see your newsfeed flooded with New Year’s resolutions, gym memberships and diet plans in the coming weeks. To balance triggering and unhealthy messages, remember to reality check all the bogus weight-loss ads and surround yourself online and IRL with body-positive people and organizations.

Pay attention to which images and messages contribute to your feeling badly about yourself or your body and do what you can to remove them from your daily life. When you notice them, remove them (unsubscribe, throw them away, etc.) or challenge them.

Focus on gratitude for the functionality of the breath in your body, the ability to move, see, hear, taste or touch. Try to elevate those in your mind as you go through your day.

Create your own New Year’s goals with body positive thoughts. Work to set aside unhealthy ideals and embrace your body.


Day 8: Tackle eating disorder stigma by dispelling myths among friends and family.

Major misconceptions about eating disorders are widespread, even among those closest to us. Family can be a key component to recovery success. Unfortunately, some family and friends may still subscribe to ED myths that lead to stigma and might make it harder to ask for help or to seek treatment. Help educate and increase awareness about eating disorders among your loved ones.


Day 9: Friends and family can be a great support network. Be open with the people closest to you about how they can best support you.

Holiday conversations often revolve around what people are eating or not eating, who’s eating too much or too little and even criticism or praise about body weight and size.  Did this happen for you during Chanukah or Christmas this year?

The start of a new year can be a great time to enlist family members as allies by being open about your needs and boundaries. Set the stage for healthier gatherings in the new year by having a post-holiday conversation with them about how their words impacted you and what they can do instead to support you at the table and in other stressful situations.


Day 10: Meditate or listen to soothing music to start your day in a positive place.

It’s not just about food and body image. Incorporating mindfulness in the new year can be a way to care for your overall mental health. If you’re heading back to work or school after winter break, find a way to change up your routine to build in mindfulness practices.  Even just three minutes of meditation can help you set a positive intention for the day.

You can be mindful in your social connections too. Cultivate awareness about the different support each generation of your family can offer. Hanging out with cousins can be a nice way to connect and get support on specific life stage issues like being away at college, parenting stress, job hunting, etc. On the other hand, reaching out to older generations, like grandparents, is an opportunity to see how priorities can shift throughout life. Even the youngest generations have something to offer you in your recovery-focused festivities.


Day 11: Aim for balance and flexibility rather than perfection.

Individuals who are perfectionists often struggle with the urge to compare themselves to people around them. Research has shown perfectionism to be a significant risk factor for the development of eating disorders.

Constantly striving to be perfect with food or appearance during the holidays can lead to tension and stress. Even those holiday photo cards hanging around your house can trigger negative social comparisons. Try making some small changes to help ease perfectionist tendencies this time of year.


Day 12: Support is essential to your wellbeing. Recovery is possible with treatment and support.

Whether you are an individual working on recovery, or a loved one who is close to someone in recovery during this time of year, it’s important to remember that support is essential to wellbeing.

Remember, you don’t have to go through this alone.

Ask for help.

 

If you are experiencing symptoms of an eating disorder and you’re not connected to a therapist or receiving treatment, don’t wait any longer.  There is no reason to go through this alone. Call (410) 938-5252 for a free phone assessment today.


This holiday season, and year-round, carry these tips with you. Recovery is possible and recovery is worth it.

How to Stay Recovery-Focused When Interacting with Triggering Media

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

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

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

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

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


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

 

 

 

 

 

To Watch or Not to Watch: That is the Question

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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