Spring Blog Round-Up


“Where flowers bloom, so does hope.”
~Lady Bird Johnson
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Our CED Staff has been busy guest blogging for Eating Disorder Hope on a variety of topics from nutrition and meal plans to body image and relapse prevention. We hope you’ll take a look and share with friends, colleagues or clients who might benefit from the following information.

If you have questions about eating disorder treatment or a topic you’d like to see us write more about, please send your suggestions and requests to our Community Outreach Coordinator, Kate Clemmer at  kclemmer@sheppardpratt.org


The Importance of Incorporating Fear & Challenge Foods in Recovery

Written by Caitlyn Royster, R.D. & Rebecca Hart, R.D., Registered Dietitians

While you may technically be following your meal plan, without incorporating fear foods you are still giving the eating disorder a major foothold by preserving fear and anxiety. It might seem like choosing safe foods is better than acting on symptoms. However, over time this restriction can snowball and lead to relapse. READ MORE…


Mother’s Day Makeover: Boosting Body Image for Ourselves and Future Generations

Written by Irene Rovira, Ph.D.
Psychology Coordinator

Most of us appreciate all the mother figures and mom-types in our lives – including aunts, sisters, mentors and best friends – for the love they give or how they make us feel. We do not value them based on their weight or size. Yet we often hold a double standard when it comes to how we view ourselves…READ MORE to find 7 Tips to help boost body image for yourself and future generations



4 Changes You Can Make in Your Home to Support Eating Disorder Recovery & Reduce Relapse

Written by Kate Clemmer, LCSW-C
Community Outreach & Education Coordinator

It’s safe to say no one who has been through recovery from an eating disorder would downplay the difficulty or complexity of it. And while recovery is never simple or easy, there are some simple and straightforward changes you can make to reinforce recovery efforts and help prevent relapse. These specific modifications are not changes in thinking (cognition) or even changes in behavior but rather, changes to your physical living space – your home environment.  READ MORE…


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Perfectionism: Aiming for an elusive target

archery_by_kongsky


Imagine that you are extremely dedicated to an archery team. You spend day and night in target practice, regardless of the weather conditions and without regard for your own basic needs. You have an unlimited amount of arrows and you continue over and over again to launch the arrows in an attempt to hit the bull’s eye. Day after day, year after year, you never reach that bull’s eye. No matter how hard you train and commit your mind to it, no matter what the conditions are, you always miss what you are aiming for. Sometimes, you get very, very close and think that you just might have reached your goal, but ultimately, you never hit the mark. As a result, you feel that you have failed. In fact, failing becomes part of the way you define yourself.  Fear of failing becomes a constant worry for you.

Now imagine, that one day you realize that this target that you have spent all of these hours and days and years trying to hit is so very small that you can barely even see it. Actually, when you look closely, and assess the situation you find the bull’s eye is not just small and faded, it is nonexistent. Upon realizing this, you see you have spent years and years feeling like you have failed because you were trying to hit a target that wasn’t actually there. This is perfectionism.

In this imagined scenario, perfect is the nonexistent target. A sense of failure results from believing that anything but perfect is not good enough. If you are struggling with perfectionism, or you have in the past, you probably know how exhausting this can be.

 

Perfectionism is an unobtainable illusion guaranteed to make you feel badly.

Under the weight of extreme perfectionism, difficulty with a specific task may be generalized.  This can quickly lead to self-criticism. For example, instead of thinking, “I did not do well on that part of the exam; those must have been really difficult questions,” the perfectionist might think “I am so stupid. How could I have missed both of the multiple choice questions?! I am terrible at math.”

Constantly striving for perfect results can lead to feelings of tension and stress. It can also trigger an avoidance of appropriate challenges and risks. For example, you might find it difficult to connect with new people in social relationships at the risk of appearing flawed or imperfect to someone else. Or you may not apply to a great job because you haven’t mastered every single skill set listed as a prerequisite.

In general, perfectionism can cause you to miss out on opportunities to learn from mistakes and may ultimately get in the way of living a balanced, rewarding life.

 

Addressing perfectionism can aid in eating disorder recovery

Perfectionism is a genetic personality trait that many people are born with. Research has shown this characteristic to be a significant risk factor for the development of eating disorders. Furthermore, once someone has developed an eating disorder, perfectionism can sustain or perpetuate the illness, getting in the way of recovery efforts. For this reason, it can be important to work on perfectionism head on.

With support from a cognitive-behavioral therapist, you can start by making clear, manageable behavioral changes to test out what it would be like to attempt tasks without looking for a perfect outcome. For example, trying to complete tasks “good enough.” It’s usually helpful to start off with very small goals and work your way up to more situations that might be more difficult. Consider these two examples below:

Example 1: If you identify yourself as a “neat freak,” try setting a timer to limit cleaning time to smaller intervals or set a guideline that you will vacuum only 50% of the time that you typically do. Experiment with this and see what the advantages and disadvantages are of approaching this task in a new way. Learn from this experience and make changes accordingly.

Example 2: If you are someone who needs to complete every item on your to-do list before leaving the office (at the expense of family, friends or self), see what happens if you have a couple of items left to work on the next day. Test out how this might affect you. Perhaps you were able to get home on time and enjoy more time with your family or you were able to drive home while it was still light out and enjoy the scenery. See if leaving those items for the next day made much of a difference as you may have approached them more efficiently with a good night’s sleep. Test out if sometimes your perfectionism causes you to put in more effort that will only bring very marginal gains. If so, figure out when is the time to stop and focus on something more profitable.

Starting to make changes on your own is a great first step toward decreasing the amount of influence that perfectionism has in your life. You might also want to consider engaging in a cognitive-behavioral therapy (CBT) group or individual therapy to learn how to change the way in which you interact with your perfectionism.

Committing to decrease your need to be, or appear, perfect will help you to take more and more breaks from target practice and actually enjoy being on the archery team.

 

Do you want to learn more about perfectionism?

when perfect isnt good enough
We recommend the book, When Perfect Isn’t Good Enough, written by Drs. Martin Antony and Richard Swinson.

If you are a treatment provider and would like to learn more about cognitive and behavioral treatments for perfectionism, join us on April 9, 2016 at The Center for Eating Disorders’ Annual Professional Symposium where Dr. Antony will be presenting on The Nature & Treatment of Perfectionism.

Online registration and event details are available at www.eatingdisorder.org/events.

You can also download the program brochure (pdf) here.


Written by:
Laura Sproch, PhD
Research Coordinator and Outpatient Therapist at The Center for Eating Disorders

Photo Credit: Freedigitalphotos.net / kongsky

 

 

Adventures in Self-Care with Melissa Fabello, Part II

 

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

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

 


Q & A with MELISSA FABELLO: Part II

 

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

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

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

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

 

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

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

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

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

 

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

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

 

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

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

 

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


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

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

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

 



 

Adventures in Self-Care with Melissa Fabello: Part 1

 

If you’ve ever seen one of her YouTube videos than you probably already know Melissa Fabello is a talented and passionate activist.  She also writes boldly and beautifully about eating disorder recovery, body image, diet culture and a host of other important issues. In advance of National Eating Disorders Awareness Week and her presentation in Baltimore on February 21, we asked Melissa to share her thoughts on why self-care is not self-ish, the intersection of eating disorders and perfectionism, and her experience with recovery in a society obsessed with dieting.  We are honored to share her responses with you below.

 

 


Q&A with MelissA Fabello – Part I

 

Q: A lot of people assume self-care to be synonymous with personal hygiene or the daily chores of living. This can sound like a pretty boring topic. Given that you will be in Baltimore on February 21 to discuss the Adventures in Self-Care as part of National Eating Disorders Awareness Week, can you explain more about what self-care really is and why it’s something we should be talking about?

MF: To start, I would actually argue that self-care should, indeed, be a daily chore of living. It should be an intentional practice that we partake in – every single day – in order to take care of ourselves. It really can be as simple as getting the right amount of sleep, drinking enough water, or eating a meal that fuels your body. It’s finding ways to insert self-care into those daily chores of living, which in turn, creates a life that may feel a bit more adventurous.

And when I say “adventurous,” I don’t necessarily mean thrill-seeking, but rather, simply, more livable. And what is more of an adventure than life itself? Self-care puts you in the position to live life more fully and to experience it more broadly because it cultivates your self-awareness and forces you to consider what makes you the happiest.


Self-care, really, is just any set of practices that are nourishing to you – physically, emotionally, and spiritually. Those practices can be preventative (like taking care of your physiological and mental health needs to the best of your ability every day), and they can also be intervention methods (think: calling out sick just to spend the day taking a bubble bath and reading novels). But the point is that they are necessary to all of our lives, but especially necessary when we’re in eating disorder recovery.

 

Q: We often hear from patients who fear that engaging in self-care is a selfish act. How would you respond to someone worried about being, or being perceived as, selfish?

MF: That’s a real concern, and it needs to be validated as such. We live in a culture that’s driven by capitalism, and the number one value held by capitalism is that of productivity. Have you ever slept in because your body needed rest, but then berated yourself for not getting up early enough to start in on your housework? Or have you ever taken a much needed day off to marathon your favorite TV show, but then felt bad that you didn’t work on your school work, even though you hadn’t taken a day off in two weeks? That guilt is the product of believing that our worth is tied up in how productive we are.

670_06_NEDAW_TWITTER_01_2016_P12 This is especially difficult for women. In our society, men are frequently defined by what they do out in the world. Women, though, are judged by how they take care of others. As such, women’s moral development, according to Carol Gilligan, is all about how we understand ourselves in relation to other people. Women, in particular, are taught that taking care of ourselves and putting ourselves first is not only a selfish act, but even an immoral one. And that’s just straight up sexist.


One small shift we can make is to redefine what “productivity” means to us. I have an ex-girlfriend who was a hustler, trying to make it in the music business. As such, every day when we talked, she’d ask me, “What did you do today?” or “What did you accomplish today?” And sometimes that really overwhelmed me – because what if I didn’t “do” or “accomplish” anything? But the truth is that even if what I did that day was laugh while playing with my cat, or if what I accomplished was taking a trip to the bookstore for fun, then I’ve been productive. I’ve produced something: self-care. I think we need to remind ourselves that taking care of ourselves is an accomplishment.

 

Q: Perfectionism is one of several genetic traits that have been identified by research to be associated with an increased risk for the development of eating disorders. From your experience and observation, how does the topic of self-care intersect with tendencies toward perfectionism?

MF: I like to think of myself as a recovering overachiever, although I still fall back into those old habits sometimes. Again, in a culture where we’re taught to value our productivity, it can be hard not to fall into perfectionism as a way to prove our worth. But the truth is that we need to learn to be okay with the fact that none of us is perfect, that we’re all going to make mistakes.

One of the most valuable pieces of self-care advice I’ve received lately is that of learning to be okay with “good enough.” I’m one of those people who, when I give 75%, will feel guilty and ashamed for not giving 100%. What happens that’s interesting, though, is that no one can ever tell that I didn’t give something my all. As far as they can tell, I gave 110% because what I did was absolutely, positively awesome. Learning to be okay with “good enough” means giving something a shot, but not letting it run our lives, and feeling comfortable with the amount of attention that we were able to give something.

Part of self-care is being able to say, “I can’t (or don’t want to) work on this anymore because it’s possible that continuing to do so will damage my mental health. So I’m done now.” And that means letting go of the idea that we – and everything associated with us – has to be perfect.

 

Q: Another risk factor for eating disorders stems from the emotional and physiological consequences of dieting. What other impacts do you see from a culture that markets diets as a valid form of self-care and a path towards self-acceptance?

MF: I’ll be honest: The day that I actively decided to go through weight restoration was the day I realized that I could never be both thinner and happy. I could only ever be one of the two. I could spend every second of every day counting, measuring, and restricting in an attempt to achieve self-acceptance through (what I thought was) self-improvement, or I could attempt to apologize to my body and recreate a healthy relationship with food and within that freedom, find happiness. That concrete realization – that I couldn’t work toward a “better” body and experience day to day happiness – was a huge shift for me.

A spoken word poem that I really love, “When the Fat Girl Gets Skinny” by Blythe Baird, has a line in it that says: “This was the year of eating when I was hungry without punishing myself / And I know it sounds ridiculous, but that sh– is hard.” And it is. It is hard. Because we live in a culture that is so focused on dieting as, like you said, “a valid form of self-care and a path towards self-acceptance” that deciding to go against that grain and to seek validation and happiness from elsewhere is a radical act. And make no mistake: Giving up diet culture is a radical act, both personally and politically. Our culture thrives on making us feel small, weak, and less-than. Rebelling against that pressure, declaring that you will not be contained, and saying “no” to everything that our culture and media want us to believe? That is an incredibly courageous act.

 

Be sure to check out Part II of our discussion with Melissa in which she delves into body image and the concept of intersectionality as it relates to eating disorders.

Join the conversation on Facebook and Twitter using the hashtag #bmoreselfcare. 


MF 006Melissa A. Fabello, M.Ed. is a body acceptance activist, sexuality scholar, and patriarchy smasher based in Philadelphia. She is currently a managing editor of Everyday Feminism, as well as a doctoral candidate at Widener University, working toward a PhD in Human Sexuality Studies. Melissa has worked closely with The National Eating Disorders Association, The Representation Project, and Adios Barbie on campaigns related to body image, eating disorders, and media literacy. Find out more about Melissa and her work at melissafabello.com.

 

 

 

Simple solutions for holiday (and everyday) conversations about food and weight


dining room
As we head into the holidays, it can be helpful to have a very simple plan for responding to family and friends drawn to the very topics that may be most troubling during recovery from an eating disorder.  Depending on how you spend your holiday this year, one or all of these suggestions may come in handy when the conversation takes a turn toward triggering language regarding bodies, food or weight.


Step 1:
Obstruct or change the conversation if you notice someone is heading into a discussion that makes you uncomfortable.

Remember people generally like to talk about themselves and their interests. If Aunt Marie is pressuring everyone to eat more pie or is gushing over a family member’s weight loss, use that as an opportunity to reflect the attention back to her. So who taught you how to bake? What are you up to at work Aunt Marie? How was that vacation you went on?

If you’re comfortable staying on the topic but exerting your power into the conversation you could try something like this: I’ve actually been learning a lot about how weight is not a good determinant of overall health. I’m focusing on my work-life balance and healthier ways to deal with stress. I’m thinking about meditation…have you ever tried it?


Step 2: Set boundaries
if someone continues to target you with questions or comments about your body or what you’re eating.

Here are some simple examples with varying levels of intensity.  You can choose which ones you think would work well for you, or create your own.

  • I try not to get involved in discussions about dieting and weight loss.
  • I’d prefer not to talk about my weight today.
  • I am so happy to be here with everyone, I don’t want to waste our time together talking about food/weight.
  • Please don’t comment on my body.
  • Let’s find something else to do or talk about.
  • I’d much rather tell you about school / work / hobby
  • It’s really stressful to me when people make comments about what I’m eating.
  • It’s actually not helpful for me to talk about calories or exercise.
  • I’m choosing to focus on other things this year.
  • It is not beneficial for me to feel badly about my body or guilty about what I ate.

The great thing about practicing these responses with other people is that you’ll be more likely to use them when struggling with negative self-talk or eating disorder thoughts in your own head too.


Step 3:
Step away & seek support.

If stressors persist or you find you just need a break from the crowd, locate your holiday ally or text a friend. Take some time to vent about what’s bothering you, take 3 very deep breaths, and then re-focus on the positive parts of the day.  Sounds simple but it can make a big difference.

You are deserving of a happy and healthy holiday. How you choose to create that is up to you.  Just remember that one insensitive comment from one person does not have to ruin your entire holiday. At anytime, you can choose to re-engage in both the celebration and your recovery.

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Read more about healthy holiday coping…


 Concerned that you or a loved one may have an eating disorder?  Call us at (410) 938-5252 for a free and confidential phone assessment or visit www.eatingdisorder.org for more information about treatment options.

 

Photo credit: freedigitalphotos.net / digidreamgrafix

 

 

 

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8 ways to take the focus off of food this Thanksgiving


Who’s bringing a dessert?  Can someone help with appetizers?  Here, have some more!  Are you really taking another helping?  I wish I could eat like you.  Ugh, my diet must start tomorrow!

guitarSound familiar? It’s not unusual for pre-Thanksgiving talk between family members to focus on food and food-related tasks. It’s also not uncommon for holiday conversation to revolve around what people are eating or not eating, who’s eating too much or too little and, in some cases, criticism or praise regarding weight and size. To be clear, making sure there’s enough food to feed everyone at a gathering is important, but it doesn’t need to be the center of everyone’s day.

When an individual is struggling with an eating disorder, or working hard to maintain recovery from one, these topics can activate disordered thoughts about food, trigger negative body image and impact a person’s ability to be emotionally or physically present at the gathering. Intentionally steering the day towards gratitude and connection instead of food and weight can take a bit of work in our diet-obsessed culture but it stands to benefit many, not just those with eating disorders.


Where to start?
These are just a few suggestions from our therapists and dietitians. Feel free to share your ideas and recommendations on our Facebook page.


1. Offer roles for family and friends who want to contribute something but may not want to bring food.
Not everyone enjoys cooking and some people, especially those with eating disorders, might feel incredibly anxious around food. There are definitely other ways to help and have a meaningful connection to the day that don’t involve preparing food. For example:

  • Planning activities or bringing a craft for the kids (or adults!) to work on.
  • Pet duty. Someone might really love to take the dogs out for a walk while everyone else is distracted in the kitchen or watching the football game.
  • Helping with clean-up and dish-washing (Yes, some people enjoy washing dishes!)
  • Ask the musicians of the family to bring their instruments.
  • See if anyone would be willing to put together a slideshow of past Thanksgiving photos for after-dinner viewing.

Quick Tip: Tap into everyone’s strengths. If your brother has taken up a recent interest in photography ask if he’d be willing to document the day and capture different positive interactions. How great would it be to have a beautiful photograph of a grandparent rocking a new baby or all the cousins playing football outside? These are, after all, the moments you’d choose to remember about a holiday, not how many calories you ate or an offhanded remark someone made about your weight gain/loss.


2. Give in to the gratitude trend.
Gratitude might seem like a big social media gimmick right now but the truth is it does have the power to shift your attitudes and perceptions. The moment dinner is served and everyone sits down to eat can be a moment of peak anxiety if you have an eating disorder. In anticipation of this, Google “gratitude quotes”, pick your favorites and write them on small cards to place at each table setting. Depending on how willing your family is, you could also give everyone a chance to go around and verbally share something for which they are grateful.


3. If you’re hosting, do a quick assessment of reading material around your house.
Put away (or better yet, recycle) any magazines that are overly focused on appearance, diet or beauty. Studies show even just 3 minutes of looking at fashion or “fitness” magazines can negatively impact self-esteem and trigger feelings of sadness and guilt. Do you really want your 7 year-old nephew to practice his reading skills with a fitness magazine full of photoshopped bodies? Do yourself and your guests a favor by instead stocking your coffee table with photo albums, short stories written by your kids, or some photography books by a favorite artist. (If you really want to make a body positive impact, you could leave a copy of Intuitive Eating or Health At Every Size laying around as well.)


4. Identify an ally (or two).
Many of us look forward to holidays with great anticipation because we get to spend time with family members we don’t often see. Some of us experience dread and stress for the very same reason. It’s no secret that family dynamics can be complicated. Instead of focusing on family members who are particularly difficult to handle, focus on the ones who can help. If you have a grandparent, cousin or significant other who knows you’re struggling with recovery, have a conversation with them in advance about the ways in which they can support you at the gathering, at the table, and in specific situations throughout the day.


5. Step away from the bathroom scale.
If you’re hosting and you have a scale in your house, move it out of sight temporarily, or permanently. If you are a guest in someone else’s house, consider asking them if they can stash it in a closet for the day. As a parent, spouse or support person of someone in recovery, this would be a great thing to take care of in advance as a way to advocate for your loved one.


6. Whatever you spend time focusing on will be what you spend time focusing on.
If you’re in recovery you likely going to need to think about meal plans and meeting nutritional needs and that’s okay, but make sure you also have holiday intentions that don’t involve food, eating or weight. Why? Because if all your goals that day revolve around what you’re eating you will be hyper-focused on food just like you were with the eating disorder. Prioritize your nutritional goals, talk them over with your dietitian and then consider adding some non-food goals like these:

  • I will record an interview with a grandparent. (Check out The Great Thanksgiving Listen)
  • I would love to cuddle with a relative’s new baby.
  • I’d like to sneak off to do a 3-minute mindful meditation before dinner
  • I’m going to talk with each family member about their favorite songs, then compile a playlist to share after the holiday.
  • I will give at least 3 non-appearance related compliments to other people on Thanksgiving day.

Quick Tip: Whatever you choose, make sure your goals are easy, achievable and positively worded. Think about adding good things into your experience, instead of avoiding a negative. For example, instead of saying “I won’t go on Facebook during our Thanksgiving get together” say “I look forward to taking a break from social media so I can catch up with my loved ones.” Remember, whatever you focus on will be what you’re focused on.


7. Remember that you cannot control everyone else.
We live in a food and weight-obsessed society, so it’s likely some of this conversation will make it’s way into your holiday despite your best efforts. If and when it does, be prepared with ways you can change the conversation, set boundaries and seek support.


8. Give Back –
Identify a local charity and ask all the Thanksgiving guests to bring a donation for the cause. Even if the day is hard for you and your recovery you will be left with a visual reminder of everyone’s generosity, (even if they couldn’t stop mentioning how many calories were in the appetizer all day).


Thanksgiving can be a truly beautiful holiday that reminds us all to give thanks and reflect upon the positives in life. Taking the focus off food might not only benefit those with an eating disorder but anyone struggling with negative thoughts, low self-esteem or loneliness this holiday season.

When we lift the food frenzy and body angst we are better able to focus on gratitude and authentic connection with others and ourselves.

Happy Thanksgiving.

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You may also be interested in reading:

Simple solutions for holiday (and everyday) conversations about food and weight

 


 

Questions about treatment for an eating disorder? Call us at (410) 427-3886 or visit eatingdisorder.org

 Photo Credit: freedigitalphotos.net / bugtiger

Surviving & Thriving through Mid-Terms & Finals

It seems like many colleges and universities have moved away from the standard exam schedule. In fact, it can seem like you are constantly studying for exams or writing papers, with no downtime or lull in the semester at all. Midterms and finals just mean a heightened level of existing anxiety or stress. Unfortunately, for many college students, that means there comes a point in the semester when it seems like there are way too many obligations and way too little time to manage them all.  If you are simultaneously working on recovery from an eating disorder this can be incredibly frustrating, particularly if everything seems to be equally important on your to-do list. While it can be easy to lose sight of how critical your recovery is in the midst of these academic priorities, its crucial to remember the potential consequences.  Turning to your eating disorder behaviors will only intensify the stress you’re body is under, making it mentally and physically harder to concentrate, harder to interact and connect with other people (i.e. study groups, roommates, support people) and much harder to accomplish that long list of study tasks.

Self-care, nourishing your body, following treatment recommendations and practicing your new healthy coping skills is what will eventually get you through the stress of mid-term or final exams.  While the hectic nature of college academics can’t be completely avoided, we can offer some tips to help make it feel more manageable and less likely to derail your progress in recovery.

Prioritize: Make a list of all of your upcoming responsibilities. Pull out the larger projects and see if you can break these down into smaller, more achievable tasks. For example, break down “10 page research paper” into: print articles; read articles; write an outline; write the rough draft; write the bibliography; and revise the paper. Write deadlines next to each item on your list and then organize your to-do list by due-date or high priority items. Don’t forget to breathe.

Eliminate unnecessary responsibilities: Do you really have to do everything on your list? You might have some things on there that are optional projects, or possibly some student organization meetings that are not imperative for you to attend. Perhaps you can ask for less hours at work during exam weeks. Remember that you can also always talk to your professor; if you have 3 exams scheduled on one day, one of your professors may actually be willing to allow you to take the exam for their class on a different day. If you just can’t adjust your schedule, know that this stress is temporary. Focus on the end point and plan a reward for yourself after big assignments are turned in.

Don’t give up on the basics: As tempting as it may be, you still need to prioritize sleeping, eating and self-care. In fact, it is even more important that you take care of yourself during this stressful time. Always strive to get as close to 8 hours of sleep each night as possible, remembering that lack of sleep can have a significant effect on hunger and eating patterns.  Make sure you are scheduling times to eat your meals and snacks and that you are thinking ahead. If you know you won’t have time to go back to your room for a meal, remember to pack your food with you or bring money to eat while you are out.

“The time to relax is when you don’t have time for it.”   

~Sydney Harris

Relaxation is vital. Take some time every day to take a deep breath and be still. Enjoy what the season has to offer.  Consider setting aside 30 minutes or an hour during your busy time to catch up with a friend or roommate – no multi-tasking or studying allowed during that time.

Keep your appointments: When things get hectic, it may be tempting to cancel your therapy or nutrition appointments so that you can spend more time studying.  This often makes sense in a moment of panic or stress but can easily lead towards losing sight of  recovery’s importance.   Cancelling appointments during high stress or high pressure times can be a risk  factor for relapse.  Consider a rock climber choosing to take off her safety harness right when she gets to the highest and steepest part of the cliff.  You’d probably question that decision right?  The same applies to your “safety harness” and your support system during difficult times.  If you are struggling to get to your appointments, speak to your therapist about this and decide together what is the best way to balance your responsibilities with your recovery in mind.

Reach Out:  Recovery can feel like a full-time job sometimes, and college is a full-time job for many students.  You may be realizing that you are struggling so much with both that you just can’t focus on your academics the way that you want to. You may have missed a number of classes, gotten behind in lectures or just feel too overwhelmed to truly focus. Don’t be afraid to talk with your professor and see if there is any way that you can catch up, delay some deadlines, or work with a tutor to help you in that class.  You don’t have to go through this on your own.  Ask for help and explore your options for support on campus. If you think you need to withdraw from a class and have missed the Drop/Add deadline, or if you are thinking about taking a medical leave of absence, schedule an appointment with the Dean of Students, an Academic Advisor, or someone at the Counseling Center – that is what they are there for!

While academics and exam stress can be overwhelming, just remember that you have options regarding how you handle that stress and how you let it affect you. You have already accomplished so much this semester.  Reflect on what has been working well so far and praise yourself for a job well done. If there are things that have been a struggle, now is a good time to evaluate what aspects of your self-care and stress tolerance could be improved.  Try  coming up with a reasonable plan to put into action for the rest of the semester and continue reflecting on it to see what is working and what isn’t. If you are stumped as to how to do this, reach out to others for support and additional ideas.

CED wishes you a memorable semester of academic success, balance and self-care.  For more insight on the intersection between college and eating disorder recovery, check out our whole blog series at: Battling Body Image Concerns & Disordered Eating on Campus .

If you are struggling with an eating disorder and need help or support, please call The Center for Eating Disorders at (410) 938-5252.  You can also reach us by email at EatingDisorderInfo@sheppardpratt.org.

 

Written by Jennifer Moran, PsyD, CED Therapist & College Liaison

Originally published on 11/11/2011

Mindful Eating on Campus ~ Part 1

college student at laptopFew things are more stressful for a student who is in recovery from their eating disorder than trying to negotiate eating on campus. College living is full of obstacles to eating consistently and mindfully: buffets in the dining halls; eating between classes and on the go; staying up until 4 AM; social events involving food; and limited access to the grocery store or a working kitchen. While many students in treatment are given guidelines as to how to eat in a healthy manner, it is often difficult to implement those strategies in a campus setting but it is possible.  A great resource for this task is the book, Mindful Eating 101: A Guide to Healthy Eating in College and Beyondby Dr. Susan Albers which we will reference throughout this post.

Mindfulness is an old concept that has, more recently become somewhat of a cultural catch phrase. Standing at a coffee shop bulletin board, you may notice advertisements for mindful meditation classes or yoga classes that promise skill development in the art of mindfulness or even magazine covers that stress the importance of mindful living. So, what is mindfulness?  Mindfulness refers to the ability to bring one’s awareness completely to the present moment.  In contrast, mindlessness, refers to behaving or doing things without much attention.

Consider that you are eating dinner in your dorm in front of the TV during your favorite night of Mindful Eating 101television. As you laugh along with the show and get intrigued by products during the commercials, you occasionally pick up your phone and make plans for the evening and attempt to skim a chapter in your text book for tomorrow’s quiz.  All the while, you also continue to go through the motions of eating your dinner…mindlessly. In this situation, your attention is likely focused on the characters and themes in the TV show and not on your food or your body’s response to the food.  When this happens, it is common for people to eat more than they normally would because they aren’t really enjoying their food, and they aren’t in touch with the mechanisms in the body that tell us when we want to stop eating. In contrast, when you choose a meal from the dining hall and sit at a table to enjoy it with a friend but without other distractions, you may find that you eat more slowly, you savor the tastes of the food, and you have an increased awareness of your hunger/satiety cues, which allow you to stop when you feel full. This style of eating would be considered mindful eating.

Individuals who’ve struggled with an eating disorder or have chronically dieted often lose touch with their body’s natural ability to regulate food and eating processes.  Sometimes they may need help establishing normal eating patterns again and re-connecting to their bodies.  In eating disorder treatment, mindfulness is a concept that is used frequently in helping people to develop awareness of their thoughts, emotions, patterns, triggers, and hunger/fullness cues.

Eating mindfully is an important skill because it allows you to eat exactly what your body wants in just the right amounts. Restricting your food intake or dieting is not mindful because it denies your body of the food that it needs for fuel and nourishment.  Bingeing is also not mindful eating because it exceeds the amount of food that your body wants or needs and may cause you to feel uncomfortably full or even pained.  Mindfulness involves trusting your body to maintain a balance.  Learning to eat mindfully can take time, so be gentle with yourself as you practice the steps that will allow you to eat intuitively in response to your own body’s needs.

Dr. Albers outlines the seven habits of mindful eaters in her book.  These habits are the key components of learning to eat mindfully.

  1. Awareness: Use your senses to gather information about the world. By using sight, sound, hearing, touch and taste, you can become attuned to what is going on around you at any moment. Turning this inward, you can better recognize your hunger, fullness and thirst cues to help guide your eating choices.
  2. Observation: Simply notice your thoughts and feelings as an impartial observer. The key is to do this without judgment. For example, if you have the thought “I am fat,” simply notice that it is there, label it as a negative thought, and move on.
  3. Shifting out of autopilot: Some of our routines become so mundane that it is difficult to pay close attention to the details. These routines sometimes enable mindless eating or skipping meals completely, and so you may want to change the routine or bring awareness to it in order to be more mindful. Try waking up a few minutes earlier to fit in breakfast or consider meeting a classmate someplace for lunch that you’ve never been before.
  4. Finding the gray area: Black and White thinking refers to thinking in extremes. Food is good or bad. Someone is fat or skinny. Clearly, life is not that simple. To be mindful, one must be flexible and avoid operating in extremes. An example of this is someone who is on a diet that forbids bread; even if a person wants bread they will deprive themselves of it because of the diet. Sometimes, this deprivation can lead to the person bingeing on bread. In contrast, a mindful eater would recognize the particular craving and allow herself to have an appropriate serving of bread at the time when she wants it.
  5. Be in the moment:  As a college student, you may find yourself frequently eating in class, while cramming for a test, or even while walking or driving across campus. Multi-tasking like this is not considered mindful because you cannot use your senses to enjoy the food or to stay aware of your hunger and fullness cues. Ideally, a mindful eater would sit with their meal on a plate at a table and devote their full attention to eating. However, this is not always a realistic goal for a college student.  Try making small changes that help you stay present during meals, such as always sitting down to eat and turning off your phone to remind yourself to stop texting and posting on Facebook until you finish your lunch.
  6. Non judgmental: Notice judgmental thoughts and proceed with compassion instead of criticism. Often at the campus dining halls, various stations offer different types and categories of food. If you notice yourself judging a particular food station ( “I can’t order from that section, everything is full of fat.”) notice the criticism attached to the food and label it (“there I go thinking of foods in good and bad categories again.”) Practice compassion and focus on truthful statements (“this food may have fat in it, but I need some fat to help me protect my organs”).  Try to incorporate different foods from each of the various food stations at the dining hall throughout the course of the week.
  7. Acceptance: Accept things for how they are as opposed to how you think they should be. Dr. Albers gives a great example in her book of accepting your shoe size, even if you wish it were different, because there really is nothing that you can do about it. As much as you may wish to have smaller or larger feet, eventually you must let go and accept that your feet are the size that they are.

If you’ve struggled with disordered eating, it may be easier to practice mindfulness at first with something that is not related to food. Try this simple exercise to practice the aforementioned skills. Close your eyes and simply count how many sounds you can hear in the room. When you think you have counted the sounds in the room, push yourself to try to hear beyond the room. Can you hear sounds from outside? In the hallway? What about the sounds closest to you…can you hear your own breathing? The sounds that you hear are happening in the here and now; congratulations…you have been successful at being mindful of the present moment! Now you might want to try doing a similar exercise with your food, using your senses to guide your eating.

For more information and tips on healthy eating during college, read Mindful Eating on Campus: Part 2 HERE…

 

Written by Jennifer Moran, PsyD, Therapist and College Liaison at The Center for Eating Disorders at Sheppard Pratt; Originally published on 10/11/11

 Photo Credit:
1. Vichaya Kiatying-Angsulee and freedigitalphotos.net
2. Susan Albers / mindfuleatingcafe.com

For more information about Dr. Albers and her Mindful Eating series, visit her website at www.mindfuleatingcafe.com.

FOOD LOGS: How they can help with eating disorder recovery (& why you might still be avoiding them)

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coffee-writing-stuart-milesFood logs are one of a variety of therapeutic tools used during treatment for an eating disorderFood logs – also referred to as food records or food journals – can take many forms.  Some people prefer to jot things down free form in a personal notebook while others do best filling out the prepared charts provided by their dietitian.  Many others have gone tech-friendly and use an app on their phone to track info and share it with providers. Regardless of the form it takes, a food log does much more than track your food.  A helpful format for food logs will include the time of day, a description of the meal or snack, actual food and beverage intake, location/setting of the meal and, most importantly, an individual’s thoughts and feelings before, during and after eating. Completing food logs and subsequently reviewing them with a registered dietitian can be a pretty powerful part of the recovery process. Not surprisingly, and perhaps because they can be so powerful, many individuals also experience some resistance to using them.  If you’ve ever been encouraged to complete food logs as part of your treatment for an eating disorder but had trouble starting or committing to the process, we thought it might help to know why a dietitian would recommend doing them and the specific ways in which they can aid in the recovery process.

Completing food logs throughout the week maximizes time spent in session with your providers. Weekly nutrition counseling sessions are often 30 minutes long.  It could potentially take up the most of that half hour to do a 24 or 48-hour verbal recall of your meals during the session. It’s easier to get down to business if the logs are already done. Plain and simple.

Food logs are like x-rays. If you hurt your arm and asked your doctor to put a cast on it, she would require you to get an x-ray first to see if, how and where it was broken. If you refused, she broken-armwould only be able to give you broad advice, like “take a Tylenol and get some rest.”  (If you’ve broken a bone before you probably know that wouldn’t help a whole lot). On the other hand, if your doctor could look at the x-ray of your arm she could fit you for the exact type of splint or cast needed, assign the proper amount of physical therapy, and provide individualized prescriptions for your pain.  In much the same way, food logs allow the dietitian to give you tailored advice and individualized strategies, rather than simply relying on a general, one-size-fits-all nutrition goal.

Food logs provide insight into your bigger picture. Sure, your food logs communicate specific details from each meal, but they also show trends and patterns over the course of the week related to meal times, location, hunger/satiety  cues, situational triggers and thoughts. Dietitians can often see connections on the food logs that patients don’t always see themselves. Seeing “the forest for the trees”  allows the dietitian to offer the most useful and beneficial feedback to the patient. Let’s say you arrived home from work late and ate an entire large pizza. Looking back on the food log we may see that you had an 8-hour gap without a meal that caused you to feel extremely hungry. Perhaps a goal would be set to have an afternoon snack available for those situations to help you get to dinner hungry, but not ravenous. On the other hand, maybe you had a stable breakfast, lunch, and afternoon snack, but your dietitian notices you hadn’t allowed yourself pizza in six months despite the fact that it’s one of your favorite foods. A more appropriate goal in that situation would be to practice food habituation with pizza (exposure to a food over time makes the food less compelling) and having a support person around when you’re eating it for a while. The bottom line: It’s harder to learn from the incident when we only see it from one angle. Food logs help us both have more perspective on why things happen, to know whether the set-up was physical or emotional and how to address the physical and emotional needs going forward.

Food logs provide a way to monitor progress. Nutrition therapy is about making changes that improve your relationship with food and your health. We tend to set small weekly goals that create momentum towards overarching goals and bigger changes over time. How will either of us know if the goals are met if we don’t keep track of them? Keeping a food log provides an objective look at progress from week to week and month to month.  It also takes the pressure off of you and your dietitian to recall from memory all of the details of your food and symptom use from the past month.  Rest assured, as you heal from your eating disorder you will have many more important things to use your brain for!

Returning to a normal and healthy relationship with food means appropriately responding to hunger and fullness signals. It’s impossible to do that if your signals are broken from chaotic or disordered eating. The best thing to get your digestive system and metabolism back on track is structured eating – meaning adequate amounts of food with adequate frequency.  Food logs aid in structured eating accountability, and structured eating over time sharpens your signals. Food logs and structured eating can provide the training wheels to help you get to a place of intuitive eating.

Food logs help connect your mind with your body.  Putting your pen to paper before, during or after a meal increases mindfulness with eating which can decrease mindless eating. Logging intake with your thoughts improves your ability to tell the difference between emotional hunger and physical hunger.  This practice also increases awareness to how certain foods make your body feel – energy, mood, mental clarity, digestive happiness, etc. Being aware of how foods make your body feel is important in working towards more sustainable and fulfilling eating practices.

Keeping up with food logs can help prevent relapse during transitions.  If you’ve ever received care for an eating disorder in an inpatient or partial hospital setting, you know the transition into outpatient or even intensive outpatient treatment can be difficult as you are once again responsible for completing more meals on your own. One way to help maintain the stability or progress you made in the higher level of care is to continue to self-monitor your intake and associated emotions during that transition and promptly discuss any specific challenges you encounter with your outpatient providers.  If you’re completing food logs, it’s easier to catch a slip-up before it becomes a full-blown relapse.

As mentioned earlier it’s not uncommon for individuals to question the benefit of food logs or to experience some resistance to the idea of completing them. A common reaction from patients is that, “writing down everything I eat makes things worse“ or “I don’t like doing food logs because it reminds hands with pen.africa and freedigitalphotosme of acting on my eating disorder.” As providers, we completely understand that rigidly tracking food and exercise can often be a symptom of the eating disorder.  That being said, there is a big difference between keeping a detailed, private food diary and collaborating with a dietitian to complete food logs during treatment. For one, the end goals are very different. If you tracked your food before it was probably to monitor strict adherence to dangerous eating disorder behaviors or dieting techniques. Those logs probably involved weighing, measuring, and counting calories and were done to benefit the distorted rules of the ED, not to honor or nourish your body. Conversely, the goal for food logs in treatment is to monitor weekly goals, help normalize eating behavior and to improve your relationship with food. When doing food logs with a dietitian, there is no good vs. bad, no shaming, no judgement. The role of the dietitian is not to be the food police waiting to condemn you. Rather, their role is that of a supportive detective. To examine the data, to see if there is something that is setting you up for problematic eating behaviors and then provide you with education and ideas to help make improvements going forward.

Still not sure? Here are a few additional tips for those of you who may have lingering fears about food logs…

For those that are embarrassed to show anyone… Does it make you nervous or uncomfortable to think about showing someone else a record of your daily eating behaviors? If you are worried that your dietitian will be shocked, grossed out, alarmed, or otherwise disturbed by your food log it can be helpful to think of the dietitian like any other specialist.  Take a dermatologist for example. You might feel nervous or uncomfortable during an annual skin check but to the dermatologist, that’s what they do everyday – they look at freckles and moles all day long.  Food logs and weights can be things that feel vulnerable to share, but remember, those are just pieces of data that the dietitian analyzes and they’ve seen and heard it all before. It’s their job to look at meal patterns and associated thoughts/behaviors. Vulnerability takes courage, but being courageous can lead to positive change. If you’re feeling shameful about sharing your food logs, remember this quote from AA – “secrets thrive in the dark and die in the light.” Being honest with your dietitian and allowing him or her to see your food logs is one of the first steps in moving away from the pain of the eating disorder.

For those who struggle with perfectionism… Food logs aid in improving nutrition behaviors just like practicing an instrument aids in learning the skill of playing an instrument. Writing down logs is intended to keep you in the mindset of practicing your nutrition goals for the week. The more often you practice a particular skill, the more it becomes a habit over time. That progression will not be perfect, and that’s a good thing. Even when you have a rough week and the goals aren’t met, food logs are still very helpful!  As providers, we actually learn more from the rough days than we do from the stable days. The logs allow us to see and discuss what some of the barriers might have been to meeting the goal, so we know what to try or be mindful of the following week. Portraying a “perfect” day of eating when it’s not what actually happened is not helpful.  Recording struggles or slip-ups in a food log allows us to work together to correct the focus and try again. Just like it takes practicing a song on the piano before you can play it without looking at the music – food logs keep you intentional in your practice of positive nutrition behaviors before you can naturally engage in the behaviors without the logs.

For those who don’t want to be stuck doing food logs for the rest of their lives (a.k.a. everyone)… Food logs are used to benefit an individual’s relationship with food and establish normal eating.  To that end, the goal is never for someone to be reliant on tracking their intake or completing food logs for the rest of time.  Rather, this is a temporary tool to help bridge the gap between eating disordered and eating intuitively. It might seem counter intuitive to spend your time tracking food in an effort to heal from a disorder that caused you to obsessively focus on food.  But if your goal is to one day be free from disordered eating, it can help to remember this: learning a new behavior often requires focusing on it more before you can focus on it less.

If a dietitian has recommended that you try doing food logs and you were never quite ready to give it a try but you continue to struggle with your ED, it might be worth taking some time for self-reflection. Would it be worth trying something new?  Consider what you would do if your car was stuck in the mud and the first two tow trucks to the scene couldn’t pull you out because they didn’t have the right tools. What would you say to a third one that came along with a different towing device?  Trying something new can sometimes help you to get unstuck. Even if you have tried food logs before and just couldn’t commit to the process, perhaps approaching an old tool with a new perspective or deeper understanding of how it works, could make all the difference.

CED-2014-19334-Mandala-FINALNot wanting to try food logs or other therapeutic tools suggested by your team, can be a form of avoidance. Consider whether you might be avoiding an awareness of particular behaviors or feelings.  Are you trying to avoid being accountable to make changes?  Are you avoiding acknowledgement of your body’s basic needs?  If any of these resonate with you, try being honest with your dietitian or therapist about why you may have been resistant to doing food logs in the past.  Ask for some strategies to make them more manageable or less anxiety-producing. Food logs do take time and you may not always like doing them, but there’s no denying that they can play an important role in facilitating positive change with the support of your treatment team. At the end of the day, doing food logs is temporary. A healthy relationship with food and your body lasts a lifetime.

Written by Hannah Huguenin, R.D. and Kate Clemmer, LCSW-C

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Are you struggling with an eating disorder but you’re not sure where to go for help? Contact The Center for Eating Disorders at Sheppard Pratt at (410) 938-5252 to do an initial phone assessment or visit eatingdisorder.org to learn more.  You may also want to check out our upcoming free events and workshops.

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Hannah Huguenin MS, RD, LDN

Registered Dietitian

Hannah Huguenin received her Bachelor of Science degree in Dietetics with a minor in Chemistry from Olivet Nazarene University in Illinois. She received her Masters degree from the University of Kansas Medical Center in Kansas City where she also completed her Dietetic Internship. During this internship, Hannah completed a rotation on an acute care eating disorder unit at the Research Medical Center in Kansas City. She has been with The Center for Eating Disorders since 2008, and provides individual nutritional counseling for the outpatient population. In her role at the Center, she provides ongoing support to help patients decrease eating disorder behaviors, meet their nutritional goals and improve their relationship with food through nutrition education.
 
 
Kate Clemmer, LCSW-C
Community Outreach Coordinator

Kate Clemmer earned her Master of Social Work degree from the University of Maryland, Baltimore in 2005 with a focus on Management & Community Organization and a specialization in Child, Adolescent & Family Health. Before joining the Center for Eating Disorders in 2008, Kate provided school-based therapy to adolescents and families in Baltimore City and coordinated a multi-school health education and prevention program. As the CED’s Outreach Coordinator, Kate currently facilitates trainings and workshops in the community, provides outreach to individuals interested in the Center’s services and coordinates the Center’s annual community events. These events include an annual Symposium for health professionals, the Love Your Tree Body Image Campaign, and National Eating Disorders Awareness Week. Kate also facilitates the Center’s community support group for individuals with eating disorders and their friends/family, held on Wednesday evenings.

 

Photo credit: freedigitalphoto.net and (in order) Stuart Miles, Boaz Yiftach, Africa

Exciting Developments at The Center for Eating Disorders’ Intensive Outpatient Program

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An Intensive Outpatient Program (IOP) for eating disorders can be important for individuals who are transitioning out of an inpatient or partial hospital setting but would still benefit from more support and structure than is typically offered through weekly outpatient therapy.  The Center for Eating Disorders’  IOP provides 16 hours per week of intensive treatment in the evenings to allow individuals to fully engage in school, work and family during the day while continuing to focus on their recovery.

In the past six months, the IOP has seen some exciting changes and updates in programming. The program has returned to (a newly renovated!) space on the ground floor of the Sheppard Pratt B building, just downstairs from the inpatient and partial hospital units. Our multidisciplinary treatment team now includes members from psychiatry, psychology, art therapy, nutrition, occupational therapy, and social work.

Some of the recent exciting additions to IOP include:

  • Medical DirectorHeather Goff, MD has stepped into the role of Medical Director for the IOP, leading the multidisciplinary treatment team in providing care for patients. She also provides psychiatric treatment to all patients, including weekly assessments and medication management.
  • Clinical CoordinatorMorgan Krumeich, PsyD joined the IOP team in 2014 as our new clinical coordinator. She also leads group therapy and works with patients on an individual basis.
  • Collaborative Care Group – IOP now offers a weekly collaborative care group for parents, caregivers, and supports. Run by IOP social worker Annie Hanley, this group is similar to those offered at other levels of care, but is tailored specifically to the needs and issues that may arise during IOP treatment and associated transitions. All support persons are highly encouraged to attend this free weekly group, held on Tuesdays from 6:30PM-7:30PM.
  • Occupational Therapy – Occupational therapist Rachel Dehart has joined the IOP team and runs weekly OT groups for adults. Adolescents also have the opportunity to meet with an occupational therapist as needed. OT groups in IOP focus on the unique needs of individuals with eating disorders, including time management, grocery shopping, clothes shopping, involvement in the community, work or volunteering, and school.
  • Individualized Nutrition Consultations – With two dietitians now on the IOP team, Caitlin Royster and Kelly Daugherty, we continue to offer weekly nutrition groups for all patients. Additionally, dietitians are working to provide individual assessments and nutrition consultation for patients on a weekly basis.

The Intensive Outpatient Program is designed to work closely with individuals, their families, and outpatient providers in order to offer the most comprehensive care possible. And of course, we always work to incorporate patient feedback in order to ensure the IOP is continuously developing and meeting the needs of individuals, families and the community.

If you have questions about the Intensive Outpatient Program, please call (410) 938-5252 or email EatingDisorderInfo@sheppardpratt.org.

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Meet the IOP Staff

Heather Goff, M.D.
Child & Adolescent Psychiatrist
Medical Director, Intensive Outpatient Program
Dr. Goff joined the Center for Eating Disorders in 2011. A child and adolescent psychiatrist, she is board-certified in both Adult Psychiatry and Child & Adolescent Psychiatry, providing her a developmental perspective that enhances her work with patients of all ages. Her initial medical training was at New York Medical College, followed by a residency in Adult Psychiatry at Yale University, where she was a chief resident in 2005-2006. She then went on to complete a fellowship in Child and Adolescent Psychiatry at the Yale Child Study Center, where she was again chosen to be a chief resident in 2007-2008. Upon completion of her post-graduate training, Dr. Goff joined the Yale faculty, with joint appointments in the Department of Psychiatry and the Child Study Center. As a clinician-educator, she was the teaching attending for one of the adolescent inpatient units. She also served as Director of the Child Study Center at Madison, where she provided direct outpatient care to children, adolescents and their families. While at Yale, Dr. Goff was also a fellow at the Edward Zigler Center in Child Development and Public Policy, leading to her interest in the intersection of the media and social policy in the development and treatment of eating disorders. In her role at CED, Dr. Goff spent one year treating individuals in the inpatient and the partial hospital programs. In 2012, she transitioned to a new role as Medical Director of the Center’s Intensive Outpatient Program and is also completing assessments and evaluations for children and adolescents in our outpatient department.

Erin Birely, LGPC
Mental Health Counselor
Erin Birely graduated from Loyola University in Maryland in 2012 with a Master of Science degree in Counseling Psychology. She completed a year of internship at the Center for Eating Disorders from 2011-2012, and subsequently began working full time in 2012. She is currently working towards her LCPC certification. Erin provides individual check ins and goal setting with patients. Additionally she facilitates DBT groups focusing on symptom management and emotion regulation, and IPT groups focusing on processing interpersonal difficulties, as well as leading the Multi-Family and Supports Group on Wednesdays.

Kelly Daugherty, RD, LDN
Clinical Dietitian
Kelly Daugherty received her Bachelor of Science degree in Dietetics from Saint Catherine University in Minnesota. She completed her dietetic internship with an emphasis in clinical nutrition at Johns Hopkins Bayview Medical Center in Baltimore, MD. During this internship, Kelly completed rotations on an acute care eating disorder unit at Johns Hopkins Hospital in Baltimore and at the Center for Eating Disorders. Kelly joined the CED team in November 2014. She completes nutrition assessments, teaches nutrition groups and assists patients with menu planning in the inpatient, partial hospital, and intensive outpatient programs.

Caitlin Royster, RD, LDN
Clinical Dietitian
Caitlin Royster received her Bachelors of Science in Nutritional Sciences with a concentration in Dietetics from Cornell University. She completed her dietetic internship with a focus on clinical nutrition and nutrition research at the National Institutes of Health in Bethesda, MD. Caitlin joined the Center for Eating Disorders in July 2014. Here she conducts nutrition assessments, teaches nutrition groups, and assists patients with meal planning in the inpatient, partial hospitalization, and intensive outpatient programs. Prior to joining the Center for Eating Disorders, Caitlin worked in an acute care setting providing medical nutrition therapy and nutrition education to patients. Caitlin is passionate about neutralizing food for her patients and takes a non-diet approach to nutrition education.

Rachel Dehart MS, OTR/L
Occupational Therapist II
Rachel Dehart graduated with a Bachelor of Science Degree in Public & Community Health from the University of Maryland, College Park in 2007. She received her Master of Science Degree in Occupational Therapy from Towson University in 2010. Rachel is currently an occupational therapist on the Children’s Short-Term Inpatient Unit where she adapts and grades activities to meet various physical, emotional, and cognitive levels of children aged 3-12. Rachel facilitates Life Skills and Time Management occupational therapy groups in the CED Intensive Outpatient Program to assist patients with re-engagement in meaningful occupations at home and within the community.

Annie Hanley, LGSW
Family Therapist
Annie Hanley graduated from University of South Carolina with a Masters of Social Work in 2014. She is currently certified as a Licensed Graduate Social Worker and is working towards her LCSW-C licensure. Prior to joining the Center for Eating Disorders, Annie provided individual and family therapy at an eating disorder treatment center at both the inpatient and outpatient levels of care. She also has experience using the Trauma-Focused CBT model to work with children who have experienced trauma. In her current role, Annie works as a family therapist in the inpatient, partial hospitalization and intensive outpatient levels of care. She also facilitates groups in the intensive outpatient program (IOP), including the Tuesday IOP Collaborative Care group for family members and support people. Her past research includes examining the role of peer influence on eating disorder development.

Brianna Garrold, ATR
Clinical Art Therapist
Brianna Garrold received her BA in Fine Arts from Notre Dame of Maryland University in 2010 (formerly College of Notre Dame of Maryland) and her MA from The George Washington University in Art Therapy in 2012, with additional coursework in counseling and Trauma-Informed Care. Currently, Brianna works with inpatient, partial hospitalization, and Intensive Outpatient Program patients using the art process to help patients identify and express their emotions, manage anxiety, and treat body image distortions. Brianna received her ATR in September 2014, and is currently working towards completing the LCPC, and the LCPAT, Licensed Clinical Professional Art Therapist.

Morgan Krumeich, Psy.D.
Clinical Coordinator, Intensive Outpatient Program
Dr. Morgan Krumeich graduated from The George Washington University in 2014 with her Doctorate in Clinical Psychology. Prior to obtaining her doctoral degree, Dr. Krumeich obtained a Masters in Clinical Psychology from The George Washington University as well as a Masters in Education (specializing in Applied Child Studies) from Vanderbilt University. She previously spent two years at Sheppard Pratt as a psychology extern at The Lodge School, where she conducted individual therapy, in addition to co-leading group and family therapy. Dr. Krumeich completed a year of internship as a school psychologist in the Newark Public School System before returning to Sheppard Pratt in 2014 to become Clinical Coordinator at the Center for Eating Disorders Intensive Outpatient Program. Dr. Krumeich has specialized training in working with children and adolescents, but she has experience (and enjoys!) working with individuals of all ages.