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.

 

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.

Easing Anxiety About Grocery Shopping During Eating Disorder Recovery

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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


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

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

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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Turning a Body Positive Summer into a Body Positive Year

 

Turning a Body Positive Summer into a Body Positive Year(2)


We spent the summer talking about several steps you can take to turn body dissatisfaction into body acceptance. We also presented some of the very important reasons why someone might be motivated to embark on such a task. The bottom line: negative body image can negatively impact all other areas of life – career, academics, physical health, social interaction and intimate relationships. As many as 67% of women ages 15-64 withdraw from life-engaging activities because they feel badly about their bodies. And women are not alone in the struggle; Thirteen percent of college-aged men say their appearance is traumatic or difficult to handle as well.As we head into the fall, its important to remember that negative body image doesn’t just go away for most people simply because the beach vacations and relentless bikini body advertisements subside. As much as we wish that was the case, we know body image is much more than a seasonal hazard.

Body insecurity will follow young boys and girls into middle school classrooms where they may stop raising their hands or engaging in class discussion to avoid drawing attention to their appearance.

Body insecurity will follow young adults onto college campuses around the country where it, paired with genetic risk factors like perfectionism and anxiety, plus fear of the Freshman 15, may provide fuel for the development of an eating disorder.

Body insecurity will follow the new mom to the play date where she will silently compare and scrutinize her body. She’ll be sold a thousand different ways to get her pre-baby body back.


Body insecurity will follow the quiet colleague home from work each night.  He refuses to hang out with friends or start dating until he finally “bulks up” again.

These may be the realities of day-to-day life with body dissatisfaction but they don’t have to be the end of the story. In addition to the 3 Steps we laid out during the #bodypositivesummer campaign, here are a few guidelines to help boost body image in any season.

1. Don’t postpone important events or fun life goals for appearance or weight-related reasons. Putting off a special vacation, not applying for your dream job or not going on a date until you lose XX lbs. is a recipe for missed opportunities and delayed happiness. Saying you’ll get around to something in few months can quickly turn into a few years, or even decades. If you’ve been waiting to live life fully because you’re unhappy with your body, consider taking one small step today towards whatever it is you’ve been putting off. Research flights, update your resume or call an old friend.

2. Stop Fat Chat.  When among friends or in social settings commit to steering the conversation away from appearance-based judgments and into more positive territory.  The American Academy of Pediatrics recently released a report urging pediatricians and parents to stop focusing on weight, or even mentioning weight, during discussions with children and teens. The reason?  Focusing on weight backfires, often leading to unhealthy behaviors that are associated with both obesity and eating disorders. The same is true for adults. Stop focusing on your weight as the golden marker of health and you may actually find it’s easier and/or more fulfilling to engage in healthful behaviors.

3. Cleanse your social media feed. Disconnect from the negativity, surround yourself with positive, healthy, and uplifting social media accounts.  If you’re online quite a bit, there is no reason to allow Instagram followers who consistently engage in fat talk or body criticism to cloud your view of yourself. You have every right to unfollow Twitter users that promote weight loss or diet products, even if they are close friends or family members. Remember, you are the curator of your accounts; use that power to cultivate a body positive presence for yourself online.

4. Last but definitely not least…ASK FOR HELP.  Negative body image can be a risk factor in the development of eating disorders or may trigger relapse while in recovery from one. If you’re having a lot of negative body image thoughts throughout the day or they’re impacting your behaviors around food and weight it might be time to seek support. Specific evidence-based therapies like Cognitive Behavior Therapy can be effective in addressing body dissatisfaction. It can help to tell a trusted friend, spouse, or parent that you’re struggling and ask them to support you in getting connected to a counselor or therapist who is trained in these specific techniques.

Not sure where to turn?  You can complete a confidential online self-assessment here or call (410) 938-5252 for more information.

Visit eatingdisorder.org for additional resources.   

 

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Putting the Mind in Mindfulness

Mindfulness has received a lot of attention in the past decade for its beneficial effect on stress reduction, depression, anxiety, and eating disorders. But, is there a connection between mindfulness and the brain? Read on for what research has to say about the connection.Putting the Mind in Mindfulness

Mindfulness can be described in a variety of ways including, but not limited to, a state of mind or state of being. It has been described as an awareness of, and nonjudgmental attention on, immediate experiences, both internally and externally (4). This can be done not only as part of meditative practice, but also as a general mindset applied during daily activities. Mindfulness is a practice of responding to a myriad of stimuli that cross one’s attention, including thoughts, emotions, and bodily sensations, with openness and acceptance (2, 4). 

A primary means in which individuals practice mindfulness is through meditation. Contrary to popular opinion, meditation is not clearing the mind but rather paying attention to whatever crosses one’s mind as it occurs without judgment. Although meditation is an important aspect of Eastern religions, it doesn’t have to be practiced in conjunction with a particular set of beliefs.  Mindfulness has also been applied in therapeutic settings for treatment of anxiety, depression, and eating disorders (1).  The positive effects of mindfulness have long been reported firsthand by those who practice it, however, now researchers are also learning more about the intricate changes in the brain that occur to produce these benefits.  

Mindfulness meditation has demonstrated positive effects on several functions in the brain such as attention, body awareness, and emotion regulation. 

  • Attention:  The anterior cingulate cortex (ACC) is responsible for sustaining focused attention on objects while disregarding distractions. Neuroimaging has shown positive effects of long term meditative practice including both increased activity in the ACC as well as increased size which signifies more connections and better regulation of attention (1,3).
  • Body Awareness: The insula is responsible for awareness of bodily sensations. This area has been researched heavily for its association with eating disorders. Research has found both changes in function and structure of these related areas, specifically greater size and density of grey matter, for people engaged in regular meditation practice (1- 4). Benefits include increased awareness of, and accuracy of, bodily sensations.
  • Emotional Awareness: Increased body awareness also has important implications for emotional awareness, which is necessary to be able to regulate emotions and increase empathy (3, 4)
  • Emotion Regulation: Mindfulness also has direct effect on the prefrontal cortex (PFC) which is responsible for emotional regulation. This is executed by “turning down” the region responsible for emotional processing and reactivity and “turning up” the area responsible for emotion regulation. This results in enhanced control over emotions (3).

Long term practitioners of mindful meditation show the greatest changes in brain structures but short term practice can also exhibit some of these enhancements (1, 4). 

4 quick tips to help you benefit from mindfulness:

  1. Start small.  Incorporate just a few minutes of mindfulness into your daily routine.
  2. Practice.   Complete a 1 minute mindfulness exercise by focusing on your breathing while keeping your eyes open. Check your mind wandering and focus attention back on your breath as needed. Try to keep your breathing at a normal pace.
  3. Be mindful anywhere.  You don’t need a fancy meditation room or a totally quiet space.  Just sit back wherever you are and focus your attention on an object nearby. Observe it, don’t study it or think about it, just observe it for what it is. Try to do this for a few minutes at a time.
  4. Modernize your mindfulness.  You can download mindfulness apps on your phone or tablet for daily reminders and other exercises.  Some good options include Relax Melodies, Omvana, and Headspace. (Though some do have fees that may apply).

 

Lache WILKINS


This post was written by Laché Wilkins, Research Assistant at The Center for Eating Disorders at Sheppard Pratt

References
  1. Chiesa, A., & Serretti, A. (2010). A systematic review of neurobiological and clinical features of mindfulness meditations. Psychological Medicine, 40, 1239-1252. http://dx.doi.org/10.1017/S0033291709991747.
  2. Farb, N. S., Segal, Z. V., & Anderson, A. K. (2013). Minfulness meditation training training alters cortical representations of interoceptive attention. SCAN, 8, 15-26. http://dx.doi.org/10.1093/scan/nss066.
  3. Holzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6, 537-559. http://dx.doi.org/10.1177/1745691611419671.
  4. Manuello, J., Vercelli, U., Nani, A., Costa, T., & Cauda, F. (2016). Mindfulness meditation and consciousness: An integrative neuroscientific perspective. Consciousness and Cognition, 40, 67-78. http://dx.doi.org/10.1016/j.concog.2015.12.005

 

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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

 

 

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.