The Center for Eating Disorders Blog

NEDA Congressional Briefing on Eating Disorders

CED Co-Director, Dr. Steven Crawford, among panelists to speak on Capitol Hill

The National Eating Disorders Association (NEDA) in conjunction with the Congressional Mental Health Caucus hosted a Congressional Briefing on Capitol Hill on October 2, 2018. This briefing was held to educate representatives and legislative aides about eating disorders in overlooked populations. Panelists at the briefing included Chevese Turner (moderator), Mike Marjama, Claire Mysko, Janell Mensinger, PhD, and Steven Crawford, M.D.

Dr.Crawford, co-director at The Center fo Eating Disorders at Sheppard Pratt, began by discussing the different eating disorders and the risks and causes associated with them. He explained the differences in each disorder and the ways someone can help if they notice symptoms of an eating disorder in someone they care about. These include, seeking more information on the subject, locating resources, not focusing on weight, and encouraging the person to seek specialized treatment.

Dr. Janell Mensinger, an Associate Research Professor at Dornsife School of Public Health at Drexel University, presented on eating disorders and population weight. Her presentation focused on people in higher weight bodies and she explained how weight-related harassment is over four times more common than bullying. She stressed that we, as a society, need to shift focus from weight to health and provided research that shows eating disorders and extreme dieting are increasing among people in higher weight bodies.

The next panelist Claire Mysko, CEO of NEDA, spoke about a prevention program called the Body Project. The Body Project is a group-based intervention that helps decrease eating disorder symptoms and body dissatisfaction in high school girls. There are currently 388 trained facilitators for this program across the United States. Mysko also mentioned how NEDA is working on a similar program for young men.

The final panelist was former Seattle Mariners Catcher Mike Marjama who now serves as a NEDA Ambassador. Marjama presented his personal struggle with body dissatisfaction and an intense desire to change his body, which led to extreme behaviors around food and exercise, an eating disorder diagnosis and eventually hospitalization. His treatment and recovery however, led him to a baseball career and renewed appreciation for mindfulness and balance. After retiring he decided to speak openly about his disorder and his story has since been featured on Good Morning America. As an Ambassador for NEDA his goal is to help boys and men see through outdated stereotypes about eating disorders so they can get the help they need.

Eating disorders are one of the most dangerous mental health issues and should not be taken lightly. Unfortunately, they are too often overlooked in people with higher weight bodies, in athletes of all calibers and in traditionally marginalized populations. Our hope is that the information shared in the Oct 2nd hearing will assist legislators in creating policies that not only support prevention and treatment for eating disorders but improve overall public health.

Additional Advocacy Resources:

  • Get involved, learn about state-specific legislative actions and become a NEDA advocate.
  • Read summaries of current legislative actions, read about current initiatives and get involved with advocacy days on Capitol Hill with the Eating Disorder Coalition.
  • You can find out more about The Center for Eating Disorders’ recent advocacy work here.

Written by: Julie Seechuk, Social Work Intern 

NEDA Walk: There are many ways to make a difference


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

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

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

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

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

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

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

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

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

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

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

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

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

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

 


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

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

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


Unique Stressors Faced by LGBT+ Individuals

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


The Transgender Community

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

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


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

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

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

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


LGBTQ+ and Related Hotline Numbers

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

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


Blog contributions by Catherine Pappano, CED Research Assistant 

You may also be interested in reading:

 


References

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

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

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

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

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

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

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

It’s Hot Outside!  Take the Plunge and Wear the Bathing Suit* How to break the avoidance/anxiety cycle so you can have more fun


It is a well-accepted notion in psychology that avoidance of a particular item or situation can lead to anxiety.  This anxiety leads to more avoidance which leads to more anxiety and on and on…and on.  For individuals with eating disorders, avoidance can take many forms including food avoidance, social avoidance and emotional avoidance. However, there is one particular type of avoidance that seems to blossom and intensify in the summer months and in warmer climates1… body avoidance.  Body avoidance is refraining from wearing seasonally appropriate, more revealing, cooler clothes due to fears about having one’s body exposed or being more visible.  Perhaps the most dreaded, and most often avoided, is the bathing suit. It is the one clothing item pretty much required to take part in some of the most fun and refreshing summer activities… jumping into a cool pool, running into the chilly ocean, or floating on top of a serene lake.

For people who have a preoccupation with weight and shape, oftentimes just the thought of wearing a bathing suit can stir up a lot of negative body image thoughts and tremendous amounts of anxiety.  In an effort to escape those thoughts and feelings, many people go to great lengths to not wear a bathing suit at all (avoidance). While the goal might be to not feel badly, as discussed earlier, avoiding the feared situation and the discomfort momentarily actually leads to more anxiety in the long-term. And so, the avoidance/ anxiety cycle begins.

The only way to stop this exhaustive and stressful process from continuing is to stop avoiding the feared situation.  In this case, it is to face the bathing suit head on…to wear a bathing suit, feel very anxious, survive the situation, and repeat.  Over time, a new, less threatening, response to one’s fears will ultimately develop and the anxiety will slowly subside.  The best strategy for doing this is to fully exposure yourself to wearing a bathing suit.

  • First, make a plan to visit a pool or beach in the next week and commit to wearing a swimsuit for a set period of time.
  • Second, know that you will likely feel extremely anxious initially but allow yourself to feel your full anxiety. Knowing that you feel very anxious and that you can survive the anxiety is a key element of exposing yourself to your fears.
  • Next, once this first exposure is complete and your anxiety has decreased, make a formal plan to put on your bathing suit as much as possible in the days ahead. Plan to reward yourself after the exposure- take yourself to a movie that you have been wanting to see, put $10 in a jar to work toward buying that new piece of furniture you’ve been eyeing, or treat yourself to a long phone conversation with an old friend.
  • Finally, repeat. The feared stimulus (aka the bathing suit) has to be worn regularly and without escape in order for the anxiety reduction to stick.  Track your anxiety and monitor to see that as the exposures progress, your anxiety starts to go down.

Science tells us it is best for positive outcomes to jump in feet first on body image exposure experiences like this. However, if it feels too overwhelming, consider breaking it down into smaller steps like first just wearing your bathing suit* around the house when you’re home alone, then wearing it in your backyard, then somewhere with just a close, trusted friend. Remember that the longer you put it off, the scarier it will seem. If you can start today, by the end of the summer you may actually be able to associate wearing a bathing suit with feeling refreshed and rejuvenated, instead of feeling distracted and fearful.

If you are struggling to take the plunge, consider working with a behavioral therapist who can offer guidance by providing education and support for helping to develop a systematic planned exposure schedule.

*Insert here any feared and avoided article of clothing- tank tops, shorts, skirts, light colored clothes, fitted clothes, dresses, formal attire.

Looking for more summer inspiration? Check out these other posts about overcoming negative body image and making the most of your summer season

Body Positive Summer: Step 1 – Stop Critiquing Your Body. Start Critiquing the Thin Ideal.

Body Positive Summer: Step 2 – Stop Comparing. Start Contrasting.

Body Positive Summer: Step 1 – Set yourself up for success.


Laura Sproch, Ph.D.

Written by Laura Sproch, PhD.
Research Coordinator & Outpatient Therapist
Dr. Laura Sproch is a licensed clinical psychologist who serves as Research Coordinator and outpatient individual and family therapist at The Center for Eating Disorders at Sheppard Pratt. Currently, Dr. Sproch is initiating treatment outcome studies, managing quality improvement projects, and developing novel research projects in an effort to contribute to the field’s understanding of effective eating disorder treatment methods. Dr. Sproch received her Ph.D. in Clinical/School Psychology from Hofstra University in Hempstead, NY where she completed her dissertation examining cognitive similarities between differential eating disorder diagnoses.  Dr. Sproch originally joined the CED team in 2011 as a postdoctoral fellow on the inpatient and partial hospitalization units acting as a family, individual, and group therapist.  She has also worked with adolescents and adults struggling with disordered eating at a variety of levels of care, including at Friends Hospital in Philadelphia, PA and ‘Ai Pono: The Anorexia and Bulimia Center of Hawaii in Honolulu, HI.  Her professional interests also include family-based treatment, psychological assessment, school psychology, and research on the transdiagnostic model for eating disorders

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References:

Sloan, D. M. (2002). Does warm weather climate affect eating disorder pathology?. International Journal of Eating Disorders32(2), 240-244. doi: 10.1002/eat.10077

 

 

What is the Difference Between ARFID and Anorexia Nervosa?

ARFID or Anorexia: What is the Difference?

Most parents have dealt with their children being picky eaters at some time or another. With so much to think about when it comes to children’s diets, from allergies and food sensitivities to maturing taste buds, how do you know if a “picky eater” is struggling with an eating disorder – and which one? When should you get concerned and seek help? Knowing more could be the key to whetherwhen and how to offer support.

With that in mind, it’s worth exploring a commonly overlooked eating disorder called Avoidant Restrictive Food Intake Disorder (ARFID) and why it is sometimes confused with anorexia nervosa.

ARFID

Since it was added to the American Psychiatric Association’s latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as an official diagnosis in 2015, it has been increasingly examined and discussed within the professional eating disorder community. Outside of that, many remain unaware about this illness.

ARFID is formally described as a feeding or eating disturbance that involves an inability to meet appropriate nutritional and/or energy needs (1,2). This can be due to a lack of interest in eating or food, avoidance of certain foods due to taste/texture or anxiety about health consequences or choking. ARFID typically presents in one of the following ways:

  • Considerable weight loss
  • Compromise in growth
  • Dependence on nutritional supplements (like Ensure, Boost or similar products)

Kids and adults with ARFID also experience a noticeable “interference in psychosocial functioning” (1). Put plainly, this is when an individual’s thoughts influence their social behavior. For example, someone experiencing ARFID would struggle with eating the typical food served at restaurants, parties or even in the school cafeteria. Consequently, they may avoid social gatherings. Over time, this isolation and avoidance may naturally have a negative impact on mood, social relationships and daily functioning.

In a diagnosis of ARFID, it’s important to rule out that any of the behaviors or symptoms you’re noticing are driven by concern about body shape or weight as this may indicate a distinctly different diagnosis. Let’s take a closer look at anorexia nervosa to further distinguish the two.

Anorexia nervosa

Anorexia was included in the first edition of the DSM published in 1952. Awareness of the condition in the medical community dates back even further to 1873, when a British doctor presented a paper on it to the Royal College of Physicians (4).

Anorexia is characterized by the following:

  • Strong fear of gaining weight or becoming fat, or a continuing behavior that interferes with weight gain, despite being at a noticeably lower weight (3)
  • Body image or shape is not experienced in a normal manner, i.e. too much influence of body weight in how a person evaluates him or herself. There is also a persistent inability to recognize or address the seriousness of the low body weight (3).

These thought patterns lead the person to:

  • Restrict the amount of food eaten, to the point where it becomes less than the amount of energy exerted (3).

Which can result in:

  • Low body weight*, specifically when looked at regarding age, gender, the path of development, and overall physical health of the individual (3).

*It’s important to note that Atypical Anorexia can also develop in people are of normal or above average body weight and they are just as likely to suffer from the debilitating consequences, even more so in some cases because early identification is less likely when the physical signs of malnourishment are not visibly obvious to loved ones or medical professionals.

Similar but different…

Clearly, both anorexia and ARFID have some similarities in that they include food restriction  and inability to eat enough food. Both conditions typically result in considerable weight loss, low body weight, malnutrition, and/or interference with normal growth and development. ARFID, however, is not associated with the negative or distorted body image thoughts. People who have ARFID do not fear weight gain and they do not have the “drive for thinness” that we see in anorexia nervosa (1). This is the key distinguishing factor between the two diagnoses.

It is important to be aware of and recognize the differences between ARFID and anorexia because they are two very different disorders that require different treatment protocols. If you recognize the signs and symptoms of ARFID or AN in your child – or yourself – plan a time to check in with a health provider who has expertise in treating these eating disorders. Additional descriptions of both eating disorders are available here.

If you’re not sure whether the behaviors you’re seeing are related to an eating disorder, our online self-assessment can help you evaluate specific risk factors and identify recommended next steps. Visit www.eatingdisorder.org/letscheckin to learn more.

Written By:

Alexandra Hayden, Research Assistant 
Alexandra just graduated from Loyola University Maryland, with honors, obtaining her Bachelors of Arts in psychology.  In the fall she will be attending Johns Hopkins University to begin the Masters of Clinical Counseling program.  She was an intern on The Center for Eating Disorders at Sheppard Pratt’s inpatient unit in the fall of 2016 and previously interned on the co-occurring disorders unit also at Sheppard Pratt. Past research projects include racial bias in the workplace, the effect of information source on leadership perceptions, and effects of mood and task difficulty on time perception.


Sources:

  1. Norris, M., Spettigue, W., & Katzman, D. (2016). Update on Eating Disorders: Current Perspectives on Avoidant/Restrictive Food Intake Disorder in Children and Youth. Neuropsychiatric Disease And Treatment. Vol 12, 213-218. Accessed 2/27/2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725687

  2. American Psychiatric Association. (2013). Feeding and Eating Disorders: Avoidant/Restrictive Food Intake Disorder. Diagnostic and Statistical Manual of Mental Disorders (5th) Accessed 2/27/2018. Available at: https://doi-org.proxyln.researchport.umd.edu/10.1176/appi.books.9780890425596.dsm10

  3. American Psychiatric Association. (2013). Feeding and Eating Disorders: Anorexia Nervosa. Diagnostic and Statistical Manual of Mental Disorders (5th). Accessed 2/27/2018. Available at: https://doi-org.proxyln.researchport.umd.edu/10.1176/appi.books.9780890425596.dsm10

  4. Plotkin, M. (2016). A Brief History of Eating Disorders & Binge Eating Disorder. Binge Eating Disorder Association. Accessed 2/27/2018. Available at: https://bedaonline.com/a-brief-history-of-eating-disorders-binge-eating-disorder/

Testimony on The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools


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The following written testimony was provided by Steven Crawford, M.D. in advance of the Maryland State Medical Society House of Delegate’s vote on the matter of advocating for the inclusion of eating disorder questions in state and national health monitoring tools. 

Additional information on the position of Dr. Crawford and The Center for Eating Disorders at Sheppard Pratt can be found by reading the following articles: 

Data Collection Critical to Understanding Eating Disorders – Baltimore Sun

30 million people will experience eating disorders — the CDC needs to help – The Hill

More detailed information about resolution 10-18 is linked in the testimony below.

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Testimony of

Steven F. Crawford, M.D., Co-Director
The Center for Eating Disorders at Sheppard Pratt

Before the

MEDCHI, THE MARYLAND STATE MEDICAL SOCIETY HOUSE OF DELEGATES

April 29, 2018

Resolution 10-18 – The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools

My name is Dr. Steven Crawford, and I am pleased to appear today on behalf of The Center for Eating Disorders at Sheppard Pratt.  For nearly 30 years, on a daily basis, I have been involved in clinical care, teaching, and research of life-threatening eating disorders including anorexia nervosa and bulimia. I started my career in at Mercy Center for Eating Disorders, and subsequently I have held leadership positions in psychiatry at St. Joseph Medical Center, and currently, with Dr. Harry Brandt, I co-direct one of the largest hospital based eating disorders programs in the United States at Sheppard Pratt Health System.  I am a member of the Academy For Eating Disorders, a Distinguished Fellow the American Psychiatric Society, and a faculty member of the University of Maryland School of Medicine.

I come before you asking your support of Resolution 10-18 which asks for the “The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools.”

In the United States there are an estimated 20 to 25 million people who suffer from anorexia nervosa, bulimia nervosa and related eating disorders.  These illnesses destroy lives and devastate families throughout Maryland.  Anorexia nervosa has the highest death rate and the highest suicide rate of any psychiatric illness.   Further, the eating disorders are unique in that virtually every major organ system in the body can be affected by starvation, poor nutrition, and the dangerous behavioral patterns associated with eating disorders.  Sudden death is not uncommon.

After over two decades of mandatory surveillance of eating disorders signs and symptoms under the CDC’s Youth Risk Behavioral Surveillance System, the Centers for Disease Control (CDC) and state stakeholders voted to remove the mandatory eating disorders surveillance questions in 2015. The questions were removed under the pretense of changing public health priorities.  This, despite growing prevalence of eating disorders, an increasing awareness of their impact and the knowledge that every 62 minutes, someone dies as a direct result of an eating disorder.  Eating disorders should be among the top priorities of CDC because of their high death rate and the evidence that early identification and treatment are essential.

In this resolution, we request support of Med-Chi in advocating to the Maryland Department of Health for the immediate re-instatement of eating disorder questions in any current and future statewide Youth Risk Behavior Surveys (YRBS).  These efforts, if successful, would position Maryland as a national leader in tracking, assessing and mitigating the negative medical, social and financial burdens caused by eating disorders.

Additionally, we are working with the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), the National Eating Disorders Association (NEDA), and The Eating Disorders Coalition (EDC) to ensure the eating disorder questions are reinstated on a national level through the CDC surveillance systems.  This resolution additionally asks the MedChi’s American Medical Association (AMA) Delegation ask our AMA to advocate that the CDC reinstate the eating disorder questions into the YRBSS.

It is our hope that the House of Delegates will support this critical initiative by passing resolution 10-18.


UPDATE: On April 29, 2018, the MedChi House of Delegates voted to adopt resolution 10-18.

 

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

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

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

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

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

 

1. BE HONEST.

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

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

 

2. EMBRACE IMPERFECTIONS.

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

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

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

 

3. PRIORITIZE RECOVERY

Self-care isn’t selfish.

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

 


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

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


References:

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

Knitting Together Skills for Eating Disorder Recovery

April is National Occupational Therapy Month ~ #OTMonth 


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

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

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

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

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

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

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

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

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


Christine Brown, MS, OTR/L

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

 


Reference:

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

 

32 Ways to Stay Recovery-Focused During a Snow Storm

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


32 Recovery-Focused Activities, Tips & Strategies:

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

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


www.eatingdisorder.org

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


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

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

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

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

 

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

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

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

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

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


References:

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

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