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Weight Stigma

Weight Stigma

Weight stigma is any bias, discrimination or stereotyping related to an individual’s weight. It supports the misconception between worth, value, and competence in regards to weight. Research has idealized weight loss and living a ‘healthier’ lifestyle due to the promise of improved overall wellbeing. However, is that really the case? Continuous societal pressure to change and reform the body, in order to fit the standards of research, can cause behavioral changes that have been linked to poor metabolic health and increased weight gain. Weight stigma can be especially harmful when exposed to children at a young age. Children who are perceived to be overweight by loved ones are two times more likely to form irregular and poor relationships with food and self-regard. As these relationships continue to develop, they can become a part of a child’s identity and the cycle of dieting continues. These influences can begin with as little as a comment from a stranger on food choices, or weigh-ins in public schools. It is our responsibility as a member of the community to prevent these influences from causing further consequences. 

While it can be hard to take weight loss out of the picture completely, it does allow the potential for a life of freedom. This does not mean ignoring your body completely, but rather learning to respect and appreciate your present self. Accepting your body entails taking care of your health, both physical and mental. This is a crucial part of making peace with your body, and is the stepping stone for making peace with food, thus supporting one to become an intuitive eater. 

Those who experience weight stigma have been shown to be at an increased likelihood of developing psychological and behavioral issues. Some of which includes depression, body dissatisfaction, and binge eating. This is exacerbated by a culture that idealizes thinness and inundates the public with fatphobic messages. When these fatphobic messages are internalized, individuals can experience self-stigma. Self-stigma has been found to have a strong effect on overall mental health due to the acceptance of weight stigmatized statements as being true for themselves, making it increasingly difficult to challenge these messages.

Unfortunately, healthcare professionals are often guilty of perpetuating weight stigma in their practices. Thus many individuals in larger bodies who choose to seek care often find themselves being treated differently due to their body size. It is important that, as providers, we continue to explore our role in ending weight stigma and work to provide compassionate, unbiased, weight-inclusive care.

We each come in our own shape and size, similar to the unique ridges and whorls that make up our fingerprints. We wouldn’t expect someone who is 5’10 to someday be 5’5. Therefore, why do we assume we must shrink or shape our body to be a size that it shouldn’t be? Spending your life trying to control your weight is essentially a constant attempt to be someone else. We must be kind and accepting of ourselves and who we are meant to be. It can be a slow process to accept a body that has been labeled as ‘not good enough’ but quitting won’t speed it up. 

References:

Emmer, C., Bosnjak, M., & Mata, J. (2019). The association between weight stigma and mental health: A meta‐analysis. Obesity Reviews, 21(1). doi:10.1111/obr.12935

Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6), 1019–1028. https://doi.org/10.2105/AJPH.2009.159491

Weight Stigma. (2019, June 27). Retrieved September 23, 2020, from https://www.nationaleatingdisorders.org/weight-stigma

United We Stand

United We Stand

Prosperity always offers individualized services that are gender, race, sexuality, religion, age, eating disorder, and body size inclusive.

A personal message from one of our staff:

A deadly pathogen is running rampant through the world, undetectable and unstoppable, middle class families are waiting in mile long lines at food banks, and those who were already a paycheck away from disaster are now homeless. The political divide is deeper than ever, no longer about differences in policy, it is now an appraisal of morality. Wearing a mask has become a partisan statement, with both sides shaming and accusing each other of ignorance.

The murders of Ahmaud Arbery, Breonna Taylor and George Floyd in close succession have shocked those who had come to accept racial bias as an unpleasant truth to be denounced, yet tolerated. The long simmering resentment of African Americans has passed the boiling point, and we are witnessing a revolt against a society that has oppressed and stigmatized their race for centuries, the type of which has not been seen since Dr Martin Luther King lit a fire for equality more than 50 years ago.

Then there are those who used to lurk in the shadows and hide under hoods, who have become emboldened to voice their hatred and hostility towards people of color over the last three years. For them, the stakes are now higher than ever; they are desperate to cling to their vision of a whiter America peering over the horizon.

All are clamoring to be heard, and the resulting cacophony of rage threatens to dissolve America. To say these are frightening times would be a ludicrous understatement. Growing up, political discourse was something I rarely witnessed. I was raised in a religion that preached neutrality, and it was considered futile to attempt to influence societal issues that could only be solved by a higher power. An independent streak and a passion against injustice brought me into frequent conflict with my family and religious leaders, but I struggled to reconcile those principles with my conscience. I saw neutrality as pacifism, and pacifism was complicity.

In 1992, as the Rodney King riots shook Los Angeles, I graduated from high school. I remember watching the riots on television and not really grasping what they were about. It was undeniable that the police had brutally and unnecessarily beaten a man, but I failed to recognize that the rage over that was fueled by a systemic problem. I lived in an all white community in the mid-west, and while I was aware racism was still prevalent, I rarely witnessed it and certainly had no concept of how it permeated the everyday existence of people of color.

I was raised to accept people of all races and nationalities, and have never felt hatred for another race, yet still, unconscious racial and class bias was cultivated in me. My relationships were filtered through the lens of how much their lives mirrored mine. I felt compassion for the less fortunate, yet my efforts to help them revolved around making them more like me. I subconsciously divided the “good blacks” from “bad blacks”- usually based only on their speech and style of clothing. I held strong opinions on homosexuality and abortion, and consideration of other viewpoints or contemplating different reasoning was not allowed by my religion. Effort was made to reduce exposure to outside influences that might contradict those beliefs, so education beyond high school was strongly discouraged. My mind remained closed because my world was.

A complicated series of events, too lengthy to detail here, slowly unraveled my faith, and I eventually discarded my religious beliefs. The consequences of that decision were personally devastating, causing me to spiral into a deep and unrelenting depression, and I sought counseling as a means to cope with my grief, disillusionment and fear. However, with the loss of what was familiar and comfortable came the gift of freedom of thought, and I embraced the opportunity to re-learn what I believed. I sought to educate myself on issues that I had been ignorant of, I listened to others’ opinions with an open mind, and I worked to envision myself in the difficult situations that others faced, so that I could develop empathy. I became aware of the judgmental lens I had unconsciously filtered others through, and began to engage with those who I would have previously avoided. I saw beyond their clothes, mannerisms and diction to the person inside, and discovered that where once I saw vast differences, now I saw sameness.

There is a video currently circulating on social media that has sparked furious controversy. In it, a young, black woman named Candace Owens expresses her disgust for the seeming martyrdom of George Floyd, due to his violent criminal past. While she condemns the actions of the officers, some of what she said seems to enforce the entrenched belief that black men being shot in some way have it coming. I was infuriated by many of her comments, but I forced myself to listen to her, and to try to understand her point of view, some of which was not without merit. She emphasized that George Floyd had not lived an honorable life- he had hurt and traumatized individuals for life. She reasoned that the victims of his crimes surely are angered and hurt that he is suddenly being treated as a hero.

I considered at length how despite her facts being accurate, millions of people were not only angered by his death, but truly grieved, even driven to tears, as I was. Why are we mourning George Floyd? It is because when we watched him die, when we listened to him gasp for air, when he cried out for his mother- for those 8 minutes and 46 seconds, we didn’t see a black man, and we didn’t see a criminal- we saw a human. People worldwide had seen past their filter and saw their human brother suffering, and it hurt. For 8 minutes and 46 seconds, we were not white or black or or any race other than the human one. That brief glimpse was enough to shock many people awake, and opened their eyes to how fellow humans are being treated. The reality of what it means to be black in America has finally resonated and made us painfully aware and ashamed of our white privilege. It is apparent that this can no longer be treated as a “black problem”- it is a human problem.

These are unprecedented and turbulent times, but also, the beginning of a new era. Just as my life changed when my unconscious prejudices were torn away, the entire country is experiencing the same. It is not enough to just not be a racist- because silence is complicity. It is no longer enough to portion shares of equality to those we feel have earned it, it has to be granted upon birth. What we are witnessing is an entire nation recognizing and acknowledging their mistakes, and actively taking measures to change. Emotions are high, and conflicting, but we have the choice to continue stripping away our ignorance and educate ourselves, with an open mind, without bias. We can stop focusing on our differences and work to see sameness. We can look at the destruction of what was familiar and comfortable with fear, or we can see it as an opportunity to start over and to re-make our country into something better. Right now, we can choose to be scared, or we can choose to be strong.

I did not write the following, but it says what I am feeling in my heart: (see below)

“WHAT IF 2020 ISN’T CANCELLED?
WHAT IF 2020 IS THE YEAR WE’VE BEEN WAITING FOR?
A YEAR SO UNCOMFORTABLE, SO PAINFUL, SO SCARY, SO RAW-THAT IT FINALLY FORCES US TO GROW.
A YEAR THAT SCREAMS SO LOUD, FINALLY AWAKENING US FROM OUR IGNORANT SLUMBER.
A YEAR WE FINALLY ACCEPT THE NEED FOR CHANGE.
DECLARE CHANGE. WORK FOR CHANGE. BECOME THE CHANGE.
A YEAR WE FINALLY BAND TOGETHER, INSTEAD OF PUSHING EACH OTHER FURTHER APART.
2020 ISN’T CANCELED, BUT RATHER THE MOST IMPORTANT YEAR OF THEM ALL.”
– leslie dwight

By Michelle Schwake

If only I had the time…..

If only I had the time…..

Let's Take Advantage

There are so many things that I would do if I only had the time. Guess what? We do!

We can use this time that we have right now to create positive change in our lives. How will you take advantage of being in quarantine. 

Here are a few of the things I came up with. 

1. Journal

2. Pay attention to our feelings

3. Spend time outdoors

4. Create structure in our lives.

5. Be rested

6. Meal Preparation

7. Read a good book

8. Start a new hobby 

9. Learn something new

10. Create a gentle yoga routine

11. Ask for support

12. Listen to inspiring podcasts

13. Take a deep breathe

14. Create a gratitude journal

15. Order a self-help workbook

16. Pray

 

 

My Confrontation at Starbucks.

My Confrontation at Starbucks

   So I don’t usually post much about work on Facebook but I figure this is a place where a large amount of people can be reached. This is going to be a novel I can already feel it lol OH NO IT’S HAPPENING AND I’M MAD SO STRAP IN.

I’m a Dietitian working in the field of eating disorders, and it has been the most rewarding job of my life. It has also been the most emotionally taxing thing I’ve ever done.

Eating disorders are the number one deadliest mental illness. Every day, I see people muster every bit of strength they have to fight these life-threatening diseases. I see people feeling completely and utterly broken, hopeless, done, sick. I have seen people dance, laugh, scream, and curl into a ball in defeat, all in a matter of an hour.

I see people cry of happiness over their victories in treatment, only to cry of sadness and guilt immediately after. I watch their face shift as they realize this “success” in treatment is (in their eyes, right now) their greatest failure.

Anita Johnston, author of “Eating by the Light of the Moon,” said it perfectly. She describes a person falling into a river. Imagine it is storming, and they are drowning. They are terrified. They grab onto a log in the water, and it saves their life. The storm calms, the water level slowly drops, they are safer now.

Their friends and family are on the shore, waving to them to come in. They try to swim while holding the log, but it is too big and powerful, and it’s holding them back. They cannot swim to shore with the log in their arms. They cannot get to where they want to be while holding the log. But they don’t want to let go of this log. Why would they? What if the storm comes again? What if they aren’t strong enough?

They will occasionally let go of the log, to try. A wave comes and they get scared, and grab on again. One day, they summon the strength to tread water for 10 seconds before they grab back on. Another day, they make it to 30 seconds. Eventually, they make a lap around the log before fear launches them back into its’ clutches. Little by little, they gain confidence in their strength to make it to shore without the log.

One day, a long while later, exhausted and close to giving up hope, they let go of the log and begin to swim. They swim as hard as they can, until they reach the shore. They no longer need the log to feel safe. They are ready to rebuild, to renew, to create. They are free. I’m paraphrasing and putting my own spin on it, but that’s the general idea.

The log in this analogy is the eating disorder, as it has served a purpose for everyone struggling. Control, escape, accomplishment, success, identity, communication, fear, numbing, punishment, coping. These are only some. They are also often biological/neurological/genetic in etiology. The rushing river is life, the shore is recovery.

I was inspired to write this post when I overheard someone in the line at Starbucks speaking about how “selfish” and “stupid” their girlfriend was for going into another eating disorder treatment center. “She’s skinny, I’ve told her that so many times,” they said. “What does she have to worry about?” “It sucks for me because I’m never going to see her.”

Eating disorders are not a disease based in vanity or a desire for a certain aesthetic. Their symptoms manifest in food, eating behaviors, and body image, but they are serious, life-threatening mental illnesses and are not to be made light of. They are never alone or without an underlying issue.

A couple years ago, I had a client who was on the 80th percentile for weight on their growth charts, and dropped to the 5th percentile in less than a year. At one point in her treatment, when she reached the 20th percentile, her doctor told me she was “medically fine now” and no longer needed treatment, and I needed to step away from her care and let them “take it from here.” “MEDICALLY FINE”……..LET YOU “TAKE IT FROM HERE”…….oh hell no. My brain exploded.

This teenager was more depressed than they had ever been, not getting their period, heart rate 38 bpm, losing full chunks of hair, and was well on their way to osteoporosis. That doctor no longer answers my phone calls (lol that’s fine good riddance sir) but the child is fully recovered because thankfully, their family trusted me.

How do we validate the seriousness of a condition if many of our medical providers, the very people we trust with our health, are telling some of the sickest people that they are “medically fine?”

How do we help people who are feeling so deeply sad and hopeless feel seen and heard, if we are viewing their disease as “selfish” and “stupid?”

How do we slow the development of these diseases when the “wellness” industry based in pseudo-science is promoting restrictive dieting in our youth? IN OUR CHILDREN.

Why was my 13 year old client congratulated on their “willpower” when they brought a bag of raw broccoli to their own birthday party in lieu of cake?

I am writing a Facebook novel right now because this is important.

I will be going to doctors offices donating the book “Sick Enough” by Dr. Jennifer Gaudiani in hope that someone will read it. I speak to health and PE teacher meetings for Fairfax and Loudoun County public schools about how to safely communicate health and nutrition information tochildren and adolescents, in hope that someone will hear it.

I feel like that isn’t enough, though. Which is why I’ve resulted to a social media post, because realistically more people can be reached this way.

“What is the take-home message?” You may be asking if you have made it this far. I’m glad you asked!

1. Be mindful of your words. Be mindful of your judgements. You never know what people are going through.

2. When communicating nutrition information to people (especially personal trainers, health teachers, and health professionals who are new to working with eating disorders) focus on what to add instead of what to take away. 

For example: “did you get some fruits and vegetables today to give your body the vitamins, minerals, and phytochemicals it needs?” Instead of: “do not eat sugar. It is bad.” Another example: hypertension. Research shows that increasing potassium in the diet is effective in lowering blood pressure. Yes, some people need to be careful of the salt shaker and high sodium foods. However, isn’t it lovely that we can talk to them about what they should include vs. what they shouldn’t, and improve their lab values without promoting dichotomous, black and white thinking about eating?

3. Stop demonizing foods, labeling themas “good” or “bad” and putting a moral value on what people eat. Food is supposed to serve two purposes: nourishment and enjoyment. That’s it. You are not “bad” because you had a dessert. You are not “good” because you ignored your basic biological needs by cutting your calories in half.

4. Let’s stop downplaying eating disorders and simplifying their complex nature by telling people they are “fine.” Let’s listen to people when they talk. Let’s keep comments about people’s bodies in a locked vault, stored in the depths of hell. Let’s help people who we believe to be struggling get help. Let’s check in with people who are exhibiting disordered eating behaviors, rather than asking them what their secret to weight loss is. Let’s stop food shaming other people.

5. Understand that eating disorders do not have a face. They do not have a shape or size. They are not only restrictive eating, or purging, or binging. They come in all shapes, sizes, and forms and manifest in many different behaviors. Men, women, non binary, it doesn’t matter. Eating disorders do not discriminate. You cannot look at someone and determine whether or not they have an eating disorder.

6. Most importantly, let’s talk about mental health, because it’s important.

Thank you for coming to my ted talk ?

Edit: To everyone who has reached out to me, thank you. Below is a link to the National Eating Disorder Association (NEDA) website. They have a lot of informative resources, along with a treatment finder to get help in your area.

https://www.nationaleatingdisorders.org/

Prosperity Eating Disorders and Wellness Center in Herndon, VA (where I work) has a free family/friend support group for those who have loved ones with eating disorders at 5pm on the first and third Monday of every month. Anyone is welcome.

We also have a comprehensive team of therapists, dietitians, and a psychiatrist/medical director. We have a Partial Hospitalization Program (PHP) Intensive Outpatient Program (IOP) and outpatient services. We offer art therapy, yoga, and acupuncture. If you or a loved one are struggling, give us a call or visit our website.

703-466-5150

http://prosperityedwell.com

Parents as Role Models Around Food and Body Image

Parents as Role Models Around Food and Body Image

  1. Why is it important for parents to model healthy eating?

Social psychologists have long explored how social experiences shape our cognitions and behavior. This type of learning, known as observational learning, provides children with the opportunity to watch a “model” (aka parent, sibling or authority figure) as they react to events in their environment. Observational learning is one of the most natural types of learning that we have available to us. The idea is we watch what the model does in a given scenario and then process that scenario or schema as desirable or undesirable; ultimately our behaviors are shaped by watching how others interact with their environment. We mimic and mirror what we see and have learned is valuable to our family system.

Food is a fundamental aspect of the human experience, we all need nutrients to survive and thrive. Unfortunately in today’s society, we have become hyper aware of image and perfection as a symbol for worthiness, resulting fad diets, preoccupation with weight / image, and a generalized sense of dissatisfaction with ourselves in comparison to a perceived ideal. Despite the negative impacts societal pressures can have on an individual’s image or self-esteem, there are many ways parents can buffer the effects of these pressures, not the least of which is healthy modeling. What does this mean? In short it’s teaching your kids to develop a healthy relationship with food by setting a positive example.

Our kids are watching us all the time (we aren’t as sneaky as we think we are), they see us reading labels and being conscious which is great! It’s a great opportunity for us to teach our children about food, nutrition, and healthy eating. Conversely, they see us cringing at calories, judging ourselves and our bodies in the mirror, and they sense the importance of image. We can be a gateway to a healthy lifestyle or we can inadvertently tell our kids that food is the enemy and image is everything. It’s easy to think this learning would have to be overt, that a dance teacher who pinches her students back would obviously result in an unhealthy relationship with food. But it can, and often does, happen far more subtlety, watching mom choose a salad time and again instead of getting what she really wants because she has attached a value to the food as bad. As with most things, moderation is key, it’s not so much what you are eating or feeding your family as it is the relationship with the food and experiences.

  1. What language should parents use/not use, around kids, to prevent unhealthy eating beliefs and behaviors?

Try to avoid making comparisons or comments, especially image oriented ones. For example don’t say,”Oh, Molly is so small, and I am just fat” or “Your friend Jen is so small and cute” “Comparisons like this aren’t helpful in promoting a positive self-image.

Kids going through growth spurts often grow out before they grow up. When your kids are in these spurts, don’t poke at them or their chubby cheeks. In general, try not to use all or nothing statements. That ice cream will make you fat, or those cookies are going to go straight to my hips. No one has ever died from a scoop of ice cream, just like if you eat a cookie or a few cookies, it doesn’t mean you are no longer loveable because your skinny jeans got a little snug. Kids don’t always have the gift of discernment, that’s another reason healthy modeling is so important. We get to teach them that food can be a wonderful and connecting experience. If you wouldn’t want someone saying it to you, then you probably shouldn’t say it to your child, they’re people too, just younger and more impressionable.

  1. How do our kids (unknowingly) teach us how to eat healthy?

Our bodies have natural triggers that tell us when we are hungry and when we are full. People don’t have to be taught when to eat or not, it’s a natural process that occurs and that we can become mindful of as we develop. Children haven’t yet learned to ignore their inner cues and will often adhere to appropriate portions when they are allowed to choose. Kids listen to their bodies, if they have cravings they typically fulfill them and move on with what they are doing. They don’t assign value or judgement to foods which means they are naturally more healthy in regard to portion control and enjoying the eating experience.

  1. How can we achieve health while feeling care free in the process?

Barring an allergy, one scoop, or cup, or plate of anything is not going to leave an indelible mark on our psyche or bodies. Remaining mindful as you eat and making food preparation a process and an act of love for yourselves and others can be a great way to bring joy and peace to a moment. If you struggle with your relationship with food, affirmations can be a great way to break the negative thought pattern. It may feel artificial at first, but keep saying the words, internalize that sense of peace with the food and the process of being healthy. Exercise can be a great way to mitigate depressive symptoms, as the endorphins released during and after a workout boost mood. Additionally, this can be a great way to channel your energy by doing something positive and active with your body, see what you are capable of, know that you are a blessing and that your body is a gift.

By Ashley Steelman, MSW

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Eating Disorder Resource

The Alliance for Eating Disorders recommends a simple acronym to help you cope during your loved one’s recovery journey:

 

C
  • You didn’t CAUSE it.
  • You can’t CONTROL it.
  • You can’t CURE it.
  • You can learn how NOT to CONTRIBUTE to it.
  • You need to learn how to COPE with it.
  • Take CARE of yourself.
P
  • Avoid PANIC. It prohibits clear thinking and calm reactions.
  • Recovery is a PROCESS. Two steps forward, one step back.
  • PROGRESS, not PERFECTION, is the goal. PATIENCE is critical.
R
  • RESPOND instead of REACT.
  • REMEMBER to listen.
  • REFLECT and REASON before you speak.
  • RECOVERY is a journey, a long ROAD that may include RELAPSE.
  • REACH out to others for love and support.

 

For more information about resources for loved ones, or to contact Prosperity for assistance, visit our website at www.prosperityedwell.com.

*Adapted from The Alliance for Eating Disorderswww.allianceforeatingdisorders.com

Suggested Reading

  • Life Without ED – Jenni Schafer
  • Healing Your Hungry Heart – Joanna Poppink
  • 8 Keys to Eating Disorder Recovery – Carolyn Costin, MA, MED, MFCC; Gewn Schubert
  • Eating by the Light of the Moon – Anita Johnson
  • 100 Questions and Answers About ED – Carolyn Costin, MA, MED, MFCC
  • Brave Girl Eating – Harriet Brown
  • Eating With Your Anorexic – Laura Collins
  • Father Hunger – Margo Maine, PhD
  • Parent’s Guide to Eating Disorders – Marcia Herrin, EDD, MPH, RD & Nancy Matsumoto
  • Life Beyond Your Eating Disorder – Johanna S. Kandel

*Adapted from the Alliance for Eating Disorderswww.allianceforeatingdisorders.com

Coming Home from Treatment

There have been many times that a client, fresh from residential treatment or partial hospitalization, has told me that he or she is surprised to return home to find that nothing has really changed. Life around them is still the same. Sure, they learned some skills in treatment but it didn’t solve the life challenges that can be so triggering. Sometimes in the moment emotions are so overwhelming that our first instinct is to return to the coping mechanism that’s become so ingrained in our daily existence. One client actually told me that she didn’t see a point in working so hard on recovery if nothing around her was going to change. She would rather cling to the one thing that’s been consistent in her life: her eating disorder.

Eating disorders are about different things for different people, and at some point in every sufferer’s journey they serve a purpose. For the person who has a difficult home life, the eating disorder may be where she retreats for comfort and control in the chaos. For the person with perfectionistic tendencies who has found that he can’t possibly excel at everything, the eating disorder is something he has complete power over and therefore can excel at. This is part of what makes eating disorders so difficult to give up- underneath the physical and psychological wreckage are definite reasons that hanging on to the illness is reasonable and even necessary.

The problem is that on some level we know that the eating disorder cannot be sustained. We cannot continue to restrict food and expect to live. We cannot binge and purge or over-exercise and expect to lead a healthy, high-functioning life. The physical body clings to every morsel of nourishment and may seem to be able to run on fumes indefinitely. Eventually, the body will crash but the mind will continue to come up with what seem like totally rational reasons to keep pushing. Sometimes, not even hospitalization is enough to spur a leap into recovery.

Life can be a shock for people returning to home, school, or work after inpatient or residential treatment. There is something of a protective bubble in higher levels of care. The intensive treatment provides a safe place for recovery to begin and skills to be learned. It is one thing to apply skills in the treatment milieu or even in family therapy sessions, but it is far another to try to apply them in the overwhelming situations that life can throw at us. According to a study discussed in the Science of Eating Disorders, following intensive residential treatment most women noticed a reduction in behaviors (i.e. they were able to maintain a healthy weight) but cognitive symptoms and thought patterns were still very much present. The cognitive changes that allow us to be able to handle life without the eating disorder take much more time to develop, which is why a solid outpatient program is so important.

The Science of Eating Disorders article lists the major factors that assist people in maintaining recovery:

  • Social support: maintaining connections with family, friends, and treatment team

  • Skills application: continued practice of assertiveness, communication, and meal planning skills

  • Stepping outside oneself: returning to work or school, volunteering, working on higher values all help the focus return to life rather than eating disorder.

Not surprisingly, one major factor that inhibits maintained recovery is loss of support and lack of structure. The importance of these cannot be overstated. People with eating disorders must engage treatment and refuse isolation, even on the worst days. This takes courage and often a profound show of “acting as if” until it becomes easier. Especially as clients return to challenging life situations, the right support can make all the difference.

Science of Eating Disorders (2012). Maintaining Change Following Intensive Eating Disorder Treatment. www.scienceofeds.org

 

DBT Skills

 

                                                             

 DBT Skill for June: Improve the Moment

Some of the ways we can Improve The Moment Are:

  • Imagery
  • Meaning
  • Prayer
  • Relaxation
  • One thing at a time
  • Vacation
  • Encouragement

When practicing this skill, we are not trying to CHANGE the external circumstance, but rather trying to improve the moment to make it more tolerable (or even more enjoyable) for just this moment.

Here are some examples of putting the skills into action:

  • Imagery: Imagine very relaxing scenes…Imagine everything going well. Imagine coping well…
  • Meaning: Find or create some purpose, meaning, or value in the pain [that’s what I do with this blog, by the way!]. Focus on whatever positive aspects of a painful situation you can find…
  • Prayer: Open your heart to a supreme being, greater wisdom, God, or your own wise mind. Ask for Strength to bear the pain in the moment…
  • Relaxation: Try muscle relaxing and tensing each large muscle group…take a hot bath…breathe deeply; half smile; change facial expression…
  • One thing in the Moment: Focus your entire attention on what you are doing right now. Keep yourself in the very moment you are in; put your mind in the present
  • Take a Brief Vacation: Rent a motel room at the beach or in the woods for a day or two. Ask your roommate to bring you coffee in bed or make you dinner (offer to reciprocate)…Get a  magazine or newspaper at the grocery store, get in bed with chocolates, and read it…
  • Encouragement: Cheerlead yourself. Repeat over and over: ‘I can stand it,’ ‘It won’t last forever.’ ‘I will make it out of this,’ ‘I am doing the best I can do.'”

 

Social Media: A Catalyst for Eating Disorder Recovery?


 
We live in a media driven culture with an endless supply of TV shows, internet sites, and phone apps to keep us busy every minute. These platforms are used to deliver messages meant to persuade, inspire, and entertain. Many of these messages contain images of men and women airbrushed to perfection….and it is that very image of perfection that haunts us as we study our own bodies and make comparisons.
 
To say that the internet has influenced body image is an understatement. In recent years, the rise of pro-anorexia and pro-bulimia websites has glorified eating disorders and praised the behaviors that keep sufferers locked in the illness. The Social Issues Research Centre (www.sirc.org) reports that these “pro-ana” websites target individuals who consider their eating disorders to be lifestyles, something to maintain and celebrate. Users share tips on how to engage behaviors and provide support for each other’s illnesses. For individuals who are in recovery, websites like this can be seriously detrimental. Some people in recovery refuse to engage in social media at all, citing the prevalence of hashtags like #thighgap and #thinspogram as just a few of many reasons to shelter themselves from the social media revolution. USA Today (www.usatoday.com) shares the story of Donna, who is in recovery from bulimia. Afraid to expose herself to the kinds of comparisons that fueled her illness, Donna has decided to stay away from popular social media sites like Facebook and Instagram.
 
While it’s clear that social media and pro-eating disorder websites have played a part in our global obsession with obtaining perfection, more and more websites  dedicated to positive body image and recovery are beginning to pop up. Someone searching for eating disorder tips may stumble upon a recovery website or blog and be drawn into a story of hope….leading to the inspiration to begin recovery. The National Eating Disorders Association (www.nationaleatingdisorders.org) shares the story of one woman who came across the NEDA website in her search for a pro-eating disorder community….a lucky accident that turned out to be the catalyst for her recovery. Nonprofit organizations dedicated to awareness and advocacy use the power of the internet to spread positive body image messages. Eating disorder treatment centers are also getting involved in the awareness movement, offering blogs, webinars, and professional events designed to educate and inspire.
 
Instagram is also proving to be a powerful recovery tool. An online photo-sharing service, Instagram users can visually communicate their lives to their followers. Some individuals in recovery have turned their Instagram accounts into recovery accounts. The Atlantic (www.theatlantic.com) describes this type of account as a place where users can gain support while maintaining as much anonymity as they would like. Some people don’t use their real names, and others find that it’s easier to open up and share initially in an online environment. Recovery accounts document the progress users are making through pictures of meals, inspirational messages, and even pictures of users’ bodies as they work toward weight restoration. Support from followers during the recovery journey can be motivating and provide comfort during difficult periods.
 
Although social media can be a positive recovery tool, users must be vigilant and pay attention to their triggers. Any concerning thoughts and behaviors should be taken seriously and addressed with a treatment team.
 
 
Totally In Control: The Rise of Pro-Ana/Pro-Mia Websites. Social Issues Research Centre, www.sirc.org
 
Rojas, M. (2014). Social Media Helps Fuel Some Eating Disorders. USA Today, www.usatoday.com
 
Kay, J. (2014). How Social Media Led Me to Recovery. National Eating Disorders Association, www.nationaleatingdisorders.org
 
Mirhashem, M. (2015). Overcoming an Eating Disorder with Instagram. The Atlantic, www.theatlantic.com
 

 

Spirituality and Eating Disorder Recovery: Rediscovering Meaning in Chaos

Eating disorders represent a emotional and cognitive struggle of some kind,  be it trauma, low self-esteem, poor body image, bullying….clients present with many different root causes of their disorder. A client’s spirit is suffering and a person tends to have a breakdown in their spirituality. The one underlying theme is the difficulty in managing the most uncomfortable feelings. The eating disorder and one’s spirituality are often at competing ends. The eating disorder serves as a coping method that presents as a friend, a confidant, a powerful secret, or a god that needs to be obeyed and the eating disorder appears at the time the client needs it most. In a storm of chaos and fear and inconsistency, the eating disorder swoops in and appears to give the feeling of rescue that the client feels temporarily from the distress.

Michelle Lelwica (2010) shares that while the client is focused on creating a “good” body or engaging in eating disorder behaviors like restricting or purging, the inner life is being ignored. No matter how thin the client gets, no matter how filling the binge, there is an eternal sense of emptiness and hunger that is never satisfied. All of the crises that pile up in life, all of the hurts and trauma, drive a wedge through the true self. Big questions like “What is important in my life” and “How do I understand my life’s purpose” cannot be answered when the soul is entrenched in an eating disorder. There is simply no energy left for living. Recovery becomes a spiritual journey as clients attempt to access their pain and face it with the help of a higher power.

Randy Hardman and Michael Berrett (2015) explain that many people with an eating disorder have had some degree of personal spirituality in their lives. Some have participated in religious observations and others may have felt connected to yoga or nature or a meditation practice. Despite this, during the course of the eating disorder these connections were lost. Feelings of unworthiness creep in as the eating disorder, which at one point served a purpose, becomes harder and harder to sustain. Indeed, eating disorders cause sufferers to chase false pursuits that ultimately replace spiritual connection. Hardman and Berrett list these false pursuits:

  • False sense of control
  • False form of communication about pain and suffering
  • False sense of being the exception or exceptional
  • False crusade for evidence against self
  • False pursuit of perfection
  • False form of comfort and safety
  • False identity
  • False compensation for the past
  • False attempt to avoid personal responsibility
  • False pursuit of approval

Eating disorders may represent some or all of these falsehoods for clients. Richards et al (1997) state that eating disorder clients often have difficulty letting go and having faith, despite their spiritual background, leading to a worship of these falsehoods in pursuit of a sense of control and well-being. Along the way the eating disorder gains control of every aspect of their lives, rendering clients powerless when all they were seeking all along was a powerful sense of being good enough.

Not all clinicians work with spirituality in treatment with their clients, but it is a significant aspect of recovery that should not be avoided. Clients who wish to regain their spiritual connections, or foster connections for the very first time, can do so in the safety of the therapeutic alliance. Eating disorders are very hard to give up because it is difficult to remember what life was like beforehand and next to impossible to consider what life might be like in recovery. There is so much unknown and that is often one of the biggest barriers to recovery. Spiritual exploration during treatment can help clients resolve any negative impacts their spiritual pursuits had in the past and move forward with new resolve to take care of their physical, emotional, and spiritual selves.

Lelwica, M. (2010). The Spiritual Dimensions of Recovering from an Eating Disorder. Psychology Today, www.psychologytoday.com

Hardman, R. and Berrett, M. (2015). Eating Disorder Recovery: A Spiritual Perspective. BYU Idaho Counseling Center, www.byui.edu

Richards, P., Hardman, R., Frost, H., Berrett, M., Clark-Sly, J., and Anderson, D.
Spiritual issues and interventions in the treatment of patients with eating disorders. Eating Disorders: Journal of Treatment and Prevention, 5(4), pp. 261-279