Back to Basics: Positive Body Image (Watch for Warning Signs of Eating Disorders)

     This month’s article was written and provided by Lindsay South, MA, LPC, RPT and the president of SMEDA and an active member of our group since the foundation of the organization.  She has been in practice since 1988 and treats children ages 5 to 12, adolescents, adults and families, working with issues like attention deficit and hyperactivity, learning disorders, weight and body image, eating disorders, divorce adjustment and trauma.

   

Watch for Warning Signs of Eating Disorders

     As summer is in full swing and bathing suits and shorts abound, many young teens become self conscious about their bodies. Both boys and girls are feeling more and more pressure to maintain a certain body type.

     The Winter 2006 issue of the National Eating Disorders Association (NEDA) newsletter points out that, although obesity among teens has doubled in the last 30 years, so has the emphasis on eating, exercise and weight. Messages about diet and exercise can become triggers for some teens to develop an eating disorder.

     In my practice, parents often bring a reluctant child in for counseling about eating. Adults report a confusing picture of their child’s weight changes, different eating patterns and food choices.

     Why is one teen affected and not another? Why are some girls, and a growing number of boys, more likely to take an attempt to lose a few pounds and change eating patterns into a clinical eating disorder?

      Research suggests that eating disorders do have a genetic component. Numerous studies reveal that children with a family history of either bulimia or anorexia are at greater risk for developing one of these disorders themselves. Strong themes of perfectionism, competitiveness and drive, which may be harnessed successfully by siblings or parents, if turned toward dieting, can produce obsessive dieting and exercise behavior.

      Trauma or intense family conflict can certainly make children vulnerable to the development of an eating disorder. Environmental factors, including media and advertising, are a tremendous influence. Uncharacteristically thin views of women and extremely buff, bulked up men fill magazines of young readers. This constant barrage of unrealistic body images creates a lot of body dissatisfaction.

      How can you help your puberty-aged child? NEDA developed these guidelines to provide a healthy “to do” list:

  • Model fitness and balanced nutrition by striving to feel good, not achieve a certain appearance.
  • Help your children feel good about themselves no matter what they achieve.
  • Remember that dieting is not innocent behavior; it alters neurochemistry.
  • Intervene rapidly through expert consultation when dieting appears extreme and increasingly compulsive.
  • Take off blinders and be objective about any changes in behavior and eating habits.
  • Encourage self expression, verbalization of emotions, and independent thought and action whenever possible.
  • Have an open door policy of talking to your child about everything — magazine articles, family conflicts, school difficulties, relationship problems, etc.
  • Encourage eating all foods in moderation, rather than labeling particular foods “good” or “bad” or going on a restrictive diet.
  • Discourage extreme perfectionism and exactness in everyday activities.
  • Encourage a balanced lifestyle with attention to play, relaxation, work, relationships and spirituality.
  • Address family conflicts and sources of strain openly and honestly.

      If you have tried these principles at home and continue to have concerns about your child, one of the best places to go for an initial consultation is your pediatrician. Locally, the Southwest Michigan Eating Disorders Association maintains a website, http://www.southwestmichiganeatingdisorders.org/, which additional resources and a listing of nearby physicians, registered dieticians, and counselors skilled in the treatment of all types of eating concerns. Getting a jump start on eating related problems is far easier than treating a more entrenched disorder.

May 2016 - May 2017 SMEDA Projects and Activities Completed

May 2016-May 2017 SMEDA Projects and Activities Completed

Compiled by

Lindsay P. South, MA/LPC, RPT-S
President, SMEDA

Ø  Development and Design of SMEDA logo

 

Ø  Website Redesign and Launching (Angela Morris and Peter Butts)

o   Blog Posts on topics such as Holiday Eating, Yoga and Eating Disorders

o   PayPal attached

 

Ø  Monthly publication of SMEDA Newsletter (now posted on-line as a blog), coordinated by Laura Smidchens.   Articles on topics such as Dialectical Behavior Therapy for Eating Disorders” and “Men and Eating Disorders” (both by Gary Snapper, LLP/LPC).

 

Ø  SMEDA Facebook Page posts with links to current research on eating disorders (Laura Smidchens & Vinay Reddy, MD)

 

Ø  Parent Support Group Reconceived into face to face parent meetings, online and telephone support and Parent Mentorship program (Angie Morris, Community Board Member and parent)

 

Ø  Free Monthly Support Group meeting for adults struggling with ED (Trina Weber, RD).  Approximately 7 adults attend regularly.

 

Ø  Dewpoint, support groups for adolescent girls and women with eating disorders at Well of Grace Ministries, Stevensville, MI (Flori Mejeur, SMEDA Lakeshore)

 

Ø  Outreach to local K-12 schools:  classroom presentations on Intuitive Eating, Eating Disorders Prevention, and What to Do if you Suspect Someone Might Have an ED (Moorsbridge Elementary, West Middle School and Portage Northern High School) (Trina Weber, RD)

 

Ø  October 2016 Co-sponsorship of and participation in St. Joseph Mercy annual eating disorders conference

o   Discounted rates for SMEDA members to attend @ $25 a person.

o   Info on SMEDA presented at table

o   (Trina Weber, RD, Deb Frisk, RD, Kris Gibson, MD, Lindsay South, MA, Sheryl Lowzowski-Sullivan, PhD, Cathy Cook, LLPC) SMEDA Professionals and 1 community board member (Angie Morris) attended.

 

Ø  Art Hop- Friday, February 2, 2017 at WMU’s Homer Stryker School of Medicine (Laura Smidchens)

 

Ø  Coffee Tasting Fundraiser-Saturday, February 11, 2017 ( 5 Coffee Roasters and at least 8 Companies involved)(Angie Morris, parent)  Profit:  $2,407.77

 

Ø  Public Speaking and Outreach:

 

1)      Brief presentation at Rambling Road Pediatrics clinical staff meeting -August 2016, (Lindsay South, LPC) this led to cultivation of new relationships with Dr. Dodich and Dr. Dobson, two female pediatricians at Rambling Road Peds.

2)      Panel Presentation to Dietetics Association in Battle Creek-September 27, 2016 (  Jillane Mofitt-Bernacki, LMSW, Danielle Seabold, parent/community board member)

3)      Presentation at Grace Health, Battle Creek on “Food Relationships and Identification of Disordered Eating Behaviors” during the monthly behavioral health staff meeting, February 17 , 2017 (Cathy Cook, LLPC, TLLP, RD)

4)      Lunch and Learning presentation to Potawatomi Reservation, March 15, 2017. ( Jillane Mofitt-Biernacki, LLMSW, Danielle Seabold, parent SMEDA board member)

5)      Article on the problems associated with dieting, (Title?), February 2017 Good News Gazette

6)      Article on eating disorders, “When Dieting turns into a Disorder,” South Haven Tribune, February 8, 2017. (Interview with Kristin Fiore, SMEDA Community Board Member and Susan Katz-Scheinker, RD, Flori Mejeur, LMSW)

7)      Radio interview with Lori Moore during Eating Disorders Awareness Week,  February 2017(Kris Gibson, MD and Angie Morris, parent)

8)      Panel Discussion at WMU after “Food Prisons,” a play about ED (Trina Weber, RD and Kris Gibson, MD)

9)      TV interview about eating disorders, February 2017 (Kristin Fiore, Community member/Down Dog Yoga)

10)   Panel Discussion on eating disorders, Kalamazoo College.  (Kris Gibson, MD, Deb Frisk, RD and Jillane Mofitt-Biernacki, LLMSW)

11)   Meetings with local representatives in Lansing to spread awareness for eating disorders. Representative Hoadley read a resolution on the House floor to support eating disorder awareness at 11:36 a.m. , February 22, 2017 (Jillane Mofitt-Biernacki, L LMSW and dietetic students)

12)   SMEDA Lakeshore mailed out over 100 letters to medical practices, counseling offices, and school counseling centers in Berrien County to raise awareness about ED and highlight SMEDA as a resource (March 2017, Flori Mejeur, Abby Black, RD)

13)   On March 28, 2017 SMEDA Lakeshore highlighted a presentation by Dr. Stephanie Style at Lakeland Regional Center.  The presentation was live streamed and was watched by over 600 people.  SMEDA members were present and offered resources and referral information.

14)   Guest Lecture, Introduction to Eating Disorder at WMU for Amy Getman’s undergraduate dietician course. March 13, 2017 (Danielle Seabold, parent SMEDA board member)

15)   Presentation at DeVos Children’s Hospital Conference entitled, “Adolescent Eating Disorders:  Early Detection and Treatment,” an Eating Disorders Interprofessional Teaching Event for third year medical students, undergraduate nursing students, Masters level dietician students and psychology PhD candidates, April 26, 2017.  Kristine Gibson, MD, WMU Stryker School of Medicine.

16)   Panel representation in Kalamazoo College’s Abnormal Psychology class discussion on eating disorders, May 24, 2017 (Jillane Moffit-Biernacki, LLMSW)

 

 

Ø  Monthly Case Presentations on eating disorders at SMEDA general meetings (Gary Snapper, LLP/LLP, Lindsay South, LPC, Trina Weber, RD, Cathy Cook, LLPC, TLLP, RD)

 

Ø  Topical Presentations for SMEDA general meetings:  “How to Cope with Therapy Interfering Behaviors” and “Evidence Based Treatment of Binge Eating Disorder” (Gary Snapper, LLP/LPC)

 

Ø  Conference for professionals on Eating Disorders and Substance Abuse coordinated with Castlewood Treatment Center, St. Louis in planning stages for Fall 2017 (Gary Snapper, LLP/LPC)

 

Ø  Formation of SMEDA’s Instagram Group, a new commitment to reaching young people about eating disorders.  First meeting:  Saturday, May 20.  Sawalls Health Food, second floor restaurant. (Angie Morris and Emily Marre)

 

Back to Basics: Positive Eating (General Guide for Families and Individuals)

This month’s article was written by Jillane Moffit, LLMSW, an active professional member of SMEDA.

Positive Eating

     The kitchen is a great place to help develop positive eating habits. Speaking positively about healthy foods and role-modeling balanced eating is essential in helping develop a healthy relationship with food.

 Plan and prepare meals

      Children can learn about positive eating by playing a helpful role in meal planning and preparing family meals, such as washing vegetables, doing some mixing, reading recipes and chopping ingredients…  Cook meals at home and try to encourage your child to help you. Involve your kids in the shopping, too.  Involving the whole family in preparing food will lead to more support for what is served at the table.

      Talk about foods from the five food groups and what they do for your body. For instance, “this apple is so crunchy and delicious – its flesh is helping to keep me staying regular and it’s filling me up with its nutritious sweetness.” Or “these carrot sticks contain a super nutrient called beta carotene that helps my eyes stay sharp and focused.” Or “this delicious glass of milk contains calcium – it helps my bones and teeth stay strong.”

 Eat breakfast

     Breakfast is the first important meal of the day.  Encourage your child to eat a nutritious breakfast every day, using foods from the five food groups.  Enjoying a healthy breakfast gives you and your child the best start to your day. When breakfast is a part of the family routine it provides more energy and better concentration.

 Continue mealtime routines

     The experience at the dinner table can have an impact on your approach to food later in life. Follow your hunger cues and offer a balanced diet. The benefits of meals go beyond nutrition.  Sharing food and talking around the table encourages other healthy behaviors.  Mealtimes are an opportunity for children and adults to build stronger bonds with those closest to them. It also gives them the chance to receive the support they need to minimize negative influences.

 Don’t forget about physical activity

     Being physically active is an important part of a healthy lifestyle.  Make time to play outside or be active.  Be a role model and make physical activity an event by going for a walk, riding a bike, playing in the park or kicking a ball around.  Start increasing incidental exercise such as walking to school or shops, taking the stairs (not the elevator), sweeping the path, or doing some gardening.

 References

Australian Institute of Health and Welfare 2012. Australia’s food & nutrition 2012. Cat. no. PHE163. Canberra: AIHW.

 Berger, E. (2013, Sept. 27). About Kids Health. Promoting positive eating habits.  http://www.aboutkidshealth.ca

Harper, K.U., Sanders, K.M. (1975) The effect of adult’s eating on young children’s acceptance of unfamiliar foods. Journal of Experimental Child Psychology. 20: 206-14. 10. 

NHS Information Centre for Health and Social Care 2007-2008. 5.

 ‘Who’s feeding your toddler?’ Infant & Toddler Forum survey 2010.

 www.healthykids.nsw.gov.au

Back to Basics: Men And Eating Disorders

     This month’s article was written by Gary Snapper, LPC, LLP, an active SMEDA Board member.  He is a licensed Professional Counselor and a Limited License Psychologist who founded Cognitive Behavior Solutions in Kalamazoo. He specializes in the treatment of eating disorders, anxiety disorders, and personality disorders.

 Back to Basics:  Men and Eating Disorders

     Most people associate eating disorders with women; women with anorexia, women who binge and purge their food, women who binge eat. Many are surprised to learn that men are also susceptible to eating disorders.  Examples of men struggling with disordered eating have appeared in medical records over the centuries. The earliest recorded example of a man with anorexia is a commonly considered case from 1689. The English physician Richard Morton described the case of a male adolescent who began fasting at 16 years of age.   Dr. Morton described the trigger for the fasting as “studying too hard,” along with “the passions of his mind.”  Dr. Morton told the adolescent to abandon his studies, move to the country, take up riding and drink plenty of milk.  This change in lifestyle led to the young man recovering, “his health in great measure.” If only all treatments of anorexia could be accomplished so directly.

     Today, males are estimated to represent up to 25% of cases of anorexia, with only 5% of these seeking treatment.  As with females, stigma contributes to treatment avoidance in males with ED.  One study concluded that being labeled gay or feminine can act as a stigma in male eating disorders, preventing some males from seeking treatment.  Another source of stigma is the pervasive female focus in the literature, support services, research, and treatment options.  One survey concluded that over 99% of books published on eating disorders assume a female bias in pronoun, as well as in the topic focus. Males who start to search resources for ED treatment are likely to observe these biases, and may be reluctant to continue their exploration.

     Comparative analyses between male and female eating disorders are needed, including manifestations, treatment options, outcomes and stigma.  Initial studies suggest a number of gender-specific trends in eating disorders.  For example, mortality of eating disorders may be higher in men.   Another trend is that males with ED tend to have a higher incidence of overexercising than do females. A study comparing results between 108 men and women receiving residential treatment for eating disorders, identified that men scored lower (less intense) on questions regarding body dissatisfaction, bulimic behavior and drive for thinness. This supports the hypothesis that assessment tools may be more effective if created to be gender specific. Similarly, further research might help steer the development of gender- aware treatment protocols to enhance effectiveness of therapy options. 

     Unfortunately, as with treatment of eating disorders in women, men with eating disorders have limited options for evidence-based treatment.  For adolescent males and females with Anorexia, there is a research-supported treatment option termed Family Based Therapy (or the Maudsley approach).  This therapy approach includes three phases of treatment.  Phase I is focused on refeeding at home, with parents encouraging the teen to eat more food per meal with the goal of weight restoration. Phase II focuses on client empowerment, giving more control back to the teen and decreasing parental supervision over time. Phase III focuses on establishing a healthy adolescent identity (increased autonomy, developing healthy boundaries toward and from parents, and fostering increasing independence over time). Studies suggest that weight restoration occurs in 70-90% of both male and female participants, with 5-year weight retention.

     For adults of both genders, research continues to support the use of Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), and Interpersonal Psychotherapy (IPT) as treatments of choice for Bulimia Nervosa, Binge Eating Disorder, and Anorexia Nervosa (mildly effective).  Unfortunately, as with all eating disorders, even the most effective treatments are not as effective for individuals with more intense symptoms of each type of eating disorder. Underfunding for research of treatments for eating disorders is yet another challenge to overcome.

     In summary, despite centuries-old records of males with eating disorders, research on males with eating disorders is and has always been limited.  The available research suggests that although current evidence-based treatments may be equally effective for both genders, males’ symptoms manifest differently and are less likely to be diagnosed than those of their female counterparts.  Males also avoid seeking treatment for different reasons than do females.   Attention to these differences and a more inclusive support environment are needed to help males get the treatments currently available that might benefit them.

References:

1)      Stanford, S.C. Volume 20, 2012 - Issue 5: Males and Eating Disorders. A Clinical Comparison of Men and Women on the Eating Disorder Inventory-3 (EDI-3) and the Eating Disorder Assessment for Men (EDAM). The Journal of Treatment and Prevention.

2)      Striegel RH, Bedrosian R, Wang C, Schwartz S: Why men should be included in research on binge eating: results from a comparison of psychosocial impairment in men and women. Int J Eat Disord. 2012, 45 (2): 233-240. 10.1002/eat.20962.

3)      Striegel-Moore RH, Leslie D, Petrill SA, Garvin V, Rosenheck RA: One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. Int J Eat Disord. 2000, 27 (4): 381-389.

4)      Zhang, Chengyuan. Journal of Eating Disorders 2104 2:138. What Can We Learn From the History of Male Anorexia Nervosa?

 

Back to Basics: Eating 101

This month’s article was written by Trina Weber, MS, RD, an active SMEDA Board member.  She is a registered dietitian who specializes in the awareness, prevention, and treatment of eating disorders. She owns a private practice in Kalamazoo.

 Back to Basics: Eating 101

     Many in our society are afraid of food. There are numerous ways to eat – low-carb, gluten-free, lactose-free, Paleo, or raw vegan, to name a few. Some have genuine food allergies and sensitivities, but too many people cut out whole food groups because they are led to believe the popular myth that it's “better for you”.  If a plate containing a ham and cheese sandwich with lettuce, tomato, and mayonnaise, an apple, and some carrots was placed in front of most people, I wonder who would eat it? Some would ask: Is the produce organic? Did the ham come from a free-range pig? Can I get this on gluten-free bread?

      Grocery stores don't make it any easier. There are so many choices between brand names, organic vs. non-organic, flavors, and cost that it easily becomes overwhelming. I reviewed pasta sauces at my local grocery store. There were nine different brands to choose from, and each brand had between 3 to 6 different flavors to choose from. That's almost 50 choices for just ONE food! I assume most of us buy several food items when we're grocery shopping.

      So what do we do? We have to decide what is important and what is reasonable. If heart disease runs in your family, watch the sodium and saturated fat intake. If cancer runs in your family, eat a larger proportion of organic foods. If finances are tight, do the best you can with what you have. Be watchful that you are not cutting out too many food groups, decreasing variety, or becoming too rigid with food. If you want to be a vegan, aim for about 80% of your intake to be plant-based, but be open to animal products for the other 20%. Most of us get invited to parties and other social events that provide little to no vegan foods. Choose not to be so rigid that you “have to” bring only your own food, go hungry at the party because there is nothing you “can” eat, or, the worst decision of all, miss out on a fun social opportunity because there won't be any foods there you're willing to eat.

      Choose not to micromanage your food. Stay focused on the big picture, which is choosing moderation, balance, and variety to ensure you get the best nutrition for optimal body function. (Notice I didn't mention weight?) We're all a work-in-progress, and do our best given our circumstances each day. Don't worry - if you feel like you “messed up” at a meal, you'll have another meal opportunity in a few short hours.

 

 

Art Hop Series: Eating Disorders with Anxiety and Depression

The Art Hop exhibit countdown:  1 days left

Art Hop                                                                                                                                 February 3, 2017 5pm to 8pm                                                                                                             300 Portage Street (WMU Homer Stryker M.D. School of Medicine)

Lindsay P. South, MA/LPC, an active SMEDA Board Member and a Registered Play Therapist-Supervisor, has written this brief explanation about one way to manage anxiety and depression that may accompany an eating disorder.  Her piece will be displayed at the exhibit along with food play examples.  http://www.southwestmichiganeatingdisorders.org/directory/

 

Eating Disorders and Anxiety

Many individuals struggle with comorbidity:  co-occurring diagnoses.  Although malnutrition certainly makes anxiety and depression worse, sometimes even after weight is restored, it becomes clear that an anxious wiring system was present long before the eating disorder developed.  Restricting food, overeating, or purging just becomes another way of managing underlying anxiety.

Anxious children can learn to manage their anxiety.  In her workbook, “What to do When You Worry Too Much,” Dr. Huebner helps kids externalize their anxiety with the creation of a worry monster.  Making these creatures and learning to talk back to them is a cognitive behavioral method of helping kids be in charge of their anxious thinking.

ART HOP Series: Food Play

The Art Hop exhibit countdown:  2 days left

Art Hop                                                                                                                                 February 3, 2017 5pm to 8pm                                                                                                             300 Portage Street (WMU Homer Stryker M.D. School of Medicine)

The exhibit is designed to not only share pieces that promote an emotional response and bring insight into what it is like to live with and recover from an eating disorder, but also to provide a greater understanding on treatment and how health care providers and parents play a role in the recovery process.  As part of that educational component...

 

Lindsay P. South, MA/LPC, an active SMEDA Board Member and a Registered Play Therapist-Supervisor, has written this explanation about how food play can be used to help children with an eating disorder.  Her piece will be displayed at the exhibit along with food play examples.  http://www.southwestmichiganeatingdisorders.org/directory/

FOOD PLAY

      Children struggling with eating disorders are often terrified of eating.  Certain foods are especially scary.  An essential part of recovery involves reclaiming all those foods which were lost and rigidly categorized as “unhealthy,”  “bad,” or “off limits.”  A nutritionist plays a key role in food restoration.  Parents and children work together to reintegrate all these eliminated foods.  This is a painful and lengthy process!

      As a therapist, I have found a playful way to handle these aversive foods:  we make and shape miniaturized play food out of brightly colored Sculpey.  The child gets to choose what challenging food to make.  Creating ice cream cones, peanut butter and jelly sandwiches, cookies, pizza and root beer floats helps kids make friends with foods they once enjoyed.

 

Art Hop Series: What About Males?

The Art Hop exhibit countdown:  3 days left

Art Hop                                                                                                                                 February 3, 2017 5pm to 8pm                                                                                                             300 Portage Street (WMU Homer Stryker M.D. School of Medicine)

 

Lindsay P. South, MA/LPC, an active SMEDA Board Member and a Registered Play Therapist-Supervisor, has written this reminder on males with eating disorders.  Her piece will be displayed on our information table at the exhibit.  http://www.southwestmichiganeatingdisorders.org/directory/

 

What about Males?

     This question is always asked at any gathering.   Although the ratio of men to women diagnosed with an eating disorder in the US is 1:2, many hypothesize that males may be underdiagnosed.    ED assessments using more female geared language, research focused on girls and women, as well as general difficulties males face for seeking psychological help, are some of the barriers boys and men face in being identified and treated (http://www.nationaleatingdisorders.org/research-males-and-eating-disorders).  It is not surprising that consciousness among healthcare professionals may follow suit.

     Interestingly, Mond (2014) found that  men possesses almost as many subclinical behaviors of disordered eating as women; episodes of binge eating, purging, laxative abuse and fasting for weight loss that did not meet criteria for a full blown eating disorder were just about as common among males and females.

     Men also face different pressures in terms of body image and advertising.  Whereas women’s magazines stress dieting for weight loss, men’s health and fitness magazines promote products, articles and incentives to mold body shape and enhance athletic performance.  Sometimes it is difficult to discern a fact-based article from an advertisement.  Products related to building muscles are paired with pictures of six (eight!) pack abs, a lean and mean physique, sculpted biceps, and an overall “ripped” appearance abound.  These increasingly “buff” men are coupled with a fast car, alcohol, and a sexy woman for an ever popular recipe for male success.

ED Therapy - Exposure and Response Prevention?

Corntney Modelewski, MA, LLPC, an active member of SMEDA and a Kalamazoo therapist that specializes in Cognitive Behavioral Therapy and DBT.  She has written this months blog article on Exposure and Response Prevention (ERP).  http://www.southwestmichiganeatingdisorders.org/directory/

     Exposure and Response Prevention (ERP) is a therapy for Obsessive Compulsive Disorder (OCD) that requires being in the presence of something that causes fear – exposure – and not avoiding the feared situation – response prevention. It can also be used during eating disorder treatment, with growing research to support its use in Anorexia Nervosa and Bulimia Nervosa. For example, in 2011 the International Journal of Eating Disorders published an article about data support ERP use to aid in weight restoration, fear of eating, learning to tolerate fear, and relapse prevention in those with Anorexia Nervosa when used as part of a treatment plan.

     With a licensed mental health therapist, a list called a hierarchy is made up of feared situations to be used as exposure tasks. Distress ratings on a scale of 0 – 100, called Subjective Units of Distress (SUD), are included on the hierarchy as well. The hierarchy gives the frame for treatment.

As an example...

Anorexia Hierarchy

Feared Situation                                                                    SUD (0-100)

Skip one day of exercise                                                                 55

Eat at a Chinese buffet restaurant                                                  95

Have friends over for dinner and eat in front of them                  100

Walk through a grocery store without buying anything                35

Fill pantry with canned food                                                           70

Eat apples with therapist                                                                 60

 

     It's common for individuals to have more than one mental health concern, especially anxiety or OCD. It helps to treat eating disorders and anxiety at the same time when doing ERP.  Kind of like killing two birds with one stone.

As an example...

Anorexia and OCD with Contamination Fear Hierarchy

Feared Situation                                                                                               SUD (0-100)

Eat sucker that has touched a grocery cart seat                                                     70

Hold a raw steak for five minutes before cooking                                                   75

Eat a bag of M&Ms off of therapist's office floor                                                     30

Eat an egg salad sandwich in the bathroom at home                                             45

Play with neighbor's dogs, eat meal without washing hands afterwards               80

 

Treatment structure will look like this:

  • One hour weekly appointments for 14 – 16 weeks.
  • Agreeing to one-half to two hours per day working on exposure tasks outside of session.
  • Getting hands-on help from the therapist to show how to complete the exposure tasks and prevent the person from trying to avoid fear.
  • Time to talk about feelings with the therapist after exposure tasks.
  • Exposure tasks outside of sessions may include help from friends, family, or members of the treatment team.
  • Tracking distress on a sheet of paper, including lessons learned from the activity, and other homework as assigned by the therapist and other treatment team members.
  • Repeating exposure tasks until SUDs go down.

     To sum it up, ERP is a process that addresses fears unique to the individual's needs. One of ERP's main goals is to help people learn skills to use when therapy is complete and encourage people to use their own ERP as needed. In other words, ERP is to help people with eating disorders to become their own ERP therapist.

Recommended YouTube video:

 

https://youtu.be/ZTwVb_3koCU

 

Sources:  (Many of these sources can be found in PubMed.)

Foa, Edna B., Elna Yadin, and Tracey K. Lichner. Exposure and Response (ritual) Prevention for Obsessive-compulsive Disorder: Therapist Guide. Oxford: Oxford UP, 2012. Print.


(Exposure and Response/Ritual Prevention for Obsessive-Compulsive Disorder: Therapist Guide, Edna Foa, Elna Yadin, and Tracey K Lichner, 2012)

Simpson, H. B., et al. (2013). Treatment of obsessive-compulsive disorder complicated by comorbid eating disorders. Cognitive Behaviour Therapy, 42(1), 64-76. doi:10.1080/16506073.2012.751124

(Treatment of Obsessive-Compulsive Disorder Complicated by Comorbid Eating Disorders, Cognitive Behaviour Therapy, 2013, Simpson, et al)

Steinglass, J. E., Sysko, R., Glasofer, D., Albano, A. M., Simpson, H. B. and Walsh, B. T. (2011), Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa. Int. J. Eat. Disord., 44: 134–141. doi:10.1002/eat.20784

(Rationale for the Application of Exposure and Response Prevention to the Treatment of Anorexia Nervosa, International Journal of Eating Disorders, 2011, Steinglass et al)

Toro, J., Cervera, M., Feliu, M., Garriga, N., Jou, M., Martinez, E., & Toro, E. (2003). Cue exposure in the treatment of resistant bulimia nervosa. International Journal of Eating Disorders, 34(2), 227-234. doi:10.1002/eat.10186

(Cue Exposure in the Treatment of Resistant Bulimia Nervosa, International Journal of Eating Disorders, 2003, Toro, et al)

Art Hop Exhibit News: Special Deadline Extensions

Eligible individuals: Currently struggling with an ED, have recovered from an ED, family members that have been involved with the care and well being of a loved one during their struggle with an ED, and health professionals that are a part of ED care teams

(The art and the accompanying paperwork needs to be submitted to one of the healthcare providers on your ED recovery team.)

Since we have extended the deadline for several projects, we are extending the deadline to everyone. (After all, it is only fair.) However, if you will need us to provide a temporary frame for the art exhibit it will need to arrive, with the filled out form, in the next two weeks. If your work is a digital arrangement, we will need it on a flash drive, with the accompanying software if needed (and the filled out form - which can be sent electronically - but not on the flash card) within the next three weeks to make sure that we have the time to prep. If your work will already be framed or does not need to be framed, please provide it and the required paperwork to your health professional (or have them confirm your status) no latter than January 20, 2017.

Mirror project: What we see in a mirror is a social construct. We will have a group piece comprised of individual submissions. If you are local and wish to be a part of the mirror collection, along with the authorization paperwork, you need to submit an altered/enhanced mirror with positive messages on the mirror, so that as you look at the mirror you see yourself and the messages that uplift and positively support you and the reflection you see in the mirror. Though it is a group project and therefore your name will not be posted for public viewing, it will be posted on the back of your mirror so that it may be returned. Consequently, it is still important to fill out the information on how you would like to be identified, so that those setting up and dismantlement the exhibit see the identifier you choose to use.)

http://www.southwestmichiganeatingdisorders.org/art-hop-2017

Coffee + Compassion = Freedom from Eating Disorders

Saturday, February 11th

Just a quick shout out to our great fundraising team for creating this magnificent opportunity to drink great coffee and tea and learn more about both, while helping out our cause

"...to use education to prevent eating disorders among people in Southwest Michigan and to improve the identification of, and treatment outcomes for, those with eating disorders."

( http://www.southwestmichiganeatingdisorders.org/ )

Check out our big event...(In case you would like to give someone tickets for Christmas, you can already order the tickets.)

This is a coffee tasting event featuring some of our area’s premier roasters along with savory breakfast bites and a silent auction of fabulous themed gift baskets.


Join us for a wonderful winter warm up  where you will learn more about your favorite coffees (and teas) score a great  gift for a loved one( or yourself ) and help raise funds to support better educational outreach and treatment options for people suffering from eating disorders in southwest Michigan.
 

For more information about the event and to purchase tickets go http://www.southwestmichiganeatingdisorders.org/coffee-fundraiser/?rq=fund%20 .

Yoga as an ED Recovery Tool

  Thank you, Kristin Fiore, for providing us with this insiteful article on yoga as a part of ED recovery.

Kristin Fiore, RYT 500, is a member of the SMEDA Board, and active in helping other professionals and their clients incorporate yoga into the recovery process.    http://downdogyogacenter.com/teaching-staff/

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   Yoga has provided me with a tangible tool to facilitate acceptance, self-love, and healing in my body.  As Donna Farhi writes in her book Bringing Yoga to Life, “Through daily Yoga practice we become present to our own fundamental goodness and the goodness of others. It is the practice of observing clearly, listening acutely, and skillfully responding to the moment with all the compassion we can muster. And it is a homecoming with and in the body for it is only here that we can do all these things.” This connection of body, mind, and spirit is key as one begins to address different aspects of an eating disorder.

As a late teen suffering from an eating disorder, I found my way into treatment with a counselor and a medical doctor.  These professionals saw me independently of each other in a clinical sitting where I sat in an examination room for medical tests or in a chair for counseling sessions. In this way, I continued to feel detached from my body as there was a lack of physical participation in the process and I found it difficult to navigate the emotional connections I was making in counseling with the actual changing of habits in my body. 

It wasn’t until I began practicing Yoga that the deeper process of healing and recovery began.  I didn’t sit in a chair and talk about my feelings, I experienced them as I engaged my strength and stretched my limits. For the first time I had access to my thoughts and feelings through my body, not despite it. As movement connected with breath, I found a place inside of me that was always steady. As I developed greater awareness of the flow of prana (life force or energy) within me, I began to feel empowered and beautiful.  This quote from Nita Rubio’s essay in the book Yoga and Body Image sums it up nicely, “As you learn to move with the internal energies, you learn how to move with life’s flow. Beauty emanates from here because it is deeply rooted from within. This beauty is not one based on a standardized list of perfection. Nor does it reference an ideal. This beauty is based on feeling. Beauty is an experience.”

Yoga is an experiential practice that uses mindfulness techniques to bridge the gap between body and mind.  As we begin to feel the connection between the different aspects of our being, we open ourselves up to process, change, surrender, and accept.  The healing benefits of Yoga are many in my experience, and recent studies show Yoga may help relieve depression, anger, and anxiety and improve mood (Harvard Health Publications). Yoga also promotes greater self-awareness, self-esteem and positive body image through the cultivation of love, acceptance, non-violence, and unity. In addition, the physical poses of Yoga help the body build muscle, bone density, and aid in digestion which may be helpful during recovery from an eating disorder and for general overall health.

As we begin to explore the healing benefits of Yoga it is necessary to practice with compassion for what may arise and to seek guidance from a trusted and well-informed teacher as needed. It is important to practice in a safe and non-competitive environment.  Exploring the edge in a yoga pose in a healthy way, not by pushing the body but learning to stay with an uncomfortable sensation and find breath, may be useful when someone is feeling full and resisting the urge to purge or compensate or when they are experiencing strong emotion.  Anastasia Nevin says, “Bringing yoga into eating disorder recovery is a way to access memories, messages, and wisdom stored in the body that are not always accessible in more traditional forms of talk therapy. The ultimate goal of recovery is in fact Yoga: re-connecting and integrating all parts of the self to live a more intuitive, peaceful, and soulful life.” (Live Fit article, “The Role of Yoga in Treating Eating Disorders”)

     I have found that the routine practice of Yoga allows me to be consistent, loving, and stable in body, mind, and spirit.  Over the years of teaching and researching Yoga, I have worked with many others who also find it to be a useful therapeutic tool.  Yoga poses can be modified to suit each individual’s needs depending on where one is in treatment or recovery of an eating disorder, and the use of breathing techniques, mindful meditation, and movement make this a great holistic treatment to compliment more traditional forms of therapy. 

List of Resources:

Farhi, Donna. Bringing Yoga to Life: The Every Day Practice of Enlightened Living. San Francisco: HarperSanFrancisco, 2003. Print.

Klein, Melanie, and Anna Guest-Jelley. Yoga and Body Image: 25 Personal Stories about Beauty, Bravery & Loving Your Body. Llewellyn Publications, 2014. Print.

  Nevin, Anastasia. "The Role of Yoga in the Treatment of Eating Disorders." Sonima Live Fit. 2 July 2015. Web.

"Yoga for Anxiety and Depression - Harvard Health." Harvard Health.  Apr. 2009. Web.

Tips for Eating with Ease

Southwest Michigan Eating Disorders Association members suggest several strategies for enjoying/handling your holiday meals/gatherings:

 

Cathy Cook, LLPC, TLLP, RD Nutritional Therapist at Life Coach Psychology:

When attending parties or family events during the holiday season have a "support buddy." This is someone whom you 'Identify' and 'Ask' to help meet your planned goals before, during and after meals or eating events. Create a plan with the "support buddy" so they are prepared to divert triggering conversations, are ready and committed to go for a walk or participate in a planned activity after eating to combat unpleasant body sensations, and mainly a support person to help you lead a healthy life during the holiday season and beyond.

 

Cortney Modelewski, MA, LLPC, CBT Therapist at Cognitive Behavior Solutions:

Coping Cards are easy and effective way to help you stay on track. Write down techniques you plan to use, positive self-statements, your goals, or anything that will help you feel motivated and confident on an index card before a holiday event. You can make as many cards as you would like. Read your cards 2 - 3 times per day or any time you feel the urge to act on eating disorder thoughts and emotions. If you don't like using index cards, you can use notebook paper, a small notebook, sticky notes, your phone - anything that can fit in your pocket or purse discretely.

 

Kristin Fiore, Yoga Instructor and Owner of Down Dog Yoga Center:

Before a Meal:

Take a few moments to do some gentle twisting and slow, diaphragmatic breathing (inhale and count your natural breath, extend your exhale by the count of two) before you attend a holiday gathering.

During a Meal:
Eat slowly and mindfully, putting down your fork between bites and taking a few breaths - remember to chew 10-30 times for each bite.

After a Meal:
Do alternate nostril breathing (inhale through the left nostril, exhale through the right, inhale back up the right nostril and exhale out the left - repeat for at least 9 rounds) to de-stress and re-balance after a meal.


Sit and notice thoughts and urges while maintaining a focus on the natural breath. Tell yourself all is well~ all things arise and pass.

 

Trina Weber, MS, RD, LLC, registered dietitian & owner of private practice:

Choose not to compensate before or after the Thanksgiving meal. It could be served at a time you do not normally eat, which can throw off your regular meal plan times. You might be tempted to skip breakfast and snacks before the meal, purposely eat until you get sick, significantly reduce what you normally eat afterwards, or abuse exercise. This will only lead to more eating disordered behaviors. Be flexible with your meal plan. For example, if the meal is being served at 2:00 PM, eat your regular breakfast and have a snack at around 11:00 AM. You can have some dinner around 7:00 PM. Remember that these few days are only a tiny part of your overall eating picture.

 

Practice Owner, Lindsay P. South, MA/PLCC & Associates, Registered Play Therapist-Supervisor:


Plan ahead for activity after the holiday meal. Ask your guests ahead of time to bring walking shoes so you can take a stroll around the neighborhood or on a nearby trail after the meal. If the weather is too cold or snowy for a walk, play board or card games. Getting involved with your guests doing something fun and interactive can help you enjoy the holiday more fully and ease feelings of physical or social discomfort.

 

From all of us at SMEDA, have a happy, peaceful holiday season!

Successful Food Strategies for Holiday Nourishment

We want to wish you a successful and happy holiday by offering some helpful tips.  Thank you Kendall Dick, Nutrition Intern for AB Nutrition Solutions for providing us with this week's article and our professional members that vetted it.

The holiday season is a wonderful and magical time that can often be equally as stressful. For many, the stress of being in containment with certain relatives for long periods of time is quickly alleviated by the thought of the secret family recipe they bring to the table. But for those suffering or recovering from an eating disorder, the cornucopia of food that feeds the holiday season only adds another helping of stress to their plates.

For those who are overcoming disordered eating, the holidays bring more challenges than varieties of Christmas cookies, but they are NOT insurmountable. When food is front and center for what seems like a never-ending season, those confronted with extra calories and extra tensions struggle against retreating into former patterns of restriction, purging, and extreme anxiety.

Individuals recovering from anorexia nervosa will likely experience quite a bit of anxiety over the quantity of rich and indulgent food which they typically restrict themselves from eating. For those with bulimia nervosa and binge eating disorder, the day is filled with persistent temptation to overindulge. These temptations can often lead to loss of control and subsequent feelings of shame or guilt.

To overcome all of these temptations and anxieties, a game plan must be prepared to make it through the twilight zone looming between the candy craze of Halloween and the midnight suppers of New Year’s Eve. Here are four tips on how to survive the holidays with an eating disorder:

  1. Plan ahead. More planning equals less stress and anxiousness about eating. Remember to stay hydrated throughout the day and eat regularly scheduled meals before a party so you don't show up overly hungry and irritable. Think about where and what foods will be available, portions, and how to stop eating when it’s time. In some cases, skipping an event altogether to avoid temptation or stress may be the safest option.
  2. Have a support system. Positive support from a trusted someone can reduce likeliness to eat in an unhealthy way. Before the holiday chaos ensues, enlist a confidant who will be around. Suggest that they assume the role of plate monitor, don’t allow any disappearances to the bathroom, and deflect comments from oblivious or overly concerned relatives.
  3. Stay in touch with your registered dietitian nutritionist, therapist, and doctor. Talking to them about food concerns is a healthy way to cope with holiday pressure. If travel demands mean missing an appointment, be sure to stay connected by phone or email. Accountability is the key to success.
  4. Shift the focus onto people and relationships rather than food. Think of parties and meals as opportunities to connect with others instead of fixate on food. The holiday season is a great time to enjoy relationships with loved ones, be thankful for blessings received, and to give back through loving service to others. These practices will help properly feed your soul, as well as your body.

Slowing down, soaking in the love of the season, and celebrating accomplishments of another year past can be an encouragement to pursue health and wellness in the upcoming year. Not only can these practices inspire a New Year’s resolution, but they also relieve stress and provide comfort in the current season. Even if all of this is easier said than done, the important thing to remember is that it can be done. And with persistence and support, it will be done.

 

 

ED Therapy - DBT?

This month's blog article was written by Gary Snapper, LPC, LLP, a member of the SMEDA Board and a founder of Cognitive Behavioral Solutions in Kalamazoo.  http://www.southwestmichiganeatingdisorders.org/directory/

DBT History

Marsha Linehan, creator of DBT therapy, described DBT as “a multimodal cognitive-behavioral treatment originally developed to treat chronically suicidal individuals meeting BPD criteria.”  Since DBT’s inception in the 1990s, researchers and clinicians have experimented with broadening the application of DBT to multiple mental-health disorders including OCD, Bipolar Disorder, Substance Abuse Disorders, Depression, and Eating Disorders.

 DBT Components

DBT is a high-intensity treatment program that combines aspects of Cognitive Behavioral Therapy with the concepts of Dialectics and Mindfulness.

 Dialectics is the concept that two apparently polar opposites can be true concurrently.  Dialectics help clients to avoid all-or-nothing thoughts and actions. For example, a person can be doing the best they can AND need to try harder.

 Mindfulness is associated with Eastern Religions, and portions of it have been described in most major religions.  Mindfulness is the nonjudgmental awareness of one’s internal and external experiences and states. This also can be explained as follows:  Attempting to be aware of one’s focus and gentle re-directing of the mind to the present when one notices one’s mind drifting towards judgmental thoughts or over-focusing on past or future worries.   Research has shown Mindfulness helps to reduce anxiety and to increase a sense of balance.

 DBT implements these concepts through a comprehensive regimen that requires all of the following:  1) Individual therapy, 2) Skills training,  3) After hours skills-based phone support, and 4) Weekly DBT team consultation meetings.

 DBT Theory and Eating Disorders (ED)

A cornerstone of DBT theory is that emotion dysregulation contributes to many disorders, including EDs.  Difficulty regulating intense emotions can lead to avoiding  “emotion experiencing”.  Emotions that are avoided may lead to ED symptoms, including food restriction, binging, purging, and over-exercise. DBT provides specific skills to cope with intense emotions in tandem, with a forum to learn, practice, and apply the skills.  This helps the client to replace ED behaviors with effective coping strategies. In essence, DBT teaches the ED client a new language that allows for skills-based emotion regulation in place of ED behaviors.

 Along with new coping strategies, DBT’s use of Mindfulness techniques, Dialectics, and after-hours Coaching, all apply to the treatment of ED’s, and has become a comprehensive approach for treating Eating Disorders.

 Although none of the researched eating disorder treatments are as effective as we would like them to be, research suggests that DBT rivals and/or surpasses the effectiveness of traditional CBT, which has been considered the Gold Standard for treatment of eating disorders in adults.

 A simple 8-minute video describing DBT for Adolescents can be found at: https://youtu.be/Stz--d17ID4?list=PLV9RJQek2bix34tBuHaOp12gt-sHf32yV  .

 Sources:

 Linehan, Marsha, M., (1993).  Cognitive-Behavioral Treatment of Borderline Personality Disorder.  New York: Guilford Publications.

 Linehan, M. and Chen, E. (2005). Dialectical-Behavior Therapy for Eating Disorders. In Freeman, A. Encyclopedia of Cognitive Behavior Therapy. (pp168-171). New York: Springer.

Holiday Food And Fun For Everyone

With holiday parties and social gatherings starting, here is some sound advice from one of our professional members...

If you're having someone with an eating disorder over to your house for Thanksgiving, you might be feeling a bit nervous. Here are some tips for you:

1. Serve food you normally serve. You don't need to make special accommodations. In fact, serving “special” foods might encourage eating disorder behaviors.
2. Choose not to push your guest to eat. Doing so will actually push them into more eating disorder behaviors. Do not stare at them or their plate. If you are concerned about what your guest did/did not eat, wait and approach them at least a day after Thanksgiving and set up a specific time to talk about your concerns.
3. Choose not to take it personally if your guest eats differently than what you expect. It will take a lot of courage for them just to show up for a Thanksgiving meal. Your guest will probably have already decided what they were going to eat before they even knew the menu.
4. Choose not to make comments about your guest's size, weight, or appearance in any way. Watch how you talk about your own appearance and the appearance of others, including celebrities.
5. Remember there is much more to your guest than the eating disorder. Ask about their job, school, hobbies, friends, and other interests.

Art Therapy: Beyond the Therapist's Office

by Laura Smidchens

Art therapy is not only a way for the individual to communicate with the therapist and gain greater insight during a supervised session. It also helps individuals build skills to continue to contemplate and express themselves throughout their lives. Here are individuals’ messages...

We all have an exterior side that we show to the world and a part that we shield and protect. Art therapy helps individuals connect with, confront, and work with that private/hidden side.

The art samples shown in this volume were submitted for display in one of SMEDA’s public awareness Art Hop exhibits. The artists chose pieces that helped express their cur- rent or past relationship with their eating disorder.


Our next Art Hop exhibition will be in February, 2017. Click here for further details.

Art Therapy: Confronting Our Inner Selves

by Laura Smidchens

Art therapy is often done by specially-trained therapists that adjust the artistic medium to better match the clients and their needs. While some methods allow persons to express them- selves in less permanent forms, such as working in sand basins with figures and other items, other methods provide a more permanent form. Either type of art gives clients a safe way to explore themselves and their relationship to their eating disorder (ED) and the world around them.

Whether looking at their goals and the roots that will help them achieve those goals....

 

Or looking at their relationship with others...

Or their relationship with their ED...

The medium and skill are not as relevant as the insights and the personal gains that are made.

The art samples shown in this volume were submitted for display in one of SMEDA’s public awareness Art Hop exhibits. The artists chose pieces that helped express their current or past relationship with their eating disorder.

Our next Art Hop exhibition is scheduled for February, 2017. Please go to our website for further details.

Click here to download the complete newsletter.

Art Therapy: Creating a Voice

by Laura Smidchens

Art allows individual creators to express themselves. For those individuals that either do not have the words to express themselves or find it too painful to talk openly about something, art gives them a way to explore and express their inner selves. Even simple forms of expression can be packed with meaning that allows the creator to organize and analyze their feelings and reactions... Though even in the apparently simple forms of expression, it is important to look at the details...

Click here to read more and see examples.