Submitted by The Massachusetts General Hospital Neuroendocrine Unit
Bone loss is an important health concern in anorexia nervosa because it is common, can be severe, and increases the risk of fracture now and in the future. Osteopenia and osteoporosis are the medical terms for bone loss. Many factors contribute to bone loss in anorexia nervosa:
How can I learn more?
The Massachusetts General Hospital Neuroendocrine Unit is working to further medical knowledge about bone health and treatment of bone loss in women with a diagnosis of anorexia nervosa. If you are interested in learning more, please contact Melanie Schorr, MD at 617-726-3897, firstname.lastname@example.org, or Erinne Meenaghan, NP at 617-724-7393, email@example.com, or fill out our pre-screening survey at: www.myresearchsurvey.org.
By Sydney Keller, Mental Health Worker at Monte Nido Eating Disorder Center of Boston
Self-care is a key component of recovery for one’s emotional, mental, and physical health. This is something that should be practiced consistently as it is vital for one’s overall health and well being. Self-care is all about balance. When your emotional, mental and physical needs are met, you become the best version of yourself. It may be hard to discover what your body and mind may need in regards to self-care, but push yourself to explore a variety of options. This could include journaling, yoga, meditation, buying your favorite scented soap, running a warm bath, going on a walk, onhealthy valium spending time with those you love, organizing your personal space, receiving adequate hours of sleep each night, the list goes on and is not limited to these suggestions
Listen to the wants and needs of your mind and body, and do not force yourself if any of these suggestions do not feel right for you. Self-care will only remain constant if it provides you pleasure and does not feel forced. At the end of the day, your health, your happiness and your relationships are all factors that depend on self-care. Give yourself time each day, even if it is only a few minutes, to do something that makes you happy.
by Amy M. Klimek, MA, LPC, Eating Disorder Program Coordinator, Timberline Knolls
The new college year is firmly underway. Thousands of young people have left home and started a whole new chapter in their lives. Although exciting and new, these first months can be highly taxing with new social networks, academics and living environment.
The experiences in these pressure-filled months can be a breeding ground for new habits, some valuable, others damaging. Disordered eating can develop long before being noticed by others and sometimes the person themselves. Awareness of disordered eating habits can help friends support those in need before it leads to life-threatening circumstances.
Obsessive or Judgmental Food Talk
Food exists to provide a measure of satisfaction, while fueling the human body. Food is meant to be part of a balanced life – it is not intended to be the measure of value. Obsessive talk about food — what is good or bad, healthy or unhealthy, fat grams, calories, the newest attractive fad diet — indicates that an individual may be moving into an unhealthy, controlling relationship with food. A verbal obsession can be an attempt to find “acceptance” of the new behaviors from others, in the effort to solidify approval for themselves. “I am now on a dairy-free, gluten-free, fat-free, food-free diet. I feel better already.” Or “I binged again last night; I really need to learn how to control myself.” Some of these comments are passive, while others are clear signs of an imminent eating disorder.
Negative Body Talk
College is nearly synonymous with the concept of change; one aspect of this change is the body. Meeting new people comes with new comparisons some flexible and fleeting – others may elicit negative judgments and motive to “fit in.” A rigid relationship with food combined with a negative body image can lead to isolation to avoid the conversations.
It’s important to keep in mind that maladaptive behaviors can manifest in a number of ways, from one extreme to another, yet equally dangerous. For example, both restrictive eating or compulsive overeating may cause a student to withdraw, no longer attending parties or engaging with friends. Altered behavior can also extend to exercise: a student may feel the need to run three hours a day to burn calories, while another might spend inordinate hours in the gym to build excessive muscle mass.
Help with an Open Heart and Open Mind
If the warning signs are apparent, take action. Action comes in the form of honest, heart-felt, compassionate conversations. “I” statements are best used, as in “I have noticed that …” or “I care about you so much that when I see …” Also, serve as a role model by giving attention to a person’s character, not waistline. If you express concern over a friend losing weight, but are also relentlessly dieting, your words will lack meaning. It can help to become familiar with resources available on campus and if needed, be available to go to appointments to support your friend.
By Bertha Tavarez, PsyD
Director of Clementine Adolescent Treatment Program at Oliver-Pyatt Centers
How does the opera singer take care of the voice? The baseball pitcher, the arm? The woodcutter, the axe? The ballerina, the legs and feet? The counselor, therapist, teacher, or heath professional, the self?
-Excerpt from ‘The Resilient Practitioner: Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers, and Health Professionals 2nd Ed.’ Thomas M. Skovhoh & Michelle Trotter-Mathison
“Experiencing burnout? Who, me? Never!” If you are lucky enough to make it your life’s work to care for others, chances are, you have experienced the burning hot coals of burnout. Burnout is defined as ‘a state of chronic stress that may lead to physical and emotional exhaustion, professional detachment, and perceived lack of effectiveness and accomplishment.’ Burnout can be experienced on a continuum, and, if left unchecked, can negatively impact even the strongest treatment providers.
In a qualitative analysis of job burnout, eating disorder treatment providers were found to be at high risk of burnout due to characteristics of pathology, patient characteristics, and work-related factors (Warren, C. et al., 2012). Work-related factors that contribute to burn out include: lack of structure in the organization, poor support from team members, and difficulty managing large caseloads with multiple professional responsibilities. Although we cannot control the nature of the diagnosis or patient characteristics, we can empower ourselves to create a paradigm shift in how we manage work-related factors.
As the Clinical Director of Clementine Adolescent Treatment Program at Oliver-Pyatt Centers, I wanted to combat the effects of burnout in our staff by crafting team-building opportunities. I developed a plan to engage the staff in daily exercises that would promote practitioner resiliency. I hope these daily exercises act as a fun and dynamic shift in how we relate to one another as well as the clients via a deliberate parallel process.
I presented staff members with individual gratitude jars and a bag of glass pebbles. I encouraged staff members to place a pebble in the jar every time they experienced gratitude for their work. This exercise really encouraged us to find gratitude in the little moments. For most of us it opened our eyes to attend to moments of gratitude. At the end of the week, we counted and reviewed our pebbles (75 total! Woo hoo!) We realized that although we were unable to recall every moment, we had the awareness that they occurred.
The Clementine Staff was given “self-care homework” and asked to spend some time coloring using Valentina Harper’s Creative Coloring Inspirations book after a long workday. The next day, we discussed what the experience was like and how it influenced our ability to find closure in the workday and engage in a soothing activity at home. The response from staff was positive and uplifting! For those who struggled to complete the task, it provided greater awareness about the importance of self-care. Others reported gaining insight regarding a tendency toward perfectionism during the coloring process, and how this may have hindered self-care. A binder of blank pages was placed in the staff office and made available for continued use. These coloring pages were given to clients who shared similar experiences to use as a primary method of coping during difficult times in treatment.
Staff members participated in “adult show-and-tell” during lunch. They were encouraged to bring in a prized possession that proved meaningful in their lives. The purpose of this exercise was to encourage the staff to share aspects of themselves with greater meaning and value and build relationships with one another outside of the typical work-related dialogue. Staff members brought in emotional treasures from their past, and we took turns presenting them and sharing stories. Through laughter and tears, we found a place of greater connection. One of our staff members described this moment perfectly when she said, “I will never forget this work day.”
On Friday, staff members were given bubbles to use in order to encourage a playful mindfulness moment at the end of the week. This simple exercise proved to be a catalyst for joy for all of Clementine. Recovery coaches, therapists, and clients were united in play!
As I think back at these activities, I can say they greatly benefited us individually and collectively. The most rewarding aspect was that, as we took better care of ourselves, we were able to spread this loving energy to those we serve.
‘In dealing with those who are undergoing great suffering, if you feel “burnout” setting in, if you feel demoralized and exhausted, it is best, for the sake of everyone, to withdraw and restore yourself. The point is to have a long-term perspective.’ – Dalai Lama
Warren, Cortney S.; Schafer, Kerri J.; Crowley, Mary Ellen; Olivardia, Roberto; Eating Disorders, 2012 May-Jun; 20 (3): 175-95.
By Sydney Keller, Mental Health Worker at Monte Nido Eating Disorder Center of Boston
I have come across handfuls of clients that feel the only way they have ever identified themselves is through their eating disorder. The number on the scale, the size of their jeans, the amount of times they have been in treatment, the list goes on and on. When I have asked clients in group settings to talk about themselves, I have been shocked when their opening statement is, “I’m Mary and I’m anorexic” or “I’m Linda and I’ve had bulimia for the past ten years.”
Your onhealthy fosamax eating disorder gives you nothing. It takes and takes and will never stop taking. It robs you of your health, your happiness, your relationships with family and friends, and it will continue to take from you. Your eating disorder is not and will not ever be your friend. You are not defined by your eating disorder and your eating disorder will never be your true identity.
On your journey of recovery, your eating disorder identity will begin to diminish and your true identity will resurface. In many instances, clients feel they do not know who they are without their eating disorder and feel they need to relearn the facets that include their healthy soul and self. This is your time to explore. Recognize your role among your family and friends, rediscover your passions, re-establish your self-worth, and redefine your abilities and attributes.
Pat yourself on the back for all you have done and all you will continue to do on your journey of recovery. Now will the real you please stand up?