Debunking Myths About Remote Care

From our friends at Within Health

Many professionals and people in need of care may still believe myths that remote care is an  inferior level of treatment for mental health concerns, like eating disorders. In truth, studies show remote care for eating disorders is a helpful and proven option that offers wonderful benefits that in-person care cannot match. (1,2)

Keep reading to learn more about remote care of eating disorders and the reality behind the myths.

What is remote care for eating disorders?

Remote care is a general term used to describe any treatment method that does not depend exclusively on in-person, face-to-face appointments between the professional and the person receiving treatment. Rather than the person driving to an office, remote care utilizes technology for communication and care.

Remote care for eating disorders may involve:

  • Real-time text message communication
  • E-mail
  • Phone calls
  • Video chatting
  • Message boards
  • Group therapy
  • Support groups
  • Meal support
  • One on one sessions

Remote eating disorder care is not a new type of treatment. It is a new way of offering what is already known to be effective in treating eating disorders, like CBT and FBT,  in a way that utilizes technology to increase the accessibility to this type of specialty care.

A multidisciplinary approach is the gold standard in eating disorder treatment. Remote care can gather a team of specialized treatment professionals to provide collaborative care in one’s living room. This unique approach to providing care makes it more accessible, more transferable into one’s daily life, and more convenient to include the factors that enhance recovery motivation in someone’s experience.

Debunking common myths about remote care for eating disorders

To accurately understand the benefits of virtual treatment, it’s essential to debunk the common myths surrounding remote care for eating disorders.

Myth: You can’t treat trauma remotely

The Truth: Remote care is an excellent  and effective way to address the trauma that often accompanies or contributes to eating disorders.

In a study of fully-remote care for trauma and post-traumatic stress disorder (PTSD), participants generally showed lower levels of trauma-related symptoms after services. The treatment was so successful that more than 82% of participants no longer had a PTSD diagnosis at a 6-month follow-up. (3) Here, remote care was as effective or more effective than traditional treatment.

Often, people who are working through their trauma share with their team that being treated at home provides additional elements of comfort that are not usually available to them in brick and mortar settings. Things like familiar surroundings, safe places, and even pets can help people remain in a more regulated state during this work.

Myth: You can’t weight restore

The Truth: Weight restoration is an important part of recovery for many people with disordered eating, and it is absolutely possible to do so in remote care.

For a person who is in need of nutritional support, remote treatment for eating disorders is an appropriate option when people are medically stable enough for step-down levels of care like PHP, IOP, or outpatient. With any eating disorder care, the level of behavior interruption should match the person’s medical stability, motivation, and need for support.

Remote meal support offers intervention during some of the most challenging times in the disorder, including the ability to interrupt symptom patterns, provide distraction and connection and external accountability.

Myth: Patients are less engaged

The Truth: Patients may actually be more engaged with the use of remote treatment than those who use traditional, in-person treatments. Remote treatment removes so many barriers to help people enter and continue in care. Additionally, remote care casts a wider net for those seeking treatment and has a greater ability to connect people with similar presentations and experiences of eating disorders, thus allowing more connection, understanding and growth.

Those in treatment can continue to be a part of the aspects of their life that provide motivation for recovery. Things like work, family, pets, and friends continue to be a part of one’s environment while still being in care. This can help to fuel engagement and motivation for recovery.

Remote therapy works to engage people through:

  • Access to experts
  • Flexibility with evening and weekend appointments available
  • Convenience since there is no need to drive to appointments, leave work, or arrange childcare
  • Family engagement with loved ones connecting from their locations
  • Privacy as you no longer must walk into a treatment center
  • Connecting individuals by shared experiences such as diagnosis, age, and race

Remote treatment helps people get engaged and stay engaged. Studies of remote treatment find very low dropout rates. (3)

Myth: Can’t provide meal support

The Truth: Remote treatment can provide meal support that surpasses options available to those using in-person treatment.

While in-person treatments rely on the client bringing recommendations and techniques into their home, remote treatments enable the professional to be with the client in their own kitchen or dining room. They can offer a level of personalized care not available with in-office meal support.

Remote care works with your natural environment and the triggers that happen in everyday life. The care and support your team offers while navigating these challenges help translate recovery from a controlled treatment center environment to your daily life.

Myth: Remote treatment is a watered-down version of in-person

The Truth: Remote treatment uses the same tested interventions used during in-person sessions.

Remote care providers use telemedicine techniques to connect with their patients wherever and whenever they need support. The same techniques that work so well at an in-person treatment program are used in remote settings with similar results. Nothing is watered down here.

A unique innovation in remote care is the ability to build treatment programming around the individual instead of putting an individual into a ready-made program. Remote care is not bound by the same time limits an in-person program is, so can offer different blocks of time, various evidence-based treatment offerings based on what is best for the person, and specific experience-based care that reflects the person’s unique needs to recover.

Where can you find remote care for an eating disorder?

Anyone interested in learning more about remote care for an eating disorder or starting treatment should consult Within Health. The multidisciplinary team at Within can guide the person through all phases of treatment, from intake to post-treatment support groups. Remote treatment may not be best for everyone, but many people can receive the assistance they need from the safety and comfort of their homes with remote care.


  1. Gorrell, S., Reilly, E. E., Brosof, L., & Le Grange, D. (2022). Use of Telehealth in the Management of Adolescent Eating Disorders: Patient Perspectives and Future Directions Suggested from the COVID-19 Pandemic. Adolescent health, medicine and therapeutics, 13, 45–53.
  2. Falco, C. B., Peres, M. A. A., Appolinario, J. C., Menescal, L. L., & Tavares, I. G. A. M. (2022). Remote consultation with people with eating disorders during the COVID-19 pandemic. Revista brasileira de enfermagem, 76Suppl 1(Suppl 1), e20220197.
  3. Bongaerts, H., Voorendonk, E. M., Van Minnen, A., Rozendaal, L., Telkamp, B. S. D., & de Jongh, A. (2022). Fully remote intensive trauma-focused treatment for PTSD and Complex PTSD. European journal of psychotraumatology, 13(2), 2103287.

Check out MEDA Listed as One of the Best Eating Disorder Support Organizations

These organizations make it easier for people with eating disorders to get treatment.

3 Ways to Tune Out New Year’s Diet Ads

3 Ways to Tune Out New Year’s Diet Ads by our friends at Center for Discovery

The coming of a new year is highly anticipated and often brings with it soaring expectations of the all too familiar phrase “new year, new you.” The expectation with this phrase may be accompanied by feelings of stress and anxiety around how you’ll achieve this so-called “new you”—will you need to embark on a new diet? Adopt an intense exercise routine? Or give up something you enjoy? What brings the belief that with a new year you must change some part of who you are or what you look like? There isn’t one single group, company or individual responsible for this belief. Instead, you can blame it on something we call diet cultureDiet culture can be defined in different ways depending who you ask, but in general it refers to a culture that places a person’s worth and value on their size and outward appearance. It encourages the belief that smaller bodies are better, healthier, and can be achieved through diet and exercise, if one tries hard enough.

The truth is bodies of all sizes can be considered healthy. It’s important to know that many factors play a role in determining the size and health of someone’s body, including genetics, environment, food security, and access to equitable healthcare. Body size and health are not connected the way diet culture would have you believe. Further, diet and exercise are so minor in the overall picture yet are held in such high importance by the companies that profit off them. We know that food and movement can play a role in supporting the physical and mental health of our bodies, but the emphasis should be on having a healthy relationship all with foods rather than on calorie/macronutrient intakes. Along the same lines, finding a form of movement that you enjoy and look forward to is far more valuable than feeling pressured into a rigid exercise routine that you dread.

Bottom line is, we know that ads fueled by diet culture are wrong and just plain inaccurate, but they are still out there. And being surrounded by restrictive diets and rigid exercise trends is more harmful than helpful in supporting your health, so what can you do to focus on the things that matter? How can you tune out messages of diet culture in the new year? We’ve got three things that can help:

1. Remind yourself who diet culture really benefits (spoiler: it’s not you).

Companies that promote diet culture typically make it seem like they really care about you—your wellbeing, your happiness, your health and longevity. Despite this outward facade, it’s important to remember that these companies are in business for one thing and one thing only, which is to turn a profit. They do this by taking advantage of the increased pressures from society for you to make a “lifestyle change.” The diet and weight-loss industry is estimated to be worth $71 billion in 2020 (this  enormous value is already down from the previous year, with 2019 reporting a worth of $78 billion), and they didn’t become successful by helping people feel good about their bodies. They strategically found a way to make people believe they could always achieve more—gain the “perfect body,” and find success in every aspect of their lives purely—by altering their bodies to fit society’s standards. So, when you see ads promoting the “perfect” diet and exercise programs, keep in mind that they are developed to be profitable, not to improve your health and wellbeing.

2. Anticipate seeing diet/fitness ads and prepare healthy coping skills to use.

It’s inevitable that you will see ads on TV, social media and other outlets promoting the belief that you must invest in changing your body size. These ads can be persuasive and a bit extreme, making substantial claims that your health, life and happiness will change if you purchase their product or membership. We know these ads aren’t likely to benefit your mental health and may influence you to begin comparing yourself with paid models who have been edited and polished for their photoshoots and commercials. Instead of falling into this trap of comparison, have some effective coping skills ready to use when you see these ads.

  • Positive affirmations: If a thought comes up from a diet ad, ask yourself if it is a helpful or unhelpful thought: does it make you feel neutral or positive about your body? Or does it make you feel poorly and responsible for changing it? If the answer aligns with the latter, having a list of affirmations ready to use can be an effective way to help challenge and cope through the negative thoughts that may arise.
  • Grounding: This can be a great technique to use to break an unhelpful thought cycle and refocus your mind and body. Use your five senses to focus on what you can see, hear, touch, taste and smell, and really take the time to be mindful of each sense.
  • Breathing exercises: Seeing diet ads may trigger some feelings of stress and anxiety, and using breathing exercises can be a helpful way to calm down those responses. Start by breathing in slowly through your nose and exhaling through your mouth, paying close attention to how each inhale/exhale feels throughout your body.

3. Join communities or follow individuals that are supportive of body acceptance and positivity.

One of the best ways to tune out the influence of ads promoting diet culture is to surround yourself with people, groups and messages that support the body acceptance movement and positivity. Clear your social media feed of accounts who support the promotion of diet and fitness ads and instead create a feed where you can browse and feel supported and accepted as you are. Follow body-positive and inclusive accounts that show diverse body types and share messages that support you in challenging the “new year, new you” mindset. You can also talk with people you’re close with about how these diet culture messages affect you—you never know who might be feeling the same way.

New year messaging will likely never be fully free from diet and fitness ads. Understanding their aim and knowing how to refocus your thoughts after seeing them is the best way to stop them from affecting your own mental health. Remember what is truly important for supporting your health when it comes to food and exercise: a healthy relationship with all foods and joyful movement that helps you feel good both physically and mentally. Remember, if you or a loved one is struggling with an eating disorder, Center for Discovery can help you on your recovery journey.

Madeline Radigan Langham is a registered dietitian who works with adolescents in mental health residential treatment. She is passionate about advocating for weight inclusivity and a non-diet approach to help people heal their relationships with food and their bodies. In her free time, she enjoys being outdoors and spending time on trails with her family. You can find more of Madeline’s thoughts and work at or on Instagram at @mradnutrition.

How to Prioritize Your Health and Eliminate Negative Self-Talk During Holiday Meals

How to Prioritize Your Health and Eliminate Negative Self-Talk During Holiday Meals

Written by Jacqui Cooper-Morgan (Center for Discovery)

Prioritizing your health during the holidays can look different for everybody. Whether you are in recovery from an eating disorder or not, you may feel guilt or shame about eating during the holidays. The first and foremost thing for prioritizing your health through the holidays is eating enough. This is regardless of your body size, what you ate yesterday or what you ate today. You need to eat enough food and a variety of food. But with all the chaos that comes along with the holidays, what exactly does that look like? How do you prioritize your health this holiday season?

5 Tips to Prioritize Your Health During the Holidays

1. Don’t skip meals

A lot of people restrict or overexercise before a holiday meal. Seeing your family engage in these behaviors to “prepare” for holiday meals might be triggering for you. During the holidays, schedules are off, so eating at regular intervals is key to maintaining and protecting your health and recovery, if you’re in recovery.

2. Set boundaries around diet talk

If you predict there will be triggering conversations around diet culture at a gathering, have a code word or a safe buddy that you can give a nod or a smile to. Have someone who sees you and knows your struggle. Offer a different topic to talk about. If you just want to leave the situation, that’s also an option. Working towards accepting that you cannot always control a conversation, or the actions of others can also be a positive strategy. People might still talk about their diet even if you’ve asked them not to. Work towards acceptance.

3. Remember that you don’t need to earn food

You deserve food just because you’re a human. Think of food not just in terms of numbers this holiday season. Food can also be nourishment in a spiritual way, or a soulful way. It adds value to our lives because it’s family, culture or just plain tasty.

4. Be mindful of your alcohol use

Alcohol can interfere with your ability to connect with your body, so if you’re not totally in touch with your hunger and satiety cues, you might not be able to register if you’re still hungry or full.

5. Plan ahead

If a certain meal or a certain time that you are going to be eating is causing so much anxiety for you, have a plan of what you might want to do. Go through it in your head. If there are a lot of options in a buffet style to select for your meal, eat a little bit of everything in a mindful way. How does the food taste? Bring it back to the meal. I think this is a good coping skill for triggering conversations. Negative food or diet related talk, focusing back on your meal can be a way to avoid that conversation.

Feeling Dysregulated this Holiday Season?

The holidays present many challenges, such as a change in schedule, travel plans and seeing people you may not typically be around. This can all lead to dysregulation of the body. If you are feeling super dysregulated, the following strategy can help you get grounded, bring you away from triggering conversations and allow you to focus on your meal.

In the “5,4,3,2,1 skill” first identify:

  • Five things you can see
  • Four things you can hear
  • Three things you can touch
  • Two things you can smell and
  • One thing you can taste.

This grounding strategy can help bring you back to yourself during times of dysregulation. If you’re feeling overwhelmed or like you can’t focus on your meal or internal cues of satiety, this tool might be able to help.

Enjoy Yourself this Holiday Season!

While it may seem like you’re just trying to go through the motions of the holiday season, remember to try to enjoy yourself, too. You deserve a break. Even if it’s just for an hour. Give yourself permission to enjoy yourself and your meal.

About the Author:

Jacqui Cooper Morgan, RD, CEDRD is the Director of Nutrition at Discovery Mood & Anxiety Program. She utilizes a compassionate, individualized approach to support individuals heal their relationship with food and move towards long-term health goals. Jacqui started her career as a dietitian working at the residential level of care, treating individuals with eating disorders. She has since provided care for individuals struggling with mental health and substance use issues. Jacqui is a certified eating disorder registered dietitian whose work is grounded in evidence-based nutrition practices including Intuitive Eating® and Health at Every Size®.

Using Trauma-Informed Yoga To Treat Eating Disorders & Substance Use Disorders

Using Trauma-Informed Yoga To Treat Eating Disorders & Substance Use Disorders by Timberline Knolls

Many people struggle with the effects of trauma during their lives. But this can be especially true for people who are working toward healing from certain behavioral health conditions, including eating disorders and substance use disorders.

For those who are struggling with these concerns, trauma-informed yoga can be a powerful component of the healing process. Trauma-informed yoga is a gentle and person-centered approach to yoga practice that strives to empower participants and help them reconnect with their bodies in a safe and therapeutic way.

Characteristics of Trauma-Informed Yoga

Trauma is a person’s unique response to an overwhelming or distressing situation. According to survey data, about 61% of U.S. adults have endured at least one adverse childhood experience (ACE), and almost 1 in 6 have been through four or more ACEs prior to age 18.

Trauma-informed approaches recognize the need to support people wherever they may be on their personal paths to healing from trauma. Key components of trauma-informed care include:

  • Physical and emotional safety
  • Choice and control for participants
  • Collaboration with providers
  • The presence of trust and respect
  • Opportunities for empowerment and success

Trauma-informed yoga embraces the above principles while also incorporating the potentially healing practices of mindfulness, breathing, and safe movement. Recognizing the way trauma can reside in the body, trauma-informed yoga invites participants to connect with their physical experiences in a safe, supported way. While trauma can disrupt self-regulation, harm self-esteem, and cause a heightened sense of danger, trauma-informed yoga can begin to repair these feelings of disconnection and reestablish safety.

How Trauma-Informed Yoga Can Help

The lingering impacts of trauma can contribute to or worsen the symptoms of an eating disorder or substance use disorder, as well as complicate the recovery process. So it can be crucial for someone who is in recovery and wondering whether yoga can help to find a safe trauma-informed program.

A trauma-informed approach to yoga involves helping participants access healing in an individualized and careful way. Participants should ideally experience the following qualities in a trauma-informed yoga session:

  • The facilitator uses accessible and inclusive language to guide the class and respects each person’s bodily autonomy.
  • Healing and safety are top priorities, and each person moves at their own pace and only engages in practices they feel comfortable with.
  • The experience supports nervous system regulation and helps each participant achieve a calm and present state. This can help someone who is receiving treatment for an eating disorder or addiction establish a sense of safety and stability that can promote recovery.

For those who have eating disorders, trauma-informed yoga can also help with managing some of the unique struggles that may come with these disorders, including feelings of anxiety, shame, and low self-worth. Because trauma-informed yoga uses simple, accessible movements and lets participants determine their own experience, it can offer a safe, nonjudgmental, and healing setting for participants. Additionally, it can help deepen the mind-body connection and promote needed relaxation.

Trauma-informed yoga can also help those who are suffering from substance use disorders navigate recovery and improve their well-being. One study looked at the benefits of trauma-informed yoga for various groups, including people who were receiving treatment for substance use concerns. The study found that:

  • After attending multiple trauma-informed yoga classes, 18%-36% more students stated that they were using self-regulation skills in their daily lives.
  • Among the students who were receiving substance use treatment, a majority said that yoga was a helpful part of treatment and that they learned skills that helped them abstain from substance use.

Finding the Right Trauma-Informed Yoga Programming

Trauma-informed yoga can offer many pathways to better well-being and be an excellent complement to traditional therapies. But it is not a one-size-fits-all approach. If someone is receiving treatment for an eating disorder or substance use disorder, it can be helpful for them to be their own best advocate. Many treatment programs and providers offer yoga that is trauma-informed, but an effective program ideally honors individual needs and promotes emotional and physical safety at each step. Recovery is a process, and yoga can play a healing role when it meets someone where they are on their journey.

Why Family Therapy Truly Matters in the Treatment of Eating Disorders

Why Family Therapy Truly Matters in the Treatment of Eating Disorders

By the Klarman Center at McLean Hospital

Eating disorders are time-consuming, soul-crushing, and insidious to your suffering loved one…and to you! Watching helplessly as your child/partner/sibling puts themselves at life-threatening risk can result in the ping-ponging between terror, frustration, and fury. By the time someone has gotten into residential care, everyone is worn out. The secrecy and what can feel like a cat and mouse game around eating, food, and other problematic behaviors may have eroded trust. Your loved one may feel taken over by their eating disorder and you may feel like they are lost to you. While the eating part is central to treatment, there is so much more psychological work that is involved in recovery. In addition to individual therapy, family therapy is also crucial.

A dedicated family therapist for weekly meetings who is separate from the individual therapist, or a case manager is critical. The therapy aims at creating a safe space for the discussion of difficult feelings to help the patient and family move towards more open communication and shifting the patterns that have gotten in the way of connections. The family therapist is part of your loved one’s team which includes an individual therapist, psychiatrist, dietician, and other specialized clinicians.

Whether therapy is addressing what has been difficult in the past, the feelings around the eating disorder, or what kind of support would be helpful now, the goal is to ultimately increase openness, foster connection, and help people to move forward together. A hand-out, a set of instructions, and even a family meeting that is focused only on the patient’s needs, will not do this. The family therapy must support a deeper kind of change, healing and finding one another.

In the wonderful words of Maya Angelou:

“We do the best we can with what we know.”

Work that is geared towards growing that knowledge through intensive therapies and having supported behavioral experiences reaps the best outcomes. Patients tend to thrive when they have increased choice in not only feeding themselves, but in moving forward with better self-esteem and towards a life that holds meaning for them.

The involvement of families in this process may differ from family to family. There are, however, certain themes that come up frequently. One of the most common dynamics has to do with the amount of understandable anxiety family members may have been experiencing over time regarding the child’s/friend’s/partner’s bodies. Often there have been years of trying to make sure that your loved one is eating. Sometimes, there are suspicions that something isn’t right- food wrappers that are hidden, long bathroom sessions after meals, weight swings, etc. And, for some families there is a confession, or a trip to the ER, or a concerned call from a friend or provider- and suddenly there are confusing decisions that need to be made about treatment while trying to integrate this new information. There are also those families who have been coached in Family Based Treatment when their kids were younger, and they are less certain of their roles with their young adult children. There may have been tension at the dinner table and difficulty having meals with family friends or extended family; it may have gotten to the point where the family has stopped eating all together or stopped eating the same food at mealtime. Sometimes children who have gone away to college get too sick to finish a semester. Or their struggles became more obvious during the lock-down phase of the pandemic when people were home with each other all the time. For those who have been in and out of treatment, not only may they be experiencing increased hopelessness, but their families may also be profoundly discouraged. One of the fallouts is that families may reach for more and more desperate measures to try to fix things. They may have become the “food police,” monitoring intake, threatening consequences if behaviors are used, locking cabinets, taking doors off of their hinges. Life may have devolved into a “them” vs. “us” battleground. The eating disorder may have become personified and there may be arguments about “who is speaking; the ED or the loved one.”

Residential treatment provides an opportunity to shift these unhappy and often unhelpful patterns. The treatment team takes on the role of monitoring meals, holding the line, making meal plan increases, and watching over medical concerns. The treatment designed so that parents and/or significant others may take a step back from these struggles offers a welcome reprieve and reset. It is crucial that the family/loved ones are supported in “dropping the rope” so that you can support your loved one in the truly difficult undertaking of residential care. Equally crucial is the work with your child/spouse/sibling/friend to help them to experience their ambivalence internally rather than it getting played out with others in what can feel like a battle for control. If the established dynamic had become the anxiety of the family member vs. the eating disorder, there may not be enough space for the person with the eating disorder to understand why they may be holding onto the eating disorder and to understand what internal battles are at play. So, for instance, the child with social anxiety may have come to deal with their loneliness by numbing themselves through weight loss, purging, starvation, or obsessive preoccupation with food/eating/body. It is never as simple or straightforward as recognizing that the eating disorder has the immediate function to mute the painful feelings of self-doubt and social isolation, yet it has really exacerbated poor self-esteem and avoidance. But, in this example, there may be exploration of what may be motoring the eating disorder, what may be alternative ways to respond to painful feelings, and how one might address what leads to those painful feelings that may make a difference. These are the kinds of discussions that may expand understanding and to help people to talk about how they might best be there for each other. There may be feelings about misunderstandings or different parties feeling unseen or unheard. Family therapy provides a space to be curious, to put into words what may be new or difficult, and to repair or deepen fragile connections…and all of this helps drive healing and recovery forward.

The Klarman Center at McLean Hospital expertly offers the approach described above. Our staff is experienced and devoted. We appreciate the complexity of each person engaging in treatment and do not view anyone as “an eating disorder.” Comprehensive psychiatric evaluations are a standard part of our care. Because the Klarman Center is part of a larger, renowned psychiatric hospital, there are resources available that extend far beyond regulating eating.  For example, if indicated, we can order consultations with experts in specialized areas such as substance abuse or OCD, investigate the differential diagnosis and treatment of different depressive disorders, encourage expression through art, explore the role of spirituality in one’s recovery, and have individual sessions aimed at approving body image.  Without minimizing how hard this treatment may be, we believe in recovery, and we will work with you or your loved ones towards a more flexible and more fulfilling life. If you have questions about you or your loved one, please contact us at 617-855-3408 or CRADULKSKI@MGB.ORG

How Dialectical Behavior Therapy Can Effectively Treat Eating Disorders

How Dialectical Behavior Therapy Can Effectively Treat Eating Disorders 

From our friends at Timberline Knolls 

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that teaches people effective coping skills to help them live happier, more fulfilling lives. Through DBT, individuals can learn that it’s possible to simultaneously accept where they are on their recovery journeys and work toward positive change. The unique combination of these seemingly opposite concepts can help people who are battling an array of mental health disorders find healing.

While it was originally created for the treatment of borderline personality disorder, DBT has since been adapted to address a range of other behavioral health concerns, including eating disorders. Because everyone has different needs and life experiences, DBT therapists work with each person to identify the behaviors they would like to decrease as well as the ones they would like to enhance.

People who participate in DBT attend group sessions where they can learn to observe and restructure unhealthy behaviors by strengthening four core skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. They may also benefit from receiving individual therapy, telephone coaching, case management services, and comprehensive support from a consultation team. Generally, DBT programs last six months to a year, though the actual length of time a person spends in therapy depends on the severity of their symptoms and their treatment goals.

The Benefits of DBT Skills for Eating Disorder Recovery

Oftentimes people who are struggling with eating disorders develop harmful, disordered behaviors to deal with intense emotions. In these cases, DBT can be a beneficial approach for helping individuals learn alternative skills for coping with life’s stressors in a productive way. By focusing on the four categories of DBT, people can develop the ability to accept the challenges they are facing and make strides toward changing them.


Mindfulness in its simplest terms is a mental state of being aware. This guiding principle of DBT is paramount in helping people begin to develop acceptance. Mindfulness therapy encourages a person to be present in each moment so that they can observe their thoughts and emotions as well as their surroundings in a nonjudgmental manner. For someone who is battling an eating disorder, practicing mindfulness can help them notice negative thoughts and slow down emotional reactivity.

Distress Tolerance

The threshold for the amount of discomfort a person can endure without becoming overwhelmed is known as distress tolerance. This level can vary from one person to another and may change depending on the situation. While it’s normal for a person’s tolerance for stress to fluctuate, those who have consistently low levels of distress tolerance may find it nearly impossible to cope with hardship. A person’s inability to manage stress may cause them to turn to harmful coping mechanisms to deal with emotional suffering. For this reason, enhancing distress tolerance can help those who have eating disorders accept uncomfortable situations for what they are and let them go so that they can move forward.

Emotion Regulation

Emotion regulation skills can help a person manage intense emotions in a healthy way. Through this DBT competency, a person can learn to recognize their emotions and label them without judgment. For someone who has an eating disorder, emotion regulation can help them understand how their feelings affect their behaviors as well as pinpoint triggering situations so that they can avoid them. By developing this skill, they can decrease their susceptibility to intense emotions and learn how to deal with them when they do arise.

Interpersonal Effectiveness

Intense emotions can impact a person’s ability to maintain healthy relationships. Through this module, individuals can work toward improving connections with loved ones by learning how to resolve conflict, actively listen, and articulate their needs. This core skill empowers people to ask for what they want confidently to promote self-respect. By learning to communicate clearly and effectively, a person who is facing behavioral health challenges can strengthen relationships and reduce feelings of resentment.

Overall, DBT can help people who have eating disorders avoid thinking about challenges in a black-or-white manner by encouraging them to recognize and accept the complexities of life. Through therapy, they can benefit from learning how to identify triggers, implement mindful eating practices, and improve their reactions to painful emotions. DBT can allow them to achieve better functioning on a day-to-day basis by helping them manage emotional turmoil and increase their problem-solving abilities.

CEDO Response to AAP Guidelines

As a member of the Collaborative of Eating Disorders Organizations (CEDO), the Multi-Service Eating Disorders Association Inc (MEDA) strongly opposes the new clinical guidelines introduced by the @Ameracadpeds. We do not support intentional weight loss in children via the methods included in the guidelines, especially the recommendation of bariatric surgery and pharmaceutical products for children.

The AAP’s guidelines for childhood “obesity” are harmful, may increase or exacerbate eating disorders or disordered eating, significantly contribute to medical weight stigma and fat phobia, and are not in the best interest of children. We strongly ask the AAP to please reconsider the guidelines, and engage with the eating disorders community to reduce the potential for harm to children.

Check out the full letter PAGE 1 and PAGE 2

Autism and Eating Disorders

Autism and Eating Disorders from our friends at The Emily Program

Note: In this blog, we use identity-first language (e.g., “an autistic individual”) to reflect the preferences of self-advocates who embrace autism as an identity category – a diverse way of perceiving and interacting with the world (Taboas et al., 2022Bury et al., 2020). However, we recognize that preferences for this language vary; whenever possible, please ask an individual what they prefer.

Living with and treating an eating disorder may be complicated by the presence of a co-occurring condition, particularly when the condition shares characteristics with an eating disorder. One such condition that shares some psychopathology with a disordered eating mindset—and is frequently seen alongside an eating disorder diagnosis—is autism spectrum disorder.

There are a number of factors that increase the risk of disordered eating or an eating disorder in an autistic individual. By looking at the nature of both eating disorders and autism spectrum disorders, we can better understand their relationship and improve the detection, care, and treatment of both conditions.

What is Autism?

Autism, or autism spectrum disorder, refers to a broad range of neurodevelopmental conditions characterized by challenges in social skills, interpersonal communication, and restricted or repetitive behaviors or interests. It’s important to note that autism doesn’t have “one” look. Autism is considered a spectrum disorder, meaning that there are many types and variances in how it presents from person to person.

An autism diagnosis can generally be made around 18–24 months of age, when characteristics can be distinguished from those typical in early development. That said, signs of autism may not be noticed or identified until an individual is much older.

There are many limitations in pinpointing the global prevalence of autism, such as a lack of public awareness, an evolving clinical definition of autism, shortcomings in public health responses, and underdiagnosed populations such as adults, marginalized groups, and those who identify as girls or women. Experts estimate that for every three cases of autism spectrum disorder, there are two additional undiagnosed cases (Fusar-Poli et al., 2020). Recent studies suggest the median prevalence of autism is one in every 100 individuals worldwide (Zeidan et al., 2022).

There is no medical test used to diagnose autism. Rather, a diagnosis is given after observing symptoms and assessing the severity of behaviors. Some of the more common symptoms of autism include:

  • Difficulty interpreting others’ body language, facial expressions, and social cues
  • Narrow or intense interest in certain topics
  • Difficulty speaking, making eye contact, and/or appropriately managing tone of voice
  • Repetitive or ritualistic behaviors
  • Trouble managing and regulating emotions
  • Feeling overwhelmed in social situations
  • Difficulty maintaining a conversation and understanding conversational give-and-take
  • Need for routines and resistance to change
  • Sensory issues, involving either heightened or under-sensitivity to sounds, smells, light, touch, pain, and other stimuli

The Overlap of Autism and Eating Disorders

The relationship between autism and eating disorders is not well known, but it is surprisingly common. We see higher rates of autism—and autism characteristics—in people who have eating disorders. There is a crossover in the underlying neurological underpinnings of eating disorders and autism spectrum disorders. Like eating disorders, autism spectrum disorders are biological, brain-based conditions. Autistic individuals and people with eating disorders share a number of traits, most notably:

  • Inflexible thinking
  • Sensory processing issues
  • Repetitive behaviors
  • Insistence on routines

While we don’t know the precise scope of the intersection between eating disorders and autism, we do know that autism is more prevalent in eating disorder populations than in the general population. It is estimated that 20–30% of adults and 3–10% of young people with eating disorders also have an autism diagnosis (Solmi et al., 2020).

Traits That Could Present a Risk Factor

Despite the high rates of autism in eating disorder populations, autism does not definitively predate someone to an eating disorder. That said, there are certain characteristics that may precipitate disordered eating habits or the development of an eating disorder in those already susceptible.

Sensory processing challenges

One eating-related issue common in autism are sensory processing challenges. This is a characteristic that is often present but not required for an autism diagnosis. Sensory processing challenges include both over-reactivity (a heightened sensitivity to sensory inputs from the environment, such as sounds feeling extremely loud or lights seeming too bright), or under-reactivity (an inadequate reaction to sensory input, such as not noticing that a fire alarm has gone off).

For individuals on the spectrum who have this heightened sensitivity, the texture of foods can be especially significant. A person with heightened sensitivity to the texture of foods might complain that the food they’re consuming is too mushy or too wet, too crunchy or too dry. This sensitivity can have a profound impact on an individual’s food choices, leading them to be very selective about what they will consume on a regular basis. They might be highly attuned to differences among brands of the same food or the cooking style and day-to-day preparation of the food.

This sensitivity to food can lead to a very narrow nutrition profile—one limited to “safe” foods with repetitive flavors and textures. In reducing the range of what is okay to eat, an individual with heightened sensitivity may become undernourished, making it harder for the brain to work effectively and clearly. People who struggle to meet their nutritional needs from food as a result of sensory qualities typically meet the criteria for Avoidant/Restrictive Food Intake Disorder (ARFID).

On the flip side, other autistic individuals may struggle with eating because they don’t have a good sense of when they’re hungry or full; they lack interoception, or awareness of what’s happening in their body. People who struggle to be aware of what their body needs may go through spurts of overeating, undereating, or a mixture of both.

Intense interest

Another characteristic common in many autistic individuals is the tendency to dive intensely into an interest. Rather than being interested in a wide variety of things on a surface level, many individuals tend to have one or two areas of all-consuming interest. Autistic individuals who exhibit this pattern may find themselves narrowing in on an obsessive interest in food or weight. Some will be intensely interested in nutrition or physical activity.

Sometimes this focus will turn inwards to a fixation on a particular body type. In pursuit of this interest, an individual may begin tracking their measurements or calorie counting, which are warning signs of anorexia nervosa. It is very likely that an individual with this intense interest and approach may have a limited range of nutrition or very strict, inflexible rules around eating. This puts them at a heightened risk of developing a full-blown eating disorder.

When this narrowed interest in nutrition and the body intersects with a strong desire for things to stay the same (another hallmark trait present in autism spectrum disorders), an individual may struggle deeply with natural fluctuations in weight or shape, particularly during puberty or pregnancy. This may contribute to an all-consuming focus on nutrition intake and body size or shape to ensure their weight is consistent. This inflexible thinking puts an individual at risk of disordered eating or exercise behaviors that do not support their wellbeing.

Ritualism and avoidance to change

It is common for autistic people to have a ritualistic approach to eating. The term “food jag” is frequently used in the autism community, and refers to a tendency to eat the same foods, prepared the same way, every day, and sometimes every meal. These restrictive eating patterns are often displayed in children and may continue into adulthood.

Autistic people may struggle with cognitive flexibility, which can lead to dichotomous thinking about food. Autistic individuals might display a rigid desire for control that manifests in the form of a very limited nutritional palette composed entirely of “safe” foods. This predetermined inflexible eating path could trigger or intensify an eating disorder.

Treating Eating Disorders in Autistic People

The presence of autism spectrum disorder has the potential to complicate a client’s illness, as well as their eating disorder recovery. Research shows that autistic adults tend to experience longer-lasting and more severe eating disorders (Tchanturia et al., 2019). The good news is that autism does not make eating disorder recovery impossible—or even less likely (Nielsen et al., 2015).

The key to achieving full recovery—which is, and has been proven to be, completely possible for autistic people—is comprehensive, individualized treatment that prioritizes the needs of the autistic individual with an eating disorder. Providers must keep the potential presence of sensory issues, intense interests, cognitive inflexibility, and interoception at the forefront of assessment, diagnosis, and treatment. It is essential that eating disorder treatment for an autistic individual is inclusive, enabling, and affirming. Because autism is a spectrum disorder, a treatment plan should ultimately honor and reflect the unique needs of the client.

The Emily Program takes a personalized approach to eating disorder treatment and recovery. Please give us a call at 888-364-5977 or click here to learn more about the individualized care we offer.

Ethics in Eating Disorder Treatment

Ethics in Eating Disorder Treatment

From Our Friends at Veritas

Eating disorder clinicians are guided by ethics to ensure the best for every patient that comes into their care. In general, ethics help clinicians determine appropriate clinical decisions and behavior. They provide a compass for what is “right” and what is “wrong,” although determining that is not usually so simple. Treatment providers will encounter a variety of moral dilemmas in their careers, and ethics can provide a general framework for navigating these situations.

In this blog, we will cover key ethical principles in the treatment of eating disorders, as well as several dilemmas that the field’s clinicians may face.

Ethical Principles in Eating Disorder Treatment

When a person’s work involves caring for the health and wellbeing of others, ethical principles need to be considered regularly. Just like eating disorders themselves, the ethics in the treatment of these illnesses is complex. Eating disorders treatment requires a multidisciplinary team including registered dietitians, therapists, medical providers, and psychiatrists. Depending on a provider’s specific profession and scope of work, ethical principles and standards can vary.

The following are examples of the ethical principles commonly used in the field of eating disorder treatment:

  • Autonomy: giving the patient the freedom to choose, where that is possible
  • Beneficence: taking actions or giving recommendations that are in the best interest of the patient
  • Confidentiality: protecting a patient’s private information and sharing that information responsibly
  • Informed consent: ensuring that a patient has all the information they need in order to give full consent
  • Duty to protect: protecting patients from harming themselves or others
  • Justice: making decisions for the patient that are fair and equitable
  • Paternalism: choosing a course of action without the patient’s consent but in their best interest
  • Integrity: adhering to a moral code that includes honesty and truthfulness

Potential Ethical Dilemmas in Eating Disorder Treatment

Even with the guidance of ethical principles, the treatment of eating disorders is complex. Clinicians will most likely find themselves dealing with conflicting principles, which can make it challenging to decide the best course of action. Learn about several different kinds of ethical dilemmas that arise in eating disorder treatment below:

Resistance to treatment

A patient’s resistance to treatment is often reinforced by the eating disorder itself. Discussing the patient’s reasons for wanting to change and pursue recovery can be helpful in reminding them why they reached out for help in the first place. Resistance to treatment is normal and understandable. Seeking help often comes with concerns about facing social stigma for their illness, fear of letting go of their eating disorder, anxieties about possible weight changes, and more.

The power of the therapeutic relationship

The relationship between a patient and a therapist is essential to aligning eating disorder treatment goals and recommendations. If the patient values their relationship with their therapist, they are more inclined to heed their advice in eating disorder treatment, particularly when pursuing higher levels of care. Therapists must be careful to not abuse the influence they may have over their patients.

Involuntary treatment

Involuntary treatment involves treating someone against their will for the purpose of their safety. For obvious reasons, this concept comes with various ethical dilemmas. Providers must take into account the patient’s illness history, the severity of their eating disorder symptoms, and their general psychiatric state. There are very rare cases when someone may need to be forced into treatment for their own safety.

Treating at a lower level of care than is clinically recommended

There are instances where the patient or the patient’s family does not want to enter the level of care recommended by their treatment team. They could be concerned about other life responsibilities or simply believe that they can take care of the illness on their own. Ethically, providers must respect patient choices while also ensuring that they have all the information they need to make an informed decision.

Provider bias

Everyone, including eating disorder treatment providers, has biases and different subject areas in which we are not experts. Individuals working in healthcare can ensure that they are held accountable for examining these biases by participating in ongoing supervision and consultation, regardless of their years of experience. Getting this support is not shameful; it demonstrates a person’s dedication to their patients and the quality of their work.

Considering personal experience

It is common for eating disorder treatment providers to feel pulled to the profession because they have experienced the illness themselves and want to help others through it. If a provider is in recovery or recovered from an eating disorder themself, they need to be sure to protect their own recovery while they help others. Ongoing supervision, as well as setting and maintaining boundaries, is essential to protecting a provider’s personal health and boundaries.

Considering ethical principles in the treatment of eating disorders is essential to providing quality care that is built on empathy, competence, and integrity.

If you work with patients with eating disorders, please consider attending “Ethical Considerations in the Treatment of Eating Disorders,” a webinar presentation from Krista Crotty, LMFT, PsyD, on Thursday, May 9th.

5 Misconceptions About ARFID in Adults

5 Misconceptions About ARFID in Adults

What is ARFID?

Avoidant/Restrictive Food Intake Disorder, ARFID for short, is an eating disorder impacting thousands of Americans. Often thought of as “extreme picky eating”, it can result in failure to gain developmentally appropriate weight, malnutrition, nutrient deficiencies, and psycho-social impairment. Although individuals have struggled with its symptoms for far longer than it has been a diagnosis, many are unfamiliar with what ARFID is and how it impacts individuals.

There are some common misconceptions when it comes to ARFID and adults.

  1. ARFID only affects kids

ARFID is frequently believed to only impact children and adolescents. The idea of being a “picky eater’’ is often associated with kids, which can make it difficult to recognize and validate adults who suffer with ARFID. Despite the limited amount of data on adults with ARFID, researchers have determined that roughly 9.2 percent of adults with eating disorders meet the criteria for ARFID.

  1. Individuals with ARFID eat like kids

It is often assumed that those who suffer with ARFID limit their intake to foods that are considered “kid foods” like chicken tenders and macaroni and cheese, even though these foods can be for anyone. There are adults with ARFID who love a variety of foods, and this eating disorder doesn’t always limit people to the foods that fall within the kid food stereotype.

  1. There’s no help. Things won’t change.

People who suffer with ARFID might believe that there is no treatment for them. This eating disorder isn’t typically brought to the forefront of conversation, and it can be easy to assume that there isn’t treatment out there. However, treatment centers like Walden offer help to those who are suffering. Walden, for example, offers electives in PHP and IOP for adults that focus on understanding and treating the three subtypes of ARFID: sensory sensitivities, fear of aversive consequences, and lack of interest.

  1. ARFID doesn’t have consequences for adults

ARFID can be consequential in the lives of both kids and adults creating devastating impacts. ARFID impacts adults in ways that might be unexpected. Adults may find they struggle to advance professionally if they are unable to attend company outings or client dinners. Additionally, they may find social and romantic outings also impacted by either their limited intake or fear of aversive consequences.

  1. You have to be underweight to have ARFID

In general, an issue in the eating disorder field is the discrepancies in treatment between those who are underweight and those who are weight neutral. Underweight individuals tend to get more attention, and those who are weight neutral can fly under the radar. Weight neutral people who suffer with ARFID might be overlooked and assumed to be picky eaters, when in reality, they deserve treatment for the disorder that they are suffering with.

For more information about Walden’s ARFID treatment programs visit

Amanda Smith, LICSW, CEDS (she/her/hers) is the Director of ARFID Programming and the Program Director of the Peabody and Amherst clinics with Walden Behavioral Care. She has over ten years of experience in the treatment of patients with eating disorders. She manages a therapeutic milieu of adolescents and adult eating disorder patients across partial hospitalization and intensive outpatient programming, including the new ARFID Intensive outpatient program for adolescents. She also conducts community outreach related to eating disorders to increase awareness, education, and support for community providers.

Eating Disorders Among Reasons Why College Students Consider Leaving College

Eating Disorders Among Reasons Why College Students Consider Leaving College

By Timberline Knolls 

Many students are thinking about leaving college, and their struggles with mental health concerns like eating disorders are a major reason why.

A survey of 2,000 college students, parents, and family members found that nearly 40% of students thought about leaving their academic institutions within the past year. For some, lack of mental health support was a key factor behind their doubts about whether they should complete their degrees, with 77% of respondents reporting struggles with an eating disorder.

Nationally, eating disorders affect about 11%-17% of cisgender women and 4% of cisgender men on college campuses across the country. These devastating illnesses also impact 12.3% of gender-expansive college students, 11.1% of genderqueer and gender-nonconforming students, 10.5% of transmasculine students, and 6.3% of transfeminine students in the United States.

A challenging time

The college years can be a challenging time for young adults, one that comes with stressors they may not have encountered before. Students typically contend with a much less structured environment than that of high school, and they must learn to balance an intense workload with making new friends.

“College can be a time of a lot of excitement and stimulation and also a lot of stress,” Alison Baker, M.D., a child and adolescent psychopharmacologist, told Child Mind Institute. “It asks young people who are not yet adults to act in a very adult way, especially if they’re contending with mental illness and suddenly have to begin managing it on their own.”

For transgender, genderqueer, and gender-nonconforming students, those stressors are often compounded by other factors in their lives. College might be the first time they have the freedom to explore their gender identities, and that can lead to an intense focus on body shape or size. Others may encounter people or policies that reject their gender identities, leading to severe distress or potential gender dysphoria.

Finding a sense of control

There are many reasons why a college student might develop an eating disorder, but a need for control and a drive for perfection often top the list of risk factors for this age group.

When so many things might feel completely out of their hands, the way they eat or shaping how their body looks might become the one area of their life that they feel like they can control during such a stressful time. This can be particularly true for students who struggle with perfectionism.

Many college students may feel intense anxiety if they don’t get things right in every aspect of their lives. They may feel overwhelmed if their grades aren’t perfect or they aren’t making friends as quickly as they thought that they would.

The new environment, stress, and drive to control it all can be the perfect storm that leads a college student to develop an eating disorder. And without the right support, many students are now worried that they won’t make it to graduation, according to the survey.

Getting to graduation

If a college student thinks that they may have an eating disorder, it’s important that they get a professional assessment to determine the type and level of care that is right for them. The best place to start is at a student’s college health center, which can allow them to access treatment right on campus and experience the least amount of interruption to their academic career.

But not all colleges and universities have the resources to help students who are struggling with mental health concerns like eating disorders. That doesn’t mean that help isn’t available. Students can also reach out to their primary care provider or find a facility that specializes in eating disorder treatment.

Eating disorders can impact people at any age, but they often affect young adults as they head off to college. But with the right support, college students can find recovery and enjoy successful academic careers.



Why Eating Disorder Screenings Should Check for Addiction

Why Eating Disorder Screenings Should Check for Addiction

By Timberline Knolls 

Eating disorders and addiction are like partners in crime. Where one goes, the other often follows.

Up to 50% of people who are in treatment for an eating disorder also have a substance use disorder, while about 35% of those who are in treatment for addiction also have an eating disorder. Experts estimate that people who are suffering from addiction are 10 times more likely to have an eating disorder than the general population.

So why are these behavioral health conditions so connected?

The Battle with Body Image

Part of what ties these two conditions together is their connection with body image. Feeling uncomfortable with the size or shape of your body can be upsetting, and it can make even everyday activities too nerve-wracking to get through. When you spend nearly every day with that kind of stress, you may look to almost anything to change how you feel about your looks.

Some turn to over-the-counter medications like laxatives and diuretics, while others misuse prescription stimulants like Adderall® and Ritalin® and still others may use illegal drugs like cocaine and methamphetamine to control their weight.

For many people, abusing certain substances is the only way they know how to manage the distress they feel about their body. The unintended consequence: an eating disorder and addiction.

Numbing Difficult Feelings

But eating disorders don’t always have to do with the way someone feels about their body. Sometimes someone’s relationship with food is actually tied to painful memories or difficulty managing intense emotions.

Research shows that people who have an eating disorder are much more likely to binge eat on days when they are feeling depressed, anxious, or stressed. Eating in certain ways can be a coping mechanism in the absence of healthier strategies.

But if those feelings or memories become overwhelming, a person might try to self-medicate the emotional pain they’ve been experiencing by abusing a substance like alcohol or prescription painkillers.

If they don’t receive any sort of professional intervention, that puts them at a high risk for developing an addiction on top of the eating disorder they’re already struggling with.

Comprehensive Screenings Are Key

There’s no doubt that eating disorders and addiction can be intertwined in many ways. That’s why it’s so important for someone who has an eating disorder to also be screened for addiction.

By conducting a comprehensive evaluation before a person starts eating disorder treatment, their care team can assess whether their life has been impacted by substance misuse. This will allow the care team to create an eating disorder treatment plan that also integrates therapies and services that are geared toward addiction recovery.

Living with two behavioral health conditions can be incredibly challenging. But with the right treatment, it’s possible to live a healthy, productive and satisfying life.




Eating Disorders a Danger for Competitive Young Athletes

Eating Disorders a Danger for Competitive Young Athletes

By Timberline Knolls 

For many parents, getting their children involved in athletics is a top priority during their young ones’ school-age years.

Participating in sports helps children get regular exercise, develop lasting friendships, and learn valuable skills like leadership and teamwork that extend outside of the playing field.

But as some kids advance in certain sports and look for any possible competitive edge, there can be obstacles along the way that can have dangerous consequences. One of the most serious hazards for many young people who are striving to be the best athlete they can be is the risk for developing an eating disorder.

The pressure to excel 

Though it’s certainly possible for an athlete in a team sport to develop an eating disorder, these dangerous health conditions are more common among those who play sports that have a strong focus on appearance, diet, and weight requirements. These can include:

  • Track or cross-country
  • Gymnastics
  • Wrestling
  • Figure skating
  • Dancing
  • Swimming or diving
  • Boxing

There’s also the individual aspect of many of these sports. Figure skating and gymnastics, in particular, place an athlete as the center of attention in what is often tightfitting clothing. The spotlight and pressure to strive for perfection, both in sport and in appearance, are immense.

That can lead a young person to consider habits that seem simple enough on the surface but, as you look further, are often the precursors to disordered eating. Calorie counting may turn into dieting, which can lead to excessive exercise. All of a sudden, a young athlete’s quest to be their best may take a sharp turn toward an unhealthy spiral that requires professional help.

The types of eating disorders that affect athletes

 The most common eating disorders in athletes are anorexia nervosa, bulimia nervosa, and binge-eating disorder. It’s important to understand how they differ so that you can look for signs of these disorders if an athlete you know may be struggling.

  • Bulimia nervosa: This is marked by repeated episodes of eating a large amount of food at once, called bingeing, and then doing something to avoid weight gain, such as purging.
  • Anorexia nervosa: Athletes who are living with anorexia tend to eat very little and severely limit the types of food they eat. Severe calorie restriction can lead to extreme thinness, a badly distorted body image, and fear of weight gain.
  • Binge-eating disorder: This is a loss of control over what you’re eating and how much. People who have binge-eating disorder eat a large quantity of food without purging, which often leads to guilt and shame.

These aren’t the only disordered eating habits a young athlete can struggle with. Athletes can also be prone to conditions that are not recognized as clinically diagnosed eating disorders but are still frequent and potentially as dangerous.

These include orthorexia, an unhealthy focus on clean, healthy eating that can lead to malnutrition, and compulsive exercise, which can lead to muscle soreness, osteoporosis, an increased risk for injury, and loss of a menstrual cycle.

Warning signs and how to help

If you notice a young athlete who seems to be increasingly concerned with weight limits or goals, weight check-ins or measurements, or who exercises frequently away from their sport, it may be time to take further action.

If you see things like dehydration or changes in your child’s hair, skin, or nails, it’s likely time to consult a physician or mental health provider. But there are also steps you can take even if you’re not noticing red flags.

  • Try to make sure that your child understands that what they see on social media isn’t always real. Many fad diets and improper weight loss techniques begin here.
  • Talk to your child’s coach to see if they’re a positive influence and not someone who makes negative remarks about weight.
  • Find coaches who stress motivation and enthusiasm rather than body size and shape.

Eating disorders are extremely dangerous conditions that can derail a young athlete’s career — and their long-term health. By understanding what to watch out for — and the right steps to take if you notice any warning signs — you can ensure that your child is happy and healthy in competition, at school, and at home.

Eating Disorders & LGBTQ Community: Treatment Best Practices

Eating Disorders & LGBTQ Community: Treatment Best Practices 

From Walden Behavioral Care 

What research tells us

The COVID-19 pandemic has increased the diagnoses of eating disorders in people under 30 by 15 percent in 2020 compared with previous years according to a recent study. While eating disorders affect people of all genders, ages and ethnicities, some groups are particularly susceptible.  According to the Trevor Project National Survey, LGBTQIA2s+ folxs are 50 percent more likely to develop an eating disorder or die by suicide.

A 2015 study published in the Journal of Adolescent Health revealed that an eating disorder diagnosis is highest among individuals who identify as transgender, and higher still among people who identify as a sexual minority (i.e. lesbian, gay, bisexual) when compared with heterosexual women who identify as women (i.e. cisgender females).

These heartbreaking statistics speak to the magnitude of treatment for mental health needs in the queer community. And sadly, when it comes to mental health, there continues to be an inaccurate dominant narrative that only certain bodies get eating disorders, when in fact LGBTQIA2s+, BIPOC and AAPI people are more likely to develop an eating disorder than this narrative would suggest.

 Where we fall short 

Despite this, there’s little evidence-based research on effective treatment practices for this population, sometimes making it difficult for healthcare providers to meet the distinct needs of the LGBTQ+ community.

Additionally, many providers lack adequate knowledge of the unique issues faced by LGBTQ+ people, such as life stressors due to marginalization, the ways in which bodies and identities intersect, and the importance of establishing outpatient providers that are welcoming and educated about their specific needs.

How to build inclusive treatment environments

Inclusive treatment environments – built on knowledge, respect, empathy and understanding for everyone – are imperative. Based on my work as an eating disorder specialist, and my own experience as a member of the LGBTQ+ community, I’d like to share a few tips:

1) Develop cultural humility. Cultural humility is an “ability to maintain an interpersonal stance that is other-oriented (or open to the other)” and should be viewed as an evolving concept. Seek to increase your personal understanding through self-education so as not to tokenize a person or group of people. We can act equitably by reading books, blogs and pausing in conversation to make room for other, perhaps-less often-heard, voices.

2) Include names and pronouns during introductions. This not only applies to clients, but to ourselves and our colleagues. By introducing ourselves using names and pronouns and asking the name and preferred pronouns of those we meet, regardless of whether they choose to answer, we sidestep treating people differently based on our own assumptions and biases.

3) Properly identify gender neutral spaces. Although gender-neutral bathrooms are becoming more common in workplaces, college campuses and other public areas across the U.S., more can be done. Explicit signage such as gender-neutral bathroom markers, rainbow decals, or transgender flags is highly encouraged. They communicate a welcoming and safe space for all types of individuals.

4) Host regular trainings. Knowledge is powerful in creating inclusive settings. There are many great organizations offering workplace trainings, some free of charge. This includes a local chapter of Gay, Lesbian, and Straight Education Network (GLSEN) of PFLAG, or a local college or university’s LGBTQ+ center.

Change is a process. Signage, training and self-education are all great places to start though not an ending point. A more complete list of best practices on working with LGBTQ+ populations as recommended by the APA (American Psychological Association) is another resource for continued improvement and inclusivity.
Walden’s Rainbow Road 

To help our industry begin to address the disparities for the LGBTQIA2s+ community, Walden Behavioral Care recently launched Rainbow Road, an IOP that addresses the specific needs and challenges of this population in terms of body image, relationships, and the social cultural trauma experienced being queer in an often-hateful world.

Rainbow Road is the first of its kind in the country in terms of eating disorder treatment for queer clients, by queer and allied providers who have a deep understanding of intersectional therapy and the nuances needed to work with this population in a way that is affirming and creates sustainable recovery.

We are proud to be modeling what the new societal expectation should be for mental health and eating disorder treatment providers and programs, and how to compassionately care for people of all genders and sexualities.

If you’re interested in learning more about our Rainbow Road IOP, Walden is here to help you. Contact us today and tell your evaluator that you are interested in Rainbow Road.

Author M Reim Ifrach  (They/Them) is the Director of Rainbow Road IOP for Walden Behavioral Care. Their credentials include: REAT, ATR-BC, LPC. M is on the Board of Directors for Project HEAL and a contributor to the Museum of Modern Art’s “Artful Practices” Program. When M is not seeing clients, they teach Masters Level students on Diversity Practice in Art Therapy, Eating Disorders and Gender Affirming Care. M’s passion lies deeply with the LGBTQIA2S+, BIPOC+ and AAPI communities and seeks to expand mental health care to be more inclusive of all those with marginalized identities and barriers to treatment.

Eating Disorders & Substance Use Disorders Commonly Overlap

Eating Disorders & Substance Use Disorders Commonly Overlap

By Timberline Knolls 

Struggling with an eating disorder or substance use disorder by itself is difficult enough. Facing both of these challenges at the same time can feel impossible.

Unfortunately, these two disorders commonly co-occur. Different studies cite various numbers depending on what is being measured or which population is being studied, but the rate of co-occurrence is generally thought to be somewhere between 17% and 46%.

The likelihood of someone who is living with an eating disorder also misusing substances is particularly high. A 2003 study by the National Center on Addiction and Substance Abuse found that up to 50% of individuals who have an eating disorder abuse alcohol or illicit drugs, compared with just 9% of the general population. That same review found that more than 35% of people who abused substances also had an eating disorder.

Most research seems to note a stronger association between bulimia nervosa and substance use (36.8%), with anorexia (27.0%) and binge-eating disorder (23.3%) the next closest comorbidities.

Complex Illnesses with Complex Relationships 

It’s unclear exactly what the associations between eating disorders and addiction are. Substance use can begin before, at the same time as, or after the onset of an eating disorder, and it’s uncertain whether one drives the other or if they co-occur coincidentally.

People often use food and substances to cope with various obstacles throughout life, so even without a specific link, it’s easy to see how a person in recovery from an eating disorder may use substances to offset the stress of recovery. In a similar manner, a person who is recovering from a substance use disorder may develop disordered eating traits to compensate for the lack of chemical reinforcement in their body.

Based on a variety of research, there are several theories about why these two disorders may overlap. Substance use disorders and bulimia nervosa, for example, seem to share some behavioral traits, such as increased impulsivity. Some researchers believe that both disorders have some common risk factors, such as:

  • Low self-esteem, depression, or anxiety
  • History of childhood abuse
  • Family history of eating disorders or addiction
  • History of trauma
  • Shared brain chemistry
  • Being prone to messages from advertisers or media

How Someone Who Is Struggling Can Get Help

Both eating disorders and substance use disorders can have an array of frightening physical, emotional, and mental complications. Medication that is used to treat certain substance use disorders may exacerbate symptoms of an eating disorder, for instance.

It’s crucial to find a comprehensive treatment model that treats the whole person rather than just the symptoms of addiction or an eating disorder. This method considers each person’s unique needs, caring for both disorders while accounting for the potential of overlapping complications.

Through a holistic approach that may include principles of expressive therapies, family systems, 12 Step, spirituality, nutrition therapy and dialectical behavior therapy (DBT), people who are struggling with co-occurring addictions and eating disorders can begin to find that recovery is attainable.




Art Therapy in Eating Disorder Treatment

Art Therapy in Eating Disorder Treatment

By Timberline Knolls 

Art therapy is a form of treatment that can include a wide range of creative pursuits that are undertaken with the guidance and support of a trained professional. This type of care can be incorporated into a comprehensive treatment plan for people of all ages and genders who have been struggling with eating disorders and several other mental and behavioral health concerns.

According to the American Art Therapy Association (AATA), art therapy can “foster self-esteem and self-awareness, cultivate emotional resilience, promote insight, enhance social skills, [and] reduce and resolve conflicts and distress.”

Drawing, painting, pottery, sculpture, and crafts are just a few examples of the many endeavors that can fall under the umbrella of art therapy.

“If you can dream it, we can help you make it,” said Susan Mericle, ATRBC, an art therapist at Timberline Knolls Residential Treatment Center. “We’re going to help you find your creative voice and express it.”

In a July 2001 article in the Western Journal of Medicine, registered art therapist Shirley Riley wrote that art therapy benefits both the therapist and the person who is receiving treatment.

“The therapist gains greater knowledge of the problem because the client uses metaphor and narrative to explain the product,” Riley wrote. “The art allows clients to distance themselves from their own dilemma and, in that manner, work with the therapist toward alternative solutions to a problem.”

Riley’s article also noted that art therapy can be particularly effective for adolescents, who may initially be hesitant or unwilling to open up to an adult therapist in a traditional setting. During art therapy sessions, the adolescent patient’s attention will be focused not on a potentially uncomfortable conversation with an adult, but instead on a creative pursuit.

“Art therapy offers a nonthreatening way for teens to express their inner feelings,” Riley wrote.

As described by the AATA, art therapy “engages the mind, body, and spirit in ways that are distinct from verbal articulation alone. Kinesthetic, sensory, perceptual, and symbolic opportunities invite alternative modes of receptive and expressive communication, which can circumvent the limitations of language.”

Many people who struggle with eating disorders have a history of trauma. They may also experience feelings of shame or revulsion about their body shape, size, and weight. Art therapy sessions are safe and supportive places where people can address these and other painful experiences or emotions in a manner that doesn’t require them to put their thoughts into words.

Although nontherapeutic artistic endeavors are usually undertaken with the goal of producing a finished piece, art therapy within an eating disorder treatment program is focused more on process than product.

Art therapists may interact with participants during and after this process, providing guidance and asking questions related to the materials being used, the focus of the piece, and the emotions the participant experienced as they created their art.

This emphasis on process can also help alleviate participants’ fears that they are not talented enough to make art while promoting a sense of mindful presence. With proper support, art therapy participants can fully engage in the process of creation without judging themselves or assigning value to the perceived quality of their creation.

In the context of treatment for eating disorders, art therapy can help patients develop confidence, identify their innate strengths, and embrace a more promising outlook for the future.

“Often it’s what helps people connect with hope again,” Mericle said.

Navigating Ambivalence in Eating Disorder Recovery

Navigating Ambivalence in Eating Disorder Recovery by A Recovery Warrior in the Community

Ambivalence is like being stuck in the middle of or vacillating between two opposing decisions. There’s hesitancy, uncertainty, and doubt. We’ve all been there before – confronted by the ultimate indecision. But recovery isn’t quite like choosing which restaurant to go to for dinner or picking out which outfit to wear. With ambivalence in recovery, while an understandable part of the process, there is a lot at stake.

Why does ambivalence about recovery make sense?

One experiences ambivalence when there’s a fear of losing something that brings comfort, pleasure, a sense of safety, etc. While in the long-term, eating disorders don’t provide these, in the short-term, they often feel like they do. Of course, there’s going to be ambivalence about giving up these behaviors! So, a part of you might want to really hold onto the eating disorder, while another part wants to let go of the hold the illness has on you.

Ambivalence can be overwhelming, with the constant opposing forces of recovery versus the eating disorder going back and forth in your mind. One day you might feel super confident in your ability to recover. Then, the next day, after a fight with a loved one, for instance, that confidence may be called into question. We’re constantly pulled between how things are and how things could be. This can be frustrating to see for both the individual with the eating disorder and their loved ones.

Here are some tips to help navigate ambivalence in recovery:

  1. Create a pros/cons list for living in recovery and living in the eating disorder. Don’t necessarily pay attention to the number of items in each list, rather, focus on what each item means to you and how it impacts your daily life.
  2. Name and explore all the emotions you are experiencing about recovery, including the ambivalence. This could be helpful to do with a support person.
  3. Be kind and patient with yourself. Try not to judge the feeling of ambivalence as good or bad. Just notice that it is there and explore it further.
  4. Get in touch with your values. Values work is one way to potentially influence your motivation. If you become aware that you are not acting in ways that align with your values, it may shift your motivation to start changing your behavior.

When faced with the choice between existing in your eating disorder or living a life in recovery, the choice might not always be so easy, and that’s okay. Try to keep your mind on what the future will look like if you continue a life in your eating disorder. This mindset may help you take that next right step toward recovery.

Dispelling Diet Culture Once and For All

Dispelling Diet Culture Once and For All by A Recovery Warrior in the Community

Despite its pervasiveness in our society, “diet culture” is not an easy term to define because of the many facets it encompasses. That said, “diet culture” is a belief system that idolizes thinness and equates it with moral superiority and good health. Diet culture is more than going on a diet. It is, as mentioned above, a belief system, or a culture in and of itself. Diet culture is also insidious because of its ubiquity – it becomes difficult to notice because it is so dominant in our culture. This way of thinking about food and our bodies is so deeply embedded that it becomes hard to recognize. Often, diet culture masks itself as health or wellness. Think: Noom.

The impacts of diet culture are significant and harmful to folks of all sizes. Diet culture perpetuates eating disorders, normalizes disordered eating, and instills deep-rooted insecurities. In other words, it sets all of us up to feel poorly about ourselves, judge and compare ourselves to others, all while promising that losing weight is a panacea. Diet culture suggests that in order to be loved, accepted, successful, and happy you have to be thin.

In addition, diet culture oppresses people who don’t align with what diet culture’s image of “health” is. This has racist, patriarchal, ableist, healthist, and transphobic roots. The people who are harmed the most are women, BIPOC, transgender folks, and people with disabilities.

Despite what diet culture claims, healthy and unhealthy bodies come in every shape and size. Those who are deemed “healthy” should not be put on a pedestal nor should there be a moral obligation to be healthy. But even beyond that, the use of weight, BMI, or body size as proxies for health should be rejected. Weight is just a marker of size, not health. Health is a multifaceted construct and other factors such as the social determinants of health (e.g., education, income levels, discrimination, access to health care, etc.) play a large role in whether or not you are in good health.

Additionally, scientifically speaking, diets for weight loss don’t even work. So, what we’re left with is billions of dollars poured into an industry that is capitalizing off of people’s insecurities.

So how can you begin to break free from diet culture?

  1. Challenge and think critically about comments on weight, size, and shape as they relate to “health” and “wellness”.
  2. Learn about Health at Every Size ® (HAES), a movement that acknowledges that health is primarily driven by social, economic, and environmental factors, not weight. This approach encourages pursuing one’s own health, not as an obligation and independent from a focus on weight loss. HAES is built on five principles, including weight inclusivity, health enhancement, eating for well-being, respectful care, and life-enhancing movement.
  3. Consider intuitive eating. Created by Evelyn Tribole and Elyse Resch, intuitive eating is based on 10 principles (e.g., honor your hunger, make peace with food, and challenge the food police).
  4. Reject any diet or “wellness” lifestyle that comes with rules. Do you have rules floating around in your head constantly about what you can or cannot eat, when you can eat, etc.? Diet culture instills one-size-fits-all rules into us, which goes against the many different factors that contribute to meeting our own food needs, like nutritional needs, taste preferences, cultures, and food access and budgets.
  5. Instead of spending time and energy trying to lose weight, use that space to do things you genuinely enjoy – read a book, learn a new hobby, spend time with family and friends.
  6. Accept that health is complex and nuanced. Health is not an obligation nor a measure of self-worth. Despite what diet culture may have us believe, there is very little about health that is in our control.
  7. Cultivate the belief that your body is worthy of care and nourishment no matter its size.

Navigating Weight & Scale-Neutral Conversations With Your Doctor

Navigating Weight & Scale-Neutral Conversations With Your Doctor by Sara Remus, MEDA Social Media Manager

While the concept of Health at Every Size (HAES) is slowly making its way into the medical field, finding HAES practitioners remains a struggle. While they do exist, they are still few and far between. That makes it all the more important to know how to advocate for yourself when moving through the health care system, especially as it is very likely that many of your providers will not be HAES informed. In Massachusetts, there are just 14 healthcare practitioners on the official HAES registry.

This doesn’t mean that your provider may not share HAES values. It does mean that you should be prepared to champion your needs when visiting your doctor, and that goes well beyond your physical health. We’ve compiled some tips  to help you guide your interactions with your health care team to a place that is safe for your body and mental well-being. Read on for some ideas for having a weight and/or scale neutral conversation with your doctor.

If you have the opportunity to communicate with your provider through a digital platform, use it to start the conversation. 

Many health care facilities use secure digital patient portals to schedule appointments, provide test results, and offer payment options. This can also be a great resource for setting expectations when you request an appointment with your provider. Usually, these programs will give you the ability to submit a note when requesting to see your doctor. You can disclose as much or as little as you feel comfortable with. This is an example of how you could potentially make the request:

“Hello, I’m looking for an appointment to be seen for (insert issue and any details here). Please add a note in my request that I would like for this appointment to not involve any discussions around weight, and would prefer to not be weighed. If I must be weighed, due to something like medication whose dose is weight dependent, I request that the nurse and doctor allow me to be weighed with my back to the scale and not share any of my weight information with me.”

If you are comfortable doing so, you can share that you are recovering from an eating disorder, and that these sorts of conversations and having information about your weight tends to be triggering and not helpful in your recovery process. However, you are certainly not obligated to provide this information!

If there is not a patient portal available for communicating with your doctor’s office, you can also offer this information over the phone. If you’re not comfy doing so, you could also draft a hand-written or typed note that you can fax to the office ahead of time or hand deliver to any medical personnel when you arrive for your first appointment. You might find it handy to keep several copies of this note in your wallet or bag, so that you can hand it to a provider in a pinch. If, for example, should you end up in an emergency or last-minute situation where there isn’t time for the conversation to be had ahead of time.

If you have a behavioral health provider, ask them for help.

If you have a counselor, therapist, or social worker that is helping you through your recovery, ask them for advice in navigating your specific needs with a medical doctor. In many cases, your behavioral health provider will be happy to communicate with your doctor directly, with your written permission to do so. These communications typically happen over the phone or hrough a secure platform. You can ask to see what is being communicated between your providers (or not!). Your counselor, therapist or social worker can handle discussions with your provider that you may not feel comfortable having.

If you feel you are being diagnosed incorrectly due to your size, be vocal. 

It is a sad truth that some health care practitioners blame weight as the culprit for illness or injury before investigating and addressing other potential causes. We know that weight is usually not the cause of problems that typically lead us to visit our doctor.

If you feel that your doctor is attributing your pain or condition(s) to your weight, try asking them the following questions:

  • “If weight were not a factor, how would you go about treating me?”
  • “Would you give the same advice to someone who was in a thin body?”
  • “It is important to me that we look at all the potential causes for why I am experiencing these symptoms. Can you think of any other causes aside from my weight?”

If they insist that the issue is weight related and refuse to talk to you about any other potential causes, you can request to see a different provider. Having these sorts of conversations with your doctor can be quite uncomfortable, so if you decide not to push back on your provider, walk away from this appointment without answers and go elsewhere, that is completely understandable. It is important to remember that you are entitled to look for other doctors. When looking for a new provider, make sure to ask if they’re willing to have a weight-neutral discussion.

Lastly, if you have ever worked with a specialist for an eating disorder, they can be a great resource in helping you find educated medical practitioners suited to provide you with quality care that doesn’t revolve around weight. You may also find that asking around in your recovery group is a great way to find a doctor you can trust. Don’t be afraid to advocate for yourself. If that sounds a little scary, remember that it’s OK to lean on others for support!

What do Children’s Fairytales Have to do with ED Advocacy?

What do Children’s Fairytales Have to do with ED Advocacy?

By Andrea Piazza, Primary Therapist at Center for Discovery

Diverse identity and body representation in children’s books is a crucial building block of a size inclusive culture.

The fairy tale princesses and character’s we grew up with have had an undeniably damaging effect on the expectations we set for our bodies. We grew up dressing like these characters for Halloween and pretending to be them in our imaginary games. What did we learn from these characters; that our looks are more important than our intelligence, that we need attractive bodies to have good lives? These narratives do not serve us. We need new narratives that take the good pieces from the classic stories we grew up with and then shift the focus from our bodies as a tool for power and security to our kindness as a tool for growth and happiness.

According to numerous studies, Body Dysmorphic Disorder has a prevalence rate of 2% to 13% in nonclinical adult student samples meaning its relatively common. Characterized in the DSM-5 as “a distressing or impairing preoccupation with slight or imagine defect(s) in one’s physical appearance.” Another to a recent journal article in The Journal of Family Medicine and Primary Care by Himanshu body dysmorphia is on the rise. It’s easy to see how media consumption plays into the way individuals measure their own features against the cultural beauty standards.

As an eating disorder therapist, I am constantly helping clients investigate their own body image development. Characters in the movies and books they grew up watching are nearly universal archetypes for the qualities one needs to possess as an adult… which tend to be physical. Patients will mention dressing up like Hercules or Princess Jasmine and subsequently looking at themselves in the mirror attempting to suck in their tummy or flex their muscles only to be overcome by a child’s sense of inadequacy. In even more heartbreaking stories patient share how they were so excited to dress up or pretend to be these characters with no initial self-doubt, only to have someone say they would need to eat differently to look like that character.

Imagine a world where the characters we grew up modeling ourselves around were diverse with realistic bodies and had goals that were about accepting oneself and or others. How would our dress up change? How would our play have changed? It’s said that we learn just about everything we need to know by age 5 or within a critical period from 5-7. Imagine a world where we learned about body neutrality and inclusion and diversity during our critical period.

The critical period is Noam Chomsky’s idea that language acquisition is learned during a critical period in childhood. It’s the reason it is so difficult to learn a new language as an adult and that its likely that we will always have some challenges speaking it even if we do. It also makes sense why it feels so much more natural to have conversations around the ways we want to change and modify our bodies than the things we appreciate or like about our bodies.

Larger bodies are also villainized in the stories we grew up with. They are the bodies that are drowned in the seas or beat out by stronger more able bodies. They are the bodies that end up alone and bitter.

Even worse than that people of color and people of diverse ability are often completely absent from the narratives we grow up with. In this moment of finally valuing diversity and inclusion we start to realize how intentional we need to be to make change because it’s not something we have been practicing. We need stories that highlight the powerfulness of inclusion and treat it as something normal and basic. Imagine if we saw as many montages about inclusion and accepting ourselves as we are as makeover montages…

Stories like Peter Pan in Everland by Andrea Lynn Piazza and Nicole Warren where tropes are countered on every page from having open discussions on autism and adaptive technology, to women working while the man vacuums, are incredibly important. Even the details in the story can lead to a huge cultural value shift and to an overall healthier and more inclusive society. We need more children’s literature and media, in general, that focuses on body acceptance and inclusion.

By retelling classics with inclusive casts of characters in diverse circumstances we can create a new set of fairytale heroes for our children and therein new healthier expectations for their minds and bodies. It is important to understand the profound impact of seeing characters of all abilities taking part in the stories we already know and love.

Bjornsson, A. S., Didie, E. R., & Phillips, K. A. (2010). Body dysmorphic disorder. Dialogues in clinical neuroscience12(2), 221–232.

Himanshu, Kaur, A., Kaur, A., & Singla, G. (2020). Rising dysmorphia among adolescents : A cause for concern. Journal of family medicine and primary care9(2), 567–570.

Hartshorne, J. K., Tenenbaum, J. B., & Pinker, S. (2018). A critical period for second language acquisition: Evidence from 2/3 million English speakers. Cognition177, 263–277.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

The Role of the Dietitian in Eating Disorder Treatment

The Role of the Dietitian in Eating Disorder Treatment

By Timberline Knolls Staff

Treating a person who has developed an eating disorder can be a complex process that requires the dedicated service of a multidisciplinary team of professionals.

Dietitians are among the many experts who can play a vital role in helping people establish a solid foundation for long-term eating disorder recovery.

Depending on a person’s specific needs, their comprehensive treatment for an eating disorder may address the medical, psychological, behavioral, and social concerns that contributed to or were exacerbated by their struggles with disordered eating. Services provided by dietitians can contribute to positive outcomes in each of these areas.

In an article that was published Nov. 17, 2020, on the Journal of Eating Disorders website, authors Shane Jeffrey and Gabriella Heruc wrote that dietitians’ contributions to eating disorder treatment include identifying “the severity of malnutrition, the presence of disordered eating habits, and deficits in nutritional skills and knowledge that inhibit the attainment of adequate nutrition.”

In other words, dietitians at eating disorder treatment facilities may work with patients to help them achieve improved health by expanding their understanding of vital nutrition-related concepts, eliminating self-defeating behaviors, and developing a better relationship with food.

Accomplishing these efforts may involve services such as:

  • Assessing patients’ eating behavior patterns
  • Providing nutrition counseling and education
  • Creating individualized meal plans for patients
  • Helping patients develop more effective coping strategies

A dietitian’s work in eating disorder treatment can involve both providing valuable information and dispelling myths or misconceptions.

For example, one unfortunately common misunderstanding about nutrition is that following a “healthy diet” somehow means abandoning enjoyable foods, sacrificing choice, and limiting variety. Not true! As dietitians help patients develop their meal planning skills, they will introduce them to the wide range of delicious options. Patients learn that, truly, all foods fit.

The concepts of balance and choice can also be key elements in a dietitian’s work with patients in an eating disorder treatment facility.

People who receive treatment for eating disorders may have a wide range of problematic behaviors from restricting to bingeing to compensatory methods. In all cases, a dietitian can help the patient develop a meal plan that provides necessary structure while also offering appropriate amounts of choice, variety, and flexibility. The dietitian can also help the patient understand the nutrition and behavioral concepts that are fundamental to a healthy relationship with food. For many people this creates the foundation for moving towards developing interoceptive awareness and eating intuitively.

As a result, patients won’t merely follow a schedule that tells them when, what, and how much they should eat. Instead, they will have a firm grasp on the reasons for their new behaviors. This can help them take ownership of their continued recovery and escape the fear- or frustration-based patterns that had previously characterized their eating behaviors.

To support patients in following their new meal plans, dietitians may also work with them to develop healthier coping skills. This may be especially beneficial for patients who had previously engaged in disordered eating behaviors in an attempt to punish themselves for perceived failures or numb themselves from emotional pain.

Regaining control of one’s thoughts, decisions, and actions is a vital part of eating disorder recovery. Through continued personalized service, dietitians help patients develop the knowledge, skills, and capabilities that can allow them to achieve long-term recovery and experience improved quality of life.

Recognizing Anorexia Athletica in Athletes

Recognizing Anorexia Athletica in Athletes

By Timberline Knolls Staff

Anorexia athletica, also known as exercise bulimia, is a type of eating disorder that involves excessive exercise in athletes. The disorder is similar to anorexia nervosa, a condition that involves restrictive eating. With anorexia athletica, a person may restrict their diet as well as overexercise, resulting in dangerous weight loss and malnutrition. Anorexia athletica can be difficult to detect, but it is important to receive treatment for the disorder  as soon as possible to avoid physical and emotional damage.

Understanding Anorexia Athletica

Anorexia athletica is an eating disorder that affects athletes. Typically, the more physical activity you get, the more calories your body needs. However, those who struggle with anorexia athletica consume limited calories despite their high activity levels.

The restrictive eating of anorexia athletica is similar to that of other eating disorders like anorexia nervosa. Focus on appearance, distorted body image, and fear of weight gain can also be present in those who have anorexia athletica. However, individuals who have anorexia athletica may not meet all the criteria for other eating disorders, making it an eating disorder not otherwise specified (EDNOS).

What Causes Anorexia Athletica

Anorexia athletica can be difficult to detect because exercise can be healthy and an essential part of training for athletes. An athlete’s dedication to their sport may even be mistaken for the symptoms of anorexia athletica. Athletes are typically under immense pressure from coaches, teammates, and peers to be in the best shape they can be. Unfortunately, many sports have an emphasis on losing weight and even require regular weigh-ins, which only exacerbates the problem.

Participation in sports in which athletes feel pressured to lose weight in a short amount of time, like wrestling and boxing, may also increase an athlete’s risk for anorexia athletica behaviors. According to one study, 33% of male athletes in weight class sports showed signs of an eating disorder. For women in weight class sports, nearly 62% of athletes reported disordered eating.

For some, low self-esteem and negative body image may also play a role. Sports like gymnastics, swimming and diving, and dance involve tight-fitting uniforms that may worsen body dysmorphia for athletes.

Eating disorders like anorexia athletica are considered mental health conditions, and other mental health disorders, such as anxiety, depression, and obsessive-compulsive disorder, may increase a person’s risk for developing an eating disorder.

Warning Signs of Anorexia Athletica

While anorexia athletica may go undetected even by the person who is struggling with it, there are some warning signs to watch closely for. One of the main signs of anorexia athletica is restricting calorie intake. Restricting calories can result in some noticeable side effects, such as:

  • Difficulty concentrating
  • Lack of energy
  • Fatigue
  • Irritability
  • Increased recovery time between workouts
  • Frequent injuries

The other major sign of anorexia athletica is excessively working out. This can involve feeling anxious, angry, or guilty when having to miss a workout and becoming defensive when told that they work out too much.

Left untreated, the symptoms of anorexia athletica can lead to damage to the bones and joints, a weakened immune system, arthritis, osteoporosis, and irregular menstruation. It is important to take the signs of anorexia athletica seriously and seek treatment for the disorder right away to prevent future damage.

Treating Anorexia Athletica

Anorexia athletica is treatable and requires the right mental health, nutrition, and fitness care. Therapy from a mental health professional can treat the symptoms of a range of eating disorders, including anorexia athletica. During therapy, an expert will discuss patterns of thinking, coping, and behavior to determine the root cause of anorexia athletica.

An important part of anorexia athletica treatment is discussing nutrition and how to work out in a healthy way. In treatment, those who are struggling with anorexia athletica can learn how to focus on optimizing their nutrition while avoiding dangerous calorie restricting, and finding a more balanced exercise routine.

If you or someone you know is struggling with anorexia athletica, help is available.


Top 5 ARFID Questions Answered

Top 5 ARFID Questions Answered by Margot Rittenhouse, MS, PLPC, NCC

Avoidant/Restrictive Food Intake Disorder (ARFID) is a lesser-known eating disorder diagnosis that is no less serious than the more commonly-known Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder. Supporting earlier diagnosis and treatment of this disorder can be achieved by increasing awareness and understanding of signs and symptoms.

What is Avoidant/Restrictive Food Intake Disorder?

Criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines Avoidant/Restrictive Food Intake Disorder as “an eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs [1].” Symptoms used to diagnose ARFID include significant weight loss or nutritional deficiency, dependence on enteral feeding or oral nutritional supplements and marked interference with psychosocial functioning [1]. ARFID can be distinguished from Anorexia Nervosa or Bulimia Nervosa by a lack of “disturbance in the way in which one’s body weight or shape is experienced [1].”

Is ARFID the Same as Picky Eating?

This is a common misconception that can be dangerous, as underestimating ARFID symptoms as “just picky eating” can result in mis/underdiagnosis and lack of proper and timely support. The biggest difference between engaging in picky eating and ARFID symptoms is that picky eating behaviors do not result in long-term consequences. ARFID behaviors also tend to be more persistent despite potential consequences.

Clinical Psychologist Dr. Gillian Harris, BA, MSc., Ph.D., CPsychol, AFBPsS, distinguished, “The difference between a ‘picky eater’ and a child with ARFID, is that a picky eater won’t starve themselves to death. A child with ARFID will [2].”

Is ARFID a “Children’s Disorder?”

While ARFID is more common in children and teens, it would be unwise to assume it cannot present in adults as well. In fact, studies indicate that approximately 9.2% of adults experience ARFID symptoms [3]. The National Eating Disorders Association reports that those adults struggling with ARFID “might include those who went untreated as children and have a long pattern of selective eating based on sensory concerns or feelings of disgust with new foods [4].”

How do I Identify Avoidant/Restrictive Food Intake Disorder?

ARFID hurting childARFID can present similarly to other eating disorders as well as picky eating. Therefore, any display of symptoms should be considered concerning, and observing a combination of symptoms might mean it is time to seek a professional opinion.

Someone struggling with ARFID “may have difficulty chewing or swallowing, and can even gag or choke in response to eating something that gives them high levels of anxiety [4]. Additionally, “foods may be avoided based on physical characteristics such as texture, smell, and appearance, or based on past negative experiences like choking or vomiting [4].” Any presentation of avoidant food which is to the detriment of an individual’s health and not motivated by weight loss indicates ARFID and professional help should be sought for an official diagnosis.

What is an Effective Treatment for ARFID?

ARFID can be treated with many of the treatment methods used for other eating disorders. One method particularly helpful is Exposure and Response Prevention which involves an individual being exposed to that which provokes an anxiety response and learning to cope with thoughts and feelings this brings up in-the-moment.

Individuals with ARFID would, therefore, be exposed to the foods they have been avoiding in order to cope effectively with the responses that arise from these foods. This treatment can be effective long-term as the individual learns skills to support eating avoidant foods as well foods that may cause discomfort in the future.


[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.

[2] Unknown (2019). What is ARFID? ARFID Awareness UK. Retrieved from

[3] Hull, M. (2020). Avoidant Restrictive Food Intake Disorder Facts and Statistics. The Recovery Village. Retrieved from

[4] Lesser, J. K. (2018). More than picky eating – 7 things to know about ARFID. National Eating Disorders Association. Retrieved from


About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

Music Therapy Can Be a Vital Component of Eating Disorder Treatment

Music Therapy Can Be a Vital Component of Eating Disorder Treatment

By Timberline Knolls Staff

The thought of using music to help with behavioral health concerns can be traced back to the writings of Aristotle and Plato, but it became popularized in the 20th century after World War II.

As musicians went to veteran’s hospitals around the country to play for those who were struggling with symptoms of trauma from the war, the armed forces officially recognized music as a way to help begin to heal both physically and mentally.

Physicians noticed that the veterans who were present for those sessions were leaving the hospital sooner, and modern music therapy, in a way, was born.

Shortly thereafter, the National Association for Music Therapy (NAMT) was founded. It merged, along with the American Association for Music Therapy, into the American Music Therapy Association (AMTA) in 1998, uniting a profession that now helps individuals in a variety of therapeutic spaces.

One of those is eating disorder treatment. Participating in music therapy has shown to help people who are struggling with mental health disorders improve their quality of life, build social skills, and nurture relationships.

Music therapy helps to promote self-determination and collaboration in patients who are experiencing symptoms of behavioral health concerns by focusing on their strengths. As it relates to eating disorders specifically, it can offer motivation for recovery, distraction from negative thoughts and feelings, and a sense of autonomy and creative expression.

One researcher at Florida State University found six studies conducted in the 21st century that examined the specific effects of music therapy as a supplemental therapy for eating disorder treatment. The author found four primary goals of treatment:

  • Increase autonomy/self-confidence
  • Increase emotion regulation
  • Reduce stress and anxiety
  • Increase motivation for treatment

Some studies of the benefits of music therapy in eating disorder treatment have shown that participants have an increase in mental engagement and the ability to distance themselves from life’s problems. One particularly interesting study from 2015 looked at whether music therapy could decrease post meal-related anxiety in patients who have anorexia nervosa in an inpatient or residential setting.

Other research showed that post meal support therapy was beneficial for inpatient eating disorder treatment programs, but this study found that those who participated in the music therapy group — compared with standard post meal therapy — had a more significant decrease in anxiety levels after mealtime.

Music therapy isn’t just about listening to music. Many music therapists incorporate songwriting, playing instruments, lyric analysis, and music-assisted relaxation into their programming.

Each has different benefits. Songwriting gives patients a chance to express themselves in a judgment-free environment and can lead to conversations that allow for connection and understanding. Playing instruments can tie into emotion regulation (determining which sounds might best represent happiness, sadness, or loneliness, for instance). Lyric analysis can be built around different themes, such as empowerment or emptiness. And music-assisted relaxation can involve building playlists to help participants through challenging events, such as shopping or mealtimes.

As with any form of therapeutic intervention, music therapy may be more effective in certain contexts — and for certain patients — than in others.

The overarching goal in music therapy is to provide a path to healing. There is much research still to be conducted on the large-scale benefits of music therapy for eating disorders, but what we know so far is that emotional healing can be a key catalyst in physical healing. Music therapy can serve as a basis for patients to address body image, self-esteem, anxiety, and other key areas that often undermine eating disorder recovery.



The Powerful Connection between Trauma & Eating Disorders

The Powerful Connection between Trauma & Eating Disorders

By Timberline Knolls Staff

Untreated trauma can disrupt your daily life — including your relationship with food and your body.

There’s a powerful link between eating disorders and trauma-related concerns such as posttraumatic stress disorder (PTSD). The National Comorbidity Survey-Replication Study found that approximately 80% of people who struggled with behaviors such as restricting their food intake or bingeing and purging also reported exposure to trauma [1].

In a study of more than 100 adult female patients who have anorexia nervosa or bulimia nervosa, 95% of the respondents reported experiencing at least one traumatic event at some point in their life. The highest number of traumatic experiences the participants reported was 11, while the average number the participants said that they experienced was four [2].

There are many different types of experiences that can be traumatic, but what connects them is that they can make a person feel like they’ve lost a sense of control or fear for their life. For the women in the study, the most common traumatic events they experienced included a life-threatening illness, the death of a loved one, and sexual assault.

Not everyone who experiences a trauma develops posttraumatic stress disorder, but about 24% of the study participants also suffered from PTSD. And nearly 70% of the participants said that they experienced their first traumatic event before they started struggling with symptoms of an eating disorder.

Understanding Trauma & Eating Disorders

So, what ties these complex conditions together? Researchers conducted five focus groups and two in-depth interviews with 20 female veterans, including one transgender woman, to understand the relationship between trauma exposure and eating disorders [1].

The participants consisted of a racially diverse group of women, with more than half being women of color (55%), including four Black women (20%), one Asian American woman (5%), and six women who reported their race as “other” (30%).

The researchers chose the participants based on their exposure to trauma and their histories of eating disorder symptoms. At the conclusion of the study, they identified three themes that connected these conditions:

  • Because of troubling or negative emotions – Some participants turned to food because they had painful or negative thoughts or emotions. In some cases, they overate because they felt enraged about the trauma they experienced. In others, they used food to punish themselves because they felt shame or guilt. Whatever they were feeling, those emotions were reflected in their eating behaviors.
  • To alleviate troubling or negative emotions – Other participants found comfort or relief from troubling thoughts or feelings from the way they ate. Food helped many participants ease anxiety, cope with anger, or create positive sensations after negative experiences. Others used food to numb negative feelings or emotions.
  • To avoid unwanted attention from perpetrators – Those who had suffered interpersonal trauma said that they engaged in disordered eating behaviors to change their weight or body shape to avoid suffering another trauma in the future. The researchers noted that their goal was to make themselves invisible to those they deemed threatening and to regain a sense of control.

Because everyone’s experiences are so different, this study offers just a glimpse at how trauma and eating disorders might affect a person. The researchers’ findings highlight how important it is to gain an understanding of the root causes of a person’s struggles with an eating disorder — including whether they have a history of trauma.

Trauma-Informed Eating Disorder Treatment
When you’re living with an eating disorder, you may not even realize that the compulsions you’re struggling with have any connection with trauma from your past. Fortunately, there are eating disorder treatment programs that use a trauma-informed approach to ensure that you receive holistic care.

You should always complete a comprehensive evaluation before taking part in eating disorder treatment so that your care team can customize your plan of care to your specific needs. This will also help your care team determine whether you may benefit from a trauma-based approach.

Trauma-informed eating disorder treatment programs typically help participants process the traumatic experiences that have been barriers to their recovery. These programs also help participants learn healthier coping strategies and relapse prevention skills to better prepare them for life’s stressors and challenges.

Living with these two conditions might seem unmanageable right now, but with appropriate treatment that uses a trauma-informed approach, it’s possible to manage the symptoms you’ve been struggling with and live the life you deserve.


[1] Breland, J. Y.; Donalson, R.; Dinh, J. V.; and Maguen, S. (2018). Trauma exposure and disordered eating: A qualitative study. Women & Health, 58(2), 160–174.

[2] Tagay, S.; Schlottbohm, E.; Reyes-Rodriguez, M. L.; Repic, N.; and Senf, W. (2014). Eating disorders, trauma, PTSD, and psychosocial resources. Eating Disorders, 22(1), 33–49.

Body Dysmorphic Disorder & Anorexia Nervosa

Body Dysmorphic Disorder & Anorexia Nervosa

by Eating Disorder Hope Guest Columnist, Margot Rittenhouse, MS, PLPC, NCC

The way that we view our bodies and feel existing in them is of the utmost importance. Body image can influence our self-view, feelings of worth, and fulfillment with our lives and ourselves. A negative or toxic body image has implications that can vary from feeling uncomfortable in one’s skin to having low self-worth to developing disordered eating, exercising, and living habits. Body Dysmorphic Disorder is commonly discussed in disordered eating circles and important to explore for anyone that loves or works with someone with an eating disorder.

Beyond Body Image

You are likely aware that body image involves the representations an individual has about their physical appearance. What is less commonly discussed is that body image is the subcategories body image can fall into – perceptual, affective, cognitive, and behavioral [1].

Perceptual body image refers to how an individual perceives their body. For example, feeling that they are “too thin” or have a body part that is “too big.” Affective body image is the feeling that one has about their body, “especially the amount of satisfaction or dissatisfaction you experience in relation to your appearance, weight, shape, and body parts [1].”

Cognitive body image refers to the thoughts and beliefs that individuals have about themselves. Finally, behavioral body image includes the behaviors individuals engage in as a result of their body images, such as disordered eating, excessive exercising, or self-harming behaviors.

Considering body image from each of these perspectives can help an individual look more deeply at how they relate to their body and learn which area their self-view and body image is most harmful.

Body Dysmorphic Disorder

Woman struggling with Body Dysmorphic DisorderFor an individual with Body Dysmorphic Disorder (BDD), all 4 of these areas of their body image are likely distorted. Individuals with BDD go beyond having negative thoughts about their body to have an “intense preoccupation with a perceived flaw in one’s physical appearance [2].”

For those that struggle with BDD, “large amounts of time may be spent checking their appearance in the mirror, comparing their appearance with others, and engaging in behaviours designed to try to hide or conceal the area of concern [2].”

Typically, these perceived flaws are non-existent or so insignificant that others do not perceive them. Even so, being told this will not decrease the obsessiveness these individuals feel.

“BDD is a distressing condition which is often associated with depression, social anxiety, and feelings of shame. BDD often creates significant interference with day-to-day activities, as it can limit one’s desire to leave the house, socialise, and participate in activities such as work or study [2].”

BDD and Anorexia Nervosa

BDD is commonly associated with eating disorders, as individuals will engage in disordered eating and exercise behaviors to alter a perceived flaw. A recent study found that Anorexia Nervosa and BDD also have a neurological component in common.

The study, completed by UCLA researchers, determined that “found that abnormalities in brain function are related to severity of symptoms in both disorders, and may be useful in developing new treatment methods [3].”

One study creator, Dr. Wesley Kerr, stated, “these are brain abnormalities, and how we treat those brain abnormalities could be with psychotherapy, or psychiatric medications, but brain changes need to happen in order to address these disorders [3].”

This study, and numerous others, serve to remind us that disorders such as anorexia nervosa and BDD are not simply choices related to eating (or not eating) food. These disorders are much complex, with biopsychosocial components that must be considered.


[1] Unknown (2020). What is body image. National Eating Disorders Collaboration, retrieved from

[2] Anderson, R. et al (2012). Understanding body dysmorphic disorder. Centre for Clinical Interventions. ISBN: 0 9757995 9 2.

[3] University of California – Los Angeles Health Sciences (2020). People with anorexia and body dysmorphic disorder show brain similarities, differences: Key patterns of brain function are more pronounced with more severe symptoms.” Science Daily, 11.

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

Can You Predict That a Teen Will Develop an Eating Disorder?

Can You Predict That a Teen Will Develop an Eating Disorder?  by Timberline Knolls Staff

Are there factors that may predict a young person is more likely to develop an eating disorder later in life? Researchers think so and they say this information could offer a chance to help teens at the earliest signs of trouble.

Factors That May Predict Eating Disorders in Adolescents

Researchers conducted a longitudinal study of 1,623 adolescents starting when the teens were 14 years old. They then followed up with the participants when they were between the ages of 16-19. Throughout the course of the study, the researchers identified several factors that may indicate a young person is at a higher risk for developing an eating disorder [1]:

  • High levels of neuroticism, behavioral problems, and self-harm were associated with future binge-eating.
  • Being less agreeable, self-harm, behavioral problems, alcohol misuse, and drug abuse were associated with future purging.
  • A high body mass index was associated with future dieting.

The researchers’ findings also suggested that teens who have attention-deficit/hyperactivity disorder (ADHD) or a personality disorder were more likely to struggle with the compulsion to restrict their food intake, binge-eat, or purge their food.

“Given the interwoven nature of both childhood psychiatric disorders, namely [ADHD] and adolescent affective disorders with eating disorder symptoms, greater clinical awareness and prompter recognition of psychiatric comorbidities by primary care teams are essential,” the study authors told Medscape Medical News.

The teenage years are undoubtedly a complex time, but these behaviors do not always indicate a young person is troubled by urges they can’t control. It’s critical for their loved ones and healthcare providers to talk to them about how they’re feeling about their bodies and their self-image.

Improving Eating Disorder Prevention Among Teens

The predictors the researchers identified can go a long way in getting teens help sooner. But it’s even more critical to apply these equitably so that every young person has a chance to succeed.

Sadly, healthcare providers often underdiagnose eating disorders in racial minority teens, causing a disparity among those who receive treatment and, ultimately, better outcomes. Researchers evaluated data from interviews with more than 10,000 U.S. adolescents ages 13-18. They found that [2]:

  • Hispanic teens reported the highest rates of bulimia nervosa compared to other racial minority groups
  • Teens of colors reported the highest rates of binge-eating disorder compared to white teens
  • White teens reported the highest rates of anorexia nervosa

While it’s clear that eating disorders affect young people regardless of their race, the researchers found that white teens were nearly twice as likely to be diagnosed with an eating disorder as teens of color [2].

“There is a stereotype that [eating disorders] affect only skinny, white, affluent girls, leaving out numerous people who do not fit that stereotype and contributing to disparities in treatment and diagnosis,” Kendrin Sonneville, Sc.D., R.D., the study’s lead author, told Medscape Medical News.

Setting aside myths and stereotypes about eating disorders allows us to apply these predictors more equitably — and that is a major step toward preventing more teens from struggling with these devastating conditions.


[1] Brooks, M. (2020, December). Can eating disorders be predicted? Medscape.

[2] Yasgur, B., & Vega, C. (2018). Eating disorders: Are we missing men and minorities? Medscape.

Dieting Apps for Kids Send All the Wrong Messages

Dieting Apps for Kids Send All the Wrong Messages by Timberline Knolls

The American Journal of Clinical Nutrition has found that the incidence of eating disorders has more than doubled over the past decade. The emergence of dieting apps during that same time period is more than just coincidence.

In 2019, WW, the company formerly known as Weight Watchers, unveiled a health coaching app called Kurbo that is geared toward kids ages 8-17.

Kurbo’s website claims that the app helps kids and teens build healthy habits for life by picking what they eat, receiving weight coaching advice from experts, and then seeing progress in real time, but dietitians, doctors, and therapists noticed a number of red flags immediately.

Parts of Kurbo are based on the traffic light diet, a program first developed in the 1970s for children that has a murky track record. That regimen — and many elements of the Kurbo app — flies in the face of 2016 advice from the American Academy of Pediatrics (AAP) that said that children shouldn’t be placed on diets and the focus on kids’ health shouldn’t be on weight loss due to its documented association with eating disorders.

“Giving an app to your child to solve difficult problems like relationship to food, movement, and body is like taking a pill the doctor prescribed while telling you ‘there’s a 95% chance this won’t work,’” Rebecca Scritchfield, a registered dietitian nutritionist, author of Body Kindness, and owner of a non-diet medical nutrition therapy practice, told U.S. News and World Report in a 2019 article.

There are many healthy foods, like nuts and milk that Kurbo considers “red lights,” items that, while not restricted, are designed to be limited. It’s easy to see the dangerous path this could lead most 8- to 17-year-olds down rather quickly.

Kurbo isn’t the only calorie and diet tracking app children and adolescents are using. Apps like MyFitnessPal and Noom require users who sign up to be 18 or older, though kids can get around those restrictions pretty easily. But the fact that Kurbo is specifically targeting children as young as second grade is a different world.

If you have a child who has a difficult relationship with food, diet apps and food trackers aren’t the answer. Help your child listen to their unique body, teach them about body diversity, and stick to normalized eating patterns whenever possible.

Most importantly, encourage them to feel good about themselves. Real wellness is about much more than a diet.

The Value of Detaching Emotional Responses from Thoughts in Eating Disorder Recovery

The Value of Detaching Emotional Responses from Thoughts in Eating Disorder Recovery by Jessica Boghosian, ACSW Freelance Writer for Eating Disorder Hope

Despite what popular psychology and self-help gurus tell us, we cannot control our thoughts. However, we can learn how to change our response to our thoughts. A valuable skill in eating disorder recovery is detaching the emotional response from an intrusive and unhelpful thought.

One might be thinking, “well, how do I do that?” or may even be completely confused by this concept. Well, let’s explore together.

Thoughts can be a beautiful thing, we can think of great things to create, ideas that enhance our lives, explore ourselves, and daydream. However, thoughts can also be destructive and lead us into a habitual pattern of maladaptive behaviors.

Now, in eating disorder recovery, it is not the thoughts alone that can create distress and destruction. It is our response to the thoughts that result in great action or destruction.

Cognitive Behavioral Therapy (CBT) provides an excellent overview and understanding of this concept of getting caught in a thought cycle. CBT utilizes a triangle to represent the cycle of having a thought, experiencing an emotion, and then engaging in a behavior.

An example of this could be, one seeing their reflection as they pass by a large window, which triggers an intrusive thought about their appearance, they experience an emotion (anxiety, insecurity, shame, etc.), and this results in an eating disorder behavior. So how do we stop the cycle?

To begin, it is important to become aware of the cycle. It is often helpful to start from the identified problem behavior and follow it back to the intrusive thought.

Once one becomes aware of the thought-emotion-behavior cycle, it will become easier to categorize thoughts as either helpful or unhelpful. A helpful thought would be one that elicits a response that brings one closer to a full and meaningful life.

Whereas an unhelpful thought will elicit a response that knocks us off course and possibly into a shame spiral. Authors of the book The Happiness Trap, Harris & Hayes (2008) [1] states that “whether a thought is true is not that important. Far more important is whether it is helpful.

African American woman in Eating Disorder RecoveryTruthful or not, thoughts are nothing more than words” [1]. This idea that thoughts are no more than just some words is liberating because that exactly is what they are. Again it is not the thought itself that causes one to experience distress and use behavior. It is the emotional response.

CBT guides one to understand the cycle of thought and how it triggers a behavioral response. Now to detach the emotion from the thought, we look to Acceptance Commitment Therapy (ACT). In ACT, one is guided to use skills called thought defusion techniques.

Thought defusion techniques aim to defuse a thought from creating an emotional response, and we do this by creating space between ourselves and the thought itself. One way to create space is to have some fun with the thoughts, Harris & Hayes (2008) teaches us to do this through the use of The Silly Voices Technique.

This technique is perfect for those self-critical thoughts that are common with eating disorders. To practice this technique, one would bring to mind a common self-critical thought and notice any sensations or emotions, that arise with this thought.

Then choose a cartoon or favorite tv/movie character, with a funny voice, and play that thought in the voice of the character. Again notice what happens to this thought as it is played in a humorous voice [1]. One may notice how irrational the thought is, or notice that it does not hold as much power anymore.

When in eating disorder recovery, gaining control over your emotional response is key. The truth is, no matter how real a thought feels, if we do not listen to it, the world will not open up beneath us and swallow us whole. Thought defusion skills will provide the needed separation of emotion from the thoughts, and by doing so will give the power back to us to make an adaptive decision.


[1] Harris, R., & Hayes, S. (2008). The happiness trap. London: Robinson.

About the Author:

Jessica Boghosian ImageJessica Boghosian, ACSW, is a Registered Associate Clinical Social Worker and a Clinical Therapist at Bright Road Recovery in Claremont, CA. She lives for the present moment and shares her warmth and joy at every chance she gets. Jessica currently works with individuals with eating disorders at various levels of care, including Residential, Partial Hospitalization, Intensive Outpatient, and Outpatient. She also works with individuals with other mental health diagnoses at an outpatient level of care.

She holds a Master’s in Social Work from the University of New England and is currently working towards licensure. Jessica’s love for her work with patients at Bright Road Recovery is clear to see. She aims to meet each patient where they are at and walks beside them in their journey to recovery. Jessica honors each patient’s individual journey and dedicates herself to increasing their love of life and themselves.

Impact of COVID-19 Pandemic on Eating Disorders

Impact of COVID-19 Pandemic on Eating Disorders by Margot Rittenhouse, MS, PLPC, NCC – Freelance Writer for Eating Disorder Hope

One of the most impactful triggers for disordered eating thoughts and behaviors involves the disruption in daily life. It is hard to believe anything in recent history has been as disruptive as the COVID-19 pandemic.

With millions of people afflicted or deceased, businesses closed, jobs lost, social interactions all-but non-existent, and entire countries around the world quarantined within their homes, life barely resembles the way it looked just 6 months ago.

These changes can be incredibly triggering for individuals vulnerable to, struggling with, or recovering from an eating disorder.

Dr. Cynthia Bulik, founding director of the UNC Center of Excellence for Eating Disorders, and Dr. Christine Peat, director of the National Center of Excellence for Eating Disorders, quickly noticed the potential this pandemic had to impact eating disorder relapse rates [1].

In fact, both reported that they saw a 30% increase in referrals to their program early-on as the pandemic struck the United States [1].

Not only are many people feeling triggered by the stress of current circumstances, but they are also isolated in their homes. Many people report increasing attempts to cope with food or disordered behaviors as a result.

Seeing these changes, Dr. Peat and Dr. Bulik, who both work as professors at the University of North Carolina, surveyed 1,000 individuals with eating disorder diagnoses from the United States and the Netherlands [1].

According to Dr. Bulik, survey results indicated that “three things stood out when it came to what was currently concerning people with eating disorders the most: lack of structure, living in a triggering environment and lack of social support [1].”

These surveys also showed that individuals with Anorexia Nervosa are “reporting increased dietary restriction and fears about being able to find foods consistent with their meal plan [1].”

Those diagnosed with Bulimia Nervosa reported “increases in binge-eating episodes and urges to binge [1].” Many respondents shared feeling fearful that their eating disorder would worsen due to the triggering events and urges.

For example, individuals recovering from an eating disorder may find grocery shopping in “average” moments to be challenging. Now, with certain brands selling out and the chaos of grocery shopping during a pandemic, that anxiety and fear may be increased.

Dr. Wierenga, professor of psychiatry at the University of San Diego, stated, “Isolation is a real concern. Our patients tend to socially isolate anyway. They have social anxiety. A lot of times, they’re depressed [2].”

As Dr. Bulik points out, “it’s almost as if some of the measures that we took in order to flatten the curve were tailor-made to make it more difficult for people with eating disorders [1].”

Even so, this new information on the specific concerns, urges, and triggers individuals are facing can help eating disorder treatment professionals provide more effective care during COVID-19.

For example, it is important for professionals to embrace conversations about how the pandemic and virtual services are impacting their symptoms and recovery. Dr. Bulik stated, “talk to each other about what’s working and what isn’t working so that you can really make the platform work for you [1].”

Additionally, professionals and clients would benefit from embracing the flexibility of the unknown and working within this to provide the most effective treatment in the current circumstances.

Dr. Bulik and Dr. Peat’s survey has provided us with more specific information regarding what exactly has become more challenging in the realm of eating disorders and eating disorder recovery during this pandemic.

Using this information to directly ask clients how they are experiencing these aspects can help create a more detailed understanding of their current challenges and more effective treatments.


[1] Kehres, E. (2020). UNC researchers study effects of eating disorders during pandemic., retrieved from[2] Huff, C. (2020). For people with anorexia, COVID-19 presents new challenges. American Psychological Association. Retrieved from

Why Healthy Communication Skills Are Essential to Eating Disorder Recovery

Why Healthy Communication Skills Are Essential to Eating Disorder Recovery by Timberline Knolls Staff

Living with an eating disorder can affect a person’s health and life in so many ways. And because these illnesses are so complex, they also often influence the way an individual communicates with others. That’s why developing healthy communication skills is such a critical component of successful recovery from an eating disorder.

How Eating Disorders Can Affect Communication

When someone is struggling with an eating disorder, it is crucial for them to maintain healthy communication with their main support system, whether that’s family members, a significant other, friends, or even members of their care team. However, many factors in a person’s life can influence how they perceive a message and whether they feel heard and supported throughout their recovery journey.

Some people who are grappling with the symptoms of an eating disorder may interpret a communication differently than intended because of the way the illness is affecting them and because of various factors in their life. For example, in response to a statement like, “you look healthy,” an individual who has an eating disorder may hear, “you got fat,” says Martha Peaslee Levine in Eating Disorders: A Paradigm of the Biopsychosocial Model of Illness.

Lack of communication can also sometimes convey unintended messages. Sometimes, loved ones stop asking an individual about their healing progress if they seem to be doing well or are at a good point in their healing journey, says Levine, and they may interpret that to mean that their family members don’t care about the illness they are struggling with anymore.

“We need to understand that eating disorders are not only isolating for the individual, but also often for the family as well as they try to cope with the rules and expectations that the eating disorder demands,” Levine said.

Learning how to communicate effectively, especially with members of your support system, can increase the likelihood of having better, longer-lasting recovery outcomes.

A Pathway to Healthier Communication

Starting to communicate with loved ones in a healthier way can help you heal past wounds and build a stronger foundation for the future as you embark on your recovery journey. Some ways you can get on the path to healthier communication include:

  • Communicate more often – Sometimes, what is left unsaid can lead to miscommunication. Checking in with one another more regularly and intentionally can build a better emotional connection with those closest to you.
  • Use active listening – Be present when your loved ones are talking, and show an active interest in what they are saying. If you feel concerned about anything, ask questions to get clarification so that there are no misunderstandings.
  • Have recovery-focused conversations – It’s crucial to understand how discussing weight gain or loss, physical appearance, or the foods you eat can affect a person who is in recovery from an eating disorder. Avoiding those topics or talking about how to set healthy boundaries around those topics can help keep communication open.
  • Practice compassion – The recovery process can be challenging, and it’s likely that someone will unintentionally hurt or disappoint another despite their best efforts to be a better communicator. Having compassion for one another will help you and your loved ones overcome conflicts as you progress on your path to healing.

Healthy communication can be difficult for anyone but is particularly challenging for those who are battling the compulsion to engage in disordered eating behaviors. Working closely with your loved ones to open lines of communication can strengthen your bonds and build stronger relationships that help support you through the eating disorder recovery process.

TikTok and Its Effect On Your Teen

TikTok and Its Effect On Your Teen by Rebecca Manley, MS, CTC, CCTP, MEDA Founder

Dieting is the most common precipitating factor in the development of an eating disorder. In the United States alone, 30 million people struggle with an eating disorder and every 62 minutes someone loses their life due to direct complications of their eating disorder.

As a teen coach, recently I have had increasing numbers of clients talk about the weight loss posts suggested to them on TikTok AND how these posts are harming their mental health and well-being.

41% of TikTok’s 800 million monthly users are between the ages of 16-24. This age group is already at a heightened risk of eating disorders and to encourage them to diet further is can be detrimental to their long-term mental and physical health. By promoting dieting and weight loss, as well as before and after transformations, TiKToK is perpetuating dangerous weight stigma, which is the second most common type of discrimination after gender. Weight stigma can increase body dissatisfaction, a leading risk factor in the development of eating disorders.

Adults think with their prefrontal cortex, the brain’s rational part, which helps with decision making, good judgment and an awareness of long-term consequences. On the other hand, teens tend to process information with the amygdala, the emotional part of their brain. In teen’s brains, the connections between the emotional part of the brain and the decision-making center are not fully developed until age 25 or so.

TikTok exposes tweens/teens with developing brains to weight loss messages constantly. Currently, children of any age can view these harmful messages and videos. TikTok accounts #dailyweightlosstips has 560 million views and #weightloss transformation (fat phobia fuel) has 28 million.

Many of these viewers are watching the videos, comparing themselves, which may lead them to engage in unhealthy behaviors, such as skipping meals, using fad diets, drinking home-made weight loss concoctions, drinking diet teas or excessively exercising. Our teens are not aware of the health risks associated with these actions. Dietary supplements, like teas and powders, are associated with serious health risks and side effects including organ failure, testicular cancer, heart attack, stroke and even death.

What can you do to protect your child?

*Talk with your child about the dangers of dieting and engaging in diet culture.

*In addition, watching weight loss videos and engaging in unhealthy weight loss behaviors leads to body dissatisfaction. The result of these behaviors can result in the development of a deadly eating disorder. They certainly result in lowered self-confidence and increases in anxiety and depression.

*Be a positive role model and talk about your body in an affirming way.

*Focus on health not weight in your house. Don’t push your child to eat and don’t push your child to restrict.

*Promote body positivity and diversity in your home and community.

*Discuss the importance of appropriate activity with your child. Emphasize the importance of moving for pleasure and how it helps our bodies feel better. Do not equate exercise with weight loss.

*Monitor your child’s social media use. Children under the age of 11 (6th grade) should not be engaging in social media.

*Slowly add social media to your child’s technology diet. Add one app at a time. See how they handle one before adding more. In addition to people, consider following a nature, cultural or arts app.

*Friend or follow your child on all social media outlets.

*Sign the TikTok petition at to ensure that children under the age of 18 are unable to post or view videos under all weight loss categories.

If you think your child maybe struggling with an eating disorder or poor body image, MEDA can help. Contact us at or call us at 888-350-4049.  THE SOONER THE BETTER

What is self-compassion?

What is self-compassion? by Meagan Mullen, MA, MHC, MEDA Clinician

Most of us are familiar with our inner critic—you know, the voice that seems to pipe up whenever you’ve made a mistake or feel like you’re not good enough. If you struggle with an eating disorder or another mental health issue, you’re probably pretty familiar with this voice!

Sometimes it can be loud and angry, other times it can be a little more covert—almost sweet and persuasive. Getting a good picture of what this voice is like or how you notice it in your own head can be extremely helpful, especially if you’re interested in moving away from it.

Reflection question: how do you notice your inner critic? Does it yell at you? Does it call you names? Take a minute to get an image for that critic.

Enter self-compassion! A great definition of self compassion comes from Dr. Kristen Neff:

Self-compassion involves acting the same way towards yourself when you are having a difficult time, fail, or notice something you don’t like about yourself. Instead of just ignoring your pain with a “stiff upper lip” mentality, you stop to tell yourself “this is really difficult right now,” how can I -comfort and care for myself in this moment?

We all have those moments where we feel inadequate in some way, shape, or form. Unfortunately, our society is one that encourages us to have a harsh environment in our minds. You know the drill, no pain, no gain. We’re taught, growing up, that we should be hard on ourselves if we expect to see change, success, or even growth. But let me ask you this: has beating yourself up all these years actually done you any good?

Sure, some of you might be able to pinpoint a time where you were tough on yourself and did end up finding success of accomplishing a goal. But what if I told you that you can find success, happiness, and all of those amazing things while still offering yourself kindness?

That’s how self-compassion works.

Some people might confuse self-compassion with excuse making or laziness. They might think that if they don’t push themselves, they’d never accomplish anything. But let me make this clear: self-compassion isn’t “I don’t have to try,” it’s “I’m going to try, and if I mess up, that’s okay. I’m human. I can try again.”

Reflection question: Have you ever been able to offer yourself compassion? If yes, how did it feel? If no, has anyone else ever offered you compassion? How did it feel?

Shifting towards this perspective is hard for so many of us, especially if you identify with traits of perfectionism or struggle with mental illness. It can often be helpful to remember that our inner critic is trying to help—as wild as that may seem. That inner critic voice inside of us thinks that if we shame ourselves or beat ourselves up, we’ll stop making those mistakes and finally get it right.

But it doesn’t really work that way. When we’re feeling down, embarrassed, or like we’re struggling, that inner critic (though sometimes well intentioned), doesn’t make us feel any better. That inner critic probably thinks that being so hard on us will help us avoid the pain of failure. But guess what? We still make mistakes, and when that does happen, the inner critic only makes it worse. Here’s another example: think about a young child. If a young child is struggling to learn how to tie their shoes, screaming at them won’t make them learn any faster. Instead, it will create a panic response, incite fear and shame, and ultimately, put more distance between the child and the goal they are trying to accomplish.

Adults are the same, and another quote from Brene Brown helps put it in perspective:

What we don’t need in the midst of struggle Is shame for being human.

Reflection question: what’s someone you can tell yourself the next time you hear that inner critic? How might you respond to it or ask that voice to quiet down?

Changing any type of mindset is difficult, especially if it’s one that you’ve grown used to or have dealt with for a long time. As we take steps to offer ourselves compassion, we must keep the very crux of this blog post in mind. We’ll make mistakes. That inner critic voice might sneak in some days. That’s okay. Don’t beat yourself up, just try again tomorrow.

Maintaining a Support System in Quarantine

Maintaining a Support System in Quarantine

written by MEDA Undergraduate Intern, Julia Faxon

If you’re like me, or if you’re like a lot of people, perhaps you have recently been spending a bit (or, you know, a lot) more time at home than you usually do. This is good and important– social distancing is our duty to ease burdens on healthcare institutions and protect the most vulnerable in our community. Stay home, stay safe! Flatten the curve! If your state has a lockdown or shelter in place mandate, listen to it! 

That being said, these new norms regarding where we can be and who we can be with are difficult transitions to make. We all rely on our communities to support us, especially in times of stress, and many of us are missing those communities while holed up in our respective quarantines. Here are some ways we can maintain connections and show love to our friends, even if it can’t be IRL.  

  • Schedule, schedule, schedule! If you can, set up regular times to virtually meet with friends and communities. FaceTime, Zoom and Skype are examples of some great ways to do that. My friends and I have set up a Zoom call every Tuesday and Thursday night at 9, and I feel comfort in knowing that I have a set time in my calendar to be with people I love. If you are part of a club or group, it can be helpful to have virtual meetings at your regular meeting times to maintain a sense of normalcy and rhythm. If you aren’t part of a group, there are a lot of free groups online right now, including right here at MEDA. Check out Online ED Free/Low $ Support during COVID 19
  • Daily Check-Ins! I have found it very useful to establish an expectation of daily text or call check-ins with friends. This gives you a chance to both practice active listening and ask for what you need each day. In one group chat I’m in, we each share a rose (positive event), bud (thing we’re looking forward to), and thorn (challenge) every night. This is an excellent way to verbalize your highs and lows and keep in regular touch. 
  • Pen Pals! One of my best friends suggested that we start sending snail mail to each other, and it has been invigorating! It is a real act of love to write a true pen-to-paper letter to someone who means a lot to you, and there is no thrill like the thrill of opening unexpected mail. 
  • Watch a show! My favorite silver lining of this situation has been discovering Netflix Party, a Google Chrome extension that lets you watch Netflix with others. My friend and I are currently rewatching Glee, and it is an emotional rollercoaster and welcome escape. 
  • Find creative ways to connect! In addition to watching a Netflix show together, this could mean setting up a virtual happy hour, virtually cooking together, creating a playlist as a group, or discussing a podcast or book. 
  • Therapy! It is important to take care of our mental health, especially in times of stress. If you are already working with a therapist, ask them if they are offering services remotely. If not, there are many virtual options to speak with therapists, including Betterhelp and Talkspace (which is offering free services to medical workers!) If you need some meal support, check out @covid19eatingsupport on IG right now. They’re doing meals and snacks on their Live every 2 hours. It’s great to have company and therapeutic conversation when you’re struggling to take care of yourself…and even when you’re not. 
  • Give or ask for help! It is important to remember members of our community who need more aid during these times. If you are in a position where you can give financially, or with your resources or time, look up mutual aid efforts in your area. If you need support, mutual aid is a good place to ask for it. In addition to sending resources to those who need them most, this can help root you in your community and establish a sense of agency. 

These are certainly unprecedented and difficult times, but we don’t have to go at them alone. Make sure to take care of yourself, and those around you, by intentionally making space for the people you love.

Self-care and stress management

Self-care and stress management, by Meagan Mullen, MA, MHC

Managing stress is always difficult, but when you’re struggling with an eating disorder or a related mental illness, it can feel even more overwhelming.

When it comes to mental health, we talk a lot about self-care, and we could probably all list off a few ideas that get thrown around when it comes tor relaxing or de-stressing. But what about when you don’t have the time (or money!) to have a spa day, go out with friends, or even take a bubble bath?

Self-care can be really small—it doesn’t have to be these big, lavish things we read about online or hear advertised on TV. Sometimes, self-care is as simple as brushing your hair, making your bed, or getting outside for some fresh air.

Here are some (small) ways that you can manage stress, relax, or engage in self-care even when the going gets tough!

  1. Fresh air and sunshine. It might not be your favorite thing ever, but sometimes opening a window or going for a quick walk can help shake things up.
  2. Taking a shower. Forget the bubbles, bath salts, beautiful aromas and all that. Taking care of our physical hygiene can often help us feel better mentally, too!
  3. Listen to hunger and fullness cues. This one might not be as easy, especially if you struggle with an eating disorder, but making sure we are fueling ourselves adequately and doing our best to avoid eating disorder behaviors can free up mind space and leave us feeling more energized!
  4. Changing your clothes. If you’ve been wearing the same sweatpants for the last few days (we have ALL been there), it can be nice to put on a fresh outfit. This can leave us feeling
  5. Having a routine. Maybe you’re not a big fan of schedules, but sometimes outlining our days can help us feel a bit more organized.
  6. Take things one day (or hour, minute, second) at a time! It can be easy to fall down the rabbit hole of thinking about all the things we have to do. When your brain starts to get wonky and remind you about ALL OF THAT STUFF, take a deep breath and remember you can’t do a million things at once.
  7. Make a list (if that’s your style)! Sometimes, when our brains try to remind us about the things we still haven’t done, it can be helpful to pick one or two things to manage today. But remember, go at your own pace and don’t be too hard on yourself.
  8. Don’t spend too much time on technology. Maybe this means you should stop scrolling on Instagram and comparing yourself to others. Maybe it means turning off the news and playing a board game. Whatever type of tech is dragging you down, get a minute away from it!
  9. Move your body. This can be another tricky one if you’re someone who has struggled with your relationship with exercise, or if movement can trigger body thoughts. Maybe try going for a gentle walk or even just some simple stretching. Be sure to talk this out with your team if necessary!
  10. Do something creative! This is the part of us that often gets turned off as we grow up. As children, we love to play, be silly, and create art or games or stories. It can be so refreshing to try your hand at a new art form you’ve always been curious about or take some time to get back into something you used to love! You don’t have to be an artist to create!

Again, managing our stress and engaging in self-care can be tough. These suggestions are just a few to get you started and to remind you that self-care doesn’t always have to be so glamorous. You deserve to take moments for yourself throughout the day, even if they’re quick!

Study Links Eating Disorders, Exercise Addiction

Study Links Eating Disorders, Exercise Addiction by Timberline Knolls Staff

A person runs on a treadmill.

A recently published study from the United Kingdom suggests that individuals who develop eating disorders may also have a significantly elevated risk of becoming addicted to exercise.

According to this study, which originally appeared in the January 2020 edition of the journal Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, the prevalence of exercise addiction among individuals who have an eating disorder is 3.7 times greater than it is among those who have not been diagnosed with an eating disorder.

This conclusion was based on a meta-analysis of nine separate research projects. The nine projects included data on 2,140 subjects from multiple nations, including the U.K. and the United States. This pool of subjects included 408 people who had been diagnosed with an eating disorder and 1,732 who had not.

“Our study shows that displaying signs of an eating disorder significantly increases the chance of an unhealthy relationship with exercise, and this can have negative consequences, including mental health issues and injury,” the study’s lead author, Mike Trott, said in a Jan. 28 news release that announced his team’s findings. Trott is a Ph.D. researcher at Anglia Ruskin University in Cambridge.

What Is Exercise Addiction?

Exercise addiction is not included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This means that this condition is not recognized by the American Psychiatric Association (APA) as an official diagnosis with an established set of diagnostic criteria.

However, exercise addiction’s absence from the DSM-5 does not mean that the condition is ignored by professionals. Multiple studies, such as the one conducted by Mike Trott’s team at Anglia Ruskin University, have attempted to document the symptoms, causes, and effects of exercise addiction. Many clinicians and programs have developed treatment protocols to assist individuals whose lives have been impacted by exercise addiction.

As is the case with other forms of addiction or behavioral compulsions, exercise addiction is characterized by overpowering urges and an inability to moderate or control one’s actions, even after experiencing negative outcomes. People who develop exercise addiction may work out excessively, overexert themselves, fail to allow for proper rest periods, and otherwise act in a manner that puts their physical health and mental well-being at risk.

When people who struggle with exercise addiction are not able to work out, they may experience anxiety, depression, and other forms of emotional distress.

The National Eating Disorders Association (NEDA) has identified the following as among the many potential health consequences of compulsive exercise:

  • Altered resting heart rate
  • Diminished energy levels
  • Loss of bone density
  • Disrupted menstrual cycle
  • Pain in muscles, bones, and joints
  • Increased prevalence of stress fractures and other injuries
  • Increased frequency of upper respiratory infections and other illnesses

Excessive Exercise and Eating Disorders

Although exercise addiction is not included as an official diagnosis in the DSM-5, this reference manual does contain multiple references to unhealthy exercise-related behaviors in relation to eating disorders.

For example, the DSM-5 identifies excessive exercise as a compensatory behavior among individuals who have developed bulimia nervosa. In the aftermath of binge-eating episodes, people who have bulimia may exercise excessively in an attempt to prevent weight gain.

The DSM-5 also notes that some people who develop anorexia nervosa demonstrate excessive levels of physical activity prior to the onset of the restrictive eating behaviors that are symptomatic of anorexia.

Excessive exercising is also associated with body dysmorphic disorder, a mental health disorder that is characterized by a preoccupation with perceived flaws in one’s physical appearance. As the DSM-5 notes, body dysmorphic disorder can co-occur with eating disorders.

As is the case with exercise addiction, the excessive exercise-related behaviors that are associated with anorexia, bulimia, and body dysmorphic disorder are self-defeating actions that can harm a person’s physical health and contribute to the onset or exacerbation of mental health concerns.

Comprehensive Solutions

Anyone who struggles with an eating disorder needs effective care from a qualified provider. When an eating disorder is accompanied by a compulsion to exercise excessively, it is vital that the individual receives comprehensive treatment from a provider who can identify and address all the concerns that have been preventing them from living a healthier life.

In the press release that announced his team’s findings about eating disorders and exercise addiction, Mike Trott emphasized the importance of including an exercise component in eating disorder treatment.

“Health professionals working with people with eating disorders should consider monitoring exercise levels as a priority, as this group have been shown to suffer from serious medical conditions as a result of excessive exercise, such as fractures, increased rates of cardiovascular disease in younger patients, and increased overall mortality,” he said.

Tips for Preventing Eating Disorder Relapse

Tips for Preventing Eating Disorder Relapse by Timberline Knolls Staff

Recovering from an eating disorder, such as anorexia nervosa, bulimia nervosa, or binge-eating disorder, is often a process that can take a significant amount of time. The recovery process is different for each person, and for many people, relapse might be a part of that journey. However, there are measures you can take to help decrease your chances of experiencing relapse as you progress through your recovery journey.

Understanding Eating Disorder Relapse

Even after someone has participated in treatment for an eating disorder, they may still be at risk for relapse of some of the symptoms they struggled with previously. In fact, according to a 2016 study in the journal BMC Psychiatry, studies on relapse prevention have found that up to 41% of patients in recovery from anorexia nervosa experience relapse within 18 months.

Many different influences can trigger the compulsion to engage in disordered eating behaviors after treatment, including:

  • Experiencing extreme stress or trauma
  • Becoming pregnant or having a baby
  • Being around someone who is on a restrictive diet
  • Starting a new relationship or going through a breakup
  • Experiencing an injury that keeps you from exercising
  • Any weight gain, whether age or health-related

Eating disorders are complex illnesses that no two people experience the same way, so each person has their own personal triggers that may make them more vulnerable to relapse. What might be a trigger for one person might not be a trigger for another.

Eating Disorder Relapse Prevention Tips
Viewing recovery from an eating disorder as a journey rather than a destination is the first step toward preventing relapse. This requires a firm understanding that the healing process may take years depending on your unique situation. Your journey might be shorter — or longer — than others’, but the key is to prepare for the process. These are some of the most beneficial relapse prevention tools to add to your recovery toolkit:

  • Identify your triggers: Understanding what situations and emotions trigger the urge to engage in disordered eating behaviors can help you anticipate these influences before they become triggers. Identifying your triggers can also help you understand why you might be struggling to cope with specific situations.

  • Turn to your support system: Two major factors of eating disorders are secrecy and isolation. To prevent these influences from creeping back in, turn to a trusted friend or family member when you’re feeling triggered and let them know you’re struggling. If the symptoms you’re experiencing start to become overwhelming, ask your support network for help.

If you do experience a relapse, it does not mean you have failed. There is hope for recovery no matter where you are in your wellness journey. With some preparation and self-awareness, you can minimize your risk for experiencing a relapse.

Re-framing the New Year

Re-framing the New Year

Written by Meagan Mullen, MA, MHC, Clinician & Community Outreach Specialist

The start of a New Year is often associated with self-improvement, and we ALL know that this often takes the form of diets, “lifestyle changes,” and other ways to control your body.

It can be hard to ignore the messages that seem even more prevalent this time of year, but we’re here to remind you that changes you make in your life don’t have to be external or physical!

We compiled a list of ways you can take care of yourself in the New Year without sacrificing your recovery, your health, or your sanity!

  1. Work on self-compassion. It’s easy to be your own worst enemy or critique yourself. This year, try to remember that you’re doing the best you can. Find some mantras that will help you shift negative self-talk or negative patterns of thinking. We love these ones!

  2. Remember that your time is precious. It’s so important to be mindful of how we spend our time. If you’re someone who needs alone time, make sure you get some, and don’t feel guilty! If you feel reenergized by spending time with friends, schedule that in! There is plenty to do in this day and age to keep ourselves busy, but say “no” to things you don’t have (or want) to do, and remember that you deserve to feel good and enjoy yourself!

  3. Work on your relationships if needed. Do you have a friend you’ve fallen out of touch with or a family member who you’d like to feel closer to? Take time to reach out to people you want to connect with! On the other hand, practice setting boundaries in relationships that feel toxic.

  4. Find a new hobby. You are a multidimensional human! You are not just an employee, a parent, a child, a student. Find things that make you smile and take your brain off of diet culture or your eating disorder. Try to find that inner joy and be gentle with yourself as you do!

  5. Find other ways to focus on your health. Health is more than your weight, shape, or the physical aspects that are so often focused on! Take care of your mental health, emotional health, spiritual health. Reach out when you need support, find ways to rest. If you feel inclined to consider your physical health this year, read more about intuitive eating or joyful movement.

Need more support this year? MEDA is here to help! Call us at (617)558-1881 or email us at

Taking Focus Away from Diet Culture

Taking Focus Away from Diet Culture

By Victoria Kupiec RD, LDN, Director of Nutrition Services, Timberline Knolls

Diet culture is a prominent part of society that is often difficult to avoid. Conversations surrounding diet are ever-present on social media, in stores, and on television. This diet culture places a strong emphasis on achieving the ideal level of thinness with the promise of love, acceptance, and health to follow.

We are often told that we will suffer from disease and feelings of worthlessness if we fail to achieve an appropriate weight. Blame and ever-changing body standards that transform with time serve as major barriers to sustaining well-being.

The focus on unrealistic body standards promotes a cycle of shame that further attracts individuals to diet culture and products with the intention of “fixing” their bodies. Yet, the majority of diets that are started with the intention of weight loss are unsuccessful in the long term. Individuals often feel shamed or guilty if they are unable to meet the goals they set for themselves. If someone does not experience or sustain the weight loss they desire, they may adopt the belief that they are weak and do not possess enough willpower to manage their weight.

The overwhelming number of individuals whose dieting is unsuccessful points toward a big-picture issue with approaches rather than a problem with the individual. Another aspect that impacts the effectiveness of dieting tools is their heavy reliance on external cues and strategies. A more effective approach to support a positive relationship with food should instead focus on building sustainable habits that are not rooted in restriction and that help rebuild the body’s own innate wisdom to guide one’s eating.

Individuals who begin dieting will often regain the weight shortly after, which triggers the continuation of the dieting cycle. This cycle and the associated negative feelings leave our bodies and minds exhausted. Over time, this fatigue takes a toll on our emotional and physical well-being. The adverse effects of dieting can be seen with every fad diet that emerges, yet it is common place to fault the individuals rather than the approaches.

One solution to this struggle is to allow ourselves an open-minded approach to discover how we interact with food. Individuals are encouraged to develop and honor internal cues of hunger and fullness while exploring how different foods affect their bodies. This would also involve permission to incorporate foods for enjoyment. By allowing ourselves to explore the tastes, smells, and textures of food through an unbiased lens, we can find a balanced, yet diverse connection with what we eat.

These methods of self-inquiry are important, especially when supplemented by education from healthcare professionals who are trained in nutrition. There is no single solution to achieve a body image that you are comfortable with. Because each individual, and their relationship with food and eating, is unique, it is important to emphasize the body as a complex and multifaceted system that must be nurtured and cared for. In this way, our society can begin to see the importance of a person’s well-being, rather than focusing solely on their weight.

5 Tips for Holiday Success

5 Tips for Holiday Success by Meagan Mullen, MA, MHC, Clinician and Community Outreach Specialist

The holidays can be stressful enough as is—but when you pair the busy time of year with eating disorder recovery, it can be even more daunting.

Here at MEDA, we believe that everyone can make it through the holiday season with success, but we also understand that it can be difficult.

We’ve come up with five tips for holiday success to help support you through parties, gatherings, and celebrations alike.

  1. Be kind to yourself

It may sound simple, but offering yourself compassion in difficult moments can go a long way. If you’re feeling stressed or overwhelmed, find a helpful mantra or quote that can soothe your anxiety. Or, when it doubt, give yourself a bathroom mirror pep-talk about how much of a Rockstar you are. Beating yourself up or letting that inner critic voice get too loud won’t do you any good.

2. Reach out for support when needed.

Identify someone who can be a listening ear if you need to process a few things. Maybe it’s someone in your family, a trusted friend, or maybe it’s the “notes” app on your phone or a journal page until you’re able to process it aloud in therapy. Remember that you’re not alone in this!

3. Take care of yourself physically.

As stressful as the food part of the holiday can be, remember to stay adequately fueled throughout the various events you might be attending. While holiday food might be different from what you’re eating every day, it still offers nourishment and fuel to your body! Pack snacks if needed and make sure to listen to the advice of any team members. Get enough sleep and rest when needed.

4. Identify a few ways you can engage in self-care.

Maybe you need some alone time after a party. Maybe you want to take a nice hot bath at the end of a long day. Pick a few things in advance that you can do to relax, unwind, and handle any stressors/triggers that come up!

5. Set healthy boundaries.

Whether it’s walking away from a conversation with your family members about the latest diet trend or avoiding a gathering altogether, make informed decisions about what you do and don’t do over the holidays. Sometimes meeting up with triggering friends or family isn’t the best bet—especially if you’re already in a vulnerable place. Or if it’s unavoidable, have a good excuse to dip out of any conversation that feels uncomfortable. Try coming up with a list of topics you can bring up if the conversation veers off in a direction you don’t want to go! And don’t feel guilty!

MEDA is here to be a support, and we wish you all a wonderful holiday season! We are rooting for you!

Creative Arts Therapies Help Patients Struggling with Eating Disorders Communicate Through Nonverbal Language

Creative Arts Therapies Help Patients Struggling with Eating Disorders Communicate Through Nonverbal Language

Written by: Timberline Knolls Staff

Sometimes when an individual is struggling with an eating disorder, they also struggle to find the words to express the depths of how they are feeling. But just because an individual is having difficulty communicating doesn’t mean that there is no hope for recovery from the compulsion to engage in disordered eating.

When combined with other evidence-based therapies, creative arts therapies such as art therapy or dance/movement therapy (DMT) can allow individuals to use nonverbal forms of communication to rediscover their voice. By participating in creative arts therapies under the guidance of licensed therapists, individuals who are suffering from an eating disorder can start to express the feelings that they were unable to verbalize through traditional talk therapy.

The Benefits of Art Therapy

Oftentimes, there just don’t seem to be any words available to truly describe what a person is thinking and feeling about the many ways an eating disorder has disrupted their life. Those feelings are there, affecting their ability to function every single day, but identifying what those feelings are and connecting with them in a tangible way can be challenging.

An art therapist can help an individual to identify those emotions through creative techniques such as drawing, sculpting, painting, or collage. An individual does not need any artistic experience or talent to participate in art therapy because, often, their body and their mind will start to communicate specific messages through these creative activities without even having to think about it.

After an individual creates a piece of art in an art therapy session, their art therapist will work with them to decode the nonverbal messages, metaphors, or symbols in their creation. By engaging the patient in verbal communication through questions about the creative process and their art, an art therapist can help an individual start to express themselves in a safe, nonjudgmental environment.

The Benefits of Dance/Movement Therapy

Our first language is movement, so it comes as no surprise that the mind and body are interconnected. As the name suggests, dance/movement therapy (DMT) uses both dance and movement to help patients achieve specific therapeutic goals, such as improving their self-esteem and body image, understanding how to regulate their emotions, and building better communication skills.

Like with art therapy, patients don’t need any dance experience or talent to engage in DMT. In fact, DMT doesn’t even always involve dancing. Although some DMT programs do consist of various forms of dance, such as ballroom dancing, they also might involve movement such as yoga and stretching.

In a therapeutic setting, dancing or movement activities can help people who are struggling with eating disorders to use nonverbal language to communicate their conscious and unconscious feelings. A therapist who is trained in DMT can assess a patient’s nonverbal language and respond to their movements with the appropriate therapeutic interventions, helping to translate their nonverbal communication into information that can promote the patient’s recovery.

Creative arts therapies are proven, effective methods of helping individuals start to heal from the damage they have experienced from living with an eating disorder. There are so many different ways to communicate, and art therapy and DMT allow patients to open up in ways that they may not have realized were possible.

MEDA’s Statement on WW’s App Kurbo

MEDA’s Statement on WW’s App Kurbo

Dieting is dangerous—no matter your age.

Here at MEDA, we are seeing younger and younger people with concerns about body image, disordered eating habits, and a constant preoccupation with food, body, and exercise.

We are saddened and angry with WW for encouraging young children to focus on food morality, weight, and BMI through the use of their newly launched app, Kurbo. We stand with those who have voiced their concern and echo their thoughts: health is more than physical.

By encouraging people to focus on physical health—especially weight—we are contributing to an appearance obsessed culture that fails to accept and respect all body sizes and often neglects mental health.

This app does not recognize the multitude of factors that contribute to a person’s overall health, or normalize weight gain as a necessary and healthy part of child development and puberty. Children who grow up in households where weight is a common topic of conversation—which this app promotes–are at an increased risk for unhealthy attitudes and behaviors around food and body.

Research shows that weight stigma is linked to a decrease in both physical and mental health—often leading to depression and low self-esteem. Eating disorders and disordered eating habits are serious and can be life-threatening—and they affect people of all body sizes, races, genders, ages, and socioeconomic statuses.

We ask that you carefully consider the various risks and the emotional harm that come along with these types of tracking apps before using or suggesting to others.

MEDA continues to work with professionals, clients, and the community at large to further educate about the dangers of dieting in order to support those in their recovery and prevent others from struggling with disordered eating and body image issues.

Eating Disorder Treatment: Levels of Care

Eating Disorder Treatment: Levels of Care

written by Meagan Mullen, MA, MHC, Clinician and Community Outreach Specialist

Entering treatment for an eating disorder can be scary—no matter what level of care you’re embarking on. What can feel even more overwhelming, though, is trying to understand the differences between levels of care and what each entail.

To make it easier, we are going to take a look at the different levels of care one by one, including details about how the different levels can be helpful to people with eating disorders.

Inpatient Treatment

This is the highest level of care. Inpatient treatment, or inpatient hospitalization, can be beneficial when someone requires 24/7 medical supervision. This may be due to vital signs, lab findings, and other complications. Clients who need inpatient treatment might be struggling with other psychiatric issues, such as suicidal ideation or mood disturbances.

Inpatient treatment often occurs in a hospital-like setting, and clients are typically supported by both medical and mental health staff. This level of care provides clients with round-the-clock support as they work to become more medically stable and ready for a lower level of treatment. People receiving inpatient care can often need intravenous fluids (IVs), daily bloodwork, or other monitoring to ensure their medical safety. Clients sleep on an inpatient unit until they are discharged.

Residential Treatment

This level of care is when someone does not need round-the-clock medical monitoring, but still needs a high level of support to avoid behavior use. Residential treatment operates 24 hours a day, 7 days a week. In residential treatment, clients will partake in group therapy, individual therapy, and nutrition therapy, along with scheduled free time and opportunities for visits from family and friends. People in residential treatment have access to nursing staff 24/7 and are medically monitored, but they are considered medically stable enough to not need IVs, daily bloodwork, or other medical assistance. Residential treatment can occur in a home-like setting, and clients sleep at the treatment center location until discharge.

Partial-hospitalization Program (PHP): A PHP is intended for clients who do not need round-the-clock support, but who still need structure to avoid behavior use. PHPs typically run during normal business hours for 5-7 days per week. Clients in a PHP program sleep off site—either at home or in supportive living arrangements that are in conjunction with the treatment center they are attending. These supportive living arrangements offer more independence than residential treatment, but still offer support for clients when needed.

In a PHP, clients engage in group and individual therapy, and often in nutrition therapy. Some PHP programs offer medical monitoring, but this can vary from program to program.

Intensive-Outpatient Programs (IOP): Intensive-outpatient Programs are for clients who need more support than an outpatient team, but who do not need as much support as a PHP or residential program. Clients in IOPs sleep at home and partake in programming only a few days per week.

 IOPs typically offer three days per week for a few hours, and evening programming is often available. This level of care can be beneficial for clients who are in school or working and do not require daily support. Clients in IOPs typically partake in individual therapy, group therapy, and a supported meal.

Outpatient: Outpatient support is the lowest level of support and often provides the most flexibility for clients. Often, clients will have an outpatient team, consisting of different professionals to support different aspects of recovery. MEDA often recommends working with an outpatient therapist who specializes in eating disorders, a dietitian who specializes in eating disorders, and maintaining regular contact with a primary care provider. Additionally, some clients benefit from working with a psychiatrist to prescribe any needed medication.

Clients can benefit from varying levels of care throughout their recovery, and often, clients find it beneficial to “step down” or “step up” a level depending on how much support is needed. If you have any questions about the various levels of care, a MEDA clinician can help.

Fatphobia is probably something you’ve heard about but didn’t have a name for.

Fatphobia is probably something you’ve heard about but didn’t have a name for.
Written by Meagan Mullen, Clinician and Community Outreach Specialist

It is no secret that our society can be judgmental, competitive, and appearance-obsessed. So it’s no surprise that people in bigger bodies can be treated poorly. Most people are probably aware of the fact that being in a bigger body comes with a certain stigma, and having negative attitudes or thoughts about these people is called fatphobia. Similarly, weight stigma is stereotyping people based on their weight.

These types of thoughts and beliefs can often lead to chronic dieting, disordered eating, or full blown eating disorders!

There have been plenty of articles (here and here) that highlight the dangers of fatphobia (and weight stigma!) and showcase how present it is in our society, but what do we do to work against this type of discrimination and unhealthy belief?

There are a few steps we can take to address this issue, and they might be easier to achieve than you think.

1. Recognize your own bias.

Just like with any type of discrimination or unfair treatment, it’s important to be aware of our own biases. It can be hard to live in a society with such apparent judgments on appearance and not catch ourselves slipping up. In a way, we’ve been taught to think certain things that we hear from others, from the media, or even from parents, friends, and family. That being said, acknowledging our own biases is the first step in changing our thought patterns and beliefs.

2. Challenge fatphobic thoughts you have or words you use.

When you catch yourself saying things that might have a negative connotation in relation to someone’s weight or size, STOP! Be patient and kind to yourself as you work against these beliefs that have been ingrained in so many of us. Try using language that is more neutral like “bigger-bodied,” or just drop the body descriptors all together!

3. Read up/learn more about Health At Every Size® (HAES) or body positive movements.

Research and engage with communities/resources online or in person to learn more about how toxic diet culture is! Not only will this information help to challenge some of your own biases, it will also provide you with the necessary language and information to educate/share with others.

4. Set boundaries with others in regards to their language.

If you hear someone else making comments that are fatphobic or degrading about someone’s weight or size, speak up! You can always try to educate others about the Health At Every Size® (HAES) movement, or you can simply tell people that commenting on appearance isn’t appropriate and can lead to negative body image and disordered eating. You can also talk with a trusted friend, adult, family member, or therapist to strategize ways to set these boundaries. My personal favorite: reminding people that there are more interesting things to talk about than someone’s body, diet, exercise, etc.

5. Advocate for and work towards body acceptance.

This is a lifelong goal! So many people are affected by negative body image, chronic dieting, and eating disorders. Helping others realize that a lot of what we’ve been taught about weight and size is false can continue the growth of body positivity.

While no single person can change the world alone, there are plenty of likeminded individuals who see the harm that fatphobia does. Working on these small steps in your own life can begin to change your thought patterns, beliefs, and might even improve your own body image!

How to be an LGBTQ+ Ally

How to be an LGBTQ+ Ally

written by undergradaute intern Emily deBettencourt

You may have noticed the word “ally” is being used more and more these days, but you might not know exactly what being an ally means. Webster’s dictionary defines ally as a verb: “to unite or form a connection or relation between: to associate.” The Human Rights Campaign defines an ally as “a person who is a member of the dominant or majority group who works to end oppression in their personal and professional life through support of, and as an advocate for, the oppressed population.” In GLSEN’s safe space kit they describe an ally as “an individual who speaks out and stands up for a person or group that is targeted and discriminated against.”

Being an ally doesn’t necessarily have to follow any one definition, it’s all about being accepting, supportive, and understanding to those in the LGBTQ+ community. Here’s a few simple reminders of how you can do that:

1. Don’t assume everyone is straight

I get it, it’s just habit to ask if a girl has a boyfriend but it’s always such an awkward situation for me when I have to correct that person and say “well, no… but I have a girlfriend.” One way to easily avoid this is to take gender out of the equation when you ask these questions: “do you have a partner?” Or, just don’t ask at all.

2. Respect people’s pronouns

This can be hard when we are so used to male or female pronouns but if someone doesn’t fall within that binary it’s important to validate their existence by using their preferred pronouns. If you’re not sure what someone’s pronouns are, find a polite and respectful way to ask. Ex: “What pronouns do you use?” Or you can introduce yourself and give your own pronouns to make things a little less awkward.

3. Avoid homophobic slurs at all costs

This is pretty straight forward, but you’d be surprised by the amount of people that still use these hateful words. There are countless other ways to say something is annoying, weird, bad, etc. besides saying it is “so gay.” Even if you don’t “mean it like that” it still perpetuates the rhetoric of homophobia and can be very hurtful.

4. Let your pride flag fly

I’ll never forget the relief I felt going to a new doctor and seeing that they were wearing a rainbow lanyard in support of LGBTQ+ patients. It’s not exactly easy going to any sort of appointment as a teen knowing you might have to come out to that person. Having pride flags or other welcoming LGBTQ+ posters, pins, signs etc. is one of the easiest ways to tell someone in the community that you accept them for who they are. (As a student or someone who doesn’t have a work place to display their pride, this can take shape as a sticker on your water bottle or computer, a pin on your backpack, a mini pride flag in your pencil mug or anywhere else.)

5. Speak up

One of the most important parts about being an ally is speaking up if you hear other people say negative things about the LGBTQ+ community. It is crucial to let people know that their language is not okay. There are so many LGBTQ+ people who don’t feel comfortable or confident enough to stand up for themselves, but if straight allies can stand beside them in advocacy, we will continue to move closer to a world of acceptance. It’s also important to help others learn about what it means to be an ally and help them find ways to support the community.

Why this is important at MEDA:

As MEDA works to promote eating disorder recovery and body positivity, it is imperative that we acknowledge how eating disorders affect the LGBTQ+ community at alarmingly disproportionate rates. For example, the National Eating Disorders Association reports that research shows gay, lesbian, and bisexual teens, beginning as early age twelve “may be at higher risk of binge-eating and purging than heterosexual peers.” Additionally, a 2015 study found that “transgender youth are four times more likely to suffer from an eating disorder and twice as likely to engage in purging” (Diemer et al.)

These statistics reiterate the importance of LGBTQ+ people having allies to turn to when they need help. As an undergraduate intern at MEDA, I’ve seen firsthand the compassion and dedication that MEDA has towards minimizing these disparities. Additionally, over the last few months here I have been on the receiving end of MEDA’s active ally-ship which has made me feel not only welcome, but important and heard as a member of the LGBTQ+ community.


Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. Journal of Adolescent Health, (2), 144.

The Tools of a Nutrition Therapist

The Tools of a Nutrition Therapist

Written by Jenn Burnell, CEDRD, Regional Director of Clinical Outreach for Carolina House

Every day, individuals seek professional nutritional help in implementing the “perfect diet” that is blowing up their social media feeds.  To make it even more confusing – and potentially dangerous – is that there are varying levels of nutrition experts marketing their services, and knowing who to trust can be just as daunting.  Nutritionist? Dietitian? Medical Nutrition Therapist? Nutrition Coach?  What does it all mean? It can mean everything and/or nothing at all – and if someone is seeking help for eating behaviors that have become life intrusive and are impacting their health, seeking a properly qualified professional is even more crucial.  So… just to make this even more murky, I’m going to add one title more to the mix: Nutrition Therapist.

First off, I must acknowledge that using Nutrition Therapist is not an accredited term nor a certified title- in fact it is not even 100% used among Certified Eating Disorder Registered Dietitians (CEDRDs), which are considered the most experienced practitioners in the eating disorders field.  “Nutrition Therapist” technically can be freely used by anyone, so it is be important to check that the provider also is a Registered Dietitian or Registered Dietitian Nutritionist (RD/RDN).


A nutrition therapist provides (want to guess?) nutrition therapy to clients seeking eating disorder recovery and help around chronic dieting patterns.  Nutrition therapy is different from the typical pictures of a dietitian in a lab coat telling a person what to and not to eat.  Instead of focusing on nutrition education and standardized meal plans, a nutrition therapist guides a client along on a self-discovery journey around their beliefs around food.   By dispelling myths with sound nutrition information, and providing a non-judgmental space for clients to discuss, explore, and challenge the “whys” of their thoughts and behaviors, the nutrition therapist helps move an individual towards a life enhancing relationship with food.  On top of this, a nutrition therapist also must provide clinical nutrition interventions to aid in the medical complications associated with eating disorders.

Sounds simple enough, right?  Actually, as many seasoned nutrition therapists will tell you, it takes a long time to hone in on these skills, which often means attending various trainings that are not typically provided in most didactic nutrition programs. Understanding counseling approaches such as motivational interviewing (MI) is integral to help guide clients through the resistance and ambivalence around their detrimental behaviors.

A nutrition therapist must also have a strong understanding of therapeutic modalities that mental health clinicians use when treating eating disorders, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), family-based therapy (FBT), and internal family systems (IFS) to name a few.  Incorporating the language and principles from these approaches not only help create cohesive messaging within one’s treatment team, but it also makes the nutrition therapist more effective in helping their clients.

What about specific nutrition-focused approaches that are best practices for nutrition therapists?  Effective nutrition therapists understand, embrace, and embody the principles of both Intuitive Eating (IE) and Health at Every Size (HAES), and discuss nutrition using a non-diet approach.

I first discovered the book Intuitive Eating back in 1997 at my first job out of grad school.  I credit that book, written by Evelyn Tribole and Elyse Resch, for changing my life both professionally and personally, and plotting the course that led to where I am today.   Their first edition shattered my world as a way to “Make Peace with Food”, and its Ten Principles around breaking the diet mentality served in working with all of my outpatient clients, especially those coming in for weight loss.

Where some aspects of the book may be challenged by staunch non-diet proponents, the overall message embraced by nutrition therapists around the IE model is that of body trust: that the vast majority of individuals have an innate ability to sense hunger, satiety and what food will best honor your needs in that moment.  However, as idyllic as it sounds, it is that simplicity and freedom that can make it seem inaccessible to eating disorder clients.  Also, it could leave individuals (especially those black-or-white thinkers) feeling like a “failure” if they ate when not hungry or past satiety, which are what we as humans and social beings all do from time to time.  Cue Ellyn Satter…

Ellyn Satter is another pioneer in creating guiding principles for nutrition therapists.  Her simple handout called “What is Normal Eating?”, which was penned in 1983, still resonates true today.    Where much of her work revolves around child feeding dynamics, her Eating Competence Model (also known as ecSatter) is based on two key elements: 1) the discipline of providing yourself with regular, reliable, and rewarding meals and snacks and paying attention while you eat and 2) the unconditional permission to eat what and as much as you want at those regular eating times.*  These principles require more structure around eating, which differs from IE, yet both can be important tools for eating disorder clients at different points in their journey.

A component of both Intuitive Eating and the Eating Competence Model, and often discussed in nutrition therapy, is the concept of mindful eating (ME).  Some people may confuse Intuitive Eating and mindful eating on the surface, but they are quite different.  The idea of mindfulness is all about being present in the moment and fully aware of the experience (in this case the meal or snack).  Mindful eating does not suggest anything about your physical state (i.e., whether you are hungry or full) in order to do it, just the ability to notice all that is happening in that moment.  An objective and curious awareness is often the best approach in implementing ME in nutrition therapy work.  Some ideas include: Notice the color of the plate…What do you notice about the temperature of the food/how does the weight of the food feel on in your hand or on your utensil?… and one of my favorite questions: If I was an alien that came from outer space, how could you describe it to me?  If a client does or does not like a food (which is completely okay), a nutrition therapist might ask what is it about the food that objectively is not their preference – notice what specifically about the taste or texture is not appealing, or is one aware if a thought versus or past experience is making that decision.

Lastly, where not a nutrition specific strategy, I would be amiss if I didn’t discuss the importance of Health at Every Size® in nutrition therapy for eating disorders.  I was first introduced to this platform at the Binge Eating Disorder Association (BEDA) conference in 2012, where it created this landing space for the things that inherently made sense from my experiences in weight management and eating disorder work, and shared solid and pivotal research to support it all.  At that time, the take-home messages I assimilated were that 1) one cannot determine anything about one’s health based on a person’s body size, 2) the shame and stigma our society creates around larger bodies is the true health crisis and 3) weight cycling and chronic dieting are the culprits related to poor health versus size or weight.   What I have grown to truly understand over the years is that HAES is really a social justice movement advocating for safety and inclusion of bodies of all sizes (and colors and gender identities and abilities).  In order for a nutrition therapist to be effective in their work, they must truly embody size diversity acceptance, and have done a thorough assessment of their own weight biases.  This can be hard and uncomfortable work, especially because dietetic education provides so many guidelines around weight management.

If you are looking to work with a nutrition professional on eating disorder or chronic dieting struggles, do not be afraid to ask them about their qualifications and approaches to working with clients.  Are you a registered dietitian?  What do you know about Intuitive Eating or Health at Every Size?  What is your approach to weight management?   If you are an RDN hoping to learn more on how to effectively work with clients seeking the above help, there are several resources listed below.  Also – seek out the support and supervision of the many amazing CEDRDs and Nutrition Therapists that are available to mentor and share their vast knowledge with you, and help our world break free from the frivolous search for the perfect diet.

Online Resources:

Where to find a qualified nutrition professional (CEDRD/ Nutrition Therapist)


Jenn Burnell is a regional Director of Clinical Outreach for Carolina House, an eating disorder program in Raleigh/Durham, NC.  She is a Certified Eating Disorder Registered Dietitian Supervisor, and owns CEDRD Nutrition, where she helps RDNs in becoming Nutrition Therapists.

Is it Binge Eating Disorder (BED) or are you stuck in a vicious cycle?

Is it Binge Eating Disorder (BED) or are you stuck in a vicious cycle?

Written by Graduate Clinical Intern and Clinical Support Specialist, Meagan Mullen

Binge eating disorder is an eating disorder characterized by episodes of uncontrollable eating, typically not followed by compensatory behaviors. People often get confused and believe that if they are engaging in a binge, they automatically meet criteria for a BED diagnosis, but that’s not always the case!

Let’s break it down by taking a look at Binge Eating Disorder, Bulimia Nervosa, and the binge-restrict cycle.

As previously stated, BED is characterized by episodes of binge eating that are usually not followed by compensatory behaviors such as vomiting, laxative abuse, fasting, or excessive exercise. Bulimia Nervosa, however, differs from BED in the sense that people with this disorder do engage in these modes of compensation. People often believe that Bulimia Nervosa strictly refers to self-induced vomiting after eating, but purging can refer to many different kinds of unhealthy compensation.

Despite the fact that these two diagnoses exist, many people engage in binge eating but do not meet criteria for BED or Bulimia. Instead, they find themselves stuck in a cycle of bingeing and restricting, often unsure of how to stop the cycle and get the help they deserve.

People can find themselves in this cycle for a variety of reasons, but let’s take a look at two of the most common ways people get stuck in this pattern.

Many people begin a diet in hopes of controlling their weight or shape, but after time, they’re physically and psychologically depleted. Dieting can lead to obsessive thoughts about food and feelings of extreme hunger. When people experience extreme hunger paired with an increase in thoughts about food and eating, they’re more likely to binge. Dieting (which is a form of restricting), often denies the body of necessary nutrients. This will lead to hunger that sometimes results in bingeing.

After a binge, however, people are overwhelmed by feelings of shame. They often believe that they lack the willpower to “successfully” diet. They’re shamed by the media and by diet culture and ultimately recommit to a restricting their intake. And as we know, restriction leads to physical and psychological depletion, which can ultimately lead to a binge. Thus creating the cycle of bingeing and restricting.

An alternative way that people find themselves stuck in this cycle is when the binge eating occurs first. If someone is struggling with binge-eating and is using food as a way to cope with uncomfortable emotions, they might result to restricting their intake due to the shame they feel about engaging in these behaviors. Oftentimes, people will restrict the day after a binge, eating small amounts of food at breakfast and lunch, or throughout the day entirely.

However, after making it through most of the day on an insufficient amount of food, people experience hunger at the end of the day. The combination of a lack of food and exhaustion can also lead to another binge. This evening binge can lead to more feelings of shame, therein restarting the cycle.

This pattern of bingeing and restricting can lead to health problems, such as cardiac issues, metabolic issues, and various emotional and mood disturbances. While someone engaging in this cycle might not be diagnosed with BED or bulimia, they may be given a diagnosis of OSFED or Unspecified Feeding or Eating Disorder. Both of these diagnoses are serious and deserve proper treatment and attention.

If you or someone you know is engaging in this cyclical pattern of eating, recovery is possible. Many people who struggle with eating disorders or disordered eating receive the help they need through therapy, nutrition therapy, and other group and individual supports.

If you or someone you know is struggling with an eating disorder, or if you feel like you might be stuck in the binge-restrict cycle, MEDA is here to help, and fully recovery is possible!

Mindful & Intuitive Eating for BED Recovery

Mindful & Intuitive Eating for BED Recovery

Written by MEDA undergraduate intern, Stephanie Wall 

Binge Eating Disorder (BED) is the most common eating disorder in the United States (NEDA, 2018). About 3.5% of American women, 2% of American men, and 1.6% of American adolescents currently suffer from BED (ED Referral, 2018). It is characterized by recurrent episodes of eating large quantities of food, often very quickly and to the point of discomfort. Those who suffer from BED tend to feel a loss of control during the binge and experience shame, distress, or guilt afterwards. Further, compensatory measures, such as using laxatives or forcing oneself to vomit, are not enacted to counter the binge. In addition to typical therapy for eating disorders, such as Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT), using both intuitive and mindful eating techniques can be quite powerful in helping those struggling with BED.

A common symptom of BED is engaging in any new practice with food or fad diets. This contributes to body dissatisfaction, food and body preoccupation, and weight stigmatization (Tribole, 2017). The fallout from this mindset is mandating what and when one eats, regardless of one’s biological needs. In those with BED, this rigidity can lead to a binge, and thus feelings of a loss of control. This is known as the binge/restrict cycle.

Intuitive eating can be helpful in breaking this cycle. Intuitive eating is a personal process of honoring your health by responding to your body’s biological signals (Tribole, 2017). Here at MEDA, the EmbodiED Group focuses on self-compassion in their sessions, emphasizing this idea. Because a major idea in intuitive eating is listening to oneself and meeting one’s needs, the individual undergoing this change must be ready for it. This is a key factor for therapy to work, which is why intuitive eating works best for those who have the internal motivation to recover.

One major component of intuitive eating is “legalizing all food” (Hirschmann, 158). This means viewing all food in the same way, in order to remove the idea of “good” vs. “bad” calories. Because namely “junk food” is consumed during a binge, removing the negative connotation associated with that food may help alleviate some of the guilt felt after a binge. This also destroys the idea of “trigger foods” because all food is seen as the same. Many individuals who suffer from BED believe that even the slightest consumption of a certain kind of food will automatically invoke a binge session. According to Dr. Sandra Aamodt, a neuroscientist, hunger and energy use are controlled by the brain, mostly without one’s awareness. Thus, if we truly listen to our bodies and eat without guilt, the more we will naturally crave nutritious food.

Moreover, the idea of the “clean the plate club” has to be disregarded for intuitive eating to work. Being sure that everything on a plate is eaten disconnects us from our bodies and our feelings of fullness (Tribole, 2017). The basis of intuitive eating is to eat when hunger strikes. By legalizing all food as well as ending adherence to rigid rules, intuitive eating can be achieved.

Often those with BED eat when they are overwhelmed and stressed. To eat both intuitively and mindfully, we must ask ourselves how we are feeling and thus why we are eating. As a therapy, having the patience to sit with their feelings instead of eating to quell them is very effective (Tribole, 169). This coincides with mindful eating, based on concepts in the Buddhist faith, which involves being fully aware of what is happening within and around you in the moment. In addition to learning how to eat intuitively, learning how to eat mindfully is important.

Staying present and mindful while eating “allows you to feel the direct experience of your body and the many sensations of eating” (Tribole, 137). Someone who eats mindfully acknowledges that there is no right or wrong way to eat, varies their degree of awareness surrounding the experience of food, accepts that their eating experiences are unique, directs their attention to eating on a moment-by-moment basis, and gains awareness of how they can make choices that support health and wellbeing (The Center for Mindful Eating, 2013). A common method for eating mindfully is eating with one’s non-dominant hand. In one study, participants were instructed to eat popcorn while watching a movie. Unknown to them, the popcorn was a mix of fresh and stale. Those who ate with their non-dominant hand recognized the stale popcorn, and ate less of both the stale and fresh popcorn. Their counterparts didn’t recognize the stale popcorn and ate more (Tribole, 2017).

Experts suggest starting gradually with mindful eating by eating one meal a day or week in a slower, more attentive, manner. Thinking about the flavor, texture, temperature, and aromas of what you want to eat before you settle down to eat will help you eat in a mindful manner (Tribole, 135).

Intuitive and mindful eating are quite useful for re-establishing one’s relationship with food, however these concepts will not address all components of the eating disorder. Typical forms of therapy proven to work include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and interpersonal psychotherapy. By working on both the physiological and psychological aspects of Binge Eating Disorder, recovery can be achieved.


Aamodt, S. (2013, June). Why Dieting Doesn’t Usually Work. Lecture presented at TEDGlobal 2013. Retrieved August 2, 2018, from

Baer, R., Fischer, S., & Huss, D. (2006, March 03). Mindfulness-based cognitive therapy applied to binge eating: A case study. Retrieved August 2, 2018, from

ED Referral. (2018). What is Binge Eating Disorder? Retrieved August 7, 2018, from

Harvard Health Publishing. (2018). Mindful eating may help with weight loss – Harvard Health. Retrieved July 31, 2018, from

Hirschmann, J. R., & Munter, C. H. (2010). Overcoming overeating. Place of publication not identified: OO Publishing.

McQuillan, S. (2014, October 21). Mindful Eating Helps Prevent Overeating. Retrieved July 31, 2018, from

NEDA. (2018, February 22). Binge Eating Disorder. Retrieved July 26, 2018, from

The Center for Mindful Eating. (2013, August). Introducing Mindful Eating. Retrieved July 31, 2018, from

Tribole, E., & Resch, E. (2017). The Intuitive eating workbook: Ten principles for nourishing a healthy relationship with food. Oakland, CA: New Harbinger Publications.


How Parents Can Spot an Eating Disorder in Their Child

How Parents Can Spot an Eating Disorder in Their Child

Written by: Caroline Rudnick, MD | Family Medicine Physician, McCallum Place

Early Signs and Symptoms of an Eating Disorder in Your Child or Adolescent​

Our culture and media spend a lot of time thinking, talking, blogging and watching videos about dieting, food choice, weight loss, and exercise. Amid this wave of information, our children can get caught up in information that is misleading, misinformed or simply harmful. Combined with the stresses of childhood, this focus on food, appearance, and exercise can contribute to some children and adolescents developing disordered eating behaviors or fully diagnosable eating disorders.

Sometimes these disorders go unrecognized for a period of time, and a child may lose a substantial amount of weight or suffer other medical effects. Because early detection of an eating disorder improves the chances of recovery it is important for parents to know the signs and symptoms of anorexia, bulimia, binge eating disorder, and other disordered eating behaviors.

Signs and Symptoms of an Eating Disorder in Your Child or Adolescent

We often see kids skipping meals, wanting to prepare their own meals, eating alone, avoiding whole groups of foods, counting calories, grams of fats or carbohydrates, or being very picky about food. Sometimes kids will be overly concerned about the nutritional value of food and spend a lot of time reading, thinking and researching food, calories, and diet choices.

Other Signs that Should be Noticed by Attentive Parents

Children spending a lot of time in the bathroom after meals may be an indication that purging is occurring. Binge eating is often discovered when food is suddenly missing from the household supply. Children or teens who are obsessively exercising or secretively exercising are likely struggling with body image distress and concern about weight, size, and shape. Of course, noticing weight loss or sudden weight change is important as these can indicate an eating disorder or another medical issue which would merit the attention of a physician.

Finally, a child’s appearance can offer clues to health concerns or disordered eating behaviors. Kids with eating disorders will often appear pale and withdrawn. Their clothes may no longer fit or they may begin wearing baggy clothes or out-of-season winter clothes to hide their appearance.

Seek Professional Help for Your Child or Teen

If you notice any of these things in your child, please seek medical attention for the possibility of an eating disorder or another medical problem. Your first appointment should be with a medical professional who is confident and educated on the symptoms of an eating disorder. Your doctor may also recommend working with a licensed therapist or a registered dietitian. To find resources in your area or to have a free assessment completed by an eating disorder professional contact McCallum Place at (314) 957-5042.

This blog was originally published at on December 10, 2018 and is republished here with permission.

The Intricacies and Complexities of Pregnancy and ED Recovery

The Intricacies and Complexities of Pregnancy and ED Recovery

Written By Jena Morrow Margis, CADC, Alumnae Coordinator, Timberline Knolls

Today countless women throughout the world who previously struggled with an eating disorder are living successful and bountiful lives. Although their individual stories are different, each has learned to navigate the various challenges inherent to recovery. And then, whether by design or sheer happenstance, a pregnancy enters the picture.

Most women in recovery are no different than many other expectant mothers in terms of how delighted they are by a positive pregnancy test, how very much they want a child to love. Nevertheless, pregnancy for a woman in eating disorder recovery can prove exceedingly difficult due to a variety of factors. For a woman who used to view food and the commensurate weight gain as the “enemy,” the constant and necessary consumption can be stressful.

Typically women in recovery move into a state of healthy acceptance with their bodies. No longer do they strive to make their physical being something it was never meant to be—they have achieved peace. Now, that familiar body is morphing into something utterly foreign. The fact that the body is doing exactly what it is supposed to do—grow another human being—is not the issue. The figure and shape that she has grown comfortable with is no longer there.

Add these two factors to a bubbling cauldron of pregnancy hormones that create a whole new normal and it is no wonder a woman even solid in recovery might experience all kinds of fears or emotions.

So if you are this woman, what are you to do?

Perhaps more than ever, honesty must be the coin of the realm. Be truthful with yourself about your thoughts and feelings as well as with those who love and support you. If your expanding breasts or waistline upset you, that is okay; you are allowed to feel that way.

Most important, honesty is imperative with your prenatal provider, midwife, or whoever you are entrusting with your care. Tell your team about your history with food or body image.  If the numbers on a scale are triggering to you, ask to be weighed backwards.

If your team seems unresponsive or unsympathetic to your unique needs, consider going elsewhere. You and your baby need understanding professionals who respect your position and are willing to work with you. Which is why you may want to consult a nutritionist, preferably one with eating disorder expertise, throughout your pregnancy. Individual counseling or support groups can also prove beneficial to reduce the fear surrounding food and weight gain.

Be judicious with social media and social interaction. This might not be the best time to spend countless hours on Facebook, Instagram, or other outlets where women post filtered or altered photos of themselves and their bodies. If viewing these images generates negative thoughts about yourself, your changing body, or cause you to feel “less than,” make a healthy pledge to yourself to limit this time. Instead, pick up a book and read to your growing baby.

The same holds true with chat groups where future mothers either complain or boast about how little weight they have gained. Neither of these topics are beneficial.

In daily life, keep in mind that most people know very little about eating disorders, including recovery from them. If someone at the grocery store comments on your weight or size, try to extend the same grace to them that you are hopefully extending to yourself. Frivolous comments are just that—they are spoken from a place of unawareness, not a malicious desire to hurt you.

Remember that pregnancy is not only a process, but it is temporary. As such, be mindful, endeavor to live in the moment. Try not to project into the months and years ahead, obsessing about work, family finances, preschool. These are topics for the future.

Instead, when you are sitting quietly and your child is saying hello by relentlessly kicking you from within, try to capture that moment in your heart. Not only is this form of communication a priceless gift, but a fleeting one, so try to cherish it every day.


For pregnant women and moms struggling with eating disorders, Timberline Knolls is pleased to offer Lift the Shame—a free monthly, one-hour telephonic support group facilitated by Jena Morrow Margis—on Friday, December 21, 2018, 3- 4 p.m. EST, and every third Friday of the month thereafter.

Participants have the opportunity to express their feelings and share concerns about body image and eating behaviors. Women are invited to share personal successes and challenges, beliefs, fears, and anxious feelings about pregnancy or being a mom during a time when they might be struggling with an eating disorder, disordered eating, or unhealthy thoughts and emotions.

All are welcomed to join; participation is not required. Simply listening to and learning from others often helps alleviate guilt and shame, reduces stigma, and eradicates the feeling of being alone.

Contact for more information or to register.

Combining the Parasympathetic Nervous System and the Outdoors: A Match Made for Maximum Relaxation

Combining the Parasympathetic Nervous System and the Outdoors: A Match Made for Maximum Relaxation

written by MEDA undergraduate intern, Kellie Marie Martin 

Most people can imagine a time when they felt stressed or overwhelmed. Everyday people are exposed to numerous forms of intense stimuli: careers, social media, family matters, and more. When these stressors build up, it isn’t uncommon for individuals to look for a release from their negative emotions. Knowing ways to effectively cope with stress is important for maintaining a healthy well-being. The brain also has methods to induce relaxation that we often aren’t aware of. Understanding how the brain combats stress can very effectively help (or be used as an addition to) other methods used to relieve tension fast.

When people get stressed, sometimes the brain reacts by activating its fight-or-flight response. This is controlled by the part of the brain called the sympathetic nervous system (SNS), which is one of two parts of the autonomic nervous system.1 The fight-or-flight response essentially prepares the body to handle the stressful situation by either bracing for a fight or getting ready to flee. Unfortunately, often this response is triggered by non-life-threatening situations, so it is helpful to know how to combat it. This is where the second part of the autonomic nervous system comes in, otherwise known as the parasympathetic nervous system (PSNS).2 The job of the PSNS is to regulate the body’s heart rate and stress levels so that normal bodily functions can resume, rather than be controlled by, the fight-or-flight response.3

The easiest and fastest way to activate the PSNS can be done by putting your face in cool water for approximately 30 seconds.4 This triggers the mammalian diving reflex, which changes the body’s chemistry in order to stimulate the PSNS to initiate a relaxation response.5 The brain essentially thinks it’s in a dangerous underwater situation where remaining calm is vital for survival, so it responds in a way to do just that.6 Although not required, dunking your head in water outdoors (such as in a lake or pool) can provide additional support in making you feel relaxed.

After the PSNS kicks in from the mammalian diving reflex, staying in the water provides an opportunity for gentle movement. Some options for gentle movement include swimming, kayaking, or stretching. Moving the body releases endorphins, which are hormones that help combat anger, anxiety, and sadness. Staying in the water, however, is not always an option.

Another way to activate the PSNS is by practicing yoga. When practicing yoga, the body connects to the mind through breathing techniques, holding postures, and consciously trying to relax.7 Additionally, yoga provides the opportunity for body-awareness and self-awareness. Having the time to look inward is important for maintaining a healthy well-being.

Another possibility to try is activating the PSNS while indoors, and then going outside to maintain maximum relaxation. There are numerous benefits to spending time outdoors, such as increasing vitamin D levels and improving concentration and focus.8 Healthy levels of vitamin D help combat depression, fatigue, and muscle pain as well as promoting strong bone growth.9 The easiest way to increase vitamin D levels is to be outside in the sun. So, while outside, do something enjoyable. Some options are to go on a walk or a hike, plant some flowers, or sit on a park bench. Doing something that requires attention provides the opportunity to only focus on that one thing and push out any stressors from the mind.

Practicing deep breathing outdoors is an effective option that allows you to reap the benefits of being outside as well as cueing the PSNS to kick in. Deep breathing essentially means inhaling and exhaling slowly. This can be done by counting to five as you inhale, and then again counting to five while exhaling.

The next time that you are feeling overwhelmed, consider trying these methods. Dunk your head in cool water, practice some gentle movement (preferably outdoors, but indoors works well too), try practicing yoga, and breathe slowly and deeply. Reducing stress and tension in the body does not have to be a difficult task, but one that is enjoyable instead.



[1] Parasympathetic Nervous System. Biology Dictionary. (2017).

2 Ibid.

3 Ibid.

4 Sevlever, Melina. Dialectical Behavior Therapy (DBT) Distress Tolerance Skills: TIPP Skills. Manhattan     Psychology Group, PC (2018).      dbt-distress-tolerance-skills-tipp-skills/

5 Ibid.

6 Ibid.

7 Oijala, Leena. This is How (and Why) a Yoga Practice Strengthens Your Nervous System and Brings  Balance Back to Your Body. Organic Authority (2016).       and-why-a-yoga-practice-strengthens-your-nervous-system-and-brings-balance-back-to-your-body/

8 A prescription for better health: go alfresco. Harvard Health Publishing: Harvard Medical School (2010).

9 Ibid.

The Symbolic Separation of ED and Self in Narrative Therapy

The Symbolic Separation of ED and Self in Narrative Therapy

by Melissa O’Neill, LCSW, Director of Clinical Operations at Timberline Knolls 

An eating disorder is an all-consuming disease. It seeks to destroy a woman or girl’s body through the abuse of food. But equally important, yet unseen, is the disorder’s desire to consume her soul.
Over months or years, the individual abdicates more and more of herself to the illness. Eventually, she is completely defined by the disorder to the degree that she and the disease are one.
An important goal in therapy is to redefine the relationship, to separate the individual from the disorder and reestablish her power and control over her life.

Narrative therapy aims to externalize the eating disorder first by reassigning the disorder to an inanimate object, such as a hardcover book or even a coat rack. The person is then encouraged to confront the object (and disorder) directly—tell it how it has damaged her life, compromised her health, and hurt her relationships with family and friends. By labeling the disorder as a relentless, mean bully, she can ultimately challenge its right to be a part of her life.

This symbolic separation and straightforward confrontation is not just emotionally beneficial, it has profound cognitive value. In certain ways, the human brain is similar to a computer. If a specific keystroke creates a new document, it will always do so… until the computer is reprogrammed.

The brain also works in a default system. The distorted thoughts of a person with an eating disorder will continue to reinforce themselves as they repeatedly travel along the same neuro pathways. Yet neuroplasticity research has revealed that the brain is also highly flexible and resilient. It delights in establishing new pathways and discarding the old when they go unused. When a person intentionally creates new thoughts, the brain embraces these new connections. Repeating the mantra, “I am strong, I do not want you in my life anymore,” creates a new default. Commensurately, the previous default, “I love you, I cannot do anything without you in my life,” slowly fades away.

Establishing new thoughts in the form of neuro pathways, strengthening them through practice, repetition and active engagement leads to change. It is this tangible transformation that often proves the bedrock for true, sustainable recovery.



Photo credit: 

Change in Season, Change in YOU

Written by Hannah Beaver, LCSW, Alumni Coordinator at The Renfrew Center

As summer winds down, we often find ourselves exposed to the various changes happening all around us, whether it’s through the changing colors of nature, or the plethora of “back to school” messages, it’s hard to ignore the theme of change. Change can be a scary process in our life, and even more so in recovery.

Change in recovery looks different for each individual, and whether they are big changes or small ones, fast or slow, external or internal, they all play a significant part in your journey and deserve to be recognized. In our daily lives, it’s easy to get caught up in the chaos of the endless demands, making it feel near impossible to take a moment to actually recognize the change that’s happening. Taking time to not only accept the process of change, but also appreciate it, can do wondrous things for your recovery. The more we ignore or try to fight off the changes that need to happen, the harder it becomes to embrace this and move forward. Give yourself this meaningful gift, and know that no matter how hard it might feel at the time, it will be so worth it!

Tip: Make a list of small changes or steps you would like to take during this autumn season. Determine whether this list is something you want to tackle each day, week, month, or just as it comes. Share the list with your support system so that you can receive love and guidance as you embark on the process. Make sure as each step is completed, you take the time to applaud yourself and recognize the hard work you’re doing!


Supporting Your Adolescent with the Back to School Transition

Written by Clementine Portland Clinical Director Zanita Zody, PhD, LMFT 

Zanita guides her team with warmth and compassion as they provide comprehensive care to the adolescents who entrust their treatment in them. In this week’s blog post, Zanita shares tips on how to support your adolescent as they get ready to make the transition back to school.

Transitions represent points of vulnerability. Imagine breaking down a cardboard box. It is along the points of transition that one focuses. Similarly, life transitions increase vulnerability to a variety of mental health concerns. In fact, most eating disorders develop during transitions. Because your children are still learning to manage the stress and emotions that come with transitions such as returning to school, they are at an increased risk of returning to familiar behaviors.

There are several things you can do to help support success through this transition:

  1. Explore their excitement and this may be met with resistance, especially if there is a history of avoidance. It can be difficult to determine if this is in service of the healthy self (HS) or the eating disorder (ED). Asking them to share the thoughts and feelings of both can help clarify internal conflicts and encourages them to open up by honoring the ED and any fears or grief they may have about letting it go.
  2. Consider the dialectic,which acknowledges two conflicting truths simultaneously (e.g., excited and afraid). Rather than glossing over this by “staying positive,” honor your child’s experience while also emphasizing motivation and skills to support success.
  3. Create a plan for managing potential challenges.
    1. How does wellness class align with their current exercise plan?
    2. Are they hoping to return to competitive sports?
    3. Any concerns about changing in front of peers in the locker room?
    4. Does health class cover nutrition and weight?
    5. Do they feel “left out” after being away?
    6. Do their peers eat lunch? Is this a time they were likely to use behaviors?
    7. How will snacks fit into their schedule?
    8. Do they feel pressure to “catch up” or perform academically?
  4. Help them identify coping skills that encourage mindfulness, distress tolerance, affect regulation, and interpersonal effectiveness. These skills are likely challenging for your child and arguably necessary for creating a sense of balance and well-being as they return to school.
  5. Discuss what they may want to share with peers and teachers and role play those conversations.
  6. Consider a 504 plan, which addresses individual needs and can offer critical supports. If potential stigma is a concern, weigh this against the benefits of additional support, recognizing too that these plans can be modified at any point.

While returning to school can be frightening, with your support and open communication the return to “normalcy” can help facilitate a renewed sense of meaning and purpose, moving your child further towards recovery.

For more information about Clementine adolescent treatment programs, please call 855.900.2221, subscribe to our blog, and connect with us on FacebookTwitter, and Instagram.

This blog was originally published at on August 21, 2018 and republished here with permission. 


Why Telling Men to Simply Talk about it Simply isn’t Enough

Written by by Rogers Behavioral Health with insights from Dr. Rachel Leonard, clinical supervisor at Rogers

Man up. Boys don’t cry. Feelings are for the weak. What happens when for generations, men are held to unhealthy and, as it’s becoming increasingly clear, dangerous stereotypes of masculinity?

More than 76% of all suicide deaths in the U.S. today are male. And of them, 84% did not have a diagnosed mental health condition.

Yet this does not mean that men aren’t living with mental health issues. In fact, each year:

  • More than 6 million men suffer from depression.
  • 3 million struggle with anxiety.
  • 1 in 5 develop alcohol dependency during their lives.
  • 10 million will be affected by an eating disorder.

So why are so many men suffering in silence?

“Stigma plays a role in many individuals not seeking treatment even if they realize that they are struggling with mental illness,” explains Dr. Rachel Leonard, clinical supervisor at Rogers Behavioral Health.

“This can especially impact men, who may hold beliefs about masculinity and gender roles that indicate that they should not express vulnerability or show certain emotions. They may view their struggles as a sign of weakness instead of a common, yet serious issue that can be successfully treated.”

As Aaron, a former patient at Rogers, explains, “Being a male who has dealt with an eating disorder, I was hesitant to disclose details of my struggles because of the widespread stigma and perceived femininity of the disease. Opening up about my personal battles was certainly not an easy task. I felt doing so would risk others viewing me in a different, unfavorable light.”

“Research demonstrates that peoples’ attitudes improve when they have direct contact with others with mental illness,” says Dr. Leonard. “Increasing dialogue about our own experiences with mental illness or mental health treatment can be helpful to normalize these experiences.”

She adds that men are often less likely than women to discuss their struggles with mental illness or their experiences seeking treatment with friends, family members, and coworkers, which can contribute to mental illness being viewed as more uncommon than it actually is.

Changing future conversations by changing perception

A tide seems to be changing as more and more men in the public spotlight are coming forward with their own experiences with mental health.

A tide that may be redefining what it means to be a healthy, strong, powerful man.

Whereas it may have once been inconceivable to imagine John Wayne or Steve McQueen address their mental health, today’s headlines include men from nearly every walk of life including The Rock, Larry Sanders, Prince Harry, Ryan Reynolds, and Kanye West.

“I’m very encouraged to see increasing awareness of mental illness among men and more open dialogue about this, especially among individuals who may be viewed as masculine role models,” says Dr. Leonard.

“I especially appreciate the conversations men are having regarding their own experiences in treatment, and I’m hopeful they inspire others to seek help and to talk more openly about their feelings and struggles.”

As Aaron attests to, “Addressing my issues openly has been a positive thing for me, and the reaction I received was overwhelmingly encouraging. Now I believe that opening up about struggles is more an act of courage, rather than weakness.”


This blog was originally published at on 7/13/2018 and is republished here with permission. 

Eating Disorders in the Asian American Community: A Call for Cultural Consciousness

Written by MEDA Undergraduate Intern, Lauren Kim 

If you’re Asian American, you know that there is nothing good about hunger. Many of our parents, whether they came to the country as immigrants or refugees, know real hunger. They make sure that we never leave the house without full bellies and greet us when we return with heaps of warm homemade food. Food is our love language – the one thing that transcends the language barriers, the cultural differences, the generation gaps, and all the other things that keep us from saying “I love you” out loud.

But by twisted logic, food is also the enemy. If you’re Asian American, you also know that being fat in an Asian family is tantamount to falling short of making the honor roll. It is understood as an indication of personal weakness – a lack of discipline, laziness, failure. When you’re “fat” by Asian standards, it can be hard not to feel like a burden to your family because you’re told, either implicitly or explicitly, that the shame is not only carried by you, but by your family as well. And so, the burden of shame begins to feel even heavier.

What makes things exponentially more complicated is this idea of familial duty. Because so many Asian Americans are commonly raised on the rhetoric of hard work and sacrifice, we are ingrained with a deep desire to express our gratitude to our parents by fulfilling their hopes and dreams for us. For some, that might mean becoming a doctor or a lawyer. But for others, it could mean losing weight to get closer to the ideal Asian body – small, pale, and willowy thin.

One thing that sets Asian culture apart from others is the level of brutal honesty with which people speak. Time and time again, I’ve noticed that there is a general willingness to make comments, especially on other people’s appearances, which can be so abrasive that they sometimes err on the side of cruelty. When you are taught that being thin is a virtue, and that being heavy and being happy cannot be feasibly reconciled in one body, “fat” becomes the worst thing you can be called. So whether we want to or not, Asian Americans cannot help but internalize our culture’s guidelines on what a desirable body looks like, and by default, what its converse looks like.

Growing up, I resented the unreasonable expectations placed on me by my family and my culture and I looked to every family gathering with anxiety and dread. Being around extended family always meant one thing: that I’d have to bear hours of being force-fed excessive amounts of food by the same people who would tell me to my face that I had gained weight since the last time they saw me. And through it all, I would force a tight-lipped smile and try to maintain my composure. If I was ever so bold as to politely refuse the food that was offered, I’d be urged by my mother to “just be polite” and eat. And if I did accept the food and finished it, more would immediately be piled onto my plate, pressuring me to eat way past the point of fullness.

As my fellow Asian Americans know all too well, there is no winning when you grow up in this contradictory culture. The only thing that never seems to change is our culture’s steadfast commitment to a singular definition of beauty. In a world that has begun to promote loving yourself and finding beauty in your flaws, Asian culture has not managed to keep up. There’s an overbearing pressure to be perfect naturally, or to constantly be improving yourself if you’re not. This mentality helps to make sense of why plastic surgery is so prevalent and even normalized in Asian countries. Why love your flaws, when you can remove them, right?

It’s easy to see how these dangerous messages can encourage body dissatisfaction in the Asian American community and eventually manifest as an eating disorder. According to a statistic cited on the National Eating Disorders Association’s website, Asian, Black, Hispanic, and Caucasian youth have all reported attempting to lose weight at similar rates [1].

But there’s no way that you would know that, judging by what is commonly portrayed in the media. Eating disorders continue to be an issue that is typically attributed to white, straight, cis-gendered, able-bodied women of high-income backgrounds. Though we are slowly making progress in challenging this narrow-minded view of what someone with an eating disorder looks like, there is far more work to do. The lack of Asian Americans represented in the national discussion on eating disorders seems to indicate that many are still suffering in silence. According to Dr. Szu-Hui Lee, a clinical psychologist and director of training at the McLean Hospital at Harvard Medical School, Asian Americans tend to under-report mental health issues. She explains: “There’s a big stigma with seeing a psychologist. [Asian American] parents are more likely to send their kids to an academic counselor than a psychologist.” [2]

In a culture where optics matter so much, it is not hard to see why individuals with eating disorders struggle to speak up and ask for help. The stigma attached to mental illness is so severe in our culture that our parents are likely to respond to our pleas for help with fear, denial, blame, and anger.

As someone who has struggled with and recovered from my own eating disorder, I am familiar with this kind of reaction. When I found that I could no longer keep my suffering at bay, I rehearsed the words I wanted to say before mustering up the courage to tell my parents. Their response was dismissive at first, eventually evolving into frustration and then hopelessness. As much as they wanted me to get better, they didn’t understand why I was doing this to myself, and had no clue where to go for help. And when I tried to learn more about treatment and recovery on my own, I found that my background bore little resemblance to the movies I watched and the stories I read online. For a long time, it seemed like nobody understood quite how I felt.

While eating disorders certainly span all cultures, the way they are experienced can differ drastically depending on the culture in which an individual is raised. For me, being Asian felt like an obstacle to my recovery because I had trouble overcoming my shame and locating the resources I needed to get better. It is evident that the Asian American community is in desperate need of greater awareness and more resources catered to our experiences. Hiring people of different backgrounds and making efforts to provide intercultural awareness trainings for clinicians is a good place to start.

And to those who are recovered from or currently struggling with an eating disorder, don’t be afraid to talk about it. Allowing yourself to be vulnerable with someone you trust could be the first step to healing. It was for me. Uprooting a stigma that is so deeply entrenched in our culture can’t be done overnight, but we can start to chip away at it by exposing our suffering and finding strength in our shared experiences.

Like what you read? Check out Lauren’s final MEDA project, an E-Zine on the topic of eating disorders and body image in the Asian American community:


Maintaining Recovery During the Summer

Written by Registered Dietitian Vanessa Garcia, RD from Oliver-Pyatt Centers 

In this blog, Vanessa offers some tips in helping to maintain continued recovery during the summer months. 

Throughout the year, summer months can often be the busiest of times. Some individuals may be ending their current college year and transitioning towards their next, or even entering the workforce. Others may be parents with a new change in schedule as their children are on their summer break and spending more time at home. For many, summer is widely considered the perfect time to take a vacation! While this season is regularly known to be a staple of transition, change, and an opportunity for leisure, summer may also pose potential challenges for clients to face during recovery.

Typically, in a treatment setting, clients learn to adapt to a daily schedule and have a higher focus on meals, snacks, clinician appointments, and programming hours. This usual stability allows for clients to gain confidence towards their recovery and adhere to their meal plan. However, if clients are either discharging from treatment during the summer or experiencing their first summer outside of treatment, most likely there are some upcoming daily routine changes. Clients may find it more difficult to follow their normal daily meal plan. This may lead to deprivation of nutrition and variety, and higher risks for behavior engagement. Additionally, eating disorder behaviors and urges are known to rise during times of change.

Some signs for families or loved ones to know if their loved one may need residential treatment include fluctuations in weight, decreased variety and portions of meals or snacks, missing meals or refusing food, increased time using the bathroom, isolation from family or friends, eating alone or lying about eating, excessive exercise, rigid eating patterns, social withdrawal, and change of mood.

For clients that have recently discharged from treatment, it is highly recommended for them to continue scheduling routine sessions with outpatient team members including therapist, dietitian, psychiatrist and medical doctor. This way, ongoing support may be provided and potential summer challenges can be discussed during sessions while pursuing recovery at home. Additionally, for those seeking individual or family support during summer months, it is also recommended to seek outpatient care providers with possibility of a higher level of care for a loved one.

 For more information about Oliver-Pyatt Centers, please call 855.254.5642visit our websitesubscribe to our blog, and connect with us on FacebookLinkedInTwitter, and Instagram.

This blog was originally published at and is republished here with permission. 

Tips for Talking to Your Doctor About Their Weight Stigma and Your Eating Disorder

Written by Monique Bellefleur, Ed.M, LMHC, MEDA Director of Community Education

I hear time and again from clients that they are afraid to go to the doctor’s office. I don’t blame them when I hear their stories: The doctor told them they were eligible for gastric bypass surgery (even though they had not asked about it and have an active eating disorder); They had a heart rate in the low 40’s and the doctor told them they were perfectly healthy (even though they had a BMI of 17 and an active eating disorder); They went to the doctor’s for a sinus infection and the doctor told them they need to lose weight. The list goes on…

However, it remains important to receive medical care. Although we wish the medical community understood more about eating disorders, we unfortunately have to learn to be our own best advocates until the medical community catches up.

Here are MEDA’s 5 tips for speaking to your doctor about their weight stigma and/or your eating disorder:

  1. Don’t be intimidated: Remember, doctors are just people who have gone to medical school. Yes, they have spent years studying the human body, but that does not mean that they are perfect, all-knowing beings. Even though eating disorders have the highest mortality rate of any mental illness (Smink et al, 2012), a 2014 national survey found that out of 637 internal medicine, pediatric, family medicine, psychiatry, and child and adolescent psychiatry programs, 514 did not offer any scheduled or elective rotations for eating disorders (Mahr et al, 2015).
  2.  Use your Voice: Doctors are often overbooked, overworked, and rushing to the next appointment. We all know the overwhelming feeling that comes from listening to your doctor rapidly firing off questions while simultaneously directing you to stick out your tongue, say “ahh”, take deep breaths, cough three times, undress, redress, on and on. It may seem impolite to interrupt this process to ask your own questions, but you deserve to be heard, especially when it comes to your health. Speak up and express your questions and concerns about your care and your body until you feel satisfied with the information you have received. It is not your fault that you have an eating disorder. It is a serious mental illness that deserves appropriate care, and you may need to be very upfront with your doctors regarding your ED. Learning to use your voice is an important part of eating disorder recovery- think of it as an opportunity to practice.
  3. Confidence is Key: It’s a natural response to respect a person of authority’s opinion, but you are the expert on yourself. If something doesn’t feel right, let the doctor know, including when you feel dismissed. For example, if not seeing your weight is helpful for your recovery, tell the doctor and medical staff directly. If they happen to let that information slip (which seems to happen frequently!), bring it to their attention. If you feel like your doctor is dismissing your condition due to your body size or eating disorder diagnosis, tell them. Doctors take the Hippocratic oath to “do no harm”. It may be uncomfortable, but if their comment or behavior harmed you, you can let them know. By educating your doctor on how they made you feel, you may be saving another patient from a similar experience.
  4. Come Prepared: Have you created a plan with your treatment team for how you will handle your doctor’s appointments? Have you done research of your own on a suspected condition? Bring this information with you. Write your questions and symptoms down in advance. Bring along a friend or loved one if you need support. When you are prepared, you will be less likely to panic and forget your questions. If you have literature to share with your doctor about eating disorders, weight stigma, or any other condition, share it with your doctor and express how important it is to you that they consider the information. They may not have had a chance to learn about these topics in their medical training.
  5. Connect them to MEDA: MEDA offers free trainings to the medical community on eating disorders and weight stigma. If you feel like your doctor could benefit from a training, connect them to MEDA at or at 617-558-1881.

Resources to bring to your doctor’s office on eating disorders and weight stigma:


Mahr, F. , Farahmand, P. , Bixler, E. O., Domen, R. E., Moser, E. M., Nadeem, T. , Levine, R. L. and Halmi, K. A. (2015), A national survey of eating disorder training. Int. J. Eat. Disord., 48: 443-445. doi:10.1002/eat.22335

Smink, F. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports,14(4), 406-414.

Do I have Orthorexia? 4 Questions to ask

Written by Meg Salvia, MS, RDN, CDE  from Walden Behavioral Care 

Is there such a thing as eating too healthfully?

Orthorexia can be bit of a tricky topic: while it isn’t formally included as its own eating disorder in the Diagnostic and Statistical Manual (DSM-5), there’s growing concern about the physical and psychological impact of striving to eat “properly” in overly “healthy” patterns. At the same time, it seems counterintuitive to be concerned about eating too healthfully.

When is this a problem, and what should you do if you have concerns that this might be an issue for you or someone in your life?

Orthorexia is a pathological obsession or compulsion to eat healthfully or purely. Anorexia nervosa, as included in the DSM-5, includes the hallmark drive for weight loss and thinness. With orthorexia, the goal isn’t necessarily weight loss but a drive to consume foods considered pure, natural, or virtuous—distress is typically experienced around foods perceived as unhealthy. It’s also separate from appropriate or constructive efforts at supporting bodily function, because orthorexia results in a negative impact on functioning or health. 

Although there isn’t an official screening tool or standardized diagnostic criteria to assess (yet this is a work in progress [2]), asking the questions below might highlight if or how orthorexic tendencies might be problematic. It can be helpful to take a look at this from both the mental health and physical health points of view.

1) If my eating choices are driven by a desire to support my body’s health, am I actually meeting my body’s needs?

To support our physical health, meals and snacks need to meet the basic principles of adequacy, balance, and variety. We need to get enough fuel (energy and hydration) to support metabolic functions, include all the major food groups (including carbohydrates, fats, and proteins) and be exposed to a wide variety of foods to engage our senses and provide an array of micronutrients.

It’s certainly possible that pursuing an aggressive eating pattern means we’re not getting all the nutrition our body needs in one form or another. If our choices are rigid, omit entire food groups, or get progressively more and more limited, malnutrition could be a problem.

2) Are you no longer eating foods you once enjoyed?

Often, choosing nutritious foods to help support physical function and overall health means adding foods to ensure adequate intake of healthful foods. “Pathological nutrition” (as eating disorders dietitian and orthorexia expert Jessica Setnick calls it) often results in reductions or limitations around intake. Preference for eating only healthy foods can be a socially acceptable way of restricting our intake.

Is there a sense of fear and anxiety around foods that once brought enjoyment and pleasure? Do you notice your food choices becoming narrower and narrower?

3) Do my eating patterns and choices impact my functioning and engagement in life?

Here are some of the ways that orthorexia can have a negative impact on your daily life, outlook, and mental health:

• Obsessive thoughts: frequent and intrusive thought patterns about what you’re allowed or not allowed to eat, what you’ve eaten in the past, or what you will eat in the future. These thoughts can occupy a large chunk of the day, distract from other activities, or be a frequent and repetitive focus of attention.

• Feeling isolated or socially limited: Do rigid eating patterns or limited permission to eat a variety of foods prevent you from hanging out with friends, socializing with coworkers, or joining family at meals or events? Are your eating patterns helping you plug in to your social life, or are they barriers? Are you only able to socialize with those whose eating patterns look like yours?

• Attaching moral value or self-worth to what are perceived as virtuous choices: Do you see yourself as a better person for the choices you make around food? Are you harsh on yourself when your meals and snacks don’t live up to your own standards? Is this an ever-moving target you never reach? Feeling a sense of accomplishment with nourishing and taking care of our bodies can be appropriate, but if this feels like a significant or inflexible part of your identity or how you judge your self worth, it can be a sign that it’s orthorexia.

• Harsh judgment of yourself or others’ food choices: Are you unable to eat at restaurants based on what else is on the menu? Is your social circle limited because of what others are eating? It might feel uncomfortable to recognize there’s an element of judgment in our assessment of others’ choices. What impact is this having on our lives?

4) What’s the deeper reason behind my food choices?

See if you can identify what is driving your quest to eat healthfully. Have you experienced a health event in your family that brought health and eating patterns to the forefront of your attention? Experiencing a loss or having a health scare often prompts us to evaluate our own health risks or those of other people in our lives; If this feels panicky or obsessive, though, that can be a red flag.

Does making specific food choices give you a sense of control or safety? Are you choosing foods based solely on the fact that they feel safe and won’t cause you anxiety?

If it feels like you’re experiencing any of the above symptoms, or answered yes to any of the questions, know that it is absolutely worth it to get help. As always, we’re here for support.


1. Setnick, Jessica. The Eating Disorders Clinical Pocket Guide, 2nd Edition. 2016 Academy of Nutrition and Dietetics.
2. Dunn TM, Bratman S. On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors. 2016: 21(11-17).

Meg Salvia, MS, RDN, CDE is the dietitian at Walden Behavioral Care’s Peabody clinic. She sees adolescents and adults in the partial hospitalization program as well as in the binge-eating intensive outpatient program. She is also a board-certified diabetes educator (CDE). She began her career working in research at Joslin Diabetes Center and joined Walden Behavioral Care’s team in 2013. Meg earned a Master’s degree in nutrition from Boston University and a BA in English from Boston College.

This blog was originally published March, 2018 at and is republished here with permission. 

Recommendations for Parents of an Adolescent Discharging from Residential Eating Disorder Treatment

Written by Simone Arent of Walden Behavioral Care 

One of the biggest obstacles of eating disorder recovery may come after being discharged from a residential program. Helping your adolescent integrate back into their day to day routine can be challenging for everyone. Remember, recovery is not linear. There may be ups and downs as your family navigates returning to home, school, extracurricular activities, and most likely embarking on treatment in lower levels of care. Here are a few tips to help support this transition.

1.) Cultivate Trust and Open Communication

At the very beginning of the recovery process, trust may need repair. In order to restore trust, open and honest communication is encouraged. Creating transparent and nonjudgmental dialogue between family members can help to decrease shame and lend itself to improved understanding of one another–and the eating disorder. Individuals often find residential treatment to be a place that feels safe to discuss their feelings and thoughts related to their eating disorder. A goal would be to continue this progress at home following discharge. I often tell parents that cultivating an environment where candid discussion about the eating disorder feels comfortable, can help take the power away from the eating disorder, and increase confidence and motivation for recovery.

2.) Identify Triggers

Triggers can be defined as events that create some type of uncomfortable emotion for an individual. Some common emotions that are often reported in those living with eating disorders are shame, guilt, anxiety, sadness and stress among others. In order to best prepare for recovery success outside of treatment, it is crucial to have some understanding about what the triggers are for the individual and for the family. The goal then would be to create a game plan of how–as a family–you can cope in a safe and contained way when those uncomfortable emotions arise. Your treatment team can be great collaborators in helping you to identify these triggers and in brainstorming some helpful coping skills that might be appropriate to use in those difficult moments.

3.) Incorporate Supervision to Support Recovery

Following discharge, one challenge many families face is the increased need for supervision of the adolescent. Going from an environment with 24-hour supervision back home, can feel shocking to many adolescents who may have been in treatment for an extended period of time. After residential care, supervision of all meals and snacks is highly recommended. This added necessary precaution might be difficult with all of the other commitments you might have, so sometimes I suggest that parents/caregivers enlist the help of trusted friends and family for extra support. Oftentimes, schools are more than willing to provide space for the adolescent to be monitored for snack and lunch. In the beginning, supervision can be a lot to balance. Remember that the end goal is to eventually decrease supervision as trust is repaired and the eating disorder has less control.

4.) Ask for Help!

Supporting and caring for someone with an eating disorder can challenge a person or family system in ways you weren’t expecting. The road to recovery can also be long. We want to avoid burnout and running on empty so it will be important for caregivers to have space to talk about their experience and discuss strategies for managing their own emotions. These spaces can support caregivers in feeling and processing things as they arise. We often recommend that parents seek their own therapeutic support through avenues such as parent support groups in addition to family or individual therapy. In order to support your adolescent effectively, taking care of yourself is of utmost importance. Remember you are not alone, and it is okay to ask for help

To learn more about residential treatment at Walden Behavioral Care, please visit

Simone Arent is an adolescent clinical intern at Residential treatment, providing individual, group, and family therapy to adolescents. Simone received her Bachelor’s degree in Psychology from Western New England University, and is currently in pursuit of her Doctorate degree in Clinical Psychology at William James College. Simone works to meet each individual where they are at by using a strength-based approach, and incorporating dialectical and cognitive behavior therapies. In Simone’s free time, she enjoys being outdoors and solving Rubik’s Cubes.

This blog was originally published at in March 2018 and is republished here with permission. 


7 Things Providers Need to Know about Gender Identity and its Effect on Body Image

Written by Christine Lang, MSW, M.Div. from Walden Behavioral Care 

Christine Lang is an adolescent clinician in the partial hospitalization and intensive outpatient programs for Walden Behavioral Care, providing individual, family and group counseling for adolescents and families with eating disorders. This includes a specialized treatment track for LGBTQ individuals

Did you know that transgender youth are four times more likely than their female, cisgender, heterosexual counterparts to have eating disorders? There are many factors that contribute to this population’s higher incidence of increased rates of body dissatisfaction, elevated rates of co-occurring mental health conditions such as depression and anxiety and increased risk for bullying, psycho-social stressors and emotional distress.

Even if you don’t consider yourself a specialist in working with these populations, it is important to have a general understanding of why they might co-exist and how you can best support individuals who present with either or both of these conditions.

1. Both transgender people and people with eating disorders may experience body dissatisfaction – the source of it may be both different and similar. In our culture, we seem obsessed with a particular ideal of “beauty” — one that has prompted an unhealthy diet culture, as well as general body unhappiness. Similarly, a trans person’s body may not match up to our society’s binary gender ideals of either “masculine” or “feminine” bodies, which may cause trans people to embody another layer of body dissatisfaction; neither are their bodies the right gender nor do they fit society’s ideal body type of that gender.

2. According to the current research, it seems that the idea of “an ideal thinness” and the idea of “an ideal femininity/masculinity” are risk factors for developing eating disorders.

3. Not everyone whose gender identities differ from their sex assigned at birth has a negative body image.

4. As clinicians, it’s important to help individuals to understand the function of their eating disorder. Many transgender people report using food and behaviors as a way to manipulate their bodies in an attempt to “better” align with mainstream culture’s idea of beauty and femininity / masculinity. I’ve also seen cases where a client’s eating disorder has nothing to do with either of those things—rather eating disorder behaviors are utilized as a way to cope with difficult situations / emotions. Having this information will help to guide treatment and determine the most appropriate interventions.

5. Our job is also to create a safe space where clients can notice and process their negative thoughts. This means, doing your best to ask for and use preferred pronouns and being aware of the unique stressors that can often be experienced by this population. Eating disorder treatment is hard—we want to make sure we are fostering an environment where individuals can feel comfortable making their recovery their number one priority.

6. Just as we don’t blame parents for the development of their child’s eating disorder, it is important that we help individuals understand that they are not to blame for being gender dysphoric. Those who have gender dysphoria experience a fair amount of body dissatisfaction because of external pressures created by society, which often become internalized forms of oppression. As such, it is important to work with individuals on identifying the difference between external oppression that has been internalized vs their own values and beliefs. Similarly, we work with individuals with eating disorders to be better able to distinguish between the voice of the ED and their own unique thoughts and feelings.

7. In providing an ongoing clinical space for individuals to explore the intersection of their gender identity and eating disorder behaviors, as well as the appropriateness of hormone therapy for themselves, we as clinicians will be better able to help provide long term eating disorder recovery.

If you or someone you work with is transgender and living with an eating disorder, there is hope for recovery.


a) Author: Monica Algars, Katarina Alanko, Pekka Santtilla, N. Kenneth Sandnabba
Title: Disordered Eating and Gender Identity Disorder: A Qualitative Study
b) Jennifer Couturier; Bharadwaj Pindiprolu, Sheri Findlay, Natasha Johnson
Title: Anorexia Nervosa and Gender Dysphoria in Two Adolescents.
c) Stuart B. Murray, Evelyn Boon, Stephen W. Touyz
Title: Diverging Eating Psychopathology in Transgendered Eating Disorder Patients: A report of two cases.
d) Monica Algars, Pekka Santtila, N. Kenneth Sandnabba
Title: Conflicted Gender Identity, Body Dissatisfaction and Disordered Eating in Adult Men and Women
e) Lindsay A. Ewan, Amy B. Middleman, Jennifer Feldmann
Title: Treatment of Anorexia in the Context of Transsexuality: A Case Report
f) Sarah E. Strandjord, Henry Ng, Ellen S. Rome
Title: Effects of Treating Gender Dysphoria and Anorexia Nervosa in a Transgender Adolescent: Lessons Learned
g) Bethany Alice Jones, Emma Haycraft, Sarah Murjan, Jon Arcelus
Title: Body Dissatisfaction and Disordered Eating in Trans People: A Systematic review of the Literature


This blog was originally published on and is republished here with permission.