By: Caroline Christian, B.S.
As anyone who has recovered from an eating disorder knows too well, the road to recovery is never a smooth one. Seeing someone you care about going through this process can be frustrating and confusing. You want to do your best for them, but often it can be hard to even understand or sympathize with what they are going through. Eating disorder recovery is incredibly hard, and everyone going through this process has to work really hard as they endure a lot of really uncomfortable and scary things. If you are having a hard time understanding what eating disorder recovery is like for your loved one, here are just a few of the reasons why recovery can be so difficult.
Giving up on your eating disorder can often feel like losing a friend, or losing a part of yourself. With other types of therapy it can be easier to want to get rid of the illness. For example, with therapy for depression, there is less motivation to want to keep the depression around, as depression doesn’t make you feel good. This makes it a little easier to stay motivated to kick it to the curb. However, eating disorders are not only an enemy, they can also be a friend (see Brenna’s blog post on When an Eating Disorder becomes a Friend). Even though part of your loved one knows that the eating disorder is holding them back, stopping them from enjoying time with family, ruining their relationships with friends, and keeping them in a cycle of disappointment from unrealistic standards, the eating disorder has also been there for them when nobody else was. The eating disorder gave them something to be proud of, it helped with their anxiety (even if just for a brief moment), and it helped them feel in control when everything else was going wrong. Especially if your loved one has been with their eating disorder for a long time, it can start to feel like a part of them. Disentangling this relationship in recovery can be hard, and it can feel like they are losing a friend, ending a relationship, or losing part of their self. This battle of friend vs. foe throughout recovery can drain motivation and make them feel conflicted and frustrated.
Recovery means facing your biggest fears. Another difficult part of recovery is that most of the parts of an eating disorder are designed to make you feel safe and help you avoid (temporarily) scary things. For example, counting calories or avoiding certain foods help prevent the scary or uncomfortable expectation of feeling full, gaining weight, or being judged. But when someone recovers from an eating disorder, they have to face these fears head on. To know what this is like, I want you to imagine your worst fear. Let’s say it is spiders. Now imagine that you have to go into a room full of spiders (or whatever your biggest fear is) every day, and each day there are more spiders and bigger spiders. That’s what eating disorder recovery can feel like. To outsiders, eating certain foods and gaining weight may not seem like a big deal. But when your body is reacting to food and weight like it is a room of spiders, it can be really scary. Having to face your biggest fears isn’t easy for anybody. Your loved one recovering from eating disorders has to put a lot of energy into being courageous in the face of fear, which can be really draining.
You have to put effort into recovery all day everyday. Unlike individuals recovering from substance use disorders, who abstain from using all together and can avoid situations where they may be tempted to some extent, individuals with eating disorders can’t abstain from food. We need food to live, our society is built around food, and messages about food are all around us. Because of this, everyday with an eating disorder means confronting food and other scary situations multiple times. Recovery requires putting thought, effort, and strength into recovery everyday, whether it be the thought that goes into following a meal plan, the effort it takes to challenge negative body talk, or the strength to confront, instead of avoid, difficult emotions. The nonstop effort your loved one has to put in to recovery is a huge part of what makes the process so exhausting and difficult.
If you have a loved one who is struggling in eating disorder recovery, here are a few words of advice from an eating disorder therapist that may help you be there for them as they push through the inevitable hard times.
1. Be patient with the process. Eating disorder recovery can be a slow and difficult. A few months down the road, you may wonder why your loved one is still not eating as much as you’d like, or not hitting goals you have for them. The process of recovery takes a different amount of time for everyone, and pressure from family and friends to get better faster will not speed it up. Try to be patient with your loved one and their own personal journey, and know that just because it has been a long journey, doesn’t mean it is endless.
2. Don’t take things personally. You may notice that your loved one is more irritable, tired, or withdrawn throughout their eating disorder recovery. It can be easy to get frustrated with them. Instead of being offended if your loved one doesn’t come to your events or support you like they used to, know that they are going through a lot, and they may not have a lot left to give. Try to do things to give them support and energy, instead of asking more of them.
3. Try to open lines of communication. Everybody in eating disorder recovery utilizes their support system in a different way. Some people benefit from talking about it, while some would rather process things on their own first. The best thing you can do is let your loved one know that you are there for them and would love to talk with them if and when they want to. You have to find your own balance in which you are not forcing your loved one to talk about their struggles with recovery, as this can add more pressure and frustration for them, but also not avoiding the topic, because that can feel very isolating.
4. Educate yourself. Continue to try to read, talk, and learn about eating disorders. They are much more complicated than just not eating enough, or eating too much. They are complex psychological disorders that researchers are still trying to fully understand and treat. Learning about the disorder and how you can fit in to the picture, will help you be more aware about what your loved one is going through and how to not add stress. For example, not promoting dieting or weight loss around them, as diet culture can make ED recovery more difficult.
5. Be encouraging. Most individuals in eating disorder recovery struggle with slip-ups throughout recovery, which can feel really discouraging. Your loved one in recovery is going to be hard on themselves, and they may even feel like a “failure” when this happens, so what they need from you is encouragement. Try to remind them of all the little victories they have throughout recovery. Remind them that you are proud of them and their growth so far, and tell them about all the awesome changes you have already noticed. This can help them feel supported and energized to keep going when it is hard.
Understanding why eating disorder recovery can be so difficult is an important step to help you better support your loved one through this difficult journey. For more tips on how to support your loved one in various stages of recovery check out NEDA’s advice for caregivers.
Reflections and Advice for Future Clinical Psychology Graduate School Applicants From a 2018-19 Cycle Applicant
This post was written by Shruti Shankar Ram, who is the EAT lab’s outgoing lab manager and will be starting her PhD program in Fall 2019 under the mentorship of Dr. April Smith at Miami University. Shruti also applied during the 2016-2017 cycle and then again during this past cycle (2018-2019). Miami University was her top choice program. Persistence pays off!
While my time at the EAT lab may soon be coming to an end, it marks the beginning of my graduate school career, and the culmination of a successful round of clinical psychology doctoral applications and interviews. Potential applicants for psychology graduate school programs often need to seek out a lot of information on the application process on their own.
Luckily, I had the support and advice from graduate student mentors and professors who helped me on my journey, and I have been able to reflect on some of the things other potential graduate school applicants should know before undertaking the process of applying. Please keep in mind that it is important to consider several factors when deciding which programs to apply for, whether it be doctoral or master’s level programs, but the advice given here will primarily pertain to clinical psychology PhD programs:
1. Research your potential mentor(s) thoroughly, and have as solid of an understanding of your research interest as possible. Especially for PhD programs, it is important to consider your potential mentor more so than the program or university itself, as the work you do in their lab will define your career and PhD training. Spend time thinking about your specific research interests and which mentors will align best. This will also make writing your statement of purpose much easier, and faculty are pretty good at telling when you have a genuine interest in the work and a good fit with their lab. The places I interviewed were the places where my research interests fit best with the research interests of the mentor, regardless of my current skillset or what I'd need to learn after arriving at the program. I think partly this is just because it makes it a lot easier to talk with the mentors about follow-up studies and you're more interested in papers they've probably read as well, so it's just easier to interview. Also be up front with POIs about your research interests, and don't try to change your interests to fit with the lab in the hopes it gets you an acceptance. You're going to be spending several years in this program, so you want to make sure you're doing work you enjoy. Also, they can tell a student who is truly passionate about what they do from one who isn't.
2. Make sure you REALLY want it before you apply. The application process for PhD programs is way too stressful to just do it without extensive thought and planning. Despite the common misconception, you do not necessarily need a PhD to treat patients and be a therapist. As I want to pursue a career in research and academia, I only applied to PhD programs in Clinical Psychology. However, if I wanted to primarily be a practitioner, I would have considered a master’s degree such as a Master of Social Work (M.S.W.) or Master’s in Counseling Psychology (M.S. or M.Ed.). A PsyD (Doctor of Psychology) is another alternative to a PhD (Doctor of Philosophy) for those oriented more towards therapy, and offers more opportunities for higher level practice administration and supervision, but does typically involve more debt. Another important consideration is that PhD programs are typically fully funded, but PsyD and Master’s programs are not, but they also accept far fewer applicants because of this. Think carefully about what your long-term goals are and what degree might make more sense for you, your interests, and finances. If being a clinician is your primary interest, opt for a psychotherapy program that's literally half the amount of time and effort. So while you may have more financial debt, you will have less of a time debt.
3. Talk with anyone in your current department who will advise you. Talk to graduate students, faculty you've worked with, faculty you haven't worked with, etc. Be respectful of their time because everyone is busy, but I asked for as many opinions as I could get. Current graduate students can help you identify potential mentors, assist with personal statements, mock interview you, and potentially even go over offer letters with you. It can be really helpful and insightful to get the assistance of someone who has been through the same process.
4. START EARLY. Everyone that applies to graduate school will tell you to start early, but seriously, start early! Writing statements of purpose and studying for and taking the GRE can be time consuming, so work ahead so that you have everything ready far in advance of your deadline.
5. DO sweat the small stuff. Psychology PhD programs have an acceptance rate of around 7%. Before I applied, I had no idea it was more difficult to be accepted into a PhD program than it was to be accepted into medical school. Because most PhD programs only accept about 5-8 students per year, and each lab typically accepts one student, even little things can make a big difference in your application. Think realistically to make sure your GPA, GRE scores, strong letters of recommendation, research experience in your CV, and number of posters/publications are up to the standard of the graduate schools you are applying to before you apply. PhD programs are getting more and more competitive, so it is becoming more common for people to take years off to work and get research experiences before applying and entering PhD programs.
6. Apply to as many schools and POIs as you can without sacrificing too much of your research interests. As PhD programs are so competitive, it is a good idea to maximize your chances by applying to as many programs as possible. I was advised to apply to at least around 11-15, and I ultimately applied to 13. That may seem like a lot, but with the amount of luck that goes into this process, you need to maximize your chances. It's pretty common to apply to many and then only get 3-5 interviews. There are many individuals with strong applications, but who only apply to 2-3 programs, which considerably lowers their chances. If you have a niche interest, it is a good idea to apply to programs of both your primary and secondary research interest, as long as the labs will allow you to study both.
7. There's a lot of luck and connections that go into this process. Because PhD programs are so competitive, small things like connections can make a big difference. Potential mentors talk to several students, and sometimes they might want to take all of them but just can't. Network as much as possible by attending conferences and making a note of all talks and poster presentations given by the labs you are applying to – attend them and introduce yourself and your intention to apply to both the P.I. AND their graduate students. Everyone in the lab typically has some say in the application and interview process, so make a good impression and network with all lab members you see from those labs!
8. BE RESILIENT. When I interviewed at doctoral programs, a common answer I received when asking potential mentors about what they were looking for in applicants is resilience. The whole process of applying to psychology doctoral programs can be disheartening, and rejection is inevitable – it may take several rounds to be accepted to a program. Not everyone is ready at the same time to start graduate school, so do not be afraid to take time off to get more research experience if needed. I first applied to doctoral programs my senior year in college, and did not get accepted until I applied again two years after graduating and working at the EAT lab during that time. Working at the EAT lab allowed me to develop and refine my research interests and has set me up for success in graduate school, and I have no regrets, no matter how much the initial rejection stung. Initial rejections will pay off in the long-run, as long as you keep working and trusting in the process.
If you are planning to undertake the process of applying to psychology doctoral programs – good luck! Remember to not only work hard, but show yourself self-compassion during this process. It is impressive to even apply for these programs! No matter how difficult it may seem to get into a doctoral program, if clinical psychology and research are truly your career goals, keep working towards those goals and you will get there. Hard work and persistence pay off!
By Irina Vanzhula, M.S.
Its January, and my social media field is filled with articles about New Year resolutions to change our bodies (i.e., lose weight, gain muscle), ways to achieve such resolutions, and negative and judgmental comments about our bodies. What if instead of embarking on another journey that is likely to result in disappointment and self-hate, we consider a different approach this year: Learning to love our bodies. Consider these facts:
If you are even slightly persuaded by body acceptance, read on. First, let’s define acceptance. Acceptance does not mean giving in, giving up, or learning to deal with, but rather to perceive something as adequate or suitable and embrace it without judgment. Here are some strategies to get started on the body acceptance path.
Body acceptance is a process and does not happen in one day. You are used to thinking about your body in a particular way, and it will take time to shift that perspective, but it is definitely possible. Just think of what you can do with the extra time and energy when you are not constantly worrying about how your body looks!
Bacon, L., & Aphramor, L. (2014). Body respect: What conventional health books get wrong, leave out, and just plain fail to understand about weight. Dallas, TX, US: BenBella Books.
Barry, V. W., Baruth, M., Beets, M. W., Durstine, J. L., Liu, J., & Blair, S. N. (2014). Fitness vs. Fatness on All-Cause Mortality: A Meta-Analysis. Progress in Cardiovascular Diseases, 56(4), 382–390.
Chao, A. M., Jastreboff, A. M., White, M. A., Grilo, C. M., & Sinha, R. (2017). Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight. Obesity (Silver Spring, Md.), 25(4), 713–720.
Lowe, M. (1987). Set point, restraint, and the limits of weight loss: A critical analysis. In Treating and preventing obesity. Johnson, William G., (Ed); pp. 1-37; US: Elsevier Science/JAI Press.
Matheson, E. M., King, D. E., & Everett, C. J. (2012). Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals. The Journal of the American Board of Family Medicine, 25(1), 9–15.
Meisel, S. F., & Wardle, J. (2014). “Battling my biology”: psychological effects of genetic testing for risk of weight gain. Journal of Genetic Counseling, 23(2), 179–186.
Patel, S. R., & Hu, F. B. (2008). Short Sleep Duration and Weight Gain: A Systematic Review. Obesity, 16(3), 643–653.
By Brenna Williams, B.A.
Think about this: What do you look for in a friend? Maybe you look for someone who is kind and trustworthy. Maybe you think a good friend would always be supportive and lift you up when you feel down. Maybe you search for people who are particularly fun to be around and tell great jokes. Whatever you look for, usually our friends are people who make us feel good about ourselves. But what happens when an eating disorder becomes your friend?
Sometimes people with eating disorders experience an inner critical voice, commonly called “the anorexic voice” or “the disembodied voice” in research (Pugh & Waller, 2016; Pugh & Waller, 2017), but more commonly named “Ana,” “Mia,” or “Ed” by those with eating disorders (Williams & Reid, 2012). While this voice is most commonly found among individuals with anorexia nervosa, it is found among all eating disorders (Pugh & Waller, 2017). This eating disorder voice is not a hallucination, but a perception of thoughts in the second or third person (Pugh & Waller, 2017). It says things like “You’re so fat,” “You have to be thinner,” “You shouldn’t have eaten that,” and “No one will love you unless you are perfect.” It may be difficult to think of this voice as a friend. It’s saying things that would make any person upset. So why do people with eating disorders commonly view this voice as a friend (Williams & Reid, 2012)? It may have to do with the onset of the voice.
The voice develops with the eating disorder, starting off by praising the person for losing weight or restricting their food intake (Tierney & Fox, 2010). Ultimately, the voice assists the person in gaining a sense of control over their lives and reinforces them in their disordered eating behaviors. It also offers support and companionship during a time where many people with eating disorders may isolate themselves from others (Damiano et al., 2015). However, as the eating disorder continues to progress, the voice becomes more critical (Tierney & Fox, 2010). The voice shifts from being a friend to a foe (Williams & Reid, 2012) and begins to repeat harsh words similar to the ones mentioned above. Not only that, but the voice becomes grows even more harsh if the person attempts to recover (Tierney & Fox, 2010). As a result, the voice has been theorized to be a maintaining factor of eating disorders (Pugh & Waller, 2017). The voice could also be a potential reason for the high remission and relapse rates among people with eating disorders (Keel & Brown, 2010; Keel et al., 2005).
There is hope, however! Researchers are beginning to study the voice in an effort to better understand it (Pugh & Waller, 2017). As we being to better understand the voice, we will also be better able to treat it and potentially reduce remission and relapse rates. It may be difficult to break the relationship with this friend/foe and recover from an eating disorder, but it is possible!
Please tell us about your experience with the eating disorder voice in the comments!
By Shruti Ram, B.S.
In today’s culture, people in the United States live in a media-saturated environment, and over 92% of American adolescents report going online every single day (Elmore, Scull & Kupersmidt, 2018). Social media allows us exchange and develop ideas and stay connected with each other, but it also allows us to monitor others’ social lives, compare ourselves to others, and quantify our friendships. It may not come as a surprise, but increased media exposure has been associated with increased anxiety, depression, drug abuse and eating disorder symptoms (Mabe, Forney, Keel, 2014; Elmore, Scull & Kupersmidt, 2018), leading researchers to label social media as “super peer” to adolescents.
So how exactly does social media influence the development of disordered eating?
Social media use has been found to be a risk factor for adolescents with eating disorders, and increased engagement in image-centric social media platforms such as Instagram, Facebook and Snapchat have been associated with increased body satisfaction, drive for thinness, perfectionism, and social comparison across different genders and races (Mabe, Forney, Keel, 2014; Howard et al., 2017; Griffiths, Murray, Krug & McLean, 2018). Individuals with disordered eating are more likely to spend time on image-centric social media, place increased importance in receiving likes and comments, spend more time editing photos, and compare their own photos to other individuals on social media (Bennett, 2018).
One reason this might be the case is that existing eating disorder symptoms might drive maladaptive uses of social media. The terms “thinspiration” and “fitspiration” are increasingly being used in order to reference something serving as motivation for a person seeking to maintain a very low body weight. The abundance of “thinspiration”, “fitspiration” and other pro-anorexia blogs and social media accounts can be used to disseminate information about harmful eating disorder behaviors, such as extreme restriction, exercise, and laxative use. These communities normalize these harmful behaviors, and often romanticize eating disorders and mental illnesses, contributing towards the development of worsening of symptoms (Branley & Covey, 2017). Social support, typically seen as a prosocial aspect of social media, can thus become harmful.
Censorship of these pro-anorexia sites and forums may have a minimal effect on disordered eating, considering the pervasiveness of the thin ideal in our everyday lives, which is present even in generic messages. Whether it is celebrities endorsing laxative “flat-tummy tea” or the increased popularity of photoshop and facetune to erase everyday imperfections, individuals have reported being less satisfied with their lives and bodies (Griffiths, Murray, Krug & McLean, 2018). Moreover, censorship would discount the positive effects of social media, such as the use of social media for pro-recovery and relapse prevention groups.
As social media continues to become a bigger part of our daily lives, it is important to consider its role in contributing towards eating disorder symptoms and the harmful idealization of the thin ideal. One way to combat the negative messages represented in the media is through media literacy.
What is social media literacy?
Media literacy, and specifically social media literacy, could be a promising form of eating disorder prevention. Media literacy is the ability to access, analyze, evaluate, and create media in a variety of forms (McLean, & Paxton, 2018). The idea behind media literacy is that individuals should be educated on informed interpretations of the media, and be able to critique images and to make an assessment about how realistic or otherwise images are. Social media literacy is a novel approach to media literacy (McLean et al., 2017; McLean, & Paxton, 2018) that includes two perspectives:
Social media literacy allows us to see the motivations for messages we are fed. Commercial messages have idealized images in order to sell us a product. Brands like Victoria’s Secret attempt to sell us a heavily edited fantasy in order to increase sales for their lingerie, profiting off of women’s body dissatisfaction. On the other hand, messages from our peers may lead us to believe that their lives are perfect, but your friend’s perfectly curated Instagram feed does not show the hidden insecurities we all may have about our appearance, career, or relationships.
One popular message that has been circulating in social media recently has been to ask yourself “who profits off this emotion?” in response to body/appearance dissatisfaction – this question is an excellent way to challenge appearance ideal norms in social media. The reality is that no one is perfect, despite what the smiling, filtered images on social media may be telling you. Holding yourself to an unrealistic standard benefits no one but the corporations that are profiting from it.
Pilot tests of social media literacy as a prevention program for eating disorders have proven successful (McLean et al., 2017; Tamplin), however, everyone can benefit from it. Through social media literacy, we can begin to understand that social media is not a healthy scenario for social comparison. We are less likely to post about our personal failings, or images that show our imperfections, and the same is true for celebrities and magazines. Becoming social media literate allows us to realize the discrepancy between social media and “real life”. It shows us that comparison on social media is unrealistic – we are comparing our “real” selves with others’ “best” selves, whether it be on Instagram or the pages of Cosmopolitan.
Another idea related to social media literacy is evaluating the time you spend on social media altogether. The number of social media networks you are active on is associated with increased negative outcomes, and reduced time on social media has been associated with a variety of positive outcomes for mental health (Primack et al., 2017). If you find yourself spending more time on social media rather than enjoying experiences with your loved ones, or engaging in other hobbies, you may find yourself more at risk for social media’s negative influences. There are many benefits to social media, but if you find yourself obsessing over getting the perfect picture or looking at other people’s achievements, you may run the risk of not living in the moment, and hence feeling less satisfied with your own life.
We might not have the power to regulate standards in the beauty and entertainment industries, but we can make changes in our own lives to minimize the negative impact the appearance ideal has in our daily lives. Social media literacy has the potential to reduce disordered eating symptoms, as well as increase satisfaction in our lives and appearances. However, you might be doing yourself a favor by just logging off.
Bennett, M. (2018). Factors contributing to eating disorders in pre-adolescents. Dissertation Abstracts International: Section B: The Sciences and Engineering. ProQuest Information & Learning. Retrieved from http://echo.louisville.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2017-43829-143&site=ehost-live
Branley, D. B., & Covey, J. (2017). Pro-ana versus pro-recovery: A content analytic comparison of social media users’ communication about eating disorders on Twitter and Tumblr. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.01356
Elmore, K. C., Scull, T. M., & Kupersmidt, J. B. (2016). Media as a "Super Peer": How Adolescents Interpret Media Messages Predicts Their Perception of Alcohol and Tobacco Use Norms. Journal of youth and adolescence, 46(2), 376-387.
Primack, B. A., Shensa, A., Escobar-Viera, C. G., Barrett, E. L., Sidani, J. E., Colditz, J. B., & James, A. E. (2017). Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among US young adults. Computers in human behavior, 69, 1-9.
Griffiths, S., Murray, S.B., Krug, I., McLean, S.A. (2018) The contribution of social media to body dissatisfaction, eating disorder symptoms, and anabolic steroid use among sexual minority men. Cyberpsychology, Behavior, and Social Networking. 21(3):149-156. doi:10.1089/cyber.2017.0375.
Howard, L. M., Heron, K. E., MacIntyre, R. I., Myers, T. A., & Everhart, R. S. (2017). Is use of social networking sites associated with young women’s body dissatisfaction and disordered eating? A look at Black–White racial differences. Body image, 23, 109-113.
Mabe, A. G., Forney, K. J., & Keel, P. K. (2014). Do you “like” my photo? Facebook use maintains eating disorder risk. International Journal of Eating Disorders, 47(5), 516–523. https://doi.org/10.1002/eat.22254
McLean, S. A., Wertheim, E. H., Masters, J., & Paxton, S. J. (2017). A pilot evaluation of a social media literacy intervention to reduce risk factors for eating disorders. International Journal of Eating Disorders, 50(7), 847–851. https://doi.org/10.1002/eat.22708
Powers, K. L. (2018). Social media use and media literacy in relation to adolescents’ understanding of the internet. Dissertation Abstracts International: Section B: The Sciences and Engineering. ProQuest Information & Learning. Retrieved from http://echo.louisville.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2018-00726-191&site=ehost-live
Tamplin, N. C., McLean, S. A., & Paxton, S. J. (2018). Social media literacy protects against the negative impact of exposure to appearance ideal social media images in young adult women but not men. Body Image, 26, 29–37. https://doi.org/10.1016/j.bodyim.2018.05.003
Teo, N. S. Y., & Collinson, S. L. (2018). Instagram and risk of rumination and eating disorders: An Asian perspective. Psychology of Popular Media Culture. https://doi.org/10.1037/ppm0000205
By: Caroline Christian, B.S.
Eating disorders affect approximately 10% of the population (Stice, Marti, & Rhode, 2013). Despite this, effective treatments for eating disorders are extremely limited. The empirically supported treatments for binge eating disorder and bulimia nervosa have relapse rates estimated to be as high as 50% (Olmstead, Kaplan, & Rockert, 2005). Additionally, the only empirically supported treatment for anorexia nervosa is for adolescents, meaning there are no effective treatments for adults with anorexia nervosa. Our lab is working hard to try to fill this need by researching new interventions for treating eating disorders, such as imaginal exposure therapy and personalized treatment for eating disorders.
Because treatment interventions for eating disorders are currently not as advanced as we would like them to be, eating disorder prevention is even more critical. Prevention and early detection of eating disorders has the potential to drastically reduce the high prevalence of eating disorders, and thus, reduce the number of individuals who struggle with treatment-resistant eating disorders. Our lab has recently been trained in the Body Project, which is a dissonance-based eating disorder prevention program. We are very excited to disseminate this program around Louisville and on University of Louisville’s campus to help reduce the burden of eating disorders on our community.
What is the Body Project?
The Body Project was first developed by Dr. Carolyn Becker, a professor at Trinity University in San Antonio. She first implemented the college version of the Body Project in collaboration with Delta Delta Delta Sorority, and the program quickly expanded to several colleges around the nation. The purpose of the Body Project is to inform young women about the “appearance ideal,” which is the “perfect” appearance, as promoted by society, which is often unrealistic and unattainable. After discussing this ideal, participants then brainstorm the costs of pursuing this unattainable ideal and learn skills and activities they can do to act and speak against this ideal. This intervention has shown to be effective in reducing eating disorder symptoms, thin ideal internalization, and body dissatisfaction in young women (Stice et al., 2013; Stice, Rohde, Gau, & Shaw, 2009). Additionally, individuals at the Body Project are also working on developing and validating new versions of this intervention for different groups, including cultural minorities, non-English speakers, males, and middle school students. This could allow for the Body Project to reach more people across the world and prevent eating disorders in more individuals! Two versions of the intervention that we currently have in Louisville are the 4-session high school version and the 2-session peer lead version for college students.
High School Version
The high school version in Louisville is conducted in four one-hour sessions and takes place during the school day as part of the health class curriculum. So far, the Body Project has been conducted at Mercy and Presentation Academy in Louisville. In an investigation of the effectiveness of the Body Project in these Louisville high schools, we found that the Body Project reduced eating disorder symptoms, body dissatisfaction, as well as many other eating disorder risk factors and comorbidities, including anxiety, depression, and maladaptive perfectionism (Christian et al., 2018). This upcoming year we are planning to expand this program even more, and there is currently a call for interested individuals to become a trained facilitator of the high school version of the Body Project. If you are interested in attending a training event, please reach out to firstname.lastname@example.org for more details on the training and the Body Project.
This January, a group of students and professionals from the Eating Anxiety Treatment (EAT) lab, the Louisville Center of Eating Disorders, and the Psychological Services Center underwent a training for the peer-led version of the Body Project, so that we can start disseminating it to college students at the University of Louisville. We have already done a few sessions of the Body Project on campus in collaboration with the Women’s Center, and they were very successful. This semester, we are planning on expanding the reach of the Body Project at UofL by turning it into a Registered Student Organization (RSO). We hope that this RSO will allow for students who are passionate about eating disorder prevention or spreading body positivity on UofL’s campus to get more involved, as well as create a sustainable model of disseminating the Body Project on campus. In addition to doing the peer-led Body Project with interested groups, we also hope to spread a body positive message that could change the campus culture around body image by partnering with other groups to promote external events and initiatives. If you are interested in being part of this new RSO, please contact email@example.com to learn more about the RSO or to RSVP for the peer-led Body Project facilitator training.
We are very excited to bring the Body Project to Louisville to help increase awareness and prevention of eating disorders in our community and on the University of Louisville campus! We hope that through disseminating this intervention, we will spread a body positive message to more individuals and decrease the number of friends, family members, and neighbors that struggle with eating disorders in our community.
Christian, C., Brosof, L. C., Vanzhula I.A., Williams, B. M., Shankar Ram, S., Levinson, C. A. (2018). The Efficacy of a Dissonance-Based Eating Disorder Prevention Program in the Reduction of Eating Disorder Comorbidities and Risk Factors in High School Students. Manuscript submitted for publication.
Olmsted, M. P., Kaplan, A. S., & Rockert, W. (2005). Defining remission and relapse in bulimia nervosa. International Journal of Eating Disorders, 38(1), 1-6. DOI: 10.1002/eat.20144
Stice, E., Butryn, M. L., Rohde, P., Shaw, H., & Marti, C. N. (2013). An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students. Behaviour Research and Therapy, 51(12), 862-871. DOI: 10.1016/j.brat.2013.10.003
Stice, E., Marti, C., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology. 122(2), 445. DOI: 10.1037/a0030679.
Stice, E., Rohde, P., Gau, J., & Shaw, H. (2009). An effectiveness trial of a dissonance-based eating disorder prevention program for high-risk adolescent girls. Journal of Consulting and Clinical Psychology, 77(5), 825. DOI: 10.1037/a0016132
By: Leigh C. Brosof
This year’s fifth-annual Louisville National Eating Disorder Association (NEDA) Walk was held a few weeks ago on September 15 at Bellarmine University. From the speakers to the attendance (497 people registered!), it is clear that the community rallying around eating disorder awareness and advocacy only continues to grow in Louisville. This growing sense of community is imperative in Louisville to increase resources devoted to eating disorder treatment, decrease stigma, and letting individuals in recovery or recovering from eating disorders know that they are supported and that there is hope.
Ken Fleming, a Kentucky State Representative, who helped spearhead legislation recognizing an eating disorder awareness week in Kentucky, spoke about the steps being taken in Frankfort to help address legislation surrounding eating disorders. I was lucky enough to attend one of these meetings in Frankfort and got to see the legislative process in action!
Dr. Andrea Krause, a pediatrician in Louisville, spoke about the seriousness of eating disorders and how professionals work with families and individuals with eating disorders to treat these disorders and work toward recovery.
Megan Ward gave an inspiring speech about her personal struggles with an eating disorder and how she ultimately was able to get the help she needed to reach recovery. She also spoke powerfully about how eating disorders come in all shapes and sizes and do not discriminate based on age, race, ethnicity, gender, or anything else.
This message was echoed by the last speaker of the day, former MLB catcher and NEDA Ambassador Mike Marjama, who battled with an eating disorder while playing professional baseball and now works to increase awareness about eating disorders in all individuals. This was truly an important message for everyone to know that eating disorders do not “look” a certain away, that they can affect anyone, and that everyone is worthy of treatment.
Ultimately, all of the money raised through NEDA goes directly back to clinical resources, awareness about eating disorders, research endeavors, and to help our local community continue to fight eating disorders. Fundraising efforts for the Louisville NEDA Walk continue through October 15.
To donate, go to: https://nedawalk.org/louisville2018. It was a powerful day to remind our community that we continue to get stronger in the fight against eating disorders, and that if you struggle, there are others around you to support you, and there is help and hope available for a full recovery.
If you or a love one is struggling with disordered eating, there is help available. NEDA offers a helpline to speak to someone about seeking help, and a screening tool to help identify if any eating concerns you are having may be an eating disorder.
NEDA Helpline to speak to someone over the phone:
By: Lisa Michelson, M.A
Upon hearing about the experiences my lab had at the 2018 International Conference on Eating Disorders in Chicago, Illinois, we discussed the controversial nature that exists when researchers use “triggering,” terminology. Audience members became upset with certain researchers who used words such as “overweight,” and “obese,” which were used to describe study participants. These words have been part of the terminology present in fat-shaming, fat discrimination, and micro aggression towards a population that society has deemed to have above average weight. Furthermore, these words become associated with individuals that society has frequently labeled as “lazy” or “incapable” as dictated by their portrayals in films, television, and other media outlets. However, this begs the question: Should researchers use these words if they are so triggering in the public domain? The answer is complicated.
“Obese,” comes from the latin “obesus,” which means “fat, stout, plump.” It was believed that Hippocrates recognized obesity as a medical condition as it gave rise to the onset of other diseases (Christopoulou-Aletra & Papavramidou, 2004). The modern term “obesity,” one that became stigmatized by society today, took shape in 1942, when The Metropolitan Life Insurance Company began to determine mortality rates based off of age and weight. For the first time, individuals were standardized and the notion of what an individual “should” weigh was popularized (Statistical bulletin of the Metropolitan Life Insurance Company). While initially designed to determine “desirable weight” dependent on age, height and mortality values, the insurance company changed the medical term into one that society was able to pass medical judgment on, completely discounting the innate nature in which all bodies are different.
Researchers Meadows and Danielsdottir (2016) said it best, “Part of the problem is that the very act of labeling is a process of othering, one that creates a distinction between us and them; which raises the question: who is entitled to do the labeling and why, and in what conditions is such a distinction needed?” Within research, othering is needed in order to determine differences between two groups of individuals. However, when presenting research, the two groups must be labeled in order for other researchers to understand what populations the research is being done on. The questions Meadows and Danielsdottir (2016) raise are both legitimate and further contemplation could give rise to an ethics paper worth developing.
However, I argue, researchers ought to be allowed to use the triggering word, upon critical consideration, as long as its intent is to use the word as it originally appeared in the dictionary and not one that was shaped from societal norms. I recognize this statement contains many caveats, like “what if the word in the dictionary was created offensively in the first place?” It is the responsibility of researchers to develop a common word that can be used for research purposes.
Let’s say for instance, researchers were to change the word of a specific demographic every time social norms dictate it as “triggering.” Not only would this be a disservice to the population in which the research was presented on, but also could have a negative impact on the research itself. For example, if researchers cannot come up with a common language for the subject in which they are communicating, then the ability to share research will be dependent on how long the terminology within that research is deemed “acceptable.” For this reason, when reporting on demographics, researchers ought to be careful in the first place of the terms they do use.
In the end, I believe that “obese” as a research term ought to continue to be used, reporting results unbiased without regard to social norms. Further, if new information comes to light, for example if it was discovered that Hippocrates used “obese” as a derogatory term, then it is the ethical responsibility of researchers to utilize different terminology for this demographic.
By: Shruti Shankar Ram
While the culture in the United States has come a long way in terms of normalizing and destigmatizing mental illness, particularly with respect to depression and anxiety, there are still a lot of misconceptions and stereotypes surrounding other mental illnesses, such as eating disorders and obsessive-compulsive disorder. Eating disorders, and mental illness in general, is still a taboo topic in a lot of communities, specifically among people of color.
As an Indian-American, I have witnessed the culture surrounding mental illness within my community. Rather than being seen as a real illness that warrants the same attention and level of care as a physical ailment, mental illness is often dismissed and not legitimized. Even when one’s mental illness is acknowledged, their family might try to explain it by giving it a biological cause, such as rationalizing it as a thyroid dysfunction. Due to a myriad of sociocultural factors, South-Asians face unique barriers to seeking treatment for eating disorders.
One issue is that eating disorders are still stereotyped as an issue that only affects young, affluent, White women. In reality, eating disorders affect people of all genders, ethnic groups and ages (Marques et al., 2011).
While extensive research on eating disorders has been conducted in European-American populations, and some research has been conducted in African, Latin-American, and Hispanic populations, eating disorder research has been historically sparse in Asian populations (Soh & Walter, 2013). Research has suggested that referrals to eating disorder services from South-Asian populations are under-represented (Abbas et al., 2010), despite evidence suggesting that rates of disordered-eating behaviors are similar to the rest of the population (Wales et al., 2017). Studies have also shown that there is a high prevalence of disordered eating behaviors in minority populations in general (Solmi et al., 2014), and research in South-Asian populations have suggested that the incidence of certain eating disorders, specifically bulimia nervosa, is higher in South-Asian populations than White populations (Mumford et al., 1991).
Eating disorders are particularly relevant in the South-Asian community due to role that food plays in the culture. Any large gathering of family or friends usually involves a lot of sugary, fatty food, and people are encouraged to socialize and eat, and those that do not partake are seen as asocial. However, it is also a common occurrence in the South-Asian community to have various relatives or family friends comment on various aspects of one’s life, including one’s physical appearance. In the Indian community, being light-skinned and thin are seen as not just sufficient, but necessary to be considered attractive, if you are a woman. Societal pressure in the form of comments or suggestions are often made if a woman does not match this ideal body type, conditioning individuals to go to extremes pursuing this ideal. Research has found that this is a common theme in the South-Asian community that can prime individuals to develop disordered eating habits and behaviors (Wales et al., 2017). Much of this pressure is faced by young women and adolescent girls, as patriarchal norms dictate that they are expected to look attractive to find an ideal husband. Men in the South-Asian community also face the same societal pressures, but generally to a lesser extent. Older women often note that they do not face the same pressures after marriage, though some pressures still exist. This dual pressure to eat in social settings and yet maintain a thin figure may be one reason why there is a higher than average prevalence of bulimia nervosa in South-Asian women, and why anorexia nervosa might not be as common (Mumford et al., 1991; Abbas et al., 2010). Klump and Keel (2003) also provide other explanations on cultural differences in eating disorders, and their research has found that bulimia nervosa has greater variability cross-culturally than other eating disorders, such as anorexia nervosa.
Additionally, women who are part of the South-Asian diaspora, but who live in the Western world face experience many conflicting messages about food and weight, as they are exposed to more traditional South-Asian influences from their family, as well as being exposed to various Western disordered eating triggers such as peer pressure, pictures of thin celebrities and pro-anorexia websites.
Not only do South-Asians face unique sociocultural pressures that may contribute towards disordered eating, but they also face barriers to seeking treatment. One of the biggest barriers to accessing services is lack of knowledge – while younger South-Asians tend to be more aware and exposed to ideas about mental illness, they may be dismissed by elder family members or friends. The lack of communication and understanding of the seriousness of eating disorders can keep younger South-Asians from accessing care, particularly if they are dependent on family members to assist with paying for treatment (Wales et al., 2017). This goes along with the general stigma surrounding mental illness in the South-Asian community – seeking treatment involves acknowledging the mental illness, and many South-Asians do not want to admit that there is a “problem” in their family or community.
While South Asian populations face these unique barriers to accessing care for eating disorders, progress is still being made. Mental health is being discussed in a serious way in South-Asian media, such as in Bollywood movies, reshaping the way it is viewed by the general population. However, increasing eating disorder research on this understudied population is important, as it could contribute towards reducing barriers to treatment and improving quality of care to the South-Asian population. Moreover, eating disorders may present differently in Eastern populations versus Western populations, so more research needs to be done to parse out if such differences exist. Additionally, normalizing topics within these communities is essential, as stigma can keep South-Asians from accessing mental health services, even when readily available.
Abbas, S., Damani, S., Malik, I., Button, E., Aldridge, S., & Palmer, R. L. (2010). A comparative study of South Asian and non‐Asian referrals to an eating disorders service in Leicester, UK. European Eating Disorders Review, 18(5), 404-409.
Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological bulletin, 129(5), 747.
Marques, L., Alegria, M., Becker, A. E., Chen, C. N., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders, 44(5), 412-420.
Mumford, D.B., Whitehouse, A.M., & Platts, M. (1991), Sociocultural correlates of eating disorders among Asian schoolgirls in Bradford. The British Journal of Psychiatry, 158(2), 222-228.
Soh, N.L. & Walter, G. (2013), Publications on cross-cultural aspects of eating disorders. Journal of Eating Disorders, 1(1), 1-4.
Solmi, F., Hatch, S.L., Hotopf, M., Treasure, J. and Micali, N. (2014), Prevalence and correlates of disordered eating in a general population sample: the South East London community (SELCoH) study. Social Psychiatry and Psychiatric Epidemiology, 49(8), 1335-1346.
Wales, J., Brewin, N., Raghavan, R., & Arcelus, J. (2017). Exploring barriers to South Asian help-seeking for eating disorders. Mental Health Review Journal, 22(1), 40-50. doi:10.1108/MHRJ-09-2016-001
By Irina Vanzhula, M.S
Everyone experiences shame and guilt at times. While these emotions can be helpful in guiding our social behavior, they can also bring a lot of discomfort and even trigger depression and other psychological disorders, such as eating disorders. Let’s differentiate between shame and guilt, describe in which situations they can be useful or harmful, and discuss how to cope with them.
Guilt is an unpleasant emotion about something we have done. It is often used synonymously to remorse, meaning that we regret the action, and guilt may involve sadness and empathy towards the person harmed. Guilt is generally seen as a useful emotion that encourages us to follow moral and societal norms. For example, we may feel guilty about lying to a friend or skipping a volunteering shift at the local shelter. Guilt may also occur if we act inconsistently with our personal values. For example, someone who values family above all else may feel particularly guilty about skipping a family holiday dinner.
In contrast to guilt that involves feelings about an act one has done, shame involves negative feelings about oneself. Shame encompasses a feeling of inferiority and perceiving oneself as a small, lesser person, worthless, and a failure. Another way to differentiate guilt and shame is by what the emotion urges us to do: guilt usually triggers a desire to apologize and redeem oneself, while shame may lead to a desire to hide or escape. Although shame can be helpful in some situations (i.e. serious wrongdoing) and is used in programs redeeming violent offenders (Loeffler, 2009), it generally is associated with increased distress and may lead to depression, self-harm, and disordered eating (Muris, 2015).
Feelings of guilt can also be harmful if it is based on an irrational belief, such as feeling guilty for something that was not our fault. For example, if we witness an injustice, we may feel guilty because we think we could have done something to prevent it. Guilt can also transform into shame if a “bad” action is interpreted as having occurred because one is a “bad” person. Example: “I feel guilty that I didn’t visit my family this month” can lead to two different outcomes: 1) Call or visit the family to release the guilt or 2) Feelings of shame because “I am a bad son.” The problem with feeling shame in the second scenario is that it may lead the individual to further avoid visiting family and feeling even more shame.
How then can we cope with guilt and shame? First, check your guilt or shame statement for accuracy. Was it really your fault? Can you think of anyone or anything else that may have contributed to the situation? Make a list of any other possible causes and state how much you think each cause contributed in percentage. Then add up all the percentages and subtract from 100%: How much is left? You may want to do this exercise with someone else who can help you see all the perspectives.
To cope with shame, it can be very helpful to examine the evidence and rewrite shame statements into statements of guilt. For example, if you got frustrated and yelled at your child, does it really mean that you are a bad parent? Generally, we want to change the statement from “There is something wrong with me” to “I have done something wrong.” Most of the time, a guilt reaction is more accurate than shame.
Statement of shame: I yelled at my child again! I am a terrible parent.
Statement of guilt: I feel guilty about yelling at my child.
What if you truly have done something bad and can’t shake the regret or shame? Think back to the situation and answer these questions: What purpose did this action serve to you at the time? What did it help you accomplish? What would have happened if you didn’t make that choice in the moment? It’s easy to see what we did wrong looking back and knowing what we know now; it’s called hindsight bias. Most often, we make the best decision based on what we knew at the time.
Finally, if logic and reason are not helpful in dealing with guilt and shame, practice self-compassion. Most of us are very good at being compassionate towards others, but find it hard to be compassionate to ourselves. Self-compassion entails being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or beating ourselves up with self-criticism. Imagine that your close friend or a loved one tells you about their guilt or shame, what would you say to them? Say those words to yourself. You can also find many useful self-compassion exercises on Cristin Neff’s website http://self-compassion.org.