Reflections from the NEDA walk
By: Cheri A. Levinson, Ph.D.
I was fortunate to join over 200 fellow walkers on Saturday to fight against eating disorders and bring awareness to the psychiatric disorder with the highest rates of mortality. I left the walk feeling extremely inspired. Inspired to continue the hard work that my team at the University of Louisville (www.louisvilleeatlab.com) and at the Behavioral Wellness Clinic (http://bewellproviders.com/) spend our lives on.
Perhaps the most inspiring part of the walk was the community of people coming together showing our state and the city of Louisville how many people are impacted and that we are not alone. As I said in my speech (read full transcript here) ‘…every day I have conversations with people, many of you who are here, many who are across the globe, but all who care about changing society and the treatment of EDs for the better. This inspires me.’ It was inspirational to see so many people come together to bring about change. It made me feel not alone, as I am sure it did to most all who attended the walk.
But I also left the walk feeling that a few messages still need to be communicated. A WDRB article (http://www.wdrb.com/story/36382951/hundreds-take-part-in-walk-at-bellarmine-university-to-raise-awareness-of-eating-disorders) covered the walk and highlighted two points. First, more treatment centers are needed locally. Second, there is very little research funding allocated to eating disorders. These messages need to be out there. But I also think that a word of caution is needed when putting these messages to the public.
More treatment centers are needed locally. Yes! This is a given. Our community needs a treatment center. We are a city of 1 million people, meaning at least 70,000 people in our community have an eating disorder. We need more access to empirically-validated treatments in Louisville. Key words here are empirically-validated treatments. We need to be careful about recruiting an eating disorder center to our community. Treatment centers vary in the quality of treatment provided. I can say from experience (and from research) that there is often a huge gap in the type of treatment that is provided and the type of treatment that *could* be provided. We need a treatment center in Louisville, but we need more than a ‘status quo’ treatment center that will provide sub-optimal care.
More funding for research is needed. Figures from the National Institute of Health show a huge discrepancy in the funding allocated to eating disorders versus other mental and physical health problems given the societal and personal costs. In plain language, research in the eating disorders is extremely underfunded. I am in the process of applying for three national grants. Two from NEDA and one from the National Institute of Health that would establish UofL as the primary site in a network of seven treatment development centers. In my opinion (which is of course, obviously biased) these grants hold the power to transform eating disorder treatment. Unfortunately, the stark reality is that the likelihood of receiving these grants are low, not because they shouldn’t be funded, but because there are not enough research dollars.
I do not see either of these issues as separable. The ideal treatment center is grounded in research and good research that has real impact is grounded in actual treatment. We stand at the cusp of an opportunity to create a world-renowned, state of the art, treatment, research, and training facility right here in Louisville that will provide treatment, development of novel treatments, and training, that our state (and nation) desperately needs. We are working hard at UofL and at the Behavioral Wellness Clinic to make these goals happen, but the more support, both financial and physical we receive, (which can only happen through awareness) the faster we can make this a reality, so that we can decrease the extreme amount of suffering and impairment that eating disorders cause.
Anorexia Nervosa in Russia
By: Irina Vanzhula
I grew up in the city of Saint-Petersburg, Russia and moved to the United States 10 years ago. I have noticed many differences, including how women’s sizes are perceived in each country. A woman wearing dress size 8-10 in the US would be considered by most to be of normal weight, but in Russia, she would be called overweight. Most clothing stores do not even carry sizes higher than 10, and Plus size starts with 12. The “normal” clothing size in Russia is 0-4, and women go to considerable lengths to obtain this size at all costs. The thin-ideal is pervasive in Russian culture with its famous ballerinas and supermodels.
My 14-year old brother Vasya is a student at the world famous Vaganova Academy of Russian Ballet. He spends about 6 out of his 12-hour day dancing and only eats once a day. He is underweight, but is repeatedly told that if he gains weight he will be kicked out of the Academy. Vasya is not the only one. Although media’s focus on thin bodies is ubiquitous across countries, Russian women experience additional pressures to look “perfect.” Russia has approximately 85 men for 100 women, and considering very high rates of substance abuse in men, the number of ‘quality bachelors’ is even lower. To be competitive, Russian women pay extreme attention to their looks, including body weight and shape. It is considered necessary to dress up and do hair and make-up just to go to a grocery store, and wearing sweatpants in public is unthinkable. Much of woman’s value is based on looks, and being thin is a sign of having strong willpower and being successful.
Based on these observations, I suspect that prevalence of eating disorders and especially anorexia nervosa (AN) in Russia would be higher than in the US. Thus, I decided to do some research. My search revealed that no epidemiological studies have been done and no official statistic of eating disorders exists in Russia. Prevalence rates reported range from 0.5% (Bobrov, 2015) to 20% (Anorexia in Russia, n.d.). Since Russians don’t believe in mental illness and most people don’t seek treatment, the rates are likely underreported. A large population with subclinical AN symptoms may account for the large discrepancy in prevalence rates.
I continued my search to uncover how AN is portrayed in both internet and the scientific community. Most internet articles accurately described the disorder and emphasized fear of fat, perfectionism, and disturbed body image. Health complications were usually mentioned, but I did not find anything about high levels of suicide, which is likely due to the topic of suicide being a social taboo in Russia. One disturbing discovery was that the webpages that described the dangers of AN were full of advertisements of various diets. For example, next to the article “Anorexia – severe disease statistics” you can find “how to lose weight and keep it off forever” and advertisements of various diets (www.http://www.on-diet.ru).
Most internet articles recommended the help of a professional, but after reviewing treatment options, I lost most of my optimism. I did not find any specialized eating disorder clinics in the entire country, and help with AN was offered at general medical or psychiatric hospitals. One gastrointestinal clinic advertised AN treatment, but the treatment team consisted most of the dietitians and only one psychologist. Even the clinics that offer any kind of treatment for eating disorders are few and spread thin. Most clinics are located in Moscow and Saint-Petersburg. Considering size and population of the country, the majority of Russians don’t have access to any eating disorder treatment or even a therapist. Thousands of small Russian towns are lucky to have one general practitioner, and the closest psychologist is usually hundreds of miles away.
Next, I turned to scientific journals. Most of the information was consistent with that in US journals. I came across one surprising trend strongly linking AN with psychotic disorders. Bobrov (2015) describes AN as having inaccurate cognitive perceptions of reality and empathizes its high comorbidity with schizophrenia. Further, Artemyev & Vasiliev (2012) explain that some researchers see AN as a schizophrenia syndrome, citing an article from 1932, and report that schizophrenia precedes AN in 25% cases. In another study, out of 101 women with AN on inpatient psychiatric unit, 81 were diagnosed with schizophrenia (Artemyeva & Arsenyev, 2010).
Patients with AN often report that their family and friends find their eating disorder related beliefs strange and unusual, and refusing to eat despite life-threatening complications may be perceived as particularly strange. This interpretation may have led to over-diagnosis of schizophrenia in those with AN. However, recent studies report that prevalence of psychotic in those with AN is no higher than in general population (Seeman, 2014). Russian psychologists, however, may still over-diagnose schizophrenia, or these statistics are a result of a biased sample. They mostly studied patients in psychiatric hospitals, where comorbidity of severe mental disorders is high. On the other hand, new research revealed a genetic link between AN and psychosis (Duncan et al., 2017), so there may be some connection there after all.
One major implication of connecting AN with schizophrenia in the literature is increased stigma. If seeking treatment for AN means the high probability of being diagnosed with a psychotic disorder and likely prescribed anti-psychotic medication, it is not surprising that people would avoid it at all costs.
In conclusion, the amount of social pressure on all Russian women to be thin is incredible, and the standards are impossible to achieve. People who have symptoms of AN are admired and praised for their strong wills and dedication. The scientific community is lagging behind in proper diagnosis and further contributes to already high stigma of mental illness. Although rates of AN may be high in Russia, treatment options are almost non-existent. Epidemiological studies that bring attention to prevalence of AN in Russia and lack of treatment options are needed. While the research field is catching up, all of us can help increase awareness by making translated US articles available on the Russian web.
The Importance of SEEING your Weight in Eating Disorder Treatment
By Cheri A. Levinson, Ph.D.
One question I hear a lot from parents, eating disorder providers, and patients themselves, is about weighing. Do I have to be weighed? Should I see my weight? Should I show my patient their weight? But if they do see their weight it causes them distress- isn’t this bad? I’m going to talk a bit about why it is SO IMPORTANT to see your weight when you are in treatment for an eating disorder.
One of the scariest parts of eating disorder treatment is gaining weight. In fact, there is growing evidence supporting the idea that fear of weight gain plays a central role in maintaining eating disorders (e.g., Levinson et al., 2017; Murray et al., 2016). What this means is that being afraid of gaining weight may actually be what keeps an eating disorder going. That means that to get rid of the eating disorder – we need to get rid of (or reduce) this fear!!
So what do we do about this? How do we minimize fears of potential weight gain? This question is so important to us that we are currently working on developing a treatment specifically for fear of weight gain here in the EAT lab. In the meantime, the good news is- there are other treatments out there that work! And part of the reason they are thought to work is because of a practice called open weighing (seeing your weight in treatment). In these treatments patients see their weight once (or twice) a week when they meet with their therapist. Their therapist then plots out their weights across time and then uses this chart in treatment with the patient.
So what are these treatments? Cognitive Behavior Therapy (CBT) and Family Based Therapy (FBT) both use open weighing. These are the treatments we know work best for eating disorders. In fact, FBT is the type of treatment with the most support for adolescents with anorexia nervosa and weekly, open weighing is a non-negotiable part of treatment.
But I still don’t understand why seeing my weight is so important? Let’s do a thought exercise. If I tell you to not think about the purple elephant, what are you going to do? DON’T THINK ABOUT THE PURPLE ELEPHANT….you are going to think about the purple elephant. If I tell you, not only don’t think about the purple elephant, but avoid elephants and anything purple at all costs, what is going to happen? You are going to think more and more and MORE about the purple elephant, elephants in general, and anything purple, and purple elephants are going to become a bigger and bigger deal in your mind.
What do purple elephants have to do with fear of weight gain? The same principle applies to seeing your weight. Our goal in eating disorder therapy is to help patients become less afraid of gaining weight, to realize that gaining weight is not catastrophic, and to put less over-evaluation on weight and shape. The only way that patients can learn that weight is really not as big of a deal is for them to regularly see their weight!!! Patients then learn that just because they have gained weight (or maybe they really haven’t even gained weight like they predicted they would!) the terrible things that they imagined would happen from gaining weight (or seeing their weight) do not happen. After all, your weight is just a number – it does not define who you are as a person!
Perhaps the biggest complaint I hear about this practice is: But if I let my patient see their weight they get really upset, anxious, and it triggers their eating disorder! I get it, it’s tempting to not let patients see their weight. Anxiety is uncomfortable and it’s really hard to see someone who is already in distress get more distressed. Let’s take a deep breath...
I truly believe that the job of the therapist is to help patients learn that they can tolerate uncomfortable emotions. And this is not just me! There is mounds and mounds of literature that shows that learning to tolerate anxiety and distress is actually what makes the anxiety go away and gives you better control of your life. This is what we call exposure therapy and this is how we treat anxiety disorders. By letting patients with eating disorders continue to avoid seeing their weight, we are interfering with learning, we are teaching them that yes, seeing your weight is scary and you SHOULD avoid it. In fact, this is the opposite of what we want them to learn. We want them to learn that they CAN see their weight, it is just a number, and THEY CAN TOLERATE THEIR DISTRESS when they see their weight. The take-away here is this: LETTING PATIENTS SEE THEIR WEIGHT IS ACTUALLY HOW WE REDUCE ANXIETY IN THE LONG TERM.
When I see someone for eating disorder treatment, weekly, open weighing is a non-negotiable part of treatment. In our first session, I take weights and let them know that starting in the following session they will begin seeing their weight, once a week, when they come to treatment. They shouldn’t weigh themselves in between sessions, but they will see their weight and we will talk about their reactions until weighing becomes ‘no big deal.’ I’ve found that the most common reaction to seeing a weight is “oh that wasn’t really as bad as I thought it was going to be.”
So what does this mean for someone with an eating disorder? For a parent? For eating disorder providers? The evidence suggests that we need to be practicing open-weighing. If you are a parent or a patient with an eating disorder and your provider/treatment center does not practice open-weighing- ask them why not? Unfortunately, most eating disorder providers do not practice open weighing, in spite of the evidence (Forbush et al., 2015). If you are a provider or treatment center, it’s up to us to teach our clients that they CAN tolerate being anxious and that their weight is really no big deal. That means we need to make it a point to include open-weighing in our practice.
For more discussion and research on how to best implement open weighing, please see the following two articles:
Waller & Mountfold (2015). Weighing Patients Within Cognitive Behavioral Therapy for Eating Disorders: How, When, and Why.
Forbush et al., (2015). Clinicians Practice Regarding Blind Versus Open Weighing among Patients With Eating Disorders.
Developing a Measure of Non-Binary Gender (Genderqueer) Assessment
by: Lisa Michelson, B.A.
Classifications of gender identity, gender expression, and biological sex have become prevalent topics within contemporary healthcare conversations. These topics were once understood as a binary of options (i.e. male/female, masculine/feminine), but now these topics are viewed as a part of a spectrum (i.e. an individual can vary in how much they identify as “male” and “female”/”masculine” and “feminine”). However, the healthcare system has not yet been able to adapt its treatment plans, insurance plans, and other types of documentation within healthcare to this new ideology of gender and sex. This causes individuals who do not associate or perform as the stereotypical “male” or “female” (at the very least) to be misunderstood, and (at most) to receive inadequate healthcare.
Before we move on, let’s define some terms. Performing gender is “performing” one’s gender in alignment with societal expectations of that gender (i.e. a woman would be performing gender if she were to wear a dress). Non-performing gender is deviating from what culture depicts as an individual’s “authentic self,” or the individual’s identity that society is most comfortable with. Examples of non-performing gender are cross-dressing or identifying as transgendered. Heteronormativitiy are policies, beliefs, norms, and disciplinary mechanisms that reinforce the sex/gender system; for example, heteronormative culture endorses “female” and “male” sex designations on birth certificates. Cisnormativity is the expectation that all people are cissexual, that those assigned male at birth always grow up to be men and those assigned female at birth always grow up to be women. Not performing gender (i.e. cross-dressing or being transgendered) can cause a variety of negative outcomes, such as bullying and teasing, to be elicited. It is this performativity of being a “man” and being a “woman,” that has affected how individuals are treated within the healthcare system.
There are issues if an individual does not perform his/her/their gender identity. For example, Trans* individuals are poorly understood and medicated by healthcare professionals, who mostly lack training in Trans* healthcare. Because physicians are not trained in the treatment of Trans* individuals and because important healthcare documents force individuals to designate their sex as “male” or “female,” Trans* individuals experience systematic violence by the healthcare system; for example, they do not have the option of identifying as two genders on medical documents, if they feel their identity is a blend of male and female. If one does not follow the gender binary system, then one’s identity undergoes erasure and is not viewed as legitimate. There are serious ethical issues with forcing Trans*, inter-sexed, or non-binary individuals to associate with one of two genders if they view their identity as either a mixture of male and female, or one outside of the binary scale.
Because there are currently no assessments that attempt to understand gender separate from performativity, I, along with the EAT lab, have developed the Non-Binary Gender Assessment (NBGA). This assessment asks individuals questions about how they view themselves rather than through performativity questions. Traditional performativity questions assess items such as “I like guns.” In scoring, this individual would be described as “masculine.” However, this is based off of stereotypical analysis of gender performativity within a heteronromative, cisnormative culture. In other words, it is unfair to attach masculinity to the “I like guns” statement. In fact, a female who considers herself feminine may like guns as well.
Instead, we are trying to develop a measure that does not rely on these stereotypes. In the Non-binary Gender Assessment (NBGA) individuals are asked questions regarding how they view their identity. For example, individuals have the opportunity to quantify their gender identity on a scale from 1 to 10 in three categories “Female,” “Male,” and “Other.” Allowing individuals to quantify their own gender rather than assigning them a gender based off performativity aids in the individual’s agency, which is defined as one’s ability to make an autonomous decision for himself/herself. Through this 62-item survey, individuals answer a series of questions regarding ones’ gender identity, gender expression, and biological sex; for example “I am afraid to not wear clothes in public because people will look at my body (i.e. at a swimming pool or sauna).” The individual is not marginalized by a series of “yes” or “no” questions, but rather have the opportunity to scale one’s answer and provide clarification for answers if desired.
The hope in creating this scale is to better understand an individual’s gender and sex identity. Additionally, the goal is to see if the NBGA illuminates any relationships between both gender and sex identity and eating disorders. Previous research suggests that there is a higher prevalence of eating disorders in non-binary populations when compared to the same demographic in binary populations (Feldman & Meyer, 2007; McClain & Peebles, 2016). If the NBGA is able to detect the parts of an individual’s gender and sex identity that can cause an increase prevalence in eating disorder symptoms, then this may help in better understanding why non-binary individuals engage in disordered eating behaviors in the first place. Stay tuned as the EAT lab continues to develop and validate this measure!
Culture and Eating Disorders
by: Benjamin J. Calebs, B.A.
Eating disorders have traditionally been viewed as impacting the lives of non-Hispanic White women in Western countries. Relatedly, there have been debates about the degree to which eating disorders may be culture-bound syndromes (Keel & Klump, 2003). The DSM-5 defines a cultural syndrome as “a cluster or group of co-occurring, relatively invariant symptoms found in a specific cultural group, community, or context” (American Psychiatric Association, 2013, p. 14). As you can imagine cultural and ethnic differences in eating disorders are a very complex topic!
Some researchers have argued that eating disorder diagnoses such as anorexia nervosa and bulimia nervosa are culture-bound syndromes motivated by Western ideals of thinness, while others have emphasized the substantial biological and genetic components to eating disorders. After a review of the evidence on eating disorders across cultures and time periods, Keel and Klump (2003) concluded that bulimia nervosa is heavily influenced by culture, while anorexia nervosa is experienced similarly across cultures. The authors suggest that bulimia nervosa may be so influenced by culture because binge eating is reliant upon an individual having access to enough available food to have a binge episode. Relatedly, purging seems to predominately occur in cultures where thinness is highly valued (Keel & Klump, 2003).
In spite of the traditional view of eating disorders outlined before (i.e., that eating disorders are predominately seen in non-Hispanic White, Western women), it is now clear that disordered eating behaviors occur across different ethnicities and cultures. Lifetime prevalence rates of eating disorders vary among ethnic groups in the United States, yet disordered eating has been found among European Americans, African Americans, Hispanic Americans, and Asian Americans (for a recent review see: Levinson & Brosof, 2016).
Our lab recently completed a review on disordered eating across ethnic groups. I will discuss a bit about what this review found. African American women tend to show lower levels of disordered eating behaviors than European American women, which may be related to the lower levels of both body dissatisfaction and thin-ideal internalization reported by African American women as compared with European American women. Hispanic American women may have higher levels of binge eating than either European American women or African American women. Asian American women show lower levels of many disordered eating behaviors than European American women. Ethnic minority groups in the United States are less likely than European Americans to seek treatment for eating disorders, suggesting a further need to examine how cultural and ethnic differences relate to differences in eating disorder symptomatology and treatment.
Both similarities and differences in disordered eating symptoms have been found across cultures as well. Researchers have found that Japanese women may have levels of body dissatisfaction that are similar to women in the United States; yet there may be different motivations behind body dissatisfaction among Japanese women. For example, body dissatisfaction is largely motivated by the thin-ideal in American culture, while body dissatisfaction may be driven more by a desire for delayed maturation in Japanese culture. In Chinese culture, fear of fatness may play a role in body dissatisfaction similar to American culture.
However, such generalizations may be limited by common definitions of cultural and ethnic groups. For example, China is inhabited by 56 different ethnic groups. As was seen when looking at the differences in disordered eating between ethnic groups in the United States, it’s likely that variability exists in levels of disordered eating across ethnic groups in China (and everywhere!). Imprecise definitions of culture or ethnicity can contribute to difficulties in examining similarities and differences across cultures.
Eating disorders are the outcome of a complex interaction between a variety of factors, including culture, environmental risk factors, individual differences in personality, and genetic factors. In order to understand how to reduce the distress and impairment that eating disorders cause, it’s important to examine the unique contribution of each of these factors. In so doing, researchers and clinicians can create interventions that best meet the needs of diverse populations.
Eating Disorder Treatment: Where to Start and What to Expect
by Laura Fewell, B.A.
Choosing an eating disorder treatment program can be overwhelming, especially when you are not sure exactly which treatment (if any) you need. Outpatient? Intensive treatment? A therapist, dietitian, or other specialist? And how exactly do you know if you have an eating disorder or disordered eating? If the thought of receiving eating disorder treatment feels overwhelming or too foreign to consider, read on below for helpful information on where to start and what to expect from treatment.
First things first: Do I have an eating disorder (or disordered eating)?
How do you know if your eating behaviors are problematic or maybe just a bit eccentric? One question to ask yourself is if your thoughts about your weight, shape, or eating habits interfere with your life (such as making you feel bad about yourself or preventing you from going out with others). Another is to pay attention to how you feel before or after eating—do you feel anxious, guilty, or upset? Other signs or symptoms of disordered eating include:
If you can relate to any of these statements, you may consider talking to an ED professional. You can also access online screenings through trusted websites such as NEDA http://screening.mentalhealthscreening.org/NEDA or McCallum Place Eating Disorder Treatment Centers https://www.mccallumplace.com/do-i-have-an-eating-disorder.html.
I might have an eating disorder—now what?
If you think you might struggle with an ED or disordered eating, the best thing you can do for your health and well-being is reach out to a professional. You can start by talking to a therapist, dietitian, psychologist, or psychiatrist with experience in EDs about your concerns. Research shows that if you have an eating disorder you will have the best chance of recovery if you are treated by a professional who is an eating disorder specialist. It is a good idea to ask about their ED experience or to find someone with a CEDS designation (Certified Eating Disorder Specialist). Although many professionals are willing to work with EDs, they are not all ED experts. Most ED professionals will recommend treatment options, such as going to regular outpatient appointments or looking into a higher level of care, like day programs or residential treatment. Some ED treatment centers offer free assessments and provide recommendations for levels of care to fit your needs. You can find ED referrals through the National Eating Disorders Association (http://www.nationaleatingdisorders.org/find-help-support), Eating Disorder Hope (https://www.eatingdisorderhope.com/treatment-for-eating-disorders/therapists-specialists), or by contacting Dr. Cheri Levinson at firstname.lastname@example.org.
Eating disorder treatment: What to expect
If you find that you need more than outpatient ED treatment (or a professional suggests you need a higher level of care), you may be referred to a day program or a residential program. Though spending most of your day (or overnight) at a treatment center may seem overwhelming, most programs are designed to take place in a therapeutic environment and have the goal of integrating you back into your normal life as quickly as possible. Below are general components of treatment programs that you can expect.
Prior to treatment: Once you find a program that looks like a good fit, call the admissions or intake office to inquire about an assessment. They will schedule a time to ask you about your personal information and history and will likely ask you to see your doctor for a medical workup. They will also call your insurance provider and discuss what types and portions of treatment they are willing to pay. Once they get this information, they will make treatment recommendations and set up an admission date if necessary.
Day 1: Arrive at the treatment center and expect to fill out lots of paperwork. You will be introduced to treatment professionals, other clients, and staff. Staff will go over program guidelines with you and layout what the program will be like. This day will probably feel like a whirlwind! I advise our clients that the first couple of days are the most difficult—between new faces, a new environment, and the fear of the unknown, there are lots of factors that can make the first few days feel scary. Typically by the 3rd or 4th day, though, clients are used to the routine and begin getting to know their peers and the staff. Soon after, they begin developing bonds with others and learn to trust the treatment center as a safe environment comprised of people who care about them.
Weights: Most programs will collect weights regularly, such as daily or weekly. This can feel a bit awkward at first, but most people get used to it quickly. In fact, it is part of your treatment & recovery!
Treatment team appointments: Throughout treatment, you will meet with your treatment team regularly. Your treatment team will likely be made up of a therapist, dietitian, and doctor, all of whom will set up a treatment plan for you and work with you towards your goals.
Meals: This is often the most anxiety provoking component of treatment. People often wonder, “Will I be forced to eat or not be allowed to eat enough? What happens if I feel too anxious during meal times?” Rest assured that, while not always easy, you will be given a personalized meal plan that will be exactly what you need. Your dietitian will work with you to educate you on what types of meals and portions are best for you.
Groups: An important part of treatment is developing skills and insight that will assist you in recovery. There are a variety of therapeutic groups each day that take place outside of meal times. These often include skills and processing groups, nutrition, art, and other specialized treatment modules (like cognitive behavior therapy) that aid in the healing process.
Other components of treatment: Depending on the treatment center, there will be nurses and/or doctors on staff who are available if a medical issue comes up. Patient care staff are available if clients need something, such as using the restroom or just talking after a hard day. There may also be exercise specialists to help clients who struggle with unhealthy or limited exercise, and some programs even have specialists who help athletes seeking recovery from their eating disorder while training for their sport.
A sample day program schedule may include:*
9:30am: weights and vital signs obtained
10am: snack (if applicable)
3pm: snack (if applicable)
7:30pm: program ends
*During the day, treatment team members may meet with patients in place of attending groups.
Treatment discharge: As you progress through treatment and get your eating habits and health back on track, you will begin preparing for discharge. A good treatment team will help you make a plan for what you’ll do after treatment, and they should help you find outpatient professionals so you can continue care in a meaningful way. Though many people want to know how long they’ll be in treatment, it is hard to give an exact length of time because of the highly individualized components of care. Some people need a few weeks to get on track, while others require a longer treatment stay to reach their health goals.
Taking the next step
Deciding to seek help for an eating disorder or disordered eating is not easy, but it is worth it. There is hope out there! Below are a list of resources if you would like to begin your journey to recovery. You can also contact Dr. Cheri Levinson if you have questions or would like to discuss treatment options.
Dr. Cheri Levinson: email@example.com
National Eating Disorders Association: www.nationaleatingdisorders.org
Eating Disorder Hope: www.eatingdisorderhope.com
McCallum Place Eating Disorder Centers: www.mccallumplace.com
Why Being Perfect Isn’t Always What It Seems: The Link Between Eating Disorders
By: Leigh C. Brosof
We all know someone who is (or perhaps recognize within ourselves) a perfectionist: the person who gets good grades or excels at their job, is involved in a myriad of activities outside of school/work, and seems to never settle for anything but the best. This can’t possibly be a bad thing, right? While having high standards is not necessarily harmful, high levels of perfectionism can create vulnerability for certain problems to develop, especially in terms of disordered eating. In fact, perfectionism is recognized as a vulnerability factor for eating disorders.
In order to understand why perfectionism can be harmful at times, it is first important to define exactly what perfectionism is. Colloquially, perfectionism is defined as anything less than perfect being unacceptable, where being “perfect” means living up to standards of extreme excellence or not making any mistakes (Merriam-Webster, 2016). This is actually a pretty complex definition when you look at it, and that’s why perfectionism is defined in a slightly different way by researchers. Researchers view perfectionism as a multi-dimensional construct, meaning that it’s made up of multiple parts (Frost et al., 1990).
More specifically, perfectionism can be broken down into two parts: adaptive and maladaptive perfectionism (Hewitt, Flett, Turnbull-Donovan, & Mikail, 1991). Adaptive perfectionism is when an individual has high standards for themselves. Maladaptive perfectionism can also be called evaluative perfectionism. In this type of perfectionism, individuals become preoccupied over making mistakes, which then leads to self-critical evaluation. Whereas adaptive perfectionism is healthy because it pushes an individual to do his or her best and set high expectations (DiBartolo, Frost, Chang, LaSota, & Grills, 2004), maladaptive perfectionism is harmful because it means that nothing we do will ever be good enough and that we set unattainable standards for ourselves. This can obviously lead to disappointment and feelings of inadequacy.
So, how does this relate to eating? If an individual sets unattainable standards for themselves in all areas of their life because of perfectionistic tendencies, then this can lead to negative outcomes for mental health, such as anxiety and depression, as well as disordered eating attitudes and behaviors (DiBartolo, Li, & Frost, 2008). In fact, some research has linked a specific type of perfectionism to eating disorders (Bardone-Cone et al., 2007). This type of perfectionism is the excessive worry over making mistakes.
Researchers have proposed different theories as to why perfectionism may lead to eating disorders. For instance, some researchers have proposed that disordered eating behaviors manifest after an individual high in perfectionism internalizes the thin-ideal (or the societal belief that being thin is the ideal body type). This thin-ideal set by society, however, is unattainable. The pursuit of this impossible thin-ideal along with the self-criticism that accompanies maladaptive perfectionism might lead to disordered eating. Other theories suggest that perfectionism may lead to other negative outcomes, such as low self-esteem or fears of being judged by others based on appearance and that these outcomes then lead to disordered eating behaviors (Brosof & Levinson, 2017; Mackinnon et al., 2011).
Importantly, by better understanding how perfectionism relates to eating disorders, we now also know that we can create interventions to target perfectionism to help treat eating disorders. For instance, one type of treatment might be having a patient practice making mistakes to help them learn that making a mistake does not lead to terrible outcomes. We can also help prevent eating disorders by helping people already high in perfectionism through similar interventions.
It is important to remember that everyone makes mistakes and that making mistakes is normal! In fact, making mistakes is how you learn. It is also important to know that there is no such thing as a “perfect” body or a “perfect” diet. All of our bodies are different in order to do different things and need to be fueled according to our own needs. You are worthwhile person and you are good enough, no matter what. If you are or someone you know is struggling with disordered eating or other mental health problems due to perfectionism, there is help. We are currently offering a perfectionism group treatment, please reach out if you are interested in joining. You can also call the National Eating Disorder Association helpline at 1-800-931-2237.
Dr. Levinson is featured in a story on positive self-image, read the story here: