GÜRZE/SALUCORE EatingDisorders RESOURCE CATALOGUE HOW DO WE THE MOST WIDELY REACH PEOPLE -USED RESOURCE WHO CAN’T IN THE EATING DISORDERS FIELD ACCESS SINCE 1980 TREATMENT?
Bringing Neuroscience to the Patient
LETTING GO
OF SECRETS 2020 EDcatalogue.com IN ED RECOVERY ADVANCEMENTS IN THE FIELD // EMERGING RESEARCH // RECOVERY & SUPPORT We Can’t Promise it Will be easy. but We Can Promise you’re Worth it.
Care Without Compromise
Why do people across the country choose Veritas Collaborative to begin their recovery journey?
Veritas Collaborative is a comprehensive national healthcare ERC Ad goes here system—hospitals, outpatient centers, and assessment clinics—designed to bring a new standard of care to eating disorder treatment. Your JourneY to a Brighter Future Begins here We provide a full continuum of care, from inpatient to Eating Recovery Center, the pioneer in comprehensive, innovative eating disorder treatment, offers individuals outpatient, supporting our belief that the right level of care best-in-class care for the most optimal outcomes. at the right time is key to lasting recovery. • Nationally-recognized physicians, psychiatrists and psychologists partner with registered dietitians to create individualized treatment plans We collaborate with referring providers to ensure a seamless • The most effective evidence-based psychotherapy and advanced pharmacologic care for eating disorders and transition and continuous support, from admission to co-occurring conditions discharge and beyond. • Full continuum of treatment services, including a first-of-its-kind Intensive Treatment Unit (ITU) as well as Inpatient, We are determined to change the eating disorder field so Residential, Partial Hospitalization and Intensive Outpatient Programs, enable treatment of the most complex cases that with eating disorders, their families, and and continuity of care all persons their communities have access to best-practice care, ongoing • Leading Child and Adolescent Treatment Program provides unmatched family therapy, education and support support through our alumni and family advocacy programs, • Specialized programs accept all genders and gender identities, ages 10 and up and helpful resources on the journey to recovery. • National network of 31 world-class treatment centers in 18 metro areas across eight states Why do people come to Veritas? Because they won’t compromise on their care. And neither will we. “When I first came to ERC, I didn’t believe I was worth recovery. Now, I feel like life is worth living again.” — A.D., Former Alum
We are stronger together. Contact us today.
877-825-8584 | EatingRecoveryCenter.com | Majority of private insurance accepted California • Colorado • Illinois • Maryland • Ohio • South Carolina • Texas • Washington DURHAM, NC | CHARLOTTE, NC | ATLANTA, GA | RICHMOND, VA VERITASCOLLABORATIVE.COM | (855) 875-5812 © 2019 Eating Recovery Center. All rights reserved. We Can’t Promise it Will be easy. but We Can Promise you’re Worth it.
Care Without Compromise
Why do people across the country choose Veritas Collaborative to begin their recovery journey?
Veritas Collaborative is a comprehensive national healthcare system—hospitals, outpatient centers, and assessment clinics—designed to bring a new standard of care to eating disorder treatment. Your JourneY to a Brighter Future Begins here We provide a full continuum of care, from inpatient to Eating Recovery Center, the pioneer in comprehensive, innovative eating disorder treatment, offers individuals outpatient, supporting our belief that the right level of care best-in-class care for the most optimal outcomes. at the right time is key to lasting recovery. • Nationally-recognized physicians, psychiatrists and psychologists partner with registered dietitians to create individualized treatment plans We collaborate with referring providers to ensure a seamless • The most effective evidence-based psychotherapy and advanced pharmacologic care for eating disorders and transition and continuous support, from admission to co-occurring conditions discharge and beyond. • Full continuum of treatment services, including a first-of-its-kind Intensive Treatment Unit (ITU) as well as Inpatient, We are determined to change the eating disorder field so Residential, Partial Hospitalization and Intensive Outpatient Programs, enable treatment of the most complex cases that with eating disorders, their families, and and continuity of care all persons their communities have access to best-practice care, ongoing • Leading Child and Adolescent Treatment Program provides unmatched family therapy, education and support support through our alumni and family advocacy programs, • Specialized programs accept all genders and gender identities, ages 10 and up and helpful resources on the journey to recovery. • National network of 31 world-class treatment centers in 18 metro areas across eight states Why do people come to Veritas? Because they won’t compromise on their care. And neither will we. “When I first came to ERC, I didn’t believe I was worth recovery. Now, I feel like life is worth living again.” — A.D., Former Alum
We are stronger together. Contact us today.
877-825-8584 | EatingRecoveryCenter.com | Majority of private insurance accepted California • Colorado • Illinois • Maryland • Ohio • South Carolina • Texas • Washington DURHAM, NC | CHARLOTTE, NC | ATLANTA, GA | RICHMOND, VA VERITASCOLLABORATIVE.COM | (855) 875-5812 EDcatalogue.com 3 © 2019 Eating Recovery Center. All rights reserved. letter from the editor
Contents
Welcome! PAGE STORY 6 Bringing Neuroscience to the Patient DEAR READERS, By Guido K.W. Frank, MD 8 BOOK EXCERPT I Can Beat Anorexia! Finding the Having been a member Motivation, Confidence, and Skills to Recover and Avoid Relapse By Dr. Nicola Davies of the eating disorders 10 The (In)Visible Other: Intersubjectivity, community for more Blackness, and Eating Disorders Treatment than 25 years, I welcome By Marvice D. Marcus, PhD newcomers and send 12 How Do We Reach People Who Can’t Access the Treatment They Need? my best to everyone By Douglas W. Bunnell, PhD, FAED, CEDS invested in eating 14 BOOK EXCERPT The Eating Instinct: Food disorders prevention Culture, Body Image, and Guilt in America By Virginia Sole-Smith and recovery. 16 The Many Faces of Binge Eating Disorder As we enter this By Amy Pershing, LMSW, ACSW new decade together, I am emboldened by 18 BOOK EXCERPT Binge Eating Disorder: The hope. There is a dynamic wave of optimism Journey to Recovery and Beyond By Amy Pershing, LMSW, ACSW, and Chevese Turner spreading throughout our community, led 21 BOOK EXCERPT Cognitive-Behavioral Therapy by evidence-based approaches to treatment for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults By Jennifer J. and prevention, current research that both Thomas, PhD, and Kamryn T. Eddy, PhD answers our questions and sparks important 22 Letting Go of Secrets in Eating Disorder Recovery new ones, the energy of our activists, and By Mark Warren, MD, MPH, FAED improvements in access to treatment. 24 BOOK EXCERPT Ending the Diet Mindset: Reclaim a Healthy and Balanced Relationship with Food Our resources and support services for all and Body Image By Becca Clegg, LPC, CEDS aspects of eating disorder recovery continue 26 What Does a Nutrition Therapist Really Do? to reach many, and we appreciate the positive, By Sondra Kronberg, MS, RD, CDN, CEDRD-S encouraging feedback we receive. Our 28 BOOK EXCERPT The Body Is Not an Apology: The Power of Radical Self-Love By Sonya Renee Taylor contributors are always gracious in sharing 31 BOOK EXCERPT Loving Someone with an their knowledge and wisdom in the pages of Eating Disorder: Understanding, Supporting, each catalogue, and while we can’t fit every and Connecting with Your Partner By Dana Harron, PsyD worthwhile book recommendation in our 32 Fertility and Pregnancy in Eating Disorders magazine, we invite you to visit EDcatalogue. By Mittsi Crossman, MD, CEDS com/books for additional titles. 34 BOOK EXCERPT The Clinical Guide to Please take a thoughtful look at our Fertility, Motherhood, and Eating Disorders: From Shame to Self-Acceptance Treatment Facilities Index. These centers are By Kate B. Daigle, MA, LPC, CEDS dedicated to eating disorder recovery and your 37 BOOK EXCERPT Treating Eating Disorders in well-being, and we are grateful for their support. Adolescents By Tara L. Deliberto, PhD, and Dina Hirsch, PhD 38 Recognizing Institutionalized Weight Bias WITH WARM REGARDS, By Janell Mensinger, PhD, FAED
40 BOOK EXCERPT Eating Mindfully for Teens Kathy Cortese By Susan Albers, PsyD LCSW, ACSW, CEDS 42 Treatment Facilities Index Editor-in-Chief
Copyright © 2020 Salucore, LLC, unless otherwise stated. All rights reserved. Contents may not be reproduced without permission. Cover and inside images: Getty Images. Models used for illustrative purposes 4 only. Creative Director: Antonella D'Agostino. Catalogue designed by Wendy Robison, wendyrobison.com. This catalogue is printed on recycled paper with at least 10% postconsumer waste. WE WILL FIND THE ANSWERS, TOGETHER.
McLean’s Klarman Center: the place for e ective bulimia and anorexia treatment.
■ Comprehensive assessments and specialty consultations ■ Specialists in treating co-occurring depression and anxiety ■ Residential treatment for young women ages 16-26
877.203.6623 mclean.org/klarman
EDcatalogue.com 5
McLean 2020 Gurze Ad_C.indd 1 11/20/19 2:42 PM anorexia
Bringing Neuroscience to the Patient BY GUIDO K.W. FRANK, MD
When anorexia nervosa was first described Review articles of the brain-imaging by Richard Morton in 1689, as what he literature on anorexia nervosa have called “nervous consumption,” and later repeatedly implicated reward- processing circuits, aside from independently by Gull and Lasègue in 1873, pathways involved in cognition or there was little understanding of the causes emotion processing; nevertheless, understanding the exact behind the condition. Then, in the late 1960s neurobiology of anorexia nervosa has and 1970, largely promoted by Hilde Bruch’s been challenging. My lab has pursued the study of reward circuits in writings, including her famous book The anorexia nervosa and specifically the Golden Cage, a psychodynamic model was dopamine-associated prediction error model. The dopamine prediction error adopted that saw the family as the origin and is a learning signal important for food etiology of the problem, like it had been for approach, and animal models have schizophrenia and autism before. Only over suggested that neuronal dopamine activation has a central role in food the past three decades has research made intake and restriction. tremendous progress in understanding the The dopamine neurotransmitter system has been intensively studied neurobiological underpinnings of eating and and is well-characterized. Its neurons’ other psychiatric disorders. This has come cell bodies lie in the brain stem in the ventral tegmental area and substantia on the heels of improved technology to nigra, and from there distribute to the study the living human brain, and the fields cortical and subcortical brain. The basal ganglia, especially the ventral of neuroscience and psychology developing striatum, which includes the nucleus models to tie behavior with brain function in accumbens, receives dopaminergic input and has been involved in healthy individuals and test those models in the drive to approach rewarding individuals with eating disorders. stimuli. Those reward stimuli can be
6 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com NATIONAL EATING
to real life. For instance, a colleague DISORDERS surprises a coworker by leaving a ORGANIZATIONS piece of cake on his desk, and when he gets to his desk and sees it, he has a surge in dopamine, because there • Academy for Eating Disorders (AED) aedweb.org is a reward that was not expected. If this colleague now puts a piece • The Alliance for Eating Disorders Awareness of cake on that person’s desk every allianceforeatingdisorders.com Monday, he will learn that Monday • Eating Disorders is a day when he will find a piece of Anonymous (EDA) cake on his desk. Biologically what eatingdisordersanonymous.org happens is that when the person • Eating Disorders Coalition for gets up on Monday morning, he may Research, Policy & Action (EDC) think of the cake that he will later eatingdisorderscoalition.org receive, and “Monday” will become a • Eating Disorders Information conditioned stimulus and he will have Network (EDIN) myedin.org a dopamine surge. However, when he • The Elisa Project theelisaproject.org gets to his desk and finds the cake, there will be no dopamine surge, • Families Empowered and Supporting Treatment of Eating unconditioned (such as sweet tastes because the reward received and the Disorders (F.E.A.S.T.) being preferred by babies at birth) reward expected were similar and feast-ed.org or conditioned (learned later in and there was no “error” in expectation • The International Association of throughout life), just like in Pavlov’s or prediction. What happens if the Eating Disorders Professionals famous conditioning paradigm. friendly colleague is unexpectedly Foundation (IAEDP) iaedp.com A central feature of dopamine sick one Monday and cannot bring • Maudsley Parents neuron response is that it is triggered the cake? The person still had the maudsleyparents.org by unexpectancy—i.e., a discrepancy expectation of getting cake, but • Multi-Service Eating Disorders Association, Inc. (MEDA) since there is no cake and, thus, between what one expects and what, medainc.org in fact, happens. After receiving an he is experiencing an unexpected • National Association of Anorexia unexpected reward such as food “omission” of the reward, he may feel Nervosa and Associated or money, a dopamine surge is disappointed, and that is associated Disorders (ANAD) anad.org elicited in the striatum and midbrain, with a dip in dopamine neuron • The National Eating Disorders called a positive prediction error activity. Screening Program (NEDSP) response. When receiving this reward This dynamic can be studied in the mentalhealthscreening.org becomes a regular occurrence and living human brain with functional • National Eating Disorders can be associated with a specific brain imaging during application of Association (NEDA) nationaleatingdisorders.org predictor or conditioned stimulus, a Pavlovian conditioning paradigm: Parents to Parents the dopamine signal is elicited by the Participants learn to associate • parents-to-parents.org conditioned stimulus that predicts sweet tastes or monetary stimuli • Project HEAL theprojectheal.org the reward. However, the dopamine with pictures of colored shapes that system does not respond when the become the conditioned stimulus • Trans Folx Fighting Eating Disorders (T-FFED) actual reward is received, because and appear on the screen before transfolxfightingeds.org the prediction matches the outcome. money or sweet solution is delivered. If the reward is predicted but not Sometimes when the participants received (there is no food or money expect to get the reward, they will not More after expecting it), there is a dip in get it; at other times, the reward is information on dopamine activity in the brain, which delivered unexpectedly. these organizations can be found at reflects the negative prediction error EDcatalogue.com. (unexpected omission). The beauty THIS ARTICLE CONTINUES AND CAN BE FOUND of this model lies in its applicability IN ITS ENTIRETY AT EDCATALOGUE.COM.
EDcatalogue.com 7 anorexia
BOOK EXCERPT I CAN BEAT ANOREXIA! Finding the Motivation, Confidence, and Skills to Recover and Avoid Relapse In this excerpt from I Can Beat Anorexia!, Dr. Nicola Davies offers tips on how to jump-start your anorexia recovery.
What Does It Take to eat the same foods at the same time Beat Anorexia? each day.” So, what is beating anorexia truly about? It • Fearing what others might say requires embracing a lifestyle change—one about your attempts at making a that begins with the mind. It isn’t just about serious change: “People see me as changing what you eat or what you do, but someone who is in control of her wanting to make changes to how you live food. What will they think of me if the rest of your life. To jump-start your I start eating more?” beating anorexia journey, you need to begin • Postponing lifestyle change plans by looking closely at your attitudes and and blaming it on work demands, behaviors. From there, you need to peer pressure, or family issues: “I develop the willingness, readiness, and want to get better, but I need to wait confidence to make the changes required until I am out of this stressful job.” to beat your illness. Reprinted with permission If you aren’t willing to examine and from Jessica Kingsley identify your unhealthy mental patterns Publishers, I Can Beat Be Willing and attitudes, you may find it difficult to Anorexia! Finding the Motivation, Confidence, Do you really want to live a healthier life? motivate yourself to accept and maintain and Skills to Recover If yes, then you need to be willing to look change. In which case, any changes you and Avoid Relapse, at various aspects of your life, such as the make will only yield short-term results. by Dr. Nicola Davies, 160 pages, paper, 2017. habits and routines that are contributing toward the anorexia. Next, you need to be Be Ready willing to take steps toward reducing or Health psychologists use something getting rid of these destructive habits. known as the Readiness to Change scale to Rather than focusing on your physical help people change unhealthy behaviors, weight, start considering your mental including behaviors related to anorexia. weight and cutting down on the excess Understanding and using this tool yourself weight in your mind—the unhealthy can help you progress through your attitudes and habits that are maintaining journey to beat anorexia. In particular, if the anorexia. Some examples of mental you have been unsuccessful in changing weight include the following: your lifestyle in the past, this tool can help • Giving in to deeply ingrained you evaluate the obstacles that may be in unhealthy eating rituals: “I must your way.
8 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com M M E N O D C E
E D
R DIAGNOSING R E G ANOREXIA NERVOSA A D I N
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, BULIMIA
less than that minimally expected. ANOREXIA B. Intense fear of gaining weight or of Anorexia New 50 Strategies to becoming fat, or persistent behavior that Nervosa: Focal Developments Sustain Recovery interferes with weight gain, even though Psychodynamic in Anorexia from Bulimia at a significantly low weight. Psychotherapy Nervosa Jocelyn Golden, 221 Hans-Christoph Research: Eating pages, paper, 2011 C. Disturbance in a way in which one’s Friederich, Beate Disorders in the body weight or shape is experienced, Wild, Stephan 21st Century undue influence of body weight or shape Zipfel, Henning Carla Gramaglia & Schauenburg & Patrizia Zeppegno, on self-evaluation, or persistent lack of Wolfgang Herzog, 208 pages, recognition of the seriousness of the 124 pages, paper, hardcover, 2014 current low body weight. 2019
DIAGNOSING My Name Is Caroline, Second Edition: A Candid, OTHER SPECIFIED Hard-Hitting Account of a FEEDING OR EATING Seven-Year Anorexia Nervosa, Descent into DISORDER Eating Disorders Second Edition: Bulimia, Leading Anonymous: The A Recovery Guide Up to a Final Story of How for Sufferers, Victorious Triumph
This category applies to presentations We Recovered Families, and over the Addiction from Our Eating Friends Caroline Adams in which symptoms characteristic Disorders Janet Treasure & Miller, 285 pages, of a feeding and eating disorder that 544 pages, June Alexander, 192 paper, 2014 cause clinically significant distress or paper, 2016 pages, paper, 2013 impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class. The other feeding or eating disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific Positively Caroline: feeding and eating disorder. How I Beat Bulimia for Good… and Found Real by the American Psychiatric Association, excerpted from Diagnostic and Statistical Manual of Happiness Mental Disorders, Fifth Edition (DSM-5) © 2013 Caroline Adams by American Psychiatric Publishing Miller, 278 pages, paper, 2013
Please visit our website for additional book recommendations. EDcatalogue.com/books 9 The (In)Visible Other: Intersubjectivity, Blackness, and Eating Disorders Treatment BY MARVICE D. MARCUS, PHD
Identity and Representation Sociodemographic factors heavily influence our experience of the world. Physical and mental health outcomes are two of the domains in which identity yields fascinating and sometimes harrowing information about individual lives. Arguably one of the most powerful social determinants of life chance is race, an otherwise troublesome organizing principle buttressed by colonial thought. Understood as specious in nature, race as a construct is far-reaching and governs material and immaterial realities. For example, blackness is a sociopolitical construction that engenders a great deal of contested meaning in the public imagination.
10 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com Historically, the ascription of blackness educators who adopt a critical limitations should be considered has translated to (in)visibility and lens of inquiry have, in many ways, before overestimating results. At erasure, ethnoviolence, pernicious nuanced conversations about cultural large, eating disorders studies commodification, and general social mistrust by integrating research conspicuously focus on White, death. Contextually, research suggests on antiblackness. A discussion on non-Hispanic women and elucidate that race, among many identity antiblack racism (ABR) is pertinent a hegemonic cultural production in variables, profoundly dictates unmet to cultural mistrust in light of the collective unconscious. Critical mental health needs for Black people, deafening neoliberalism, which scholars urge us to interrogate with eating disorders treatment seeks to rewrite America’s sordid the “normal” as “abnormal,” while being an ongoing topic of discussion history of race relations and hostility bearing in mind the politics of power, in clinical science and education toward difference. In addition, I representation, and mattering. literature. contend that ABR, a permutation of Scientific inquiry has produced racism, provides additional clarity Intraethnic mixed results with regard on the reasons why Black people Treatment Dyads to incidence of body image avoid coming into contact with The efficacy of therapist-patient disturbances in Black communities, systems, including the counseling/ matching has long been a topic and yet a fundamental curiosity psychotherapy enterprise. How, of conversation and research, remains: To what extent does racial then, does one thoroughly explain particularly when confronted with bias compromise the integrity the dynamic interaction between the violence of “racial realism” of epidemiological measures, Black subjectivity and body image in the greater polity. Cabral and assessment, and intervention, and disturbances? A starting point is Smith conducted a meta-analytic psychological practice? Smith an embracing of identity, namely review of studies focused on and other proponents of rigorous blackness, in the counseling discipline. therapist-client matching along theorizing of culture and human This contention is supported by the racial/ethnic lines. Data from the behavior provide concrete tools to vast stock of literature focused on study explicated that Black people critically examine power. Mattering identity formation, as Black individuals moderately prefer a therapist with and representation come to exist by customarily privilege race as a central a shared racial identity. Other way of power and social influence, marker of their subjectivity. research has produced conflicting and thus discussions centered on data sets pertaining to preference, eating disorders and race must Stock of Literature perception, and outcomes. Therapist- incorporate an analysis thereof. As Quantitative and qualitative patient matching is emblematic such, in the sections to follow, salient methods have been used to examine of interpersonal dynamics within themes about eating disorders disordered eating within Black complex social milieus, which raises pathology are reviewed as it pertains communities. A universal thread curiosities regarding within- and to Black people, before charting within most, if not all, of the studies between-group racial subjectivity. In material on intra- and interethnic is inequality and inequity. More fact, Hall hypothesized that cultural treatment dyads. Finally, concluding specifically, racial subjugation and subgroups have their own (collective) remarks will briefly highlight the acculturative stress are hallmarks unconscious. A narrative approach to significance and utility of advancing that foreground the ubiquity of Black service, be it in the form of research criticality principles in mental health marginality as interpersonal and or counseling, may assist behavioral and allied fields. systemic indignities. The bulk of scientists and practitioners with Noteworthy is the phenomenon research, furthermore, tends to focus making inferences about identity- of cultural mistrust in Black on Black women and adolescent based ego processes and social communities. Whaley describes children, with binge eating emerging functioning. Eating disorders are cultural mistrust as a form of healthy as the primary concern. Body image exceedingly cultural phenomena; paranoia, particularly in health care dissatisfaction, including a slight therefore, critically interacting with settings, wherein unfair treatment of preference for slenderness, has lived stories vis-à-vis therapy is a Black people is rampant. Questions also been observed. Some research liberationist intervention. about provider competence and suggests that ethnic minority boys guardedness are often indicative are at a greater risk for reporting THIS ARTICLE CONTINUES AND CAN BE FOUND of cultural mistrust. More recently, disordered eating, although sampling IN ITS ENTIRETY AT EDCATALOGUE.COM.
EDcatalogue.com 11 How Do We Reach People Who Can’t Access the Treatment They Need?
BY DOUGLAS W. BUNNELL, PHD, FAED, CEDS
Eating disorders affect nearly 30 million people in the United States alone. Virtually everything known about the treatment of eating disorders has evolved on the basis of clinical and research experience with a limited subset of that 30 million. Our best available treatments are accessible to an even smaller subset because of limited clinician availability, cost, dissatisfaction with the nature of the available treatments, and pessimism about treatment effectiveness. We, as a field, need to identify treatment interventions that are both effective and accessible to a much wider population of people who struggle with the full range of eating disorders.
Think about what a typical patient more expensive. Higher levels of developed a number of low-intensity with an eating disorder has to care are also often tremendously and community-based programs manage. The patient, at one end of disruptive to a patient’s social, that utilize trained nonprofessionals the treatment continuum, will need academic, and occupational routines. to address depression, anxiety, and to find and pay a psychotherapist And, not surprisingly, the limited post-traumatic stress disorder in or family therapist, and often levels of treatment intensity reflect countries that lack adequate mental a physician, nutritionist, and the needs of providers and payers, health resources. The Mental Health psychiatrist, as well. Our best not the needs of patients and their Innovation Network, in a 2015 review evidence-supported treatments carers. of innovations in mental health recommend 20 or more sessions So here is the dilemma: How service delivery, noted that low- over the course of six to 12 months. can we develop and deliver high- intensity psychological interventions If a patient’s eating disorder is more quality, evidence-based treatment “refer to interventions that do not rely severe, the patient may need more interventions to a much wider range on specialists and are modified, brief frequent sessions over a longer of people with eating disorders? evidence-based therapies including period of time or may need referrals Might there be ways to provide more guided self-help or e-mental health. for higher levels of care, such as flexible, accessible, adaptable, and They tend to be transdiagnostic, partial hospitalization, residential, or affordable interventions? Over the delivered by paraprofessionals, and inpatient programs, which are even past decade, clinical researchers have a primary focus on teaching less accessible and considerably and public health experts have self-management skills to clients.”
12 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com The relative success of these low- intensity, low-cost programs, and the ease with which they can be scaled up and implemented, has sparked DO YOU HAVE AN EATING DISORDER? tremendous interest in how to adapt the model to address underaddressed mental health needs in the developed Respond honestly to these questions. Do you: world. How might these programs help n Co stantly think about your food, weight, or body image? address the gaps we see in our eating Have difficulty concentrating because of those thoughts? disorder treatment systems? One solution to these issues is to Worry about what your last meal is doing to your body? focus on the development of lower- Experience guilt or shame around eating? intensity treatments that are easily Count calories or fat grams whenever you eat or drink? accessible, affordable, and scalable across a wide region. Many, if not Feel “out of control” when it comes to food? most, people needing treatment for Binge eat twice a week or more? their eating disorder are not able to Still feel fat when others tell you that you are thin? access adequate treatment because our treatments tend to be delivered Obsess about the size of specific body parts? by individual clinicians in a single Weigh yourself several times daily? office for a limited number of hours. The inconvenience and burden of Exercise to lose weight even if you are ill or injured? committing to a full course of treatment Label foods as “good” and “bad”? can be overwhelming and unavoidably Vomit after eating? activates and empowers ambivalence. We’ve also seen a consistent and Use laxatives or diuretics to keep your weight down? reductionistic consolidation of Severely limit your food intake? treatments deemed “evidence-based.” Yet we know that the best available If you answered “yes” to any of these questions, your attitudes and behaviors around food and weight may need to be seriously addressed. An eating disorders professional can give you a treatments for eating disorders, thorough assessment, honest feedback, and advice about what you may want to do next. particularly family-based treatment and enhanced cognitive behavioral therapy, do not lead to full recovery in at least half of the patients who enter Warning Signs treatment. Most of our treatment •An obvious increase or decrease in weight not related to a medical models continue to struggle with condition premature termination, and we have a limited understanding of why so many •Abnormal eating habits, such as severe dieting, ritualized mealtime behaviors, fear of dietary fat, secretive bingeing, or lying about food people find so many of our treatments to be unacceptable to them. Guided •An intense preoccupation with weight and body image self-help (GSH), telehealth, community Mood swings, depression, and/or irritability or peer support programs, mental • Compulsive or excessive exercising, especially without adequate health/eating disorder “coaching,” and • nutritional intake or when injured or ill applications such as Recovery Record all try to address these fundamental challenges in our current treatment delivery models by layering in extra interventions and support that are and treating people for a variety of particularly effective for individuals delivered in less costly ways. behavioral health issues, including with less severe symptomatology, These various interventions have anxiety, depression, and eating there is actually considerable evidence research track records that suggest disorders. Newer iterations of GSH that it may be an effective first-line they can have a significant impact can now be delivered through the intervention for more severe clinical for people with eating disorders. internet, either in groups or on an presentations.
GSH is a low-intensity intervention individual basis. While it seems THIS ARTICLE CONTINUES AND CAN BE FOUND that has shown promise in screening intuitively obvious that GSH might be IN ITS ENTIRETY AT EDCATALOGUE.COM.
EDcatalogue.com 13 body image
BOOK EXCERPT THE EATING INSTINCT: Food Culture, Body Image, and Guilt in America In this excerpt from The Eating Instinct, Virginia Sole-Smith holds a mirror up to America’s diet culture and the myth of willpower.
e don’t want to be hungry and Nutrition Institute at Massachusetts because our culture has told General Hospital. Burgard argues that us that we don’t want to be even attempting to classify obesity by fat.w Sixty percent of Americans are currently type or origin is misguided: “We have trying to lose weight, and 75 percent have this fundamental misunderstanding that made some effort in the past, according to a everyone should be close to the same survey published by University of Chicago weight, and therefore higher-weight bodies researchers in October 2016. And there is can never be healthy and well regulated,” a deeply held belief in our society—one she explains. “But what if most people’s that runs all the way back to the Bible, to bodies are regulating themselves fine, just at the seven deadly sins—that people get fat a wider variety of weights than we’ve been because they are gluttonous, slothful, and taught to consider acceptable?” weak, and lack willpower around food. This Nevertheless, the willpower Excerpted from The Eating Instinct: isn’t true: Though some obese people do eat misconception persists, and it contributes Food Culture, Body Image, compulsively (as do some thin people), the to our sense that being overweight is and Guilt in America by vast majority do not. Only 3.5 percent of dysfunctional and abnormal—that the Virginia Sole-Smith. Published by Henry Holt women and 2 percent of men are diagnosed size of our body is proof that our eating and Company. Copyright with binge eating disorder (itself a is somehow out of control, and that we’ll © 2018 by Virginia Sole- complicated psychological condition that is only have a good life if we can conquer Smith. All rights reserved. 283 pages, hardcover. about much more than self-control), while our hunger and lose the weight. Because 68.8 percent of Americans are classified we think hunger is bad and weight loss is as overweight or obese. Even if binge good, the idea that a surgery can remove eating disorder is wildly underdiagnosed, the former and achieve the latter is deeply it’s a crude mischaracterization to assume seductive. But one consequence of that that being overweight is only about trade-off is never again eating the other eating too much. Genetics, biology, half of the protein bar, let alone the psychology, socioeconomic status, and other muffuletta sandwich. Is merely removing environmental factors all contribute to the experience of physical hunger enough body size. “We know there are probably a to cancel out that loss? Can someone’s hundred or more kinds of obesity, each with ability to eat really be so permanently different causes and clinical characteristics,” transformed? The very reasons for weight- says Lee M. Kaplan, a gastroenterologist loss surgery’s purported success also require and the director of the Obesity, Metabolism, us to ask: Should we be doing it at all?
14 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com M M E N O D C E
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R E G A D I N BODY IMAGE BODY
Body Image, Mind Your Own PREVENTION Fat Talk: A Body Respect: What Prevention Second Edition: Body: A Body Feminist Conventional Health and Recovery A Handbook of Image Handbook Perspective Books Get Wrong, from Eating Science, Practice, Gina Macdonald, Denise Martz, 204 Leave Out, and Disorders in and Prevention 174 pages, paper, pages, paper, 2019 Just Plain Fail to Type 1 Diabetes: Thomas F. Cash & 2018 Understand About Injecting Hope Linda Smolak, 490 Weight Ann Goebel-Fabbri, pages, paper, 2012 Linda Bacon & Lucy 152 pages, paper, Aphramor, 240 pages, 2017 paper, 2014 h atWr nEtn iodr Prevention Disorders Eating on Word Last The
The Last Word on Eating Disorders Prevention dtdb eg Cohn Leigh by Edited
Edited by Leigh Cohn Fat Tactics: The
an informa business ISBN 978-1-138-68934-3 Pursuing www.routledge.com Rhetoric and ,!7IB1D8-gijded! Perfection: Structure of the No Weigh! A Eating Disorders, Fat Acceptance Teen’s Guide to Body Myths, Movement Healthy Bodies The Last Word on Positive Body and Women Erec Smith, 114 (curriculum): Eating Disorders Image, Food, at Midlife and pages, hardcover, Teaching Kids Prevention and Emotional Beyond 2018 What They Leigh Cohn, Wisdom Margo Maine & Joe Need to Know editor, 124 pages, Signe Darpinian, Kelly, 230 pages, Kathy J. Kater, 260 hardcover, 2016 Wendy Sterling & hardcover/paper, pages, paper, 2012 Shelley Aggarwal, 2016 192 pages, paper, 2018
Healthy Habits: The Program Plus Food Guide Index and Easy Recipes: Journeys of 8 Essential Handbook of Embodiment at Kid-Friendly Positive Body the Intersection Nutrition Lessons Image and of Body and Every Parent and Embodiment: Culture: The Educator Needs Constructs, Developmental Laura Cipullo, 108 Protective Factors, Theory of pages, paper, 2013 and Interventions Embodiment Tracy L. Tylka & Niva Piran, 336 Niva Piran, editors, pages, paper, 2017 464 pages, hardcover, 2019
Please visit our website for additional book recommendations. EDcatalogue.com/books 15 binge eating disorder
The Many Faces of Binge Eating Disorder BY AMY PERSHING, LMSW, ACSW
Binge eating disorder (BED) is endemic in our culture. BED is three times more common than all other eating disorders combined, more prevalent than breast cancer, HIV, or schizophrenia. Binge eating affects people across the life span, in all socioeconomic groups, races, sexual orientations, genders, and all body shapes and sizes. It is by I have treated BED for more than 30 years. In that time, I have deeply far the most common eating disorder among explored the adaptive roles binge men (40 percent of people with BED identify as eating plays in the lives of my clients. Among these roles, binge eating male). BED is present in three to five out of every creates a temporary disconnection 10 people seeking weight-loss surgeries. Literally from pain or fear, and allows other millions of people struggle with the disorder. Yet feelings like anger and grief to be expressed with more psychological even with this prevalence, BED is still an eating safety. A client of mine, Linda, says disorder often missed in clinical and medical this: “Food thoughts and planning a binge gave me a safe harbor when I assessments. Research suggests that only 40 was afraid or lonely. It got me through percent of those with BED will receive treatment my past, my divorce, a whole lot of pain I had no idea how to address.” in their lifetime (and this is among only those Such a relationship with food brings diagnosed). For many with BED, efforts to stop respite from a psychological and somatic experience that seems binge eating are short-lived, and resulting yo-yo impossible to withstand. Molly weight losses and gains are common. By the time describes the experience of a binge this way: “The urge happens when I’m people with BED arrive in our offices for help, they thinking about something upsetting are exhausted, hopeless, and ashamed. or uncomfortable. My thoughts drift
16 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com DIAGNOSING BULIMIA NERVOSA
A. Recurrent episodes of binge eating. An episode of binge eating is I am tired of performing, of getting characterized by both of everything right everywhere. Binge the following: eating is a way to do nothing right. In a 1. Eating, in a discrete weird way, it makes me feel powerful period of time (e.g., for a moment. Then it comes crashing within any 2-hour down, and I feel totally out of control.” period), an amount of Claudina describes it this way: “I first food that is definitely experience the urge to binge-eat larger than what most physically. I start to feel anxious in my individuals would eat stomach. I feel a gnawing deep in my in a similar period of belly right above my belly button, but time under similar it’s not hunger—not physical hunger, circumstances. anyway. It’s feelings of anxiety and 2. A sense of lack of control over eating self-doubt and worry. I think of it as a during the episode mini-tornado in my stomach, twisting (e.g., a feeling that one and turning furiously and growing cannot stop eating or bigger and gaining strength until I control what or how make it go away with food.” much one is eating). People with BED live myopic B. Recurrent inappropriate and diminished half-lives, often compensatory behaviors with the sense that some profound in order to prevent weight characterological weakness must gain, such as self-induced be at the heart of their inability vomiting; misuse of to what ‘bad’ foods I have to eat. It’s to change. In fact, as clinicians laxatives, diuretics, a seemingly innocent line of thought. know well, many forces collide to or other medications; Something like, Oh, what could make create BED. Genetics, the biological fasting; or excessive exercise. me feel better right now? And then impact of dieting and often severe the decision comes quickly and food restriction, trauma of all C. The binge eating and inappropriate overwhelmingly. The energy shifts to kinds (including weight stigma), compensatory behaviors something compulsive and shameful. sociocultural oppression, and access both occur, on average, Once I’ve committed to bingeing, to health care all can play a role. at least once a week for I need to do it as soon as possible. In my clinical work with BED, I 3 months. The blinders come on, and as soon have found four precepts especially D. Self-evaluation is as I’m in the house, I’m reaching important to creating a platform on unduly influenced by body for whatever I can.” Binge eating is which recovery from this complex shape and weight. typically frenetic and impulse-driven, disorder can progress over time. E. The disturbance does and seems impossible to waylay. As These precepts promote the most not occur exclusively my client Katie notes, “It’s eating fast. critical components of successful during episodes of Shoveling food in. It tastes so good. I treatment: depathologizing the client’s anorexia nervosa. want more. It’s taking another bite— relationship with food, and empowering by the American Psychiatric and another, and another—while still people to listen to themselves (and Association, excerpted from chewing the first bite. I tell myself I others) through a lens of curiosity, Diagnostic and Statistical Manual of Mental Disorders, deserve it. It’s been a long day. It’s compassion, and strength. Fifth Edition (DSM-5) late. I’m tired. I’ll exercise more, soon, © 2013 by American Psychiatric Publishing tomorrow, next week. I’ll make up for THIS ARTICLE CONTINUES AND CAN BE FOUND it somehow.” Allen says this: “I know IN ITS ENTIRETY AT EDCATALOGUE.COM.
EDcatalogue.com 17 binge eating disorder
BOOK EXCERPT BINGE EATING DISORDER: The Journey to Recovery and Beyond
In this excerpt from Binge Eating Disorder, Amy Pershing, LMSW, ACSW, and Chevese Turner reveal the surprisingly wide breadth of people who struggle with BED.
Who Struggles with BED? more research will help us determine the ED is not confined to the eating disorder nuances of the clinical picture. stereotype of young, white women. Sexual orientation can be a contributing Approximately 40 percent of those with factor in developing BED as well. There binge eating disorder are male. Additionally, remain significant dangers in coming out, over the past few years, there has been including fear of rejection, discrimination, evidence of significant disordered eating bullying, and violence. Stigma and shame across racial and ethnic minorities. Analysis from non-binary gender expressions or of the Minnesota Adolescent Health Study transgender identity are common. Body found dieting, a common precursor to BED, image ideals within some LGBTQ was associated with weight dissatisfaction, communities may also contribute to body seeing oneself as “overweight,” and low body shame. Differences in rates of binge eating pride in all ethnic groups. Exact statistics within the LGBTQ community have yet to on the prevalence of eating disorders among be described in the research, but one thing is Pershing, A & Turner, women of color are still largely unavailable. clear: Many of these factors can be traumatic, C. (2018) Binge Eating Additionally, more research is needed to and trauma, as we will see, sharply increases Disorder: The Journey to Recovery and determine if the experience of the disorder vulnerability to an eating disorder. Beyond. Routledge. is the same for people from different food Poverty and food scarcity can also 182 pages, paper. cultures and differing genetic makeup. significantly impact the development of Environmental race-based stress for binge eating behavior. Research shows people of color can trigger the onset an increased prevalence of various eating of disordered eating patterns as well. disorder features, particularly binge Among women of color, the process of eating, in people who are unemployed or acculturation can be one such source of underemployed. Poverty is especially hard stress. “By definition, acculturation is the on young children. The stress and hardship process by which one group asserts its that goes along with growing up poor can influence over another. The result is likely cause a child to cope in unhealthy ways, to be difficult, reactive, and conflictual, and food may well be one of few available affecting one’s physical and psychological soothing mechanisms. If food itself is functioning,” according to Davis and scarce or unpredictable, enforced cycles of Katzman. The dominant images of restriction (as with intentional behavioral femininity in mainstream culture are still weight loss programs) can in and of thin, white, and young. Body ideals and themselves increase the likelihood of binge social and cultural expectations vary, and eating when food is available.
18 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com M M E N O D C E E D DIAGNOSING R BINGE EATING R E G A D I N DISORDER
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time When Food Overcoming The DBT® Solution Is Comfort: Binge Eating, for Emotional under similar circumstances. Nurture Yourself Second Edition: Eating: A Proven 2. A sense of lack of control over Mindfully, Rewire The Proven Program to Break eating during the episode (e.g., Your Brain, and Program to Learn the Cycle of a feeling that one cannot stop End Emotional Why You Binge Bingeing and Out- eating or control what or how Eating and How You Can of-Control Eating Julie M. Simon, 336 Stop Debra L. Safer, Sarah much one is eating). pages, paper, 2018 Christopher G. Adler & Philip C. Fairburn, 243 Masson, 278 pages, B. The binge-eating episodes are pages, paper, 2013 hardcover/paper, associated with three (or more) of 2018 the following: 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physically hungry. Dialectical 4. Eating alone because of feeling Behavior Therapy embarrassed by how much one is for Binge Eating Questions and eating. and Bulimia, Answers About Binge Control: Reprint Edition Binge Eating A Compact 5. Feeling disgusted with Debra L. Safer, Disorder: A Guide Recovery Guide oneself, depressed, or very guilty Christy F. Telch & for Clinicians Cynthia M. Bulik, 38 afterward. Eunice Y. Chen, 244 Wendy Oliver-Pyatt, pages, paper, 2015 pages, hardcover/ 96 pages, paper, C. Marked distress regarding binge paper, 2017 2017 eating is present. D. The binge eating occurs, on average, at least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not Eat What You occur exclusively during the course of Love, Love What bulimia nervosa or anorexia nervosa. Outsmarting Reclaiming You Eat for Overeating: Boost Yourself from Binge Eating: Michelle May & Your Life Skills, Binge Eating: by the American Psychiatric Association, End Your Food A Step-by-Step Kari Anderson, 194 excerpted from Diagnostic and Statistical Problems Guide to Healing pages, paper, 2014 Manual of Mental Disorders, Fifth Edition (DSM- Karen R. Koenig, 232 Leora Fulvio, 327 5) © 2013 by American Psychiatric Publishing pages, paper, 2015 pages, paper, 2014
Please visit our website for additional book recommendations. EDcatalogue.com/books 19 M M E N O D C E E DIAGNOSING D R AVOIDANT/ R E G RESTRICTIVE FOOD A D I N INTAKE DISORDER
A. An eating or feeding disturbance (e.g., apparent lack of interest in
eating or food; avoidance based ARFID on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to Conquer Picky Eating for Teens Living Full: meet appropriate nutritional and/or and Adults: Shattered Image: Winning My energy needs associated with one Activities and My Triumph over Battle with Strategies for Body Dysmorphic (or more) of the following: Eating Disorders Selective Eaters Disorder Significant weight loss (or Danielle Sherman- 1. Jenny McGlothlin Brian Cuban, 224 Lazar, 256 pages, failure to achieve expected & Katja Rowell, 162 pages, paper, 2013 PERSONAL STORIES PERSONAL paper, 2019 weight gain or faltering growth in pages, paper, 2018 children). 2. Significant nutritional deficiency. 3. Dependence on enteral feeding or oral nutritional supplements. 4. Marked interference with psychosocial functioning. B. The disturbance is not better explained by lack of available food Life Without Ed, Almost Anorexic: or by an associated culturally Food Refusal and 10th Anniversary Is My (or My sanctioned practice. Avoidant Eating Edition: How Loved One’s) in Children, One Woman C. The eating disturbance does not Relationship Including Those Declared occur exclusively during the course with Food a with Autism Independence Problem? of anorexia nervosa or bulimia Spectrum from Her Eating Jennifer J. Thomas nervosa, and there is no evidence Conditions: A Disorder and & Jenni Schaefer, Practical Guide How You Can Too of a disturbance in the way in which 287 pages, for Parents and Jenni Schaefer one’s body weight or shape is paper, 2013 Professionals with Thom experienced. Gillian Harris & Rutledge, 188 D. The eating disturbance is not Elizabeth Shea, 232 pages, paper/ audiobook, 2014 attributable to a concurrent medical pages, paper, 2018 condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional Goodbye Ed, clinical attention. Hello Me: Recover from Your Eating Man Up to by the American Psychiatric Association, Disorder and Fall Eating Disorders excerpted from Diagnostic and Statistical in Love with Life Andrew Walen, 202 Manual of Mental Disorders, Fifth Edition Jenni Schaefer, (DSM-5) © 2013 by American Psychiatric pages, paper, 2014 249 pages, Publishing paper, 2009
20 Please visit our website for additional book recommendations. EDcatalogue.com/books BOOK EXCERPT Cognitive-Behavioral Therapy for AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER: Children, Adolescents, and Adults In this excerpt, Jennifer J. Thomas, PhD, and Kamryn T. Eddy, PhD, share tips on how to approach patients with ARFID.
Provide psychoeducation on ARFID in them understand that they are trapped in a general. The therapist should begin by vicious cycle that limits their opportunities asking the patient (or family) what he or for exposure is critical. In contrast, those with she knows about ARFID. It is important fear of aversive consequences may believe that the therapist not assume a great deal that their inability to eat without choking of prior knowledge about the disorder, represents a physical problem rather than a given its relative newness to the psychiatric psychological one. Last, some patients and/ nomenclature. Using the initial knowledge or parents might need additional support to as a base, the therapist should review the push for weight gain because they do not see patient education handout depicted in Fig low weight as a problem, particularly if the 6.1 (“What is ARFID?”). Important points patient has not fallen off the growth curve to emphasize include that ARFID is a (as in AN), but rather always been slight. © Jennifer J. Thomas and Kamryn T. Eddy 2019, psychiatric disorder and that individuals with Similarly, eating insufficiently or irregularly published by Cambridge ARFID have underlying biological traits that may become part of the core identity of a University Press. initially made limiting their eating a logical person with ARFID—rather than viewed as Cognitive-Behavioral Therapy for Avoidant/ choice. Once established, this pattern of food the symptoms of a disorder—thus limiting Restrictive Food Intake restriction and avoidance becomes self- insight into negative consequences. Disorder: Children, reinforcing and highly resistant to change. Provide psychoeducation on all Adolescents, and Adults. 181 pages, paper. Fortunately, there are helpful steps that maintaining mechanisms relevant for the patients and families can take to interrupt patient. Although the therapist should this pattern. During this collaborative review Figs 6.1 (“What is ARFID?”) and review, the therapist should ask the patient 6.5 (“How is ARFID treated?”) with all to highlight any aspects of the handout that patients, Figs 6.2, 6.3, and 6.4 should be feel especially relevant to his or her current presented only if they are relevant to the situation. The therapist should also encourage patient’s primary maintaining mechanisms the patient (or family) to ask questions. established in the initial assessment. For Psychoeducation is crucial to support example, the therapist would only need to treatment engagement, regardless of the present Fig 6.2 (“What happens when you patient’s current weight or nutritional status. eat a limited variety of food?”), but not Fig For example, patients who have ARFID 6.3 (“What happens when you eat a limited with sensory sensitivity may feel powerless to volume of food?”), for a patient with sensory expand their low-variety diet. Thus, helping sensitivity alone.
EDcatalogue.com 21 recovery
Letting Go of Secrets in Eating Disorder Recovery BY MARK WARREN, MD, MPH, FAED
If you have ever had an eating disorder, regardless focused on what it was like to be of what kind it was, it is an amazing thing a man with an eating disorder at a time when men were not believed to to feel recovered. If, like me, you suffered before have eating disorders. My narrative the illness was recognized as an illness, never focused on triggers, my childhood, the media, the impact of running had adequate treatment, and knew that eating cross-country, an increase in eating disorders were regarded as a social disease, then disorder behaviors, weight loss, and the development of behaviors, finding yourself healthy is likely a fantastic relief. thoughts, and feelings related to the eating disorder. In the end, my eating disorder behaviors became so severe that they ultimately forced me to I was probably 10 years into my to those in recovery, but I was also discontinue school to pursue some anorexia before I knew I had it. At that finding support from them. form of treatment. point, I was already on a recovery path. I was approached by a colleague At this point, I didn’t know I had an Perhaps this is common. Naturally, I at a conference who wanted me to eating disorder. All I knew was that I wanted to know what had happened talk about being a professional with was having disturbing thoughts and to me: What was my story, how did I an eating disorder. My initial response I could not function. I also did not get sick, and how did I get better? But was no. I didn’t want to be that guy know how to get better. So, the second I put these questions aside and closed with the eating disorder. After all, part of my narrative focused on what down this part of myself because, no other male professional at the happened next—meeting my wife. of course, why would I not? I was Academy for Eating Disorders had When I met my wife, I was struggling ashamed of my illness, I thought I had talked about his personal history. But with my eating disorder and she was caused it, I still had some very odd I did choose to give that talk, and I did a chef who loved me despite this. She thoughts about food and body, and I become that guy. I’m glad I did. made a condition of our relationship never had any therapy to address it. In creating my initial presentation that I had to eat what she cooked. So I did not really think about my to share my story around 15 years she was then and still is the star of my narrative for recovery until I was a ago, I knew this was an opportunity story because I began to understand well-established professional who was to clarify a narrative for myself of my recovery through that relationship. active in the eating disorder field. At my experience with anorexia. This I understand now that I was involved in that point, I was providing support narrative, almost by definition, was some type of family-based treatment,
22 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com M M E N O D C E
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Hunger for Connection: Finding Meaning in Eating Disorders Alitta Kullman, 168 pages, hardcover/ paper, 2018 where through the power of love and for Eating Disorders meeting, and connection, I was able to move into went around the country discussing a place of weight restoration. This, my illness and recovery narrative. of course, was very hard, and my So, to a fairly large degree, that behavior was challenging at times, but narrative started to define who I was. together through this, we bonded. Then, one night a few years ago, at a I returned to medical school, but Renfrew conference, a distinguished following my internship, I dropped out professional casually mentioned that again from medical training because she had been exploring the potential even though my weight was restored, for eating disorder recovery using Using Writing I was not happy. My wife and I hallucinogenic drugs. I was seized by as a Therapy for decided to spend a couple of years shame in that moment because this Eating Disorders: The Diary Healer living on a farm with friends, where was something that was true for me June Alexander, 278 I learned more about my eating. I that I had chosen to delete from my pages, paper, 2016 learned how to be comfortable eating narrative. with others; I also learned a lot about I spontaneously shared this part shame, because I was spending all of my history with her and another of my time with others. In particular, friend. Between 1982 and 1985, I I got very in touch with the shame I was doing my residency at Harvard, carried about my body. and I was able to join an MDMA Of course, this understanding study on the use of the psychedelic extended into the rest of my life, as a therapeutic agent, which compelling me to seek therapy about was fortunately legal at that time. 13 years after my disorder began. I During my experience participating Recover Your did therapy for many years, primarily in this study and utilizing MDMA, Perspective: Gestalt therapy focused on sensation I experienced a dissolving of body A Guide to Understanding and awareness. shame and an ability for me to have Your Eating This narrative is what I told myself, full contact with my own skin, which Disorder and and it became essential to who I was was something I’d never had before. Creating Recovery Using CBT, DBT, in the eating disorder field. For over 10 and ACT Janean Anderson, 306 years, I spoke to many people about THIS ARTICLE CONTINUES AND CAN BE FOUND pages, paper, 2018 this, did a keynote at an Academy IN ITS ENTIRETY AT EDCATALOGUE.COM.
Please visit our website for additional book recommendations. EDcatalogue.com/books 23 healthy behaviors
BOOK EXCERPT I have not failed. I’ve just found 10,000 ENDING ways that won’t work. THE DIET —Thomas Edison
MINDSET: nstead of seeing repetition as a sign of being stuck or a lack of progress, Reclaim a embrace repetition as evidence that you iare a strong and tenacious warrior committed Healthy and to creating your best life. Summary Balanced 1. Change is not a linear process, but rather a process full of twists and turns that enhance your experience and teach you the Relationship lessons necessary for the change you are trying to achieve. with Food and 2. Your journey of change is an internal process where you change perspective and acquire wisdom, as opposed to an external Body Image process where external variables change. In this excerpt from Ending the Diet 3. Failure is a linear, dichotomous-mindset Mindset, Becca Clegg, LPC, CEDS, concept. When looked at through a offers a new perspective on nonlinear, compassionate mindset, setbacks and long-term growth. however, the concept of failure becomes evidence that we are changing, growing, and actively living our lives. In other words, the old concept of failure is now a badge of honor, signifying that you are indeed courageous and strong. 4. Embracing the inner critic, rather than trying to escape it, allows you to learn Reprinted with from your behaviors rather than react to permission: BookLogix, copyright © 2018 them or avoid them. by Becca Clegg, 5. Embracing repetition as evidence of 149 pages, paper. success begins to undo the linear mindset and establishes a new growth mindset that embraces a natural part of the nonlinear- change process.
24 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com M M E N O D C E
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Eating Disorders: A Treatment Health at 50 More Ways to Psychoanalytic Spiritual Every Size: Soothe Yourself Workbook for Treatment of Eating
SPIRITUALITY Approaches in Outpatients and The Surprising Without Food Disorders: When the Treatment Therapists Truth About Susan Albers, 336 Words Fail and of Women with Lenore McKnight, Your Weight pages, paper, 2015 Bodies Speak Eating Disorders 171 pages, paper, Linda Bacon, Tom Wooldridge, P. Scott Richards, 2019 400 pages, editor, 288 pages, Randy K. Hardman paper, 2010 hardcover/paper, 2018 & Michael E.
HEALTHY BEHAVIORS HEALTHY Berrett, 304 pages, hardcover, 2007 PROFESSIONAL TREATMENT PROFESSIONAL
Eat to Love: A Mindful Guide to Transforming Embodiment Intuitive Eating: Your Relationship and Eating Understanding A Revolutionary with Food, Body, Disorders: Theory, Anorexia Nervosa Program That and Life Research, in Males: An Mom in the Works Jenna Hollenstein, Prevention, and Integrative Mirror: Body
Evelyn Tribole & 248 pages, paper, Treatment Approach Image, Beauty, Hillary L. McBride & Elyse Resch, 344 2019 Tom Wooldridge, 146 and Life After Janelle L. Kwee, 392 pages, paper, 2012 pages, hardcover/ Pregnancy pages, hardcover/ paper, 2016 Dena Cabrera paper, 2018 & Emily T. Wierenga, 242 pages, hardcover, 2013
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live out true beauty
In a culture that bombards women with “thinspiration” messages and pressures women to “do it all” while wearing the mask of perfection, we are left feeling alone and overwhelmed. It’s easy to lose our courage, to lose our sense of who we truly are, and to wonder if we will ever be good enough.
But on the sidelines, some women are choosing to take off their masks and live their most authentic lives. In Brave Is the New Beautiful, Lee Wolfe Blum weaves these women’s inspiring stories of everyday bravery with reflections from her own journey. Through call-to-action questions and ideas, she encourages us each to live without fear and shame as we embrace our true selves. Because by sharing our deepest fears and most passionate hopes, we are stronger. We are brave. We are beautiful.
INCLUDES QUESTIONS FOR INDIVIDUAL REFLECTION OR GROUP DISCUSSION
LEE WOLFE BLUM is an energetic and passionate speaker who loves to help women find hope in healing from perfectionism and addictions. She works as a mental health practitioner in the field of eating disorders and chemical dependency. She lives in Minnesota with her husband and Embody: three boys. FOREWORD BY SHANNON ETHRIDGE ALSO AVAILABLE AS AN EBOOK
US $16.99 ISBN 978-1-4347-1030-7
RELIGION 138164 Managing Severe Christian Life Learning to Love Women’s Issues
CLWI Taking a Detailed Printed in USA Your Unique Body and Enduring Eating Disorder (and Quiet That Anorexia Nervosa: History: A Critical Voice!) A Clinician’s Guide Brave Is the Connie Sobczak, Comprehensive Stephen Touyz, New Beautiful: 288 pages, paper, Guide for Daniel Le Grange, Finding the
2014 Clinicians J. Hubert Lacey Courage to Be James R. & Phillipa Hay, the Real You Kirkpatrick, 302 editors, 320 pages, Lee Wolfe Blum, pages, hardcover/ hardcover/paper, 224 pages, paper, 2018 2016 paper, 2017
Please visit our website for additional book recommendations. EDcatalogue.com/books 25 nutrition therapy
What Does a Nutrition Therapist Really Do?
BY SONDRA KRONBERG, MS, RD, CDN, CEDRD-S
It’s Monday morning, and I now invite Midway through the day, 25-year-old you into my office. I want to share a Kaitlyn, who struggles with symptoms of anorexia and exercise bulimia, sampling of patients with you and enters and declares that she won’t hopefully broaden your understanding sit on the chair! She must stand and walk around the room or she won’t be of the actual role of a nutritionist able to stay. During the session, she when working with a patient struggling discloses that she ate a muffin with her girlfriends and then went home with an eating disorder. to cut the word FAT onto her arm. My first patient, Sally, is a new patient: Hmmmmm. Sally is a 40-year-old woman in a My last client, Matthew, an overly anxious 12-year-old, is practically larger body. She enters, looks me over, dragged in by his mom, who is equally sits down, and says, “What does a anxious and weeping hysterically because they had another eating skinny broad [really, she says bitch] battle this morning. She fluctuates like you know about losing weight?” between frustration with and empathy for Matthew. He will only Hmmmmm. eat five specific foods, of specific
26 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com M M E N O D C E brands, at specific times and exact themselves in my office because they E D temperatures. He is also now refusing don’t feel good about themselves R to go to school. Hmmmmm. and they have adapted food and R I am a seasoned nutritionist with body beliefs as a mechanism of E G A D I N years of experience, better described self-evaluation. Most have long ago as a nutrition therapist who specializes lost connection to their own inner in the treatment of eating disorders. knowledge, wisdom, and life force.
What is my role? What really goes on This exhausting struggle with food, A Step-By-Step ree-Year Journal Daily
in my office? Is it about the food, or weight, and body image often stems Step-By-Step is it not about the food? How does from a sense of worthlessness. It is an A ree-Year Daily Journal a nutrition therapist contribute to all-consuming attempt to feel better the treatment team to help patients about themselves, numb their pain, recover? cope with feelings, or gain a sense In the early days of my practice, of control. This eating-disordered encountering these behaviors would symptomology is not only a clever Step-by-Step: often leave me feeling like a deer in the adaptation for survival, but also a A Three-Year Daily Journal headlights, immobilized and stuck— crucial means, often the only means, Kathryn Cortese, perhaps similar to how the patients of communication. As destructive as 365 pages, were feeling. The traditional role of the it may seem to the outside world, the hardcover, 2018 nutritionist in the medical model is to eating disorder can be a mechanism provide information to the client: to of self-care and a measure of security devise and implement a meal plan that for the person who is struggling. It fixes the problem and to provide some takes a lot more than information and oversight to ensure accountability direction to reach, understand, and or compliance for a relatively short shift the eating-disordered thoughts, time. Armed with scientific training beliefs, and behaviors that have been and medical model concepts, I was purposefully integrated. geared up for providing patients No amount of nutritional with information and meal plans. information and schooling regarding My Story: BY SONDRA KRONBERG, MS, RD, CDN, CEDRD-S Healing Through Having acquired the scientific the roles and functions of protein, Self-Reflection: A answers about food, nutrition, health, carbohydrates, and other nutrients, Fill-In Journal weight, and bodily function, I was and no amount of meal planning Kathryn Cortese, 102 pages, now qualified to help others improve expertise would even touch the depth hardcover, 2019 their nutritional status. I was naive of what is attached emotionally, enough to believe that merely knowing physiologically, and behaviorally to information and providing direction these patterns that get communicated would catalyze action and create through food and body dialogues. change. My job would be to: 1) Assess How in the world would a 30-minute patients’ physiological status; 2) session about what foods to eat and Determine their nutritional needs; 3) how to nourish oneself compete with Calculate the correct percentage of the thoughts and mechanisms that of its adherence. Providing a meal plan macronutrients and micronutrients have evolved in the formation of these is a small part of the whole process. to be included in the daily allotted patients’ disordered relationships Progress and recovery can only really calorie intake; 4) Produce a food with their food, their aversions or occur through the relationship the plan that meets their nutrient and compulsions, and the embedded patient and nutritionist can develop. energy needs; 5) Provide a brief assist perceptions of their weight or bodies? Patient willingness to progress in getting started. While all these Understanding the depth of is connected to the ability of the tasks are an important part of the the behaviors, the purposes they nutritionist to both have empathy for nutritionist’s role, they are only a piece serve, and the mechanisms involved the patient’s current adaptations and of the whole when it comes to treating has taught me that the role of the hold hope for a different future. individuals with eating disorders. nutritionist in the treatment of eating
The majority of patients who disorders goes well beyond the setting THIS ARTICLE CONTINUES AND CAN BE FOUND struggle with eating disorders find up of a meal plan and the supervision IN ITS ENTIRETY AT EDCATALOGUE.COM.
Please visit our website for additional book recommendations. EDcatalogue.com/books 27 body image
BOOK EXCERPT but just knowing that there was a point in your history when you once loved your body can be a reminder that body shame THE BODY is a fantastically crappy inheritance. We didn’t give it to ourselves, and we are not obligated to keep it. We arrived on this IS NOT AN planet as LOVE. We need not do anything other than turn on a television for evidence affirming APOLOGY: how desperately our society, our world, needs an extreme form of self-love to counter the constant barrage of shame, The Power of discrimination, and body-based oppression enacted against us daily. Television Radical Self-Love shows like The Biggest Loser encourage dangerous and unsustainable exercise and In this excerpt from The Body Is Not an food restriction from their contestants Apology, Sonya Renee Taylor preaches while using their bodies as fodder for the power of reclaiming self-love. our entertainment and reinforcing the notion that the most undesirable body one can have is a fat body. Researchers have shown that American news outlets adical self-love is deeper, wider, regularly exaggerate crime rates, including and more expansive than a tendency to inflate the rates of Black anything we would call self- offenses while depicting Black suspects rconfidence or self-esteem. It is juicier than in a less favorable light than their White self-acceptance. Including the word radical counterparts. People with disabilities are offers us a self-love that is the root or origin virtually nonexistent on television unless of our relationship to ourselves. We did not they are being trotted out as “inspiration start life in a negative partnership with our porn.” Their stories are often told in bodies. I have never seen a toddler lament ways that exploit their disabilities for the size of their thighs, the squishiness the emotional edification of able-bodied of their bellies. Children do not arrive people, presenting them as superhuman here ashamed of their race, gender, age, for doing unspectacular things like reading or disabilities. Babies love their bodies! or going to the store or, worse yet, for
Excerpted with permission Each discovery they encounter is freaking overcoming obstacles placed on them by from The Body Is Not an awesome. Have you ever seen an infant the very society that fails to acknowledge Apology: The Power of realize they have feet? Talk about wonder! or appropriately accommodate their bodies. Radical Self-Love, Sonya Renee Taylor, Berrett- That is what an unobstructed relationship Of course we need something radical to Koehler Publishers, ISBN with our bodies looks like. You were an challenge these messages. 1626569762, 137 pages, infant once, which means there was a time Using the term radical elevates the paper, 2018. when you thought your body was freaking reality that our society requires a drastic awesome too. Connecting to that memory political, economic, and social reformation may feel as distant as the farthest star. It in the ways in which we deal with bodies may not be a memory you can access at all, and body difference.
28 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com M M E N O D C E
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R E G A D I N RECOVERY The Anorexia The Food Nourish: How to Heal Body Mindful Sick Enough: Recovery Skills and Feelings Your Relationship with Yoga: Create A Guide to Workbook: A Workbook: A Full Food, Body, and Self a Powerful the Medical Comprehensive Course Meal on Heidi Schauster, 228 and Affirming Complications of Guide to Cope with Emotional Health pages, paper, 2018 Relationship with Eating Disorders Difficult Emotions, Karen K. Koenig, 216 Your Body Jennifer L. Gaudiani, Embrace Self- pages, paper, 2007 Robert Butera 276 pages, hardcover/ Acceptance, and & Jennifer paper, 2018 Prevent Relapse Kreatsoulas, 240 Catherine L. Ruscitti, pages, paper, 2018 Jeffrey E. Barnett
RECOVERY WORKBOOKS RECOVERY & Rebecca A. Wagner, 256 pages, paper, 2017
The Food Addiction 8 Keys to End Recovery Emotional Eating Workbook: How Howard S. Farkas, 174 to Manage pages, paper, 2019 The Recovery Cravings, Reduce Mama Guide Stress, and Stop Yoga and Eating to Your Eating Hating Your Body Disorders: Ancient Disorder Recovery The Body Image Carolyn Coker Ross, Healing for Modern in Pregnancy and Workbook, 240 pages, paper, Illness Postpartum Second Edition: 2017 Carolyn Costin & Joe Linda Shanti An Eight-Step Kelly, editors, 228 McCabe, 208 pages, Program for pages, paper, 2016 paper, 2019 Learning to Like Your Looks Recovery Is: Thomas F. Cash, 232 Stories of Healing pages, paper, 2008 Liana Rosenman & Kristina Saffran, 128 pages, paper, 2015
The Intuitive Eating Workbook: 10 Principles for Nourishing French Toast for a Healthy Getting Better Bite Relationship Breakfast, New by Bite, Second Revised Edition: with Food Edition: A Survival Evelyn Tribole Declaring Peace Kit for Sufferers of 8 Keys to with Emotional & Elyse Resch, 244 Bulimia Nervosa Recovery from an pages, paper, 2017 Eating and Binge Eating Eating Disorder Lasagna for Lunch: Mary Anne Cohen, Disorders Workbook Declaring Peace with 246 pages, paper, Ulrike Schmidt, Janet Carolyn Costin & Emotional Eating 2016 Treasure & June Gwen Schubert Mary Anne Cohen, 348 Alexander, 182 pages, Grabb, 288 pages, pages, paper, 2013 paper, 2015 paper, 2017
Please visit our website for additional book recommendations. EDcatalogue.com/books 29 family and loved ones
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Getting over The Intuitive Family Eating KIDS/TEENS Overeating for Eating Workbook Father Hunger, Disorders Manual: Teens: A Workbook for Teens: Help Your Second Edition: Guiding Families to Transform Your A Non-Diet, Teenager Beat an Fathers, Daughters, Through the Maze Relationship with Body Positive Eating Disorder, of Eating Disorders Approach to and the Pursuit of Second Edition Food Using CBT, Laura Hill, David Dagg, Building a Healthy Thinness James Lock & Daniel Mindfulness, and Michael Levine, Linda Relationship Margo Maine, 288 Le Grange, 310 Intuitive Eating Smolak, et al., with Food pages, paper, 2004 pages, hardcover/ (Teen Instant 227 pages, spiral- Elyse Resch, 240 paper, 2015 Help) bound, 2012 Andrea Wachter, 184 pages, paper, 2019, pages, paper, 2016, teens
teens ONES AND LOVED FAMILY
Skills-Based Emily’s Guide to Caring for a Loved How to Nourish Eating Disorders: Positive Body One with an Eating Your Child Understanding A Workbook for Image for Kids: A Disorder, Second Through an Teen Eating Children Ages Strengths-Based Edition: The New Eating Disorder Disorders: Warning 5-11 Curriculum for Maudsley Method Casey Crosbie & Signs, Treatment Sherri Hicks, Children Aged 7-11 Janet Treasure, Wendy Sterling, 324 Options, and illustrated by Ruth MacConville, 256 Gráinne Smith & Anna pages, paper, 2018 Stories of Courage Stacey Lyddon, pages, paper, 2017, Crane, 294 pages, Cris E. Haltom, Cathie 32 pages, paper, ages 7-11 hardcover/paper, Simpson & Mary 2017, ages 5-11 2016 Tantillo, 204 pages, hardcover/paper, 2018
Your Dieting Daughter, Second Amanda’s Big Letting Go of ED Edition: Antidotes Dream – Embracing Me: When Your Teen Parents Can Judith Matz, A Journal of Self- Has an Eating Provide for Body Ed Says U Said: illustrated by Discovery Disorder: Practical Dissatisfaction, Eating Disorder Elizabeth Patch, 32 Maria Ganci & Linsey Strategies to Help Excessive Dieting, Translator pages, paper, 2015, Atkins, 234 pages, Your Teen Recover and Disordered June Alexander & ages 4+ paper, 2019 from Anorexia, Eating Bulimia, and Binge Carolyn Costin, 256 Cate Sangster, 288 Eating pages, paper, 2013 pages, paper, 2013 Lauren Muhlheim, 168 pages, paper, 2018
30 Please visit our website for additional book recommendations. EDcatalogue.com/books BOOK EXCERPT LOVING SOMEONE WITH AN EATING DISORDER: Understanding, Supporting, and Connecting with Your Partner
In this excerpt from Loving Someone with an Eating Disorder, Dana Harron, PsyD, suggests a few key communication tips for difficult conversations.
Communicating Clearly Using I-Statements All the emotional centeredness and Just as important as what you say is what you appropriate boundaries in the world won’t will want to avoid saying. How do you feel matter unless you can convey this stance to when somebody starts a sentence with, “You your partner. Yet, as important as it is, we are being…” and then goes on to characterize actually don’t talk very much in our culture something you did or said? The structure of about how to communicate well. As a result, the you-statement usually puts the listener on surprisingly few people learn to speak clearly the defensive, because what you hear next and listen for understanding. The following is likely either a criticism or an assumption communication strategies will help you hit the about your experience (or both). Instead, I right tone, convey your intended meaning, and recommend using the I-statement. The basic accurately hear what your partner is saying. idea is that when you want to communicate how you are feeling, you focus on your own Timing Communications Well feelings. This ensures you are only speaking Reprinted with Never ever discuss loaded topics during a for yourself, not your partner. Other people permission: New Harbinger Publications, Inc., meal, when your partner is about to eat, or are likely to be receptive to I-statements— copyright © 2019 when he’s just eaten. Food situations make after all, who can argue with you about what Dana Harron, PsyD, Loving people with eating disorders extremely your feelings are? Someone with an Eating Disorder: Understanding, anxious, and you want to have your important Using I-statements doesn’t mean talking Supporting, and conversations at a time that is as calm as only about yourself, but it does mean that Connecting with Your possible. To that end, it can be helpful to you’re talking about experiences only from Partner, 163 pages, paper. remember the acronym HALT, which comes your perspective. A good I-statement would from the substance abuse field: Don’t pursue be, “I am worried about your health when I the conversation when either you or your don’t see you eat much.” If you are talking partner is hungry, angry, lonely, or tired. about something your partner is doing, try Both of you should be in as centered and to keep your focus on the behavior instead grounded a place as possible. Remember, you of the person: “I feel upset when you miss aren’t a mind reader, so it’s always a good idea dinner” or “I am sad that you are struggling to check with your partner if it’s a good time so much.” Keep in mind that I-statements are to talk before forging ahead with your topic. not accusations; they are a way of providing You can simply ask, “I’d like to talk to you information to your partner about what is about something. Is this a good time?” happening for you.
EDcatalogue.com 31 Fertility and Pregnancy in Eating Disorders BY MITTSI CROSSMAN, MD, CEDS
Fertility and pregnancy in eating disorders are important topics, as eating disorders affect many young women. The purpose of this article is to Vignette 2 A young woman with a history of provide an overview of these areas as well as nicotine and alcohol use disorder, as recommendations for further reading. Consider well as bulimia nervosa (BN), with irregular and infrequent periods, the following vignettes: becomes pregnant. She stops smoking and drinking alcohol, and significantly minimizes purging. She struggles with urges to binge. During Vignette 1 needed. She also has increasing the first trimester, she experiences A young woman with irregular menses anxiety, depression, and significant morning sickness and anorexia nervosa (AN), restricting worsening body image. Her (hyperemesis gravidarum), which she type, since her early teens struggles pregnancy, labor, and delivery finds confusing and triggering. She to get pregnant. After consultations are significant for a healthy-but- strengthens her skills to tolerate the with endocrinologists and fertility small-for-gestational-age baby. physical discomfort and nausea more specialists, and continued work with c. believes that the weight she easily than she did with BN because her treatment team, which specializes gained while trying to become she accepts these physical symptoms in eating disorders, she slowly weight pregnant should be adequate for as “normal” in pregnancy. During restores and eventually conceives. the duration of her pregnancy. checkups with her obstetrician, she During pregnancy, she… Eating disorder symptoms has blinded weigh-ins. Her previous increase as she struggles to fear of weight gain if she stopped a. continues to gain weight prevent additional weight gain. purging is obscured by the expected appropriately, learns to She experiences a fall from a weight gain of pregnancy. With this integrate regular eating, finds spontaneous hip fracture early in neutralization of weight-gain fears, she normalization in meals and her third trimester, which induces is able to put her efforts into stopping hunger and fullness cues, and preterm labor. Her premature purging and, eventually, bingeing. After carries to full term without baby requires treatment in the delivery of her baby, she… complications. neonatal intensive care unit b. struggles to gain the weight (NICU). a. continues to maintain the skills
32 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com Fertility in Eating Disorders Hormones Eating disorders occur more frequently in women than in men and frequently coincide with puberty, when sex hormone levels increase. Within a menstrual cycle, food intake and meal size can fluctuate cyclically. During pregnancy, estradiol and progesterone increase until childbirth and then decrease postpartum; however, eating disorder symptoms don’t seem to correlate with hormone increases. At menopause, there are decreases in estradiol and progesterone. Menopause is associated with increased body weight, fat that she accomplished during her food cravings and gives in to them, accumulation, and food intake, and pregnancy. trusting that her baby must “need” the hormone replacement with estradiol b. finds that without the protective foods that she usually wouldn’t eat. As reverses these postmenopausal factor of the baby in utero, she is pregnancy continues… effects (the risks and benefits of more susceptible to engaging in hormone replacement therapy should bingeing and purging again. a. she continues to struggle with be discussed with one’s doctor). c. continues to refrain from cravings, overeating, and binge bingeing and purging but begins eating, as well as low-grade Nutrition and to restrict, especially with the depression and anxiety. Menstruation justifications of stress and the b. she gains weight in excess of her Nutritional deficits found in eating busy life of new motherhood. expectations as her tolerance disorders cause decreased production for exercise diminishes and she of hormones, including the sex indulges in foods that she had hormones estradiol and progesterone, Vignette 3 normally considered forbidden. which regulate menstrual cycles, A young woman, a self-proclaimed She doesn’t see the point in ovulation, and pregnancy. With “exercise addict,” fad dieter, and “dieting” while pregnant and malnutrition, the primitive hardwired emotional overeater, prone to develops symptoms consistent brain registers famine or extreme depression and anxiety, finds herself with binge eating disorder (BED). stress, and the body downregulates unexpectedly pregnant with her She has complications during hormone production to preserve long-term partner. During her first labor and requires a Cesarean available resources for the most vital trimester, she continues to exercise at section. life-maintenance functions. We are pre-pregnancy levels and is pleased to c. she develops gestational still learning the precise biological find that her weight remains relatively diabetes and begins working mechanisms as to how hormone stable. As she enters her second with a dietitian. She learns production is regulated, but it may trimester, her exercise tolerance about intuitive eating and include leptin in individuals with AN diminishes and her body begins to better understands her eating or BN, and insulin and testosterone in change more visibly, yet she fully behaviors. She remains nourished individuals with BED. embraces pregnancy as she shares in pregnancy, and overeating her exciting news with family and diminishes. She delivers a healthy THIS ARTICLE CONTINUES AND CAN BE FOUND friends. During this time, she relishes baby without complications. IN ITS ENTIRETY AT EDCATALOGUE.COM.
EDcatalogue.com 33 BOOK EXCERPT The Clinical Guide to FERTILITY, MOTHERHOOD, AND EATING DISORDERS: From Shame to Self-Acceptance In this excerpt from The Clinical Guide to Fertility, Motherhood, and Eating Disorders, Kate B. Daigle, MA, LPC, CEDS, discusses the unique challenges faced by women who have dealt with ED.
ou may be thinking that getting can be triggering and obsessive, especially if pregnant is the best gift you could the woman’s medical team overemphasizes possibly experience after many years the role of weight in fertility health (or any of struggling with yourself, your form of health). body, and food. And you are right—the gift of Finding trust in your body and working getting pregnant is unlike any other. to believe that it is telling you exactly what it However, even for women who desire to needs to create a healthy baby may seem like have a family so badly, the changes that occur an utterly foreign concept for someone who emotionally and physically during pregnancy is struggling with an eating disorder. When may take them off-guard. Your body a woman has dealt with infertility, as many changes more rapidly when you are pregnant of the women who I interviewed had done than at any other time of your life. In the for years, getting pregnant and attempting to first trimester, your body may once again develop or revitalize that trust in their body feel as if it’s against you, or you against it. can also be very challenging and wrought Symptoms of early pregnancy include nausea, with loss. Daigle, K. (2019) constipation, weight gain/bloat, dizziness, While no one chooses to have an eating The Clinical Guide to Fertility, Motherhood, and lack of appetite or increased appetite, and disorder, one can choose recovery for the first Eating Disorders: From sleep disturbances, among other things. All time or re-enter recovery if they have slipped. Shame to Self-Acceptance. of these are messages from your body to you, A woman and her partner can choose to start Routledge. 154 pages, paper. saying that it’s working extra hard and trying a family, and yet once a woman is pregnant, to grow another human inside of it. there is so much out of her control that can These changes continue during the length be big triggers for her. A few of these are: of the pregnancy as the child grows larger and stronger and begins to demand more and • Weight gain more energy, food, resources, and brainpower • Food cravings from the mother’s body. Pregnancy is also a • Emotional mood swings and hormone time where women will get weighed by their fluctuations doctor consistently and their weight will be • Nausea and morning sickness monitored and discussed more than any other • Stretch marks and growth of hips/breasts time of their lives. If the scale has been given • Back problems absolute power over a woman’s self-esteem, • Forgetfulness, memory loss as may happen in the presence of an eating • Exhaustion disorder, this focus on weight and numbers • Insomnia/sleep issues
34 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com M M E N O D C E
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The Eating Disorders Clinical Pocket Guide, The Second Edition: Comprehensive ACT for Anorexia Quick Reference Learning Teaching Eating Disorders The Wiley Nervosa: A Guide for Healthcare Handout Series for in America: Handbook of for Clinicians Providers Eating Disorders A Reference Eating Disorders Rhonda M. Merwin, Jessica Setnick, Sondra Kronberg, BOOKS SOURCE Handbook Linda Smolak Nancy L. Zucker & 139 pages, spiral- 50 handouts, CD David E. Newton, & Michael P. Levine, Kelly G. Wilson, 286 bound, 2013 (PDF format), 2009 348 pages, 1,016 pages, pages, hardcover/ hardcover, 2019 hardcover, 2015 paper, 2019 PROFESSIONAL TREATMENT PROFESSIONAL
Eating Disorders, Eating Disorders, Anorexics A Brain-Based Addictions, Third Edition: The Oxford Approach to and Substance and Bulimics A Guide to Anonymous: The Handbook of Eating Disorder Use Disorders: Medical Care and Eating Disorders, Treatment Research, Clinical, Fellowship Details Complications Its Program of Second Edition Laura Hill, e-text, and Treatment Philip S. Mehler & W. Stewart Agras 2017. Go to Perspectives Recovery for Arnold E. Andersen, Anorexia and & Athena Robinson, EDcatalogue Timothy Brewerton editors, 400 pages, editors, 560 pages, .com/hill for a & Amy Baker Dennis, Bulimia hardcover/paper, 288 pages, paper, hardcover, 2018 special bonus! editors, 681 pages, 2017 hardcover, 2014 2002
Eating Disorders: Understanding Helping Patients Family Therapy Encyclopedia of Causes, Outsmart Eating Disorders for Adolescent Feeding and Eating Controversies, Overeating: in Children and Eating and Weight Disorders and Treatment Psychological Adolescents Disorders: New Tracey Wade, editor, (2 volumes) Strategies for Daniel Le Grange Applications 901 pages, hardcover, Justine J. Reel, 716 Doctors and & James Lock, 512 Katharine L. Loeb, 2017 pages, hardcover, Health Care pages, hardcover, Daniel Le Grange 2018 Providers 2011 & James Lock, Karen R. Koenig & editors, 474 pages, Paige O’Mahoney, hardcover/paper, 260 pages, hardcover, 2015 2017
Please visit our website for additional book recommendations. EDcatalogue.com/books 35 professional treatment
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Beyond a Shadow Treatment of Treatment Measuring Clinical Handbook of a Diet, Second Eating Disorders: Manual for Health from the of Complex and Edition: The Bridging the Anorexia Inside: Nutrition, Atypical Eating Comprehensive Research- Nervosa, Second Metabolism, and Disorders Guide to Practice Gap Edition: A Family- Body Composition Leslie K. Anderson, Treating Binge Margo Maine, Beth Based Approach Carolyn Hodges Stuart B. Murray Eating Disorder, Hartman McGilley James Lock & Chaffee & Annika & Walter H. Kaye, Compulsive Eating, & Douglas W. Daniel Le Grange, Kahm, 168 pages, editors, 440 pages, and Emotional Bunnell, 526 pages, 271 pages, paper, 2015 paper, 2017 Overeating hardcover, 2010 hardcover, 2012 Judith Matz & Ellen Frankel, 338 pages, paper, 2014
Please visit our website for additional book recommendations. EDcatalogue.com/books
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36 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com BOOK EXCERPT
and-true behavioral intervention of providing TREATING praise… . From this perspective, the emotional escalation is interpreted as an effort to block reinforcement of the meal completion, in service EATING of protecting the eating disorder. If the eating disorder is protected, the person is also protected from feeling all the negative emotions that the DISORDERS IN eating disorder regulates (fear of weight gain, guilt after eating, disgust with one’s body, and so forth). We have even heard patients say, “If you ADOLESCENTS keep saying, ‘Good job,’ it will make me fat.” In this excerpt from Treating Eating Disorders in Eating Disorder– Adolescents, Tara L. Deliberto, PhD, and Dina Exacerbating Behaviors Hirsch, PhD, expose the complications of ED- Just as eating disorder–protecting behaviors protecting behaviors. involve the deflection of recovery-fostering reinforcement, and therefore block progress in treatment, other types of behaviors appear Eating Disorder– to actively exacerbate the eating disorder. Protecting Behaviors In particular, we have noted a disturbing As mentioned earlier, people with eating phenomenon in the context of eating disorders— disorders experience intense negative emotions, namely, patients asking for others to body-shame which include, but are not limited to, fear of them about their weight. Specifically, patients “fatness” and weight gain, guilt, and disgust. Once report seeking out abusive comments about their the eating disorder is in place, behaviors such as body as “motivation” to further restrict caloric food restriction, food avoidance, purging, calorie intake, avoid foods, exercise, and engage in counting, compulsive exercise, and so forth, serve other eating disorder behaviors. For instance, on to decrease these negative emotions temporarily. pro-anorexia (pro-ana) websites, people can post Probably because these behaviors are so pictures of themselves and ask others to “guess” effective at reducing negative emotions, it quickly their weight in a mean-spirited way. Other
Reprinted with permission: becomes apparent in treatment that patients participants in the forum will then intentionally New Harbinger are resistant to change when they are pushed to “guess” clearly higher weights. There is even a Publications, Inc., meet treatment goals. Patients display behaviors term for this, meanspo, which is a variant on the copyright © 2019 by Tara L. Deliberto and Dina that serve to protect the eating disorder from more popular thinspiration (thinspo) or fitspiration Hirsch, Treating Eating treatment. More specifically, patients display (fitspo). The latter two terms are certainly Disorders in Adolescents: behaviors that block reinforcement of recovery- maladaptive, but thinspo or fitspo content is not Evidence-Based Interventions for Anorexia, oriented and non-eating-disorder behaviors. as disparaging and abusive as meanspo content Bulimia, and Binge Eating, For instance, after a patient finishes a meal, the is. Do not introduce these terms to patients, because 304 pages, paper. therapist may say, “Good job finishing the meal,” they may look them up and start engaging in these to which the patient may respond, “I hate you behaviors or participating in online meanspo forums. when you say that.” The therapist’s “good job” Further, introducing the specific term meanspo to remark was intended to reinforce the patient’s carers may also be unwise, because some carers recovery-oriented behavior, but patients with may discuss this term with the patient. It is best to ego-syntonic (self-eclipsing) eating disorders avoid introducing this term into any conversation often react rather aggressively to the tried- in which the patient hasn’t used it first.
EDcatalogue.com 37 Recognizing Institutionalized Weight Bias
BY JANELL MENSINGER, PHD, FAED
“It is inherently dangerous to grateful for the profound insights Before you allow that explanation to be a fat woman Chevese—and many other advocates, justify why you are surrounded by teachers, scholars, and clinicians from thin white women at the majority of in the eating the Health at Every Size® (HAES®) your eating disorder events, think community—has given me about the about this statistic from a recent disorders world.” issues of the structural weight stigma epidemiological study: Individuals in our community. Know that I stand with a BMI over 30 have a 12-fold on their wise shoulders as I write this. increased probability of disordered For any readers who may be eating compared with their peers These powerful and somewhat questioning the accuracy of the with a BMI less than 25 (and there jarring words were relayed to me in opening statement, I challenge are multiple studies showing very a conversation with Chevese Turner, you to observe the body sizes of similar figures regarding prevalence then founder and CEO of the former your colleagues the next time you of eating disorders and weight Binge Eating Disorder Association find yourself at an eating disorders status). Now ask yourself, where is (now integrated into the National conference or a gathering of eating this representation—not just among Eating Disorders Association). I am disorders professionals. Compare those who show up at conferences, beginning this commentary with this to a representative sample of but in the field as a whole? (Not that particular statement because, our population, and undoubtedly, it to mention the representation of before writing anything at all, I will be clear to you that our field is folks with black and brown skin— want to underscore the fact that drastically askew from the population but that is a whole other needed there is a pure lack of safety (yes, parameters. For the scientists in the commentary…) When we truly take in SAFETY—one of our very basic audience, it would be true even if the body sizes of the majority of our needs) for people in larger bodies we matched them by education and peers at eating disorder conferences, in the health care community, and other demographic characteristics it is ever apparent that it must be this very much includes the eating to minimize some confounding inherently dangerous to show up in a disorders profession. While this variables. Some might argue that this fat body. Let this brief diatribe, that conversation occurred many years is not due to fat phobia in our field, will only scratch the very surface of ago, I carry the message with me but rather because the field tends the nature of the issues at hand, help every day in my work as an eating to draw many people who have lived you recognize the amount of work we disorder professional. I am eternally experience with disordered eating. have to do in order to change this.
38 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com When I was initially asked to write this article on weight stigma for the Gürze/ Salucore Eating Disorders Resource Catalogue, I began to reflect on the content of that conversation with Chevese (as well as many others I have had with fellow members of the HAES® community and advocates for fat acceptance). Honestly, my first thought was, Should I be the one writing about this?
To allay my anxiety, I reminded myself respond to someone who has never part of why I am given opportunities of my professional qualifications: I have been the target of anti-fat prejudice to use my voice like this is because conducted research studies, reviewed writing it. of my privilege, and when possible, I journal articles, participated in expert Ultimately, I decided to move try to center the voices of my more panels, and read many hundreds of forward with writing this article because marginalized peers. It should not be the scientific papers on the topic of weight I have never been the target of anti-fat case that we repeatedly see thin, white stigma. This hesitation was not about prejudice. I am a thin, white, cisgender cis-women (and men) given platforms a lack of qualifications or passion woman with education, employment, in the eating disorder field, and that is about this topic. I have gained all of health care access, food, and housing what happened here. For readers who this experience through my personal security. I should be the one writing felt irritated by this, know that I see and and professional commitments to this article. Some might ask, why? hear you, and you have a right to your educate people about the harmful The efforts of educating others about anger. The complexity grows… effects of weight stigma. And yet, weight stigma should not be on those when I sat down to write this article, I with more marginalized identities. I THIS ARTICLE CONTINUES AND CAN BE FOUND began questioning how readers would also recognize there is the reality that IN ITS ENTIRETY AT EDCATALOGUE.COM. kids/teens
BOOK EXCERPT EATING MINDFULLY FOR TEENS In this excerpt from Eating Mindfully for Teens, Susan Albers, PsyD, discusses how to cope with stuck thinking.
CHLOE: Whenever I eat too much, I tell myself that I’m awful. I completely ruined everything, so I might as well keep eating. I wish I could think rationally and say, “Just stop now!”
❏ for you to know I ate one cupcake. I might as well eat It’s easy to fall into the trap of black-and-white the rest of them. ❏ thinking. The situation is all good or all bad, I forgot to do my chores, and Mom perfect or awful—you get the idea. There is got mad at me. I’m nothing but a no gray area. What about in your life? Have screw-up. ❏ you witnessed or experienced all-or-nothing I came in last in the race today. My thinking? Have you ever heard yourself running career is over. ❏ thinking things like this? I backed into the mailbox with my • I ate perfectly today. I was good today. dad’s car. He’s never going to trust • I did terribly on my exam. I was me again. ❏ completely awful. I’m not thin and beautiful like • I already ate too many chips, so I might [insert celebrity name]. Nobody will Reprinted with permission: New Harbinger as well eat the entire bag. ever ask me out. ❏ Publications, Inc., My belly is too big. I know everyone copyright © 2018 Susan for you to do sees it and wonders if I’m pregnant. Albers, PsyD, Eating ❏ Mindfully for Teens: A Look at these examples of black-and-white I’m a guy who has a crush on Workbook to Help You thinking, and put a check mark next to the another guy. If anybody finds out, Make Healthy Choices, End ones that are like things you have thought. they’ll hate me. Emotional Eating, and Feel ❏ Great, 151 pages, paper. It’s OK if you check a lot of boxes. The idea I had a sip of beer for the first time isn’t to be right or wrong (all or nothing!); today. I’m going to become an the idea is to understand the messages your alcoholic. brain might be sending you without you even realizing it. Think about how the statements above ❏ I was making a joke and accidentally made you feel. Did you have a knot in your upset my friend. She’ll never talk to stomach? Did your chest feel tight? Black- me again. and-white thinking can feel similar to the ❏ I failed my math quiz. Now I’ll never fight-or-flight response we experience when get into the college I wanted to. we’re in danger.
40 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com #NEDACON 2020
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F A L L 2 0 2 0 Washington, D.C. Details to come!
For more information: myneda.org/nedacon TREATMENT FACILITIES
ALL CHILDRENTEENS ADULTS FEMALES MALES Specialized Treatment for Adolescent Girls TREATMENT CENTER STATE PG GENDERS* Center for Change (males PHP, IOP, and Outpatient) UT, ID 43 • • • • • & Adult Women with Eating Disorders Eating Recovery Center CA, CO, IL, MD, OH, SC, TX, WA 2 • • • • • • EDCare CO, KS, NE 45 • • • • • The Healthy Teen Project CA 45 • • • • Hidden River Eating Disorder Treatment NJ 46 • • • • Laureate Eating Disorders Program (males outpatient only) OK 48 • • • • McLean Klarman Eating Disorders Center MA 5 • • • Penn Medicine Princeton Center for Eating Disorders NJ 47 • • • • • • www.centerforchange.com Reasons Eating Disorder Center CA 45 • • • • • The Renfrew Center CA, CT, FL, GA, IL, MA, MD, NJ, NY, NC, PA, TN 42 • • • • Rogers Behavioral Health FL, IL, MN, TN, WI 44 • • • • • • Upstate New York Eating Disorder Service NY 46 • • • • • • Veritas Collaborative GA, NC, VA 3 • • • • • • * All genders is a designation for individuals who do not identify as a binary gender.
Providing Expert Treatment to Adolescent Girls & Women for 35 Years • RESIDENTIAL “There is No Substitute for Experience” • DAY TREATMENT - Inpatient Treatment - Outpatient Therapy • INTENSIVE OUTPATIENT - Residential Treatment - Aftercare Follow-up - Day & Evening Programs - Accredited High School • OUTPATIENT SERVICES - Independent Living Program - TRICARE® Certified • VIRTUAL THERAPY - Diabetes (ED-DMT1) Program - Joint Commission Accredited for Eating Scan to take our THE RENFREW CENTER Disorders eating disorder quiz • 1-800-RENFREW (736-3739) www.renfrewcenter.com FIRST IN EATING DISORDERS CA | CT | FL | GA | IL | MA | MD | NC | NJ | NY | PA | TN www.CenterForChange.com 888-224-8250 [email protected]
42 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com “TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.” MULTIPLE LOCATIONS
STATE PG Specialized Treatment for Adolescent Girls UT, ID 43 • • • • • & Adult Women with Eating Disorders CA, CO, IL, MD, OH, SC, TX, WA 2 • • • • • • CO, KS, NE 45 • • • • • CA 45 • • • • NJ 46 • • • • OK 48 • • • • MA 5 • • • NJ 47 • • • • • • www.centerforchange.com CA 45 • • • • • CA, CT, FL, GA, IL, MA, MD, NJ, NY, NC, PA, TN 42 • • • • FL, IL, MN, TN, WI 44 • • • • • • NY 46 • • • • • • GA, NC, VA 3 • • • • • •
“There is No Substitute for Experience”
- Inpatient Treatment - Outpatient Therapy - Residential Treatment - Aftercare Follow-up - Day & Evening Programs - Accredited High School - Independent Living Program - TRICARE® Certified - Diabetes (ED-DMT1) Program - Joint Commission Accredited
Scan to take our eating disorder quiz
www.CenterForChange.com 888-224-8250 [email protected]
“TRICARE is a registered trademark of the Department of Defense, Defense Health Agency. All rights reserved.” MULTIPLE LOCATIONS
I was lost in my eating disorder. Now I’m finding myself again. I will
If someone you love is struggling with an eating disorder, you don’t have to suffer alone. At Rogers Behavioral Health, we can help find a path to recovery. Together, we can not only face your challenges, we can rise above them. Locations nationwide rogersbh.org MULTIPLE LOCATIONS/CALIFORNIA
OUR INCLUSIVE TREATMENT CENTERS OFFER: • Partial Hospitalization Program • Day and Evening Intensive Program • Housing Accommodations • Insurance Accepted
OFFERING FOUR SPECIALTY TRACKS Binge Eating Disorder Substance Use Disorder Elite Athlete Trauma
Free Confidential Assessments Virtual Tour Visit us at www.eatingdisorder.care ® Denver | Colorado Springs | Kansas City | Omaha [email protected] | 303-771-0861
EDcatalogue.com 45 NEW JERSEY/NEW YORK
SUBSCRIBE TO THE Gürze/Salucore Podcast AT EDCATALOGUE.COM/PODCAST
46 Request free copies of the 2020 GÜrze/Salucore Eating Disorders Resource Catalogue at EDcatalogue.com NEW JERSEY
Want to learn more about eating disorders but don’t know where to turn? Don’t have time to weed S T E P P I N G through all the available information? BACKINTO We know. It’s a lot. LIFE THE GÜ RZE/SALUCORE ED Pulse Delivered to your inbox every other week.
However far you travel, you will come a long way at Princeton Center for Eating Disorders.
People travel from all over the country to receive treatment at Princeton Center for Eating Disorders. We have earned a national reputation for our expert care with access to on-site medical treatment and our healing approach that provides the tools for long- term recovery. No matter how far you travel to get here, you’ll defi nitely go far while you are here. Inpatient treatment for people of all genders, ages 8 and older. Take the fi rst step today. Call 877.932.8935 or visit us online at princetonhcs.org/eatingdisorders.
We curate the most up-to-date Princeton Center for Eating Disorders information from the web, newsletters, and magazines, to get you in the know. Learn more now. EDcatalogue.com/edpulse
EDcatalogue.com 47 Scott Moseman, M.D., CEDS and Katherine Godwin, M.D.
MEDICAL DIRECTORS OF THE LAUREATE EATING DISORDERS PROGRAM HEALING ENVIRONMENT. PERSONALIZED CARE.
The internationally recognized Laureate Eating Disorders Program in Tulsa, Oklahoma, is personalized to meet the individual needs of patients with anorexia nervosa, bulimia and other eating-related difficulties. As a not-for-profit organization, Laureate provides values- and mission-driven care for girls and women from all over the world.
At Laureate, you can expect evidence-based care and an experience tailored to the unique needs of the patient. This includes: • an intentionally small milieu that provides • separate, specialized treatment programs for adult opportunity for meaningful connection; women and adolescent girls; • a therapist-to-patient ratio of 1:3; • a monthly Family Week program to support and • a dedicated clinical team that follows each patient educate family members; and through acute, residential and partial-hospital care; • an affiliation with the Laureate Institute for • Magnolia House, a group home focusing on Brain Research, which focuses on identifying new, independent living for adult women in recovery effective treatments for eating disorders. from eating disorders;
1-800-322-5173 | saintfrancis.com/laureate
SAINT FRANCIS HOSPITAL | THE CHILDREN’S HOSPITAL AT SAINT FRANCIS | WARREN CLINIC | HEART HOSPITAL AT SAINT FRANCIS | SAINT FRANCIS HOSPITAL SOUTH | LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL SAINT FRANCIS HOSPITAL MUSKOGEE | SAINT FRANCIS HOSPITAL VINITA | SAINT FRANCIS BROKEN ARROW | SAINT FRANCIS CANCER CENTER | SAINT FRANCIS HOME CARE COMPANIES | SAINT FRANCIS GLENPOOL