Eating Disorders News by Marcia Herrin and Nancy Matsumoto

Check it out online: Binge Eating Disorder Week

Some of you may have read this post I wrote a while back, about the website, Beutiful, devoted to battling fashion-mediated body ideals and empowering individuals to make their own decisions about what is beautiful.

Now, site founder Patricia Colli is among the sponsors of an awareness campaign and week’s worth of special BED online events that will take place from May 27-31. The event, explains Colli, which includes live tweetchats, new website articles and other social media happenings, celebrates the inclusion of BED in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

On May 29 a live tweetchat will take place from 12 to 1 pm EST using the hashtag #BEDCHAT. Look for articles, newsletters, blog posts and tweets focusing on education, preventing weight bias and stigma, promoting positive body image and legislative activism, as well as information on where to find support. Hashtags will be #BEDWEEK, #DSM5, #BEDAWARENESS, #EATINGDISORDER and #ED, or check updates on the BED Week event Facebook page. For a link to the full week-long program click here.  

Also involved in BED Week are Amy Pershing, LMSW, ACSW; executive director, Pershing Turner Center LLC, Annapolis, MD; clinical director,The Center for Eating Disorders, Ann Arbor, MI; Chevese Turner, founder, president and CEO of BEDA (Binge Eating Disorders Association); Lizabeth Wesely-Casella, founder, BingeBehavior.com, and Kari Adams, tv host, mother, blogger and ED survivor.

I’ll be following along, and am looking forward to learning more about BED through these online happenings and postings.

Photoshopped Fashion Models: Let’s Get Wise to Them

Recently, Marcia and I received an email from a college student writing a paper on the relationship between Photoshop and eating disorders. This is an ongoing discussion, and part of the larger issue of mass media’s depiction of unrealistic body types for both women and men and its effect on body image and self-esteem.

With Photoshop and other image-editing software, photo editors can touch up, manipulate, merge, blur and take all kinds of creative license, turning a fairly accurate likeness of a person into Barbie and Ken doll look-alikes.

One of the biggest issues we have with “Photoshopping” in fashion magazine is that editors don’t have to disclose its use. If Vogue photo layouts came with the equivalent of the surgeon general’s warning on cigarettes that might help.

Here are some of the questions we were asked, and our responses. Answers in the first person are all Marcia’s:

Q. Do manipulated images contribute to eating disorders?

A: I don't think anyone knows for sure. Very thin women have been used in ads long before Photoshop. Most people with eating disorders do acknowledge how images of beautiful thin women have affected them (me included).

Q. In what way are women affected by these altered images?

A: The images shape what our standards of beauty are, and obviously illustrate a societal ideal. If one is aiming to be the best in everything these images can encourage women to try to be as thin as possible. Society’s idea of absolute beauty hasn’t always been that of a sickly stick figure: take a look at this witty piece in London’s Daily Mail, “What if Boticelli had Photoshop?”

Q:  Do Photoshopped images affect men?

A: My male patients tell me that pictures of male models and actors with sculpted, six-pack abs are very disturbing.

 Q. Is there anything that can be done to limit the use of altered images?

A: A law passed in Israel in 2012, known as “The Photoshop Law” prohibits advertising or fashion media from employing models who fall below the World Health Organization’s standard for malnutrition (18.5 Body Mass Index), and also regulates the use of Photoshop in photographs.

No movement to pass such a law in the US has yet surfaced. At its 2011 annual meeting, the American Medical Association issued this fairly toothless statement warning the public that manipulated advertising images can result in  “unrealistic expectations of appropriate body image,” especially among children and adolescents. The AMA also encouraged advertising associations to try to prevent body image problems and eating disorders by working with organizations concerned with child and adolescent health

Q. What do you think should be done to counter the negative effects caused by unrealistic manipulated photographs?

A: We support governmental action because the fashion industry has done next to nothing, and we like what Israel has done. Whether or not regulations are imposed, Americans are in a buyer beware situation. It’s important to talk to both adults and children about the fact that most of the fashion photos we see have likely been Photoshopped. We need to remind ourselves whether manipulated or not, these images should have no bearing on how we evaluate our bodies. They should have as much to do with our self-esteem and size and shape goals as do National Geographic photos of tropical fish; that is to say zero effect!

 

 

What Are You Avoiding? Adolescent and Parent Behaviors That Allow Anorexia to Thrive

One often-overlooked aspect of recovery from adolescent anorexia is the need for both child and parent to shake off negative, established patterns of coping. For the adolescent, the illness can play the valuable role of masking or numbing feelings of fear, anxiety, low-self esteem, loneliness or boredom.  It can also be away to avoid experiences that are threatening or scary: unwanted attention, new social situations or challenges of any type.

 For parents, another form of avoidance can come in the form of accommodation: aiding a child in her ritualistic eating behaviors and self-starvation in order to avoid the immediate distress that results in opposing those behaviors.

 These would be the parents who stock their fridge with non-fat foods, no-calorie lettuce, “acceptable” energy bars and other such staples, who avoid providing “challenging” foods in order to maintain calm in the home or because they can’t bear to see their child in any more anguish.

 A group of researchers has devised a treatment called Acceptance-based Separated Family Treatment for Adolescent Anorexia Nervosa (ASFT), which they hope will help both parents and adolescents learn to replace their rigid and avoidant behaviors with more accepting, flexible behaviors driven by long-term values and goals.

 One of these researchers, C. Alix Timko, PhD, explains that AFST is broadly based on a form of psychological treatment called Acceptance and Commitment Therapy (ACT). ACT itself is an increasing popular form of “acceptance-based” Cognitive Behavioral Therapy, one that interprets psychological problems as rooted in emotional and experiential avoidance.

 A National Institute of Health-funded pilot project begun in 2008 yielded promising enough preliminary results to spur Dr. Timko and her colleages Rhonda M. Merwin, PhD and Nancy Zucker PhD, to continue their research, which they describe in this article in the latest edition of the Renfrew Center Foundation’s journal Perspectives.

 AFST incorporates key concepts of Family Based Treatment (FBT), the current gold-standard approach to refeeding adolescent anorexia patients, but supplies a psychological component that FBT has heretofore not stressed. It involves 20 90-minute sessions of treatment spread over 24 weeks, divided evenly between adolescent and parents. For the first 16 sessions, adolescent and her or his parents are seen separately. Joint sessions are held during the last four every-other-week sessions.

 Three phases of treatment take place. In the first, therapists prepare patient and parents for the tough work ahead, stressing the importance of being willing to experience some difficult thoughts and feelings. Parents are encouraged to recognize their own importance as healthy role models, and are given a workbook with information on authoritative parenting, the psychological aspects of eating disorders and behavior management. All this happens as they are taking control of their child’s eating according to FBT protocol.

 In the next phase, the therapist conducts a “functional analysis,” during which the patient comes to see how the disorder has both helped and harmed her. Parents are encouraged to think about how they may have over- or under-reacted to the disorder, and how they can improve their lives in other areas to make them better caretakers. As part of this phase, explains Dr. Timko, therapists create a timeline with the adolescent to help him visually graph factors that may help maintain the disorder.

 “We ask, ‘When is the eating disorder loud?’ ‘When do you have urge to exercise or restrict?’ ‘What were your thoughts and feelings in this situation?’ Throughout the course we look for patterns,” explains Dr. Timko.

 The third phase is the heart of AFST, when the real work of changing attitudes and behaviors takes place. The catch-words “open,” “centered,” and “engaged” are used to help patient and parents accept difficult thoughts and feelings nonjudgmentally, and to distance themselves from these subjective experiences. The joint parent-adolescent sessions focus on communication and relapse prevention.

 Drs. Timko, Merwin and Zucker plan to eventually create a treatment manual for therapists based on AFST. For now, though, they’re collecting more data on its effectiveness compared to FBT. A manualized version of Dr. Zucker’s parent skills program Off the Cuff program—which  I wrote about in this blog post, is, however, available from Gürze Books.

 

 

Complex Anorexia: When to Move to a Higher Level of Care

One of the most challenging aspects of treating complex cases of anorexia is cutting through the day-by-day storm and stress of treatment, to clearly see the arc of the disorder and make the right decision about when it's time to move to a higher level of care.

 How do you assess a chaotic picture that includes incremental improvements followed by backsliding, pleading, anger, cajoling, broken promises, emotional outbursts and parental pleas that accompany the refeeding process?

 As promised in my last post, here I'll summarize a set of benchmarks created by Drs. Michael Strober and Craig Johnson, in a recent paper published in The International Journal of Eating Disorders. The two doctors followed their paper up with a workshop at The Renfrew Foundation Conference for Professionals on the complexities of anorexia and how to treat it.

 In their paper the authors explain their benchmarks are a “frame of reference” derived from scientifically supported observations and “an immense amount of clinical experience.” Here are their guidelines, directly quoted:

Consider inpatient care as a first intervention when there is:

 1. A steeply declining trajectory in body weight, especially when weight is already below 75% of expected weight for age and height.

2. Irrefutable insistence by patient that further weight loss is needed, or justifiable, because of an over- weight or ‘‘obese’’ appearance.

3. History of an extreme degree of regimentation or compulsiveness in behavioral routines from early in life; extreme fear of maturational challenge; a history of trauma, extreme hyperactivity (multiple hours of unrestrained activity), or comorbidity with major depression or obsessive compulsive disorder when their symptom intensity results in impairment on their own, or is compromising weight restoration.

When to End Outpatient Care and Step Up to Hospital Care:

[These benchmarks apply to the scenario involving an underweight child, adolescent, or a young adult, regardless of her or his previous treatment history.]

1. If weight declines steadily over the first 3 weeks of treatment (or following consultation if no treatment was initiated). In our experience, this trajectory becomes difficult to interrupt thereafter.

2. Weight is initially stable, but there is a negligible average weight gain (or a waxing and waning pattern of increases and decreases) by the end of month two of treatment (or following an initial consultation). In our experience, a steady, uninterrupted increase in weight back to normal body mass becomes increasingly less likely after this point.

3. There is initial weight gain, but the slope of the increase levels off prior to the patient achieving full weight restoration, and this flattened pattern remains unaltered for at least 6 continuous weeks.

[The authors note that if there is a change of therapist, these benchmark algorithms start over.]

These benchmarks apply to older adults at low body weight who have been ill for at least five years:

1. Weight is declining steadily in the first three weeks after commencing treatment.

2. Weight is initially stable, but the patient is unable to initiate, and then sustain, a steady increase in weight by the end of month three of treatment; in our experience, uninterrupted weigh gain after this point is increasingly unlikely with such a patient.

3. Weight increases initially, but the slope of this increase then levels off and remains so for 3 continuous months.

The authors preface their guidelines by repeating their warnings that these benchmarks have to be applied within the context of seeing anorexia as a highly complex disease. In summary, their caveats:

•  Though a patient may exhibits “noteworthy” improvements, the continuation of even mild symptoms should not be taken lightly.
•  Lack of early weight gain in outpatient therapy may indicate a limit on what can be achieved over time.
• Single interventions will not suffice when a disease as complex as anorexia is at issue, and psychological care should be present at all times in conjunction with other treatments.
• Beware of therapist inexperience, which can result in either an overly lax approach when more oversight is needed, or excessively rigid control when more time is needed to let the treatment course evolve.
• A patient’s “avowed enthusiasm for eating,” the doctors ask us not to forget, “is often the last refuge” in an attempt to avoid a more intense level of treatment. “The appearance of change is not necessarily meaningful change,” and failure to recognize the difference can have serious consequences.
• The longer the illness goes on, so will it’s damaging effects on the physical health and the independence of the patient.

 I look forward to hearing your reactions and feedback to these guidelines.

Are Current Treatment Approaches to Eating Disorders too Narrow?

This blog post started as a short report on a workshop held at the recent Renfrew Center Foundation Conference for Professionals in Philadelphia. It was titled  “Understanding the Complexities of Anorexia Nervosa and Implications for Therapeutic Management,” but many attendees knew the back story: that the workshop was prompted by a controversial paper written by its two leaders, Drs. Michael Strober and Craig Johnson.

The polarizing paper, published in the March 2012 issue of The International Journal of Eating Disorders, bears the unwieldy title “The Need for Complex Ideas in Anorexia Nervosa: Why Biology, Environment, and Psyche All Matter, Why Therapists Make Mistakes, and Why Clinical Benchmarks Are Needed for Managing Weight Correction.”

At the November Renfrew Center Foundation workshop, Dr. Strober referred to the paper’s fallout of “handwringing, angst, and statements on the (American Academy of Eating Disorders) list serve that were frank and critical.”

The paper, Strober went on to say, was prompted by his and Dr. Johnson’s increasing dismay over the “increasing reduction, narrowness and singularity of treatment paradigms.” qualities which he called “simply a marriage that does not work” when applied to treating an illness as complex and challenging as anorexia nervosa.

As your faithful blogger, I realized that in order for the Renfrew workshop contents to make sense, it would be helpful to give you some background by summarizing the academic paper the duo wrote.

So here goes. Bear with my explanation, for there really is a practical application to all of this, although I won’t get to it until my next post.

The paper took on the two prevailing treatment paradigms for the treatment of anorexia today. The first is Family Based Treatment (FBT, also known as the Maudsley Approach), which is founded on the belief that far from being the cause of their child’s disorder, parents must play a key role in their child’s recovery by refeeding their child in order to restore her or his weight.

At the same time that this widely heralded treatment has been gaining adherents in the U.S. (it originated in England over 30 years ago), many in the profession have increasingly advocated the second (and not mutually exclusive by any means) paradigm that Drs. Strober and Johnson took on, based on the importance of genes and biology in the genesis of an eating disorder. According to the proponents of this paradigm, there is irrefutable clinical evidence that eating disorders are one of many biologically based mental illnesses (BBMI for short), and they should be treated as such. You can read the American Academy of Eating Disorders position paper on the issue here.

Both in their paper and at the workshop, Drs. Strober and Johnson were at pains to acknowledge the value and importance of both treatment paradigms, even as they lamented the overly doctrinaire attitude that they say both camps have taken on.  

In their paper, they noted “three worrisome trends: (1) that many therapists apparently see no place for the sort of clinical wisdom that can never be manualized [FBT is touted for its evidence-based manuals for both professional clinicians and parents on how to help reefed their anorexic adolescent or teen, and further manuals dealing with bulimia and binge-eating disorders]; (2) that the emphasis on empirically validated interventions is drawing attention away from more broad-based training experiences; and (3) that therapists who will one day encounter very ill patients are not being prepared adequately for taking on the many complex predicaments they will face.”

The paper and workshop also make a plea for appreciating the complexity of anorexia. Strober and Johnson write, “after biology, the rearing environment—the larger social context too” must be addressed, aspects of eating disorders treatment that have been devalued of late. They advocate the “common sense notion” that therapies shouldn’t overlook the parts of life that “potentially maintain or accentuate vulnerability: the family, school, or interpersonal environment.”

The family, in fact is a primary concern of the authors, who write, “The notion of stress engendered vulnerability is not at odds with treatment models that see families as critical partners in care; it argues that broad attention must be given to sources of intrafamilial strain and the need for other forms of therapeutic dialogue to reduce it.”

Although this topic may seem overly theoretical, there is actually a practical aspect to both the doctors’ paper and their Renfrew Center Foundation workshop that I will go into in my next blog post, namely their recommendations for benchmarks to help eating disorders professionals answer a question that plagues many parents and patients: “How do we know when a course of outpatient treatment in anorexia has reached the limit of benefit and we need to move to a higher level of care?”

Stay tuned for a summary of Drs. Johnson and Strober’s recommendations.

Saying No to Holiday Gatherings to Protect Recovery

One of my goals this year is to reclaim the holidays from the clutches of commercialism, family drama and the belief that things have to be perfect. It’s ironic that the biggest holiday season of the year is also the most stressful for many people. It’s as if we all decided to throw ourselves a party with the foreknowledge that it’s going to be miserable. Wouldn’t just going to work instead be the more peaceful option?

 How crazy! It’s sobering, though, to remember that for the many people struggling to recover from an eating disorder, the stakes are much, much higher. The holidays aren’t just a challenge to common sense, they can be downright dangerous.

 “Even for patients who are making good progress in overcoming an eating disorder,” says licensed professional counselor Bonnie Brennan, “we may have to hit the ‘reset’ button after the holidays.”

 Brennan, who is cinical director of the Eating Recovery Center's Adult Partial Hospitalization Program in Denver, tells the story of one patient who quailed at the thought of making the annual holiday trek to the family home. The house was usually packed to the rafters with extended family, affording very little privacy and opportunity to escape from the “family ledger of past resentments.”

Even ostensibly warm and nostalgic annual rituals such as posing for the annual family picture could erupt into discussions about past differences, by both the patient and her siblings.

Since she couldn’t put a physical wall between herself and the family, says Brennan, the next best thing her patient could do to set boundaries was to sneak off into the garage or the laundry room, where food for the holiday festivities was temporarily stored. There, she could binge in secret, “taking a time out, but not in the most functional way,” explains Brennan. The sensation of numbness that follows a binge, of “not being emotionally present, was a way of putting an invisible wall around herself.”

So what was Brennan’s advice? To politely tell her family’s inner circle that as much as she loved them, it was not healthy to be at the annual extended family holiday gathering, and instead to plan smaller events with individual family members throughout the year. For the holidays the patient planned to stay in her hometown, where she and her husband and children could visit with family friends in environments she knew she would feel safe.

Instead of being honest about the reason for not coming to the family gathering, some people in this situation might be tempted to finesse their way out of the situation, offering excuses other than the truth. Brennan disagrees with this approach, saying, “Unless there’s some dire consequence to being transparent it’s usually healthier to be straightforward about why you might be making the decision to take care of yourself. You can say to your family member, ‘I love you, I really appreciate you but I need to take care of myself during this family holiday’…eating disorders thrive in secrecy and it’s about how to have relationships that are more meaningful and authentic.”

Fair enough. But what about extended family members? Do you reallyhave that conversation with them too? Brennan believes, yes, not necessarily immediately, but gradually over time letting everyone know the truth. Since there is a strong genetic component to eating disorders, it’s highly possible that you might see evidence of an emerging disorder in a niece, nephew or second cousin. “There is a benefit to letting blood relatives know because 40-50% of the risk of developing an eating disorder is genetic. For example, a woman with a sister or mother with anorexia is 12 times more likely to develop anorexia nervosa and four times more likely to develop bulimia nervosa” explains Brennan. “You might be helping a family member get early access to treatment.”

 

Eating Disorders Through the Lens of Buddhism

While reading a book on Buddhism recently, I came across an idea that seemed to perfectly describe the nature of an eating disorder.

Translated into English as “dependent origination,” the idea is considered one of the central truths of Buddhist thought. Wait! Before your eyes finish glazing over and you click to close this window, bear with me as I explain. It sounds daunting, but the term simply means that all things arise out of something else, and all things are dependent on each other. They are linked by causes and conditions.

In Lotus in a Stream: Essays in Basic Buddhism, Master Hsing Yun explains, “Dependent origination depends first on the presence of a cause and then on the presence of right conditions. When both causes and conditions are right, a result or an effect will be produced. If there is no cause, there can be no effect.”

Simple enough, right? Let’s imagine that in the case of an eating disorder, the “cause” is a genetic predisposition to an eating disorder and the “conditions” (although we can hardly call them “right” conditions) are things like a diet-crazy peer group, being the target of teasing about weight, shape or size, or some early childhood trauma.

The master explains, “Cause and effect are really interlocking parts of an endless chain of events. Seen from one angle, a cause is a cause. Seen from another angle, it appears as an effect.” True for an eating disorder as well. We call it a “multi-factorial” disorder because there can be many causes and effects; what matters is not so much which came first or which is most to blame, but that many different causes and conditions have massed together to form a very difficult situation, one that can push families to the brink of exhaustion and threaten their very cohesion.

The flip side of this principle is that solutions to an eating disorder also consist of an array of causes and effects. Master Hsing Yun would says that all eating disorder patients hold within themselves the seed, or “cause” of recovery, just as they contain the “seed of Buddhahood.” The catch is that if “they do not surround the seed with good conditions, then that seed is not likely to grow into a healthy plant.” The “seed” of recovery, then (perhaps the motivation to change), needs to be surrounded with good conditions, such as a good food plan; surrounding oneself with supportive, not undermining friends and family members, and avoiding both emotional and food-based triggers. (In the case of the nascent Buddhists those “good conditions,” the master writes, would be studying Buddhist thought, practicing precepts, etc.)

Another interesting aspect of dependent origination is that perception of appearance depends on conditions. Master Hsing doesn't just mean outward physical appearance, of course, but for the sake of our eating disorder and body image analogy, let’s assume he does. All things have two universal features in common: impermanence and interconnectedness, he explains. But each thing also has other features: “Fire is hot, ice is cold, people all look different.” You would think that we would all perceive these things the same way, yet in fact, how these features are perceived varies from person to person. “Our perceptions of outer appearances are profoundly affected by the inner conditioning of our minds,” Master Hsing writes.

How true this, for anyone who has studied body dysmorphic disorder! Those who suffer from it often perceive their bodies in vastly different ways than other people. The normal-weight person suffering from body dysmorphic disorder, for example, looks in the mirror and sees a grossly fat person, while everyone else is mystified by her self-flagellating comments about “looking like a fat cow,” and so forth.

You may not subscribe to the Buddhist belief that the reason peoples’ perceptions of things can vary so widely is that the conditions of their minds precede their births. Yet as a practical strategy it’s helpful to think about the Buddhist advice of countering negative perceptions created by our own minds by engaging in “intentional acts.” These can include acts of kindness to one’s self. If those who believe that they are somehow unattractive repeatedly try to think of and treat their bodies as beautiful, they will gradually come to see how that might be true. Master Hsing writes, “Once our minds have been conditioned in a certain way, then our worlds will ‘appear’ around us in a way that is consonant with that conditioning.” In a way, Buddha was the first proponent of cognitive behavioral therapy.

Those who are much more learned in Buddhist thought will no doubt find many bones to pick with this post, but it is my own rudimentary interpretation of my reading; I hope some of you find it helpful.

Ethnic Identity and Eating Disorders

Not too long ago I heard the interesting cross-cultural story of a young India-born woman who developed an acute and life-threatening case of anorexia nervosa as a high school student in Canada. Her story illustrates how growing up an ethnic minority and negotiating two different cultures can be both a risk factor and a pathway to recovery. The woman is now a retired doctor, yet as we conversed via a long-distance telephone call, the memory of that heart-wrenching time was still vivid for her. (Our paths crossed when I was introduced to the woman, who prefers to remain anonymous, by her cousin, a friend of mine in New York City.) The recovered woman, whom I’ll call Alice, was born in Southern India and emigrated to Canada with her family at a young age. As the eldest of three daughters, she was the first in the family to have to juggle traditional Indian cultural expectations with the social code of her small-town Canadian public school.

An avid athlete, Alice ran track in high school, and traces the beginnings of her eating disorder to one comment made by her coach. “I remember him looking at us, and saying we have to eat better, cut out junk food,” recalls Alice. “I thought he was talking to me personally, and that kind of set off this whole thing.”

It wasn’t just that one comment, though. “I wanted to be accepted in the West,” Alice adds. Although she was already thin to begin with, she thought “the thinner I am, maybe the more accepted I will be.” Looking back, she believes her disorder was complicated by the nature of her relationship with her parents and the cultural disconnect that all immigrant families face. “There were control issues with my parents,” says Alice. “They were very loving,” she recalls, but pushed traditional Asian values of modesty and hard work especially firmly with their eldest daughter. It was hard for them to adjust to the western world of dances, revealing fashions and boys, not to mention the youthful rebellion of the late ‘60s and early ’70s. Not that Alice ever got into trouble; instead, she threw herself into the traditional activities of the ambitious Canadian high schooler, student government and sports.

Alice ran and ran and didn’t eat much. Within a year-and-a-half, her weight had plummeted by 40 percent. periods stopped, her hair fell out, yet she recalls, “I thought I was fat. People would tell me ‘You’re thin,’ and I’d think, ‘Oh, they’re jealous.’” Alice was hospitalized for four months, during which she was force-fed hourly and only allowed to get out of bed and walk around if she showed continued weight gain. Her doctor told her parents that if they had waited a few more days before seeking treatment Alice would not have been alive. “As I gained weight, I started getting more rational and realized how sick I’d been,” she recalls.

Her mother decided she needed to get away from western influences and took Alice to India for a year. Alice credits being away from negative media images of women as well as her love of sports for getting her healthy again. In India, she was surrounded by her extended family and in a culture where size and shape was not as emphasized. “I had done sports all my life and had gotten into playing semi-competitive squash in university,” she says. She realized that severely underweight athletes can't compete.

The experience helped propel Alice into a career as a primary care physician in Canada, where she focused on preventive health, nutrition and fitness. Today she maintains a normal weight, runs, swims and eats balanced meals. Although she acknowledges that not everyone's recovery is as smooth, she points out "there is a lot more professional help now than there was forty years ago." Her advice to others: "Recovery from a severe eating disorder is not only possible, but can be followed by a happy and fulfilling life. The key is to acknowlege you have a problem, trust that your loved ones have your best interests at heart and, above all, seek professional help."

I hope Alice’s story helps those of you who are now in the throes of an eating disorder realize that you too, whether you come from a minority culture or not, can recover. Focusing on the things that you used to love to do and your desire to do them again can be a very effective tool in your recovery, as can a supportive family or close friends.

 

A Tour of the Year's Best Eating Disorders Sites

The site Healthline, which offers consumer-oriented information on a wide range of medical topics, recently posted its picks for the 18 Best Eating Disorder Blogs of 2012. I was happy to see that among this terrific collection of resources was Eating Disorders Blogs, a group of voices to which our blog, Eating Disorders News, belongs.

"The range of perspectives and topics covered by Eating Disorders Blogs is perhaps unparalleled on the web," according to Healthline. FYI, our posts appear both on PsychologyToday.com and here under the Eating Disorders Blogs umbrella. The blog collection was put together by eating disorders experts Lindsey Hall and Leigh Cohn, who are also the founders and publishers of Gūrze Books, a specialty house focusing on body image and eating disorders. Lindsey and Leigh have been able to draw on their wide range of expert authors to put together a truly diverse forum for opinions and information.

From the emotional explorations of Why She Feels Fat by Johanna Marie McShane, Ph.D., to notes from the perspective of someone who has overcome an eating disorder (Jenni Schaefer's Recovered), to the reassuring voice of Joanna Poppink, PhD, in Women Healing Through Crisis, Eating Disorders Blogs is a portal worth passing through often.

Among the other blogs recommended by Healthline, the blog Eating Disorder Hope caught my eye with this recent post: Beyond Barbies and Baby Dolls, which reported on a recent study on self-sexualization in a group of girls in the Midwest ages 6 to 9. The results indeed revealed that at a very young age, a majority of girls identify the "sexy" doll as their role model  (versus the "modest" doll), and as the type of girl most likely to be popular. The good surprise of the study, though, was that media influence on these young girls is actually not as strong as maternal influence. 

For those involved in the push to make eating disorders a bigger public health priority, who are interested in the interplay beetween the eating disorders awareness movement and the anti-obesity fight, or who are interested in eating issues/body image advocacy in general, The Eating Disorders Coalition site will keep you up-to-date on the national conversation on this topic.

And because boys and eating disorders never gets enough attention, the blog Boys and Anorexia is worth mentioning, written by a UK mother whose bright, athletic son fell prey to anorexia and now, with the aid of a "eating disorders recovery contract," fights to maintain healthy eating and exercise habits.

Take a moment to tour all 18 of these sites -- they are well worth it.

 

Online Magazine Takes on Self-image-Busting Beauty, Fashion Industries

Not long ago, I noticed a new follower on our @ednutrition Twitter account. @BeutifulMag had an intriguing sound, and sure enough, its web site turned out to be a welcome addition to the public conversation on body image and self-esteem. 

Started by Patricia Colli over two years ago, the site at the moment mainly collects good content around the net on the subject of body image, self-esteem and the destructive effect of mass media on women’s conceptions of self, with positive, encouraging commentary on the articles. Beutiful Magazine’s tagline is “Embrace who you are with no apologies about who you’re not,” and its Facebook page explains, “Our purpose is to show how perfect and beautiful you really are—regardless of any society-made standard. By undefining, we are redefining.” 

 

Colli, a Philadelphia graphic designer who will turn 26 this week, has been thinking about these issues for a long time. At the age of eight, she was a compulsive exerciser. She was short but didn’t care about that. Her weight was average, in fact she was on the thin side. Yet she thought she was fat and was self-conscious and self-critical. Her negative body image didn’t come from her family, which was supportive and nurturing, and in her strict Catholic home tv viewing and access to fashion magazines was limited. She did read lots of fitness magazines, though, and fashion/beauty magazines whenever she could find them outside her home. 

When her friends were out socializing, Colli was at home, compulsively doing crunches or any other exercises that could be done with no special equipment, or spending hours on the only exercise device in the house, a trampoline. “Now that I look back,” says Colli, “it was completely bizarre.” Although she never suffered from a full-blown eating disorder, she did swing between compulsive junk food binges and restricted mealtime eating. 

The idea for Beutiful Magazine came to Colli on one particularly deadly low self-esteem day during her junior year of high school. She had come to realize that her desire to “reflect the ‘perfection’ that I was seeing” in the mass media was the root of her problem, and explains, “I needed to challenge the media in order to reverse it. I wanted to create something that would show people they were beautiful as individuals, tell them to believe in themselves, and allow them to be happy and raise their quality of life.” One big source of inspiration was the groundbreaking Dove Campaign for Real Beauty launched in 2004. 

Later, as a graphic design student at the Art Institute of Philadelphia, Colli saw close-up to what extent the images she was basing her ideas of beauty on were a sham. “Just learning how to Photoshop was very eye-opening—if I had known all that I might have gotten healthier a lot faster,” she notes. Colli learned that photo editors can replace and resize body parts, change complexion and skin tones, and endless other more subtle manipulations. “Ninety-nine percent of what we see has been manipulated,” says Colli, even if it’s just color and lighting.” 

Her site, she explains, is not just about eating disorders and body image, but also about “acceptance of all people - race, age, gender, sexuality, religion…the right to be yourself, hence the "be u" spelling in the ‘Beutiful’ logo.” 

Interestingly, Colli says, “Once I started working on how I could express these ideas to others, my own ideas [of self] started to change.” Her eating and exercise normalized, and she notes, “It's amazing what a change in perception and mental dialogue can do!” As with many things in life, actively discussing and acknowledging a negative obsession can not only be empowering, it can also lessen its power over us.

 In addition to her day job as a graphic designer, Colli is now working to produce a more robust version of her site and would like to eventually generate more original content and launch a print version of her magazine. Good luck, Patricia!