Eating Disorders and the Holidays

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The National Eating Disorder Information Centre offers a valuable resource about how to cope with eating disorder recovery during the holiday season. Read below for ideas from this great article!

“Coping with the Holidays”

NEDIC Staff, Maria Jacobsen and with thanks to our volunteers

The holiday season is often a very stressful period for individuals with food and weight preoccupation issues. The emphasis on spending time with family and celebrating with food can be very distressing. This article will focus on exploring ways in which individuals may make this time less difficult. It is not an exhaustive list, but may get you started on generating ideas that are adaptive to your own situation.

You don’t need a crystal ball to be able to predict some things about family and friends! Based on past experience and an understanding of the people close to you, you may be able to avoid or cope constructively with uncomfortable situations.

The holiday season is a time when you may find yourself overwhelmed by commitments. It is easy to overlook your own needs while fulfilling others’ expectations.

  • Predict high stress times and places

  • Plan which events you will attend and which you won’t attend.

  • Plan to have restorative time for your own needs: Go to a movie, unplug the phone, or take a walk. Visit a trusted friend. Buy yourself a present.

  • Plan and carry a phone list of friends and crisis lines.

  • Plan to do volunteer work or join an interest or support group if you are without many friends or family as the holiday season may be a time of loneliness, emptiness or pain.

For example, make time available for pleasurable activities between visits to family. Say that you will attend one big family gathering and make plans for other fun alternatives or smaller, more manageable celebrations. Find a listing of local activities and join in those that appeal to you.

Predict which people might make you most uncomfortable, and in which ways

  • Plan as to whether you want to, or can, avoid these people.

  • Plan appropriate ways of excusing yourself from their company.

  • Plan ways in which to shift the focus of attention from you.

For example, X and Z always demand that you sit next to them. It makes you feel as though they are monitoring or restricting your behaviour. Say that you will only spend a few minutes with them as you want to visit with Y; say you will sit with them a little later, but you first need/want to do something else. There is no need to apologize for satisfying a need or desire that you may have.

Predict what people might say to you that would lead you to feel uncomfortable

  • Plan and practice verbal responses.

  • Plan to set boundaries ahead of time: Ask that people not comment on your body, appearance or eating habits.

  • Plan ways of desensitizing yourself to the comments. 

For example, “You eat like a bird. Come on, have another helping…You need to gain weight.” Response: “Thanks for your concern, but I won’t get into a debate about my weight. Please leave it up to me to decide how many helpings I eat.”

Use coping statements:

  • Before events: “I am within my rights to say no. ”During events: “I can handle this. ”After events: “I did… very well” or “I can see that X is upset; however, it was important that I take care of myself.”

  • Remind yourself that you are a worthy individual and are entitled to respectful behaviour.

  • Put the value of the other person’s position and power in your life into perspective.

Predict negative thoughts that you might have during the season

  • Plan how you could challenge these thoughts; Try to be realistic about events and your own behaviours.

  • Plan and practice alternative, positive thoughts. Write them down. 

For example, you might think, “She gave me a bigger gift than I gave her, she must think I am cheap.” It is important to think in a way which would be more realistic, helpful and adaptive. A challenge to the above thought could be: “People will understand that I can’t afford expensive gifts but give thought to what they would enjoy.” A way to expand on the use of coping statements is to look at events as having three parts: before, during and after.

You can prepare three sets of statements:
Before: “I’m entitled to…”
During: “I can handle this.”
After: “I did… very well.” 

Complimenting yourself on your actions may be difficult. It may help to focus on individual steps you have made. It is important to come up with coping statements that work for you.

Predict how you might respond to the thought of a banquet of food

  • Plan to consistently eat three meals a day to help avoid the desire to binge.

  • Plan ways to feel more comfortable around food: be realistic in your goals. Dispel myths of “good” and “bad” foods. Think of how you can distract yourself if you find yourself counting calories.

  • Plan to allow yourself to eat “treats” and “extras.” This is socially and psychologically healthy!

  • Plan for possible discomfort around feelings of fullness: distract yourself by engaging in a pleasurable activity, e.g., singing.

  • Plan to be compassionate towards yourself. If you binge or purge, remember this is a behaviour that will decrease in regularity with healthier attitudes and eating behaviour rather than punishing yourself for relapses.

  • Plan to hide or throw away your scale to avoid sabotaging yourself.

For example, you may have a close friend with whom you can review strategies for remaining in control during stressful occasions at which food is a focal point…review deep breathing techniques, hold on to a magical, comforting thought, seek out someone who is affirming of you.

For some people it is helpful to realize that the picture-book holiday scene is not a reality for many people. Some cannot afford it, there are many single people who are not close to their families or do not have a family and there are many families that do not fit into the nuclear family model. Don’t blame yourself for family/friendship conflicts. People are no different during the holidays than any other time of the year. Remember that you are responsible only for your own actions and for taking care of yourself.

Places you may want to explore for things to do during the holidays

  • Women’s centres

  • Community centres

  • Parks and recreation department

  • City hall

  • College and university campuses

  • Community newspapers and websites

  • Social media, blogs and message boards

© NEDIC 1992; reviewed and updated 2015  www.nedic.ca

Some Teens Hospitalized for Anorexia are Not Thin

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We are so glad to see more articles emerging about Atypical Anorexia. This article from Psychcentral sheds light and awareness on this serious disorder:

Some Teens Hospitalized for Anorexia are Not Thin

By Traci Pedersen

“A new Australian study finds that 31 percent of adolescents hospitalized for anorexia nervosa exhibit all the cognitive and physical complications of the disease without being underweight.

Dietitian Melissa Whitelaw at the University of Melbourne is calling for a change to the diagnostic criteria for the disorder after finding that patients with “atypical anorexia” suffer serious health concerns despite being within or even above the healthy weight range.

“What we are seeing now is that you can have a healthy body weight but be just as sick as someone with typical anorexia nervosa, including having the same thoughts about eating and food,” said Whitelaw.

“We need to redefine anorexia because an increasing proportion of anorexia nervosa patients are atypical and more difficult to recognise. The definition should refer to weight loss, not just underweight.”

For the study, Whitelaw looked at 171 anorexia patients, ages 12 to 19, who were admitted to the Royal Children’s Hospital’s eating disorder program in Melbourne, Australia between 2005-2013.

She found the following:

  • 51 of the patients were “atypical” with significant eating disorder psychopathology, but not underweight;

  • Rather than being underweight, greater weight loss was associated with life threateningly low pulse rates, a complication of starvation in anorexia nervosa that requires admission;

  • Patients with atypical anorexia also suffered low blood pressure and deranged blood electrolytes;

  • Importantly, no complication was independently associated with being underweight, the typical hallmark symptom of anorexia;

  • None of the patients in the study were being monitored by a health professional for weight loss, their relationship with food, or their methods of losing weight.

Atypical anorexia patients might have lost about a quarter of their body weight, but the body can go into “starvation mode” if as little as 10 percent of weight was lost quickly, causing the heart rate to slow in order to preserve energy.

According to Whitelaw, atypical patients may have been encouraged by family or health professionals to lose the weight. This frequently results in praise and encouragement about how good they look, re-enforcing even more weight loss.

“If adolescents lose weight, it doesn’t matter what weight they are, a health professional should monitor them to check that weight loss is appropriate and if so, that it is done gradually,” said Whitelaw.

“They should also monitor the adolescent’s dietary intake and relationship with food and exercise for signs the patient was spiralling into an eating disorder. Following large amounts of weight loss, careful medical assessment is also recommended.”

Once a person goes into starvation mode the only way to increase the heart rate is re-feeding and weight gain, which in this cohort, required hospitalization.

Whitelaw said people can understand an extremely thin patient needing to gain weight, but it is often a shock to patients and families when someone within or above the healthy weight range needs to gain weight.

And while atypical anorexia nervosa is often seen as less severe than anorexia nervosa, the new findings show that the health consequences can be just as dangerous. Whitelaw believes it is time to change the current diagnostic criteria which states that those with anorexia nervosa must be underweight.

“The face of eating disorders is changing against a backdrop of increasing prevalence of overweight and obesity. Families, teachers, sports coaches and others interacting with young people should not delay seeking help for adolescents with worrying eating patterns if they have lost weight, even if they are not underweight,” said Whitelaw.”

The new findings are published in the Journal of Adolescent Health.

Source: University of Melbourne

Family Based Treatment for Teen Eating Disorders

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Does your child or teenager struggle with an eating disorder? This is a helpful article from the National Eating Disorders Association (NEDA) on the topic of Family Based Treatment for eating disorders.

Just what is Family Based Treatment (FBT)? According to NEDA, FBT (also known as the Maudsley Method or Maudsley Approach) is a home-based treatment approach that has been shown to be effective for adolescents with anorexia and bulimia. FBT doesn’t focus on the cause of the eating disorder but instead places initial focus on refeeding and full weight restoration to promote recovery. All family members are considered an essential part of treatment, which consists of re-establishing healthy eating, restoring weight and interrupting compensatory behaviors; returning control of eating back to the adolescent; and focusing on remaining issues.

Potomac Behavioral Solutions offers this evidence-based treatment for families. Contact us to learn more!

Community Education

On Wednesday, November 14 Dr. Marino presented on the topic of “A Parents’ Guide to Evidence-Based Treatment” at a county sponsored event. Participants learned about the latest and most robust evidence-based treatments for a variety of behavioral issues.

If you are interested in scheduling Dr. Marino for a professional or educational event, please contact us here. Additionally, we offer professional consulting services to the following (including but not limited to):

  • DBT Consultation Teams

  • Clinicians

  • Professionals

  • Universities

  • Organizations

You can learn more about our consulting services here.

Interview with Laura Cusumano

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Interview with Laura Cusumano


What inspired you to specialize in eating disorder treatment?

In college, I double majored in psychology and theatre. Throughout my life, I encountered a number of people in the theatre community who struggled with body image and disordered eating, and I wanted to help promote a culture of listening to and loving one’s body. I joined a group on campus called CARES, which stood for Collegiate Awareness Regarding Eating Smart. We did outreach on campus to build awareness about eating disorders, to educate about eating disorder prevention, and to inspire body positivity. Ever since then, I have been drawn to the topic of eating disorders. During my graduate studies, I focused a great deal of my research on eating disorders, and I was fortunate to complete my internship at an eating disorder treatment facility in the Midwest. I love helping people who are struggling with physical, psychological, and emotional challenges move toward healing and flourishing.

Describe what your favorite therapeutic skill is, and why:

I enjoy helping my patients learn how to validate others and how to recognize when others are validating them. I think it is so important to feel understood and to feel like one’s experiences matter and make sense. Validation is an excellent skill to achieve those goals.

What do you enjoy the most about working in this field?

I love being able to meet a variety of people from all different walks of life and to be part of their journeys. I feel really privileged to have the opportunity to be an important and trusted person in my patients’ lives.

What is one of your favorite Radically Open Dialectical Behavior Therapy (RO DBT) skill, and why?

One of my favorite RO DBT skills is “Flexible Mind is LIGHT.” It can be so easy to become fixed in cynicism and bitterness and to have blinders on that prevent us from seeing things that are uplifting in the world around us and in our everyday relationships. “Flexible Mind is LIGHT” helps us to go opposite to the bitterness we experience so that we can move outside of ourselves to practice kindness, help others, and practice gratitude.

Now, for a bit of fun. What is your favorite hobby or leisure activity?

My favorite hobby is singing. I have been performing for most of my life, and I love musical theatre. Whenever I have time, you can find me belting out songs around my house. Singing is something that has been part of my life for as long as I can remember, and something that I enjoyed with my mom growing up. It was an important part of our relationship, so I value it a lot. It’s a healthy way for me to express my emotions.

Is there anything else that you’d like to share?

My favorite color is hot pink, and if you come to my office you’ll pick up on that very quickly! I also really like sequins and glitter!

The Holiday Season is upon us

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By: Verity Brown

Somewhere between back-to-school shopping and snacking on Halloween candy, I blinked my eyes and suddenly, the weather was colder and the trees were colorful.

For many people, winter brings excitement and nostalgia. The smell of pumpkin pies and fir trees can evoke feelings of gratitude and warmth as we gather with loved ones and reflect upon the year. Socks get thicker, blankets get cozier, and fires get crackling! Picture-perfect, right? Not always. For all the joys that the holidays can bring, they also bring stress, conflict, overwhelm, and sometimes grief.

If the thought of standing in mile-long lines at Best Buy or facing a dinner with the relatives leaves you with dread… fear not!  Here are some tips and techniques to keep the most magical time of the year from becoming a full-blown nightmare.

Observe

Mindfulness practices are the key components to changing our instinctual (ahem- impulsive) behaviors. Pause and notice when challenging emotions arise within yourself; paying close attention to the thoughts that start firing and sensations that start brewing. Perhaps the car honking behind you is increasing your heart rate… perhaps thoughts of “why me?!” are flooding in as you’re waiting for another delayed flight.

Regardless of the context of the situation, observing what is happening internally gives us useful information about the present moment. And, just by observing, we mentally secure a little cushion between ourselves and the emotions, thoughts, and/or sensations we are feeling.

Come to Your Senses

If we find ourselves battling overwhelming emotions, distraction can be a great short-term option. Where we go, our five senses come too (sight, hearing, taste, touch, smell). Take time to pause and notice your surroundings, searching for small pleasures in large crowds.

Maybe it’s the sweet taste of your hot cocoa or the spicy smell of peppermint. Perhaps it’s the feeling of your favorite sweatshirt, or the sounds of falling snow. Find what lifts your spirits and enjoy it with as many senses as you can!

Use a Gentle Manner

The holiday season usually means increased contact with other humans. When stress is running high, it can be tempting to snap, scold, or scrutinize others. Keeping a sense of humor and a gentle manner with others increases the likeliness that both people will walk away from interactions feeling positively about themselves. Relaxing our posture, using an easy tone of voice, and staying aware of our body language can help cue our brains to release tension.

Comprehensive DBT for Complex Eating Disorders

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Are you struggling with a severe eating disorder and don’t know where to turn? If you have been through traditional treatment for your eating disorder and are still suffering, read more about our newest program that is coming in Spring of 2019.

Eating disorders are complex and serious illnesses and traditional treatment does not always resolve symptoms adequately. In these instances, Comprehensive DBT can be another option.

COMPREHENSIVE DBT FOR COMPLEX EATING DISORDERS

Individuals can benefit from comprehensive DBT for an eating disorder when:

  • Traditional treatment for the eating disorder has not yielded desired results

  • Emotion dysregulation is central to the eating disorder symptoms

  • Significant co-morbidities such as substance use, mood disorders, self-harm, or suicidality impacts standard treatment

  • There is a history of significant therapy interfering behavior(s)

If you are interested in learning more about Comprehensive DBT for Complex Eating Disorders, please contact us.

Rock Climbing - Team Building Event

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At a recent team building event, members of the PBS team went to Earth Treks in Crystal City for an afternoon of team building. Staff participants had the opportunity to practice individual climbs as well as trust exercises as a team. The team activities in particular helped staff to tap into their skills of communication, listening and observation in order to meet challenges. 

Not only did this experience help to build trust and rapport among the staff, but some staff members who were afraid of heights did their own mini-intensive exposure to help them overcome their fears!  

What is a true friend?

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Have you ever wondered about a friendship in you life? How do you know what a true friendship involves? According to Goodnet.org, you choose your friends, not your family, and in many ways, the people we bring into our lives intentionally can mean just as much, if not more. Our friends help us live more meaningful, joyful lives in so many ways, and we should never under-appreciate the value of a true friend who supports us through thick and thin.

1. Good Friends Accept You for Who You Are

A truly supportive friend will love you for the person you are, flaws and all. That doesn’t mean friends have to agree with each other all of the time. In fact, different outlooks can help expand our horizons. Still, a true friend will accept you and even find beauty in your quirks and imperfections.

2. Friends Stick Around During the Good Times and the Bad

Life has its ups and downs. Having supportive friends can help us get through the hard times. A true friend, because they love you, will stand by to help overcome obstacles. That could mean giving a shoulder to cry on, listening to our problems, or finding ways to cheer us up. Those small gestures can mean a lot especially when times get tough.

3. A Real Friend Celebrates Life with You

In going through life, a friend’s support not only matters during the hard times. A friend means someone who genuinely wants to see you succeed. Unfortunately, disingenuous people may feel insecure and want you to fail. But a true friend celebrates your accomplishments and feels happy to see things go well.

4. True Friends Will Make the Time to See You

Sometimes our hectic schedules make it difficult to see our friends as much as we would like. A best friend will treat you as a priority and set aside quality time to catch up, whether through a phone call, stopping by the house, or even hopping on a flight to see you.

5. A Real Friend Will Tell You the Truth, Even If You Don’t Like It

If you choose your friends the right way, you’ll surround yourself with people who share your values. In this way, you can always rely on friends to give good advice and help guide you through life. Sometimes, we may not notice ourselves falling off track. A good friend will help us make the right choices even if that means saying something we don’t always want to hear.

6. A True Friend Encourages You to Achieve Your Goals

We should all work to become the best version of ourselves, and a good friend will support you in working toward personal improvement. Whether it means cutting out unhealthy habits, pursuing a dream job, or cultivating a creative outlet, friends will give us the motivation to help follow through with the things we want to achieve. 

7. A Real Friend Helps Us Feel Comfortable in Our Own Skin

Sometimes we just can’t force that special connection between friends. It just happens. Two people come together and feel completely at ease being themselves. Whether it means laughing at silly jokes for hours or talking the night away, a long-lasting friendship involves an effortless connection in which two people understand each other when simply being themselves.

Do you know of a special person who shows all the signs of a true friend? Don’t forget to be a good friend in return and show how much you care. Even if you haven't talked in a while, remember to reach out to the important people in your life who love and support you.

Gratitude

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“Gratitude turns what we have into enough.” – Anonymous

One of the DBT Distress Tolerance skills is that of distraction with Comparisons. You can practice this by comparing yourself to individuals who are less fortunate, or to a time when you felt different. As we approach the holiday of giving thanks, consider taking some time to reflect on what you are grateful for in your life. Perhaps even start a gratitude list!

SPIRIT WEEK: DAY 5!

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Today was the final day of spirit week 2018...today the team celebrated 80’s day!

SPIRIT WEEK: DAY 4!

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It’s “favorite sports team day” at Potomac Behavioral Solutions for our fourth day of spirit week! If you haven’t already joined in the fun, consider doing so tomorrow for our last day of spirit week…which will be 80’s day!

SPIRIT WEEK: DAY 3!

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HAPPY HALLOWEEN from Potomac Behavioral Solutions! Our team showed up today with all sorts of creative and festive costumes…we hope you have a wonderful day!

SPIRIT WEEK: DAY 2!

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It’s Hat Day at Potomac Behavioral Solutions! We are on day 2 of Spirit Week here at the office…stay tuned for the rest of week!

Spirit Week: Day 1!

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Pajama Day at Potomac Behavioral Solutions! Today was just a normal day at PBS…with one small difference…

Remember - All are welcome to join in the fun and accumulate some positive experiences!

Join us for Spirit Week at Potomac Behavioral Solutions!

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In the spirit of the season and upcoming ghoulish holiday, we here at PBS will be celebrating the season with a SPIRIT WEEK 10/29 - 11/2!  

Monday (10/29): Pajama Day

Tuesday (10/30): Hat Day

Wednesday (10/31): HALLOWEEN! Costume Day

Thursday (11/1): Favorite Sports Team Day

Friday (11/2): 80s Day!

Come one, come all and please feel free to JOIN IN THE FUN!

Dr. Kim's Lecture at Georgetown University

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By: Dr. Aileen Kim

Last month, I gave a talk to post doctorate clinicians at Georgetown University about Mindful Management of Shared Treatment with Borderline Personality Disorder Patients.

Many patients with BPD see a therapist for psychotherapy and a psychiatrist for medication management. This treatment model is commonly called "split treatment", but I prefer to describe it as "shared treatment" which I consider a more accurate reflection of what is happening when the model is being used effectively.

We examined ways that Dialectical Behavioral Therapy principles can be applied by non-prescribing therapists and prescribing clinicians alike to integrate care for BPD patients. Additionally, we discussed how using our own skills as clinicians can be part of care for caregivers and create an effective professional culture. 

Interview with Alyson Nuno

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Interview with Alyson Nuno


What inspired you to become a mental health clinician?

As a child I was drawn to idea of working in a helping field, such as being a nurse or doctor. It was a natural calling for me, but I didn’t know I would eventually become a mental health clinician until after I graduated from college. In I majored in foreign languages with a dream of working in teaching and translating, but when I entered the “real world” after school I found myself in jobs that did not quite fit where I saw myself long term. At some point I decided to just go for it and pursue a Master’s degree in Mental Health Counseling. To me, it was a life worth living goal.

What do you enjoy the most about working at Potomac Behavioral Solutions?

I really enjoy the team aspect. It is comforting to know that I don’t have to operate alone and that supportive colleagues are always right around the corner. It makes the environment more comfortable, and enhances the work I do so that I can be a more effective clinician to my patients. Additionally, I truly enjoy working with my patients and feel lucky to be part of their journey toward their life worth living. I come to work everyday knowing that I am in the field I love, and it’s a good feeling.

What is your favorite Dialectical Behavior Therapy (DBT) skill, and why?

Checking the facts is my favorite DBT skill because it really helps me to slow down and get out of Emotion mind. Sometimes, it seems like what I’m feeling in the moment is truth or factual, but once I’m able to sit down and objectively examine the data, it makes it easier to think things through and problem solve effectively. Basically, it help me get to wise mind faster since I’m able to detach from some of the emotions that might cloud my view on Wise Mind.

How do you find a balance of acceptance and change in your own life?

Well, I’m very naturally change oriented so I don’t have to work much for that part. However, I carve out time every day to work on acceptance. I make it a daily practice to use mindfulness and radical acceptance to notice when I’m not in acceptance, and pushing for change when it is not effective to do so. Intentionally practicing this helps me find that balance in my own life.

Now, for a bit of fun: What is your favorite hobby, and why?

Crossfit is one of my favorite hobbies and one of my favorite PLEASE skills. I find that the physical activity helps me to unwind, and it’s actually one of my favorite forms of self care as it reduces my vulnerability to stress. Not only that, but I also use it as a mindfulness practice since I focus on what I’m doing in the present moment and increase awareness of what’s going on with my body. The community aspect of Crossfit is something else that draws me to it, because I form relationships with the people I work out with, and we share that common bond. It’s empowering and a lot of fun!

Is there anything else that you’d like the readers to know?

I speak 3 other languages, and I have an interest in art and art history. If you ever want to practice Italian, French, or German, stop on by my office! I learned these languages in high school and actually wanted to be a translator. In college I studied this further and traveled abroad to enhance my foreign language skills. Another fun fact about me is that I have 2 cats and that I love ALL furry creatures! I am hoping to get a dog one day, too, but right now that decision is up in the air.