Other Signs of Hunger

When we think of hunger signs we commonly imagine the classic sign of a growling stomach. Yet, there are a variety of hunger sings, some more subtle than others.

1. Headache or Mental “Fog”

   1. When you haven’t eaten in 3+ hours your body will experience a gradual dip in blood sugar levels. This can lead to a headache or lack of mental clarity. You might find it difficult to focus on a task or notice yourself continually zoning out.

2. Tiredness

   1. If the body is running low on energy, then we will likely feel tired. This can be one sign that it’s time to eat again.

3. Food Thoughts

   1. Are you constantly thinking about food or drawn to pictures of food? We are biologically wired to seek food when our body is hungry. This might show up as obsession with cooking, food pictures, grocery stores, or planning food.

4. Anxiety or Fidgeting

   1. While anxiety can have many origins and influencers, one of those can be related to hunger. When the brain is malnourished or hungry, it can produce an anxious state. Scientists suspect the anxiety might be a biological drive to make us more alert for food sources.

5. Irritation or Hangry

   1. Hangry is the mix of hunger and anger. When you notice your irritated (especially if its for no reason) check in with yourself. When was the last time you ate? Was it enough? Perhaps try eating something.

6. Feeling shaky or weak

   1. When the body is running low on energy, you might feel physically shaky or weak. Physical exertion, such as lifting weights, running, etc. may become more difficult than usual. This is a sign that your body doesn’t have enough energy.

7. Nausea or Stomach Pains

   1. This one may seem counterintuitive, however, nausea can sometimes be a symptom of hunger. This can occur due to the acidity of stomach acid, in addition to taking certain medications (ex. NASIDS) or supplements (ex. multivitamin) without food.

While this isn’t an exhaustive list of hunger signs, it hopefully provides you some guidance on navigating your less obvious hunger cues. Questions or want more? Contact us to meet with our nutritionist!

Diets Don't Work

FACT: Research shows that diets are proven to fail long term (~5-10 years post start of the diet). The research that shows weight loss diets “working” is all conducted within the 5 years time or less.

Why do diets not work?

Well, first of all, your body is WAYYY smarter than any diet program. Your body recognizes “oh crap, I’m not getting enough energy; there is a limited amount of food…guess I should slow things down.”

You’re body doesn’t know the different between purposeful restriction and unintentional /environmental restrictions. And let’s be real, it all has the same outcome of reducing the body’s ability to repair, move, think, grow, and heal.

Now you’re probably thinking “okay, great, what do I do now?”

Eat like you did as a young child. Eat in a way that respects your physical and emotional needs. Become attuned with your body, listen to it, and nourish it.

If you feel really detached from with body’s needs, that okay. You’re not alone.

Working with an ED-informed or intuitive eating specialist can be really helpful in rebuilding a healthy relationship with food.

Note: this post is not meant to replace individualized healthcare recommends. Information has been simplified for the purpose of making a brief post.

Reclaiming Your Binge Foods

What does it mean to reclaim “binge foods?”

First, a “binge food” can be any type of food and it is specific to the individual. It’s a food that tends to be eaten in a binge. For some individuals they may have specific foods while others don’t.

When recovering from binge eating disorder (BED) you might be tempted to want to completely cut out all foods that you usually binge on. They may feel like triggers or scary.

Yet by cutting them out this is reinforcing restriction, and science shows us that (mental or physical) restriction often fuels binging.

Reclaiming that food means learning to eat it in a way that respects your emotional and physical needs.

For example if you usually binge X food, then reclaiming it would mean that you’re eating X food when desired until you are emotionally satisfied and physically comfortably full. You are reclaiming that food from the eating disorder.

The eating disorder has likely made it an “all or nothing” food, and by eating it in a self-attuned mindful way you are creating a middle ground.

This can be really scary and/or hard to do and should be done with the help of an ED-informed therapist and/or dietitian.

Contact us if you are interested in learning more!

Mindful Movement

What is mindful movement?

Mindful movement is physically moving your body in a way that feels energizing, enjoyable, and uplifting. It celebrates your abilities and respects your limits. It brings your more in touch with your physical self.

Mindful movement is NOT…

- a workout program (it can include this if this is what feels good to you but it itself is not one)

- punishing, punitive, or painful

- focused on weight loss or changing the shape / size of your body

Mindful movement includes so many types of movement, not just the conventional ones.

For example, here are some potential types of mindful movement:

- hiking / walking

- sports (e.g. volleyball, spike ball, soccer, ping-pong, etc)

- dancing 👩‍🦽

- cleaning

- kayaking

- roller skating 🛼

- yoga / stretching

- rock climbing

slacklininging

- martial arts

Remember, some types of movement will feel positive while others may not. That is okay! And variety is key. Switch up your movement often. Focus on enjoying it, celebrating your abilities, and feeling connected with your body.

*Disclaimer: Make sure you are medically cleared by your healthcare teams before engaging in physical activity.

New Upcoming Event: Family-Based ED Caregiver Skills Group

Family-Based ED Caregiver Skills Group starting on September 13th!

Will be held VIRTUALLY Monday 6-7pm for 10 weeks.

Lead by Eva-Molly Dunbar, MA

Co-lead by Rebecca Hardin, PsyD

This group is for caregivers of individuals with eating disorders, that are receiving FBT treatment at PBS.

In this group you will be able to:

• share experiences on caring for your loved one with an eating disorder

• receive peer support and professional guidance

• and build coping skills to prevent burnout

Interested? -> contact us!

571-257-3378

info@pbshealthcare.com

Clothing Sizes and Body Image

THESE JEANS ARE ALL THE SAME “SIZE” ACCORDING TO THE TAGS.

Now visually we can tell that of course these jeans are not physically the same size as each other.

So even though you may be a size [something] in one brand, doesn’t mean there’s anything wrong with your body when the size doesn’t fit right elsewhere. Using arbitrary sizes to judge your body will likely lead you feeling upset and frustrated. Our bodys change from day to day, hour to hour. This is natural, normal, and healthy! We are dynamic and organic beings, rather than static machines.

With that being said, we recognize it can be hard to accept your body, or to accept that your body will change. We recognize that from a young age, many of us have been taught to feel a certain way about our bodies - such as it “needs” fixing. Therefore, it can be difficult to accept that your body doesn’t need to fixing. Instead, it likely needs compassion. So…

REMEMBER.... the clothes are meant to fit YOU. And not the other way around!

Contact us via our website or phone number if interested in services regarding body image.

When is your child's picky eating TOO picky?

“My kid is such a picky eater! I’m afraid they arent getting enough.”

Ever heard or said this phrase? Or perhaps you’ve said it before. It’s common for kids to go through a picky eating phase when they’re young. But….

How do you know when it becomes TOO PICKY?

• they become emotionally distressed when told to have a food they dislike (e.g. crying, screaming, running away from table, etc)

• they’re gagging on foods they don’t like

• they will only eat VERY specific foods

• their variety is severally limited

• they aren’t growing sufficiently

This isn’t a diagnostic list but it gives an idea of the difference between simple food preferences and a type of disorder eating, called Avoidant Restrictive Food Intake Disorder (ARFID).

ARFID is typically first noticed in young children and can persist into adulthood if not addressed.

It frequently includes severe texture, taste, smell, and temperature preferences, resulting in a very limited diet and anxiety around food.

How to approach treatment?

• Work with a trained ED-informed dietitian or therapist that provide in-person sessions

• they will likely have your child do controlled food exposures with feared / disliked foods

• these food exposures will likely need to be replicated and repeated at home

• understand that these feared / disliked food may be very distressing for your child… AND that don’t mean they can’t grow distress tolerance to them

Interested in treatment? Message us through our website portal!

Coronavirus and Eating Disorder Concerns

Check out below for a message from our nutritionist on the connection between COVID-19 and eating disorders. Thanks for your input, Jennifer!

If you or someone you care about struggles with an eating disorder, this time of social isolation and the associated anxiety could exacerbate their symptoms.  Uncertainty can increase feelings of powerlessness and tendencies to engage in destructive behaviors; social distancing can create challenges in maintaining a support network; difficulty in procuring food and household items can lead to anxiety and drive one to unhealthy coping skills. Here are some things to be mindful of during this time.

* While staying safe at home and grocery shopping less frequently, a person might experience the inclination to ration food, which could lead to food restriction.  At the same time, stockpiling and hoarding food could increase vulnerabilities and lead to binge eating.

* News and social messaging could influence thoughts regarding eating “immune boosting” or “virus defeating” foods and supplements, possibly supporting orthorexia.  It’s worthwhile to note that none of these claims are scientifically proven.  Rather, a balanced diet of fresh or frozen fruits, vegetables, and whole grains is rich in antioxidants, fiber, and flavonoids, all of which naturally support the immune system. 

*With gyms closed and sporting events cancelled, someone who leans toward excessive exercise can experience panic and increased negative body perceptions. 

All of these lay the groundwork for obsessive thinking about food, weight, and body image, which are all hallmarks of eating disorders. During this challenging time, the best way to maintain a balanced diet and physical health is to stick to the basics:  strive for a wide variety of colorful fruits and vegetables, whole grains, and lean meats, minimize sugar and processed foods, and get the recommended 30 minutes of moderate exercise daily.

If you notice the above symptoms developing or increasing in yourself or a loved one, please reach out for help.  The Eating Disorder Team at Potomac Behavioral Solutions is here to support you. We are open and using telehealth during this time, so please reach out to our admin team at (571) 257-3378 to schedule an intake call with our clinical coordinator. 

 Jennifer Moore, MS, CNS

Nutritionist

We Are Published!

Congratulations to PBS for a superb accomplishment! A published article by some of our brilliant team!

It does cost in order to read the full work, but it’s worth it! Check it out here.

Happy NEDAwareness Week!

Hey All!

Happy ED Awareness Week!

We want to focus on, and continue showing solidarity, to those who struggle with an eating disorder this week. This is your week! And you deserve all the recognition in the world for what you are fighting each and every day. We are here as a support—always.

Check out this story of Paul below (thanks Rogers Behavioral Health for sharing!). Paul is now a triathlon competitor who struggled with his own ED battle in high school. If he can work for a better future for himself so can you!

What does it mean to be "over controlled" and radically open?!

Here is a great podcast about Radically Open DBT and its effectiveness for temperaments of over control!

Marielle Berg from Bay Area DBT recently interviewed Neil Howell for a new podcast that explains OC and RO nicely. Marielle does a great job asking the questions to help get to the bones of RO, and Neil answers with humour and humility.

Here's the link https://bayareadbtcc.com/08-emotional-over-control-with-neil-howell-mft/

Here’s the link to our RO DBT services for more information! Don’t hesitate to contact us with any further questions or how RO DBT might be a good fit for you!

Binge Eating Disorder- The cycle that continues to feed itself

Binge Eating Disorder- The cycle that continues to feed itself

By: Annyck Besso, MS, RD

“I woke up the next morning, in distress, telling myself that I needed to have more control over my eating and then everything would be ok.”  This sentence or a similar one may sound familiar to several individuals. In a society that places a great deal of importance on weight loss and healthy eating, most people believe that the problem is related to their “lack of control," rather than something greater. 

What is Binge Eating Disorder?: 
Binge Eating Disorder (BED) was first recognized as an eating disorder in the DSM V, which was published in 2013 (APA, 2017). The diagnostic criteria for BED include, but are not limited to, the perception of loss of control while eating a larger quantity of foods than considered “normal” in a specific period of time in addition to extreme feelings of guilt and shame afterwards.  While diagnostic criteria for BED does not include compensation following a binge (e.g., vomiting, laxative use).

Figure 1- Common nutritional and emotional pattern that arises in many patients with BED

Restriction and the Binge Cycle:
People with BED often report that they try to make up for the behavior the following day through restrictive eating. This restrictive eating behavior can present itself in several forms, such as using food rules to eat “healthier,” avoiding certain foods or limiting oneself to a certain amount of calories. Sometimes just the idea that tomorrow will be different can keep the binge cycle going. 

The goal of your dietitian is to target restrictive eating, which normally perpetuates the cycle of feeling overly hungry then bingeing. Messages from social media often seem to condition us to believe that we can control what our bodies want and what they should look like. This battle can have dire consequences on our physical health, our mood and our emotional well-being.

 
Sandra’s Story
One example is a client who I will name Sandra. Sandra has always had a very difficult relationship with her body,  creating  food rules to try to control her weight and shape. For years, she attempted several diets, which worked initially, but then she ended up heavier and more demoralized after each one. She became confused as she was following her food rules and eating “healthy,”but was unable to lose any weight. Often, Sandra would come home from a long day of work and describe “zoning out” and eating whatever “forbidden foods” she could find over a period of an hour. When she would finally “snap out of it,” she was filled with feelings of guilt, shame and loathing for herself. She would reassure herself by saying that this was the last time and that she was going to get things under control the following day; she would get rid of all the junk food in her house and start anew. 

While this may seem like a good strategy, this is exactly what I would NOT recommend a client to do. Food rules typically perpetuate the cycle of loss of control(led?) eating. It is not a lack of control that leads to bingeing; it is instead primarily the emotional relationship people have with food and their body (amongst other reasons). 

Treatment Goals:
Stopping the cycle: after a binge, do not try to “get back on track”. 
Reconnecting with your body: try asking yourself how hungry you feel before a meal and how satisfied you feel after a meal. Try to let your body guide your food choices, rather than deciding what it should be having. 

Accepting all foods: there is no such thing as a good food or bad food. All foods are good and serve different purposes in our lives. Eliminating a food or food group simply makes it novel and more interesting which leads us to become preoccupied with the food. 

Eliminating mindless eating: if you eat at your desk, in front of the TV or in the car, this one is for you. Take time to just EAT and taste the food you’re putting in your mouth. It will feel much more satisfying. 

Please note the strategies above are NOT as simple as they may seem. If you can identify with this article or know someone who has an emotional relationship with food, it may be beneficial for them or for you to talk with a Registered Dietitian. Please don’t hesitate to reach out.  
 
 
References:
American Psychiatric Association. (2017). DSM History. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm on June 19th, 2017. 

Binge Eating Disorder Association. (2016). Characteristics of BED. Retrieved from https://bedaonline.com/understanding-binge-eating-disorder/symptoms/ on June 19th, 2017. 
 
 

The Downside of Missed Periods

Sam Tryon, MS, RD

For some, the idea of not having their period might be cause for celebration.  No cramps, bloating or having to worry about keeping tampons or pads on hand; awesome right?! Unfortunately, not getting your period could be cause for concern.*

If you are 16 years old and have not yet started your period or if you have missed at least 3, you could be diagnosed with amenorrhea.1 Amenorrhea can be caused by a variety of factors including genetic abnormalities, gland problems, and certain gynecological conditions.1  Amenorrhea may also be due to what you eat and how active you are.

The roles of nutrition and activity

Low energy availability is one cause of amenorrhea.  Energy availability is a measure of the energy left for bodily functions (i.e. heart beating, digestion, breathing) after subtracting for energy used during exercise and other activities of daily living (i.e. vacuuming, walking to work, gardening).  Low energy availability means that there is not enough energy for body functions and exercise.

Low energy availability can be a result of not taking in enough fuel (A.K.A. not eating enough) and/or using too much energy for exercise.  Among other effects, the lack of energy left for bodily functions leads to decreased production of gonadotropin-releasing hormone, a hormone important in reproduction, which causes decreased production of estrogen and progesterone and disruption of the menstrual cycle.2

Amenorrhea and Bone Health

Both low energy availability and reproductive hormone changes have negative impacts on bone density.  In addition to not having the available energy and nutrients to maintain bone mass, lack of estrogen is associated with bone loss.  In a healthy body, our bones are constantly being broken down to release minerals like calcium and then rebuilt.  Without estrogen, there is increased breakdown without rebuilding which leads to decreased bone density.  This can progress to osteopenia and osteoporosis, putting a person at risk for fractures.  

Studies have found that up to 95% of people with Anorexia Nervosa have osteopenia and as many as 40% have the more severe osteoporosis.3 Weight gain is associated with return of menstruation and possible reversal of at least some bone loss.

Amenorrhea and bone loss are especially concerning in adolescents as peak bone mass is reached during this time. Bone loss from low energy availability during this stage of life may prevent patients from reaching a normal peak bone mass. This can put them at increased risk for fractures later in life.

Next Steps

If you have missed 3 or more periods, an appointment with your general physician can help to determine the cause of amenorrhea.  They may recommend a bone density test to look for possible bone loss.  

If the cause is found to be nutrition related, a dietitian can help you change your diet to make sure you are taking in enough energy to fuel your body. Amenorrhea can occur with or without disordered eating and a dietitian can also help assess for any disordered eating behaviors.  If disordered eating is a problem, a therapist may be added to the team to best tackle these concerns and get you back to the activities you love.  

*The content of this article is for informational purposes only and does not constitute medical advice, professional diagnosis, or treatment.  See your healthcare provider before making any healthcare decisions or with any questions you have regarding a medical condition.  

References:

1. Amenorrhea. Eunice Kennedy Shriver National Institute for Child Health and Human Development; [accessed 2017 May 31]. https://www.nichd.nih.gov/health/topics/amenorrhea/Pages/default.aspx

2. Mallinson, R and De Souza, M. Current perspectives on the etiology and manifestation of the “silent” component of the Female Athlete Triad. Int J Womens Health. 2014; 6: 451–467

3. Mehler, P and MacKenzie, T. Treatment of Osteopenia and Osteoporosis in Anorexia Nervosa: A Systematic Review of the Literature. Int J Eat Disord. 2009; 42: 195-201

NEDA Walk, Washington, DC: April 2, 2017

Alexa, Charlie (with Daria!), Joanna, and Rebecca 

Alexa, Charlie (with Daria!), Joanna, and Rebecca

Evelyn and Alexa- Our WONDERFUL intake staff! 

Rebecca and Alexa

Evelyn and Joanna

Joanna Marino, PhD giving a keynote speech at the DC NEDA walk!

Alexa ;)

Our booth at the walk

Joanna Marino, PhD giving a keynote speech at the NEDA walk

Ellyn Satter's Hierarchy of Food Needs

Below is a description of how our nutritionists view food needs

Resistance in Eating Disorder Treatment

Resistance to treatment is a common symptoms in eating disorders. It's never too early to get screened for symptoms. Read more here.

#NEDAwalk Washington, DC April 2!

Join us for the #NEDAwalk in DC where Dr. Joanna Marino will give a keynote speech about eating disorders.