As the summer ends and the crisp fall air approaches, the season of back to school is upon us. While this time of year can excite some, for others, the beginning of school is coupled with feelings of anxiety and stress. For those individuals considering going away from home for school for the first time or leaving home once again to return to college, this time can be fraught with decisions around lack of parental involvement which can lead to struggles with schedule, sleep, study, exercise and food.
I recently spoke with a client regarding a “quick admission” to residential treatment so she could return to college for her junior year. During the course of the conversation, this lovely, articulate and bright twenty-year-old told me every summer for the previous three years she had been in treatment. When we explored those treatment stays, she reported she consistently discharged to “get to school on time”. We discussed what it would mean for her to commit to being present in treatment for the recommended length of stay, rather than entering treatment for a specified period of time to engage in minimal weight restoration, receive a quick tune-up and brainstorm potential pitfalls for her return.
This conversation is one many professionals have during this time of year. When is it time for our clients to remain in a higher level of care and when is it time to return to their college campus? College students are left to cope with high-pressure academic environments, navigating complex social nuances and trying to engage in self-care; even in the best of circumstances this is challenging. Add an eating disorder to the mix and an individual is left to manage feeding themselves, self-monitoring exercise and managing substances which can significantly increase engagement of eating disorder symptoms, anxiety and depressive symptomatology.
The National Eating Disorder Association (NEDA) conducted a Collegiate Survey Project in which they reported:
The increased pressure and stress of school and leaving home may lead to mental health problems among college students and a greater need for campus services. This is also a period of development in which disordered eating is likely to arise, resurface or worsen for many young men and women. Full-blown eating disorders typically begin between 18 and 21 years of age (Hudson, 2007). Although some students will experiment with dieting and escape unscathed, 35 percent of “normal” dieters progress to pathological dieting. Of those, 20 – 25 percent progress to partial or full-syndrome eating disorders (Shisslak & Crago, 1995).
With every client, parent and provider I speak with, I encourage them to dig deep in consideration around the return to school. The idea of taking a semester off may be a painful one; however, the ultimate benefits may far outweigh the potential challenges.
I believe it is more beneficial for an individual to engage in treatment fully and completely, rather than potentially need to reenter in the future.
For questions or more information on supporting your client or loved one in the transition from treatment to school, please email us directly.
Join us for First Wednesdays at Oliver-Pyatt Centers! Director of Clinical Programming Jamie Morris, MS, LMHC, CEDS-S will present “Healing the Relationship with Mind, Body and Sport: Considerations in Working with Athletes” on Wednesday, September 6th.
Removal from sport, whether through injury or illness, influences sense of identity, self-esteem and body image. For the September edition of First Wednesdays at OPC, Jamie Morris will provide an overview of clinical considerations in treating athletes and their importance in delivering effective treatment with this subpopulation. Proper assessment of a client’s relationship with exercise and sport will be reviewed, with a focus on how to evaluate the factors specific to sport and athlete identity that have contributed to and maintained eating disorder symptoms. Special focus will be placed on work with collegiate-level athletes.
Through this presentation, participants will be able to define two factors that increase vulnerability for development of eating disorders in athletes. Participants will be able to describe how removal from sport through injury or illness influences self-identity, self-esteem and body image. Lastly, participants will be able to list at least three weight pressures that exist in the athletic environment and list at least two treatment considerations that are specific to athletes.
Registration, lunch and mingling will begin at 12 pm and the presentation will be from 12:30-1:30pm. 1 CE hour will be offered for:Ph.D., Psy.D., LMFT, LMHC, LCSW, LPCC, and RD. If you would like to join OPC’s First Wednesdays on September 6th, please RSVP to Jennifer Carlo at JCarlo@montenidoaffiliates.com or RSVP here by Tuesday, September 5th.
Dr. Stacey Rosenfeld is a clinical psychologist specializing in eating disorders and body image concerns. She also works with substance misuse, anxiety and mood disorders, infertility, and relationship difficulties. A certified group psychotherapist and certified eating disorder specialist, Dr. Rosenfeld has worked at various treatment centers and universities and now directs the Gatewell Therapy Center in Miami, Florida. Dr. Stacey Rosenfeld is the author of “Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight”, based on her award-winning blog of the same name. She is committing to helping people develop healthier relationships with food and their bodies. Check out Dr. Rosenfeld’s podcast on Life Unrestricted where she discusses disordered cultural messages, compulsive exercise and co-occurring issues.
Oliver-Pyatt Centers Director of Nutrition Services Mary Dye, MPH, RD, CDN, LD/N shares about the Intuitive Eating Model in this week’s blog post. Mary gives insight into how OPC supports clients to lay a foundation of intuitive eating so that they are able to improve their relationship with food on their recovery journey.
Sometimes, when eating disorder professionals hear of intuitive eating, they aren’t sure how this method can be incorporated into treatment at higher levels of care. The concept of listening to the body’s internal cues sounds like an ideal long-term goal for a person who has imposed strict and maybe even aggressive dietary guidelines on themselves. However, the reality for an individual living with an eating disorder, requires nutritional structure to ensure adequate nourishment and re-engagement of cues while working through all aspects of treatment. Oliver-Pyatt Centers’ nutrition programming, often referred to as an Intuitive Eating model, utilizes individualized, structured meal plans while assisting clients in increasing their awareness, understanding and ability to appropriately respond to innate cues with increasing autonomy over time. Throughout treatment, mindful eating practices and participation in thoughtfully planned, supported food exposures serve as the basis of each client’s journey toward the goal of full recovery, freedom and flexibility with food.
An individual with an eating disorder typically has little to no awareness, connection or ability to appropriately respond to their bodily cues. A key characteristic of the eating disorder is disassociation- a person comes to disregard their body’s hunger and fullness cues for so long that they forget what it feels like to be comfortably hungry for a meal and what it feels like to be satiated after eating. Our work is to reorient our clients with their own body’s language. As they work towards making peace with food, movement, and their bodies, we continually draw their attention back to their own experience- we ask them over and over again to describe what is happening in their body in the present moment. We do this first by having them assess their hunger and fullness on a scale of 0-10; zero being empty, and ten being painfully full. We also ask them to explore how these cues equate to emotional hunger and fullness. On empty, a person is experiencing cognitive deterioration or numbness, while when painfully full, the sensation is profound and distracting. During the initial phases of nutritional restoration, a client’s hunger and fullness cues are all over the scale and this can be confusing and quite anxiety provoking for the individual. However, as the body is restored to health and becomes accustomed to the routine of the meal plan laid out by the nutritional team, these cues start to fall in a less extreme and more comfortable range where hunger and fullness are experienced more gently and predictably. By noticing hunger and fullness in more comfortable, and less distressing ranges of sensation, clients learn to better recognize their body’s physical needs and address them before they become unmanageable.
Another key aspect of nutritional philosophy at Oliver-Pyatt Centers is the way we incorporate the Principles of Exposure Response Prevention Therapy to guide our client’s supported interactions with food. Because of our intimate staff to client ratio, we are able to provide a high volume of exposure experiences in a controlled and safe setting. We remind clients that exposures must be repeated and while there is a peak in shame, anxiety, and disassociation, we find that overtime maladaptive responses decrease. To support our clients through daily exposures, meals are reported in a safe setting just prior to exposure experience and intentions for that specific meal are set in a focused and supported environment. These built in, habitual exposures are paired with individualized challenges to address specific eating disorder behaviors and beliefs. We work with clients to quell their anxieties in the moment to work through challenges early on as they continue towards the goal of mindful connection to their experience in the moment.
Throughout each client’s treatment stay, we work to lay a foundation of mindful, and eventually intuitive eating, with the goal of reconnecting mind and body. We believe that after following treatment recommendations and continuing to work toward full recovery, our clients are capable of making peace with food through intuitive eating.
1. What is your name and how long have you been with Oliver-Pyatt Centers?
Mary Dye. I have been with Oliver-Pyatt Centers for two years. Prior to working here, I had the pleasure of knowing Oliver-Pyatt Centers as an outpatient dietitian. I was so impressed by their work I had to move down and join the team!
2. Provide a few sentences about your role at Oliver-Pyatt Centers.
I oversee all of the nutrition services at Oliver-Pyatt Centers. I supervise the nutrition work in all levels of care and across our various programs. Additionally, I meet individually with all of the women participating in our Transitional Living Program. I also have the pleasure of meeting many providers around the country and speaking with family members about the treatment their loved ones receive at Oliver-Pyatt Centers. A big perk of my role is the ability to educate professionals and the public about eating disorders.
3. What is your favorite thing about working as the Director of Nutrition Services at Oliver-Pyatt Centers?
My team. I could not ask for a more passionate, dedicated, loving, creative, and smart group to work with every day. The entire OPC team, from our graphic designer and human resources department to the clinicians, chefs, and recovery coaches, has such a high level of dedication to patients and their families and true passion for helping our women succeed. The team puts a smile on my face every day and reassures me that every woman who enters our doors is in the best hands possible.
As a mother of two young girls, I feel a real obligation to help create a culture I want them to live in. Whether advocating against school BMI screenings, pointing out the dangers of photoshopping, or fighting for insurance coverage for eating disorder treatment, I have the pleasure of working on a team devoted to the same causes. For so many of us the work we do speaks to larger cultural issues we feel a personal obligation to change. This passion inspires and motivates my work.
4. Tell us three things nobody knows about you.
I grew up surfing and feel so blessed to have been raised near the ocean. I grew up in a family of pilots so many weekends were spent doing take offs, landings, and stalls in the air. It has resulted in a real love of spontaneity, travel, and roller coasters! The ice cream cone was invented in my hometown of Norfolk, VA (I am particularly proud of this one!)