Thoughts & Reflections

Forbidden foods

2009-07-26T16:23:00.000-04:00

How do I role model healthy eating in my home without restricting junk food and if I restrict junk food, is that going to cause problems??

Believe it or not, this is actually a common question or issue for health conscious parents. It is a tough question to answer. I have worked with several moms who do not allow a lot of junk food in their homes, who have always offered healthy snacks and choices to their children and they themselves role model healthy eating. But, many of their kids grow up with some type of eating problem.

So, here is my professional opinion. We live in a culture where �junk� food is accessible even if it is not in your home. When you restrict it completely in your home, your child is likely to get a taste of it outside your home. They then want more of the forbidden, restricted food and tend to overeat it when it is around. On the flip side, if you make it available to your child but educate them on healthy eating and choices, for example, that chocolate is not so great for breakfast because it affects your thinking at school, or inform them that protein helps concentration. I recognize that many kids, even my own, have to test this theory maybe a few times but hopefully they eventually get it.

The goal is to not forbid any food items but provide education on nutrition and guide your children.

Mother Daughter conference

2008-11-10T11:49:00.000-05:00

On October 18, 2008, I had the opportunity to be part of a Mother Daughter conference which was held at the Summit Medical Group. It was a great day and a great conference. I worked specifically with the moms in a break out session entitled, Checking your Messages. Below are some of the issues that were discussed.

The goal for the moms was for them to look at the messages, both implicit and explicit, that they might be conveying to their daughters. Our daughters are struggling. Debra Waterhouse in her book, Like Mothers Like Daughters, says by age 5 most girls describe thin friends as being more desirable than overweight ones, by age 9 50 percent of girls have already embarked on their first diet. In the majority of American families the ever increasing pressure for thinness has created an almost universal shift toward body unhappiness�. We talked about how these influences are so powerful.

Body image does not refer to what you actually look like. It refers to your personal relationship with your body�especially your beliefs, perceptions, thoughts, feelings and actions that pertain to your physical appearance. So many of the young girls I see for treatment view their bodies by what they believe they should look like in order to be accepted or popular etc. The challenge for any young girl to accept and even like her own body is tremendous. The cultural influences and the media influences are so strong. And clearly, the messages many of these young women receive from those vehicles are negative. So, so much is out of our control as moms raising daughters, so we must focus on the things we do have some power over. For example, how we communicate with our daughters about their bodies. Moms also struggle with their own body image issues.

Sometimes, we give subtle messages to our daughters about their bodies and or weight and sometimes the messages are not that subtle. I have worked with teens who say that when their moms strongly suggest they go to the gym often that they feel their moms are saying they are fat. I have worked with moms whose daughters ask them time and time again; do I look fat in this???? And the moms feel conflicted about how to answer. Here are a few suggestions for moms. Do not talk about weight as a consistent topic in your house. Do not talk about diets often. It is okay to talk about healthy eating and a healthy lifestyle. Impart to your children the things about yourself and them that you are proud of. Do not allow teasing in your household.

Understand normal bodily changes, especially for teenagers. This is so so important. Understand the genetics of your body type and structure. Our daughters are often unprepared for changes during puberty. We, as mothers are often unprepared for the changes in our bodies. Debra Waterhouse states, �this unrealistic portrayal of womanhood reflects a lack of understanding, appreciation and acceptance of the stages of female passage.

For younger children, give your children the opportunity to experience their bodies as positive whether it is a sport, dance or just running around outside. (Thomas Cash) Teach children to pay attention to sensations occurring within their body. �Body awareness is crucial for the establishment of identity and mental health�. And lastly, when your daughter asks do I look fat in this?? Tell her that question is not allowed but she can ask, �how do I look in this?� Yes, you can answer her.

In conclusion, our daughters are exposed to so many negative influences that we cannot control. Take time to reflect on the ways in which you as a parent influence your daughter. Establish healthy open communication with your children. If you struggle with body image issues, take the time to make changes. Believe in yourself, embrace your strengths and let go of the negative tapes.

Perfect Girls, Starving Daughters

2008-09-05T10:49:00.000-04:00

Perfect Girls, Starving Daughters
A book written by Courtney E. Martin

I am so excited that I have the privilege to be part of the Eating Disorder Association of New Jerseys first mother daughter conference. The key note speaker will be Ms. Courtney Martin. This workshop will challenge mothers and daughters to explore their beliefs about their bodies and body images.

For more details on the conference please visit the Eating Disorder Association of New Jerseys website at www. EDAof NJ.com.

Courtney�s book is an unbelievable account of what generations of mothers and daughters have addressed with regard to their bodies, their perception of themselves as well as many eating and food issues. I would like to quote the following paragraph from the book because it is so powerful. �Health and wellness, joy and love have come to seem ancillary compared to the desire for a perfect body. Even though eating disorders first became generally known about twenty-five years ago, they have burgeoned, worsened, become more difficult to treat and more fatal (50 percent of anorexics who do not respond to treatment die within ten years). Consider these statistics:

� Ten million Americans suffer from eating disorders.

� Seventy million people world wide suffer from eating disorders.

� More than half of American women between the ages of eighteen and twenty-five would prefer to be run over by a truck or die young than be fat.

� More than two-thirds would rather be mean or stupid.

� Eating disorders have the highest mortality rate of any psychological disease.

This is so frightening to me. Having been in practice for 20 years, I can see the difference and agree that things are worse. This conference is about empowerment. I highly recommend reading Courtney�s book. If you are a woman whether you are a mother, a daughter, a sister or a friend, this read will be thought provoking for you. Thanks for visiting my site. Suzanne

Interesting Information

2008-06-22T13:54:00.000-04:00

I caught a glimpse of the following points and I thought they were interesting and important.

1. People with eating disorders think about and use food in ways that are physically and emotionally destructive.

2. An eating disorder changes relationships with friends and family as the focus on food and eating increases.

3. Eating disorders don�t discriminate. They affect people of all ages, both genders, from all walks of life and all ethnic and socioeconomic groups.

4. Eating disorders don�t just happen or pop up out of nowhere. They have logic, initially serve a purpose in your life and may be triggered by a specific life event.

5. Eating disorders can create serious problems in every aspect of life: physical, emotional, social, intellectual economic.

6. Recovery is possible by challenging the beliefs and changing the behaviors that support the eating disorder.

These important bits of information are from the �Beginner�s Guide to Eating Disorders Recovery� book.

Inpatient Hospitalization

2008-03-19T18:26:00.000-04:00

Do inpatient hospitalizations for eating disorders really work?

In the early 1990�s when I first entered the mental health field, I worked at Fair Oaks Hospital. They had an eating disorder program. The average length of stay for a patient with an eating disorder was 7-10 weeks. This past year in my practice, I have worked with 2 clients who have been hospitalized, both at Somerset Medical Center. The average length of stay for both of these women was 14-21 days. I feel both places offered excellent treatment. I do feel, however, that the shortened length of stay makes a difference in the treatment. Most patients that require hospitalization today have some type of medical complication from their eating disorder and once they are stabilized, they can go home. Years ago, once the patient was stabilized, they could stay and really get involved in the full program. It seems as though, insurance parameters make the stay shorter. I hope in the future policy makers and insurance companies become more familiar with eating disorders and their treatment.

Compulsive Eating

2008-03-12T09:52:00.000-04:00

I have been asked many times by other mental health professionals as well as many clients what do I find is the most difficult eating disorder to treat and why?

I find people who have a compulsive overeating disorder the most difficult to treat. Let me define compulsive eating. Compulsive eating is characterized by periods of impulsive gorging or continuous eating. Usually there is no purging but there may be sporadic fasts or repetitive attempts at dieting. Body weight can vary from normal to mild, moderate or severe obesity. Many of the compulsive overeaters I have seen in my practice are struggling with obesity issues. I think this makes their illnesses more complicated and perhaps more difficult to treat.

Compulsive overeaters usually eat when they are depressed, anxious and or frustrated. These people struggle with body image issues. People, who compulsively eat similar to other eating disorders, struggle with low self-esteem, feelings of inadequacy, self hatred. Often times these feelings are at the core of who they are�it is a challenge to change these ideas. For example, when the person overeats, they will often report to me that they call themselves names, they retreat to bed for feeling shameful and to turn that around feels insurmountable to them.

Additionally, many of these people report that their binge eating began when they were children. This is often not the case with anorexia and or bulimia. I feel this also makes recovery more complicated.

An important part of treatment is to help people learn to like themselves because only then can they begin to nurture their minds and bodies and hence, the compulsive eating behavior improves. One thing I suggest in treatment with these clients is an exercise which seems so simple but becomes very difficult to sustain. I ask them to pay conscious attention to the amount of times they degrade themselves in the course of a day. Then I help them to recognize when the thoughts come and recommend they make a very specific effort to stop the thoughts and replace them with positive affirmations which we create together. And, I promise them if they commit to this and can do this long term they will begin to improve their self �esteem. I have seen this happen many times. It is the beginning of recovery.

Recovery from any eating disorder is difficult and takes tremendous commitment but as I always share it is possible. If you are struggling with these issues�remain hopeful and seek professional help and guidance.

A Question About Recovery

2008-01-15T20:26:00.001-05:00

This past month, I have been asked this question 2 times by 2 moms. Both of these moms have daughters recovering from an eating disorder.

�Now that my daughter is in recovery from her anorexia, is it okay for her to diet to lose a few pounds? Will it ever be okay for her to diet?�

I find this a difficult question to answer. I have treated both of these young women and they have both done great work to be in recovery, one from anorexia and one from anorexia and bulimia. In their recovery both have gained weight. In my opinion, they are both at a healthy weight range but for them they feel they have gained too much weight. I told both of these moms that their daughters will always be vulnerable to eating issues. Relapse can happen quickly and be all consuming. So, a diet that involves a lot of deprivation and restriction is not okay because most likely it will end in either a desire to binge eat or a desire to restrict more and more. A healthy eating plan which is not too restrictive and encourages variety and balance is okay. I also recommend that there is not a lot of focus on a particular weight. Most importantly, if one of these moms or their teenage daughters attempt a weight loss plan and they seem like they are showing signs of preoccupation, they must reevaluate the situation before the eating disorders resurfaces.

AN EXPERIENCE IN CAT SITTING

2008-01-08T20:39:00.000-05:00

Last month, I was cat sitting for a family member�a job I have done many times before. However, this particular cat sitting job would prove to be a little different. On the third day of my job, I had done the usual feeding and petting of the cats. While I was shutting off the lights and getting ready to leave, I saw a glimpse of a cat�s tail hanging from a small hole in the wall. This small hole housed the washer and dryer hook up and yes, the kitten attempted to climb in the hole and she was lodged in the wall. The only part of her I could see was her tail and hind legs. I felt a surge of panic run through my entire body�my limbs felt numb and my hands were trembling. I tugged gently on the cat's legs to see if I could pull her out and her body would not budge. My anxiety and panic increased and I felt nauseous. Where was the cat�s head? How would I get her out quickly and safely?

I took some deep breaths, attempted to ground myself and made a plan of what to do. I contacted family members and once they arrived about 20 minutes later, we cut a hole through the sheetrock around the cat and pulled her out. She was very frightened but thankfully she was okay.

The ordeal ended after about 3 hours. For the remainder of the day, I felt sick to my stomach and very tired. My body was completely off balance and my mind felt foggy. My body was completely transformed by the anxiety and panic I had endured that day.

The physiological role of the anxiety was very dramatic. If a person were to sustain that type of anxiety or any type for that matter, consistently in their life, the toll it takes is enormous.

Chronic stress and anxiety can cause long term changes in our minds and in our bodies. If I were unable to ground myself and calm down, my judgment and my ability to make decisions would have been impaired.. I have been under stress before but for some reason, I was particularly aware of what was happening to my body in this situation.

In Mark Gold�s book, The Good News about Panic and Anxiety Disorder, he states, �The central nervous system includes the brain and the spinal cord and the peripheral nervous system includes the remaining network of the nerves. The CNS is the main center for control and coordination of the entire body. The activity of the CNS regulates a wide range of human behavior from sleep wake cycles and muscular coordination to memory, thought, and emotions.� Stress and anxiety interact with our central nervous systems.

The good news is that panic and anxiety disorders are treatable. Treatment often involves a combination of psychotherapy and medication. It is essential to get relief from your symptoms so you can minimize anxieties long term effects.

Below are some basic steps to help manage your anxiety and you can incorporate these steps into your lifestyle today!

Learn the technique of deep meditative breathing�often a yoga instructor or hypnotherapist can teach this properly. Use these breaths everyday not just when you are stressed and anxious. Try to be sure the environment is quiet. This can be done for 5 minutes a day.
Use imagery to relax�create a place in your mind such as a beach that always helps you feel calm and relaxed. You can do this anywhere at any time.
Build exercise into your life
Reduce caffeine and sugar at times where you are more anxious or stressed.
Try to write in a journal�often the ritual of writing can help to relax and calm.
Bring music into your life. There are numerous C.Ds that are promoted to be soothing.

In closing, I would like to say that I recognize from 20 years in practice, that these ideas and suggestions do not cure anxiety and or panic disorders. And as I always report in any of my lectures or writings, there are a host of factors that contribute to the onset of these disorders. Successful treatment, I believe, should address all of them. That being said, the techniques I reviewed, if done routinely should help relieve some symptoms of anxiety and stress. If you are suffering with chronic anxiety or panic, I am available for consultation. I can be reached at (908) 273-4220. A great resource and a book I often refer to for panic and anxiety is The Anxiety and Phobia Workbook by Edmund J. Bourne, Ph. D..

SELF ESTEEM

2007-12-02T09:30:00.000-05:00

What exactly is self esteem? How do we define it and how do we measure it? We hear and read about it all the time. We know as parents how important it is in child rearing but how do we know if we are raising kids with positive self esteem.

There is no specific recipe for raising a child with positive self esteem. There are ideas and guidelines which I will discuss below. As you will see in most of the material I write, I believe there are a host of factors that contribute to low self esteem, to eating disorders, to anxiety problems, to depression etc. We must always consider environmental influences, psychological factors and biological issues. Environmental factors, for example, being what televisions shows our children are watching. Psychological factors being what type of family structure there is and biological factors being what type of temperament someone is born with. Two children can be raised by the same parents and one has a positive sense of self and the other has low self esteem.

I will discuss below some basic easy steps and ideas to enhancing self esteem in your family.

Step 1: Do not talk about yourself negatively in front of your children. It is okay if this happens once in a while but if it is happening consistently, it will impact their self esteem. Do not say, "I look so fat today" or "See my stomach, it is so big and ugly" or "I am so stupid". Many of the teenagers I work with that struggle with self esteem and eating problems will often tell me they vividly remember a parent saying these types of comments repeatedly. If you as a parent are having a bad day or feel any or all of those things, it is okay to say that but the negative comments should be kept to yourself. We are significant role models to our children, especially the same sex parent. It is crucial to role model positive self esteem.

Step 2: Reinforce positive attributes and behaviors in yourself and in your children. You do not need to constantly praise your children but you can let them know when they have done something important, special etc.. It is also okay to comment on things that are not okay. The way you comment on those things is essential. For example, if your daughters hair is messy and she is going to school , do not say, "Oh you look terrible, your hair looks horrible", instead try saying, "Hey, we forgot to fix your hair, once we style it, you will look great." If your teenager gets a poor grade on a test and you know they can do better, instead of saying "I can't believe you did so bad. What is wrong with you," try saying, "What is up with this grade, usually you do better. Is something wrong?"

Step 3: Keep fighting, yelling and arguing to a minimum in your family. This is easier said than done as we are all stressed as parents. Fighting and yelling really diminish self esteem. Children and teenagers do not feel good when their parents are fighting with each other or with them often. If you are struggling with this issue, there are many techniques available to help with anger management such as deep breathing, time outs etc.

Step 4: Validate, validate and validate!!! A few times a year, 60-80 teenagers get together for a spiritual weekend. These teens are from different schools and different backgrounds, many of them do not know each other. I had the pleasure last month to be at the closing ceremony to this great event. The lecturer stated that he felt the weekend and all the events that occur truly join and bond these teenagers because they all feel validation from each other. I could not agree more. I feel that all human beings no matter what age, gender or ethnicity want to feel validated. And feeling validated greatly enhances self esteem. Validating your children can be as simple as "I love you" or "you are so important to our family". Validating can be taking an interest in something important to them. It sounds so simple but we can get so busy in our daily lives that we forget to do these simple tasks that take moments.

If you as a parent incorporate these few ideas into your life, you will enhance your self esteem and your children's. I am only scratching the surface, picking a few items that are easy to do. If you are concerned about your low self esteem or someone in your family's self esteem, I am available for consultation. Good luck with these ideas. If you raise a child with a good positive sense of self, you have given him or her a gift. A gift that will be of tremendous value in their lives.

Insights: Dec 2007

2007-12-01T12:59:00.000-05:00

When is my child's ritualistic behavior considered a problem that needs intervention?

I have been asked this question by a parent who is worried about her son's behavior. Rituals are a part of our daily lives. We all engage in them and many of us take comfort in them. For example, when we help our children before bed, we often engage in routine rituals: brushing teeth, a bedtime story and some hugs and kisses. Many children feel disrupted if this routine is changed for some reason. As adults, we often have a routine before work or bed. So I believe that rituals help children feel secure and safe. When a child takes on a lot of his or her own ritualistic behavior it is important to monitor this. Some children can become more obsessive compulsive in their thinking and this can be a problem.

In obsessive compulsive behavior the obsessive part is the thoughts and ideas a person has and the compulsive part is the behavior that the person engages in. So, if you constantly thinking about germs and that your hands are dirty: this is the obsessive thinking. Then, if you cannot stop the thoughts until you wash your hands many times, this is the compulsive part. The thoughts can be about a multitude of things. The issue with germs is the most common. If your child shows symptoms of this and the thoughts or behaviors seem to be interfering with home life, school life and or social life it may be time to further evaluate this issue.

In this particular case, the parent explained to me that her son's thoughts were affecting his concentration at home and at school. She felt that no matter what she said to him, he was not able to stop these thoughts. I recommended that she have him further evaluated.

A lot of children as well as adults experience ritualistic behavior and or obsessive compulsive behavior because they are anxious. Having a specific thought or action sometimes relieves anxiety.

The good news is that all of these issues are treatable with the proper intervention. The proper intervention often includes a combination of behavioral therapy, desensitizing and sometimes medication.

If you are currently struggling with this type of issue, I am available for phone or in-person consultation. Please call 908.273.4220 to arrange an appointment.

KIDs and Eating

2007-11-01T09:30:00.000-04:00

Have you ever thought, as a parent, that the relationship between you, food, and your child are all so intertwined that it can impact your child's relationship with food for a long time?

As a therapist working with people who have eating disorders, I am particularly intrigued about the relationship between moms, kids and food. In the next few pages, I will share experiences from my years both as a parent and a therapist that will illustrate the importance of developing an emotionally healthy attitude toward food and eating and imparting that to your children.

There are many factors that contribute to the onset of an eating disorder. There are biological, sociological and psychological factors. I will be addressing in this article some of the psychological factors. I will address the other factors in the coming months.

A person's early relationship with food definitely plays a role in the evolution of an eating problem. Let me share an example from my practice to help illustrate my point. A thirty year old woman attends individual psychotherapy because she has bulimia and anorexia. She is raising and 8 year old daughter. She is trying to do the right thing and educate her daughter about healthy eating and serves only "healthy" foods but in that process, she controls her daughter's portion sizes and restricts sweets most of the time. This is a common scenario. As parents we can relate to some more of these types of scenarios; your child comes home from school starved and wants to eat something sweet or crunchy. You suggest fruit and the power struggle begins or it is Halloween time so the candy is abundant. You hide most of it giving your child a few pieces a day. And lastly, you, as a parent are health conscious, so you offer sweets only after your child eats all his or her dinner. The good news is that parents are really trying to be more aware and healthy with regards to their children�the bad news is the way parents are doing this might not be the best approach.

One of the most essential tasks you can teach your child with regards to food and eating is to eat when they are hungry and to stop when they are full and of course, to understand healthy food choices. If we as parents can accomplish this we will greatly minimize that our children will develop eating problems. In the next few paragraphs I will give an example from my practice to help understand my perspective. A client of mine, B, is in therapy for a 15 year history with bulimia. She has a seven year old daughter. The family is celebrating a special occasion so they are going out to dinner. When B tells her daughter, the first thing the girl says is, "can we have dessert tonight?" B responds by saying, "yes, of course, it is a special day." The family eats dinner at the restaurant and B orders an ice cream sundae at dessert time. She eats half of it and says to her mom, "this is so good. I am getting full." Her mom says, "Don't eat it all. You had enough." B's daughter pauses for a moment and continues to eat the rest. Her mom says, "I thought you were full." B's daughter replies, "I am but I have to eat it all because I love it and we never get to have ice cream."

The problem with this is that the daughter does not respond to and listen to her body's cues for fullness because ice cream is rarely allowed in her day to day life. Whenever she has the opportunity to eat it, she overindulges. I believe if B's daughter was not so restricted on ice cream she could have said she was full and not finish the rest because she knows she can have ice cream at home.

There are three areas of our child's development that we cannot control. Those three areas are sleeping, eating and toileting. We as parents can provide education and guidelines that help our child in those areas. We can work toward successful toilet training but no matter how hard we try we cannot make a child urinate or have a bowel movement if they are not ready. We can provide the right environment for sleep but we cannot control when a child falls asleep or wakes up. The same is true for food and eating. We cannot control what food a child likes or dislikes. We cannot control when a child is hungry or full. The more we try the more potential there is for trouble. If we as parents can accept some of these limitations�step out of any type of food and eating battles, we will greatly help our children develop a healthier emotional relationship with food.

I have a daughter who loves chocolate. She sometimes asks for it at 8:00 A.M. Instead of saying no way, no how you are having chocolate for breakfast, because I know that will cause a battle, I try to educate her by saying, "how about toast with some peanut butter and your chocolate because if you just have the chocolate, you will not have a lot of energy for school." There have been days, Halloween time, where she eats a lot of chocolate in the course of the day and she might say that her belly hurts. I use that as an opportunity to educate her and help her see her body's response to so much chocolate is not good. The goal is for her to understand that is she eats sweets all day she will have a stomach ache and not feel good. I want her to be able to listen to her body and know about healthy choices. The less we power struggle over food and eating, the better it will be for her. This is the most important piece of my article. If you are engaged in power struggles over eating with your child, take a moment to look at your own relationship with food and eating and do what you can to step out of the struggle�you will greatly benefit your child.