Wednesday, December 10, 2014

Holiday Book Contest!

It's hard to believe that my book has been out for six months. For almost eight years, I toiled away on this blog, and then, this past June, the book finally came to print.

In celebration of this half-year publication mark, and in keeping with the holiday spirit, I am going to give away two signed copies of Does Every Woman Have an Eating Disorder? to my loyal readers. It's this community that inspired me to write the book and that continues to motivate me to post regular content on this blog.

To enter the contest, either email me privately (drstaceyny at gmail dot com) or comment below with your DEWHAED New Year's resolution. No diet talk, no rigid exercise plans, no weight-loss promises - only body-positive, revamped resolutions that promote eating in peace and accepting/respecting yourself. No resolution is too small or too big - just an intention to create a healthier relationship with food or your body.

The deadline for resolutions is 12/22. Winners will be selected at random that week, and the books should arrive around the new year. In celebration of good health. . .

Fine print: Please enter the contest only once. For those who submit via email, please include your mailing address to receive a book if you win. If you submit via comment, be sure to send me a follow-up email with your mailing address. By submitting a resolution, you authorize DEWHAED to post your anonymous response. Winners will be selected by drawing so as to preserve resolution integrity.



You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Wednesday, December 03, 2014

Is DBT Effective for the Treatment of Eating Disorders?

My article appeared originally on Recovery Brands' Pro Corner site.


Dialectical-behavioral therapy (DBT), as developed by Dr. Marsha Linehan, is a type of therapy that helps patients reduce emotional reactivity and improve thought patterns and interpersonal interactions. The therapy, a hybrid of cognitive-behavioral therapy and tenets from eastern philosophies (primarily Buddhism), was created to help those who struggle with borderline personality disorder and chronic suicidality. However, DBT has also shown promise in the treatment of substance use disorders and eating disorders.
DBT is a problem-solving, but accepting approach – one that helps patients change, while accepting them for who they are. This duality (or “dialectical” view) seems to sit well with many patients as they struggle on the road toward recovery. The avoidance of either/or thinking (e.g., “I’m either recovered or I’m a failure”) can help patients restructure other black-or-white thought patterns common in those with eating disorders.
DBT offers an affect-regulation approach to eating disorders – helping sufferers to cope less pathologically with some of the challenging emotions that might precipitate eating disorder symptoms.-STACEY ROSENFELD
DBT offers an affect-regulation approach to eating disorders – helping sufferers to cope less pathologically with some of the challenging emotions that might precipitate eating disorder symptoms. Patients who are treated with DBT learn four broad, overlapping sets of skills in the areas of: 1) mindfulness 2) distress tolerance 3) emotion regulation and 4) interpersonal effectiveness.
Individual skills in the mindfulness module include learning how to use one’s “wise mind” and engaging in non-judgmental awareness. In the distress tolerance module, patients hone crisis coping skills, such as distracting and self-soothing. With emotion regulation, patients learn how to identify and label emotions, as well as how to create a life that is less vulnerable to intense emotional shifts. In the interpersonal effectiveness module, patients learn assertiveness skills, such as asking for what they need and saying no to others’ request.

The Research

Research into the efficacy of using DBT to treat eating disorders has been encouraging, though additional, broader research is warranted. In an early study of women with binge eating disorder, participants treated with DBT showed significant reduction in binge eating behavior, with 89 percent of the sample binge-free at the end of the study and 56 percent abstinent at the six-month follow-up. In a similar study of women with bulimia nervosa, results showed “highly significant decreases” in bulimic symptoms following DBT treatment.
More recently, researchers piloted the use of DBT with adult patients with anorexia, and the treatment showed promise. DBT was associated with increased BMI in participants, evident at six- and twelve-months.

DBT in Action

A number of eating disorder treatment centers offer DBT as a complement to other types of therapies. Patients typically learn DBT in group settings, where the modules are introduced cyclically so that new patients can join the discussion at any time. Patients often report that DBT provides a helpful, solution-oriented adjunct to their treatment. Particularly when distressed, they can rely on their DBT skills to cope with emotional challenges in the moment.
Take the case of Eddie, a 45-year-old man with binge eating disorder. Learning DBT was helpful in reducing his binge episodes through various pathways. He became more mindful of his hunger and mood states through a consistent mindfulness practice. He learned how to better insulate himself against emotional distress – behaviors like consistent sleep hygiene and sufficient food intake helped protect him against any emotional waves he encountered. (Eating enough, too, helped protect him against over-hunger, which often triggered a binge).
Eddie had earmarked some tools from his distress tolerance module so that when he did experience distress, he had some alternatives to bingeing. Some of his go-to self-soothing skills included going for a drive or spending time with his dog. Finally, Eddie had learned that a significant trigger for his binges was feeling overwhelmed by life’s demands and promises to others at work and home. In the interpersonal module, Eddie learned how to say no skillfully to others’ requests, a practice that previously evaded him. These skills collectively helped Eddie experience a significant reduction in binge eating episodes and an improvement in overall wellbeing.


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com


Monday, November 24, 2014

Thanksgiving Goodness Without the Guilt

Thanks to the National Eating Disorders Association (NEDA) for asking me to blog for them! You can check out my first post here, just in time for this week's holiday. Happy Thanksgiving.


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Wednesday, November 19, 2014

Black or White

As a psychologist, I'm quick to point out all-or-nothing thinking - the kind of thought pattern that polarizes things into categories of good and bad or, really, any two camps - without leaving room for the middle ground.

So, it may come as a surprise to hear me say that I think professionals and products and plans are either recovery-oriented or not - but I do.

If a therapist is advertising her treatment program, designed to curb overeating, as a tool for weight-loss, I don't see her as recovery-oriented. Part of the reason that people overeat is due to the diet mentality. If a yoga instructor promotes the slimming effects of her teaching, I don't see her as recovery-oriented (or as the kind of yogi whose teachings I'm interested in following). If a health coach is helping people recover from disordered eating by prescribing a particular meal plan, I don't see her as recovery-oriented. And if a food company is selling a product designed to tame cravings or cure stubborn belly fat, I don't see this company as recovery-oriented.

We live in a diet-centric, disordered world. And I know it's reductionistic, but people are either buying into this mentality or working really hard to challenge it. And you can't be promoting recovery unless you're actively challenging our nation's fixation on weight and shape.

So there it is, in black-and-white terms: you're either part of the problem or part of the solution. Pick a side.


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Tuesday, November 11, 2014

Exercise Addiction: Pushing the Limits of Healthy Behavior

My article appeared originally on Recovery Brands' Pro Corner site.



The statistics are staggering; millions of Americans don’t get enough exercise. In the early part of my career, as a certified personal trainer and group fitness instructor, I focused on this end of the spectrum – helping people to incorporate exercise into their lives and adhere to regular exercise programs. But, as I trained to be a clinical psychologist, I saw more and more of other end of the exercise spectrum. On this other side sit those who have a compulsive relationship to exercise; that exercise despite pain or illness; that feel anxious, angry, or depressed if they miss an exercise session; that unhealthily use exercise to influence their weight or shape; and that engage in rigid exercise behavior, despite little enjoyment from the activity.
Females who under-eat and over-exercise are at risk for the Female Athlete Triad, comprised of disordered eating, amenorrhea, and osteoporosis.-STACEY ROSENFELDWhile not a standalone DSM-5 disorder, exercise dependence is associated with other disorders. Many individuals who struggle with eating disorders engage in compulsive exercise. Those who use exercise as a way to compensate for binge eating (with a diagnosis of bulimia nervosa), will tack on extra activity to compensate for binge eating. Those with restrictive eating disorders might also use exercise in a compulsive way – spending excessive time at the gym and pushing their bodies to the extreme, as an additional way to control their weight.
Medical complications from exercise dependence can include cardiovascular concerns, amenorrhea, stress fractures, and other overuse injuries. Females who under-eat and over-exercise are at risk for the Female Athlete Triad, comprised of disordered eating, amenorrhea, and osteoporosis.
Some who don’t suffer from clinical eating disorders might also engage in compulsive exercise. They might spend excessive time engaged in physical activity in the name of health, or to ward off uncomfortable feelings. Typically, these individuals feel guilty when they miss a workout and can experience signs of withdrawal, such as irritability, anxiety, or depression when their exercise schedules are compromised.
Robert “Raven” Kraft is an iconic example of exercise addiction. Kraft has been running the same eight-mile stretch on Miami Beach, daily, for almost forty years. He’s run during hurricanes; while sick with pneumonia and food poisoning; and despite chronic, crippling pain. When an angiogram brought him to the hospital, he clocked his eight miles by pacing the hospital halls.
Kraft, who suffers from anxiety-driven behavior, admits: “I’m a prisoner of routine, but I’ve become comfortable with it.” He reports: “It’s like, as soon as I get out there, I’m suddenly a different person. My personality changes. I almost seem taller, stronger, bigger. It’s my comfort zone, where I feel right. And once I start going, I feel good.”
While Kraft certainly pushes exercise to the extreme, there’s a fine line between healthy and disordered. Is a regular gym-goer addicted to exercise? Are marathon runners compulsive? Several measures have been developed to assess one’s relationship to exercise, including the Exercise Dependence Scale-21, theCompulsive Exercise Test, and the brief Exercise Addiction Inventory.
Does missing a scheduled workout land you in a sea of negative emotions? Do you refuse to take days off from exercise, even when injured…?-STACEY ROSENFELD
One of the most important criteria in teasing out whether or not a behavior is addictive is how it impacts your life as a whole. Do you prioritize exercise above professional, educational, familial, or social events? Does missing a scheduled workout land you in a sea of negative emotions? Do you refuse to take days off from exercise, even when injured or ill? Do your workouts persist beyond your intentions, with you regularly tacking on unscheduled activity time? Is exercise no longer enjoyable for you, now just a burdensome chore? These are clear warning signs that compulsive exercise might be at play.

If you are concerned about your relationship to exercise, then consider these tips:
  • Schedule regular days off. Your body needs time to repair and relax following demanding workouts. This can help ward off overuse injuries and illness.
  • Take some time away from exercise. Return gradually and monitor for signs of dependence.
  • Engage in physical activity with others, rather than alone. This can help make exercise less compulsive and more enjoyable.
  • Focus on the physical and mental health benefits of exercise, placing less emphasis on weight control.
  • If you are unable to develop a healthier relationship to exercise, try a course of therapy to help you manage the behavior and provide you with other coping resources. Therapy can help you learn to tolerate difficult emotions without turning to excessive exercise for relief.

You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Tuesday, November 04, 2014

You Ate It - Now Move on with Your Life!


Just in time for Halloween, some frightening posts appeared on my Facebook feed. Titled, "You ate it. . . Now negate it!" the posts featured pictures of popular Halloween candies, alongside their calorie contents and the amount of exercise required to burn them off. That mini Snickers that sang to you from your leftover stash? That'll be 50 burpees. Similar charts popped up on the websites of fitness and nutrition professionals, in newspapers and on newscasts, and, lest you think these warnings are targeted only at women, in a popular men's magazine.

In addition to the fact that nutrition science has largely dispelled the calories-in/calories-out myth, as we now know that weight is a complex biological phenomenon, these messages fuel a disordered eating mentality - suggesting that we must compensate through exercise for what we eat and making fitness a remorseful chore, rather than a way to strengthen and honor your body.

As I've written prior, this mimics the unfortunate practice of many fitness professionals, who similarly promote exercise as penance for eating, propagating our culture's disordered mentality -  in a setting that's supposed to be healthy.

My advice? Keep intake and exercise separate. Engage in exercise because it promotes physical and psychological health and because it allows you to feel alive. If you enjoy Halloween candy, a fancy coffee drink, or simply, that extra serving of fettuccine, don't atone via exercise, subsequent restriction, or any other type of compensation. Just move on with your life. . . .


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com

Tuesday, October 28, 2014

Fat Girl Costumes

Walmart's Website Features a Section of 'Fat Girl Costumes'

(photo via Jezebel)

This week, Walmart landed itself in the latest controversy involving bodies and advertising. As Jezebel fist reported, the megastore's online catalog featured a section of Halloween apparel called, "Fat Girl Costumes." Jezebel speculated the heading may have been a web developer joke that eluded final editing.

As a joke, this heading is offensive. But, let's look at the larger picture. To start, I commend Walmart for featuring plus-size costumes. Not every retailer offers size-inclusive styles. And the offensive nature of the language itself is only a product of the relative value of fat versus thin in our current cultural climate. The fat acceptance movement, as evidenced by its name, has worked long and hard to reclaim the word "fat," from something offensive to a simple description of body size. If fat weren't such a bad thing, this section of Halloween costumes wouldn't have created such a stir - like clothing for tall women or petite women, we'd just file it away under offerings that cater to the natural diversity of body sizes. But because fat is such a dagger, this title becomes offensive.

So, rather than focusing on some retailer's joke or error, let's celebrate companies that offer plus-size fashions and let's continue to evolve our dialogue so that the use of the word "fat" doesn't fall prey to jokes or mistakes and, when used in earnest, is just a descriptor, not a headline.


You can find Does Every Woman Have an Eating Disorder? Challenging Our Nation's Fixation with Food and Weight on Amazon (as a paperback and Kindle) and at BarnesandNoble.com