Trigger Warning: This article includes mentions of self-harm with details of cutting.
With the advent of spring, mental health awareness continues to remain strong as we kick off the month with Self-Injury Awareness Day on March 1st. More frequently judged than treated, people who self-harm often do not receive the proper treatment they need to regain a healthy mindset but are bullied for their scars and labeled ‘attention seekers’ instead. Self-harm is the act of deliberately harming one’s own body through cutting, scratching, burning, self-hitting, inserting objects into the skin, and more.
In my experience, when scrolling through social media, there are often more judgemental comments than supportive ones when a stranger online has the courage to ask for help. I’ve also seen hate comments on posts/videos regarding healed self-injury scars, with unfriendly sentiments comparing cuts on one’s wrist to a barcode on grocery products. However, there is always hope in the darkest crevices of the Internet and life as supportive communities spread awareness regarding self-injury and break down the surrounding stigma and social barriers.
It is reported that around 15% of teenagers have reported some form of self-injury with skin cutting being a prevalent method (Mental Health America). Self-harm is often a last resort for many people as they try to process negative emotions and the downhills in life through an unhealthy coping mechanism. Although people who self-harm may be suicidal, the majority are not as they seek temporary relief and fall victim to a self-destructive cycle of self-injury. By engaging in self-injury, a person believes they gain control over their body when everything else in life is uncontrollable.
As with all mental health issues, self-injury causes many problems to one’s health in the short and long term. Physically, it may cause permanent scarring, uncontrollable bleeding, addictions, and infections. Mentally, it can exacerbate negative emotions such as guilt or shame, lead to avoiding friends/family, cause more interpersonal difficulty in close relationships.
Starting a conversation with those around you on this topic is often very difficult to initiate. After setting a serious tone for the discussion, make sure to create a safe space, allowing others to express themselves and offering emotional support when needed. Remember to listen and not judge. If you believe a person you know has been harming themselves, you can look for these warning signs and direct them to treatment:
Professional and self-made treatment options for those who self-harm are abundant, but often hard to access due to socioeconomic status, inability to ask for help, uncertainty regarding resources, etc. Ensuring that everyone knows that such treatment exists makes a difference, so here are some examples of beginning the road to recovery:
February’s most celebrated holiday, Valentine’s Day, is (now) a heartfelt honoring of love as couples exchange gifts mainly centered around chocolates and flowers. Just one week after Valentine’s Day, however, is a week dedicated to National Eating Disorders Awareness (NEDA), taking place from February 21 – February 27, 2022. The official campaign sloga, See the Change, Be the Change, signifies the era of activism and awareness that is changing the public’s perception on eating disorders as well as accessibility to helpful resources for those with eating disorders.
Basic Information:
Eating disorders are a serious mental illness that affect a person’s internal relationship with food and body image, often leading to serious effects such as unhealthy weight loss/gain and intrusive thoughts. These disorders can affect people of all ages and backgrounds, but researchers have found that eating disorders more commonly impact teenagers and young adults. On average, almost 3 years pass before those experiencing eating disorder symptoms seek help.
Types of Disorders:
There are a multitude of eating disorder classifications, but here are three common types:
Anorexia Nervosa (AN): Characterized by unhealthy weight loss and distorted body image, people with anorexia restrict their intake of food, often not noticeable at first glance as one does not need to be underweight to be struggling. Both thinner and plus-sized individuals can be diagnosed with Anorexia Nervosa, which is classified with two subtypes: restrictive and binge-purge. AN can be fatal as suicide is the second leading cause of death for people diagnosed with AN.
Diagnostic Criteria:
Restriction of energy intake
Intense fear of gaining weight even though underweight
Disturbance in the way one’s body weight/shape is perceived
Symptoms: Dramatic weight loss, developing food rituals, denying feeling hungry, limited social spontaneity, concerned about eating in public, sleep problems, dry skin, muscle weakness, etc…
Bulimia Nervosa (BN): Bulimia Nervosa is characterized by a cycle of binging followed by compensatory behaviors such as forced vomiting and fasting. Individuals diagnosed with this disorder can be any weight. Recurrent binge-and-purge cycles affect the entire digestive system, leading to chemical imbalances in the body that affect other organ functions, which can cause fatal consequences such as cardiac arrest.
Diagnostic Criteria:
Recurrent episodes of binge-eating
Recurrent inappropriate compensatory behavior to prevent weight gain
Episodes and behavior occur at least once a week for three months
Self-evaluation influenced by body shape/weight
Symptoms: skips meals or takes small portions of food at regular meals, disappears after eating often, drinks excessive amounts of water, teeth are discolored, self-injury, calluses on back of hands from self-induced vomiting, unusual swelling in cheeks, etc…
Binge Eating Disorder (BED): One of the most common eating disorders in the U.S. and one of the newest eating disorders formally recognized in the DSM-5, BED is characterized by recurrent episodes of eating large quantities of food, a feeling of loss of control, and not regular use of unhealthy compensatory measures. Unlike BN, BED is not followed by compensatory measures so individuals with this disorder are often overweight.
Diagnostic Criteria:
Recurrent episodes of binge eating
Marked distress regarding binge eating is present
Occurs at least once a week for 3 months
Not associated with recurrent use of compensatory behaviors
Symptoms: frequent diets, having secret recurring episodes of binge eating, disruption in normal eating behaviors, feelings of disgust/depression/guilt after overeating, eating alone out of embarrassment, stomach cramps, difficulties concentrating, etc…
Avoidant Restrictive Food Intake Disorder (ARFID): Another new diagnosis recognized by the DSM-5, AFRID is similar to anorexia as individuals who experience both limit their intake of food. However, those diagnosed with AFRID do not feel distress regarding their body’s appearance (body dysmorphia). AFRID can stall the growth and weight development of children and results in psychological problems as well. Children with a co-occurring anxiety disorder, habits of picky eating, and diagnosis of autism/ADHD are more likely to develop AFRID.
Diagnostic Criteria:
Eating/feed disturbance result in one of four effects
Does not occur exclusively during course of anorexia/bulimia
Not attributable to concurrent medical condition
Not better explained by lack of available food/ cultural practice
Symptoms: dramatic weight loss, only eat certain textures of food, fears of choking/vomiting, consistent/vague gastrointestinal issues around mealtime, limited range of preferred food becoming narrower, menstrual irregularities, muscle weakness, impaired immune functioning etc…
Other eating disorders include Pica, Rumination Disorder, Laxative Abuse, Orthorexia, and more.
Resources:
If you or anyone you know is suffering from an eating disorder, contact the Eating Disorders Helpline at 1(888)-375-7767 for treatment referrals and support/encouragement. Eating Disorder Hope has also compiled a list of websites available for those struggling with certain eating disorders both based in and out of the U.S.
If you would like to raise awareness and join the fight against eating disorders, you can take action on the official NEDA website where you can share your story, register for a spring 2022 NEDA walk, represent NEDA on your college campus, volunteer as a landmark photograph, and plan a NEDAwareness Week Event.
In this episode, Taarika youth ambassadors Krupa and Anisha interview Dr. Nan Shaw, a therapist, about family-based therapy and its uses in relation to eating disorders.
Taarika Foundation(TF) Krupa: Welcome back to another episode of Mindful, Beautiful, and Thriving. Once again, I’m Krupa,
TF Anisha: And I’m Anisha! Today we’ll be continuing our podcast series on Body Dysmorphia and Eating Disorders with an interview with a therapist who specializes in eating disorders and family based therapy.
TF Krupa: Today’s guest is Nan Shaw. Nan, thank you so much for speaking with us today!
Nan Shaw: Me too. Thank you!
TF Anisha: So first off,
Would you tell us about what kind of therapy you provide for youth, specifically, with an eating disorder?
Nan Shaw: Yeah. So primarily when working with teens with an eating disorder I offer family therapy, and specifically family-based therapy(called FBT), which is a very specific kind of family therapy that is designed for adolescents with eating disorders. It’s an outpatient therapy that takes 6-12 months to complete. Sometimes it can take longer, sometimes less time, but that’s basically generally how it goes. And another part of that and how I work is also working with teens. I work with doctors, dieticians, and the family therapist, and as part of the family therapy I meet with the teen and the parents together. And sometimes the siblings too. And then if there are situations where a family can’t be involved, let’s say a college student that lives far away from their family, I sometimes also work with the teen/adolescent only, that’s called adolescent-focused therapy.
TF Krupa: That’s super interesting, I didn’t actually know you work with the family as well as the child. So [since] you specialize in family-based therapy,
Could you elaborate a little bit about what working with a patient’s whole family is like, and family involvement is important?
Nan Shaw: The working with the whole family I personally think is wonderful, I came and do this work as a family therapist anyway, and I particularly like that because really the whole family is involved in the illness, I think it’s important to involve the whole family in the recovery, and everyone is sort of in on it and everyone in the family also deserves to have the education, the support, the tools to help the teen with the eating disorder get better. But the primary focus really is getting the teen better. Family involvement is important because at its core an eating disorder is considered an illness that is keeping the teen from eating enough to survive or feeling out of control maybe with eating too much or purging and it’s the nature of the illness that the teen can’t change this by themselves let’s say. So who better to help than the parents. And also I just want to say when I say parents I also mean caregivers, maybe whoever is caring for the youth whether it’s a parent or someone also in charge. And the other reason I think it’s important to include the family is that by the time an eating disorder has been identified in a teen, they’ve been struggling by themselves for quite a while, and it’s scary and exhausting. So I think of it as sort of when they’re getting the family involved, so like the cavalry has arrived and they no longer have to do it but themselves.
TF Anisha: Right. I’d just like to say that that’s really eye-opening to me and something I didn’t know before. So we actually previously talked with a teenager who did struggle with an eating disorder and they talked about how it helped them open up to their parents a lot more. So I think on that topic,
Would you be able to talk about just what common challenges you come across when you work with teenagers and teenagers’ families?
Nan Shaw: So that’s a great question actually. Probably the first one I think of is that for the teen, even a teen that wants help, this type of treatment, family-based treatment of really any eating disorder treatment, can initially feel like things are being taken away. Whether it’s the diet they’re interested in or an exercise they want to do, that suddenly parents and other people such as myself are all involved in that. And it can feel, particularly I think to teens who are more independent and doing more by themselves to suddenly have professionals all in their business and parents all in their business, can feel both insulting and threatening and of course that’s not the goal. And because the illness by definition creates a situation where a teen isn’t eating enough or is purging too much and can’t intervene, we have to do that. But it can feel like something’s being taken away.
Another thing I think teens often [find] challenging with eating disorder recovery is if they’re dealing with anorexia and have to gain weight, that’s a hard thing. I mean we live in a culture where losing weight is always honored, and we have no idea when someone’s losing weight, and gaining weight is always judged or at least it feels that way. And so hearing from a teen in and saying “Guess what you have to gain weight,” that can be a hard thing to sit with comfortably.
Two other challenges I think of, another is that there’s sort of a belief in this treatment that all life stops until you get better and that is to prioritize recovery over everything else. And so teens that are heavily invested in their academics, studying for the SAT, or loving their soccer team, suddenly everything is “Wait, hold up, you can’t do this, you’re gonna have to leave school early” or you know “Soccer’s on hold.” That can be really hard and scary. In truth we have to “All life stops” until you get better. And then I think the last challenge for teens is they can feel pretty ashamed of what’s going on and isolated, maybe not talking to their friends, not wanting to go out and have pizza with their friends because they’re having a hard time having pizza, feeling really out of step with their peers.
TF Krupa: Yeah that was perfect. I didn’t really know any of that before, and I’m glad that we could talk about this because I know a lot of teenagers, they have these kind of like isolation issues and things about missing out on their teen years in general. And I feel like having an eating disorder would amplify that so much through recovery. I know everyone’s experience must be different, but just a follow-up question:
What advice would you give to youth dealing with an eating disorder, or for their parents?
Nan Shaw: So, let’s start with the youth with the eating disorder. I’d start with hope, that people get better, that there’s treatments out there that have been shown to work. FBT has been found to be quite successful, it’s the most successful treatment, considered really the first one. So, not to give up hope, and then [they’re] not in this alone. I would remind them that things that are being taken away or ways that the therapists or the parents are intervening are just for now, that’s sort of the hallmark of family-based treatment that we often end every sentence with, and that’s just for now. Because that’s true, [as] soon as a teen is feeling better, weight restored, eating more appropriately, we want to give all these things back. That’s the goal of treatment. So “for now” is a really important concept.
I think I would also advise “Tell somebody.” It’s an illness of secrecy, an eating disorder thrives in secrecy, and so the more open and honest a teen can be with those around them where there’s friends, parents, teachers, the better [the] chance for recovery.
And an eating disorder can’t live where there’s openness and honesty,
Dr. Nan Shaw
so I would say tell somebody, and then recognizing that recovery is hard, treatment is not all that comfortable, and that it may be hard and it may feel a little worse before it gets better but it absolutely gets better. So I would also want to say “Hey, this gets better. Hang in there.”
So for parents, I would have different advice. Some of it is similar, things like hope and “You’re not alone,” and “This is just for now,” are all important concepts for the parents, who can feel kind of bad and weird to suddenly be making sure you’re home for dinner, things like that. So “For now” is really important for the parents to know as well.
The other thing I say to parents is often by the time an eating disorder is recognized, it’s really just the tip of the iceberg, that what you can see above the water is just a little bit. You kind of go, “Huh, my kid’s struggling a little bit,” but often what’s beneath that and once treatment starts there’s a whole bunch of stuff going on underneath and that the eating disorder might be much more powerful on the teen than parents ever realized. So I’d like to prepare the parents for that, that maybe what you’re seeing is just the tip of the iceberg, and because of that, parents [who] do the quicker success to recovery goes to parents who basically kind of drop everything at the start and really focus. So they may have to take off from their work to really focus. So it’s, say, all hands on deck, giving all you got as soon as you find out about it. And you can’t overreact. I often tell parents, because parents say “Well I don’t wanna overreact, do I really have to keep her from camp,” and I might say “Well you can’t overreact, because you’re trying to save your kid’s life.” So maybe she could have gone to camp or he could have gone to camp, but why not keep them safe if you need it?
And the other thing, it’s really important for parents, is this idea of prioritizing their child to get better versus feel better. Getting better means hard stuff like eating a meal or completing a meal you don’t want to, or gaining weight if you don’t want to, or not being able to use the bathroom after a meal if you wanted to. And both for teens but also for parents, it doesn’t feel good if your kid is uncomfortable. You don’t want them uncomfortable. And yet recovery is in the analogy we often use, you may have heard this before, is imagine – and I’ve worked with parents before who use this for children children who’ve had cancer for example, and chemotherapy tends to be pretty uncomfortable, and yet if a child was struggling to go do that, the parents don’t go “Ah you can skip it today.” They will say, “I am so sorry,” and “I know this is hard,” and “I’m with you every step of the way, we’re going to get through this.” Feeling better would be to skip it right, but getting better would be to go but doing it lovingly. So that would be what I would say to the parents.
TF Anisha: Thank you for all of the advice you just gave, I think it was really helpful and I really hope that it does resonate with anybody in the audience. And so, kind of I think this was a perfect segway for the next question, because on the topic of people silently struggling with eating disorders, I know that me and people and in my community and both Krupa and I, we’ve seen people maybe start on that path to maybe a really difficult eating disorder or any sort of form of feeling body dysmorphia. And it’s an uncomfortable decision to have with a friend, so just
If you could give us any advice on how to make that better for everyone to kind of lovingly approach that sort of topic with a friend, that would be great.
Nan Shaw: That is a great question. And I guess the first thing I’d want to say is there’s no right answer. So feel free to do what kind of feels right. I guess I’d answer that two ways. If somebody that either – sibling or a friend – is not in treatment or you don’t know if they’re in treatment, I would suggest one, making it talkable. If not with a friend, you know you don’t feel comfortable talking with a friend, maybe just someone else. So you as the observer that’s worried can also go to another adult, teacher, school counselor, parent, your own parent, just say “I’m worried.” So, you could approach the friend or approach somebody else so you can get some help because being worried about a friend also creates its own anxiety.
If you want to talk to the friend, and again there’s no right answer here […] I like to recommend what I call
“Share the Dilemma.”
Dr. Nan Shaw
So, your question is even a dilemma. “What do I do, I care about this person I want to say something, is it my business? Will I hurt their feelings?” It’s a dilemma. So a great way of approaching dilemmas from my perspective is you share. And you go to this friend [and say] “I have a dilemma. I care about you, I’m worried about something, and I might be completely off and I also don’t want to upset you or make you mad. But I wanna ask you if you’re okay.” […] So you share the dilemma, and most of the time that goes really well because you’re not coming at it “I know and I know exactly what needs to happen and I’m worried.” But you’re like “I don’t know what to do here but I know I care about you and I’m worried and this is what I’m seeing.” So that’s […] if somebody’s not in treatment and you’re worried they’re not getting help.
If somebody is in treatment, and you’re worried about them, for whatever reason, one of the things we say in family-based treatment, the friends and siblings, in particular, the role of a friend and a sibling is just to do that, a friend and the sibling. So you say “Hey let’s go see a movie” or play a game or if you see them struggling with a meal, distract. Talk about the most recent episode of Grey’s Anatomy or something. You just play the role of a friend and a sibling in a distracting way, it’s not your job to make them feel better or feel responsible for their recovery, to just be a friend or a sibling.
And the other really cool thing friends and siblings can do is practice what a lot of recovery is, which has to do with body compassion, body acceptance. So you yourself don’t get involved, even if you want to, but you just don’t get involved in conversations about the latest fad diet or your own negative body comments, if you’re feeling that way, or any kind of judgment about body, […] size. And it could be good for the friend or sibling to also not engage in that, it’s usually not really very helpful. It doesn’t help our self esteem to bash our own bodies so it can be a very powerful difference just to not engage or if a friend says “Hey do you know how many calories are in what you’re eating?” you go “You know what I really just don’t care,” even if you do care.
TF Krupa: Thanks so much for that, I know it’s definitely going to be helpful for our listeners, and as Anisha said, both of us have seen people kind of start to go on that negative trend and I know that it will also helpful for us if it ever escalates for them. Thanks again for joining us on this episode of our series on eating disorders and with that comes the end of this interview. See you guys next week!
In this episode, Taarika’s Youth Team members break down what body dysmorphia means, marking the beginning of the body dysmorphia series.
In this episode, two of Taarika’s Youth Team members conduct the first of a two-part interview with a teen who struggled with Body Dysmorphia.
In this episode, we continue our interview with Kai to get a fuller teenage perspective on what it’s like to struggle with and overcome an eating disorder/body dysmorphia.
Today, I want to talk about a serious topic in our society: Body Dysmorphic Disorder. First, let’s start by really understanding what body dysmorphia is. It’s defined as, “a mental illness involving obsessive focus on a perceived flaw in appearance.”
Sometimes, the flaw can be minor, or even just imagined, but it can still cause someone to become fully obsessed with fixing it, thinking about it, and avoiding social situations and photos to hide it. I think it’s become even more of an issue in today’s society, where we see seemingly perfect people on social media, and online, and it makes us focus, and potentially obsess over, our own insecurities.
A huge symptom of BDD is repetitive compulsive behaviors. These are actions such as excessive tanning, shopping, and exercising or seeking cosmetic surgery. On their own, these behaviors may not pose a problem, but two or more together could be signs of body dysmorphia. There are many causes of BDD. Peer pressure, social media, and beauty standards are some of the biggest causes. Prevention is also very important. BDD can take over a person because they believe they are ugly and abnormal, or do not live up to societal standards of beauty. So, gaining self confidence is the best way to prevent body dysmorphia.
Although a large percentage of people don’t suffer from BDD, feeling body dysmorphia in general is very common in our society. Especially living in a time where social media dominates much of our daily lives, seeing beauty standards that seem impossible to achieve has the ability to make you feel really negative about yourself. It isn’t something to be ashamed of, but it is something you should definitely reach out to someone about.
[With] social media dominat[ing] much of our daily lives, seeing beauty standards that seem impossible to achieve [can] make you feel really negative about yourself.
Taarika Youth Ambassador
BDD is incredibly hard to go through on your own. In the long term, BDD can cause co-occurring disorders such as depression and eating disorders. It can also cause negative social impacts such as poor performance in school or work and loss of relationships. If you think you have body dysmorphic disorder, here are a few steps you should take immediately.
First, talk to a close friend or family member, and when comfortable, reach out to a mental health professional. There are treatments that can help, but you can’t do it alone.
You can also work on improving your body dysmorphia without seeking professional help.
Here are some ways:
Practice reduction strategies: as in removing excessive mirrors from your house, limiting social media screen time
Practice daily routines: develop a healthy sleep schedule, and a comfortable exercise routine
Take risks everyday: try to wear something in your closet that takes you out of your comfort zone, or try to show off something you normally hide. If you feel uncomfortable without makeup, maybe facetime a friend bare-faced, and see how you feel.
If you think that a friend or family member has BDD, this is how to help:
First, be sure that they have symptoms of body dysmorphia. An easy one to spot is when hanging out with them. If they constantly talk about a certain body part they hate and it always seems to take over the conversation, they may have BDD.
Work on steering conversations away from their appearance and try not to talk about your own insecurities. This can end up in a more negative conversation and won’t make the person feel like someone relates to them.
Don’t mock your friend or family member, even if you think it’s a joke. They most likely won’t feel the same way and may clam up later when you bring up the same issues.
Encourage them to get help and talk to a therapist or psychotherapist.
For people struggling with BDD, a lot of the negative feelings and obsessions come from someone’s individual mindset about their flaws. As we talked about earlier, BDD deals with obsessing over a flaw, or going the extra mile to make sure that that flaw is fixed. The main goal of the treatment for BDD is to change the way a person sees themself, and put them on a journey to self-love. This is much easier said than done, though. For many people who do struggle with BDD, it often becomes the main focal point, or obsession, in their life. Some ways to not let BDD derail your life are: writing down the parts of your body you feel thankful for, coming up with a plan of action when you begin to put yourself down to distract yourself, or stop yourself, and maybe taking a break from social media – if that’s a potential cause – to stop comparing yourself to other people or unrealistic beauty standards.
Regaining self confidence is hard, even if you don’t have BDD. It’s important to find someone you can talk to, especially because your flaws aren’t flaws at all. Hopefully this article gave you some insight into causes, symptoms, and treatments of Body Dysmorphic Disorder, and ways to achieve self-confidence in spite of it!
Check out our episodes below to learn more about the treatment of BDD from a clinical perspective. If you or a loved one are considering seeking professional help for body dysmorphic disorder, this information might help you make an informed choice regarding what kind of care you/they are seeking.
In this episode, two of Taarika’s Youth Team members interview Dr. Leena A. Khanzode, a child psychiatrist. Dr. Khanzode discusses her role in the treatment of ED’s and how she helps kids get on the path to recovery.
In this episode, two of Taarika’s Youth Team members interview Dr. Kelly Troiano, a pediatrician. Dr. Troiano discusses her role in the treatment of ED’s and how she helps kids get on the path to recovery.
In this episode, Taarika’s Youth Team members interview Nan Shaw, a licensed clinical social worker, and FBT credentialed therapist. Nan has been treating eating disorders for over 30 years and speaks on Family-Based Therapy, a specialized treatment for eating disorders.
In this episode, we wrap up our eating disorder series with an interview with Wendy Sterling — a well-known nutritionist in the Bay Area. She discusses her role on the team to treat ED’s and how she helps the patient.
Taarika Foundation 