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chrysalis
24/Oct/2022

October is Breast Cancer Awareness Month, and today I had the opportunity to interview one of Chrysalis’ own, Sarah Snyder, who has been cancer free for eleven years this year! A special thanks to her for being open to sharing her story of survival, inspiration, and courage. 

When were you diagnosed?

“I received the diagnosis on Tuesday, February 21, 2012, at 31 years old, with a 10-month-old and a five-year-old.

I sat alone in Dr. Charles Scott’s office at Wilmington Health. I was there because the week prior he performed a breast biopsy, and it was time for the results. He first came in and checked my biopsy incision, said that “everything looked good”, and promptly excused himself so I could get dressed and we could go over the pathology. It may not have been a red flag for others, but because I had worked in healthcare my entire career, I knew that if I were really fine he would have said just that when he checked the biopsy site- there would have been no reason for a second chat.

I knew the next time he walked into my room, I was going to hear a word that no one is ever prepared for, and even though I had hoped that I was wrong, the pit in my stomach was telling me to prepare myself because my life was about to be forever changed.”

How did you handle the diagnosis?

“When Dr. Scott came back into my room, he was carrying a piece of paper and his nurse Angela was with him. He looked me in the eyes and asked, “Ready?”, I remember slowly nodding my head “yes”, even though I was not ready. “Ductal Carcinoma Institute” was his statement to me, but behind those big words was the real diagnosis… breast cancer.

I do not remember everything that Dr. Scott said to me while I sat on his examination table because, for some reason, I was intent on not breaking down in tears. I remember not wanting to look weak in front of him, so I kept telling myself to “hold it together ” and “don’t you dare cry”. My mind was busily trying to accept my diagnosis and everything about to follow. I remember thinking about how I was only 31 years old, had a full-time job, was a full-time college student, and was just three courses away from completing my MBA. Most importantly, I had two small children at home, and couldn’t help but wonder who was going to help my husband raise them if I died? My mind went back and reviewed the previous six-month journey that brought me to this very spot and how I had hoped to get here, just not with the same ending.”

What do you mean, “hoped you’d get there”?

“In September of 2011, I was sitting on my couch when suddenly, I had this weird sensation run from the middle of my left breast to under my armpit. It was not a painful feeling, just a very odd one. At that moment, I had a powerful thought, “you have cancer”. At first, I thought, “what a crazy thought”, but at the same time, I had a pit in my stomach because breast cancer has affected every generation of women in my family. It has always been a worry hidden in the back of my mind that I, too, would pull the unfortunate short straw and be diagnosed with this disease. To ease my mind, I scheduled an appointment the next week with my GYN. When I explained the sensation I had as well as my family history of breast cancer, I was certain that my request for a simple mammogram would be instantly approved. I expected him to appreciate my being proactive and would order the test, even if just to ease my mind. He instead patted me on my knee and told me that I was being overly paranoid and that a mammogram was unnecessary because I was too young to have breast cancer and no insurance would cover it. I left that office feeling shocked and unheard, but I was not yet defeated. The following day I scheduled an appointment with my PCP to get a second opinion, believing that even though I did not feel heard the first time around, I hoped this doctor would hear me out and take my concerns seriously. Two weeks later, I told my doctor the same thing I told my GYN, the sensation I had, my family history, and my request for a mammogram. I was unfortunately told very similar statements as before, “too young”, “your family history is not that bad”, and “no mammogram is needed”. 

I wish I could tell you that the third time was the charm, but unfortunately it was not. Neither was the fourth. I spent the next six months “doctor shopping” for a mammogram. I even went as far as calling a local radiology office to ask if I could pay cash for a mammogram, but their answer was no because special testing requires a referral from a medical provider. I honestly could not believe that it was this challenging to get a mammogram! I think this is the point where I started to lose hope and began to feel defeated. Defeated as a patient and defeated as a woman, but I knew that I had to keep going and make someone hear me.

A couple of weeks later I was at work in my office when one of my medical assistants came in and asked if I was still looking for a new doctor. I told her I was, and she told me how amazing her PCP was and urged me to call her. I took down the information, but I was reluctant to call and go in because I wasn’t sure if I could handle being dismissed by yet another physician. I gathered my hope and made the call to Dr. Catherine Daum’s office at Wilmington Health later that day and scheduled an appointment with her later that same week. Walking into Wilmington Health for the first time was a little overwhelming but as soon as I met Dr. Daum, I knew I was in the right place and that this was going to be a different experience from my other appointments. Dr. Daum listened to all my concerns and without any hesitation ordered a mammogram. I cried tears of joy in her office because someone finally listened and was willing to help me. One week later, I went in and received the mammogram that I hoped for, and after I few days I was back in Dr. Daum’s office being told a mass had been found and that she was referring me to Dr. Charles Scott, a surgeon with Wilmington Health who specialized in breast health/cancer. I met with Dr. Scott for the first time a few days later and he, too, listened to everything I had to say. He asked me if I wanted to revisit the mass in six months or have him perform a surgical biopsy; I choose the biopsy and the rest is history.”

What did your cancer treatment look like?

“I opted for a bilateral mastectomy, which was performed three days after I met with Dr. Scott on February 25, 2012. I was officially cancer free. A couple of months later in May, I had my reconstruction surgery by Dr. Kenneth White at Wilmington Plastic Surgery.”

What was your biggest self-discovery or revelation after your diagnosis?

“That’s a hard one, I have had a few revelations.

“1. You must be your own advocate. If you feel that something is not right with your body, do not let anyone (healthcare professional or not) dismiss you. Get the answers you need.

2. Attitude is everything. When I was diagnosed with breast cancer, I knew that there were only two options for me to take: the low road or the high road. I refused to fall into a pit of depression and let this diagnosis win. I can’t say that I was not scared because I was, and while there were some bumps in my road to recovery, I knew my faith and hope were stronger than any fear. By no means do I mean to not take the time to break down and feel all of your emotions (I would have my breakdowns in the shower), just don’t live there.

3. Take your time and let your body and mind heal. Do not rush back to anything, work, school, or responsibilities. Too many times the mentality is to “just get back to your normal and everything will be better”. But what the message should be is, “take the time YOU need, and do not compare your journey with anyone else’s”. 

4. Ask for help when you need it. Asking for help does not make you weak.”

What was the most difficult part of your journey and how did you overcome it?

 “Survivors guilt…

Almost immediately after my cancer diagnosis and my initial surgeries were complete, I started speaking and volunteering at as many breast cancer events as possible. Although I had always participated in these charities, I felt a new pressure to pay it forward. I thought I owed it to all of the others battling cancer since I had it so much easier. I also began to experience insomnia and anxiety symptoms and found myself obsessively reliving the day I was diagnosed. I would think about that day step-by-step every single day. I thought about it while I was driving to work, even while I was on vacation with my family. Despite the persistence of the thoughts and memories, I never addressed these issues or thoughts with any of my doctors. I assumed it was normal. I told myself that since my cancer was caught early and I survived, I should just deal with these issues. After all, I did not have it nearly as bad as other individuals diagnosed with later stages of cancer, so I did not have the right to complain. I should just be grateful.

Two years after my diagnosis I received a phone call that one of my closest friends and biggest support systems during my cancer battle had been diagnosed with terminal ovarian cancer. I remember immediately breaking down, not being able to catch my breath, and saying, “She is too good, it should be me.” After she passed, the thought of “it should have been me” turned into “why wasn’t it me” and later that thought was not just directed at my friend’s battle, but at anyone that did not survive their cancer battle.

I began feeling compelled to follow stories on social media about families documenting their terminal cancer journeys. I felt like it was my responsibility to show these families support during what was the worst time in their lives. But what I did not realize was that I was punishing myself for not suffering enough and ultimately for surviving. 

One day my friend asked me why I was constantly following “those sad stories”, and I told her, “I needed to experience the pain, difficulties, and loss other cancer patients not as lucky as me go through to be worthy enough to be a “real survivor”. I will NEVER forget the look on her face after my response, in that moment I knew I needed to get this figured out. I began seeing a therapist to help figure out why I was no longer myself and had these crazy thoughts and feelings. What I learned was that I was, in fact, not crazy and that all the emotions and symptoms I had been experiencing were Cancer-related survivor guilt.

Cancer-related survivor guilt is a complex, multi-faceted emotion that has not always been recognized and talked about. Luckily, the stigma surrounding survivor’s guilt is lifting. More mental health professionals are starting to speak on this topic, as well as oncology professionals learning to recognize it so if their patients are suffering, they can offer them resources and support.” 

What advice would you give on how to best support a loved one going through breast cancer? 

 “1. Just be there. Love them. Check-in. Cheer them on. Have a positive attitude. Make them laugh. Going through cancer is hard enough. But if you have someone, or even a community of people, around you to help you through the fight it makes all the difference.

2. Spend time with them to offer a distraction, and try to attend doctors’ appointments with them.

3. Offer, but don’t force. Be flexible. Every day can be different when a loved one is going through treatment. Educate yourself and try to find yourself an outlet as well. ❤️❤️❤️


chrysalis
11/Oct/2022

October 9th marked the five-year anniversary of Chrysalis’ Intensive Outpatient Program (IOP). We proudly remain Joint Commission accredited and licensed by North Carolina’s Department of Health and Human Services. Since we launched, we have had approximately 155 admissions with an average length stay of 8 weeks. We had to pivot to virtual the first few months of the pandemic, but reinstated in-person programming in October 2020. We have revamped our programming many times over the years to be more client-centered and offer a wide variety of groups (with some new one’s coming soon!). This summer, we began an additional morning track so that we could accommodate clients’ varying schedules for school and work. We are proud of the work we have done, the clients we have served, and being able to offer this level of care in our community and beyond (the next closest IOP is over 130 miles away). Many thanks to our exceptional IOP team members who are committed to providing compassionate evidence-based care. Many thanks to our referral sources who trust us with your clients. And many thanks to the clients who show up multiple times per week to do the hard work of recovery!


chrysalis
23/Sep/2022

TW // Discussions of Drug/Alcohol Use

 

September is Recovery Month. For this year’s blog, I interviewed an anonymous friend of mine who is soon to celebrate 15 years of sobriety! Special thanks to them for sharing their inspiration, hope, and wisdom. 

Tell me a little bit about your recovery journey. How long have you been clean/sober? What was the starting point for your recovery? What were the turning points/pivotal moments in your journey? 

I believe that I am a person who was born with the genetic predisposition to become an addict. From as young as I can remember, anything that made me feel “different” or “better”, even before drugs and alcohol, like food & male attention, I wanted MORE! There was never enough. When I discovered alcohol and drugs it was the same way. I would create boundaries for myself like, “I’ll never snort anything” or “I’ll never do drugs that make me hallucinate”, but I eventually breached all those boundaries and then some. Over the years, I would use and abuse any substance I could get my hands on but alcohol and cocaine were my favorite. I experienced a lot of awful consequences, some of them legal and social, but most of them emotional and detrimental to my self-worth and self-esteem. My husband went to treatment first. He started trying to get clean in 2005.
I decided I should try too even though I wasn’t “as bad as him.” (Honestly I just thought his drug use was the problem in our relationship). Fast forward two years after he goes to treatment and I am still a sloppy, falling-down drunk who can’t stay sober on her own. I finally surrendered in October of 2007. My sobriety date (and I am 100% abstinence-based sober; no weed, no delta8, no kratom, no nothing) is 10/13/2007. I got into a 12-step program and got a sponsor and was working the steps as best I could, but I was still very sick. About two years into my sobriety I got very into my eating disorder and was underweight with some other health issues due to my ED. I found myself in therapy and soon after changed sponsors and started to work on the steps again but more in-depth. During that process, both through therapy and steps, I started to change and find some peace. I also began medication for my anxiety at around 3 years sober, which has also been an amazing help. Doing a thorough 4th and 5th step, really digging into my resentments and why I behaved and chose the things I did, really changed my life and allowed me to see how I
worked in these patterns. They were always the same, just different characters, and they never worked. I was always unhappy with who I was and how I felt in my skin, and what was going on inside my head was complete self-hatred and chaos.
Working all 12 steps and continuing to do that today, along with the aforementioned therapy and medication, and a strong spiritual practice that my 12-step program helped me develop helps keep me in a place where, at most times, I feel an immense amount of peace, and even if I am unsettled or upset the peace is deep inside of me, I know it’s there and that maybe I am going through it for some time, but as long as I’ve continued this path, the peace has been there, even in the midst of the storms of life.

What do you do to maintain your recovery? What’s most helpful? 

As mentioned above, 12 step meetings (in several Fellowships), I have a sponsor, I sponsor others, and I pray, meditate and read spiritual readings almost every day. I continue to work on steps 10, 11, and 12, which we call the “maintenance steps”. I practice yoga in a way that helps me feel centered, strong, connected, and at peace with my body. I continue therapy and medication. I am transparent about my feelings and I am surrounded by a network of supportive friends and a husband who’s also clean and sober and we support each other’s health.  

Do you ever have any urges to drink or use? If so, how do you handle them? 

I still have a lot of dreams, but rarely ever the urge. Recently I did have a brief urge, it was the 1st one in I don’t know how many years. We had to put our sweet dog to sleep less than a week ago. It was just his time as he was old and very unwell, but it was still incredibly hard. I was in so much pain over his loss and the void he left in our little family. I cried for days leading up to it and days after. On the day we said goodbye my chest was so tight when we returned home and he wasn’t there, I didn’t want to be there, I didn’t want to be in pain and the idea popped into my head “damn I could have a drink and numb this pain”. I know that’s a lie and my disease is just looking for a way to sneak in when I’m vulnerable. I talked to my husband, my sponsor, and other people in my network. I went to a meeting and shared. I prayed about it and found gratitude that I didn’t follow that urge and that it was only a fleeting thought. I emailed my therapist the next day too. I know that I am only as sick as my secrets so I don’t keep any, especially about my alcoholic mind.  

 What advice would you give to a newcomer in recovery? 

Don’t give up. If you drink again, come back to recovery anyway. Never stop stopping. You are worthy, your life can be peaceful and content. It takes time and it takes effort but the time and effort to get sober/clean is much better than the time you may stay drinking and using. It may suck in the beginning, but everyone you may meet has been where you are- so share your stuff, find a trusted group of folks in recovery that love and support your path, and get in the middle of recovery. Leave old people, places, and things alone for a while. One day you may be able to re-engage with some of your old activities as a sober person but for the first bit, let that stuff go and get on solid ground. Don’t give up on yourself. You’re not as bad as you tell yourself that you are. You are a sick person who made some bad choices, but you are not the sum of your mistakes. Those things are what you did, not who you are.

 What advice would you give to someone who has relapsed in their recovery? 

Relapse happens. It sucks, but it’s true. Addiction is a disease, so I try to think about it like this: if someone had cancer that was in remission, would we get mad at them if the cancer came back? Hell no! It’s a disease. Sometimes it takes more than one approach to treat it. Here’s another disease analogy: if you know you’re diabetic but don’t change your diet or take insulin, you will stay sick and probably die. The same is true for addiction; just knowing you have the disease does nothing for you. Self-knowledge will not heal you. Here’s the good news, recovery can and will heal you. Find a recovery path that works for you and follow it. Heal the parts of yourself that cause you to need substances to escape. Treat your disease like your life depends on it.  

Any quotes or mantras you use to help you through hard times? 

“Leap and the net will appear” – this is a quote I use about fear! Just do the darn thing. 

“Quite as important was the discovery that spiritual principles would solve all our problems” – this is a line from the Big Book and I have found this to be 100% true in my life. I got sober because I wanted to stop drinking and hurting, but what I got back was a blueprint for life, and a way of living that is unbelievable.  

“Never quit quitting.”  

 

Kelly Broadwater, LPA, LCMHC, CEDS-S specializes in working with eating disorders and co-occurring substance use disorders. She has been honored to be a part of many clients’ addiction recovery journeys.


chrysalis
22/Sep/2022

Whether you’ve been waiting for sweater weather, all the pumpkin spiced items, or for the leaves to change, you can also look forward to a different set of seasonal produce! Here are some fun ways to get more variety in your kitchen with these seasonal activities at home and within the Wilmington community.

 

Looking to start a garden? Now is the time to start, before the frost hits around mid-November. Here are some plants you could directly sow the seeds of into your outdoor garden this season!

  • FARMER’S MARKET FINDS:
    • Apples
    • Broccoli
    • Cucumbers
    • Leafy greens
    • Pumpkins (September-October)
    • Sweet potatoes
    • Tomatoes

References:
Planting calendar for Wilmington, NC. Almanac.com. (n.d.). Retrieved September 22, 2022, 
from https://www.almanac.com/gardening/planting-calendar/zipcode/28403 
When to plant vegetables in Wilmington, NC. Garden.org. (n.d.). Retrieved September 22, 2022, 
from https://garden.org/apps/calendar/?q=Wilmington%2C%2BNC&print_friendly=1  


chrysalis
08/Sep/2022

 

I recently had the opportunity to sit and talk with one of our newest hires, Jamee Pollard. Jamee is a Licensed Clinical Social Work Associate who is kind and vibrant. She specializes in helping adults suffering from trauma, anxiety, OCD, and depression.

What made you decide to go into Social Work?
I’ve always been interested in listening to the stories that make us human. The story of someone’s happiness, heartbreak, pain, embarrassment and perseverance. I realized that people often believe their story makes them undeserving of feeling seen, heard or valued… but I respectfully disagreed. And that’s why I’m here.

Please tell us about your experience prior to coming to Chrysalis?
I worked with individuals and groups in intensive outpatient and partial hospitalization settings. I specialized in treating suicidal thoughts, complex trauma, borderline personality disorder, and schizophrenia. I received a lot of training in dialectical behavior therapy, and its non-judgmental, acceptance-based philosophy really resonated with me.

What would you like your clients to know prior to their first session with you? 
They can expect a trauma-informed approach, where the therapeutic relationship is built through safety, collaboration, and transparency. I hold the belief that we all have the ability to change our lives if we feel empowered and supported.

What did you think you were going to be when you grew up and how does it compare to your current career at Chrysalis? 
I wanted to be a lawyer! It’s pretty different from what I’m doing now. However, in both positions your job is to help people navigate tough situations. there is also a social justice piece that is an important feature in both fields.

Would you rather live in a treehouse or houseboat and why? 
Houseboat! Because I could travel up and down the coast without having to pay for hotels.


chrysalis
17/Aug/2022

Back to school season is upon us, and that means the return of early mornings, fall sports, and packed lunches. Packing kids’ lunches is a great, hands-on way for parents/caregivers to make sure your kiddos are being sent with a variety of foods, foods that they like, and enough food to keep them going through long days of school.

While there is nothing wrong with a traditional PBJ in a brown paper bag, this blog post is going to dive into some innovative ways to make kids’ lunches nutritionally dense and provide them with a fun lunchtime experience.

 

First, we will tackle the lunch box. It goes without saying that any lunchbox will be perfectly adequate, but there are lunch boxes out there that are helpful for providing some structure and encouraging variety. “Bento box” style lunch pails have a lot of little

compartments, all of which can be filled with a different snack or main course. They’re somewhat similar to lunchables, in that every compartment can hold something different. There are also bento box style containers that can snap together and fit into a pre-existing lunch pail.

Options for bento box lunch pails:
Bentgo 5 compartment lunch pail (recommended portions for kids 3-7)
Bentgo 4 compartment lunch pail (with attachable ice pack)
Bentology Lunch Bag and Box set (Insulated bag and containers included)

There are tons of fun color and print options available that can help add some extra excitement to lunchtime.

Now, lets move on to what to put in packed lunches to make them satisfying and tasty. Lots of simple meals can be based on the formula: grain, protein, fat, vegetable/fruit. Grains are a source of carbohydrate, which is our brains main source of energy. Protein and fats help us feel full at the end of a meal and help “hold us over” until it’s time to eat again. Fruits and vegetables provide us some extra micronutrients, like vitamins and minerals. To make this easy, examples will be included in this post, AND we’re providing a cheat sheet to help if you’re stuck and can’t decide what to pack.

 

Meal 1: Turkey, lettuce, and cheese pinwheels with carrots and ranch

Grain: Tortilla

Protein: Turkey

Fat: Cheese, ranch

Veg: Lettuce, carrots Recipe for pinwheels linked HERE

 

Meal 2: Chickpea, mozzarella, and cucumber salad with crackers and hummus

Grain: Crackers

Protein: Chickpea, hummus

Fat: Cheese, Italian dressing (for salad, optional)

Veg: cucumber

Recipe for salad: equal parts diced cucumber and drained chickpeas, one chopped up cheese stick, 1 tbsp Italian dressing (optional)

 

Meal 3: Peanut butter and Jelly on whole wheat bread with yogurt and berries

Grain: Bread

Protein: Yogurt

Fat: Peanut butter

Fruit: Berries

 

Another essential element of packed lunches is snacks! By covering each food group in the main meal, snacks can be a little less rigid in terms of the nutrients they contain. A good rule of thumb is to plan snacks to include at least 2 food groups. This will make

them more filling.

Snack 1: Cheese-its and grapes (2 food groups)

Carbohydrate: cheese-its

Fruit: grapes

Snack 2: Crackers and cheese (2 food groups)

Carbohydrate: crackers

Protein: cheese

Snack 3: Bell peppers and cream cheese (2 food groups)

Veg: bell peppers

Fat: cream cheese

 

Remember, these are just suggestions on some simple recipes and snacks to pack for your kids. There is no right or wrong answers, and the suggestions in this post can be adapted in any way that works

for you. If you’re worried about sending your kids too much or too little, its worth noting that kids are very cognizant of their hunger and fullness cues and can adjust how much they’re eating accordingly. Don’t worry if some days they’re finishing everything and other days they’re barely touching their meal. Keep open communication with them and ask what they’re liking and not liking. This is one way to make sure they’re getting nutritionally adequate meals that they enjoy!

Happy Back to School season!

School Lunch cheat sheet (pick at least one food from each category)

Protein Fat Grain/Starchy Veg Fruit/Veg
Deli Meat: chicken, turkey,
ham, roast beef;
ground beef; ground turkey;
beef jerky; tuna; sausage;
chicken breast; chicken tenders;
beans; peas; lentils; edamame;
cottage cheese; cheese; eggs;
nut butter (almond, peanut,
sun butter); yogurt
Avocado; butter; chips; cream
cheese; mayo; nut butter; sour
cream; salad dressing; oil;
seeds; nuts
Bread; tortilla; English muffin;
bagel; hot dog bun; hamburger bun;
naan; pita bread; pancake; waffle;
crackers; rice; potato; bread roll;
graham crackers; popcorn;
granola; french-fries; oats;
quinoa; tortillas; vanilla wafers
Apple; banana; orange; peach;
apricot; kiwi; berries; applesauce;
grapes; pear; apricot; plum;
clementinePeppers; carrots; cucumber; peas;
lettuce; spinach; broccoli; tomato;
mushroom; salsa; celery; corn;
avocado

 

*This is by no means comprehensive and is only meant to help generate meal ideas*

 


chrysalis
17/Aug/2022

Body Mass Index (BMI) is a way to group individuals into categories based on their height and weight. It’s a simple formula: Kg/m2. Divide your weight in kilograms over your height in meters squared and you’re left with a number. This number places you into a category that you’ve probably seen and heard before from doctors, peers, teachers, and maybe Wii Fit.

But that begs the question, where did this formula come from and what is it based on? How were the categories developed? How did it come to pass that we use BMI so heavily in our healthcare system? These questions and more are important to discuss so we can all make a decision about where BMI belongs when we have conversations about health, weight, body size, and nutrition – if it belongs in these conversations at all.

BMI chart (source: nhlbi.NIH.gov)

History:

Adolphe Quetelet is the physicist credited with the idea that weight increases with height squared. This measurement was known as the Quetelet Index until 1972 when the name was changed to body mass index (aka BMI). Quetelet dedicated his career to the application of statistics to society, which earned him the title of a pioneer in social sciences1. Quetelet is often credited with describing the “average man” through his use of the Quetelet Index in his research, however, his career took place in Europe during the nineteenth century and centered primarily on white men. Though he was a social scientist, his attempts to describe the average man through BMI has left a significant impact on public health2.

Ancel Keys is the physiologist that picked up BMI where Quetelet left off. Keys is a renowned physicist who is credited with describing the relationship between cholesterol and heart disease, created K-rations for the military, and studied starvation and the impact it has on the body in the Minnesota Starvation Experiment during WWII3. Body mass index was one of the anthropometrics used by Keys in his Seven Countries Study to categorize participants based on body size. This is one of the reasons that BMI became so popular in our modern healthcare system.

BMI Today:

Today, BMI is a part of our daily lives. It’s taught in most basic health and nutrition courses, there are BMI charts in gym bathrooms, some insurance policies use BMI to determine rates, and it’s even in some fitness focused video games. BMI has become one of the quickest ways to categorize body size – and for some, it’s how they determine health status. Most of us know our BMI, and if you’ve ever been on a diet, tracked your macros, or taken any interest into changing what you eat in pursuit of weight loss, you may have found yourself somewhat obsessing over that number.

Even though it’s used everywhere, there are valid criticisms of BMI that call into question how useful the number is. The first and most often recognized issue is that BMI doesn’t take into account muscle mass, fat mass, frame size, and water weight. Muscle tissue weighs more than adipose (fat) tissue, so someone who is active and has more muscle on their body may fall into the “overweight” or “obese” category, even if they are at a healthy weight for their body7. The second issue is that BMI was developed using white European men. Remember, Quetelet developed BMI by doing research in nineteenth-century Europe, meaning the population he used to develop the formula and categories are from just one area of the world and all from one race and gender. Body size and body composition varies between genders, with women having a naturally higher body fat percentage than men, which makes using BMI as a tool to categorize everyone problematic. The third issue is that BMI is often used as a justification for weight-based discrimination. As previously mentioned, BMI can be used to categorize people based on body size, which can be used as a justification for weight based descrimination4. Another example of this is the practice of sending home “BMI report cards” with public school students. These cards are designed to raise parents’ awareness of their child’s health status, but have been criticized for the potential harm they can cause in terms of weight discrimination and bullying between students6.

So, where does BMI belong. That answer depends on who you ask. Health providers have used BMI as a basic assessment of body size, but this doesn’t mean that BMI is inherently a marker of health or that it should be used as such. Health professionals who use BMI should be mindful that, though it does give an idea of a patient’s size, it doesn’t give insight into overall health and is by no means a comprehensive measurement. For someone not in healthcare, BMI doesn’t mean much as a standalone number. Before putting any meaning on BMI, consider your relationship with food, your body, and how you feel. Those pieces of the health “puzzle” will hold more meaning than BMI.

Pros Cons
Provides a quick and simple method of assessing body size. Does not take into account body fat, muscle mass, or water weight.
Provides a standardized way to assess risk for certain health conditions. Used frequently in non-healthcare settings to assess overall health.
Provides standardized measurements across the board. Can easily overestimate risk for some (ex. athletes, people with larger frame size, etc.)

 

References:

1. Eknoyan G. Adolphe Quetelet (1796 1874) the average man and indices of obesity. Nephrology Dialysis Transplantation. 2007;23(1):47-51. doi:10.1093/ndt/gfm517

2. Faerstein E, Winkelstein W. Adolphe Quetelet. Epidemiology. 2012;23(5):762-763. doi:10.1097/ede.0b013e318261c86f

3. Oransky I. Ancel Keys. The Lancet. 2004;364(9452):2174. doi:10.1016/s0140-6736(04)17578-8

4. Rasmussen N. Downsizing obesity: On Ancel Keys, the origins of BMI, and the neglect of excess weight as a health hazard in the United States from the 1950s to 1970s. Journal of the History of the Behavioral Sciences. 2019;55(4):299-318. doi:10.1002/jhbs.21991

5. Roser M, Appel C, Ritchie H. Human Height. Our World in Data. https://ourworldindata.org/human-height. Published October 8, 2013.

6. Thompson HR, Madsen KA. The Report Card on BMI Report Cards. Current Obesity Reports. 2017;6(2):163-167. doi:10.1007/s13679-017-0259-6

7. Body Mass Index Advantages and Disadvantages. LIVESTRONG.COM. https://www.livestrong.com/article/40808-body-mass-index-advantages/.


chrysalis
03/Aug/2022

Both Attention-Deficit hyperactivity Disorder (ADHD) and Eating Disorders (EDs) are increasing in prevalence. There is documented overlap between the two and how the diagnoses interact with one another. Those with both ADHD and Ed will have unique experiences that will impact their interaction, with their disorder and with treatment.

ADHD is a disorder characterized by the presence and persistence of the core symptoms of hyperactivity/impulsivity and/or inattention. Hyperactivity is defined as constant movement in inappropriate situations. It can include things like fidgeting, always talking/frequently interrupting, or talking at an inappropriate volume. Impulsivity refers to hasty decision making without forethought, which can go alongside hyperactivity in social situations. Inattention, on the other hand, manifests as wandering from task to task, difficulty maintaining focus, and disorganization. Inattention is much less “visible” than hyperactivity and impulsivity, meaning that those with inattentive ADHD are easier to miss (American Psychiatric Association, 2013). ADHD is diagnosed in roughly a 2:1 ratio of males to females, but recent research suggests that this may be due in part to different presentations based on gender.

ADHD has a worldwide prevalence of about 5%(Polanczyk et al., 2007). Most of these diagnoses are made in boys below the age of 18. In the college age population, prevalence is estimated between 2-8%. Based on current research, it appears that approximately ~75% of ADHD symptoms from childhood will persist into adulthood (Biederman et al., 2010). These statistics are changing, however, because women are underdiagnosed with ADHD. Women/girls typically present with more inattentive behaviors, vs. men/boys who tend to present as more visibly hyperactive.

The worldwide prevalence of eating disorder is estimated at 8.4% for women and 2.2% for men. The estimated combined percentage of eating disorders has risen from ~3.5% between 2000-2006, to ~8% between 2013-2018. Prevalence of eating disorders in adolescents is estimated between 6-8% (Galmiche et al., 2019).

Recently, there has been an ongoing conversation about the way that ADHD symptoms can impact the development and progression of eating disorders. Symptoms such as inattention, poor impulse control, and poor executive function all support a link between ADHD and the manifestation of eating disorders. These symptoms may manifest as forgetting meals and snacks, poor awareness of hunger and fullness cues, and strong impulses to binge/purge. Other factors may include anxiety and mood disorders, both of which occur at higher rates in both those with ADHD and eating disorders (Levin & Rawana, 2016).

The research around this topic is new and ongoing, but by bringing attention to the possibility of a relationship between eating disorders and ADHD, the hope is that, over time, screening, and early intervention for those at high risk for either diagnosis will improve. If you or a loved one struggles with ADHD, an eating disorder, or both, you are not alone. Clinicians at Chrysalis treat these disorders both individually and when they co-occur.

References:
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596

Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: A systematic literature review. The American Journal of Clinical Nutrition, 109(5), 1402-1413. https://doi.org/10.1093/ajcn/nqy342

Levin, R. L., & Rawana, J. S. (2016). Attention-deficit/hyperactivity disorder and eating disorders across the lifespan: A systematic review of the literature. Clinical Psychology Review, 50, 22-36. http://doi.org/10.1016/j.cpr.2016.09.010

Polanczyk, G., M.D., Silva de Lima, M., M.D., Horta, B. L., M.D., Ph.D., Biederman, J.,M.D., & Rohde, L. A., M.D., Ph.D. (2007). The Worldwide Prevalence of ADHD:A Systematic Review and Metaregression Analysis. American Journal of Psychology, 164(6), 942-948.


chrysalis
28/Jul/2022

I had the pleasure of sitting down recently to talk to one of our newest hires, Riley Burns. Riley is energetic, enthusiastic, and adventurous. Case in point, she recently moved to Wilmington site unseen from upstate New York, looking for a change of scenery.
Riley’s training experiences included exposure to eating disorders at the outpatient, IOP, and PHP levels of care. She did her graduate research on eating disorders and ADHD and will be submitting her findings soon for publication (see below for an informational article she wrote exclusively for our blog on this topic!). She is HAES-aligned and will be seeing clients outpatient, as well as working in our IOP.

What are your areas of clinical interest/populations you enjoy working with?
Eating disorders of all types, including ARFID. Working with clients with co-occurring ED and ADHD and neurodivergent clients with ED. Children, adolescents, and college age clients.

What do you enjoy doing in your free time?
Various crafts, music (she plays the trumpet), rollerskating, hiking, backpacking, and travel (she went to Rome this summer!).

Favorite book you’ve read recently? Red White and Royal Blue and Love Hypothesis.

Any pets?
Not yet! But coming soon hopefully!

 

 

ADHD and Eating Disorders: Addressing the Overlap

Both Attention-Deficit hyperactivity Disorder (ADHD) and Eating Disorders (EDs) are increasing in prevalence. There is documented overlap between the two and how the diagnoses interact with one another. Those with both ADHD and an ED will have unique experiences that will impact their interaction, with their disorder and with treatment.

ADHD is a disorder characterized by the presence and persistence of the core symptoms of hyperactivity/impulsivity and/or inattention. Hyperactivity is defined as constant movement in inappropriate situations. It can include things like fidgeting, always talking/frequently interrupting, or talking at an inappropriate volume. Impulsivity refers to hasty decision making without forethought, which can go alongside hyperactivity in social situations. Inattention, on the other hand, manifests as wandering from task to task, difficulty maintaining focus, and disorganization. Inattention is much less “visible” than hyperactivity and impulsivity, meaning that those with inattentive ADHD are easier to miss (American Psychiatric Association, 2013). ADHD is diagnosed in roughly a 2:1 ratio of males to females, but recent research suggests that this may be due in part to different presentations based on gender.

ADHD has a worldwide prevalence of about 5% (Polanczyk et al., 2007). Most of these diagnoses are made in boys below the age of 18. In the college age population, prevalence is estimated between 2-8%. Based on current research, it appears that approximately ~75% of ADHD symptoms from childhood will persist into adulthood (Biederman et al., 2010). These statistics are changing, however, because women are underdiagnosed with ADHD. Women/girls typically present with more inattentive behaviors, vs. men/boys who tend to present as more visibly hyperactive.

The worldwide prevalence of eating disorder is estimated at 8.4% for women and 2.2% for men. The estimated combined percentage of eating disorders has risen from ~3.5% between 2000-2006, to ~8% between 2013-2018. Prevalence of eating disorders in adolescents is estimated between 6-8% (Galmiche et al., 2019).

Recently, there has been an ongoing conversation about the way that ADHD symptoms can impact the development and progression of eating disorders. Symptoms such as inattention, poor impulse control, and poor executive function all support a link between ADHD and the manifestation of eating disorders. These symptoms may manifest as forgetting meals and snacks, poor awareness of hunger and fullness cues, and strong impulses to binge/purge. Other factors may include anxiety and mood disorders, both of which occur at higher rates in both those with ADHD and eating disorders (Levin & Rawana, 2016).

The research around this topic is new and ongoing, but by bringing attention to the possibility of a relationship between eating disorders and ADHD, the hope is that, over time, screening, and early intervention for those at high risk for either diagnosis will improve. If you or a loved one struggles with ADHD, an eating disorder, or both, you are not alone. Clinicians at Chrysalis treat these disorders both individually and when they co-occur.

 

References:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596

Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: A systematic literature review. The American Journal of Clinical Nutrition, 109(5), 1402-1413. https://doi.org/10.1093/ajcn/nqy342

Levin, R. L., & Rawana, J. S. (2016). Attention-deficit/hyperactivity disorder and eating disorders across the lifespan: A systematic review of the literature. Clinical Psychology Review, 50, 22-36. http://doi.org/10.1016/j.cpr.2016.09.010

Polanczyk, G., M.D., Silva de Lima, M., M.D., Horta, B. L., M.D., Ph.D., Biederman, J., M.D., & Rohde, L. A., M.D., Ph.D. (2007). The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis. American Journal of Psychology, 164(6), 942-948.


chrysalis
28/Jul/2022

You are not necessarily new to Chrysalis. Please tell us about your training and experience prior to joining Chrysalis in a professional capacity.
That’s true! I interned at Chrysalis from January 2021 to May 2022 while I was earning my master’s degree in social work. Before that, I worked as a researcher with people with schizophrenia, as a hospital safety attendant, as a bystander intervention educator, and as a childcare worker.

Is your current job at Chrysalis consistent with your vision when you decided to pursue your MSW? If not, what made you change course?
To be perfectly candid, I had never thought about treating eating disorders before I was placed at Chrysalis. I knew I wanted to be a therapist, but at the time I wanted to work mostly with PTSD. However, by the end of my first few weeks at Chrysalis, I had changed my mind. I found a real passion for working with people with eating disorders; I loved watching my clients come back to life and grow into more self-compassionate, happier versions of themselves as they renourished. I enjoyed how much my clients wanted to get to know themselves and understand why the eating disorder had taken over. This wasn’t quite what I had expected, but I’m so grateful for the twist of fate that brought me to such a fulfilling therapy specialty.
You have had a publication already! Please tell us about your research and writing.
I do! My professor and I wrote a piece on ethics in treating eating disorders among trans and non-binary clients for a small social work magazine. I’ve done a good bit of research on working with this unique client group, and I’m thankful to my gender-diverse clients for what they’ve taught me through practice. Eating disorders can show up and function differently among non-cisgender clients, but their experiences are often not reflected in the cisgender-biased treatment they receive. We’re working to change that at Chrysalis so that all clients can access identity-affirming, supportive therapy.
What would you like your clients to know before their first session with you?
Please know how grateful I am for your vulnerability and willingness to show up. Therapy can be really tough, and I know that I’m asking for a lot of trust when I ask for your thoughts, feelings, and secrets. That trust is really important to me, and I try to honor it by being open and honest with you in return.
Rainy days in the house or sunny days at the beach?
Ooh, tough one. I like both– I love curling up with my dog and a good book– but I’d have to say sunny day at the beach. I dreamed of living close to the ocean as a kid, and I’m so excited that after two years in Wilmington, I’m finally learning how to surf!

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