September 28 – October 2, 2020 is Weight Stigma Awareness Week (#WSAW2020). We are collaborating with @neda to #EndWeightHate by eliminating stigma and discrimination based on body size. Help #EndWeightHate and spread the message that all bodies are worthy. www.myneda.org/wsaw

Weight stigma is so prevalent in our society, you might not even be aware of it. The definition, according to the National Eating Disorder Association (NEDA) is “discrimination or stereotyping based on a person’s weight.”

It is a significant risk factor in the development of eating disorders, depression, anxiety, and low self-esteem. It happens in all areas of life and may be more prevalent than gender or age discrimination. People who have experienced it indicate that it happens most often with healthcare providers and family members. And it happens in media all the time, so much so that we do not even really notice it! This means, essentially, that we accept it without thinking about it.

My hope would be that if you are reading this, you want to challenge your thinking and your stigma to change how you look at yourself and others.

Being concerned with your appearance is normal, especially when we consider that ‘attractive’ people are afforded several advantages in our society – at work, in school, in a court of law, socially. Attractiveness has many components and changes over time – this is also normal and has been true throughout history and in all cultures (though criteria are very different). The degree of difference between normal concern, vanity, and obsession is where stigma lives and thrives.

We all have implicit bias about any number of things we encounter in our world – bias is really just a different word for preferences, and we all prefer some things over others. Bias is, in and of itself, not a negative thing, though we often use the words ‘bias’ and ‘stigma’ to mean something negative or judgmental. Stigma, though, subjugates groups of people. Janet Tomiyama, a weight-stigma researcher, defines weight stigma is “the social devaluation and denigration of people perceived to carry excess weight, which leads to prejudice, negative stereotyping, and discrimination toward those people” (Tomiyama 2014).

Changing how you think is, always, easier said than done. The first step in changing stigma is to become aware of it.  Here are some questions, based on a healthcare journal for providers, that may help you think about your weight bias:

• What assumptions do I make based on weight? These may relate to a person’s character, intelligence, professional success, health status, or lifestyle.
• Am I comfortable working with or even just being around people of all shapes and sizes? Do I think about if they are comfortable in our environment?
• Do I use stigma-free language when talking about weight? Do I use words like fat, heavy, or unhealthy to label people, even in my own thoughts? Do I use “weight-centric” or inclusive language?
• Am I more negative when talking about weight than I would be with other bias issues – gender, race, sexual orientation? Why?
• Do I say things about higher weight people that I would not want them to hear?
• Do I make negative comments about my own weight that I would not want others to hear?

Weight stigma can also be seen as a misguided attempt to shame people into being healthy – and decades of research show us it does not work. We equate thinness with health – and that simply does not track. The real risk factor is the stigma itself. The myriad of ways we treat overweight and obese people differently all contribute to stress, distrust, and exclusion. Just  few examples:

• Overweight kids are more likely to be bullied.
• Healthcare providers are more likely to blame weight for various issues – even COVID! They are also the most frequent perpetrators of weight stigma.
• It is more acceptable to stare at or ignore someone who is overweight than it is to do so based on other types of discrimination.
• Here are some more examples...

The things I want you to know, something we do not often remember, is that higher weight people are aware of the stigma. Many share it themselves. In over 20 years of working with clients with eating disorders, I have never, ever, met someone who is overweight who was not acutely aware of their weight and the opinions of others regarding their weight. There is no need, ever, to inform someone that they are overweight. They know.

More articles coming soon about weight bias and next steps to combat weight stigma and promote acceptance and compassion!

If you want to find out your own level of stigma about weight, take the Harvard Implicit Attitudes Test and see what your unconscious biases may be (if you are interested, there are several other IATs on there that measure a range of implicit biases we all hold). Interestingly, people who are overweight (and people who have a history of being overweight) have higher bias towards thinness than thin people usually hold!

Articles about weight stigma and body image:

Weight Stigma (NEDA)

Weight Stigma (Christy Harrison, MPH, RD, CDN)

Tips for Reducing Weight Bias in Students

Weight Bias and Discrimination

Fat Talk (Lauren Francis, LPA at Chrysalis Center)

Body Neutrality

Body Image Research

Negative Body Image

Battling Negative Body Image

No one could have prepared for the impact coronavirus would have on our lives, our work, our families, or our mental health. In the last few weeks, there are three areas that have come up the most in my clinical practice: how to manage staying at home, how to be mindful in a crisis, and how to help people with eating disorders manage most effectively.

Mindfulness is not difficult, but it does require practice. It can help quiet the fear and help us become more aware, in the moment, of our thoughts and behaviors. Think about how often you touch your face. Think about the sensations that go with washing your hands. Think about what to do instead of shaking hands – perhaps this will encourage us to make eye contact and to think about our intentions more when interacting with other people. We can become aware of how connected we all really are when we think about our intentions and interactions. When you are afraid of something like getting sick from the coronavirus, really think about the thoughts, feelings, and sensations that make up that feeling and allow them, without judging. Keep moving through them, listen to them, and perhaps dissecting your fear will diminish its power. The behaviors of fear can also reinforce it – think about decisions you make regarding where you go or who you spend time with, what you buy at the grocery store, how much news you are watching and what other things you are doing with the extra time you have at this moment. If you are mindful of these thoughts, feelings, and decisions then you allow your values and needs (as opposed to wants and shoulds) to guide you.

How to manage stay-at-home

There are a lot of things that can make a positive difference, the first being awareness.

Most of us never think about what is healthiest for us; we go about our days and change things as something comes up. Right now, we are still in a pretty reactive phase when it comes to COVID-19 and its various impacts; however, being away from our normal routines affords us a great opportunity to increase our awareness in a way that everyday life would not. Maybe we can learn to be proactive instead of reactive when it comes to managing our own stress.

What do you need? Do you need a dedicated workspace, a structured schedule, regular social interaction, daily naps, or something totally different to make staying and working from home bearable? A lot of us are in limbo, and likely will be for a while. It is important to figure out what makes you feel positive and productive. There is a lot of information published about how to make working from home a bit easier, but some of the things that seem to be universal are:

• Stick to your routine as closely as you can (get up at the same time, work at the same time, etc.) and simulate your work environment as closely as possible if you are working from home
• Put on pants (real ones, not PJ’s), brush your teeth and your hair, take a shower, etc. every day
• Get outside every day (weather permitting)

How to be mindful in a crisis

While it might seem stressful to add mindfulness to your list, it can help us manage the stress of this very unusual situation. After all, this is a time no one every expected to have.

Here are some ways to use mindfulness to cope with stress in general as well as some ways that we can all increase our mindful awareness.

1. Practice gratitude and acceptance – If there is only one part of this list that you implement, let it be this. Practicing gratitude through journaling, affirmations, meditation or prayer has been proven over and over to increase general life satisfaction, improve medical outcomes, and elevate happiness scores. Just thinking about gratitude is enough to get the positive effects – even better if you are able to do it every day. Also, saying thanks to others helps you share that gift with the people you care about. Acceptance operates in much the same way, but it allows you to get un-stuck from the worries, demands, or people that might get you down. If you are able to identify those situations beyond your control that are getting you stuck, sometimes all it takes is acknowledgement to accept the situation and move through it. We cannot control what happened with coronavirus, but we can acknowledge a need to accept the situation as it is, not as we wish it would be.  The same way you write, speak, or think gratitude works for acceptance. If you are having trouble with acceptance, consider backing off of watching or reading the news as often – things change every day with this situation, and the news is not necessarily helpful in managing our anxiety, especially when there are conflicting or changing messages.
2. Be aware of your own needs – it is important to be open to and make space for your own needs, thoughts, and feelings. We all have different associations with staying at home – family, past experiences, loss – and need space to process them in our own ways. Do not forget to take care of yourself and be good to yourself. If you need your own space, alone time, social time, quiet time, now is the time to figure that out. Everyone also has different energy levels and preferences when it comes to productivity or creativity. Some people want to tackle projects they haven’t had time for, and some people want to learn to meditate or take up a new skill. All are reasonable – but try not to impose your preferences on others in your household.
3. Allow yourself some peace – letting go of judgement, enjoying experiences and not focusing on the outcomes, doing less, unplugging, and spending some time alone are just some of the ways we can attain some peacefulness and space in our lives. Everyone on the planet needs that in their lives. But we need to remember that everyone has different levels of need for connection and it is important to give yourself and others in your household room to do that in their own ways.
4. Play – having fun is sometimes lost in the midst of all this worry. Adults need playtime too! Think about something you liked as a child and do it with your own kids, your dog, or your partner. What makes you smile? Make it happen!
5. Practice compassion – compassion and lovingkindness are two important concepts to apply to yourself as well as others. When we keep compassion in the forefront of our minds, it allows us to take care of ourselves, and be more attentive and more relaxed. Usually, that also makes us kinder and more open to others, keeping our spirits uplifted. Hope is hugely important in a crisis, and compassion is the quickest road to hope.

How to help yourself or a loved one manage eating disorder recovery during this crisis

For those whose loved ones are suffering with an eating disorder, here are some other ways to manage food stress:

1. Don’t be the “food police” – for adults, it is not anyone else’s responsibility to manage their food choices, it is something each individual has to decide. If you have an eating disorder, try to stick with the plan that you and your therapist and dietitian have worked out. If you are supporting someone, talk about what would be helpful to them ahead of time and follow through.
2. Pick your moments – walking on eggshells or avoiding difficult topics might let your family dinner be more peaceful, but some issues do need to be addressed. If you are concerned about someone’s eating behavior, or even just their stress level, it is important to talk about it (but probably not at the dinner table or in front of your friend on a virtual group chat who gossips about everyone all the time). If you do confront them or attempt to have a conversation, make sure you are being honest and saying what you mean to say. It might even be helpful to have a plan, especially if you have tried to talk about it before and it hasn’t gone well.
3. Let go of judgment (and practice compassion) – mindfulness is all about not judging. There are lots of stereotypes that stigmatize eating disorders – do not assume you know what their experience is like (or vice versa). Family can sometimes trigger judgment and criticism – try to notice when you are judging yourself or internalizing messages from others. Next, take a step back and try to observe the feelings without judging them and you might be able to give yourself some much needed space for kindness, empathy, and compassion.
4. Use “I” statements – eating disorder or not, it is never a good idea to assume you know where the other person is coming from. “I” statements – “I feel (an emotion)   when you        do this behavior or say this specific thing)             .” help solve this problem. By expressing your own feelings, you increase your ability to connect and reduce defensiveness. Stick to pointing out what you have observed and keep your non-verbal communication calm and open.
5. Here are some things that are never appropriate – “Just eat!” and “Just stop!” are not useful comments. Never comment on the weight or someone with an eating disorder or tell them they look” healthy” – try not to make any comments about that, especially when food is involved. Commenting on what they are eating, especially during a meal, is not helpful (unless they ask you for feedback directly).

Everyone is struggling with the “new normal” and no one knows what changes the virus will create when all is said and done. Take from this post what works for you. And remember that there are a lot of people who need help right now, and there are a lot of people willing to help others. Teletherapy is an option that was not available for everyone before and could be useful to manage the anxiety, stress, and uncertainty that comes not only from the coronavirus, but also from all the changes that will result from it.

If you are worried about someone and think they may be suicidal, the most important thing is to take any suicidal talk or behavior seriously. It is a cry for help, and we want more people to talk about it when they are feeling that way. We can all help reduce the stigmas surrounding mental health and getting help, and talking through it is the first step.

There are several other warning signs we need to pay attention to:

• hopelessness – they may see nothing to look forward to
• seeking out means of killing themselves
• talking or writing a lot about death or dying
• abrupt mood swings
• extreme personality changes
• big changes in the way someone eats, sleeps, or takes care of themselves
• self-loathing or self-hatred
• making a will, giving away prized possessions, etc.
• saying goodbye
• withdrawing from their social support network
• self-destructive behavior
• a sudden change to being extremely calm and happy after a period of depression

There are several other complicating factors:

• depression
• recent loss or stressful live event
• previous attempts
• family history – of suicide attempts, depression, or trauma
• substance use
• social isolation and loneliness

If you are worried about yourself or someone you love, speak up – anyone who talks about it needs help, the sooner the better, so don’t wait. It can be very difficult, but the best thing to do is ask if you have any concerns at all. You will NOT make someone suicidal or give them ideas by asking about it. The first step is to talk about it.

Remind them they are not alone, that you care about them, and that their life is important to you. Listening and being there, taking them seriously, can help more than you realize. If you are concerned about them, they will hear that in your voice and see it in your manner and that will make a positive impact.

The next step is to respond to the crisis. Do not promise that you will keep it to yourself, try to fix them, blame yourself, judge them, or argue with them. Just be yourself and express your concern. There are resources links on this page that you can access, but it is important to get them help as soon as possible. Help them make a plan for how they will address the crisis they are in and make the changes that they want to make to improve their mental health.

The third step is to offer your help and support – not only in that moment, but for the foreseeable future. When they commit to getting better, they will need your ongoing assistance. You are part of their support, and you are encouraged to follow up with them to see if they went to the therapist appointment you made together, talked to their family, or made other changes. They will need support for the long haul, and you care about them.

This is just a very brief overview. Suicidal feelings can be very complex and take time to work through. It is always a good idea to get more information and education about the issues that plague you and your loved ones.

For more information and links about suicide prevention and what to do:

https://www.who.int/news-room/events/detail/2019/10/10/default-calendar/world-mental-health-day-2019-focus-on-suicide-prevention

https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm

http://www.suicidepreventionlifeline.org/

Hotline: 1-800-273-8255

Kendra Wilson, MSW, LCSW, CEDS-S, DBT-C is a licensed clinical social worker certified as an eating disorder specialist and a DBT specialist. Kendra is the Clinical Director of our Intensive Outpatient Program for eating disorders. 

  The holiday season is a universally stressful time of year – a lot of people get stressed about money, winter is upon us, there is a lot to do that is out of our daily routines. Given all this, it is no wonder it gets to us.

While it might seem stressful to add mindfulness to your list, it can help us manage the stress and get the most out of the season. After all, this is a time to connect and be thankful as well. And for those with eating disorders, the holidays can feel like an enormous roadblock – parties, dinners, family, travel – that just keeps hitting you from Halloween all the way to Valentine’s Day.

Here are some ways to use mindfulness to cope with the season in general as well as some ways that loved ones and those with eating disorders can use it to mitigate the negative impact their eating disorders have on the holidays.

Practice gratitude and acceptance – If there is only one part of this that you implement, let it be this. Practicing gratitude through journaling, affirmations, meditation or prayer has been proven over and over to increase general life satisfaction, improve medical outcomes, and elevate happiness scores. Obviously, we focus on this at Thanksgiving but let’s not end it there! Just thinking about gratitude is enough to get the positive effects – even better if you are able to do it every day. Also, saying your thanks to others helps you share that gift with the people you care about.

Acceptance operates in much the same way, but it allows you to get un-stuck from the worries, demands, or people that might get you down. If you are able to identify those situations beyond your control that are getting you stuck, sometimes all it takes is acknowledgement to accept the situation and move through it. The same way you write, speak, or think gratitude works for acceptance – though you might not want to tell your Great Aunt Ann out loud that you accept her fill in the blank issue.

Be aware of your own needs – it is important to be open to and make space for your own needs, thoughts, and feelings. We all have different associations with the holidays – family, traditions, past experiences, loss – and need space to process them our own ways. Do not forget to take care of yourself and be good to yourself.

Allow yourself some peace – letting go of judgement, enjoying experiences and not focusing on the outcomes, doing less, unplugging, and spending some time alone are just some of the ways we can get some peacefulness and space in our lives. There is no other time of year when we have so much time with our support system and so many reminders of the importance of them. Everyone on the planet needs that in their lives. But we need to remember that everyone has different levels of need for connection and it is important to give yourself and your loved ones room to do that in their own ways.

Play – having fun is sometimes lost in the busyness of the season. What makes you smile? What positive associations do you have with different holiday or winter activities? Adults need playtime too! Think about something you liked as a child and do it with your own kids, your dog, or your partner. Connect. Make it happen!

Practice compassion – compassion and lovingkindness are two important concepts to apply to yourself as well as others. When we keep compassion in the forefront of our minds, it allows us to take care of ourselves, and be more attentive and more relaxed. Usually, that also makes us kinder and more open to others, keeping the holiday spirit alive.

For those whose loved ones are suffering with an eating disorder, here are some other ways to manage food stress associated with the holidays:

Don’t be the “food police” – for adults, it is not anyone else’s responsibility to manage their food choices, it is something each individual has to decide. If you have an eating disorder, try to stick with the plan that you and your therapist and dietician have worked out. If you are supporting someone, talk about what would be helpful to them ahead of time and follow through.

Pick your moments – walking on eggshells or avoiding difficult topics might let your family dinner be more peaceful, but some issues do need to be addressed. If you are concerned about someone’s eating behavior, or even just their stress level, it is important to talk about it. But maybe not at the dinner table or in front of the uncle who gossips about everyone all the time. If you do confront them or attempt to have a conversation, make sure you are being honest and saying what you mean to say. It might even be helpful to have a plan, especially if you have tried to talk about it before and it hasn’t gone well.

Let go of judgment (and practice compassion) – mindfulness is all about not judging. There are lots of stereotypes that stigmatize eating disorders – do not assume you know what their experience is like (or vice versa).

Family can sometimes trigger judgment and criticism – try to notice when you are judging yourself or internalizing messages from others. Next, take a step back and try to observe the feelings without judging them and you might be able to give yourself some much needed space for kindness, empathy, and compassion.

Use “I” statements – eating disorder or not, it is never a good idea to assume you know where the other person is coming from. “I” statements – “I feel (an emotion)   when you       do this behavior or say this specific thing)        .” help solve this problem. By expressing your own feelings, you increase your ability to connect and reduce defensiveness. Stick to pointing out what you have observed and keep your non-verbal communication calm and open.

Here are some things that are never appropriate – “Just eat!” and “Just stop!” are not useful comments. Never comment on the weight or with an eating disorder or tell them they look ”healthy” – try not to make any comments about that, especially when food is involved. Commenting on what they are eating, especially during a meal, is not helpful (unless they ask you for feedback directly).

There are a lot of different methods and theories of couples therapy. One of the best ones for treating couples, is the Gottman method. John Gottman, PhD and his wife Julie Schwartz Gottman, PhD have been studying couples’ behavior in Washington State, teaching clinical and direct workshops for therapists and clients, writing books, and providing couples’ therapy for over 40 years. They are internationally recognized for their contributions to what can be a very tricky area for therapists and clients. If you want to know more about them or the Gottman Institute, please check out https://www.gottman.com/.

The Gottman Method

Since becoming a Gottman Certified Educator in 2015, I have been running workshops and working with couples using their methods (as well as all of my other clinical experience). This method takes you beyond active listening and conflict resolution to focus on friendship, respect, and acceptance that not all problems can be solved – but they can be managed.

This is a very difficult thing for a lot of people to process – that problems need to be managed and compromised on, that they cannot always be solved. And it is just one of the seven principles of a “Sound Relationship House” that form the core of their treatment philosophy.

Why Couples Come to Therapy

Couples come to therapy for a myriad of reasons. It is a difficult and stressful thing to do – to recognize that your relationship needs work and that you cannot solve all of the problems in your relationship between the two of you.

Some couples come because they don’t really interact with each other anymore – maybe they are empty nesters, maybe they have had family crisis(es) that leave them having to put out fires all the time instead of nurturing their relationship. Whatever the case, a lot of couples who come into my office do not know each other very well anymore – sometimes after only a few years of marriage! It takes energy to keep up with people – in our busy lives, we all know how difficult it is to keep in touch with friends and relatives – but you also need to keep up with your spouse, your partner, the person who you (hopefully) have some downtime with.

“Love maps” are the Gottman method’s way of getting to know each other again – drawing a map of what makes your significant other tick and keeping up with it as it changes. I also like Table Topics to generate discussions in couples or families.

Couples also come to therapy when there has been infidelity. There are a lot of potential reasons for this, but infidelity (emotional or physical) is the opposite of “Turning Towards” your relationship. When one partner is unfaithful, they have turned away from their partner and towards someone else. A “sound relationship” is one where each party can rely on and trust the other. That means that if one person is struggling with something, they turn to the other for support, guidance, opinions, or a port in their storm.

If you love, respect, and admire someone and you have a disagreement, you try to see their side and validate their point of view even when you don’t agree. You do not give in (which will just cause resentment), you do not turn away, and you do not blame the other person. Forgiveness is an aspect of “fondness and admiration” as well as “turning towards” and the “positive perspective.” You do not always have to forgive, but if you want to stay in a relationship after infidelity, you both have to forgive each other for whatever transgressions have brought you to that point.

Another reason couples come to therapy is that they argue all the time – I call it “kitchen sink” arguing when you start arguing about one thing (usually something minor in the scheme of things) and end up throwing all your other resentments, hurts, problems, and unhappiness into the argument. There is no way to win that kind of argument. You know that you are there when you do one of the “Four Horseman” of relationships. These are criticism, defensiveness, contempt, and stonewalling (see left). Whenever you get to the point of complaining about unrelated things, arguing about semantics, name calling or just not talking at all, you have done one of these.

There are a lot of other behaviors that you do with each of these, but it is important that every time you do one, you have to do at least five positive things to counter the damage to the relationship. With contempt, it is 20 to 1! Relationships cannot survive constant arguments like this. There are a lot of things – Gottman calls them “repair attempts” – that you can do to try to fix it, but it is MUCH easier not to do these in the first place. No one wins in these situations.

The average couple comes to counseling six years after the problem begins in their relationship – that is a lot of negativity to counter. There is no quick fix or shortcut to building a healthy relationship. Everyone argues, everyone disagrees, and everyone has to figure out the best way to manage their relationship. It is a puzzle that requires both partners be interested in change. It requires that both people be willing to learn and grow to make a relationship healthy. There is no shortcut to learning to listen, argue well, compromise, and value each other.  But sometimes, there is help along the way.

Kendra Wilson, LCSW, CEDS

Kendra is a Gottman Certified Educator and teaches Couples Enrichment Seminars at Chrysalis Center periodically. If you are interested in attending a seminar, please email Chrysalis and we will let you know when the next set of seminars will be scheduled.