Health Equity News Volume 2 is live now! November’s issue is all about neopronouns.

Enjoy!

https://chrysaliscenter-nc.com/wp-content/uploads/2023/11/Health-Equity-News.pdf

Health Equity News October 2023

Riley and Megan here! We are so excited to bring you the first volume of Health Equity News! We are going to have monthly installments covering different topics within the LGBTQIA+ community. This first edition is centered on supporting trans youth.  We sincerely hope you enjoy!

According to a 2020 literature review (Eskander et al.): 

• Women with eating disorders are more likely to abuse substances than those with no eating disorders.  

• Approximately 12% to 18% of adults with anorexia nervosa (AN) and 30% to 70% of adults diagnosed with bulimia nervosa (BN) have substance use disorders. 
• One-fourth of individuals with binge eating disorder (BED) reported substance use disorders. 

There are many shared risk factors between substance use disorders and eating disorders. Both are much more common in people with a history of traumatic experiences. They often occur in times of transition or stress. The biological underpinings and genetic profiles are very similar, with both sets of disorders highly correlated with low self-esteem, depression, anxiety, impulsivity, and compulsivity. 

The symptom profile of both substance use and eating disorders overlap as well, involving obsessive preoccupation, craving, compulsive behavior, and rituals. Both substance abuse and eating disorders are steeped in secrecy, shame, and social isolation. They are chronic, potentially fatal diseases with high relapse rates, which means they require intensive, specialized, and long-term therapy.  

While the statistics may seem daunting, the good news is there is hope for recovery! As with any blog for recovery month, I asked a brave and inspirational client to anonymously share their story. “Sandy” (not her real name) is approaching her six year sobriety date and is in full remission from severe binge eating disorder. Here is what she had to say: 

Good old Merriam Webster states a journey is “travel or passage from one place to another”.  

I lived a vicious cycle of bingeing and drinking for comfort when I felt “less than” or someone made me angry. Unfortunately, this happened frequently – people’s actions really got on my nerves sometimes. Why couldn’t they act like they had some sense? Why were people so mean and unthinking? Why didn’t situations seem to go my way? 

 I frequently needed the sense of ease and comfort that came with eating those sugary bites or that first few drinks – I promised myself I could learn to only use my disordered behaviors for comfort when needed – that would be it. The problem was I stayed angry or hurt most of the time because life frequently did not go my way. 

It took therapy and another recovery program to teach me about ego, letting go, and prayer. I had to succumb to the fact that there was something in this universe that was more powerful than I was. My job was to accept what I could not control and treat others with love and respect. That’s it. Acceptance and Love.  

Letting go of what I could not control is a daily; sometimes hourly practice. But it can be done and you don’t have to do “this” alone. Reaching out for help was the most humiliating, frightening, empowering, self-saving, action I have ever taken. I was coached to give myself the gift of honoring my true needs and wants while learning to have real relationships with other humans.   

To those on their journey to recovery, please know that help and support is out there. Chrysalis Center has therapists who are trained in both eating disorders and co-occurring substance use who are here to help. 

Eskander, N., Chakrapani, S., & Ghani, M. R. (2020). The Risk of Substance Use Among Adolescents and Adults With Eating Disorders. Cureus, 12(9), e10309. https://doi.org/10.7759/cureus.10309 

(with throwback photos!)

It’s truly hard to believe that today marks two decades since Chrysalis Center opened its doors. At that time, we were 2 psychologists in a small 3-room office in Oleander Office Park and now we are incredibly grateful to be in a sprawling 4-suite office space in Burnt Mill Business Park employing 12 therapists, 4 dietitians, 1 prescriber, and 4 administrative support team members.  

We are also exceptionally proud of the training programs we offer, having precepted numerous interns over the years in a variety of disciplines from several different universities who are able to provide pro bono counseling in our community. We are also a behavioral health rotation for the family medicine residents in our area, teaching future doctors about eating disorders which are highly complex disorders wrought with potential medical complications. Both Kelly Broadwater and Terri Mozingo are approved supervisors for the International Association of Eating Disorder Professionals (IAEDP) and we have several clinicians on staff who are able to supervise associates for their respective licensing boards. In addition to teaching, supervising, and supporting the next generation of clinicians, our ambitious team shares a love of learning and have (or are currently) pursuing various specialty certifications. Most recently, Jen Myers became a licensed Be Body Positive facilitator, Aiereal Lloyd earned her Perinatal Mental Health certification, and Terri Mozingo is a newly minted certified Intuitive Eating counselor. 

Outreach is another area we proudly focus on, feeling it’s important to give back to the community, as well as share our knowledge base with other professionals in our disciplines. Since our last anniversary, we have assembled a team that participated in the Cape Fear Heart Walk, we were sponsors of the Wilmington Out of the Darkness Walk associated with the American Society for Suicide Prevention, we collected and donated items to the Good Shepherd Center which supports the unhoused in our area, and we held a networking event for perinatal health professionals and will have a resource table at the upcoming Climb out of the Darkness walk which benefits the NC Chapter of Perinatal Support International.  

Our team has also been busy with professional presentations this year. Kelly Broadwater has shared her bariatric expertise with the Carolinas Bariatric Society, the Obesity Action coalition, and in a few weeks will speak at the American Society for Metabolic and Bariatric Surgeons annual meeting. Terri Mozingo and Riley Burns co-presented at the 2023 SEAHEC Pediatric Symposium in March and Alaina Van Gelder led a four-hour training at the 2nd Annual Southeastern Behavioral Health Summit in May.  

Another exciting development in the past year is our Health Equity Initiative, headed up by Riley Burns and Megan Vaughn, focusing on providing affirming care to LGBTQIA+ clients. Understanding that this population has unique needs when it comes to mental health support and eating disorder recovery, we are striving to better meet those needs via staff training and providing more inclusive programming. This year we launched an Embodying Queerness group led by Kaelin Kennedy for LGBTQIA+ clients, focusing on building trust and pride in their bodies. 

Hopefully this synopsis demonstrates just how committed we are as an organization to our values of quality and teamwork! Speaking of quality, we’d be remiss not to acknowledge and honor the memory of one of our founders who passed away in 2022, Dr. Kiersten Nash (Okine) Andersen. Kayj was a counseling psychologist and eating disorder specialist who took both our executive director and clinical director under her wing early in our careers and taught us so much during our time as our supervisor. Her passion for teaching and love of learning was truly foundational to key members of our team and we hope that her legacy lives on as Kelly and Meghan both supervise future clinicians and eating disorder specialists. 

I am humbled to be writing this blog and reflecting on the growth of Chrysalis over the past 20 years and the amazing accomplishments just in the time since our last anniversary. I hope that we continue to embody our mission, vision, and values and “Restore Hope” and “Empower Change” for many years to come. 

Is yoga actually good for treating eating disorders? If so, why? And which style is the best for recovery? As a yoga practitioner myself, these are questions I’ve set out to answer by combing through studies that asked the same questions. Lucky for me, in recent years, yoga has been empirically explored as an intervention for treating eating disorders (ED) such as bulimia nervo

sa (BN), binge eating disorder (BED), and anorexia nervosa (AN) (​Brennan et al., 2020; Diers et al., 2020; Pizzanello, 2021​). The following are highlights from recent research that indicate yoga’s effectiveness in ED treatment.  

 The Mindfulness Movement: A Catalyst for yogic interventions 

In more recent years, mindfulness-based interventions such as meditation have come on the psychotherapy and ED recovery scene. Mindfulness has proven to help with many biological and psychological functioning including emotional regulation and body awareness – two big factors in EDs and ED recovery (​Diers et al., 2020​). Yoga as an intervention for ED comes from the recent implementation of mindfulness techniques in treatment and recovery (​Brennan et al., 2020​).  

Eating disorders are associated with a disruption in emotional regulation, poor body image, and the inability to experience emotions and body sensations, including hunger and fullness cues. The mindful movement aspect of yoga can help people begin to feel body sensations, become more aware of emotions, and tolerate emotional distress as they learn to tolerate the body positions experienced in yoga practice (​Brennan et al., 2020; Diers et al., 2020; Pizzanello, 2021​). The idea that body sensations accompany most if not all emotions (​Pizzanello, 2021​), provides a strong argument that body-based interventions for ED can help patients increase emotional awareness as they mindfully awaken to their bodily sensations through yoga (​Brennan et al., 2020​). Equally important is the fact that body awareness also helps people experience hunger and fullness cues which is an important element of ED recovery (​Pizzanello, 2021​). 

Which style of yoga is best for recovery? 

Yoga practices that emphasize awareness of internal experiences including physical sensations, thoughts, and emotions can be most helpful for ED recovery. One research study used Kripalu yoga, which invites practitioners to accept these internal experiences without judgment (Brennan et al., 2020). Mindfulness and self-compassion were encouraged in each class.  

Finding a studio that is non-competitive is important for ED clients. Starting yoga in recovery could trigger over-exercising or the inclination to engage the “yoga lifestyle” (i.e., strict diet and exercise regime), which can mirror ED behaviors for those with EDs. Thus, having an instructor and yoga community that is non-competitive and encourages participants to listen to and be gentle with their bodies is key for those in recovery. Research shows that practicing yoga in a recovery group with processing afterward is ideal, especially for those newer to recovery (Brennan et al., 2020). For those who choose to do yoga outside of a treatment center or group, it is advised to process the experience with your therapist.  

Bottom-line 

Yes, yoga has been found to be a potentially beneficial intervention for treating EDs. Yoga’s focus on mindfulness of the body and emotions can help those with EDs to begin to feel and appreciate their body. Doing yoga as part of recovery should be processed with a therapist and should be sought in a safe, non-competitive environment. The Chrysalis Center offers gentle yoga for those in recovery for EDs. If you are interested in incorporating yoga into your recovery, speak with your treatment team about the best way to start your yoga practice.  

​​References​ 

​​Brennan, M. A., Whelton, W. J., & Sharpe, D. (2020). Benefits of yoga in the treatment of eating disorders: Results of a randomized controlled trial. Eating Disorders, 28(4), 438–457. https://doi.org/10.1080/10640266.2020.1731921​ 

​​Diers, L., Rydell, S. A., Watts, A., & Neumark-Sztainer, D. (2020). A yoga-based therapy program designed to improve body image among an outpatient eating disordered population: program description and results from a mixed-methods pilot study. Eating Disorders, 28(4), 476–493. https://doi.org/10.1080/10640266.2020.1740912​ 

​​Pizzanello, H. C. (2021). An exploration of yoga’s potential to incite feelings of aliveness and authenticity in women recovering from anorexia nervosa. Smith College Studies in Social Work, 91(4), 324–363. https://doi.org/10.1080/00377317.2021.1976698​ 

By: Riley Burns, RDN, LDN

Chrysalis’ Nutrition Director Terri Mozingo recently completed the rigorous Intuitive Eating Counselor coursework and sat down with us to share what she learned alongside some words of wisdom. 

How long did this certification take you?

One and a half years.  It is an intense certification process that included modules with an accompanying workbook, an exam, an intensive literature review, and group supervision with one of the founders, Evelyn Tribole.

Why was this the next step in your career? What made it feel enticing to you?

A lot of clients come to Chrysalis wanting to learn Intuitive Eating (IE).  Most of the time, clients aren’t ready for Intuitive Eating right from the get-go.  Most of the time, by no fault of their own, clients come in with an extensive background in diet culture, and I wanted to pursue this certification to gain more tools to help me help clients move from diet culture into a more neutral place where they’re ready to learn IE.

What was the most valuable thing you learned in the process?

The tools that we learned.  The certification came with an abundance of information, worksheets, research, and skills that are translatable into tools for clients that really help them to learn the language of intuitive eating.  Oftentimes one of the hardest things for clients to do is to unlearn diet culture and reframe subjective thinking around food. The language of intuitive eating is based in rejecting the diet mentality and embracing food neutrality, which is a big challenge for clients.  The tools I learned during the certification are immensely helpful in helping me help my clients. 

Another valuable component of the certification was reading the wealth of evidence-based research that backs up IE.  I’m a very science-minded person, and I thought it was fascinating to see that there is quantitative and qualitative research showing that intuitive eating promotes favorable health outcomes.  That is really important for dietitians to see because we make our treatment decisions based on evidence-based recommendations. 

Supervision was a significant part of the journey to get this certification.  What do you think the supervision added to the experience? Any takeaways?

Supervision was helpful because of all of the different perspectives that were being highlighted.  There were other dietitians, therapists, yoga instructors, and people who just wanted to learn more about intuitive eating! Everyone had different, but equally valuable insights, and it was really interesting to present cases and hear everyone’s feedback.  There was also such a  wide geographic spread, with some people living as far away as Australia.  It was awesome to see how far IE has reached. 

How does someone know they are ready to learn intuitive eating?

It’s really different for everyone.  It’s important to have the motivation to make changes, but it’s just as important to be ready to let go of diet culture and the desire to lose weight.  Intuitive eating is not a weight loss tool.  Once someone is ready to release expectations, reject black-and-white thinking around food, and learn how to live in the gray area, then intuitive eating can be a topic of conversation.  IE is a lifelong journey – it takes a long time.  Learning IE is one thing, living it is another.  

So IE has 10 principles.  What is your favorite principle? Which principle do you find most people get stuck on?

My favorite principle AND the one most people get stuck on is principle 1: Reject the Diet Mentality.  The IE principles don’t have to go in order, but Principle 1 is first for a reason.  I find myself coming back to this one the most frequently with clients too.  It is so important to reinforce, especially because we are all raised in diet culture.  Principle 1 also has incredibly compelling research to back it up.

When clients get stuck, this is usually where it happens.  This principle is also my favorite because I have so many clients that hit roadblocks because they don’t have a safe space to unlearn the diet mentality.  I also spend a lot of time reinforcing that even if you work diligently at unlearning the diet mentality, it may never feel like you’ve done it perfectly.  That’s because IE isn’t a diet plan – it’s a way of life, and life isn’t perfect.  

Interested in starting an intuitive eating journey of your own? Call us today to make an appointment! (910)790-9500

Find more Intuitive Eating resources HERE. 

Happy Pride Month from all of us at Chrysalis Center.  Make sure you stay up to date on our instagram (@chrysaliscenternc) to see educational content about LGBTQIA+ considerations in the mental health space all month long! Keep reading to learn more about ways that Chrysalis is striving to better meet the needs of the LGBTQIA+ population through our Health Equity Initiative.

Chrysalis Center is proud to be accredited with the Joint Commission (JCo) and we are putting our own spin on JCo’s new health disparity initiative with our Health Equity Team. 

Megan Vaughn (she/her, admin, check-in) and Riley Burns (she/her, Registered Dietitian) are the Chrysalis team members who are spearheading this first iteration of the Health Equity Project.  Though the project will be ongoing, we are focusing our efforts on improving our inclusivity and affirmation of the LGBTQIA+ community in our office.  

Recently you may have seen signs up around our office with a QR code on it asking you to scan and take a survey about perceptions of inclusivity at Chrysalis and what we can do to better meet the specific needs of our LGBTQIA+ clients, family, and loved ones.  If you took the survey, thank you! Your input is invaluable.  If you are a client or the loved one of a client at Chrysalis, you can still take the survey by clicking HERE, or by finding the link on the front page of our website.  

What changes will you see?

You will notice some small but impactful changes as a first-line intervention to make Chrysalis more inclusive.  First, Chrysalis staff have added their pronouns to the website and their email signature.  This change indicates that we are informed on the importance of stating our pronouns and that Chrysalis is a safe space to disclose your personal pronouns.  

Second, we have added safe space stickers to doors and around public areas at Chrysalis featuring the progress pride flag.  Click HERE to read more about the progress pride flag and its importance in the community.  

Next, we have added a robust section of resources on our website that have been vetted by our Health Equity Team.  To find it, either click HERE or go to [resources] → [LGBTQIA+ resources].  For those reading this who don’t identify as LGBTQIA+, this resource is for you too! We hope to empower you to learn more about how you can support and uplift the LGBTQIA+ community in your day-to-day life.  

Lastly (for now) we are making an effort to add a section for pronouns on all of our intake paperwork, as well as asking about preferred names and legal names.  This information will be available to clinicians, and clinicians are encouraged to introduce themselves with their own preferred name and pronouns.  This adjustment is done in an effort to continue normalizing use of pronouns and to help Chrysalis to become an overall more affirming space.  

What changes will you *not* see? (AKA – the changes happening in the background)

Changes happening in the background are the ones that are happening on the staff level.  As a staff, we have committed to pursuing more education on issues facing the LGBTQIA+ community, having Q+A presentations in our staffing sessions, and making it a point to more openly discuss recent legislature at the state and federal level that impacts LGBTQIA+ rights.  As an organization, we are committing to understand that protecting our LGBTQIA+ clients, staff, and loved ones means protecting LGBTQIA+ rights. 

All of us here at Chrysalis greatly appreciate your grace and input as we make these changes.  There is space in our survey to add additional feedback, and we would be so very grateful if you are able to take the time to participate.  Chrysalis is proud to support the LGBTQIA+ community and to continue our journey of learning and affirming. 

HAPPY PRIDE MONTH!

We can’t let May end without acknowledging Maternal Mental Health Month. Did you know that as many as 1 in 5 women experience perinatal mood and anxiety disorders? Maternal mental health concerns are actually the leading complications in pregnancy and postpartum. We believe that women’s mental health IS health and the more we can do to support moms, the better. To that end, we are proud to announce that our psychiatric provider, Aiereal Lloyd, PMHNP has now received her Perinatal Mental Health Certification in Psychopharmacology via Postpartum Support International.

I recently had the pleasure of talking to Aiereal a little more about this important topic.

Kelly– Tell us what made you interested in perinatal mental health and pursuing this designation.

Aiereal- After my daughter, I experienced Postpartum Mood Disorder. I was afraid to tell my doctor in fears that my baby would be taken away. I felt I had no support. I eventually told them and was started on medication without education (which was terrifying). I want to be that support for women who are afraid, who are clueless on the next steps.

Kelly– I know you just studied for your test and while all the info is still fresh, anything that stands out to you to share with us?

Aiereal– Most medications are pretty safe during pregnancy. Fathers are important too, when there is a supportive partner, it can be very helpful. It’s also crucial to know the importance of screening dads as well for PMAD.

Kelly– What do you think are the biggest misconceptions about pregnant and breastfeeding women being on psychiatric medications?

Aiereal– That medications need to be stopped while pregnant or while breastfeeding or that Zoloft is the only safe medication to take.

Kelly– What advice would you give to a therapist, medical provider, or doula re: talking to a client about considering medication/being referred to a prescriber, especially if the mom is wary of going that route?

Aiereal– Reassuring the mom/dad that medications are okay. Of course, therapy is #1 in my opinion. Medications do not have to be lifelong, and if they are it’s okay. Being a parent is hard no matter if you are a first timer, adopter, or an experienced parent. Each pregnancy is different and there are resources to help you decide what is best for you and your family.

Resources:

Learn More

Maternal Mental Health Hotline; a confidential, toll-free hotline for mothers experiencing mental health challenges:

1-833-TLC-MAMA (1-833-852-6262)

Screening Tools

https://screening.mhanational.org/screening-tools/

Choosing Recovery

I truly thought I would spend my entire life obsessing over food, health, and weight. I clearly remember the intense pressure I felt to eat “perfectly” and follow all of the rules I set out for myself. My eating disorder took the better part of a decade away from me, and looking back I have immeasurable anger at my eating disorder and immeasurable gratitude for my choice to recover.

My eating disorder thrived on my intense need to be perfect. I lived with persistent fear of not being “good enough” in any area of my life. No matter what I did, how many foods I cut out, how hard I worked out, how “perfectly” I ate, or how many rules I followed, I could never be good enough for my eating disorder. She was my worst critic, and she was loud. Born from childhood bullies, my sensitive nature, and my fear of never being good enough, my eating disorder was my worst nightmare and my best friend. Every vivid memory from 12-18 years old involves my eating disorder, but it was my best kept secret. My parents never knew, my teachers all remarked on how polite and quiet I was, and I was known for my discipline and “will-power”.

Choosing recovery was terrifying. My eating disorder had me completely convinced that, by pursuing recovery, I would give up everything about myself that I valued. My beliefs, my community, my passions, everything. The part of me that held that fear was wrong, of course. Once I made the decision to recover, I threw my entire self into it. I knew that I couldn’t live with my eating disorder anymore, but I didn’t remember life without it. I came of age with a mental illness that warped my view of reality completely, and my recovery was spent re-learning what a healthy relationship with food is like. I can’t accurately quantify the hours spent crying into a bowl of food that I now eat every day, or the amount of times I had to remind myself that eating is a morally neutral activity. It was the hardest thing I’ve ever done.

Now, when I think about my eating disorder, I think about it in the past tense. My life now is full of color and joy in a way I never thought was possible. I’ve given up the parts of me that I held so dearly during my eating disorder – the ones I was so terrified to lose. Now, I’m a little less quiet, and my life is a lot more vibrant. My resilience brought out the best in me in ways I could’ve never anticipated. My recovery also let me access a simple kind of joy I never thought was possible – the joy of being content with my life exactly how it is. The joy of putting on clothing I love without thinking about how I could change myself to make an outfit look better. The joy of moving my body because I love it, not because I hate it. The joy of eating in the company of those who love me. And lastly, the joy of knowing that all I have to be is myself, and that will always be more than enough.