Pride month is a wonderful time to celebrate all the awesome things about being queer (bucking gender norms! embracing diversity in sexual and gender identity! drag race!). We reflect on the heroic work of our queer forebears and celebrate the progress we’ve made. Pride month is also a time for us to look honestly at the battles we still face. For LGBTQ and allied staff at Chrysalis, this means an opportunity to raise awareness about the disproportionate impact of eating disorders on the queer community.

People in the LGBTQ community suffer from eating disorders at significantly higher rates than their cisgender and heterosexual peers. A recent study found that adults who identify as gay, lesbian, and/or bisexual were up to four times as likely to report a lifetime diagnosis of an eating disorder as their heterosexual peers¹. Eating disorders may be even more prevalent among transgender and non-binary individuals; one study found that 10.7% of trans men and 8.2% of trans women surveyed had been diagnosed with anorexia nervosa or bulimia nervosa¹. Early research on non-binary individuals suggests that this group may experience a heightened risk of eating disorders compared to binary trans folks². The disparity between queer and straight people starts young: compared to straight and cisgender kids, gender- and sexual-minority youth and adolescents were significantly more likely to report disordered behaviors like vomiting, over-exercise, fasting, and binging¹.

In our therapy groups, we often talk about how eating disorders are a coping mechanism, helping people deal with difficult things when they don’t have other resources or support. This is still true for queer individuals with eating disorders, but how the disorder allows the person to cope may be different. For individuals without access to gender-affirming medical care like hormones or surgery, eating disorders may serve to lessen gender dysphoria by minimizing secondary sex characteristics like breast or muscle development or menstruation³. For others, eating disorders may be a way to numb the distress of living in a world that denies and shames queer people’s identities². For both groups, transphobia and homophobia feed the development of the eating disorder.

What does pride month have to do with all this? For many, affirmation and pride in their identity can be the antidote to their eating disorder. Gay and bisexual individuals who experienced discrimination were at a significantly greater risk of disordered eating behaviors than those who lived in an affirming environment, indicating that acceptance and social support may buffer queer people from eating disorders¹. Among gender-diverse individuals, access to and use of gender-affirming medical interventions was associated with increased body satisfaction and lower eating disorder behaviors⁴. To cut through the scientific jargon, affirming queer identities and providing access to necessary medical care helps queer people recover from eating disorders. Advocating for our legal rights and protections, speaking out against homophobia and transphobia, and celebrating pride in the queer community are ways that all of us across the gender and sexual orientation spectrums can fight the scourge of eating disorders in our community.

If you’re a member of the LGBTQ community struggling with an eating disorder, stay tuned for the announcement of our new outpatient therapy group! We’ll explore the intersection of identity and recovery in a supportive environment. If interested, please talk to your therapist to be added to the waitlist.

1. Nagata, J. M., Ganson, K. T., & Austin, S. B. (2020). Emerging trends in eating disorders among sexual and gender minorities. Current opinion in psychiatry, 33(6), 562–567. https://doi.org/10.1097/YCO.0000000000000645
2. Diemer, E. W., White Hughto, J. M., Gordon, A. R., Guss, C., Austin, S. B., & Reisner, S. L. (2018). Beyond the Binary: Differences in Eating Disorder Prevalence by Gender Identity in a Transgender Sample. Transgender Health, 3(1), 17–23. https://doi.org/10.1089/trgh.2017.0043
3. Coelho, J. S., Suen, J., Clark, B. A., Marshall, S. K., Geller, J., & Lam, P. Y. (2019). Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Current psychiatry reports, 21(11), 107. https://doi.org/10.1007/s11920-019-1097-x
4. Ålgars, M., Alanko, K., Santtila, P., & Sandnabba, N. K. (2012). Disordered eating and gender identity disorder: a qualitative study. Eating disorders, 20(4), 300–311. https://doi.org/10.1080/10640266.2012.668482

Photo Credit: Shutterstock

This week Chrysalis celebrates our 19th anniversary of service to our community. In that time, we’ve grown from 2 employees to 22 total clinical and administrative employees, plus 2 terrific interns. We’ve expanded our services from offering just outpatient individual therapy to include nutritional counseling, an array of groups, medication management, and two tracks of our intensive outpatient program for eating disorders. We’ve had 4 different locations, starting in a 3 room office of 1000 square feet and landing in 10,000 square feet spanning 4 office suites.

In the past 5 years, we are proud to have completed the process to become and maintain our state license and Joint Commission accreditation. More recently, we navigated a pandemic, an abrupt pivot to telehealth, and an exponential need for mental health services. This year we look forward to welcoming 4 new therapists, 2 additional dietitians, expanding our outpatient group offerings, and adding a trauma-informed track to our IOP.

We’ve undergone many changes, experienced exciting opportunities for growth, worked hard, played hard, learned a lot, and enjoyed wonderful collaborations with so many partners, practices, agencies, and treatment centers in Wilmington and well beyond. Most importantly, we’ve developed therapeutic relationships with thousands of clients and been honored to be a part of so many different recovery journeys. We thank you to all who have been part of supporting us in any way, shape, or form over the past 19 years and look forward to continuing to restore hope and empower change in the coming years.

Chrysalis IOP has gone through a lot of changes in the past year and while change can be scary and uncomfortable at times, we have come out of this metamorphosis better than ever. As a team, we believe in taking a client-centered approach. This means that the client’s needs always come first. Because of that, we are constantly striving to utilize the latest evidence-based practices to make improvements and revamp groups in a way that fits our clients’ needs. Below are some of our newest additions to the program:

Summer Intensive Track
Chrysalis always strives to provide adequate treatment resources to the community. Summer can be a very difficult time for individuals with eating disorders and it can be helpful to have a little extra support during the warmer months. Because of this increased need, we have decided to offer another track of IOP this summer. This program will begin on June 15th and run through August 18th. It will be held from 9am to 1pm on Monday, Wednesday, and Thursday. Each day of IOP will consist of two therapy groups followed by a meal group. More information about our IOP can be found at https://chrysaliscenter-nc.com/iop/. This track of IOP is perfect for college students or teachers whose schedules make it difficult to commit to treatment during the school year as well as anyone who needs a summer reset. For more information, please contact our IOP treatment coordinator at (910)726-9194.

Exposure Meal Group
As previously mentioned, we strive to utilize the most effective evidence-based practices in our program. Exposure therapy is an evidence-based treatment that was created to help people confront fears. When we are afraid of something, we tend to avoid it. Although this avoidance might immediately reduce feelings of fear, it can actually make the fear worse in the long-term.
Exposure meal group gives clients the opportunity to replicate a typical meal with friends or family followed by a chance to process their experience. During this group, clients track their distress level to prove to themselves that, although the meal may cause anxiety, they CAN get through it.

Yoga
Movement is an important part of recovery and can be extremely therapeutic. We have started to incorporate regular therapeutic yoga sessions into our group curriculum. Yoga sessions are run by Rachel Levin who is a local certified yoga instructor. She is trauma informed and specializes in teaching recovery yoga in various settings.

Grocery Store Tours and Meal Outings
The COVID-19 pandemic really limited our ability to engage in some of the group activities that we had incorporated into our program in the past. As we begin to adjust to our “new normal,” we have decided to bring back grocery store tours and meal outings. Grocery shopping can cause a lot of anxiety and is often avoided by people with eating disorders. Similarly, going out to eat can be a distressing experience for individual struggling with eating concerns. These experiential activities have been incredibly useful to our clients and provide the opportunity to build skills outside of the treatment setting to assist in creating a life that is aligned with clients’ values.

We are thrilled to be able to offer these services to the community and are always here to help! Please don’t hesitate to reach out to our IOP treatment coordinator with any questions by phone at (910)726-9194 or by email at lauren.francis@chrysaliscenter-nc.com.

As many of you are aware, our dear friend and respected colleague, Chaundra Evans, RD, LDN is retiring from direct patient care at the end of this month. For the past 18.5 years, I’ve worked alongside Chaundra; whether our space was 1000 square feet or 10,000 square feet our offices have always been next to each other. We have shared thousands of clients together over the years, working together on the most challenging and rewarding of cases. Our collaboration has become so second nature that we’ve been accused more than once of sharing a brain. And despite the dismay over my extroversion enthusiastically committing us to numerous speaking engagements across the country, my introverted “work wife” has hesitantly obliged to publicly present even though she’d much rather set herself on fire. Little does she know how much I envy her natural teaching abilities; she outwardly makes it look effortless even though I know internally she’s sweating profusely.

If you have had the good fortune of being Chaundra’s client, you know how knowledgeable and compassionate she is. If you’ve collaborated with her professionally, you know how knowledgeable and compassionate she is. And if you’ve known her personally, you know how much she loves her dog(s), the water, and the important people in her life. She is a kind, gentle soul with an infectious laugh. We’ve grown up in this field together and I always envisioned we’d grow old together in this field. I will miss her dearly day to day, but I take comfort knowing that our journey isn’t over. I’m excited we still have projects and presentations in the works, as we strive to educate other professionals in our specialty areas.

As she sets sail (literally) on her next adventure, we wish her all the best. Chaundra, please know how much you’ll be missed by your clients and your colleagues and what a difference you’ve made in so many people’s lives over the years. You will forever be a part of Chrysalis’ legacy!

Repeatedly, tragedy takes place in our schools. Schools are meant to be a safe learning environment. Ongoing destruction and violence are increasing in our country. How do we process this? How do we support and have these difficult conversations with our children?

It is important for parents to take time to process before having conversation with children. It’s okay to take time and reach out to supports such as friends, family, or mental health providers. This will help parents process their own emotions and enable them to model healthy behaviors for their children. Children may become worried or upset if parents display strong emotions in front of them. It may be helpful to process overwhelming emotions with a support system or mental health professional.

American Psychiatric Association recommends avoiding the topic with children until they reach a certain age. Children under the age of 8 will struggle to process this, but it is important that we are there for them. First, check in with your children. Ask children if they are aware of what happened. Younger children may not be aware and depending on the child and age it is up to the parent if they want to talk to them about it. It is recommended to only give young children simple information and limit media exposure. Media exposure can cause secondary trauma. This is true for all ages. Provide reassurance to your children. “You are safe”, “Your home and school is safe”.

Younger children will not be able to verbalize their feelings and will need assistance. You can help them identify their feelings by saying “I feel sad about the families in Texas, how do you feel”?  If your child is unable to verbalize feelings that is okay and normal. Some children may benefit from using art or play to express their feelings. Children may also benefit from creating thank you notes to first responders and teachers at the school, giving them a sense of control and hope.

Observe your child’s behavior in the following weeks. Children can present anxiety or depression in different ways. Reach out for help if you start to notice your child isolating from family and friends, consistent meltdowns, anger outbursts, changes in sleep, or change in appetite.

Adolescents and teenagers will be more aware of recent events. More detailed conversations will be appropriate.  It is okay to have conversations on what they can do to maintain their safety at school by following safety guidelines, talking to an adult or teacher about concerns, and reaching out for support if needed from school counselor, parent, or other school staff. Adolescents and teens may be interested in getting involved and how they can help. Keeping the conversation open and asking open ended questions will allow them to feel more comfortable and supported.

Resources: APA, National Association pf School Psychologist.

Chrysalis is excited to welcome Jennifer Wolf. Please read below to learn more about Jennifer.

Please tell us a little bit about your work prior to joining Chrysalis:

​Dietetics is a 2^nd career for me, I’ve spent most of my adult life as hair stylist of 22 years, retiring completely Dec. 2021. That position and those clients supported me in going to school late into my 30’s when I decided I wanted to study nutrition.  I was fortunate to graduate with my BS degree in spring of 2019, complete the RD exam, and acquire my first nutrition position prior to the onset of COVID-19. I’ve spent the past 2.5 years working in an outpatient facility that specialized in bariatric surgeries. This wasn’t an area that got much exposure in school or my practice experience, but I learned quickly that this is a growing field in which the patients require tremendous nutrition support. I worked with patients at all phases of their weight loss journey educating them on lifestyle change prior to surgery, meeting with them during hospital stay, continuously following up with patients as the recovered from surgery and began to focus on life afterwards.

What made you interested in dietetics?

When I was in my early 30’s, I started feeling the repercussions from years of eating poorly and sedentary lifestyle.  I knew I was too young to already feel older than my years. Around this same time, I was told a medication I’d been taking for over a decade was no longer recommended for longer than 2 years because of its impact on bone density with long term use.  Afraid that this was another factor in prematurely ageing, I started researching lifestyle changes in diet and exercise that would help me combat brittle bones. I had my 1^st DEXA scan, which was normal (btw), and this appointment led me to my 1^st meeting with student dietitian at a local university. We talked about subtle changes that I could implement into my diet and activity I could incorporate to keep my bones from breaking. From there, I knew that I wanted her job, I felt that nutrition was key in overall good health. I ended up graduating from that same university program around 10 years later.

What do you like best about being a dietitian?  

Of course, I love to see my clients take pride and joy in themselves when they’ve achieved a goal they’ve set.  As a dietitian,  my objective is educating clients about nutrition, food, and diet so that they can make choices for themselves, but I love to see when they take that information and continued to learn for themselves. I think those ​self-discovered “ah-ha” moments really stick with them long term.

You lived somewhere very cold before moving to Wilmington. Do you have tips for tolerating cold weather?

I’m from Michigan, where you could get all 4 seasons in one day, so dress in layers! It’s worth it to invest in good winter gear since you will not escape the cold that lingers 1/2 the year, sometimes you need to sacrifice function over fashion. Buy a car that has a remote start and both heated seats and heated steering wheel, this improves any frigid morning, 100%.  While I’m not a fan of cold weather, I found the 6 months between Nov-April filled with darkness and gloom harder to bear. My last winter there, I finally invested in a sun lamp which I found extremely helpful, just wish I’d made the investment 40 years sooner.

What are your favorite things about living in Wilmington so far?

​Sunshine…see above. My partner and I chose a place in Midtown, so I love how conveniently located we are to everything. Central to the beach and downtown, allows for little excuse for us not to get out of the house. We’ll have to live here for the next 40+ years to eat our way through Wilmington, the restaurant options are limitless. We’re trying to create a Sunday morning routine of yoga on Wrightsville Beach followed up by either Drift coffee or Zeke’s Beans & Bowls, two of our instant faves.

Trigger Warning // suicide, suicidal thoughts

A recent quote I saw said “We have to put the person before the student and the athlete, otherwise we are at risk of losing all three.” That was in response to the passing of Katie Meyer, a standout goalie for the women’s soccer team at Stanford who died by suicide earlier this year. Four other student-athletes have died by suicide in a matter of two months– Sarah Shulze, Lauren Bernett, Jayden Hill, and Robert Martin. Both Katie and Lauren had been on national championship winning teams in their respective sports. People tend to think of high-level athletes almost like heroes– they do things few others can do, and they learn how to get comfortable with and push through pain. “They get to do what they love and have so many privileges, they must be so happy! Why would they ever choose to end it all?”

Having been an athlete myself and now working with athletes for several years as a sports dietitian, I think it’s safe to say sport provides a sense of purpose, accomplishment, a commitment to something greater than yourself that few can understand, and belonging. Athletes pride themselves on discipline, grit, and their innate need to push their own limits, all of which have probably led them to athletic success. It did for me; in college, I was a scholarship athlete, straight A student, captain of the women’s cross country team, and volunteered regularly in the community. So how was it possible that my senior year I found myself struggling with depression, anxiety, and like many others are starting to talk about, thoughts of taking my own life?

At the time, I didn’t recognize what I was feeling as these things. I did know that I felt relief when I got to sleep, dread when I woke up, panicky whenever I was around people, “down in the dumps” almost all the time, though not exactly sure why, and when I thought I did know I blamed myself because I was supposed to be able to handle everything and if I couldn’t, I was doing something wrong. I felt so very, very, alone. I thought it was my fault for feeling this way, so I didn’t see the point in telling anyone. I was taught that was complaining or being ungrateful. “You have so many things going for you! You don’t have to pay for school! You get free gear and tickets to football games! You’re friends with so many cool people! Don’t you love running and competing? You get to fly places and take trips and professors happily reschedule exams for you! You get free tutoring! You should be grateful! If you don’t like it anymore, why don’t you just stop? What is wrong with you??” Except those were things I had been told by people on the outside looking in. Those were not my actual experiences. These were:

Waking up at 5 or 6am for morning practice – can’t be late or the whole team will have hell to pay – and hoping it didn’t go over so that I wasn’t late for my 8am class. Back-to-back lectures until afternoon practice at 3:30pm,dining hall at 6pm, then right to study hall, tutoring, volunteering, and getting everything ready for tomorrow. In bed by 12am on a good day. Repeat.

Having to schedule classes only in the morning or early afternoon so that they didn’t interfere with practice. Not being able to take classes I wanted or having a minor because those classes conflicted with practice times.

Constantly worrying about not running well or getting good enough grades and having my scholarship cut, essentially ending my chance at getting a degree. Constant pressure to eat, look, and exercise like a serious athlete (hello, eating disorders!).

Planning the whole semester out before it even started to anticipate missed classes and exams for competition or handing in projects early before we left for meets. Having less time to study for exams because they usually got rescheduled earlier, not later. Catching up on assignments or studying ahead on the bus, plane, in the bleachers, at the hotel, in the tent, at meals. Getting the brunt of frustration from both professors and coaches when they prioritized their own expectations and I was caught in the middle.

Choosing to take a nap for 30 minutes instead of meeting up with my friend I haven’t seen in several weeks because I stayed up until 2am to complete that reading.

Any time we drop the ball, or seem tired, or want a break just once because we feel like we’re about to crack, we’re met with “You cannot fail. If you can’t handle it, you’re not cut out for this. Why are you wasting our time? Get it together, or get out.” Except quitting is not an option in the athlete’s mind. They’ve been trained to do the exact opposite. Anything less than that is unimaginable, unforgivable. Dealing with the disappointment from coaches, teammates, family, friends, fans, and worst of all, themselves, is too overwhelming to even think about. If they need a way out but can’t even fathom the aftermath, leaving for good seems like the only option. I remember how that felt.

The rate at which collegiate athletes receive treatment is much lower than their non-athlete peers. While roughly 30% of college student-athletes report having mental health concerns, only 10% of them seek professional help. Student-athletes often resist treatment for the same reasons as non-athletes, but also for additional ones related to sport. Some resist due to concern that having a mental health diagnosis will result in loss of playing time, status on the team, or even their scholarship. Some may fear the reactions of family, coaches, and teammates. Others may worry that treatment will negatively affect their sport performance.

A 2015 survey of student-athletes conducted by NCAA found 30% reported feeling seriously overwhelmed during the past month. Nearly 25% felt mentally exhausted while a third struggled to find energy for other tasks because of the physical and psychological demands of their sport. Sadly, less than half of those who sought help reported satisfactory care from their team or university.

Student-athletes are taught that they are “students first, athletes second”. While I believe this is meant to encourage them to prioritize education, it can be extremely dehumanizing and invalidating. Everyone, athletes included, seems to forget that student-athletes are human; they are human first, and whatever else they want to be after that. They are allowed to make mistakes, and then learn from them. They are allowed to change their minds. They are allowed to rest. They are allowed to have feelings and emotions. They are allowed to prioritize their whole selves and personhood before others’ expectations. They are allowed to advocate for themselves and receive support. They are allowed to know and trust that they are so much more than a body, and there is so much more to life than sport. And they deserve to know that they are never, ever, alone.

The conversation needs to continue, and sport culture needs to change. The system is flawed, and it is failing those who are the reason sport exists in the first place.

We are thrilled to introduce another new team member at Chrysalis, Alaina Van Gelder, LCMHC.

Alaina comes to us with a wealth of eating disorder experience and is currently accepting new clients. She sees adults for individual therapy, runs the Reflections group in our IOP, and will soon be starting an outpatient group (stay tuned for more!). She’s in pursuit of her certified eating disorders specialist designation and was recently interviewed by our Executive Director. Learn a little more about Alaina below.

You had another high profile career before becoming a therapist. What made you change course?

“I knew that I wanted to become a therapist in 12th grade AP Psychology, but my life took me in a different direction for some time — a direction for which I am grateful. But on one of my many trips to NYC for work, I had what I like to call my ‘freight train moment’. I realized I was not living in my passion/purpose lane and it was time to make a change. I had reached the top of my game, I had traveled, I had worked with and met amazing people, and my projects and direct reports were thriving — but inside I was not. It was time to pursue my dream of becoming a mental health therapist and so I took a leap of faith and now I can confidently say that I am living in my intended lane with passion for helping my clients all while fulfilling what I believe to be my purpose.”

What would you like clients to know before their first appointment with you? 

“I want to normalize that it’s okay to be nervous or anxious coming to therapy for the first time or to me for the first time… just don’t let it stop you. I also want to assure each and every new client that I am a safe space — I love to laugh and I have a goofy sense of humor; I am truly nonjudgmental; I will provide you with unconditional positive regard in each and every session. I value you for loving yourself enough to come to therapy and I am honored to be present with you.”

You recently relocated here from Maryland. What’s been the biggest culture shock or best thing so far about living on the southern coast? 

“The people — everyone is so kind and polite! I am also enjoying Wilmington’s beauty and history — there is so much to explore and do.”

We’ve all been pretty homebound the past few years. What is #1 on your travel bucket list? 

“I honestly would love to go to Bali someday. It just looks like a peaceful, beautiful place that I’d love to experience.”

We believe in “pawsitive” psychology here at Chrysalis. Any pets? 

“Of course! I have two boys — Max and Henry, both rescues and tremendously spoiled as they should be! Max is a Jackchi (Jack Russell/Chihuahua mix) and Henry is a grumpy little Chihuahua. They love their new backyard and enjoy chicken jerky. When they aren’t sleeping, they love giving hugs and kisses!”

Meet Aiereal Lloyd, Chrysalis Center’s new Board Certified Psychiatric Nurse Practitioner

We are so excited to have Aiereal join our team at Chrysalis. As is our tradition, I asked Aiereal some questions to help us all get to know her better…

Did you have a career before becoming an NP? If so, what did you do?

I taught Preschool years ago, and I have a degree In Early childhood education. More recently, I have worked as a Nurse for ten years in many settings, including corrections, long-term care, home health, and at an Acute Care hospital on a medicine unit that housed behavioral health patients.

What is your favorite part about your job?

My favorite part is the reward I get from helping someone feel better, whether with medications or just listening and being patient with them.

If you could go on an expenses-paid vacation anywhere, where would you go?

Back to Disney, I didn’t get to experience Disney as a child, and I went about three years ago and felt like a kid all over.

What do you like to do in your free time?

Free time, (HA) well, I have three kids – but I enjoy time with my family, friends, and BF- movies, playing games., listening to music (I love music)

What would you like clients to know before their first appointment with you?

Relax and trust the process. I would want them to see that they are in a safe environment, a

non-judgmental zone. The first appt can be from 30mins -1hr; I will listen to their symptoms and concerns; there are usually many questions to get through as we work through the steps of their treatment plan.

In addition to her kind response to our inquiry, Aiereal wrote some Medication Management Tips for all of us.

It has taken years to finally get to a place where medications are accepted for their role in treating mental health disorders. For far too long the stigma that medications may suppress symptoms rather than treat the problem has caused fear amongst many regarding the need for this important treatment option. Research has shown that medications play a significant role in improving mental health, especially when combined therapy. Combined treatment may not be accessible to all as cost, benefit, time, and limited resources are a factor resulting in the use of therapy alone or medications alone. However, we know that psychotherapy can enhance the effectiveness of medications by improving compliance with medication and addressing issues that the medication cannot.

 Medications will work on one of the three neurotransmitters and should not change your personality, make you “crazy,” or make you feel like someone or something other than you. If you aren’t feeling like yourself, you should talk to your prescriber about it.

 Understand that:

1. It is your personal choice to utilize a medication to treat a mental health issue.
2. Medication is often not permanent, but it does require consistency to be effective.
3. It is essential to continue therapy, positive behaviors, and coping skills while taking medications.
4. Allow your child to collaborate about their care, keeping them involved in the process.
5. Remember, the road to finding the right medication may be a tough and timely one—trust the process; it may be hard but it will be worth it.
6. There is no right or wrong answers You have the option to start and stop a medication- but consult with your prescriber first before doing so.

Aiereal is currently accepting appointment for individuals ages 5 and up. Please call Chrysalis Center to schedule your appointment. 910-790-9500

Breast Cancer and Mental Health

Every year during the month of October I write a blog for Chrysalis Center for Counseling regarding the importance of Breast Cancer Awareness. This topic is very important to me because I am one of the 1 in 8 U.S. women that will develop breast cancer over the course of their lifetime.

In 2012 at the age of 31 I sat across from my doctor and heard the words I would never forget “you have breast cancer”.  The word Cancer carries so much weight in itself that it was hard for me, in that moment, to see beyond it. When I could finally process what was happening, I realized I had a choice, I could either curl up in a ball and fall fast into depression or I could pull myself together and make cancer wish it never knew me.  I chose to pull myself together and fight and that is exactly what I did.

Breast Cancer totally changes your sense of “normal.” It may impact your ability to do your job, spend time with your loved ones, or go about your daily routine. And while the physical impacts of breast cancer and its treatments are well documented, the impacts on a patient’s mental health are just now being recognized and researched.

Because more and more breast cancer survivors are starting to speak up about their struggles with mental health issues, I felt compelled to honor their voices. Here’s what you need to know about breast cancer and mental health.

Diagnosis and Treatment Side Effects

Breast cancer can bring a mixture of emotions. The impact of a cancer diagnosis and ensuing treatment on a person’s mental health can be significant. A cancer diagnosis and treatment can lead to mood disorders (depression, worry, and anger), hopelessness, and changes in body esteem. Breast cancer treatment can bring side effects such as insomnia, memory changes and mood swings. Hormone level changes can influence your emotions, and weight gain can be discouraging. Some women self-blame while others feel punished. Studies show that most people diagnosed with breast cancer will subsequently develop symptoms of PTSD, and these symptoms tend to last longer than a year.

You may have heard about “chemo brain.” Chemo brain describes problems with thinking (cognition, memory, attention) that may occur as a result of receiving chemotherapy to treat cancer. These symptoms may affect patients during or after cancer treatments. Emotional and mental health problems that survivors may face can also contribute to difficulty with thinking and learning.

After a breast cancer diagnosis, a woman’s relationship with her body may change. While lifesaving, mastectomies can decrease a woman’s body confidence and have a negative effect on their overall mental health. For better or for worse, breasts are deeply tied to identity and self-esteem in American culture that for many women, losing one or both of their breasts is a lot to process mentally.

Fear of Recurrence

Fear of recurrence is common and expected after a cancer diagnosis. Any physical symptom, even a cough or minor pain, can trigger the fear of a cancer recurrence. It is important to always notify your doctor of any new concerning physical complaints. However, sometimes the fear or recurrence can be out of proportion to the physical complaint or thoughts become intrusive or distressing.  Every ache and pain may cause you to think, “Is my cancer back?”

Your Emotions Matter

There are ways to help ease you or your loved one’s fears and anxieties after a cancer diagnosis.

• Accept your emotions. Talk about your feelings with a healthcare provider, licensed mental health professional, trusted friend, or other survivors.
• Practice mindfulness or meditation. Awareness in the moment often helps reduce anxiety, stress, and fear of recurrence.
• Take control of your health. Ask your doctor for a written follow-up care plan, including what exams you need in the future and how often you should have them.
• Recognize important indicators. Ask your doctor for a list of symptoms you should report to him/her in between check-ups.
• Maintain a healthy lifestyle. getting enough exercise, sleep and eating a healthy diet.
• Join a support group.  Getting to know other cancer survivors will help you feel less alone as you learn how they are coping with the same worries.

• Feel your feelings You have a right to mourn your losses—but remember, you are more than your cancer. Be gentle with yourself. Look for ways to feel good inside and out. There are many options available to help you: prescription medication, counseling, acupuncture, massage, meditation, relaxation techniques and physical therapy, among others.
• Avoid the “be positive” trap. It’s completely normal to have bad days. But, if you find that your anxieties, worries, or fears are interfering with your day-to-day activities or sleep habits, talk to your doctor.

Mental Health Resources

Cancer patients and survivors may feel like it’s more difficult to talk about mental health problems and struggles. It may be because family members or friends don’t talk about mental health, cultural beliefs don’t support having mental health discussions, or they feel that they should be “strong” or “brave” and keep it to themselves.

Anyone struggling with these issues should never feel embarrassed about seeking out mental health support. You won’t need it forever, but it can help during this time.

Here are some resources to help someone psychologically get through cancer.

• Caregiving (CDC)
• Feelings and Cancer (National Cancer Institute)
• Cancer Support Groups (National Cancer Institute)
• Memory or Concentration Problems and Cancer Treatment (National Cancer Institute)
• Caregivers and Family (American Cancer Society)

I can’t tell you that my breast cancer treatment and the days, months and years following my diagnosis were always easy, I had my share of bumps in the road and experienced my own mental health struggles. Finding the strength to finally reach out and ask for support was life changing for me and I look back now and wish I had done it earlier.

If anyone you know is experiencing mental health struggles after a cancer diagnosis and are afraid or ashamed to ask for help, please remind them it is ok to take care of themselves…they deserve it!