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Eating Disorder Awareness Week

For the National Eating Disorder Association (NEDA)’s Eating Disorder Awareness Week (February 26-March 4), the theme is “Let’s Get Real.” The goal is to highlight the stories we don’t hear as often and to open the conversation to everyone.

For more info from NEDA, please go to https://www.nationaleatingdisorders.org/, and if you are concerned you might have an eating disorder, use their Helpline 1-800-931-2237 or their screening tool https://www.nationaleatingdisorders.org/screening-tool.

According to statistics provided by NEDA, 30 million Americans struggle with a “full blown” eating disorder, and countless more struggle with eating and body image concerns. Because of the stereotypes and stigma attached to mental illness and eating disorders, a lot of people don’t reach out for help.

Last year, the theme was “It’s Time To Talk About It” and Kelly Broadwater, LPA here at Chrysalis Center highlighted the high mortality rate, the lack of funding for research, the negative messages about food and weight we get bombarded with every day, getting help, and having hope. To read more from this blog post, go to https://chrysaliscenter-nc.com/its-time-to-talk-about-it/.

Truths About Eating Disorders

There are a lot of stereotypes about eating disorders. How many of those are even real? Instead of going through all the myths about eating disorders, here are some truths:

  • An eating disorder is not a choice; it is a mental illness with serious physical, cognitive, and psychological implications.
  • It is not possible to “just snap out of it.”
  • There is no one cause for an eating disorder, it is a different root for every person.
  • It is a big deal.
  • Anorexia is not the only eating disorder, even if it is the one we think of most often – bulimia, binge eating disorder, and avoidant/restrictive food intake disorder are also serious, life threatening illnesses that need to be taken seriously.
  • Just because you don’t see it physically, doesn’t mean it’s not there or that you should ignore signs because it doesn’t fit the stereotype.
  • There are a lot of other issues linked to eating disorders, including anxiety, depression, and trauma.
  • People need their support system, including friends, family, and treatment team, to recover.
  • Men can have eating disorders, and the CDC found that about 1/3 of all eating disorder sufferers are male.
  • Children as young as five can develop eating disorders, and many people who struggle with eating disorders as a child or adolescent will continue to struggle with them as an adult unless they receive help.
  • It is not just about food.

For people with these disorders, one of the biggest obstacles is the secrets and shame that go along with those behaviors.

Say Something!

Too often, loved ones will see something wrong and not say anything – if we are going to “Get Real” that needs to change. People are afraid to bring things up, but that is one of the things that keeps the stigmas about mental health and eating disorders alive.

Why not ask, or express concern? What is wrong with talking about it, really? It can be a difficult topic, but if it is approached with concern, caring, and empathy, people will rarely shut down the conversation.

If this seems too stressful or delicate to do on your own, seek help from a professional (a therapist or dietician who specializes in eating disorders) to help you have the conversation.

As an eating disorder specialist, the most important message I want people to hear is that truth and honesty is necessary from everyone affected – the person with the eating disorder and their loved ones.

Don’t walk on eggshells – but don’t smash them either. If you try to get real, make sure you are coming from a genuine place of caring before you try to open the conversation. If it is approached with compassion, the conversation has a much better chance of being productive for the person with the eating disorder and their loved ones.

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This Monday, October 9th, a years long dream will become a reality. Chrysalis will begin offering our IOP for adults 18 and older with all forms of eating disorders. IOP is considered a step up from outpatient care and a step down from partial hospitalization, residential, or inpatient eating disorder treatment. It is appropriate for those who are able to live independently, but require more structure and support than typically achieved by attending once weekly individual and nutrition therapy. It is also a useful way for those who’ve been at a higher level of care, with nearly constant supervision, to transition back to “the real world”. For those who’ve been away at treatment, IOP serves to help prevent relapse and sustain recovery.

Our mission is to offer expert level, evidence-based treatment to our clients dealing with all types of eating disorders (including anorexia, bulimia, and binge eating disorder), while also addressing co-occurring issues such as anxiety, depression and other mood disorders, trauma, and substance use. Our goal is to provide individualized care that targets every aspect of the client’s well-being in order to improve medical, nutritional, psychological, and interpersonal functioning. We seek to understand and challenge the underlying and maintaining factors of the eating disorder in order to achieve and sustain lasting recovery. It is our desire to restore hope and health to clients by empowering them to fulfill their goals, make positive changes, and prevent relapse. We believe that collaboration amongst the treatment team, clients, families, and the community will facilitate a path to successful outcomes.

Our program will be offered Monday, Wednesday, and Thursday from 3pm-7pm and will include a variety of group therapies, ending each day with a supportive meal led by a registered dietitian. These meals will rotate between catered options, “brown bag” or potluck dinners, and restaurant outings so that clients experience a variety of exposures to food challenges in different environments. Therapy groups include the ACT/DBT informed Mindful Living, Staying Open about Recovery, Motivation for Change, and a general Process Group. Additional specialty groups for trauma survivors and those dealing with substance use will be available dependent on the needs of the clients enrolled at any given time. Yoga and art therapy groups will also be incorporated into our programming.

Those clients interested in IOP can self-refer or have their treating provider (therapist, dietitian, or medical doctor) make a referral. Pre-screening with our clinical director will be required to determine if IOP is the appropriate level of care. All clients will have to undergo a medical evaluation to ensure their physical stability prior to being admitted into the program. If a client is already connected with a therapist or dietitian, they can maintain their current treatment team while also attending our IOP program. Close communication and collaboration between the IOP team and the referring provider will occur. If a client does not have a treatment team (i.e. therapist, nutritionist, or psychiatric provider) in place, Chrysalis will offer those individual services as well to round out the treatment experience. As we are the only eating disorder specific IOP within a 130 mile range, we will also accept clients from out of town. Our director of professional relations will work with those clients to attain affordable lodging options.

Insurance typically covers IOP level of care with prior authorization. Our helpful administrative team will assist clients to determine their benefits and to obtain the authorization required to attend IOP. If we are not in-network with a particular insurance company, our utilization review department will strive to negotiate a single case agreement with the individual’s carrier. Once enrolled in the program, our hope is that at least 6 weeks of continuous care will be approved.

Our staff is a friendly, knowledgeable mix of experts in the field. Our clinical and nutrition directors are a certified eating disorders specialist and a certified eating disorders registered dietitian, both with previous experience working in higher levels of care for eating disorder treatment. Our IOP therapists and dietitians have specialized training and experience in the groups that they facilitate. Chrysalis’ program is licensed by the NC Department of Health and Human Services and accredited by the Joint Commission.

Making the decision to pursue IOP care is a big step in the recovery process and should be applauded. Visit https://chrysaliscenter-nc.com/iop/ for more information about the schedule, specific descriptions of the groups offered, and to meet our leadership team. If you have further questions about our program or to request a screening, please contact us at 910-790-9500 or iop@chrysaliscenter-nc.com.

Kelly Broadwater, LPA, LPC, CEDS is the founding executive director of Chrysalis Center. She is extremely grateful for the IOP leadership team who has put in countless hours of blood, sweat, tears to develop the program (and write more policies and procedures than she ever thought imaginable) and excited to see what the future holds as the IOP “takes flight”.



The journey towards recovery can take many forms, but every person has to follow their own path towards health and make choices along the way. Some of these choices may come in the form of different treatment centers or levels of care to address the difficulties someone is having at that stage of their recovery. Every person’s process is different.

Eating disorders are very complex illnesses that require specialists to treat not only the emotional and behavioral facets of an illness, but the medical one as well. For these reasons, the American Psychological Association (APA) established guidelines for appropriate levels of care with eating disorders.

Chrysalis Center is an outpatient program and will soon be adding intensive outpatient (IOP) services. The other levels include partial hospital (PHP), residential, and inpatient levels; these last two are sometimes combined into an “IP-Res” format. To see the full APA criteria for eating disorders, click here. There are some other resources for eating disorder treatment in North Carolina, including Veritas Collaborative, Carolina House, and UNC’s Center for Eating Disorders.  Other treatment centers around the country specialize in eating disorders as well, and sometimes these other programs are a better fit for clients in terms of their individual needs and experiences.  Though not for eating disorders, there are several other levels of care in the Wilmington area for adolescents and adults in general psychiatry.

Usually, these difficult conversations start when we as clinicians recommend a higher level of care for someone who we do not think is appropriate for outpatient or IOP treatment. To be appropriate for outpatient or IOP, a person must be:

  • Medically and psychologically stable to the point that they are not a danger to themselves or others
  • Motivated to recover
  • Cooperative
  • Self-sufficient
  • Able to control their thoughts and behaviors using appropriate social support

 

When someone needs a higher level of care, they are usually:

  • Medically compromised (by weight, bloodwork, EKG, etc.)
  • Unable to manage their behavior
  • Un- or under-motivated
  • Not functioning in their lives in some significant way (work, family, relationships, etc.)
  • Unable to manage a co-morbid condition (psychological or medical) because of their eating disorder

Levels of care indicate how much structure, support, and observation a client requires at that stage in their recovery.

When someone needs a higher level of care, it can be a very difficult discussion between provider and client. Sometimes, we all know it is coming and have been trying to avoid it but it just is not working. Other times, clients may take a sudden turn. This could be for many reasons, but the important thing is that clients get the help that they need to recover from their eating disorder and co-occurring disorders. Our goal is always to help our clients and keep them focused on living healthy and productive lives, and we try to balance all their individual needs while keeping the goal of a full recovery foremost in our minds.

It is important to use the right tool to complete a task, and sometimes that tool needs to be a higher level of care in order for someone to truly recover. Often, IP-Res levels of care can get clients back on track faster than outpatient could and sometimes that is necessary for someone’s well being or even survival. PHP and IOP levels can provide support to keep someone out of the hospital or they can provide support as a step-down program. The transition between inpatient and home can be very stressful and there are a lot of facets to consider including social, family, academic, or work stressors. All of these are affected by or contribute to eating disorder behavior. A person cannot live in a vacuum so all of these need to be managed before someone goes back to their regularly scheduled lives.

By adding IOP services, Chrysalis hopes to provide a bridge for clients on their journey in recovery. It is an important stage or facet in that process. If you need us, we will be honored to work with you on that journey.

 

Kendra is a Senior Staff Therapist and soon to be Clinical Director of Chrysalis’s new Intensive Outpatient (IOP) program with 13 years of experience working with eating disorders in various settings, including inpatient, PHP, IOP, and outpatient treatment facilities.


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