THE DILEMMAS OF
MEN WHO HAVE A
LOVED ONE WITH
EATING DISORDERS
Joe Kelly
VIRTUALLY YOU:
5 STEPS TO GET REAL!
ABOUT DIGITAL EATING
DISORDER RISKS
Bobbie Eisenstock, PhD
SMARTPHONE APPS
FOR EATING DISORDERS
Adrienne S. Juarascio, PhD
and Evan M. Forman, PhD
Technology, Social Media & Eating Disorders
MAKING CONNECTIONS
NATIONAL EATING DISORDERS ASSOCIATION
VOLUME 7, ISSUE 3 – 2014
A Publication of NEDA’s Parent, Family & Friends Network (PFN)
2
Letter from the PFN Chair By Deborah Kreiger, Florida
Hello Friends,
In this issue of
Making Connec-
tions the In Focus
section speaks
to the constantly
evolving role
technology plays
in our lives. In a
word, it is transformative. The articles
assembled discuss new technologies and
their importance in the treatment of
eating disorders. Social media is part of
our daily conversation and, as it expands
our reach in the world, it can serve as a
tremendous tool for building community.
There are also responsibilities that come
with these increased opportunities, and
families should be having important
discussions together about all types of
media. With the annual NEDA conference
fast approaching and the keynote ad-
dress “Rebooting Recovery: How to Use
Tech as an Ally for Healthy Connection,
Community and Resilience” focusing on
technology, we look forward to continu-
ing this discussion in San Antonio, Octo-
ber 16-18. If you have never attended a
NEDA conference please consider joining
us. The knowledge you will gain and the
warm embrace you will feel cannot be
overstated. This year’s theme, “Think-
ing Big: Uniting Families & Professionals
in the Fight Against Eating Disorders,”
brings together top researchers and phy-
sicians, clinicians, families and friends in
an environment where we learn from one
another and, of equal importance, we
support one another. Always remember,
we are on this journey together.
Holiday celebrations and family
gatherings begin taking place in
September and oftentimes these can
be stress-filled occasions for someone
who is struggling, as well as for his or her
family and friends. Words are powerful
messengers and even the best-intended
conversations can be difficult. A recent
issue of Making Connections entitled
“Language and Eating Disorders” contains
many valuable articles and suggestions
highlighting the delicate balance and
mindfulness that go a long way toward
defining good communication for
someone who is struggling. Please
check out this archived issue at
www.myneda.org/MCv64.
On behalf of the PFN Steering Commit-
tee, we extend a very special welcome
to Claire Mysko, Director of Programs.
It has been a pleasure working with her
and Cait Graham on our shared vision for
the PFN and Making Connections. And to
our most important readers, thank you!
We value your input so please continue
to share your thoughts and suggestions
with us.
With Gratitude,
Deborah
For more information on NEDA’s Leadership Councils, please visit
www.nationaleatingdisorders.org/leadership-councils
PFN STEERING COMMITTEE:
Deborah Kreiger, Florida (Chair)
Lorri Antosz-Benson, California
Phoebe Megna, Connecticut
Mike Polan, New York
Adam Radwan, New York
April Rebollo, Washington
Don Blackwell, JD, Florida
Nancy Hemendinger, New York
NEDA Board Senior Advisors
Ovidio Bermudez, MD, Media Advisor
Douglas Bunnell, PhD, Navigators Advisor
Amy Baker Dennis, PhD, Conference Advisor
Walter Kaye, MD, Research Advisor
Margo Maine, PhD, Advocacy Advisor
NEDA Board of Directors
NEDA President & CEO
Lynn Grefe, MA
Karen Andonian
Clyde Hill, WA
Evelyn Attia, MD
New York, NY
Bob Coven
New York, NY
Julie Finkelstein
Purchase, NY
Ilene Fishman, LCSW
Montclair, NJ
Mary Lipton
New York, NY
Kimberli McCallum, MD
St. Louis, MO
Tamara Pryor, PhD
Denver, CO
Dorothy Sprague
New York, NY
Shelly Steinwurtzel, PsyD
Hastings-on-Hudson, NY
Allison Kreiger Walsh, JD
Orlando, FL
Steve Wonderlich, PhD
Fargo, ND
Ric Clark, Chair
Larchmont, NY
Mary Curran, Co-Vice Chair
West Simsbury, CT
Phoebe Megna, Co-Vice Chair
Darien, CT
Russell Marx, MD, Treasurer &
Chief Science Officer
San Diego, CA
Elizabeth Sarquis, Secretary
Minneapolis, MN
NEDA Board Emeritus
Craig Johnson, PhD
Robbie Munn, MA, MSW
Don Nielsen
NEDA Junior Board
Erin Hall, Chair
Troy Roness, MEd, Secretary
Christopher Skarinka, Treasurer
Brooks Brodrick, PhD
Mary Hageman
Heather Hower
Elizabeth Sexton, MPA
Lauren Steiner
3
Dear Readers,
I am excited to be
stepping into the
role of Director
of Programs for
NEDA. I’ve been
part of the NEDA
family since my
days as Director of
the American Anorexia Bulimia Associa-
tion, an organization that merged with
several others to form NEDA. I’ve had
the pleasure of getting to know many of
you over the years and I continue to be
inspired by the dedication and passion
of the PFN. I look forward to highlighting
more of this network’s important work as
editor of Making Connections.
IN THIS ISSUE
2	 Letter from the PFN Chair
3	 Editor’s Note
4	 Research Summary:  Setting Policy Priorities to
Address Eating Disorders and Weight Stigma
5	 Virtually You: 5 Steps to Get REAL! about Digital ED
Risks
8	 Shrinking Women
9	 Proud2Bme Featured in “High School Story” Game
10	 Smartphone Apps for Eating Disorders
12	 Supporting the ED Population through Telemental
Health: Technological and Clinical Implications
13	 Mobilizing Eating Disorder Treatment
14	 Harnessing Technology for Training Therapists to
Deliver Interpersonal Psychotherapy (IPT)
15	 Family Based-Treatment Without Borders: Utilizing
Telemedicine to Deliver Family-Based Therapy
(FBT)
17	 Penn Poised: Rewriting the Social Media Script
18	 Navigating the Jewish Holiday Season
19	 The PFN Parent Surveys Infographic
20	 Dealing with the Dilemmas of Men Who Have a
Loved One with Eating Disorders
21	 Calling All Dads
22	 NEDA Walk Volunteer Spotlight
22	 NEDA Walks 2014
23	 Because everyone has a reason: #WhyINEDAWalk
24	 Working Toward Legislative Reforms: NEDA’s STAR
Advocates Make Strides Across the Nation
25	 PFN Webinars Series: Upcoming and Recently
Archived
25	 Take Back the Tutu
26	 Blog Review
27	 Network Spotlight
27	 Staff Spotlight
28	 Our Sustaining Sponsors
Editor’s Note By Claire Mysko, Director of Programs
When I started out in the eating disor-
ders field, the internet was this cool new
thing that seemed like it might take off.
Phones were not that smart and media
wasn’t so social. Things have changed a
bit in the last two decades! In my most
recent role overseeing NEDA’s youth
website, Proud2Bme (proud2bme.org),
technology has been central to every
aspect of how we reach and engage our
audience. We give people a platform to
connect, use their voices and take action
for change. And where is this connection
and activism happening? On our forums,
on Twitter, Facebook, Tumblr and Insta-
gram, even in a story-based game that
millions of teens have downloaded on
their phones.
Our community advocates for expanded
eating disorders outreach and more ef-
fective intervention and treatment. It is
crucial that we take a close look at the
powerful potential of technology to help
us carry out our mission. How can we
best use technology to spread hope and
connect with those in need? How are the
leaders in this field incorporating technol-
ogy into their work? We’ll address these
key questions and others in this issue. I
hope you enjoy it.
Thanks for reading,
Claire Mysko
4
RESEARCH
Despite the
prevalence and
health conse-
quences of eating
disorders and weight-
related bullying and
discrimination,1,2
pol-
icy actions to address
these problems have so far been limited.
Experts from eating disorders and related
fields have called for a variety of policy
interventions to address eating disorders
and weight stigma, such as equitable
treatment and insurance coverage for
eating disorders, school-based screening
for eating disorders, government re-
strictions on access to over-the-counter
weight control drugs and legislation to
prohibit weight-related mistreatment and
discrimination. While there is certainly
increasing dialogue about these kinds of
initiatives, policy actions by the govern-
ment have been minimal. Promoting
these issues on policy agendas requires
fostering both political will and public
support. Therefore, it is important to
determine how much public support
there is for different policy actions to ad-
dress eating disorders and weight stigma
and to identify which policy actions to
prioritize.
The goal of our study, published this year
in BMC Public Health, was to examine
levels of support for a range of potential
policy actions to address eating disorders
and weight stigma among individuals
from the eating disorders field and the
U.S. general public.3
We surveyed 944
adults from a national web-based panel
(Survey Sampling International), and
1,420 members of national, professional
organizations that specialize in eating
disorders. All participants in the study
completed an identical survey, in which
they were asked how much they would
support each of 23 potential policy strat-
egies that would help prevent and reduce
eating disorders and weight stigma
in diverse settings, including schools,
healthcare and the media. Participants
also rated these policy actions according
to the impact they thought the policies
would have and how feasible they would
be to implement.
Among the general public, the majority of
participants expressed support for 20 of
the 23 policy actions, with the most sup-
port (83%) for anti-bullying policies that
would protect youth from weight-based
bullying in the school setting. The general
public also expressed substantial support
for policies to implement prevention and
training programs on the early identifica-
tion of eating disorders for health care
providers (79%), schools (77%) and sports
coaches (71%). Among experts from the
eating disorders field, more than two-
thirds of participants expressed support
for 21 of the 23 policy actions. In addition
to its overwhelming support for policies
that would require insurance companies
to reimburse for eating disorder treat-
ment (98%), this group was also highly
supportive of efforts to require training
on the prevention and early identifica-
tion of eating disorders in schools (95%)
and health care settings (99%) as well
as policy and legal measures to address
weight-based bullying and discrimina-
tion (74%-94%). In both study samples,
policies that generated the least support
were those requiring schools to measure
and report students’ body weights.
With respect to the potential feasibility
and impact of policy actions, similar per-
spectives emerged from both the general
public and members of the eating disor-
ders field. Specifically, policies requiring 1)
school-based health curricula to include
content aimed at preventing eating dis-
orders, 2) training for sports coaches on
the prevention of eating disorders and 3)
implementation of school-based anti-
bullying policies that protect students
from being bullied about their weight
were selected as having high potential
impact and feasibility by both groups.
This suggests that policy actions that
target these problems among youth in the
school setting should be prioritized. Given
increasing national attention to bullying in
youth and to efforts to improve the nutri-
tion environment in schools, there may be
opportunities to implement these initia-
tives into existing school-based wellness
policies and anti-bullying policies.
Results from our study show that there
is considerable support in both the
eating disorders field and the general
public for policy actions to address eat-
ing disorders and weight stigmatization
across a range of settings. This high level
of public support suggests that one of
the key conditions needed for fostering
political will and policy change is already
present. Given that both groups in our
study expressed support for most of the
23 policies in the survey, it appears that
there is agreement about the need for
widespread and diverse policy actions
aimed at reducing risk factors for both
eating disorders and weight stigma and
support for the use of policy-level actions
to achieve meaningful change.  n
References
1. Treasure J, Claudino AM, Zucker N: Eating
disorders. Lancet 2010; 375:583–593.
2. Bucchianeri MM, Eisenberg ME, Neumark-
Sztainer D: Weightism, racism, classism, and
sexism: Shared forms of harassment in ado-
lescents. J Adolesc Health 2013; 5:47–53.
3. Puhl RM, Neumark-Stzainer D, Austin B, King
K, Luedicke J. Setting Policy Priorities to
Address Eating Disorders and Weight Bias:
Contrasting Views of Eating Disorders Profes-
sionals versus the U.S. General Public. BMC
Public Health, 2014; 14:524-533.
Dr. Rebecca Puhl is the Deputy Director
of the Rudd Center for Food Policy and
Obesity at Yale University. As a Senior
Research Scientist, she coordinates
research and policy efforts aimed at
reducing weight bias and improving
the quality of life of children and adults
affected by obesity. Dr. Puhl received her
Ph.D. in Clinical Psychology from Yale
University. Dr. Puhl has served on the
Council of The Obesity Society and on the
Board of Directors for the Obesity Action
Coalition. In 2013, she was awarded the
Excellence in Policy Research Award from
the Eating Disorders Coalition. More
information on Dr. Puhl’s work is available
at www.yaleruddcenter.org.
Research Summary:  Setting Policy
Priorities to Address Eating Disorders
and Weight Stigma By Rebecca Puhl, PhD
Deputy Director, Rudd Center for Food Policy & Obesity,
Yale University, New Haven, CT
Technology
5
➥  continues on next page
Virtually You: 5 Steps to Get REAL! about Digital ED Risks
By Bobbie Eisenstock, Ph.D., California
Facebook. Twitter.
Tumblr. Instagram.
Pinterest. What do
social media have to do
with eating disorders?
A lot.
Our media culture
today is more body image-driven than
ever. It is virtually impossible to escape
the onslaught of picture-perfect bodies
that populate TV shows and commercials,
splash the pages of magazines, and
inhabit the online world where digital
denizens can be seen flaunting themselves
on social media.
For many years now, research has dem-
onstrated a connection between what
we call traditional media – magazines,
television and advertising – and body
dissatisfaction, reduced self-esteem, a
drive for thinness and disordered eating.
Recent studies indicate that new media –
where you hang out in the digital media
culture or what you unintentionally stum-
ble upon – can affect body image, food
and weight concerns, especially if you
struggle with these issues. Navigating the
interactive digital media culture can be
a potentially more hazardous minefield
of ED risks than using traditional media
because it empowers us as both media
consumers and creators who can post
and share, copy and paste, and upload
and download content 24/7.
We have a media body image problem
and there is no simple solution. We cannot
screen out all of the potentially harmful
messages, but we can reduce risk factors
by taking control of media’s influence on
our lives. The key is media literacy. Media
literacy skills help to meaningfully ques-
tion and challenge images and messages
that may be detrimental to developing
positive body image and self-esteem while
reinforcing those that promote health and
well-being.
To help counteract the digital media
culture’s potential influence on normal-
izing unrealistic body standards, NEDA
partnered with my students from Califor-
nia State University, Northridge to create
NEDA’s Get REAL! Digital Media Literacy
Toolkit. After studying the research on
media and eating disorders and honing
their digital and media literacy skills, the
students applied what they learned to
their personal experiences with social
media and body image, and in some
cases disordered eating, to create the
toolkit activities.
The Get REAL! Toolkit is for everyone
who goes online with a digital device –
computer, smartphone, tablet or game
console. Share the toolkit with parent and
youth groups, middle and high schools,
colleges and universities, physicians and
mental health professionals to help them
think critically about media’s impact on
body image and our social, psychological,
emotional and physical health and well-
being. Here’s what you need to know and
what you can do to effectively use the
toolkit for yourself.
What You Need to Know to Get
REAL! about Digital Media and
Body Image
While media do not cause eating disorders,
media are one of the potential factors
that can affect body dissatisfaction and
low self-esteem, which subsequently lead
to eating disorders. How much of a role
media play depends on what and how
much media an individual uses, his or her
knowledge, skills, personal relationships
and experiences, and predisposition to
the complex interplay of contributing ED
factors. The shifting media landscape has
opened a new interactive milieu where
an ED’s insidious nature is particularly
worrisome because many of the images
and messages are posted and shared
by individuals who glorify the thin ideal,
compare appearances, promote body
shaming, and affirm eating disorders as a
lifestyle choice.
Digital Footprints. Unlike our use of
traditional media, in the digital media
culture we leave a trail behind that
creates a digital footprint of our lives: a
virtual extension of our thoughts, feel-
ings and social behaviors. Everything we
share and others share about us online
– intentionally or unwittingly – is part of
our virtual identity: content we create, all
of our “likes,” who we “friend,” videos
we watch, music we listen to, magazines
and blogs we read, games we play, hob-
bies and interests we enjoy, celebrities
we follow, apps we use, key words we
search, websites we visit, communities
we join, products we browse, buy and
review, and photos and selfies we tag,
tweet, post and pin. With every screen
touch or mouse click, our digital footprint
grows larger and reveals more about who
we are. There is a lot that can be virtu-
ally known about a person’s body image
and proclivity to determinants of eating
disorders.
Ana-Mia Networks. While social net-
working can improve practitioners’
ability to educate, prevent and treat
eating disorders, it can also circumvent
and hinder their efforts. Since the first
pro-ana (anorexia) and pro-mia (bulimia)
websites surfaced on the Internet, there
have been attempts to flag and ban the
content. With the increasing popularity
of social media, a cyber-underground of
6
 Virtually You: 5 Steps to Get REAL!  continued
➥  continues on next page
social networks that facilitate and sanc-
tion ana-mia behaviors has grown and
actions to censor ED-related hashtags,
posts and photos have intensified. Sever-
al social networks implement guidelines
prohibiting posting content that “actively
promotes or glorifies self-harm,” includ-
ing anorexia, bulimia and other eating
disorders, and direct users to websites
where they can find positive support.
Just how effective are these bans?
Evidence is emerging that censoring
potentially harmful content can have a
boomerang effect: instead of eliminat-
ing risk-inducing content, censorship has
led to a continuous renewal of ana-mia
sites and stronger connections within
the surviving blogs that create a virtu-
ally impenetrable support system for
sufferers. The result is that it is more
difficult for practitioners and public
health campaigns to reach bloggers with
relevant health-promoting information,
making it more important to focus on
early intervention.
What You Can Do: 5 Steps to
Get REAL!
Here are five practical steps to use NE-
DA’s Get REAL! Digital and Media Literacy
Toolkit to jumpstart your media literacy
skills in the digital culture.
1. Walk the walk and talk the talk.
Familiarize yourself with social media and
pro-ana and pro-mia messaging. With the
majority of children and teens constantly
connected to their digital devices, the
odds are that the ones who are at-risk
or already struggling with an eating
disorder are fluent in “thinspiration”
hashtags and blogs. If you are going to
help them counteract these messages,
you need to know what they are and
how to interpret them. Think critically
about who constructed the message
and why, techniques used to create it,
underlying meanings and points of view,
and different ways the message may
be interpreted by someone wrestling
with body image issues or suffering or in
recovery from an eating disorder.
2. Start early to help kids make wise
choices on the digital playground.
Get into the habit of going online to-
gether and ask kids to show you what
they do, where they go, and who they
know. Talk about what you see, hear
and read, listen to the words they use
to describe appearance, size and shape,
and help them interpret media messages.
This keeps the communication lines
open, improves their media literacy skills,
gives you an idea of their digital foot-
print, and provides an early warning sign
for certain ED symptoms. You probably
already know the advice about estab-
lishing media guidelines, and the rule
about keeping computers, smartphones,
tablets, TV and video games out of kids’
bedrooms to better monitor their media
time and choices. This is especially impor-
tant for children overly concerned about
their appearance and during adolescence
when body image anxiety is amplified.
3. Take advantage of teachable
moments.
Kids are starting to worry about their
weight and body image as early as
kindergarten. Help boost their self-
esteem and dispel unrealistic body
expectations by taking advantage of
unplanned circumstances that lend
themselves to talking about healthy
eating, positive body image, and self-
acceptance. Teachable moments are
opportunities to practice media literacy
skills. And, if the time is right, teachable
moments can be more effective than
asking a direct question that puts a
tween or teen on the spot about a
sensitive issue, making it more difficult to
discuss.
Teachable Tips: Point out where ultra-
thin models in ads have been digitally
retouched to slim hips and waist, create
a thigh gap and enhance their cleavage,
while explaining that people don’t look
like that in real life, and even if they did,
they would be unhealthy. Talk about
how posting critical comments about
a friend’s selfie might make him or her
feel about body image. Start a dialogue
about how to help a classmate who posts
body shaming videos of herself, invit-
ing strangers to comment if she is fat or
ugly, and what kids their age can do to
enhance their self-image. Use language
appropriate to children’s ages and stages
of development to help them understand
that someone may need to find the
right support to deal with pressures that
could lead to making unhealthy lifestyle
choices.
4. Support social action to counteract
digitally-altered body images.
There is a growing movement to create
transparency of digitally-generated
illusions of body perfection that
normalize unrealistic body expectations.
Some celebrities, who are the face of
popular culture and standardize cultural
body ideals, are speaking out against
retouched picture-perfect images that
reshape their appearance, even posting
unfiltered selfies to show how they
naturally look. Several advertisers and
retailers are voluntarily adopting “no
retouching” policies to be more socially
responsible. The Eating Disorders
Coalition introduced a bipartisan-
sponsored Truth in Advertising Act of
2014 (HR 4341) requiring the Federal
Trade Commission to study the health
consequences of digitally-altered human
images in advertising.
Social Action Tips: Advocate for a new
“normal” that celebrates healthy body
shapes and sizes with social media
shout-outs: like, text, tweet, pin and
post – and urge others to do the same –
about celebrities who expose retouching,
advertisers who practice transparency,
and campaigns that demand consumer
protection from deceptive body image
advertising. Call out companies that
feature unrealistically-altered body
images in their product advertising
and let them know you will use your
consumer power by not buying from
them.
5. Think critically about body image
every time you use media.
Empower yourself with a media literacy
lens on the digital world to help mediate
its potential influence on eating disor-
ders. Use NEDA’s Get REAL! Digital Media
Literacy Toolkit as a guide to deconstruct
and reflect on body image messages,
map digital body image footprints, and
take a stand to support actions that shift
the spotlight from limited and artificial
body stereotypes to more diverse and
authentic body ideals.  n
References:
Casilli, A., Pailler, F., & Tubaro, P. (2013). Online
networks of eating-disorder websites: Why
censoring pro-ana might be a bad idea. Per-
spectives in Public Health 133(2): 94-95.
Tiggemann, M., & Slater, A. (2014). NetTweens:
The Internet and body image concerns in
preteenage girls. The Journal of Early Adoles-
cence 34(5): 606-620.
Tiggemann, M., & Slater, A. (2013). NetGirls:
The Internet, Facebook and body image
concerns in adolescent girls. International
Journal of Eating Disorders 46(6): 630–633.
7
Need personalized guidance for yourself, or in support
of a loved one affected by an eating disorder?
The NEDA Navigators are here to support you!
NEDA Navigators* are individuals who have experience,
either personally or in support of a loved one, navigating
the overwhelming systems and emotions involved with
seeking treatment for an eating disorder. Volunteers, trained
by NEDA staff and program Clinical Advisors, are available to
help you find treatment referrals, local support groups and
resources tailored to your needs; be a listening ear during your
or your loved ones’ journey; provide encouragement through
a difficult time; and share their own story responsibly to offer
hope for recovery.
The range of experiences among the Navigators is diverse, and
when you request to be connected with a Navigator, we try to
match you with someone who has been through a similar set
of challenges and who can share their experiences in a helpful,
responsible way. You can request to speak with someone who
has dealt with co-occurring conditions such as depression,
substance abuse or self-harm; who shares similar aspects
of your identity such as ethnicity, gender, religion or sexual
orientation; or who has the same relationship to the person
struggling, such as a fellow mother, father, partner, spouse,
sibling, or friend.
To request a Navigator, visit us at http://www.nationaleating-
disorders.org/neda-navigators and we’ll get you connected.
For more information about the NEDA Navigators, visit the
Navigators homepage at www.myneda.org.  n
* Navigators are not mental health professionals or treatment
providers. They are PFN volunteers who have been through an eating
disorder themselves or with a loved one and are now in strong
recovery. Navigators are trained to help you identify resources,
treatment options, and be a source of support during your journey.
 Virtually You: 5 Steps to Get REAL!  continued
Bobbie Eisenstock, Ph.D. writes,
teaches, and consults about the social-
psychological effects of the emergent
digital media culture on children, teens,
and families. A national expert on media
literacy, she facilitates workshops to help
parents, educators, health practitioners,
Get REAL! Toolkit Guide
The toolkit activities will help guide you each step of the way. Check out
the toolkit, and get involved, at:
http://www.nationaleatingdisorders.org/get-involved/media-watchdog.
Step 1: Find out what your own digital footprint says about your body
image by mapping Your Digital Footprint and taking the Digital Body
Image Quiz.
Step 2: Test your media literacy knowledge by taking the Media Literacy
Quiz (answers are included) and start asking the right questions using
Media and Your Body Image.
Step 3: Develop your skills to deconstruct body messages with Media
Literacy Key Questions and Worksheet and encourage positive body
image with the Body Positive Pledge.
Step 4: Advocate for transparency and celebrate our natural looks, body
sizes and shapes using tips for Celebrity Shoutouts and Letter Writing
Guidelines.
Step 5: For more information, check out the Digital and Media Literacy
Resources.
Community Engagement Partnership to educate,
engage and empower us about media and body
image in the digital media culture
DIGITAL
MEDIA
LITERACY
TOOLKIT
California State University
Northridge
and youth advocates understand the
risks and realities of social media and
implement strategies to manage digital
footprints. Dr. Eisenstock is on the
faculty at California State University,
Northridge where she serves as a Fellow
at the Institute for Community Health
and Wellbeing and directs the Get
REAL! Project that created NEDA’s Get
REAL! Digital Media Literacy Toolkit.
In 2013, NEDA honored her with The
Westin Family Award for Excellence in
Activism and Advocacy. Contact her at
www.BobbieEisenstock.com
8
Shrinking Women
By Lily Myers, Connecticut
When I delivered my poem
“Shrinking Women” to a room
of a few hundred people at the
College Unions Poetry Slam Invitational,
I had no idea how far my words
would travel. The poem discusses my
experience grappling with the pressures,
inherited and internalized, that women
face to stay physically and metaphorically
small. I discuss the ways I have watched
women around me shrink, by denying
themselves food or by remaining
passive. After the video was uploaded to
YouTube, I watched, absolutely shocked,
as the number of views climbed into
the millions. My Facebook inbox soon
filled with messages from people I didn’t
know, sharing thoughts and support.
This shocked me too. Not only did many
people watch my poem, but some were
so moved by it that they reached out and
confided their own stories.
As a writer, it was exciting. As a person
with a private life, however, it was com-
plicated. Since I’d had no idea how far
the poem would reach, I hadn’t thought
twice about speaking intimately about
members of my family, most prominently
my mother. This is still difficult; I some-
times worry that people might be judging
me or her, and I have to quiet the voice in
my head that imagines that judgment. It
was jarring to have such a personal story
shared on such a wide platform. I know
it was even harder for my mom, and for
that I’m truly sorry. As I received more
messages, however, I began to realize
something: when people see my video,
they don’t see me. They see themselves,
their own histories and struggles. Wheth-
er or not they agree with me, everyone
who watches that video relates the words
to their own lives, not to mine. My story
grew to be something no longer con-
nected just to me. Dialogue and reflec-
tion were being generated from this seed
of an idea that I’d started writing alone at
my kitchen table. And that, to me, is the
most important thing that writing can do.
all sure she was right, I climbed to the
stage and recited it. And I’m so glad that I
did. Showing vulnerability is always a risk.
But it’s a risk that leads to connection,
humanization, and understanding — one
that allows us to see each other with all
of our human complexities and flaws. To
me, that’s a risk worth taking.
The near-ubiquity of social media meant
that the vulnerability I showed in that
room could be broadcast across the
world. While scary, the implications of
this are also amazing. It means that we
have the technological tools to spread
empathy and compassion. We have
the ability to send stories to millions of
people – stories that show us that we
are not alone in our experiences. If this
experience has taught me anything, it’s
that people want to be reached. People
want to express to others: I can relate to
your experience. We are together in this.
For all their faults, the internet and social
media can facilitate this expression on a
mass scale. That is an enormous amount
of power, and an immense amount of
compassion that we can generate.  n
Lily Myers is currently a senior at
Wesleyan University, where she is
involved in the slam poetry community.
She runs a blog dedicated to feminism,
self-compassion and body love;
check it out or send submissions at
http://shapeswemake.tumblr.com. She is
also currently working on a young adult
novel about family and body image,
due out in 2016. Follow her on Twitter:
@lmyerspoetry
An excerpt from “Shrinking Women” by Lily Myers:
“Across from me at the kitchen table, my mother smiles over red wine that she
drinks out of a measuring glass. She says she doesn’t deprive herself, but I’ve
learned to find nuance in every movement of her fork. In every crinkle in her
brow as she offers me the uneaten pieces on her plate. I’ve realized she only eats
dinner when I suggest it. I wonder what she does when I’m not there to do so.”
To watch the whole poem, visit http://tiny.cc/lgjmlx
Technology
The near-ubiquity of social
media meant that the
vulnerability I showed
in that room could be
broadcast across the world.
In almost every message I received,
people expressed their belief that the
themes in my poem need to be openly
discussed. Many gave their thanks for
speaking out about subjects that so often
cause shame and anxiety. These mes-
sages caused me to wonder: what would
happen if we all spoke out? What would
this world look like if everyone regarded
disordered eating and body image as “the
thing you talk about,” as one message
phrased it? Would there be less shame
surrounding these topics? Could we find
more empathy, similarity and common
ground? When others came to me and
said they could relate to my words, it pro-
vided comfort; proof that I wasn’t crazy
or an outlier. The power of knowing that
is hard to overestimate.
Funnily enough, I almost didn’t deliver
“Shrinking Women” that day. As I sat
in the final moments before my turn to
speak, I decided to read a different poem,
one that I thought was less controversial.
One that didn’t make me feel so exposed.
And then my friend Emily whispered in
my ear, “You have to do it. This is the
poem that people need to hear.” Not at
9
Technology
Proud2Bme (proud2bme.org) is a
space where teens and young adults
can connect with others and get
inspired to use their voices for personal
and social change. In a culture where
more than half of teen girls and nearly a
third of teen boys use unhealthy weight
control behaviors like skipping meals
and taking diet pills, we know that early
detection and youth outreach are critical
in the fight against disordered eating
and poor body image. We’re also acutely
aware that to get to young people with
messages that make an impact, we have
to meet them where they are — online,
in social media and even in the apps on
their smart phones. That’s why we were
thrilled to partner with Pixelberry Studios
on an eating disorder storyline, FAQ
section and helpline resources for the
latest version of their top 50 iOS/Android
game, “High School Story.” The game
has been downloaded by more than 10
million users. eating. Proud2Bme also serves as a
resource for players who might relate to
the story and need help for themselves
or a friend. The quest includes a direct
link to Proud2Bme.org and players can
also request further information or
referrals from NEDA Helpline staff within
the game itself.
Not every teen develops a diagnosable
eating disorder, but all of the young
people I work with through Proud2Bme
talk about how they often end up feeling
like they can never be good enough
when faced with a steady stream of
media messages and images that place
such a high value on “perfection.” We
can’t blame media simplistically for
disordered eating and weight obsession,
but we shouldn’t let them off the hook
either. “High School Story” addresses
this full spectrum by educating about
signs and symptoms of eating disorders,
while other characters in the game
discuss their body image struggles and
Proud2Bme Featured in “High School Story” Game
By Claire Mysko, MA, New York
appearance-related insecurities. A high
school yearbook photographer even uses
Photoshop, which sparks a conversation
about how so many of the images we
consume on a daily basis are really just
digital illusions.
In the eating disorders field, we must
continue to advocate for media literacy.
It is also imperative that we look for
creative ways to use media for positive
intervention. “High School Story” is one
of those interventions. Since the game’s
launch, Proud2Bme has received requests
from players asking for information on
how to help a friend, seeking support
in finding referrals and looking for
information on how to recognize when
your behavior is a problem. Players are
clearly connecting with the message
of self-acceptance. As one recent
Proud2Bme commenter shared: “I played
this quest on High School Story. It was
beautiful how she began to learn that she
is perfect no matter what size she is. :)”  n
To get to young people
with messages that make
an impact, we have to
meet them where they
are – online, in social
media, and in their apps.
What does a partnership with a gaming
company look like? It started out with a
series of calls with Pixelberry Studios to
discuss the theme of this “High School
Story” quest, which follows Mia, a teen
who relapses into disordered eating after
a friend makes an insensitive comment
about her weight. NEDA staff then
provided input on the scripts for the two-
part story with the goals of minimizing
triggering content and educating players
about the complexities of disordered
10
As of 2013, over
half of all adults
in the United
States (56%) own a
smartphone and 93%
of smartphone users
use their phone to
access information
online.1
With the
expanding interest in and availability
of smartphones, a growing number of
mobile health apps have been designed to
provide therapeutic assistance, either as a
stand-alone platform2, 3
or in conjunction
with conventional therapy.4, 5
Empirical
evaluations of health apps suggest that
they are effective as both a stand-alone
option and as a treatment alongside
existing in-person treatment. Some
advantages of mobile health apps for the
treatment of eating disorders (and other
psychological conditions) are:
1.	 Apps can deliver treatment with
or without the need (or at least
immediate need) of a clinician.
2.	 Apps can deliver consistent,
evidence-based psychological
treatments for eating disorders.
This ability is critically important
because there is a shortage of
specialists in ED treatment and
an even greater shortage of those
who utilize evidence-based prac-
tices for ED.6
3.	 Apps can collect symptom and
other clinical data throughout
the day, in a way that is likely to
be more complete and accurate
than a paper diary or a report to a
clinician.
4.	 Apps can present patterns of data
(for example, how emotional ex-
periences relate to eating disorder
symptoms, and how symptoms
have improved over the past
month)
5.	 Apps can deliver assistance in real
time and in the moment of need.7
6.	 Apps can use computerized
algorithms to help identify when
individuals might be at high risk
for a clinical episode (e.g., a binge
or purge), and intervene ahead of
time to prevent the episode.8
Our team recently completed a compre-
hensive review of commercially available
apps for eating pathology.9
We found a
total of 20 apps that fell into the catego-
ries of ED treatment apps, self-diagnosis
tools, referral sources, recovery support,
assessment tools or clinician tools. Of the
20 apps, six were aimed at the treatment
of EDs, five designed for ED psychoeduca-
tion, and nine were considered “Other”
Despite the limitations described above,
a few apps did contain notable features
that support their use either as a stand-
alone treatment or in combination with
in-person treatments. For example, one
app, Recovery Record, has the capability
for the user to log food and meal intake
(including specific food items eaten),
thoughts (through an open text field)
and emotions and feelings (through
Likert-type scales of overall energy levels,
overall feelings and specific emotions
such as guilt and anxiety), representing
a comprehensive self-monitoring sys-
tem. Recovery Record also allows users
to request coping strategies for in-the-
moment problems (e.g. negative emo-
tions), which are derived from CBT (e.g.
delaying or distraction from an urge) and
acceptance-based techniques (e.g. defu-
sion from distressing thoughts or urge
surfing). Users of this app also have access
to a social portal that allows the posting
of recent activity to an app-wide activity
feed and allows pairing with another user
to provide and receive support and share
coping tactics. A different app, BeforeIEat,
provides in-the-moment strategies for
dealing with urges through audio clips
explaining strategies such as urge-surfing,
cognitive defusion, distraction and self-
soothing, which are broadly based on CBT
and acceptance-based strategies.
Our review noted several future direc-
tions for ED apps. First, smartphone apps
are well-suited to improve adherence
to treatment recommendations outside
the therapeutic office. Reminders and
motivational messages to complete
homework assignments can be provided
between sessions,10-12
thus increasing
motivation and compliance with treat-
ment. Second, self-monitoring, one of
the core drivers of behavior change in
CBT-E, could be enhanced if completed
via smartphone, as entry and storage is
simpler than pen-and-paper methods.
Smartphone Apps for Eating Disorders
By Adrienne S. Juarascio, PhD, and Evan M. Forman, PhD, Laboratory for Innovations in Health-Related
Behavior Change, Drexel University, Pennsylvania
Evan M. Forman
(including a self-diagnosis tool, a tool for
finding referrals, a pro-recovery/support
app, assessment tools and a reference
tool for ED clinicians). Unfortunately,
our review revealed that few of the ED
intervention apps utilized evidence-based
treatment components. Instead, the
apps’ components tended to have little to
no empirical support. Examples of unsup-
ported components include guided im-
agery, positive affirmations, and generic
coping strategies such as “eat something
healthy.” Additionally, our systematic
review indicated that ED intervention
apps are not fully utilizing the advanced
capabilities of smartphone apps (e.g. au-
tomated data entry and personalized or
automatically delivered interventions).
➥  continues on next page
Technology
11
Real-time self-monitoring could also
be enhanced through in-the-moment
recording. Furthermore, the capabilities
of app sensors (e.g. GPS) allow for the
automatic recording of information to
reduce user burden. Apps also have the
capability to sync information within or
between apps and present instant feed-
back regarding behavior patterns to the
app user. The ability to view and analyze
patterns over time is another method of
facilitating behavior change.
TakeControl, also contains full evidence-
based, cognitive-behavioral self-help
treatment modules for binge eating.
Numerous smartphone apps for eating
disorders have been developed in just
a short period of time, and the overall
quality and ability of these apps appears
to be growing quickly. Undoubtedly, the
pace of development will only con-
tinue to quicken, though we would urge
consumers to be wary of apps that rely
on scientifically untested intervention
components.  n
Drexel University’s Laboratory for
Innovations in Health-Related Behavior
Change is currently in the process
of evaluating the smartphone app
TakeControl with beta users. If you are
interested in serving as a beta user for
TakeControl, please visit
http://drexel.edu/psychology/research/
labs/innovationlab/takecontrol, email
takecontrol@drexel.edu and/or call
215-553-7111.
Editor’s Note: NEDA, while supportive
of technological advances in the field,
recommends that anyone struggling seek
professional help from an ED specialist
and does not rely on an app as a stand-
alone treatment.
References
1.	Duggan, M. and A. Smith, Cell internet use
2013, in Pew Internet and American Life
Project 2013, Pew Research Center.
2.	Free, C., et al., The effectiveness of mobile-
health technology-based health behaviour
change or disease management interventions
for health care consumers: a systematic
review. PLoS medicine, 2013. 10(1): p.
e1001362
3.	Vandelanotte, C., K.M. Spathonis, E.G. Eakin,
and N. Owen, Website-delivered physical ac-
tivity interventions: A review of the literature.
American journal of preventive medicine,
2007. 33(1): p. 54-64
4.	Bauer, S. and M. Moessner, Technology-
enhanced monitoring in psychotherapy and
e-mental health. Journal of Mental Health,
2012. 21(4): p. 355-363
5.	Newman, M.G., L.E. Szkodny, S.J. Llera, and A.
Przeworski, A review of technology-assisted
self-help and minimal contact therapies for
anxiety and depression: Is human contact
necessary for therapeutic efficacy? Clinical
Psychology Review, 2011. 31(1): p. 89-103
6.	Van Den Berg, S., D. Shapiro, D. Bickerstaffe,
and K. Cavanagh, Computerized cognitive–be-
haviour therapy for anxiety and depression: a
practical solution to the shortage of trained
therapists. Journal of Psychiatric and Mental
Health Nursing, 2004. 11(5): p. 508-513
7.	Heron, K.E. and J.M. Smyth, Ecological
momentary interventions: incorporating
mobile technology into psychosocial and
health behaviour treatments. British journal
of health psychology, 2010. 15(1): p. 1-39
8.	Forman, E.M., M.L. Butryn, A.S. Juarascio,
S.M. Manasse, S.P. Goldstein, G. Naik, and
J. Segall. Utilizing ecological momentary
intervention to enhance and disseminate
CBT: The development of TakeControl, a
smartphone app for the treatment of binge
eating disorder. in International Conference
on Eating Disorders 2014. New York.
9.	Juarascio, A.S., S.M. Manasse, S.P. Goldstein,
E.M. Forman, and M.L. Butryn, Can Smart-
phone Applications Enhance the Treatment
of Eating Disorders?: A Systematic Review.
under review
10.	Bock, B., et al., A Text Message Delivered
Smoking Cessation Intervention: The Initial
Trial of TXT-2-Quit: Randomized Controlled
Trial. JMIR mhealth and uhealth, 2013. 1(2):
p. e17
11.	Patrick, K., et al., A text message – based
intervention for weight loss: randomized
controlled trial. Journal of medical Internet
research, 2009. 11(1)
12.	Suffoletto, B., C. Callaway, J. Kristan, K.
Kraemer, and D.B. Clark, Text-Message-
Based Drinking Assessments and Brief Inter-
ventions for Young Adults Discharged from
the Emergency Department. Alcoholism:
Clinical and Experimental Research, 2012.
36(3): p. 552-560
13.	Dölemeyer, R., A. Tietjen, A. Kersting, and
B. Wagner, Internet-based interventions
for eating disorders in adults: a systematic
review. BMC psychiatry, 2013. 13(1): p. 1-16
14.	Shiffman, S., A.A. Stone, and M.R. Hufford,
Ecological momentary assessment. Annu.
Rev. Clin. Psychol., 2008. 4: p. 1-32
15.	Runyan, J.D., T.A. Steenbergh, C. Bainbridge,
D.A. Daugherty, L. Oke, and B.N. Fry, A
Smartphone Ecological Momentary Assess-
ment/Intervention “App” for Collecting Real-
Time Data and Promoting Self-Awareness.
PloS one, 2013. 8(8): p. e71325.23977016
16.	Berg, K.C., R.D. Crosby, L. Cao, C.B. Pe-
terson, S.G. Engel, J.E. Mitchell, and S.A.
Wonderlich, Facets of negative affect prior
to and following binge-only, purge-only, and
binge/purge events in women with bulimia
nervosa. Journal of abnormal psychology,
2013. 122(1): p. 111.PMC3646562
17.	 Smyth, J.M., S.A. Wonderlich, K.E. Heron,
M.J. Sliwinski, R.D. Crosby, J.E. Mitchell, and
S.G. Engel, Daily and momentary mood and
stress are associated with binge eating and
vomiting in bulimia nervosa patients in the
natural environment. Journal of consult-
ing and clinical psychology, 2007. 75(4): p.
629.17663616
18.	Jansen, A., A learning model of binge eating:
cue reactivity and cue exposure. Behaviour
research and therapy, 1998. 36(3): p. 257-
272
19.	Stice, E. and W.S. Agras, Subtyping bulimic
women along dietary restraint and negative
affect dimensions. Journal of Consulting and
Clinical Psychology, 1999. 67(4): p. 460
20.	Edelman, R.E. and D.L. Chambless,
Adherence during sessions and homework
in cognitive-behavioral group treatment
of social phobia. Behaviour Research and
Therapy, 1995. 33(5): p. 573-577.7598680
21.	Schmidt, N.B. and K. Woolaway-Bickel, The
effects of treatment compliance on outcome
in cognitive-behavioral therapy for panic
disorder: quality versus quantity. Journal of
Consulting and Clinical Psychology, 2000.
68(1): p. 13.10710836
 Smart phone apps for ED  continued
Apps also have the
capability to present
instant feed­back
regarding behavior
patterns to the app user.
Lastly, future apps may involve the
provision of interventions that are far
more tailored to the individual based on
the ongoing collection of information
about that person.8, 15
Having in-the-
moment support can be particularly useful
in the context of EDs because episodes
of disordered eating behaviors (e.g.
restriction and/or binging and purging)
can be triggered by numerous internal
(e.g. negative affect, hedonic desire)16,
17
, and external (e.g. exposure to stimuli
associated with the behavior) factors.18
When exposed to these triggers, the urge
to engage in disordered eating behavior is
high as these behaviors provide temporary
pleasure and/or relief from tension.19
In
these moments of high distress, patients
may struggle to recall and attempt skills
taught in the therapy office or feel unable
or unmotivated to implement them.20, 21
Consequently, when faced with strong
urges to engage in disordered eating
behavior, access to adaptive coping
strategies (via the smartphone app) may
facilitate skill use by providing reminders
of the skills taught, as well as step-
by-step instructions on how to utilize
strategies in moments of high distress.
Our team is completing development
of an app for binge eating that collects
real-time information about eating
patterns, emotions, binge eating triggers
and binge episodes, and automatically
delivers a personalized intervention at a
time when a computerized algorithm has
identified that the user is at high risk of
a binge eating episode. This app, called
12
Supporting the ED Population through Telemental Health:
Technological and Clinical Implications
By Martha Ireland, PhD, RN, CS, CEDS, DCC, Virginia
The introduction
of new technolo-
gies that provide
additional treatment
options for eating
disorder clients has
evolved my practice
immensely over the
past 25 years. Years ago, the only ef-
fective and widely accepted treatment
option was an in-person session, which
made continuity of care and accessibil-
ity to qualified ED therapists much more
challenging for those in need than it is
today. With the introduction of secure
video teleconferencing (VTC) systems in
the past few years I now have the ability
to effectively support and treat my ED cli-
ents even when they are homebound due
to illness, lack transportation, need to
travel for business or pleasure or live in
remote locations that are too far away to
make regular in-person sessions feasible.
Half of my sessions are now delivered via
VTC. I embrace technology, and firmly
believe in the positive impact it can make
in supporting the client’s unique needs
and circumstances, but it is important
to understand that there are a variety
of clinical implications to consider when
adopting new technolo­gies.
There are so many options today for
using technology to connect from a
distance – texting, chatting, emailing and
video teleconferencing, just to name a
few – but not all formats are secure or
appropriate for the therapeutic process.
I personally find video teleconferencing
to be the best option for my ED clients,
and insurance companies seem to find it
the most favorable for reimbursement
approval. Regardless of what type of
technology is used to deliver therapy,
it is imperative that the technology be
accessed over a secure platform. The
clinician is responsible for making sure the
delivery system used is compliant under
the Federal Health Insurance Portability
and Accountability Act (HIPAA) and Health
Information Technology for Economic and
Clinical Health (HITECH) laws.
The approaches used in VTC will vary
by therapist, and I would not suggest a
therapist using any approach that he or
she does not utilize in face-to- face ses-
sions. It is possible to adopt a multidisci-
plinary approach even when the client is
located at a distance. These approaches
include utilizing local supports, such as
a nearby medical doctor, dietitian and/
or therapeutic groups as well as develop-
ing a crisis plan, in order to create a safe
and confidential environment on their
side of the computer. It is also important
to communicate with the client about
clinical boundaries, particularly concern-
ing availability and use of social media
such as Facebook and blogs. The clini-
cian’s guidelines and policies around the
therapeutic use of technology, including
the client’s responsibility for maintain-
ing confidentiality and privacy at their
location during the sessions, should be in
writing and signed by the client after they
have been explained by the clinician and
understood by the client.
Discussing these policies and boundaries
with the client opens up the discussion
of how the client is using technology
and how they can limit their time spent
looking up websites that may be prob-
lematic for them. It is also helpful to find
out if the client is spending time in virtual
reality environments. Their avatars and
“second life” activities can provide insight
into their psyches and often disassocia-
tion and body image issues. This discus-
sion is frequently neglected in face-to-
face sessions if the clinician is unfamiliar
with technology or “cyber worlds.”
The millennial generation tends to grasp
VTC technology and navigate the site
much more easily than some of my older
clients. Without hesitation the millenni-
als will speak as though I am in the same
room, show me their art projects and
pets and jump into disclosing their vul-
nerable thoughts and feelings from the
comfort of their homes, which can make
containing the conversation a challenge
compared to traditional therapy.
Clinicians have asked me if I find it
problematic that I cannot see the
person’s whole body during the session;
the evaluation of the full body language
is important in the therapeutic process.
It has been my experience that the
view of the head down to the upper
chest area gives me a fairly accurate
picture of the client’s body language. I
am able to assess if the client is having
difficulty sitting comfortably during the
session but I am not able to see if they
are continuously moving their legs to
burn calories or using leg movements
to soothe themselves; I have to ask the
client directly for this information.
Eye contact while using VTC is more
direct and closer than in an office session
and it can initially be intimidating for
the client. The client’s level of comfort
with eye contact can indicate a struggle
with depression or relationship intimacy
issues. I have found that as the therapeu-
tic relationship strengthens eye contact
improves.
Clients who are suffering from poor body
image will sometimes struggle to see
their images while talking to me. They
will be distracted: fixing their hair, adjust-
ing the screen to exempt their body or at
times trying to move the screen so that I
can’t look at them. The client’s struggle
is also apparent when I see their eyes
shift like a pendulum, from the camera
to the picture and back to the camera.
Confronting that behavior is always an in-
teresting conversation. There is frequent-
ly shame that emerges, which usually
does not surface so early in a traditional
therapy session.
Telemental health does not attempt to
eliminate or replace the value of face-to-
face therapy sessions. It is a tool that, if
used appropriately, allows therapists to
support clients in a more consistent man-
ner, maintaining the therapeutic relation-
ship and treating those clients who might
not have local resources available.  n
Martha H. Ireland PhD, RN, CS, CEDS,
DCC is the Co-founder of Virtual Therapy
Connect (www.virtualtherapyconnect.com)
Recently she launched an online
initiative to support eating
disorder prevention in Virginia at
www.StudentEatingDisorders.info. She
also operates a private practice in Virginia
and routinely speaks about integrating
technology and psychotherapy.
13
Volunteers in the NEDA Loss
Support Network know the unique
type of grief experienced by those
who have lost a loved one to an
eating disorder, and they are
available to help support those
who have lost someone. If you
would like to become a volunteer
to support others or request
support from a Loss Support
Network member visit www.
myneda.org/loss-support-network
LOSS SUPPORT NETWORK
Byte-by-byte,
together as a
community, we
are edging closer to
equitable access to
gold standard care that
is enabled through
technology. We are
witnessing and shaping a generational
shift in the decentralization of care away
from brick-and-mortar clinics and toward
flexible treatment that is integrated into
our daily lives.
If you have an eating disorder today, you
have more options available to you than
ever before. These initiatives are expand-
ing the access and reach of treatment,
from step-down treatment and home
care programs to online counseling and
therapy to helplines and navigators, such
as those offered by NEDA. These new
options recognize that an eating disorder
is with an individual 24/7, it can strike
at any moment, and we need options to
be readily available 24/7. We know that
care solutions need to fit a wide variety
of budgets, lifestyles and personal needs,
should improve outcomes and should not
sacrifice medical efficacy.
Treatment engagement is often not
a motivation problem, but an access
problem. It is difficult to overstate the
awesome potential of smartphone
technology to transport effective
treatment into people’s daily lives. Over
200,000 people living with an eating
disorder have already added one mobile
app to their recovery arsenal. This app is
Recovery Record.
Recovery Record built its free mobile
app to make effective, best-practice
treatment available to everyone who
needs and wants it. When downloaded,
a person who has or believes they have
an eating disorder can expect to have a
continuous, secure and personal connec-
tion to many of the active ingredients of
treatment, including Cognitive Behav-
ioral Therapy (CBT), meal, behavior and
thought monitoring, and best-practice
coping skills. Testifying to the growing
power of mobile care, Recovery Record
users have already completed in excess
of six million of these therapeutic tasks.
Mobilizing Eating Disorder Treatment
By Jenna Tregarthen, Founder of Recovery Record, California
Mobile apps may not be for everyone;
some people prefer keeping up with ther-
apy tasks by using pen and paper, while
there are others for whom access to a
smartphone is not a possibility. These
limitations aside, it is clear that mobile
technology is here to stay and is helping
to drive the evolution and revolution of
eating disorders care.
Mobile technology also has the unique
potential to reach those who are living
in the shadows with their condition. 33%
of Recovery Record users have not yet
disclosed their eating disorder to anyone
in the world – except the app. For these
people, the app is a safe and convenient
first point of contact for care. A user can
immediately connect with in-person care
by clicking the NEDA Helpline feature,
at which time they’ll be able to connect
with another person for information,
referrals and resources.
For others, the greatest appeal is the
option of connecting members of their
clinical team with the app, expanding
the care they receive. Speaking to this
benefit, Jessica, who has been using
Recovery Record with her care team
for three months, said “It has helped
me to stay accountable between visits,
when I’m really struggling. Personalized
messages through the app encourage
me to work through specific issues in the
moment, versus weeks after the event.”
Jessica’s psychologist commented, “The
app lets me get inside my patient’s head
in ways that I cannot in session – I always
know what issues to address and focus
on the most.”  n
Technology
14
What is the
best way to
disseminate
evidence-based
treatments to
clinicians who treat
patients with eating
disorders? How do
we make sure that clinicians are aware
of and properly trained in the most up-
to-date treatments? How will clinicians
receive ongoing supervision with experts
in the field to ensure that patients get
continued high-quality care? The Weight
Management and Eating Disorders Lab
at Washington University School of
Medicine, directed by Denise Wilfley,
PhD, in collaboration with study principal
investigators Stewart Agras, MD, Stanford
University, and G. Terence Wilson, PhD,
Rutgers University, hypothesize that the
answer is technology. Through generous
support from the National Eating
Disorder Association’s Feeding Hope
Fund, Drs. Wilfley, Agras, and Wilson plan
to test if new and innovative technology
can eliminate barriers to receiving quality
training in the use of effective treatments
to therapists.
Standard methods of training clinicians,
such as traditional in-person workshops,
can be expensive, time-consuming and
offered infrequently to a relatively small
number of participants.1
Furthermore,
ongoing supervision (e.g., continued
evaluation and feedback) can be imprac-
tical, given the lack of trained supervisors
in evidence-based treatments.2
The use of web-based programs may
offer innovative new training methods
to decrease or eliminate these barriers.
Benefits of using web-based programs
include the easy accessibility of online
training by a large number of therapists
regardless of geographic location; the
ability to repeatedly access training
information anywhere at any time; and
the ease of performing website updates,
allowing therapists to stay abreast of new
information.1
Additionally, online train-
ing platforms allow for the collection of
data on clinicians’ usage of the program,
which can provide information on the
most accessed program features, inform-
ing program refinement for future use.
To evaluate whether or not the use of
technology can more readily disseminate
effective treatment methods to
clinicians, the study team is developing
a guided online program to train
college counseling center clinicians
in interpersonal psychotherapy (IPT),
which is an evidence-based therapy for
the treatment of bulimia nervosa, binge
eating disorder and subclinical disordered
eating.3-9
IPT is a focused, brief treatment
that targets interpersonal problem(s) and
negative mood associated with the onset
and/or maintenance of eating disorders
(EDs). IPT is supported by substantial
empirical evidence documenting the role
of interpersonal factors and negative
mood in the onset and maintenance of
EDs. The study team chose IPT for its
ideal qualities for dissemination: it is
evidence-based, widely applicable and
generally acceptable to both clinicians
and patients. College clinicians were
chosen as the ideal therapists to train
because eating disorders occur at a
higher rate in college-aged populations,
yet many students receive either no
treatment or non-evidence-based care
for these types of problems. The aim of
the study is to see if online training and
supervision in IPT are as effective as
traditional, in-person workshop-based
training and supervision methods.
The study further aims to assess the
efficacy of a telephone-based simulation
assessment in increasing the reliability
and time-efficiency of feedback and
supervision, while reducing the need for
live patient practice. Treatment fidelity
➥  continues on page 16
NEDA’s Feeding Hope Fund
and Technological Innovation
In 2013 NEDA awarded the inaugural Feeding Hope
Fund grants, supporting projects that focus on clinical
research and training dissemination. The 2013 winning
grant proposals were “Family Based-Treatment
Without Borders: Utilizing Telemedicine to Deliver
Family-Based Therapy (FBT)” by Daniel Le Grange, PhD;
and “Harnessing Technology for Training Therapists to
Deliver Interpersonal Psychotherapy (IPT)” by Denise
Wilfley, PhD. These studies unite traditional therapies
with technologically innovative met­hods and reinforce
the significance of technology in eating disorders
treatment.
The Feeding Hope Fund will raise restricted funds designated
for the distinct purpose of providing grants to:
•	 qualified clinical researchers who have been selected
through our very competitive application process
•	 qualified clinical experts providing creative submissions
for advancing the training and dissemination of
evidence based treatments to fellow clinicians
What is the Feeding Hope Fund?
Harnessing Technology for Training Therapists to Deliver Interpersonal
Psychotherapy (IPT) By Denise Wilfley, PhD, Missouri
Technology
15
Anorexia nervosa (AN) is a seri-
ous psychiatric disorder highly
recognized for both its physical
and psychological stress on the hu-
man body. Peak onset for AN is dur-
ing adolescence, and successful treat-
ment during this time is critical to
ensuring long-term remission. Family-
based treatment (FBT) is a therapy
in which parents play an active role in
order to help their child recover from an
eating disorder, and is in common use
for adolescents with AN. In standard
practice FBT requires family meetings
with a therapist at least weekly for the
first two to three months of treatment,
and then bi-monthly for a period of six
to nine months. This has typically been
accomplished by families traveling (often
far distances) to tertiary medical centers
for treatment, which is not optimal for
many families. Dissemination of FBT has
been complicated due to several factors,
including limited numbers of trained
FBT therapists and a concentration of
trained therapists in urban centers. Due
to a particularly limited availability of
FBT therapists in rural or remote areas,
many families do not have access to this
evidence-based treatment.
With the high demand for evidence-
based treatment for AN, The University
of Chicago Eating Disorders Program
is very excited to be leading a study
entitled “Family-Based Treatment With­
out Borders.” The aim of this study is
to examine the feasibility of delivering
FBT to adolescents with AN utilizing
telemedicine. The use of telemedicine
has been previously applied in the
delivery of eating disorder treatment (i.e.,
cognitive-behavioral therapy for bulimia
nervosa) and found to have equivalent
outcomes to treatment delivered in
traditional face-to-face therapy (Mitchell
et al., 2008). Participation in the study
at The University of Chicago involves
adolescents between the ages of 13-18
years of age living with their families,
meeting the DSM-5 criteria for AN. All
families participating in this research
study receive 20 no-cost therapy sessions
for AN conducted via video conferencing.
To facilitate treatment via video con-
ferencing, researchers at The Univer-
sity of Chicago are utilizing a secure
HIPAA-compliant portal to deliver all
treatment-related activities. Using this
software, members of the The University
of Chicago team are able to manage all
consents, questionnaires, assessments,
communication and video conferencing
related to this study through a secure
internet-based platform.
Preliminary data is currently being col­
lected through the first wave of five par-
ticipating families. Feedback from these
families, as well as from the members of
the research team, has been extremely
positive thus far. Families are finding
that the software is user-friendly and
that both the video and sound aspects
of this portal are extremely clear, mak-
ing it easy to conduct a therapy session
without technological glitches. Co-Prin-
cipal Investigator and lead thera­pist for
the study, Kristen Anderson, LCSW, has
found that there are only slight modifica-
tions needed to the treatment manual
to deliver FBT through telemedicine.
This includes parents weighing their
child at home prior to the session
and sending that information to the
therapist. Patients are also using the
secure messaging system provided
by the software to communicate with
therapists instead of communicating
via email and telephone.
As the study progresses, the treatment
team at The University of Chicago
has begun to think about additional
applications for the use of telemedicine,
including facilitating support or skills
groups for parents of children with eating
disorders. We are eager to continue
collecting data through this novel study
and excited about what these results may
mean for the future of eating disorder
treatment. To find out more about
our program research, please visit our
website at www.psychiatry.uchicago.
edu/page/eating-disorders-program
and Facebook at www.facebook.com/
UofCEatingDisordersProgram.  n
References
Mitchell, J.E., Crosby, R., Wonderlich, S., Crow,
S., Lancaster, K., Simonich, H., Swan-Kremeier,
L. … Myers, T.C. (2008) A Randomized trial
comparing the efficacy of cognitive-behavioral
therapy for bulimia nervosa delivered via
telemedicine versus face-to-face. Behav Res
Ther, 46(5), 581-592.
Kristen Anderson, LCSW, is the Clinical
Director and a therapist at the Eating
Disorders Program at The University of
Chicago Medicine. She treats adolescents
and young adults with eating disorders.
Her research interests include the
treatment of adolescent eating disorders,
including the use of innovative technology
to deliver treatment.
Family Based-Treatment Without Borders: Utilizing Telemedicine to
Deliver Family-Based Therapy (FBT)
By Kristen Anderson, LCSW, Clinical Co-Director, Catherine Byrne, BA, Research Assistant, and Daniel
Le Grange, PhD, Professor and Director Eating Disorders Program, The University of Chicago Medicine, Illinois
Kristen Anderson Catherine Byne Daniel Le Grange
➥  continues on next page
16
7. Wilfley, D. E., MacKenzie, K. R., Welch, R.
R., Ayres, V. E., & Weissman, M. M. (2000).
Interpersonal psychotherapy for group. New
York: Basic Books.
8. Wilfley, D. E., Welch, R. R., Stein, R. I.,
Spurrell, E. B., Cohen, L. R., Saelens, B. E.,
Dounchis, J. Z., Frank M. A., Wiseman C. V., &
Matt G. E. (2002). A randomized comparison
of group cognitive-behavioral therapy and
group interpersonal psychotherapy for the
treatment of overweight individuals with
binge-eating disorder. Archives of General
Psychiatry, 59(8), 713–21.
9. Wilson, G.T., Wilfley, D. E., Agras, W. S.,
Bryson, S.W. (2010). Psychological treat-
ments of binge eating disorder. Arch Gen
Psychiatry, 67(1), 94-101.
10. Alinier, G., Hunt, B., Gordon, R., Harwood, C.
(2006). Effectiveness of intermediate-fidelity
simulation training technology in undergradu-
ate nursing education. J Adv Nurs, 54(3),
359-369.
Denise Wilfley, Ph.D., is the Scott Rudolph
Professor of Psychiatry, Medicine, Pedi-
atrics, and Psychology at Washington
University School of Medicine in St. Louis.
She has received over $25 million from
the NIH to study the etiology, prevention,
and treatment of eating disorders and
obesity. Her research has established the
diagnostic significance and treatment of
binge eating disorder. She co-developed
the Healthy Body Image Program, an
evidence-based online platform for eat-
ing disorder screening and intervention.
She is President of the Eating Disorders
Research Society, a Fellow of the Acad-
emy for Eating Disorders, and a member
of the NEDA Research Advisory Council.
Catherine Byrne, BA, is a research
assistant at the University of Chicago
Medicine. She will be starting a clinical
psychology PhD program at George
Mason University in Virginia this fall,
where she plans to continue her research
in eating disorders and body image.
Daniel Le Grange, PhD, is Professor of
Psychiatry and Behavioral Neuroscience
and Director of the Eating Disorders
Program at The University of Chicago
Medicine. He studies psychosocial inter­
ventions for children and adolescents with
eating disorders.
 Le Grange et al.  continued
(how well clinicians adhere to a new
treatment) is traditionally assessed by
expert raters who listen to recordings
of clinicians’ sessions. This method can
be time-consuming and is dependent
upon adequate numbers of both
expert raters and ready-for-treatment
patients.1,2
Simulated assessment has
proven effective (adaptable, efficient
and accurate in assessing training) in the
medical field,10
and has several potential
advantages over traditional supervisory
methods. The telephone simulation in
this study will feature different scenarios
of standard “patients” with symptoms
of disordered eating with whom the
therapists will practice using IPT.
 Denise Wilfrey  continued from page 14
BECOME A MEDIA WATCHDOG
he Media Watchdog program empowers consumers
to advocate for positive media messages. This means
recognizing and celebrating advertisements that send
healthy body image messages, as well as taking the time
to express our concerns about advertisements that send
negative body image messages or promote unrealistic ideals.
When we act together, we have a stronger voice to hold
advertisers and entertainment media accountable for the
impacts of their media messages. Visit the Media Watchdog
homepage to alert NEDA about a praise-worthy or protest-
worthy advertisement/media message, download how-to
instructions on deconstructing an advertisement, check for cur­
rent Media Watchdog Action Alerts and more information on
becoming a media activist!  n
T
If the study hypothesis proves true, and
online training is as effective as in-person
training, the study team plans to further
explore the use of technology in training
even more clinicians in IPT using web-
based models. This reproducible, low-
cost training method would ultimately
enhance the dissemination of evidence-
based treatment for eating disorders,
improving access to high-quality care.  n
References
1. Fairburn, G. C., Wilson, G. T. (2013). The dis-
semination and implementation of psycho-
logical treatments: Problems and Solutions.
Int J Eat Disord, 46(5), 516-521.
2. Bush, T. (2005). Overcoming the barriers to
effective clinical supervision. Nurs Times,
101(2), 38-41.
3. Agras, W.S., Walsh, B.T., Fairburn, C.G.,
Wilson, G.T. Kraemer, H.C. (2000). A
multicenter comparison of cognitive-
behavioural therapy and interpersonal
psychotherapy for bulimia nervosa. Arch Gen
Psych., 57, 459-466.
4. Arcelus, J., Whight, D., Langham, C., Baggott,
J., McGrain, L., Meadows, L., Meyer, C.
(2009). A case series evaluation of a modified
version of interpersonal psychotherapy (IPT)
for the treatment of bulimic eating disorders:
A pilot study. Eur. Eat. Disorders Rev., 17;
260-268
5. Hilbert, A., Bishop, M.E., Stein, R.I., Tanofsky-
Kraff, M., Swenson, A.K. Welch, R. R., &
Wilfley, D. E. (2012) Long-term efficacy of
psychological treatments for binge eating
disorder. British Journal of Psychiatry, 200,
232-237.
6. Tanofsky-Kraff, M., Wilfley, D. E. (2010).
Interpersonal psychotherapy for the
treatment of eating disorders. Oxford
Handbook of Eating Disorders, (Agras WS,
ed.). New York: Oxford University Press.
NEDA’s Helpline is available to direct you to support group
options in your area, whether you are a family member,
friend or pursuing recovery. Call us at 800-931-2237 or
search online: www.nationaleatingdisorders.org/support-
groups-research-studies
17
My hand hovers over the mouse.
I hesitate. I slowly turn and look
behind me. The bespectacled
girl at the desk behind me has her head
buried in a stack of books, surrounded by
two Starbucks cups and an array of post-
its, highlighters, and pens.
Before I can stop myself, my finger is
clicking on the “Open new tab” button
and I’m rapidly typing in the web address
of my favorite website comparing celeb-
rity body types. My pupils dilate and my
hand begins to sweat. Who are we talking
about today?
A photo of Katy Perry in a royal blue bi-
kini appears on the screen. I immediately
begin evaluating her body and scrolling
through the comments, my eyes glued to
the screen.
Girlfriend needs a tan…
Way to go, Katy. If only my boobs
were so voluptuous.
Wow, what happened to her? She
used to be hot.
Pheww, I’m glad I don’t look like her.
And that is how it goes for the next hour.
I don’t get any work done and I become
more and more absorbed in the hamster
wheel of judging other people’s bodies,
the futile chase of trying to find the per-
fect body. Guess what? It doesn’t exist.
Three years of therapy later, I am fully
aware of the detrimental effects of social
media on body image, everything from
innocuous-sounding “healthy living
blogs,” where bloggers post photos of
perfectly portioned meals, to the pristine
bikini photos my friends post on Face-
book to the Twitter wars of “don’t eat
this/do eat this.”
I was not alone among the hordes of
unhealthy students I saw on campus
throughout my four years attending the
University of Pennsylvania. It had nothing
to do with how they looked; it was the
snippets of conversations I overheard on
Locust Walk on my way to class.
The gym-clothes-clad sorority girl
walking in front of me says to her
friend, “I can’t believe I ate that piece
of cake! Gotta go to the gym and burn
it off. Want to come?”
“Oh, I forgot to eat lunch. I was stuck
in the library all day!”
What I got from recovery is that language
matters. The language we use to describe
ourselves and to describe others, it
matters. We have a choice though. We
can choose to accept the words as true
or we can honor ourselves and what we
are committed to. Our words create our
worlds. We can live in a world where we
listen to what we’re told as the truth or
we can create the world that we want to
live in.
In October 2013, I first formulated the
idea of what my Tumblr blog, Penn
Poised, would evolve to be over the next
few months: a pathway to show people
that how we see ourselves matters,
and it starts with our relationship with
our bodies. I wanted it to be a group
committed to increasing awareness
of body image issues on campus and
promoting healthy ways of thinking about
our bodies. Most of all, I wanted everyone
to see the elephant in the room, front and
center, zoomed in to hair-inside-the-nose
resolution. Our first awareness campaign
took the form of a photo shoot turned
social media experiment. Where better to
reach people than the internet?
The photo shoot showcases a wide array
of views and experiences. Some students
chose to highlight what they love about
their bodies: they can run and dance
and hold graceful yoga poses. Others
chose to point out the unrealistic societal
standards of the world we live in, where
there is an “ideal” that we are supposed
to look like and if we don’t, we are
subject to other people’s judgments and,
most destructively, our own. My most
startling experience of the photo shoot
was the courage of all the young men
and women who participated. Everyone
who came for their half-hour time slot
over the course of two days gave 100% of
themselves in the photos, shedding all of
their pretenses and showing the camera
their pure and unadulterated humanity.
I hope that when people see the photos
on our Tumblr and Facebook page, they
see twenty beautiful people, not bod-
ies. When I first posted my own photos
online, I was terrified. I thought it would
be just like the websites I was addicted
to where my body was up on the cutting
board, waiting to be ripped into pieces by
people’s judgments and criticisms. Not
only did the photos reveal more skin than
I am usually comfortable with showing
on the internet (where anyone can see),
but these photos are a raw expression of
what I stand for in the world. It took all
of my courage to push the “post” button
while my heart was thundering in my
chest. It felt like diving into a pool with
my eyes squeezed shut.
What surprised me in the coming days
and weeks was that the photos them-
selves received very few comments.
However, according to Facebook statis-
tics, from April 16th until July 14th, 6,796
people were reached by our main photo
shoot post and our page had 216 likes.
People were definitely taking notice of
Penn Poised; they just weren’t concerned
about nit-picking my body. How about
that? My body is not the center of the
world, contrary to popular belief.
The message I am conveying to the
world is just that: we are not our bodies.
We are individuals with more strength,
perseverance and courage than I can
imagine, and to define ourselves by what
we look like is to limit the possibility of
who we are. Who we are is the possibility
of a world of love and acceptance and we
are creating it, one photo at a time.  n
Laura MacKinnon writes about her
experiences with anorexia in high
school and college with the intention of
empowering people who are struggling
with body and food issues. She hopes to
spread the message that eating disorders
are 100% preventable and recoverable
Laura has a Bachelor’s of Science degree
in Bioengineering and is currently doing
research on mindfulness at the University
of Miami.
Penn Poised: Rewriting the Social Media Script
By Laura MacKinnon, Florida
18
As the Jewish New
Year rapidly ap-
proaches, people
may find themselves
feeling anxious about
the holiday season.
Anxiety may be particu-
larly acute for individu-
als who struggle with
eating disorders or who
are in various stages of recovery. Jewish
holidays can also be stressful for family
members caring for a loved one with an
eating disorder.
Judaism’s festivals can be experienced
as a cyclical pattern of feast and famine,
and thus particularly fraught for those
struggling with eating disorders. The
holidays start with Rosh Hashana, the
Jewish New Year, a two day ‘feast.’ The
day after Rosh Hashana is Tzom Gedaliah,
a daytime fast, which is soon followed by
Yom Kippur, a 25 hour fast. The autumn
holidays culminate a few days later with
Succot (Feasts of Booth), a seven-day
harvest holiday. Thus, the fluctuations in
eating patterns that are integral to the
experience of Jewish holidays are likely to
disrupt the highly structured and regu-
lated meal plans of those in recovery,
and may throw them off balance. Fasting,
usually prohibited for individuals with
eating disorders, is risky as it may trigger
food restriction, while the many large
festive meals may feel overwhelming and
binge-like.
This framework, however, misses the
essence of what is meaningful about the
cycle of Jewish holidays. Judaism is a reli-
gion rich in symbolism. On Rosh Hashana,
we eat foods that are round and sweet
to represent the cyclical nature of the
year and our lifecycles. On fast days, we
abstain from food not to punish our-
selves, but rather to liberate ourselves
from bodily preoccupations and direct
our attention to introspection and prayer.
Finally, on Succot, we build a temporary
outdoor dwelling, a sukkah, in which
friends and family dine together. The suk-
kah is unique in that it is required to have
a lattice roof through which we can see
the sky. These symbols are reminders that
the essence of life is not physical posses-
sions or external appearance but rather
our relationships with loved ones, nature
and god.
When the focus of the holiday centers on
food alone, the Jewish holidays can be
experienced as overwhelming. However,
self-care tools that integrate the symbol-
ism and meaning of each holiday can help
to create positive, healthy and spiritual
experiences.
Symbolism of Honey
An additional highlight of Rosh Hashana is
dipping apple in honey. The combina­tion
of these foods symbolizes two ideas; the
gustatory sensation of the tart apple with
the sweet honey represents balance.
Life is about developing balance and
perspective; most of life is not perfectly
sweet or completely tart. Thus, ideally,
the holidays create reflective moments
of balance to remind us that life is not
about food, but rather that life includes
food. There is an additional custom of
dipping bread in honey for every festive
meal from Rosh Hashana through Succot,
including the meal prior to the Yom Kip-
pur fast (also considered a holiday meal).
Symbolically, by adding honey to some-
thing basic like bread, we remind our-
selves that wonderful opportunities are
everywhere, but we have to be open to
receiving and including them in our lives.
A self-care tool may be to share some-
thing that has added particular sweetness
or meaning in your life this past year,
week or day. Some families go around the
table and share their thoughts during the
holidays. You may also consider selecting
one food that you plan to enjoy eating at
each holiday meal and share its meaning
as a symbol of balance.
Symbolism of Community
and Communication
Eating disorders are often accompanied
by depression and isolation, so the
social demands of the holidays can be
challenging. The festive meals, communal
prayers and food ceremonies are
designed to bring people out of their
lonely states. Sadly, one can feel lonely
and isolated even when surrounded by
others. The prayer service has moments
of individual prayer and moments of
collective prayer – there are times to be
alone with one’s thoughts, and times to
sing, pray and beseech together.
A self-care tool may be to discuss in
advance who will be at the various meals
and whom you might be most comfort-
able sitting beside. It may be helpful to
prepare some topics of conversation that
will facilitate connecting with family and
guests.
Symbolism of Foods that are Round
The year, regardless of the calendar one
follows, is cyclical in nature. The con-
cepts of beginnings, renewal and hopes
for the future are inherent in the eating
disorder recovery process. A central
tenet of the Yom Kippur fast day is the
idea of repentance. Human beings make
mistakes. Yom Kippur is an opportunity
to acknowledge and understand our
mistakes, and, most importantly, forgive
others and ourselves. It is an opportunity
to release the fear and shame that may
inhibit future growth and recovery. While
past holidays may have been painful, this
year they can be uplifting and nurture a
renewed spirit. This year, try to focus on
forgiving yourself and allowing yourself
to be in the moment.
A self-care tool may be to create a simple
mantra, such as ‘this year is different – this
year I am different,’ that you can repeat to
yourself. This soothing self-statement can
be helpful and empowering.
Best wishes for good health and sweet-
ness in the New Year.  n
Sarah R. Roer is a psychologist with a PhD
in Clinical Psychology (Health Emphasis)
from Yeshiva University’s Ferkauf
Graduate School of Psychology. Her area
of focus, both in research and clinically,
is in the field of eating disorders. Her
previous clinical experiences include work
at The Renfrew Center of New York, St.
Luke’s Obesity Research Clinic in New York
and Hadassah Ein Kerem in Jerusalem.
Sarah’s area of research has focused on
Binge Eating Disorder, Emotional Eating
and Night Eating Syndrome, a subject on
which she presented at the Academy of
Eating Disorders. Dr. Roer maintains a
private practice in Manhattan and works
as a psychologist in the Ramaz Upper
School.
Navigating the Jewish Holiday Season
By Sarah Roer, PhD, New York
19
20
“I don’t know what’s going on when my wife is off at treatment. She comes home
saying things that don’t make sense — and I suspect she’s twisting some thera­pist
or dietitian’s words for her own purposes. But how do I know? I have no idea what
she’s being told. I’m completely on the dark. And I resent that.”
“I’m damned if I do, and damned if I don’t. Everything about this eating disorder
makes me want to scream. And I am terrified that my son is gonna die.”
“Why does the treatment program operate like they only need to treat the client?
Aren’t I a client, too? I influence my daughter more than some psychologist can.
But I can’t tell anymore whether my influence is good or bad … and whether I’m the
reason for the eating disorder. Maybe she and my family would be better off if I just
disappeared.”
Dealing with the Dilemmas of Men Who Have a
Loved One with Eating Disorders By Joe Kelly, California
➥  continues on next page
Every person with
an eating dis-
order has men
in her or his family:
husbands, partners,
exes, fathers, step-
fathers, brothers,
stepbrothers, cousins,
grandfathers, uncles and friends. These
male loved ones (aka MLOs) deal with
substantial dilemmas in the face of eat-
ing disorders — and they tend to do so
silently, in isolation.
So what do MLOs say about their dilem-
mas? First, you have to ask. Eating disor-
ders advocate Don Blackwell instigated a
survey of about 100 fathers participating
in 2014 NEDA walks. Approximately 80
percent of those fathers felt challenged
by a sense of fear and helplessness. But
only around half say they’re likely to par-
ticipate in e-mail or in-person meetings
with other fathers.
Since 2011, I’ve facilitated male-only
coaching groups for nearly 100 men in
Minnesota and California who have a
loved one with eating disorders. Many of
these men already participated in treat-
ment program multi-family groups, ANAD
support groups and other “co-ed” gather-
ings for friends and family. However, they
admit that their discussions are far more
restrained in those settings than in our
male-only groups.
Our participants report feeling impotent
in the presence of an illness they describe
as irrational, unpredictable, cunning,
powerful, stubborn, clever, baffling, devi-
ous, unfair and unjust. They struggle to
understand and articulate how the eating
disorder crisis affects their own lives.
They are angry and grieving over how the
illness’s arrival altered relationships with
their loved ones and hijacked their families.
These MLOs want to know how (and if) it
is possible to make their loved ones get
better — as well as how (and if) it is pos-
sible for a MLO to keep his sanity in the
process. They want to master the logical
arguments that will convince their loved
ones to give up the eating disorder. Their
most frequent refrain is: “Tell me what
to do.”
We men like to solve problems; this is
a wonderful trait. We (quite rationally)
want a plan that will lead to solutions.
When confronting eating disorders, there
are things we can do, but we can’t expect
those things to “fix” this problem.
Unfortunately, there is no silver bullet
cure for eating disorders or surefire way
to eliminate their impact on concerned
bystanders. As eating disorders expert
Margo Maine, PhD says about this
unreasonable illness, “Logic doesn’t
work; love does.”
The most effective responses to the
dilemmas of living with eating disorders
aren’t always obvious. In fact, they are
quite counter-intuitive — no surprise,
given the paradox and illogic of eating
disorders themselves.
At the top of my list for MLOs are self-
care, loving detachment and radical
acceptance. When I introduce these
concepts, many MLOs object: “What are
you talking about? I need to take care
of my loved one and focus on defeating
the eating disorder! What good could it
possibly do to go off and do ‘self-care,’ or
to accept and detach from the problem? I
don’t even know what ‘self-care’ means!”
For starters, self-care is not self-indul-
gent, self-centered or selfish. Instead, it
is essential human nourishment fed by
simple, rejuvenating activities like taking
a walk, dining out with a friend, meditat-
ing, reading, shooting hoops and the
like. Yes, it means temporarily removing
ourselves from the person with the eat-
ing disorder, but (paradoxically) this is a
good thing.
Here’s why: The eating disorder self
works hard to pull us loved ones into its
distorted way of perceiving and thinking
about the world. It thrives on drawing
us into arguments, arguments we simply
can’t win. It loves having us rise to the
bait of reacting in kind to its melodra-
matically intense behavior.
The challenge for MLOs is to stop react-
ing (e.g., attempting to argue with, pun-
ish or shout down the eating disorder)
and start responding — with calm words
and actions which keep our focus where
it belongs.
For example, self-care is a response that:
•	 Provides perspective by stepping
away from a chaotic and
manipulative illness
•	 Reminds us that we have a life
outside of the eating disorder vortex
•	 Strengthens our connections and
fellowship with other loved ones
and friends
•	 Clears our head and releases
emotional tension
•	 Helps us remember that our
struggling loved one is more than
an eating disorder; she or he is a
genuine person of value
•	 Demonstrates to our loved one’s
authentic self that healthy self-
nurturance is worth fighting for
Now, this approach may not make any
sense to you. Or, it may make sense in
principle, but appear impossible to pull
off. Either way, I ask you to consider
whether or not it actually works. Keep-
ing in mind our sample size of around
100 men, preliminary results indicate the
concrete benefits of learning this self-
care approach. For example: we surveyed
participants before and after the coach-
ing group; in the “post participation” sur-
21
vey, men report feeling 16 percent more
competent and 18 percent more hopeful
about dealing with the eating disorder.
Therapists, physicians and dietitians who
refer men for coaching report that nearly
every one of the men is more involved
in the identified client’s treatment than
they were before the coaching began —
by bringing the client to appointments,
asking questions, emailing the treatment
providers, etc. The providers also report
that the clients themselves notice a posi-
tive difference in how their MLOs are
responding to the eating disorder.
Men who try self-care, loving detach-
ment and radical acceptance see results.
These are things we can do, and which
produce outcomes like: “I’m much clearer
about what’s going on now. I still hate
it, but I feel like I finally know what my
choices are.”
This approach won’t cure an eating disor-
der or guarantee that anyone (other than
ourselves) will change their behavior. But,
as one husband put it, there are payoffs:
“It’s an opportunity to learn, to grow, to
become closer to your loved one. Even if
she isn’t involved in this particular activ-
ity, you’re gonna gain an understanding.
You discover you’re not alone. It makes
it a lot easier to talk about. And as soon
as it’s easier to talk about, things are
gonna be getting better.”  n
Joe Kelly has spoken at several NEDA
conferences and wrote the best-seller
Dads & Daughters®: How to Inspire,
Understand, and Support Your Daughter
and (with NEDA Past President Dr. Margo
Maine) The Body Myth: Adult Women
and The Pressure to Be Perfect. He
coaches men who have a loved one with
eating disorders — via the Internet — to
develop skills to reduce their stress
and support their loved one’s recovery
(www.joekelly.org/coaching-for-men). Joe
also consults with treatment providers
on how to mobilize and utilize men in
families. Contact him at joe@joekelly.org
or 510.423.0553.
Calling all Dads: Roll out the rolo-
dex! I am betting many of you have
sold Girl Scout cookies for your
daughter’s troops. After all, you were the
one with the list of contacts, and your
daughter needed your help. Did you bring
the sign-up sheet into work? Cart in cases
of cookies and distribute them across
your office?
Maybe the first year you were a little
hesitant, not wanting to ask your co-
workers to put up the money, but it
became easier the second year, once
you had seen that people were willing to
contribute. More importantly, it became
easier once you saw how happy, and how
proud of you, your daughter was.
Selling Girl Scout cookies for my daugh-
ter’s troop was the last time I had asked
anyone to contribute to anything until
recently. After the first five years of my
youngest daughter’s battle with anorexia
I was compelled to raise money for the
New York City NEDA Walk.
That first year I was hesitant; hesitant to
tell her story and even more hesitant to
reach out to others for contributions. I
persevered because I was touched and
motivated by what I had seen my daugh-
ter and so many others suffer through
year after year. I sent emails to several
hundred people: grammar school class-
mates; coworkers from years ago; friends
from the different towns we have lived in;
contacts from my current job and count-
less others. The response was incredible.
The first year I was fortunate enough to
raise close to $10,000. Donations ranged
from $25 to a few as high as $500. More
importantly, it was apparent that many of
the people I had emailed knew someone
who suffered from an eating disorder.
Others were moved by my daughter’s
story and were appreciative of the
glimpse into what this insidious disease
can do to someone and their family.
I felt proud that I had accomplished my
goals, both raising money for and rais-
ing awareness around eating disorders.
While enduring the realization that I
could not “fix it” for my daughter, for
once I was able to actually do something
positive for the cause.
Similar to selling Girl Scout cookies, the
second, third and fourth years were much
easier. As I have continued to support
the NYC Walk, I expand my contact list
to include people I have met in the past
year. Last year I raised $15,000 for NEDA’s
programs and its research funding.
NEDA, in addition to creating many fan-
tastic programs for those affected by eat-
ing disorders and their families, donates
money through the Feeding Hope Fund
for eating disorders research. Those of
you who have been living with someone
suffering from an eating disorder know
its baffling power and are all too aware
of the need for research and the need
for funding. NEDA Walks are essential to
meeting the organization’s funding and
research goals. The annual New York City
Walk raises $160,000–$175,000 and I
believe it has an even greater potential.
Many of the NEDA Walk team captains
are the patients who have suffered and
they reach to their friends and family for
contributions. I applaud them to no end.
Today, however, I am asking you, the
DADs, to reach into your rolodexes, your
email address books, your Linked In
contacts and your Facebook accounts.
Reach out, spread the word about eating
disorders and raise some funds. We can
foster research to prevent this disease
from impacting our children’s children.
We are the ones with the long list of
contacts. We are the ones who can make
a difference. Believe me, many of your
contacts will have an extremely positive
reaction if you reach out to them…at
least as positively as that first time you
sold them those Girl Scout Cookies. This
is your chance to help.  n
Calling All Dads
By Steve Sexton, New Jersey
 Dilemmas of Men  continued
22
Upcoming 2014 NEDA Walks:
bring communities together to increase eating
disorders awareness and raise funds for NEDA in a fun way. They
not only work to support the mission of NEDA, but also work
to bring awareness and education to the local communities in
which they take place. NEDA Walks that are coordinated by NEDA
Network Members return a majority of the funds back to the
local community and 2013 was the first year of the NEDA Walks
scholarship program, which sent local Walk Coordinators to the
NEDA Conference free of charge. Help NEDA support individuals
and families affected by eating disorders in local communities
around the country by registering for a walk near you!  n
NEDA Walks
The first-ever Vermont NEDA walk was
a long time coming. I had been hanker-
ing to participate in a walk for ages; I
had been following NEDA social media and
email, hoping that I would get a notice one
day that someone was planning an event in
Burlington. But that’s the key: if you want to
show support for something you care about,
you can’t wait for someone else to start the
planning.
I was fortunate enough to serve, over the past academic year,
as the president of the University of Vermont chapter of Mortar
Board Senior National Honor Society. With that responsibility
NEDA Walk Volunteer Spotlight
By Bronwen Hudson, NEDA Walk Coordinator, Vermont
came the incredible opportunity to gather together the mem-
bers, lead the group in an organizational initiative, and plan the
first NEDA Walk to ever occur in our state.
As we began to advertise the event, more and more volunteers
popped up; many people reached out, letting me know how
excited they were for the walk, and to tell me that they had also
been waiting a long time for an event in the area. There is a phe-
nomenal and extremely supportive community in Vermont; we
had a turnout of over 100 people, raised almost $8,000, and our
speaker Annie Cressy’s words moved and inspired the crowd. All
that was needed was a single decision to make it happen. I only
wish all my choices in life could be so meaningful.  n
Louisville, KY NEDA Walk
University of Louisville Lacrosse Stadium
Louisville, KY
Saturday, September 20, 2014
Albany, NY NEDA Walk
The Crossings of Colonie
Albany, NY
Saturday, September 27, 2014
Hartford, CT NEDA Walk
University of Connecticut Greater
Hartford Campus
Hartford, CT
Saturday, September 27, 2014
Jefferson City, MO NEDA Walk
Cole County Park
Jefferson City, MO
Saturday, September 27, 2014
Terre Haute, IN NEDA Walk
Indiana State University – Michael
Simmons Student Activity Center
Terre Haute, IN
Saturday, September 27, 2014
Wilmington, NC NEDA Walk
Hugh MacRae Park
Wilmington, NC
Saturday, September 27, 2014
Iowa City, IA NEDA Walk
Willow Creek Park
Iowa City, IA
Saturday, October 4, 2014
Lancaster, PA NEDA Walk
Long’s Park
Lancaster, PA
Saturday, October 4, 2014
Denver, CO NEDA Walk
City Park
Denver, CO
Sunday, October 5, 2014
New York City NEDA Walk
Foley Square
New York, NY
Sunday, October 5, 2014
Baton Rouge, LA NEDA Walk
North Boulevard Town Square
Baton Rouge, LA
Saturday, October 11, 2014
Virginia Beach, VA NEDA Walk
Mount Trashmore
Virginia Beach, VA
Saturday, October 11, 2014
NEDAWALK
NATIONAL EATING DISORDERS ASSOCIATION
Save a Life
23
Everyone has his or her own special reason for participat-
ing in a NEDA Walk: it could be to celebrate personal
recovery, to support a friend or family member, or to
honor the memory of a loved one. Sharing our stories of
strength, recovery and hope brings us together as a commu-
nity and shines the spotlight on eating disorders.
NEDA Walks are about building a supportive community,
and NEDA Walkers can now spread that message online by
using the #WhyINEDAWalk hashtag. By sharing our personal
reasons for walking we are spreading the word and inviting
others to join the movement.
Because everyone has a reason: #WhyINEDAWalk
Here’s a few #WhyINEDAWalk reasons we’ve heard recently:
“I walk to show people recovery IS possible and they are not
alone.” —@MAEH82
“I walk because I deserve to be happy  healthy :) I am
saying no to my ED and choosing recovery instead!”
 — @1975trumxn
“I walk because eating disorders are significant public
health concerns that demand attention and urgent action.”
 — Rachael
Baltimore, MD NEDA Walk
W Chesapeake Avenue and
Washington Avenue
Towson, MD
Sunday, October 12, 2014
Cleveland, OH NEDA Walk
The Holden Arboretum
Willoughby, OH
Saturday, October 18, 2014
Houston, TX NEDA Walk
T.C. Jester Park
Houston, TX
Saturday, October 25, 2014
Mullica Hill, NJ NEDA Walk
Ella Harris Park
Mullica Hill, NJ
Sunday, October 26, 2014
Asheville, NC NEDA Walk
Pack Square Park
Asheville, NC
Saturday, November 8, 2014
Summerville, SC NEDA Walk
Town Square
Summerville, SC
Saturday, November 8, 2014
Twin Cities, MN NEDA Walk
Mall of America
Bloomington, MN
Sunday, February 22, 2015
San Diego, CA NEDA Walk
NTC at Liberty Station
San Diego, CA
Saturday, February 28, 2015
Phoenix, AZ NEDA Walk
Phoenix Zoo
Phoenix, AZ
Sunday, March 1, 2014
 Upcoming 2014 NEDA Walks  continued
NEDAWALK
NATIONAL EATING DISORDERS ASSOCIATION
Save a Life
NYCNEDAWALK.ORG
NYC NEDA Walk
October 5, 2014
Foley Square
REGISTER  RAISE:
24
eating disorders, as well as increase
awareness about the signs and symp­toms
of eating disorders.
In Pennsylvania, legislation was intro-
duced calling for schools to educate
parents about the signs and symptoms
of eating disorders, as well as designing
an optional school screening program.
Several volunteers from across the state
gathered in Harrisburg for a Pennsylvania
Eating Disorders Lobby Day, where they
were given the opportunity to educate
legislators on the bill’s importance.
Emily Rosenberg, a college student and
Pennsylvania resident, spoke about her
personal struggle with an eating disorder
at a Lobby Day press conference and at
an August hearing of the Pennsylvania
House Democratic Policy Committee.
The bill has garnered bipartisan support,
which we will continue to build upon over
the next several months.
In 2015 NEDA’s STAR Program plans to
introduce legislation in several states
across the country, focusing on building
support for school-based screenings for
eating disorders; improving access to
care; and limiting barriers to treatment,
such as insurance complications. These
legislative reforms made possible
through the efforts of STAR Program
advocates, and we hope that in 2015
even more advocates will get involved
and take action in their states.
Your legislators want to hear from
you, and you can make a difference
by becoming a NEDA STAR Program
advocate. If you are interested in getting
involved or learning more, contact
NEDA’s STAR Program Manager Kerry
Dolan at star@myneda.org.  n
Working Toward Legislative Reforms: NEDA’s STAR Advocates Make
Strides Across the Nation By Kerry Dolan, STAR Program Manager, New York
Solutions Through Advocacy 
Reform (STAR) Program
NEDA established the STAR Program to legislatively advocate for
aware­ness, education, early intervention and prevention programs,
funding for research, and improved access to treatment of eating
disorders by speaking with legislators, mobilizing members, and
forging alliances with other groups who share our vision. STAR is
driven by passionate volun­teers. You don’t need experience to make
a difference.
Contact star@myneda.org for more information.  n
was a busy year for
NEDA’s Solutions Through
Advocacy and Reform (STAR) Program.
With major legislative victories in New
York and Missouri, a successful lobby day
in Pennsylvania and an awareness resolu-
tion introduced in Arizona, our STAR
advocates made a huge difference and
paved the way for future reforms.
In Arizona, Senator Katie Hobbs
introduced a resolution on the Senate
floor to officially declare National Eating
Disorders Awareness Week in Arizona.
Dedicated STAR advocates met with
Senator Hobbs at the Capitol to discuss
eating disorders reforms, and the group
was recognized on the senate floor as
Senator Hobbs read the resolution.
This was a big step in educating Arizona
legislators about the importance and
seriousness of eating disorders. The
group hopes to build on this success by
introducing legislation next year to create
a statewide school-based screening
program for eating disorders.
Our Missouri advocates saw yet another
victory this year, when legislation was
passed to establish the Joint Commit-
tee on Eating Disorders. The Committee
will review the regulation of insurance
and other matters impacting the care
and treatment of eating disorders and
will make recommendations for future
legislative action. In the coming months
the Committee will travel throughout
the state to gain a better understanding
of the needs of Missourians who are im-
pacted by eating disorders. This is an im-
portant victory in the fight against eating
disorders, and we hope that it will pave
the way for additional insurance reform
legislation. NEDA thanks Annie Seal and
our STAR Program advocates in Missouri
for their tireless efforts and dedication to
fighting eating disorders.
In New York, the State Senate and
Assembly passed S2530/A5294, legis­
lation amending the public health law to
establish the Eating Disorders Awareness
and Prevention Program within the New
York State Department of Health. This
program will promote available resources
and services to those who suffer from
2014
25
ARTS FOCUS
To be a ballerina is to be disciplined.
Every day we wake up sore, tired
and inspired for our day’s work.
We take class, beginning at the barre,
going through a sequence of exercises
(always in the same order), then into the
center with our tendus, bettements and
pirouettes, then small, medium and large
jumps. We wear a specific pointe shoe
that fits our feet personally. All dancers
have their own style – a way we like to do
their hair, our favorite stretching routines
and, of course, our diets. Yes, ballerinas
are disciplined, and with that discipline
comes an inherent desire for control.
Many of us find comfort in these daily
routines; but when it comes to food, that
ritualization can hurt us.
I love dancing — that’s never been the
issue. Feeling strength, control and
freedom in movement is an amazing
thing. But at times it’s hard to look at
myself in the mirror for so long every day.
Sometimes I find the slightest flaw and
obsess over it. Standing next to my peers,
I sometimes view our differences – I’m
curvy, others are not – as negative. But
sometimes I realize that my curves are
powerful – literally. Are my hips bigger
than those of some other girls? Sure, and
that means I can jump higher because of
all that muscle. It’s the ability to capture
this thinking in my darkest moments
that has helped me to stay positive, but
this doesn’t happen for everyone. I want
other dancers to find their strength and
embrace their bodies.
Take Back the Tutu
By Brittany Adams, Minnesota
we as a company had done something
to really help the students. To have a
ballet studio be the place where you are
comfortable speaking openly about body
image? That’s amazing!
We also wanted to open the public’s
mind to the many ways that professional
dancing can affect artists’ eating habits.
While some dancers remain unaffected,
others struggle with eating disorders.
Many dancers are under pressure from
their companies, their mentors and their
role models, while others do not find the
same pressure. To “Take Back the Tutu”
is to be empowered to take ownership of
our art and to throw away the idea that
we have to look a certain way to wear the
tutu. We invite you to join us: take back
your own tutu.  n
To read our reflections in full and to see
the accompanying photos by Caroline
Yang, visit http://www.emilyprogram.
com/blog/take-back-the-tutu/
For more of Caroline’s work with Saint
Paul City Ballet, visit her Instagram:
@carolineyangphoto.
The concept of “Take Back the Tutu”
came about during a small meeting of
some of Saint Paul City Ballet’s dancers
and board members. I wanted to
illuminate two truths about the dance
world: firstly, many dancers do struggle
with body image – it can be an obsession
due to constant scrutiny of their bodies.
Secondly, dancers do not have to starve
themselves to make it to the top.
We decided to use social media to raise
awareness, and we brought our company
together to write reflections on healthy
body image. What we created was
thoughtful, heartfelt, and honest. Each
individual brought personal perspective
and insight to the project. The reflections
were topped off with beautiful pictures
by photojournalist Caroline Yang. She
showed us as athletic, strong and
powerful dancers. It was an uplifting
and therapeutic week for all of us as we
posted one reflection and photo per day,
and positive feedback poured in.
We partnered with The Emily Program
of St. Paul, Minnesota for guidance and
education. They read and approved our
statements. They loved the campaign so
much they posted the project in a blog.
Sarah Hrudka, Outreach Specialist at The
Emily Program, came to the studio and
gave an informational talk to our older
students. The girls were engaged in and
inspired by all that Sarah had to say, and
they huddled around her, asking ques-
tions for almost an hour following the
talk. It warmed my heart to know that
PFN Webinars Series: Upcoming and Recently Archived
LEVELS OF TREATMENT – Led by Zoe Bisbing, LMSW
Thursday, September 25, 2014, 2:30 to 4:00 PM EST
The Role of Nutrition Therapy
in Treating Eating Disorders
Recorded live on August 14, 2014
Obtaining Treatment Authorization in
Complex World of Insurance
Recorded live on July 10, 2014
To register for an upcoming webinar, or view a recorded webinar, visit www.nationaleatingdisorders.org/webinars
26
BLOG
REVIEW
The Eating Disorders Hope (EDH) blog
offers a unique digital space that
visitors can rely on for informed,
well-sourced eating disorders informa-
tion. Each featured post serves to rein-
force EDH’s mission: “to foster apprecia-
tion of one’s uniqueness and value in the
world, unrelated to appearance, achieve-
ment or applause.” Contributors include
psychologists, specialists, therapists and
EDH affiliates, so visitors to the site can
expect reliable sources, helpful statistics
and supporting references throughout
the blog. EDH explores a range of sub-
jects, including book excerpts, authors’
personal accounts and recent ED studies.
Eating Disorders Hope is particularly
successful when discussing the diversity
of those who are affected by eating
disorders. Posts illustrate the impact of
EDs on adolescents (Impact of Eating
Disorders on Younger Generations),
highlight the scarcity of resources
available for men (Men and Eating
Disorders: The Struggle for Treatment),
explore eating disorders and pregnancy
(Pregnancy, Body Image, and Eating
Disorders and Pregorexia and How Eating
Disorders Impact Pregnancy), discuss
the roles of cultural variables (Ethnicity
and Eating Disorders: What Does The
Research Say) and explore the factors,
including susceptibility to negative body
image, that affect gay men and men
struggling with their sexual orientations.
EDH makes a point of writing about,
and for, all individuals, regardless of
their gender, age, ethnic background or
sexuality.
Despite its overall inclusiveness, there
are groups whose perspectives are not
addressed; there is a lack of posts on
intersex, transgender or genderqueer
individuals. Additionally, in posts such as
Summertime Swimsuits and Body Image
Issues, the focus on women’s struggles
with their body images during the sum-
mer season excludes men, who are just
as vulnerable to media messages that
advocate obtaining an ideal (and impos-
sible) ‘beach body.’
Even so, the blog deserves kudos for
representing the often-unrecognized
Submit a Book Review
Eating Disorders Not Otherwise Specified
(EDNOS), which are eating disorders
that cannot be categorized as anorexia
or bulimia. One particular post calls
attention to obsessively exercising
(Hypergymnasia – The Eating Disorder
that Isn’t). Such an issue may be difficult
to identify, as it can be disguised as
a normal routine in everyday life.
Many of these “hidden” diseases call
for serious medical attention. In Body
Dysmorphic Disorder (BDD) and Cognitive
Behavioral Therapy, the syndrome
Body Dysmorphic Disorder (BDD) is
profiled; BDD causes individuals to live
with a constant, negative perception
about their appearance. Like all eating
disorders, these illnesses must be spoken
about openly, and by publishing articles
about EDNOS, EDH succeeds in raising
awareness.
The Eating Disorders Hope blog provides
ample insight and resources for those
who wish to enhance their understanding
of all eating disorders, and it is especially
notable for its attention to marginalized
groups and Eating Disorders Not Other­
wise Specified (EDNOS), as some eating
disorders blogs tend to overlook EDNOS.
The Eating Disorders Hope blog manages
to provide accurate and overwhelmingly
inclusive information about eating
disorders in an accessible, easily
navigable archive.  n
Eating Disorders Hope
http://www.eatingdisorderhope.com/blog
reviewed by Christina Colon, Communications Intern, New Jersey
In the spirit of our Technology issue,
this edition’s book review is a blog
review. We would love to hear your
thoughts about the inclusion of blogs
in our resource reviews; please send
feedback to pffnetwork@myneda.org.
Have you read a book recently that offered you insights, tools or helpful information?
Write a review for the newsletter!
All you have to do is submit a 1-page article to pffnetwork@myneda.org that includes:
;; Your name and contact information
;; Title of book, author, publisher and copyright date
;; A brief summary of the content of the book
;; What you gained from the book: Hope, tools for recovery, strategies for self-care,
encouragement, educational information, etc.
* Book reviews are provided by individual PFN members to share with others what they have gained from
reading a book that served as a resource to the reviewer. NEDA does not endorse any specific book or author,
but rather provides a space for our constituents to share resources with one another. NEDA reserves the right to edit book review
submissions prior to publication. If your review is edited, you will be provided the updated version for your approve prior to publication.
Eating Disorders
HOPE
27
Staff
Spotlight
Meet the NEDA Staff!
Network
Spotlight
The National Association for Males with Eating Disorders (NAMED)
NEDA Network Spotlights are provided by the partnering organi-
zation. The NEDA Network is a collaboration between NEDA
and other like-minded organizations dedicated to our cause.
Together, we provide a unified voice of strength, advocacy and
support in the fight against eating disorders. To learn more and
explore member benefits, please contact network@myneda.org
NETWORK MEMBER
NAMED (www.namedinc.org) is a non-
profit organization committed to enhanc-
ing professional and public awareness
around the male experience of eating
disorders. NAMED provides information
and support for males affected by eating
disorders and promotes the develop-
ment of effective clinical intervention
and research in this population. NAMED
also works to accurately transfer leading
scientific advances to the lay public and
aims to dispel the stereotypes and stigma
surrounding male eating disorders.
NAMED advocates for male inclusiveness
in access to treatment and interface with
national and international media plat-
forms. Further, NAMED aims to facilitate
research collaboration between clinicians
and academic researchers, develop an
advisory board, integrate with existing
eating disorder organizations and provide
liaison and advice to community treat-
ment services.
Founded in 2011 by Chris Clark, a Florida
man recovering from anorexia nervosa,
NAMED was until recently a one-man
operation. In 2014, the organization was
restructured with a new board of directors
that includes leading academic and clinical
specialists. Tom Wooldridge, PsyD, from
Golden Gate University’s Psychology
Department and Stuart Murray, PhD,
a postdoctoral fellow at UCSD’s Eating
Disorders Center for Treatment and
Research, share the co-executive
directorship. Leigh Cohn, MAT, CEDS,
publisher of Gürze Books and coauthor of
two highly regarded books on males and
eating disorders, is the current president of
NAMED and brings 35 years of professional
expertise in the eating disorders field.  n
Caitlin Hamilton has
been an integral
part of NEDA’s
Communications
Department since
joining the team
in May 2013. As
Media  Communications Manager,
Caitlin ensures that NEDA’s social media,
emails and blog stay lively, active and
informative and keeps NEDA’s voice
prominent both online and in print.
Originally from California, Caitlin moved
to New York City to attend graduate
school at NYU, where she completed
her Master’s degree in Media, Culture
 Communication. Prior to joining
NEDA, she worked in Communications
for international nonprofits, print
publications and television media.
Media  Communications Manager is
not Caitlin’s only title at NEDA; as Deputy
Fire Marshall she helps keep the office on
schedule for fire drills and as Assistant
Fun Czar she created an office-wide “ugly
holiday sweater party” and organizes
general office frivolity as needed.
Outside of NEDA, Caitlin enjoys exploring
Brooklyn, practicing yoga, listening to
podcasts, making origami and travelling
as much as possible.  n
Caitlin Hamilton
Media  Communications Manager
The Oklahoma Eating Disorders Associa-
tion (OEDA) is a not-for-profit organi-
zation dedicated to the prevention of
disordered eating, eating disorders and
negative body image by raising aware-
ness, providing education and serving
as the leading resource of support and
identification of treatment resources
throughout Oklahoma and neighboring
states. Founded in 2008, OEDA desires
to lead and advocate for both public and
professional education and the treatment
of eating disorders. OEDA aims to further
its mission, vision and values through
community and professional events as
well as referral services for all comers.
In 2014, OEDA increased statewide
awareness of eating disorders by
participating in numerous National Eating
Disorders Awareness Week activities
throughout Oklahoma and hosting a
NEDA walk. On September 19, 2014
we will host our annual Conversations
of Hope event. This event, free to all,
is an evening focused on awareness,
recovery and hope for all eating disorders
sufferers, their friends, family and
the community at large. To improve
professional awareness and education,
OEDA hosts networking luncheons,
providing education for the varied pro­
fessionals involved in the treatment of
eating disorders. Our second professional
symposium, “Making an IMPACT
with Eating Disorders,” is planned
for September 12, 2014 in Norman,
Oklahoma. This event will bring together
a group of nationally recognized experts
to improve our knowledge of eating
disorder prevention and care.
OEDA is a proud member of the NEDA
Network, joining with our sister organi-
zations to promote awareness, healing
and the prevention of eating disorders.
For more information please visit us at
www.okeatingdisorders.org.  n
The Oklahoma Eating Disorders Association (OEDA)
National Eating Disorders Association
165 W. 46th Street, Suite 402
New York, NY 10036
PHONE: 212.575.6200  FAX: 212.575.1650
HELPLINE: 800-931-2237
info@nationaleatingdisorders.org
www.NationalEatingDisorders.org
Thank you to our generous Sustaining Sponsors for helping to make our programs
and services possible.
Gold:	 Eating Disorder Center of Denver, Eating Recovery Center, Monte Nido and
Affiliates, 4Girls Foundation
Silver:	 Remuda Ranch at the Meadows, Rogers Memorial Hospital
Steel:	 The Center for Eating Disorders at Sheppard Pratt, McCallum Place Eating Disorder
Centers, The Renfrew Center, Timberline Knolls
Bronze:	 Canopy Cove, Center for Change, Columbus Park Collaborative, CRC Health Group,
Fairwinds Treatment Center, Laureate Eating Disorders Program, Oliver-Pyatt
Centers, Rader Programs, Rosewood Centers for Eating Disorders, Veritas
Collaborative
Making Connections offers a place for our members to share their personal experiences and insights to support others.
While we value these contributions, please note that the views, beliefs and perspectives expressed do not necessarily
represent those of the organization.
Share Your Thoughts
If you have an idea for an article,
a question you’d like us to
research, or would simply like to
share your story — we’d love to
have you participate! Email us
at pffnetwork@myneda.org. Be
sure to include your full name,
email address, and daytime phone
numbers so we can contact you.
Making Connections is by parents,
family and friends for parents,
family and friends!
Join the NEDA Forums!
Connect with fellow siblings, parents, partners/spouses, friends and others pursuing recovery.
Whether you are personally affected by an eating disorder or supporting someone who is, the
NEDA forums are designed to be a safe and welcoming space to discuss issues related to eating
disorders, disordered eating and body image. Check out the community guidelines and join the
conversation at www.myneda.org/forum.

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MakingConnections_v7.3

  • 1. THE DILEMMAS OF MEN WHO HAVE A LOVED ONE WITH EATING DISORDERS Joe Kelly VIRTUALLY YOU: 5 STEPS TO GET REAL! ABOUT DIGITAL EATING DISORDER RISKS Bobbie Eisenstock, PhD SMARTPHONE APPS FOR EATING DISORDERS Adrienne S. Juarascio, PhD and Evan M. Forman, PhD Technology, Social Media & Eating Disorders MAKING CONNECTIONS NATIONAL EATING DISORDERS ASSOCIATION VOLUME 7, ISSUE 3 – 2014 A Publication of NEDA’s Parent, Family & Friends Network (PFN)
  • 2. 2 Letter from the PFN Chair By Deborah Kreiger, Florida Hello Friends, In this issue of Making Connec- tions the In Focus section speaks to the constantly evolving role technology plays in our lives. In a word, it is transformative. The articles assembled discuss new technologies and their importance in the treatment of eating disorders. Social media is part of our daily conversation and, as it expands our reach in the world, it can serve as a tremendous tool for building community. There are also responsibilities that come with these increased opportunities, and families should be having important discussions together about all types of media. With the annual NEDA conference fast approaching and the keynote ad- dress “Rebooting Recovery: How to Use Tech as an Ally for Healthy Connection, Community and Resilience” focusing on technology, we look forward to continu- ing this discussion in San Antonio, Octo- ber 16-18. If you have never attended a NEDA conference please consider joining us. The knowledge you will gain and the warm embrace you will feel cannot be overstated. This year’s theme, “Think- ing Big: Uniting Families & Professionals in the Fight Against Eating Disorders,” brings together top researchers and phy- sicians, clinicians, families and friends in an environment where we learn from one another and, of equal importance, we support one another. Always remember, we are on this journey together. Holiday celebrations and family gatherings begin taking place in September and oftentimes these can be stress-filled occasions for someone who is struggling, as well as for his or her family and friends. Words are powerful messengers and even the best-intended conversations can be difficult. A recent issue of Making Connections entitled “Language and Eating Disorders” contains many valuable articles and suggestions highlighting the delicate balance and mindfulness that go a long way toward defining good communication for someone who is struggling. Please check out this archived issue at www.myneda.org/MCv64. On behalf of the PFN Steering Commit- tee, we extend a very special welcome to Claire Mysko, Director of Programs. It has been a pleasure working with her and Cait Graham on our shared vision for the PFN and Making Connections. And to our most important readers, thank you! We value your input so please continue to share your thoughts and suggestions with us. With Gratitude, Deborah For more information on NEDA’s Leadership Councils, please visit www.nationaleatingdisorders.org/leadership-councils PFN STEERING COMMITTEE: Deborah Kreiger, Florida (Chair) Lorri Antosz-Benson, California Phoebe Megna, Connecticut Mike Polan, New York Adam Radwan, New York April Rebollo, Washington Don Blackwell, JD, Florida Nancy Hemendinger, New York NEDA Board Senior Advisors Ovidio Bermudez, MD, Media Advisor Douglas Bunnell, PhD, Navigators Advisor Amy Baker Dennis, PhD, Conference Advisor Walter Kaye, MD, Research Advisor Margo Maine, PhD, Advocacy Advisor NEDA Board of Directors NEDA President & CEO Lynn Grefe, MA Karen Andonian Clyde Hill, WA Evelyn Attia, MD New York, NY Bob Coven New York, NY Julie Finkelstein Purchase, NY Ilene Fishman, LCSW Montclair, NJ Mary Lipton New York, NY Kimberli McCallum, MD St. Louis, MO Tamara Pryor, PhD Denver, CO Dorothy Sprague New York, NY Shelly Steinwurtzel, PsyD Hastings-on-Hudson, NY Allison Kreiger Walsh, JD Orlando, FL Steve Wonderlich, PhD Fargo, ND Ric Clark, Chair Larchmont, NY Mary Curran, Co-Vice Chair West Simsbury, CT Phoebe Megna, Co-Vice Chair Darien, CT Russell Marx, MD, Treasurer & Chief Science Officer San Diego, CA Elizabeth Sarquis, Secretary Minneapolis, MN NEDA Board Emeritus Craig Johnson, PhD Robbie Munn, MA, MSW Don Nielsen NEDA Junior Board Erin Hall, Chair Troy Roness, MEd, Secretary Christopher Skarinka, Treasurer Brooks Brodrick, PhD Mary Hageman Heather Hower Elizabeth Sexton, MPA Lauren Steiner
  • 3. 3 Dear Readers, I am excited to be stepping into the role of Director of Programs for NEDA. I’ve been part of the NEDA family since my days as Director of the American Anorexia Bulimia Associa- tion, an organization that merged with several others to form NEDA. I’ve had the pleasure of getting to know many of you over the years and I continue to be inspired by the dedication and passion of the PFN. I look forward to highlighting more of this network’s important work as editor of Making Connections. IN THIS ISSUE 2 Letter from the PFN Chair 3 Editor’s Note 4 Research Summary:  Setting Policy Priorities to Address Eating Disorders and Weight Stigma 5 Virtually You: 5 Steps to Get REAL! about Digital ED Risks 8 Shrinking Women 9 Proud2Bme Featured in “High School Story” Game 10 Smartphone Apps for Eating Disorders 12 Supporting the ED Population through Telemental Health: Technological and Clinical Implications 13 Mobilizing Eating Disorder Treatment 14 Harnessing Technology for Training Therapists to Deliver Interpersonal Psychotherapy (IPT) 15 Family Based-Treatment Without Borders: Utilizing Telemedicine to Deliver Family-Based Therapy (FBT) 17 Penn Poised: Rewriting the Social Media Script 18 Navigating the Jewish Holiday Season 19 The PFN Parent Surveys Infographic 20 Dealing with the Dilemmas of Men Who Have a Loved One with Eating Disorders 21 Calling All Dads 22 NEDA Walk Volunteer Spotlight 22 NEDA Walks 2014 23 Because everyone has a reason: #WhyINEDAWalk 24 Working Toward Legislative Reforms: NEDA’s STAR Advocates Make Strides Across the Nation 25 PFN Webinars Series: Upcoming and Recently Archived 25 Take Back the Tutu 26 Blog Review 27 Network Spotlight 27 Staff Spotlight 28 Our Sustaining Sponsors Editor’s Note By Claire Mysko, Director of Programs When I started out in the eating disor- ders field, the internet was this cool new thing that seemed like it might take off. Phones were not that smart and media wasn’t so social. Things have changed a bit in the last two decades! In my most recent role overseeing NEDA’s youth website, Proud2Bme (proud2bme.org), technology has been central to every aspect of how we reach and engage our audience. We give people a platform to connect, use their voices and take action for change. And where is this connection and activism happening? On our forums, on Twitter, Facebook, Tumblr and Insta- gram, even in a story-based game that millions of teens have downloaded on their phones. Our community advocates for expanded eating disorders outreach and more ef- fective intervention and treatment. It is crucial that we take a close look at the powerful potential of technology to help us carry out our mission. How can we best use technology to spread hope and connect with those in need? How are the leaders in this field incorporating technol- ogy into their work? We’ll address these key questions and others in this issue. I hope you enjoy it. Thanks for reading, Claire Mysko
  • 4. 4 RESEARCH Despite the prevalence and health conse- quences of eating disorders and weight- related bullying and discrimination,1,2 pol- icy actions to address these problems have so far been limited. Experts from eating disorders and related fields have called for a variety of policy interventions to address eating disorders and weight stigma, such as equitable treatment and insurance coverage for eating disorders, school-based screening for eating disorders, government re- strictions on access to over-the-counter weight control drugs and legislation to prohibit weight-related mistreatment and discrimination. While there is certainly increasing dialogue about these kinds of initiatives, policy actions by the govern- ment have been minimal. Promoting these issues on policy agendas requires fostering both political will and public support. Therefore, it is important to determine how much public support there is for different policy actions to ad- dress eating disorders and weight stigma and to identify which policy actions to prioritize. The goal of our study, published this year in BMC Public Health, was to examine levels of support for a range of potential policy actions to address eating disorders and weight stigma among individuals from the eating disorders field and the U.S. general public.3 We surveyed 944 adults from a national web-based panel (Survey Sampling International), and 1,420 members of national, professional organizations that specialize in eating disorders. All participants in the study completed an identical survey, in which they were asked how much they would support each of 23 potential policy strat- egies that would help prevent and reduce eating disorders and weight stigma in diverse settings, including schools, healthcare and the media. Participants also rated these policy actions according to the impact they thought the policies would have and how feasible they would be to implement. Among the general public, the majority of participants expressed support for 20 of the 23 policy actions, with the most sup- port (83%) for anti-bullying policies that would protect youth from weight-based bullying in the school setting. The general public also expressed substantial support for policies to implement prevention and training programs on the early identifica- tion of eating disorders for health care providers (79%), schools (77%) and sports coaches (71%). Among experts from the eating disorders field, more than two- thirds of participants expressed support for 21 of the 23 policy actions. In addition to its overwhelming support for policies that would require insurance companies to reimburse for eating disorder treat- ment (98%), this group was also highly supportive of efforts to require training on the prevention and early identifica- tion of eating disorders in schools (95%) and health care settings (99%) as well as policy and legal measures to address weight-based bullying and discrimina- tion (74%-94%). In both study samples, policies that generated the least support were those requiring schools to measure and report students’ body weights. With respect to the potential feasibility and impact of policy actions, similar per- spectives emerged from both the general public and members of the eating disor- ders field. Specifically, policies requiring 1) school-based health curricula to include content aimed at preventing eating dis- orders, 2) training for sports coaches on the prevention of eating disorders and 3) implementation of school-based anti- bullying policies that protect students from being bullied about their weight were selected as having high potential impact and feasibility by both groups. This suggests that policy actions that target these problems among youth in the school setting should be prioritized. Given increasing national attention to bullying in youth and to efforts to improve the nutri- tion environment in schools, there may be opportunities to implement these initia- tives into existing school-based wellness policies and anti-bullying policies. Results from our study show that there is considerable support in both the eating disorders field and the general public for policy actions to address eat- ing disorders and weight stigmatization across a range of settings. This high level of public support suggests that one of the key conditions needed for fostering political will and policy change is already present. Given that both groups in our study expressed support for most of the 23 policies in the survey, it appears that there is agreement about the need for widespread and diverse policy actions aimed at reducing risk factors for both eating disorders and weight stigma and support for the use of policy-level actions to achieve meaningful change.  n References 1. Treasure J, Claudino AM, Zucker N: Eating disorders. Lancet 2010; 375:583–593. 2. Bucchianeri MM, Eisenberg ME, Neumark- Sztainer D: Weightism, racism, classism, and sexism: Shared forms of harassment in ado- lescents. J Adolesc Health 2013; 5:47–53. 3. Puhl RM, Neumark-Stzainer D, Austin B, King K, Luedicke J. Setting Policy Priorities to Address Eating Disorders and Weight Bias: Contrasting Views of Eating Disorders Profes- sionals versus the U.S. General Public. BMC Public Health, 2014; 14:524-533. Dr. Rebecca Puhl is the Deputy Director of the Rudd Center for Food Policy and Obesity at Yale University. As a Senior Research Scientist, she coordinates research and policy efforts aimed at reducing weight bias and improving the quality of life of children and adults affected by obesity. Dr. Puhl received her Ph.D. in Clinical Psychology from Yale University. Dr. Puhl has served on the Council of The Obesity Society and on the Board of Directors for the Obesity Action Coalition. In 2013, she was awarded the Excellence in Policy Research Award from the Eating Disorders Coalition. More information on Dr. Puhl’s work is available at www.yaleruddcenter.org. Research Summary:  Setting Policy Priorities to Address Eating Disorders and Weight Stigma By Rebecca Puhl, PhD Deputy Director, Rudd Center for Food Policy & Obesity, Yale University, New Haven, CT
  • 5. Technology 5 ➥  continues on next page Virtually You: 5 Steps to Get REAL! about Digital ED Risks By Bobbie Eisenstock, Ph.D., California Facebook. Twitter. Tumblr. Instagram. Pinterest. What do social media have to do with eating disorders? A lot. Our media culture today is more body image-driven than ever. It is virtually impossible to escape the onslaught of picture-perfect bodies that populate TV shows and commercials, splash the pages of magazines, and inhabit the online world where digital denizens can be seen flaunting themselves on social media. For many years now, research has dem- onstrated a connection between what we call traditional media – magazines, television and advertising – and body dissatisfaction, reduced self-esteem, a drive for thinness and disordered eating. Recent studies indicate that new media – where you hang out in the digital media culture or what you unintentionally stum- ble upon – can affect body image, food and weight concerns, especially if you struggle with these issues. Navigating the interactive digital media culture can be a potentially more hazardous minefield of ED risks than using traditional media because it empowers us as both media consumers and creators who can post and share, copy and paste, and upload and download content 24/7. We have a media body image problem and there is no simple solution. We cannot screen out all of the potentially harmful messages, but we can reduce risk factors by taking control of media’s influence on our lives. The key is media literacy. Media literacy skills help to meaningfully ques- tion and challenge images and messages that may be detrimental to developing positive body image and self-esteem while reinforcing those that promote health and well-being. To help counteract the digital media culture’s potential influence on normal- izing unrealistic body standards, NEDA partnered with my students from Califor- nia State University, Northridge to create NEDA’s Get REAL! Digital Media Literacy Toolkit. After studying the research on media and eating disorders and honing their digital and media literacy skills, the students applied what they learned to their personal experiences with social media and body image, and in some cases disordered eating, to create the toolkit activities. The Get REAL! Toolkit is for everyone who goes online with a digital device – computer, smartphone, tablet or game console. Share the toolkit with parent and youth groups, middle and high schools, colleges and universities, physicians and mental health professionals to help them think critically about media’s impact on body image and our social, psychological, emotional and physical health and well- being. Here’s what you need to know and what you can do to effectively use the toolkit for yourself. What You Need to Know to Get REAL! about Digital Media and Body Image While media do not cause eating disorders, media are one of the potential factors that can affect body dissatisfaction and low self-esteem, which subsequently lead to eating disorders. How much of a role media play depends on what and how much media an individual uses, his or her knowledge, skills, personal relationships and experiences, and predisposition to the complex interplay of contributing ED factors. The shifting media landscape has opened a new interactive milieu where an ED’s insidious nature is particularly worrisome because many of the images and messages are posted and shared by individuals who glorify the thin ideal, compare appearances, promote body shaming, and affirm eating disorders as a lifestyle choice. Digital Footprints. Unlike our use of traditional media, in the digital media culture we leave a trail behind that creates a digital footprint of our lives: a virtual extension of our thoughts, feel- ings and social behaviors. Everything we share and others share about us online – intentionally or unwittingly – is part of our virtual identity: content we create, all of our “likes,” who we “friend,” videos we watch, music we listen to, magazines and blogs we read, games we play, hob- bies and interests we enjoy, celebrities we follow, apps we use, key words we search, websites we visit, communities we join, products we browse, buy and review, and photos and selfies we tag, tweet, post and pin. With every screen touch or mouse click, our digital footprint grows larger and reveals more about who we are. There is a lot that can be virtu- ally known about a person’s body image and proclivity to determinants of eating disorders. Ana-Mia Networks. While social net- working can improve practitioners’ ability to educate, prevent and treat eating disorders, it can also circumvent and hinder their efforts. Since the first pro-ana (anorexia) and pro-mia (bulimia) websites surfaced on the Internet, there have been attempts to flag and ban the content. With the increasing popularity of social media, a cyber-underground of
  • 6. 6  Virtually You: 5 Steps to Get REAL!  continued ➥  continues on next page social networks that facilitate and sanc- tion ana-mia behaviors has grown and actions to censor ED-related hashtags, posts and photos have intensified. Sever- al social networks implement guidelines prohibiting posting content that “actively promotes or glorifies self-harm,” includ- ing anorexia, bulimia and other eating disorders, and direct users to websites where they can find positive support. Just how effective are these bans? Evidence is emerging that censoring potentially harmful content can have a boomerang effect: instead of eliminat- ing risk-inducing content, censorship has led to a continuous renewal of ana-mia sites and stronger connections within the surviving blogs that create a virtu- ally impenetrable support system for sufferers. The result is that it is more difficult for practitioners and public health campaigns to reach bloggers with relevant health-promoting information, making it more important to focus on early intervention. What You Can Do: 5 Steps to Get REAL! Here are five practical steps to use NE- DA’s Get REAL! Digital and Media Literacy Toolkit to jumpstart your media literacy skills in the digital culture. 1. Walk the walk and talk the talk. Familiarize yourself with social media and pro-ana and pro-mia messaging. With the majority of children and teens constantly connected to their digital devices, the odds are that the ones who are at-risk or already struggling with an eating disorder are fluent in “thinspiration” hashtags and blogs. If you are going to help them counteract these messages, you need to know what they are and how to interpret them. Think critically about who constructed the message and why, techniques used to create it, underlying meanings and points of view, and different ways the message may be interpreted by someone wrestling with body image issues or suffering or in recovery from an eating disorder. 2. Start early to help kids make wise choices on the digital playground. Get into the habit of going online to- gether and ask kids to show you what they do, where they go, and who they know. Talk about what you see, hear and read, listen to the words they use to describe appearance, size and shape, and help them interpret media messages. This keeps the communication lines open, improves their media literacy skills, gives you an idea of their digital foot- print, and provides an early warning sign for certain ED symptoms. You probably already know the advice about estab- lishing media guidelines, and the rule about keeping computers, smartphones, tablets, TV and video games out of kids’ bedrooms to better monitor their media time and choices. This is especially impor- tant for children overly concerned about their appearance and during adolescence when body image anxiety is amplified. 3. Take advantage of teachable moments. Kids are starting to worry about their weight and body image as early as kindergarten. Help boost their self- esteem and dispel unrealistic body expectations by taking advantage of unplanned circumstances that lend themselves to talking about healthy eating, positive body image, and self- acceptance. Teachable moments are opportunities to practice media literacy skills. And, if the time is right, teachable moments can be more effective than asking a direct question that puts a tween or teen on the spot about a sensitive issue, making it more difficult to discuss. Teachable Tips: Point out where ultra- thin models in ads have been digitally retouched to slim hips and waist, create a thigh gap and enhance their cleavage, while explaining that people don’t look like that in real life, and even if they did, they would be unhealthy. Talk about how posting critical comments about a friend’s selfie might make him or her feel about body image. Start a dialogue about how to help a classmate who posts body shaming videos of herself, invit- ing strangers to comment if she is fat or ugly, and what kids their age can do to enhance their self-image. Use language appropriate to children’s ages and stages of development to help them understand that someone may need to find the right support to deal with pressures that could lead to making unhealthy lifestyle choices. 4. Support social action to counteract digitally-altered body images. There is a growing movement to create transparency of digitally-generated illusions of body perfection that normalize unrealistic body expectations. Some celebrities, who are the face of popular culture and standardize cultural body ideals, are speaking out against retouched picture-perfect images that reshape their appearance, even posting unfiltered selfies to show how they naturally look. Several advertisers and retailers are voluntarily adopting “no retouching” policies to be more socially responsible. The Eating Disorders Coalition introduced a bipartisan- sponsored Truth in Advertising Act of 2014 (HR 4341) requiring the Federal Trade Commission to study the health consequences of digitally-altered human images in advertising. Social Action Tips: Advocate for a new “normal” that celebrates healthy body shapes and sizes with social media shout-outs: like, text, tweet, pin and post – and urge others to do the same – about celebrities who expose retouching, advertisers who practice transparency, and campaigns that demand consumer protection from deceptive body image advertising. Call out companies that feature unrealistically-altered body images in their product advertising and let them know you will use your consumer power by not buying from them. 5. Think critically about body image every time you use media. Empower yourself with a media literacy lens on the digital world to help mediate its potential influence on eating disor- ders. Use NEDA’s Get REAL! Digital Media Literacy Toolkit as a guide to deconstruct and reflect on body image messages, map digital body image footprints, and take a stand to support actions that shift the spotlight from limited and artificial body stereotypes to more diverse and authentic body ideals.  n References: Casilli, A., Pailler, F., & Tubaro, P. (2013). Online networks of eating-disorder websites: Why censoring pro-ana might be a bad idea. Per- spectives in Public Health 133(2): 94-95. Tiggemann, M., & Slater, A. (2014). NetTweens: The Internet and body image concerns in preteenage girls. The Journal of Early Adoles- cence 34(5): 606-620. Tiggemann, M., & Slater, A. (2013). NetGirls: The Internet, Facebook and body image concerns in adolescent girls. International Journal of Eating Disorders 46(6): 630–633.
  • 7. 7 Need personalized guidance for yourself, or in support of a loved one affected by an eating disorder? The NEDA Navigators are here to support you! NEDA Navigators* are individuals who have experience, either personally or in support of a loved one, navigating the overwhelming systems and emotions involved with seeking treatment for an eating disorder. Volunteers, trained by NEDA staff and program Clinical Advisors, are available to help you find treatment referrals, local support groups and resources tailored to your needs; be a listening ear during your or your loved ones’ journey; provide encouragement through a difficult time; and share their own story responsibly to offer hope for recovery. The range of experiences among the Navigators is diverse, and when you request to be connected with a Navigator, we try to match you with someone who has been through a similar set of challenges and who can share their experiences in a helpful, responsible way. You can request to speak with someone who has dealt with co-occurring conditions such as depression, substance abuse or self-harm; who shares similar aspects of your identity such as ethnicity, gender, religion or sexual orientation; or who has the same relationship to the person struggling, such as a fellow mother, father, partner, spouse, sibling, or friend. To request a Navigator, visit us at http://www.nationaleating- disorders.org/neda-navigators and we’ll get you connected. For more information about the NEDA Navigators, visit the Navigators homepage at www.myneda.org.  n * Navigators are not mental health professionals or treatment providers. They are PFN volunteers who have been through an eating disorder themselves or with a loved one and are now in strong recovery. Navigators are trained to help you identify resources, treatment options, and be a source of support during your journey.  Virtually You: 5 Steps to Get REAL!  continued Bobbie Eisenstock, Ph.D. writes, teaches, and consults about the social- psychological effects of the emergent digital media culture on children, teens, and families. A national expert on media literacy, she facilitates workshops to help parents, educators, health practitioners, Get REAL! Toolkit Guide The toolkit activities will help guide you each step of the way. Check out the toolkit, and get involved, at: http://www.nationaleatingdisorders.org/get-involved/media-watchdog. Step 1: Find out what your own digital footprint says about your body image by mapping Your Digital Footprint and taking the Digital Body Image Quiz. Step 2: Test your media literacy knowledge by taking the Media Literacy Quiz (answers are included) and start asking the right questions using Media and Your Body Image. Step 3: Develop your skills to deconstruct body messages with Media Literacy Key Questions and Worksheet and encourage positive body image with the Body Positive Pledge. Step 4: Advocate for transparency and celebrate our natural looks, body sizes and shapes using tips for Celebrity Shoutouts and Letter Writing Guidelines. Step 5: For more information, check out the Digital and Media Literacy Resources. Community Engagement Partnership to educate, engage and empower us about media and body image in the digital media culture DIGITAL MEDIA LITERACY TOOLKIT California State University Northridge and youth advocates understand the risks and realities of social media and implement strategies to manage digital footprints. Dr. Eisenstock is on the faculty at California State University, Northridge where she serves as a Fellow at the Institute for Community Health and Wellbeing and directs the Get REAL! Project that created NEDA’s Get REAL! Digital Media Literacy Toolkit. In 2013, NEDA honored her with The Westin Family Award for Excellence in Activism and Advocacy. Contact her at www.BobbieEisenstock.com
  • 8. 8 Shrinking Women By Lily Myers, Connecticut When I delivered my poem “Shrinking Women” to a room of a few hundred people at the College Unions Poetry Slam Invitational, I had no idea how far my words would travel. The poem discusses my experience grappling with the pressures, inherited and internalized, that women face to stay physically and metaphorically small. I discuss the ways I have watched women around me shrink, by denying themselves food or by remaining passive. After the video was uploaded to YouTube, I watched, absolutely shocked, as the number of views climbed into the millions. My Facebook inbox soon filled with messages from people I didn’t know, sharing thoughts and support. This shocked me too. Not only did many people watch my poem, but some were so moved by it that they reached out and confided their own stories. As a writer, it was exciting. As a person with a private life, however, it was com- plicated. Since I’d had no idea how far the poem would reach, I hadn’t thought twice about speaking intimately about members of my family, most prominently my mother. This is still difficult; I some- times worry that people might be judging me or her, and I have to quiet the voice in my head that imagines that judgment. It was jarring to have such a personal story shared on such a wide platform. I know it was even harder for my mom, and for that I’m truly sorry. As I received more messages, however, I began to realize something: when people see my video, they don’t see me. They see themselves, their own histories and struggles. Wheth- er or not they agree with me, everyone who watches that video relates the words to their own lives, not to mine. My story grew to be something no longer con- nected just to me. Dialogue and reflec- tion were being generated from this seed of an idea that I’d started writing alone at my kitchen table. And that, to me, is the most important thing that writing can do. all sure she was right, I climbed to the stage and recited it. And I’m so glad that I did. Showing vulnerability is always a risk. But it’s a risk that leads to connection, humanization, and understanding — one that allows us to see each other with all of our human complexities and flaws. To me, that’s a risk worth taking. The near-ubiquity of social media meant that the vulnerability I showed in that room could be broadcast across the world. While scary, the implications of this are also amazing. It means that we have the technological tools to spread empathy and compassion. We have the ability to send stories to millions of people – stories that show us that we are not alone in our experiences. If this experience has taught me anything, it’s that people want to be reached. People want to express to others: I can relate to your experience. We are together in this. For all their faults, the internet and social media can facilitate this expression on a mass scale. That is an enormous amount of power, and an immense amount of compassion that we can generate.  n Lily Myers is currently a senior at Wesleyan University, where she is involved in the slam poetry community. She runs a blog dedicated to feminism, self-compassion and body love; check it out or send submissions at http://shapeswemake.tumblr.com. She is also currently working on a young adult novel about family and body image, due out in 2016. Follow her on Twitter: @lmyerspoetry An excerpt from “Shrinking Women” by Lily Myers: “Across from me at the kitchen table, my mother smiles over red wine that she drinks out of a measuring glass. She says she doesn’t deprive herself, but I’ve learned to find nuance in every movement of her fork. In every crinkle in her brow as she offers me the uneaten pieces on her plate. I’ve realized she only eats dinner when I suggest it. I wonder what she does when I’m not there to do so.” To watch the whole poem, visit http://tiny.cc/lgjmlx Technology The near-ubiquity of social media meant that the vulnerability I showed in that room could be broadcast across the world. In almost every message I received, people expressed their belief that the themes in my poem need to be openly discussed. Many gave their thanks for speaking out about subjects that so often cause shame and anxiety. These mes- sages caused me to wonder: what would happen if we all spoke out? What would this world look like if everyone regarded disordered eating and body image as “the thing you talk about,” as one message phrased it? Would there be less shame surrounding these topics? Could we find more empathy, similarity and common ground? When others came to me and said they could relate to my words, it pro- vided comfort; proof that I wasn’t crazy or an outlier. The power of knowing that is hard to overestimate. Funnily enough, I almost didn’t deliver “Shrinking Women” that day. As I sat in the final moments before my turn to speak, I decided to read a different poem, one that I thought was less controversial. One that didn’t make me feel so exposed. And then my friend Emily whispered in my ear, “You have to do it. This is the poem that people need to hear.” Not at
  • 9. 9 Technology Proud2Bme (proud2bme.org) is a space where teens and young adults can connect with others and get inspired to use their voices for personal and social change. In a culture where more than half of teen girls and nearly a third of teen boys use unhealthy weight control behaviors like skipping meals and taking diet pills, we know that early detection and youth outreach are critical in the fight against disordered eating and poor body image. We’re also acutely aware that to get to young people with messages that make an impact, we have to meet them where they are — online, in social media and even in the apps on their smart phones. That’s why we were thrilled to partner with Pixelberry Studios on an eating disorder storyline, FAQ section and helpline resources for the latest version of their top 50 iOS/Android game, “High School Story.” The game has been downloaded by more than 10 million users. eating. Proud2Bme also serves as a resource for players who might relate to the story and need help for themselves or a friend. The quest includes a direct link to Proud2Bme.org and players can also request further information or referrals from NEDA Helpline staff within the game itself. Not every teen develops a diagnosable eating disorder, but all of the young people I work with through Proud2Bme talk about how they often end up feeling like they can never be good enough when faced with a steady stream of media messages and images that place such a high value on “perfection.” We can’t blame media simplistically for disordered eating and weight obsession, but we shouldn’t let them off the hook either. “High School Story” addresses this full spectrum by educating about signs and symptoms of eating disorders, while other characters in the game discuss their body image struggles and Proud2Bme Featured in “High School Story” Game By Claire Mysko, MA, New York appearance-related insecurities. A high school yearbook photographer even uses Photoshop, which sparks a conversation about how so many of the images we consume on a daily basis are really just digital illusions. In the eating disorders field, we must continue to advocate for media literacy. It is also imperative that we look for creative ways to use media for positive intervention. “High School Story” is one of those interventions. Since the game’s launch, Proud2Bme has received requests from players asking for information on how to help a friend, seeking support in finding referrals and looking for information on how to recognize when your behavior is a problem. Players are clearly connecting with the message of self-acceptance. As one recent Proud2Bme commenter shared: “I played this quest on High School Story. It was beautiful how she began to learn that she is perfect no matter what size she is. :)”  n To get to young people with messages that make an impact, we have to meet them where they are – online, in social media, and in their apps. What does a partnership with a gaming company look like? It started out with a series of calls with Pixelberry Studios to discuss the theme of this “High School Story” quest, which follows Mia, a teen who relapses into disordered eating after a friend makes an insensitive comment about her weight. NEDA staff then provided input on the scripts for the two- part story with the goals of minimizing triggering content and educating players about the complexities of disordered
  • 10. 10 As of 2013, over half of all adults in the United States (56%) own a smartphone and 93% of smartphone users use their phone to access information online.1 With the expanding interest in and availability of smartphones, a growing number of mobile health apps have been designed to provide therapeutic assistance, either as a stand-alone platform2, 3 or in conjunction with conventional therapy.4, 5 Empirical evaluations of health apps suggest that they are effective as both a stand-alone option and as a treatment alongside existing in-person treatment. Some advantages of mobile health apps for the treatment of eating disorders (and other psychological conditions) are: 1. Apps can deliver treatment with or without the need (or at least immediate need) of a clinician. 2. Apps can deliver consistent, evidence-based psychological treatments for eating disorders. This ability is critically important because there is a shortage of specialists in ED treatment and an even greater shortage of those who utilize evidence-based prac- tices for ED.6 3. Apps can collect symptom and other clinical data throughout the day, in a way that is likely to be more complete and accurate than a paper diary or a report to a clinician. 4. Apps can present patterns of data (for example, how emotional ex- periences relate to eating disorder symptoms, and how symptoms have improved over the past month) 5. Apps can deliver assistance in real time and in the moment of need.7 6. Apps can use computerized algorithms to help identify when individuals might be at high risk for a clinical episode (e.g., a binge or purge), and intervene ahead of time to prevent the episode.8 Our team recently completed a compre- hensive review of commercially available apps for eating pathology.9 We found a total of 20 apps that fell into the catego- ries of ED treatment apps, self-diagnosis tools, referral sources, recovery support, assessment tools or clinician tools. Of the 20 apps, six were aimed at the treatment of EDs, five designed for ED psychoeduca- tion, and nine were considered “Other” Despite the limitations described above, a few apps did contain notable features that support their use either as a stand- alone treatment or in combination with in-person treatments. For example, one app, Recovery Record, has the capability for the user to log food and meal intake (including specific food items eaten), thoughts (through an open text field) and emotions and feelings (through Likert-type scales of overall energy levels, overall feelings and specific emotions such as guilt and anxiety), representing a comprehensive self-monitoring sys- tem. Recovery Record also allows users to request coping strategies for in-the- moment problems (e.g. negative emo- tions), which are derived from CBT (e.g. delaying or distraction from an urge) and acceptance-based techniques (e.g. defu- sion from distressing thoughts or urge surfing). Users of this app also have access to a social portal that allows the posting of recent activity to an app-wide activity feed and allows pairing with another user to provide and receive support and share coping tactics. A different app, BeforeIEat, provides in-the-moment strategies for dealing with urges through audio clips explaining strategies such as urge-surfing, cognitive defusion, distraction and self- soothing, which are broadly based on CBT and acceptance-based strategies. Our review noted several future direc- tions for ED apps. First, smartphone apps are well-suited to improve adherence to treatment recommendations outside the therapeutic office. Reminders and motivational messages to complete homework assignments can be provided between sessions,10-12 thus increasing motivation and compliance with treat- ment. Second, self-monitoring, one of the core drivers of behavior change in CBT-E, could be enhanced if completed via smartphone, as entry and storage is simpler than pen-and-paper methods. Smartphone Apps for Eating Disorders By Adrienne S. Juarascio, PhD, and Evan M. Forman, PhD, Laboratory for Innovations in Health-Related Behavior Change, Drexel University, Pennsylvania Evan M. Forman (including a self-diagnosis tool, a tool for finding referrals, a pro-recovery/support app, assessment tools and a reference tool for ED clinicians). Unfortunately, our review revealed that few of the ED intervention apps utilized evidence-based treatment components. Instead, the apps’ components tended to have little to no empirical support. Examples of unsup- ported components include guided im- agery, positive affirmations, and generic coping strategies such as “eat something healthy.” Additionally, our systematic review indicated that ED intervention apps are not fully utilizing the advanced capabilities of smartphone apps (e.g. au- tomated data entry and personalized or automatically delivered interventions). ➥  continues on next page Technology
  • 11. 11 Real-time self-monitoring could also be enhanced through in-the-moment recording. Furthermore, the capabilities of app sensors (e.g. GPS) allow for the automatic recording of information to reduce user burden. Apps also have the capability to sync information within or between apps and present instant feed- back regarding behavior patterns to the app user. The ability to view and analyze patterns over time is another method of facilitating behavior change. TakeControl, also contains full evidence- based, cognitive-behavioral self-help treatment modules for binge eating. Numerous smartphone apps for eating disorders have been developed in just a short period of time, and the overall quality and ability of these apps appears to be growing quickly. Undoubtedly, the pace of development will only con- tinue to quicken, though we would urge consumers to be wary of apps that rely on scientifically untested intervention components.  n Drexel University’s Laboratory for Innovations in Health-Related Behavior Change is currently in the process of evaluating the smartphone app TakeControl with beta users. If you are interested in serving as a beta user for TakeControl, please visit http://drexel.edu/psychology/research/ labs/innovationlab/takecontrol, email takecontrol@drexel.edu and/or call 215-553-7111. Editor’s Note: NEDA, while supportive of technological advances in the field, recommends that anyone struggling seek professional help from an ED specialist and does not rely on an app as a stand- alone treatment. References 1. Duggan, M. and A. Smith, Cell internet use 2013, in Pew Internet and American Life Project 2013, Pew Research Center. 2. Free, C., et al., The effectiveness of mobile- health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS medicine, 2013. 10(1): p. e1001362 3. Vandelanotte, C., K.M. Spathonis, E.G. Eakin, and N. Owen, Website-delivered physical ac- tivity interventions: A review of the literature. American journal of preventive medicine, 2007. 33(1): p. 54-64 4. Bauer, S. and M. Moessner, Technology- enhanced monitoring in psychotherapy and e-mental health. Journal of Mental Health, 2012. 21(4): p. 355-363 5. Newman, M.G., L.E. Szkodny, S.J. Llera, and A. Przeworski, A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: Is human contact necessary for therapeutic efficacy? Clinical Psychology Review, 2011. 31(1): p. 89-103 6. Van Den Berg, S., D. Shapiro, D. Bickerstaffe, and K. Cavanagh, Computerized cognitive–be- haviour therapy for anxiety and depression: a practical solution to the shortage of trained therapists. Journal of Psychiatric and Mental Health Nursing, 2004. 11(5): p. 508-513 7. Heron, K.E. and J.M. Smyth, Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments. British journal of health psychology, 2010. 15(1): p. 1-39 8. Forman, E.M., M.L. Butryn, A.S. Juarascio, S.M. Manasse, S.P. Goldstein, G. Naik, and J. Segall. Utilizing ecological momentary intervention to enhance and disseminate CBT: The development of TakeControl, a smartphone app for the treatment of binge eating disorder. in International Conference on Eating Disorders 2014. New York. 9. Juarascio, A.S., S.M. Manasse, S.P. Goldstein, E.M. Forman, and M.L. Butryn, Can Smart- phone Applications Enhance the Treatment of Eating Disorders?: A Systematic Review. under review 10. Bock, B., et al., A Text Message Delivered Smoking Cessation Intervention: The Initial Trial of TXT-2-Quit: Randomized Controlled Trial. JMIR mhealth and uhealth, 2013. 1(2): p. e17 11. Patrick, K., et al., A text message – based intervention for weight loss: randomized controlled trial. Journal of medical Internet research, 2009. 11(1) 12. Suffoletto, B., C. Callaway, J. Kristan, K. Kraemer, and D.B. Clark, Text-Message- Based Drinking Assessments and Brief Inter- ventions for Young Adults Discharged from the Emergency Department. Alcoholism: Clinical and Experimental Research, 2012. 36(3): p. 552-560 13. Dölemeyer, R., A. Tietjen, A. Kersting, and B. Wagner, Internet-based interventions for eating disorders in adults: a systematic review. BMC psychiatry, 2013. 13(1): p. 1-16 14. Shiffman, S., A.A. Stone, and M.R. Hufford, Ecological momentary assessment. Annu. Rev. Clin. Psychol., 2008. 4: p. 1-32 15. Runyan, J.D., T.A. Steenbergh, C. Bainbridge, D.A. Daugherty, L. Oke, and B.N. Fry, A Smartphone Ecological Momentary Assess- ment/Intervention “App” for Collecting Real- Time Data and Promoting Self-Awareness. PloS one, 2013. 8(8): p. e71325.23977016 16. Berg, K.C., R.D. Crosby, L. Cao, C.B. Pe- terson, S.G. Engel, J.E. Mitchell, and S.A. Wonderlich, Facets of negative affect prior to and following binge-only, purge-only, and binge/purge events in women with bulimia nervosa. Journal of abnormal psychology, 2013. 122(1): p. 111.PMC3646562 17. Smyth, J.M., S.A. Wonderlich, K.E. Heron, M.J. Sliwinski, R.D. Crosby, J.E. Mitchell, and S.G. Engel, Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. Journal of consult- ing and clinical psychology, 2007. 75(4): p. 629.17663616 18. Jansen, A., A learning model of binge eating: cue reactivity and cue exposure. Behaviour research and therapy, 1998. 36(3): p. 257- 272 19. Stice, E. and W.S. Agras, Subtyping bulimic women along dietary restraint and negative affect dimensions. Journal of Consulting and Clinical Psychology, 1999. 67(4): p. 460 20. Edelman, R.E. and D.L. Chambless, Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia. Behaviour Research and Therapy, 1995. 33(5): p. 573-577.7598680 21. Schmidt, N.B. and K. Woolaway-Bickel, The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: quality versus quantity. Journal of Consulting and Clinical Psychology, 2000. 68(1): p. 13.10710836  Smart phone apps for ED  continued Apps also have the capability to present instant feed­back regarding behavior patterns to the app user. Lastly, future apps may involve the provision of interventions that are far more tailored to the individual based on the ongoing collection of information about that person.8, 15 Having in-the- moment support can be particularly useful in the context of EDs because episodes of disordered eating behaviors (e.g. restriction and/or binging and purging) can be triggered by numerous internal (e.g. negative affect, hedonic desire)16, 17 , and external (e.g. exposure to stimuli associated with the behavior) factors.18 When exposed to these triggers, the urge to engage in disordered eating behavior is high as these behaviors provide temporary pleasure and/or relief from tension.19 In these moments of high distress, patients may struggle to recall and attempt skills taught in the therapy office or feel unable or unmotivated to implement them.20, 21 Consequently, when faced with strong urges to engage in disordered eating behavior, access to adaptive coping strategies (via the smartphone app) may facilitate skill use by providing reminders of the skills taught, as well as step- by-step instructions on how to utilize strategies in moments of high distress. Our team is completing development of an app for binge eating that collects real-time information about eating patterns, emotions, binge eating triggers and binge episodes, and automatically delivers a personalized intervention at a time when a computerized algorithm has identified that the user is at high risk of a binge eating episode. This app, called
  • 12. 12 Supporting the ED Population through Telemental Health: Technological and Clinical Implications By Martha Ireland, PhD, RN, CS, CEDS, DCC, Virginia The introduction of new technolo- gies that provide additional treatment options for eating disorder clients has evolved my practice immensely over the past 25 years. Years ago, the only ef- fective and widely accepted treatment option was an in-person session, which made continuity of care and accessibil- ity to qualified ED therapists much more challenging for those in need than it is today. With the introduction of secure video teleconferencing (VTC) systems in the past few years I now have the ability to effectively support and treat my ED cli- ents even when they are homebound due to illness, lack transportation, need to travel for business or pleasure or live in remote locations that are too far away to make regular in-person sessions feasible. Half of my sessions are now delivered via VTC. I embrace technology, and firmly believe in the positive impact it can make in supporting the client’s unique needs and circumstances, but it is important to understand that there are a variety of clinical implications to consider when adopting new technolo­gies. There are so many options today for using technology to connect from a distance – texting, chatting, emailing and video teleconferencing, just to name a few – but not all formats are secure or appropriate for the therapeutic process. I personally find video teleconferencing to be the best option for my ED clients, and insurance companies seem to find it the most favorable for reimbursement approval. Regardless of what type of technology is used to deliver therapy, it is imperative that the technology be accessed over a secure platform. The clinician is responsible for making sure the delivery system used is compliant under the Federal Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH) laws. The approaches used in VTC will vary by therapist, and I would not suggest a therapist using any approach that he or she does not utilize in face-to- face ses- sions. It is possible to adopt a multidisci- plinary approach even when the client is located at a distance. These approaches include utilizing local supports, such as a nearby medical doctor, dietitian and/ or therapeutic groups as well as develop- ing a crisis plan, in order to create a safe and confidential environment on their side of the computer. It is also important to communicate with the client about clinical boundaries, particularly concern- ing availability and use of social media such as Facebook and blogs. The clini- cian’s guidelines and policies around the therapeutic use of technology, including the client’s responsibility for maintain- ing confidentiality and privacy at their location during the sessions, should be in writing and signed by the client after they have been explained by the clinician and understood by the client. Discussing these policies and boundaries with the client opens up the discussion of how the client is using technology and how they can limit their time spent looking up websites that may be prob- lematic for them. It is also helpful to find out if the client is spending time in virtual reality environments. Their avatars and “second life” activities can provide insight into their psyches and often disassocia- tion and body image issues. This discus- sion is frequently neglected in face-to- face sessions if the clinician is unfamiliar with technology or “cyber worlds.” The millennial generation tends to grasp VTC technology and navigate the site much more easily than some of my older clients. Without hesitation the millenni- als will speak as though I am in the same room, show me their art projects and pets and jump into disclosing their vul- nerable thoughts and feelings from the comfort of their homes, which can make containing the conversation a challenge compared to traditional therapy. Clinicians have asked me if I find it problematic that I cannot see the person’s whole body during the session; the evaluation of the full body language is important in the therapeutic process. It has been my experience that the view of the head down to the upper chest area gives me a fairly accurate picture of the client’s body language. I am able to assess if the client is having difficulty sitting comfortably during the session but I am not able to see if they are continuously moving their legs to burn calories or using leg movements to soothe themselves; I have to ask the client directly for this information. Eye contact while using VTC is more direct and closer than in an office session and it can initially be intimidating for the client. The client’s level of comfort with eye contact can indicate a struggle with depression or relationship intimacy issues. I have found that as the therapeu- tic relationship strengthens eye contact improves. Clients who are suffering from poor body image will sometimes struggle to see their images while talking to me. They will be distracted: fixing their hair, adjust- ing the screen to exempt their body or at times trying to move the screen so that I can’t look at them. The client’s struggle is also apparent when I see their eyes shift like a pendulum, from the camera to the picture and back to the camera. Confronting that behavior is always an in- teresting conversation. There is frequent- ly shame that emerges, which usually does not surface so early in a traditional therapy session. Telemental health does not attempt to eliminate or replace the value of face-to- face therapy sessions. It is a tool that, if used appropriately, allows therapists to support clients in a more consistent man- ner, maintaining the therapeutic relation- ship and treating those clients who might not have local resources available.  n Martha H. Ireland PhD, RN, CS, CEDS, DCC is the Co-founder of Virtual Therapy Connect (www.virtualtherapyconnect.com) Recently she launched an online initiative to support eating disorder prevention in Virginia at www.StudentEatingDisorders.info. She also operates a private practice in Virginia and routinely speaks about integrating technology and psychotherapy.
  • 13. 13 Volunteers in the NEDA Loss Support Network know the unique type of grief experienced by those who have lost a loved one to an eating disorder, and they are available to help support those who have lost someone. If you would like to become a volunteer to support others or request support from a Loss Support Network member visit www. myneda.org/loss-support-network LOSS SUPPORT NETWORK Byte-by-byte, together as a community, we are edging closer to equitable access to gold standard care that is enabled through technology. We are witnessing and shaping a generational shift in the decentralization of care away from brick-and-mortar clinics and toward flexible treatment that is integrated into our daily lives. If you have an eating disorder today, you have more options available to you than ever before. These initiatives are expand- ing the access and reach of treatment, from step-down treatment and home care programs to online counseling and therapy to helplines and navigators, such as those offered by NEDA. These new options recognize that an eating disorder is with an individual 24/7, it can strike at any moment, and we need options to be readily available 24/7. We know that care solutions need to fit a wide variety of budgets, lifestyles and personal needs, should improve outcomes and should not sacrifice medical efficacy. Treatment engagement is often not a motivation problem, but an access problem. It is difficult to overstate the awesome potential of smartphone technology to transport effective treatment into people’s daily lives. Over 200,000 people living with an eating disorder have already added one mobile app to their recovery arsenal. This app is Recovery Record. Recovery Record built its free mobile app to make effective, best-practice treatment available to everyone who needs and wants it. When downloaded, a person who has or believes they have an eating disorder can expect to have a continuous, secure and personal connec- tion to many of the active ingredients of treatment, including Cognitive Behav- ioral Therapy (CBT), meal, behavior and thought monitoring, and best-practice coping skills. Testifying to the growing power of mobile care, Recovery Record users have already completed in excess of six million of these therapeutic tasks. Mobilizing Eating Disorder Treatment By Jenna Tregarthen, Founder of Recovery Record, California Mobile apps may not be for everyone; some people prefer keeping up with ther- apy tasks by using pen and paper, while there are others for whom access to a smartphone is not a possibility. These limitations aside, it is clear that mobile technology is here to stay and is helping to drive the evolution and revolution of eating disorders care. Mobile technology also has the unique potential to reach those who are living in the shadows with their condition. 33% of Recovery Record users have not yet disclosed their eating disorder to anyone in the world – except the app. For these people, the app is a safe and convenient first point of contact for care. A user can immediately connect with in-person care by clicking the NEDA Helpline feature, at which time they’ll be able to connect with another person for information, referrals and resources. For others, the greatest appeal is the option of connecting members of their clinical team with the app, expanding the care they receive. Speaking to this benefit, Jessica, who has been using Recovery Record with her care team for three months, said “It has helped me to stay accountable between visits, when I’m really struggling. Personalized messages through the app encourage me to work through specific issues in the moment, versus weeks after the event.” Jessica’s psychologist commented, “The app lets me get inside my patient’s head in ways that I cannot in session – I always know what issues to address and focus on the most.”  n Technology
  • 14. 14 What is the best way to disseminate evidence-based treatments to clinicians who treat patients with eating disorders? How do we make sure that clinicians are aware of and properly trained in the most up- to-date treatments? How will clinicians receive ongoing supervision with experts in the field to ensure that patients get continued high-quality care? The Weight Management and Eating Disorders Lab at Washington University School of Medicine, directed by Denise Wilfley, PhD, in collaboration with study principal investigators Stewart Agras, MD, Stanford University, and G. Terence Wilson, PhD, Rutgers University, hypothesize that the answer is technology. Through generous support from the National Eating Disorder Association’s Feeding Hope Fund, Drs. Wilfley, Agras, and Wilson plan to test if new and innovative technology can eliminate barriers to receiving quality training in the use of effective treatments to therapists. Standard methods of training clinicians, such as traditional in-person workshops, can be expensive, time-consuming and offered infrequently to a relatively small number of participants.1 Furthermore, ongoing supervision (e.g., continued evaluation and feedback) can be imprac- tical, given the lack of trained supervisors in evidence-based treatments.2 The use of web-based programs may offer innovative new training methods to decrease or eliminate these barriers. Benefits of using web-based programs include the easy accessibility of online training by a large number of therapists regardless of geographic location; the ability to repeatedly access training information anywhere at any time; and the ease of performing website updates, allowing therapists to stay abreast of new information.1 Additionally, online train- ing platforms allow for the collection of data on clinicians’ usage of the program, which can provide information on the most accessed program features, inform- ing program refinement for future use. To evaluate whether or not the use of technology can more readily disseminate effective treatment methods to clinicians, the study team is developing a guided online program to train college counseling center clinicians in interpersonal psychotherapy (IPT), which is an evidence-based therapy for the treatment of bulimia nervosa, binge eating disorder and subclinical disordered eating.3-9 IPT is a focused, brief treatment that targets interpersonal problem(s) and negative mood associated with the onset and/or maintenance of eating disorders (EDs). IPT is supported by substantial empirical evidence documenting the role of interpersonal factors and negative mood in the onset and maintenance of EDs. The study team chose IPT for its ideal qualities for dissemination: it is evidence-based, widely applicable and generally acceptable to both clinicians and patients. College clinicians were chosen as the ideal therapists to train because eating disorders occur at a higher rate in college-aged populations, yet many students receive either no treatment or non-evidence-based care for these types of problems. The aim of the study is to see if online training and supervision in IPT are as effective as traditional, in-person workshop-based training and supervision methods. The study further aims to assess the efficacy of a telephone-based simulation assessment in increasing the reliability and time-efficiency of feedback and supervision, while reducing the need for live patient practice. Treatment fidelity ➥  continues on page 16 NEDA’s Feeding Hope Fund and Technological Innovation In 2013 NEDA awarded the inaugural Feeding Hope Fund grants, supporting projects that focus on clinical research and training dissemination. The 2013 winning grant proposals were “Family Based-Treatment Without Borders: Utilizing Telemedicine to Deliver Family-Based Therapy (FBT)” by Daniel Le Grange, PhD; and “Harnessing Technology for Training Therapists to Deliver Interpersonal Psychotherapy (IPT)” by Denise Wilfley, PhD. These studies unite traditional therapies with technologically innovative met­hods and reinforce the significance of technology in eating disorders treatment. The Feeding Hope Fund will raise restricted funds designated for the distinct purpose of providing grants to: • qualified clinical researchers who have been selected through our very competitive application process • qualified clinical experts providing creative submissions for advancing the training and dissemination of evidence based treatments to fellow clinicians What is the Feeding Hope Fund? Harnessing Technology for Training Therapists to Deliver Interpersonal Psychotherapy (IPT) By Denise Wilfley, PhD, Missouri
  • 15. Technology 15 Anorexia nervosa (AN) is a seri- ous psychiatric disorder highly recognized for both its physical and psychological stress on the hu- man body. Peak onset for AN is dur- ing adolescence, and successful treat- ment during this time is critical to ensuring long-term remission. Family- based treatment (FBT) is a therapy in which parents play an active role in order to help their child recover from an eating disorder, and is in common use for adolescents with AN. In standard practice FBT requires family meetings with a therapist at least weekly for the first two to three months of treatment, and then bi-monthly for a period of six to nine months. This has typically been accomplished by families traveling (often far distances) to tertiary medical centers for treatment, which is not optimal for many families. Dissemination of FBT has been complicated due to several factors, including limited numbers of trained FBT therapists and a concentration of trained therapists in urban centers. Due to a particularly limited availability of FBT therapists in rural or remote areas, many families do not have access to this evidence-based treatment. With the high demand for evidence- based treatment for AN, The University of Chicago Eating Disorders Program is very excited to be leading a study entitled “Family-Based Treatment With­ out Borders.” The aim of this study is to examine the feasibility of delivering FBT to adolescents with AN utilizing telemedicine. The use of telemedicine has been previously applied in the delivery of eating disorder treatment (i.e., cognitive-behavioral therapy for bulimia nervosa) and found to have equivalent outcomes to treatment delivered in traditional face-to-face therapy (Mitchell et al., 2008). Participation in the study at The University of Chicago involves adolescents between the ages of 13-18 years of age living with their families, meeting the DSM-5 criteria for AN. All families participating in this research study receive 20 no-cost therapy sessions for AN conducted via video conferencing. To facilitate treatment via video con- ferencing, researchers at The Univer- sity of Chicago are utilizing a secure HIPAA-compliant portal to deliver all treatment-related activities. Using this software, members of the The University of Chicago team are able to manage all consents, questionnaires, assessments, communication and video conferencing related to this study through a secure internet-based platform. Preliminary data is currently being col­ lected through the first wave of five par- ticipating families. Feedback from these families, as well as from the members of the research team, has been extremely positive thus far. Families are finding that the software is user-friendly and that both the video and sound aspects of this portal are extremely clear, mak- ing it easy to conduct a therapy session without technological glitches. Co-Prin- cipal Investigator and lead thera­pist for the study, Kristen Anderson, LCSW, has found that there are only slight modifica- tions needed to the treatment manual to deliver FBT through telemedicine. This includes parents weighing their child at home prior to the session and sending that information to the therapist. Patients are also using the secure messaging system provided by the software to communicate with therapists instead of communicating via email and telephone. As the study progresses, the treatment team at The University of Chicago has begun to think about additional applications for the use of telemedicine, including facilitating support or skills groups for parents of children with eating disorders. We are eager to continue collecting data through this novel study and excited about what these results may mean for the future of eating disorder treatment. To find out more about our program research, please visit our website at www.psychiatry.uchicago. edu/page/eating-disorders-program and Facebook at www.facebook.com/ UofCEatingDisordersProgram.  n References Mitchell, J.E., Crosby, R., Wonderlich, S., Crow, S., Lancaster, K., Simonich, H., Swan-Kremeier, L. … Myers, T.C. (2008) A Randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behav Res Ther, 46(5), 581-592. Kristen Anderson, LCSW, is the Clinical Director and a therapist at the Eating Disorders Program at The University of Chicago Medicine. She treats adolescents and young adults with eating disorders. Her research interests include the treatment of adolescent eating disorders, including the use of innovative technology to deliver treatment. Family Based-Treatment Without Borders: Utilizing Telemedicine to Deliver Family-Based Therapy (FBT) By Kristen Anderson, LCSW, Clinical Co-Director, Catherine Byrne, BA, Research Assistant, and Daniel Le Grange, PhD, Professor and Director Eating Disorders Program, The University of Chicago Medicine, Illinois Kristen Anderson Catherine Byne Daniel Le Grange ➥  continues on next page
  • 16. 16 7. Wilfley, D. E., MacKenzie, K. R., Welch, R. R., Ayres, V. E., & Weissman, M. M. (2000). Interpersonal psychotherapy for group. New York: Basic Books. 8. Wilfley, D. E., Welch, R. R., Stein, R. I., Spurrell, E. B., Cohen, L. R., Saelens, B. E., Dounchis, J. Z., Frank M. A., Wiseman C. V., & Matt G. E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry, 59(8), 713–21. 9. Wilson, G.T., Wilfley, D. E., Agras, W. S., Bryson, S.W. (2010). Psychological treat- ments of binge eating disorder. Arch Gen Psychiatry, 67(1), 94-101. 10. Alinier, G., Hunt, B., Gordon, R., Harwood, C. (2006). Effectiveness of intermediate-fidelity simulation training technology in undergradu- ate nursing education. J Adv Nurs, 54(3), 359-369. Denise Wilfley, Ph.D., is the Scott Rudolph Professor of Psychiatry, Medicine, Pedi- atrics, and Psychology at Washington University School of Medicine in St. Louis. She has received over $25 million from the NIH to study the etiology, prevention, and treatment of eating disorders and obesity. Her research has established the diagnostic significance and treatment of binge eating disorder. She co-developed the Healthy Body Image Program, an evidence-based online platform for eat- ing disorder screening and intervention. She is President of the Eating Disorders Research Society, a Fellow of the Acad- emy for Eating Disorders, and a member of the NEDA Research Advisory Council. Catherine Byrne, BA, is a research assistant at the University of Chicago Medicine. She will be starting a clinical psychology PhD program at George Mason University in Virginia this fall, where she plans to continue her research in eating disorders and body image. Daniel Le Grange, PhD, is Professor of Psychiatry and Behavioral Neuroscience and Director of the Eating Disorders Program at The University of Chicago Medicine. He studies psychosocial inter­ ventions for children and adolescents with eating disorders.  Le Grange et al.  continued (how well clinicians adhere to a new treatment) is traditionally assessed by expert raters who listen to recordings of clinicians’ sessions. This method can be time-consuming and is dependent upon adequate numbers of both expert raters and ready-for-treatment patients.1,2 Simulated assessment has proven effective (adaptable, efficient and accurate in assessing training) in the medical field,10 and has several potential advantages over traditional supervisory methods. The telephone simulation in this study will feature different scenarios of standard “patients” with symptoms of disordered eating with whom the therapists will practice using IPT.  Denise Wilfrey  continued from page 14 BECOME A MEDIA WATCHDOG he Media Watchdog program empowers consumers to advocate for positive media messages. This means recognizing and celebrating advertisements that send healthy body image messages, as well as taking the time to express our concerns about advertisements that send negative body image messages or promote unrealistic ideals. When we act together, we have a stronger voice to hold advertisers and entertainment media accountable for the impacts of their media messages. Visit the Media Watchdog homepage to alert NEDA about a praise-worthy or protest- worthy advertisement/media message, download how-to instructions on deconstructing an advertisement, check for cur­ rent Media Watchdog Action Alerts and more information on becoming a media activist!  n T If the study hypothesis proves true, and online training is as effective as in-person training, the study team plans to further explore the use of technology in training even more clinicians in IPT using web- based models. This reproducible, low- cost training method would ultimately enhance the dissemination of evidence- based treatment for eating disorders, improving access to high-quality care.  n References 1. Fairburn, G. C., Wilson, G. T. (2013). The dis- semination and implementation of psycho- logical treatments: Problems and Solutions. Int J Eat Disord, 46(5), 516-521. 2. Bush, T. (2005). Overcoming the barriers to effective clinical supervision. Nurs Times, 101(2), 38-41. 3. Agras, W.S., Walsh, B.T., Fairburn, C.G., Wilson, G.T. Kraemer, H.C. (2000). A multicenter comparison of cognitive- behavioural therapy and interpersonal psychotherapy for bulimia nervosa. Arch Gen Psych., 57, 459-466. 4. Arcelus, J., Whight, D., Langham, C., Baggott, J., McGrain, L., Meadows, L., Meyer, C. (2009). A case series evaluation of a modified version of interpersonal psychotherapy (IPT) for the treatment of bulimic eating disorders: A pilot study. Eur. Eat. Disorders Rev., 17; 260-268 5. Hilbert, A., Bishop, M.E., Stein, R.I., Tanofsky- Kraff, M., Swenson, A.K. Welch, R. R., & Wilfley, D. E. (2012) Long-term efficacy of psychological treatments for binge eating disorder. British Journal of Psychiatry, 200, 232-237. 6. Tanofsky-Kraff, M., Wilfley, D. E. (2010). Interpersonal psychotherapy for the treatment of eating disorders. Oxford Handbook of Eating Disorders, (Agras WS, ed.). New York: Oxford University Press. NEDA’s Helpline is available to direct you to support group options in your area, whether you are a family member, friend or pursuing recovery. Call us at 800-931-2237 or search online: www.nationaleatingdisorders.org/support- groups-research-studies
  • 17. 17 My hand hovers over the mouse. I hesitate. I slowly turn and look behind me. The bespectacled girl at the desk behind me has her head buried in a stack of books, surrounded by two Starbucks cups and an array of post- its, highlighters, and pens. Before I can stop myself, my finger is clicking on the “Open new tab” button and I’m rapidly typing in the web address of my favorite website comparing celeb- rity body types. My pupils dilate and my hand begins to sweat. Who are we talking about today? A photo of Katy Perry in a royal blue bi- kini appears on the screen. I immediately begin evaluating her body and scrolling through the comments, my eyes glued to the screen. Girlfriend needs a tan… Way to go, Katy. If only my boobs were so voluptuous. Wow, what happened to her? She used to be hot. Pheww, I’m glad I don’t look like her. And that is how it goes for the next hour. I don’t get any work done and I become more and more absorbed in the hamster wheel of judging other people’s bodies, the futile chase of trying to find the per- fect body. Guess what? It doesn’t exist. Three years of therapy later, I am fully aware of the detrimental effects of social media on body image, everything from innocuous-sounding “healthy living blogs,” where bloggers post photos of perfectly portioned meals, to the pristine bikini photos my friends post on Face- book to the Twitter wars of “don’t eat this/do eat this.” I was not alone among the hordes of unhealthy students I saw on campus throughout my four years attending the University of Pennsylvania. It had nothing to do with how they looked; it was the snippets of conversations I overheard on Locust Walk on my way to class. The gym-clothes-clad sorority girl walking in front of me says to her friend, “I can’t believe I ate that piece of cake! Gotta go to the gym and burn it off. Want to come?” “Oh, I forgot to eat lunch. I was stuck in the library all day!” What I got from recovery is that language matters. The language we use to describe ourselves and to describe others, it matters. We have a choice though. We can choose to accept the words as true or we can honor ourselves and what we are committed to. Our words create our worlds. We can live in a world where we listen to what we’re told as the truth or we can create the world that we want to live in. In October 2013, I first formulated the idea of what my Tumblr blog, Penn Poised, would evolve to be over the next few months: a pathway to show people that how we see ourselves matters, and it starts with our relationship with our bodies. I wanted it to be a group committed to increasing awareness of body image issues on campus and promoting healthy ways of thinking about our bodies. Most of all, I wanted everyone to see the elephant in the room, front and center, zoomed in to hair-inside-the-nose resolution. Our first awareness campaign took the form of a photo shoot turned social media experiment. Where better to reach people than the internet? The photo shoot showcases a wide array of views and experiences. Some students chose to highlight what they love about their bodies: they can run and dance and hold graceful yoga poses. Others chose to point out the unrealistic societal standards of the world we live in, where there is an “ideal” that we are supposed to look like and if we don’t, we are subject to other people’s judgments and, most destructively, our own. My most startling experience of the photo shoot was the courage of all the young men and women who participated. Everyone who came for their half-hour time slot over the course of two days gave 100% of themselves in the photos, shedding all of their pretenses and showing the camera their pure and unadulterated humanity. I hope that when people see the photos on our Tumblr and Facebook page, they see twenty beautiful people, not bod- ies. When I first posted my own photos online, I was terrified. I thought it would be just like the websites I was addicted to where my body was up on the cutting board, waiting to be ripped into pieces by people’s judgments and criticisms. Not only did the photos reveal more skin than I am usually comfortable with showing on the internet (where anyone can see), but these photos are a raw expression of what I stand for in the world. It took all of my courage to push the “post” button while my heart was thundering in my chest. It felt like diving into a pool with my eyes squeezed shut. What surprised me in the coming days and weeks was that the photos them- selves received very few comments. However, according to Facebook statis- tics, from April 16th until July 14th, 6,796 people were reached by our main photo shoot post and our page had 216 likes. People were definitely taking notice of Penn Poised; they just weren’t concerned about nit-picking my body. How about that? My body is not the center of the world, contrary to popular belief. The message I am conveying to the world is just that: we are not our bodies. We are individuals with more strength, perseverance and courage than I can imagine, and to define ourselves by what we look like is to limit the possibility of who we are. Who we are is the possibility of a world of love and acceptance and we are creating it, one photo at a time.  n Laura MacKinnon writes about her experiences with anorexia in high school and college with the intention of empowering people who are struggling with body and food issues. She hopes to spread the message that eating disorders are 100% preventable and recoverable Laura has a Bachelor’s of Science degree in Bioengineering and is currently doing research on mindfulness at the University of Miami. Penn Poised: Rewriting the Social Media Script By Laura MacKinnon, Florida
  • 18. 18 As the Jewish New Year rapidly ap- proaches, people may find themselves feeling anxious about the holiday season. Anxiety may be particu- larly acute for individu- als who struggle with eating disorders or who are in various stages of recovery. Jewish holidays can also be stressful for family members caring for a loved one with an eating disorder. Judaism’s festivals can be experienced as a cyclical pattern of feast and famine, and thus particularly fraught for those struggling with eating disorders. The holidays start with Rosh Hashana, the Jewish New Year, a two day ‘feast.’ The day after Rosh Hashana is Tzom Gedaliah, a daytime fast, which is soon followed by Yom Kippur, a 25 hour fast. The autumn holidays culminate a few days later with Succot (Feasts of Booth), a seven-day harvest holiday. Thus, the fluctuations in eating patterns that are integral to the experience of Jewish holidays are likely to disrupt the highly structured and regu- lated meal plans of those in recovery, and may throw them off balance. Fasting, usually prohibited for individuals with eating disorders, is risky as it may trigger food restriction, while the many large festive meals may feel overwhelming and binge-like. This framework, however, misses the essence of what is meaningful about the cycle of Jewish holidays. Judaism is a reli- gion rich in symbolism. On Rosh Hashana, we eat foods that are round and sweet to represent the cyclical nature of the year and our lifecycles. On fast days, we abstain from food not to punish our- selves, but rather to liberate ourselves from bodily preoccupations and direct our attention to introspection and prayer. Finally, on Succot, we build a temporary outdoor dwelling, a sukkah, in which friends and family dine together. The suk- kah is unique in that it is required to have a lattice roof through which we can see the sky. These symbols are reminders that the essence of life is not physical posses- sions or external appearance but rather our relationships with loved ones, nature and god. When the focus of the holiday centers on food alone, the Jewish holidays can be experienced as overwhelming. However, self-care tools that integrate the symbol- ism and meaning of each holiday can help to create positive, healthy and spiritual experiences. Symbolism of Honey An additional highlight of Rosh Hashana is dipping apple in honey. The combina­tion of these foods symbolizes two ideas; the gustatory sensation of the tart apple with the sweet honey represents balance. Life is about developing balance and perspective; most of life is not perfectly sweet or completely tart. Thus, ideally, the holidays create reflective moments of balance to remind us that life is not about food, but rather that life includes food. There is an additional custom of dipping bread in honey for every festive meal from Rosh Hashana through Succot, including the meal prior to the Yom Kip- pur fast (also considered a holiday meal). Symbolically, by adding honey to some- thing basic like bread, we remind our- selves that wonderful opportunities are everywhere, but we have to be open to receiving and including them in our lives. A self-care tool may be to share some- thing that has added particular sweetness or meaning in your life this past year, week or day. Some families go around the table and share their thoughts during the holidays. You may also consider selecting one food that you plan to enjoy eating at each holiday meal and share its meaning as a symbol of balance. Symbolism of Community and Communication Eating disorders are often accompanied by depression and isolation, so the social demands of the holidays can be challenging. The festive meals, communal prayers and food ceremonies are designed to bring people out of their lonely states. Sadly, one can feel lonely and isolated even when surrounded by others. The prayer service has moments of individual prayer and moments of collective prayer – there are times to be alone with one’s thoughts, and times to sing, pray and beseech together. A self-care tool may be to discuss in advance who will be at the various meals and whom you might be most comfort- able sitting beside. It may be helpful to prepare some topics of conversation that will facilitate connecting with family and guests. Symbolism of Foods that are Round The year, regardless of the calendar one follows, is cyclical in nature. The con- cepts of beginnings, renewal and hopes for the future are inherent in the eating disorder recovery process. A central tenet of the Yom Kippur fast day is the idea of repentance. Human beings make mistakes. Yom Kippur is an opportunity to acknowledge and understand our mistakes, and, most importantly, forgive others and ourselves. It is an opportunity to release the fear and shame that may inhibit future growth and recovery. While past holidays may have been painful, this year they can be uplifting and nurture a renewed spirit. This year, try to focus on forgiving yourself and allowing yourself to be in the moment. A self-care tool may be to create a simple mantra, such as ‘this year is different – this year I am different,’ that you can repeat to yourself. This soothing self-statement can be helpful and empowering. Best wishes for good health and sweet- ness in the New Year.  n Sarah R. Roer is a psychologist with a PhD in Clinical Psychology (Health Emphasis) from Yeshiva University’s Ferkauf Graduate School of Psychology. Her area of focus, both in research and clinically, is in the field of eating disorders. Her previous clinical experiences include work at The Renfrew Center of New York, St. Luke’s Obesity Research Clinic in New York and Hadassah Ein Kerem in Jerusalem. Sarah’s area of research has focused on Binge Eating Disorder, Emotional Eating and Night Eating Syndrome, a subject on which she presented at the Academy of Eating Disorders. Dr. Roer maintains a private practice in Manhattan and works as a psychologist in the Ramaz Upper School. Navigating the Jewish Holiday Season By Sarah Roer, PhD, New York
  • 19. 19
  • 20. 20 “I don’t know what’s going on when my wife is off at treatment. She comes home saying things that don’t make sense — and I suspect she’s twisting some thera­pist or dietitian’s words for her own purposes. But how do I know? I have no idea what she’s being told. I’m completely on the dark. And I resent that.” “I’m damned if I do, and damned if I don’t. Everything about this eating disorder makes me want to scream. And I am terrified that my son is gonna die.” “Why does the treatment program operate like they only need to treat the client? Aren’t I a client, too? I influence my daughter more than some psychologist can. But I can’t tell anymore whether my influence is good or bad … and whether I’m the reason for the eating disorder. Maybe she and my family would be better off if I just disappeared.” Dealing with the Dilemmas of Men Who Have a Loved One with Eating Disorders By Joe Kelly, California ➥  continues on next page Every person with an eating dis- order has men in her or his family: husbands, partners, exes, fathers, step- fathers, brothers, stepbrothers, cousins, grandfathers, uncles and friends. These male loved ones (aka MLOs) deal with substantial dilemmas in the face of eat- ing disorders — and they tend to do so silently, in isolation. So what do MLOs say about their dilem- mas? First, you have to ask. Eating disor- ders advocate Don Blackwell instigated a survey of about 100 fathers participating in 2014 NEDA walks. Approximately 80 percent of those fathers felt challenged by a sense of fear and helplessness. But only around half say they’re likely to par- ticipate in e-mail or in-person meetings with other fathers. Since 2011, I’ve facilitated male-only coaching groups for nearly 100 men in Minnesota and California who have a loved one with eating disorders. Many of these men already participated in treat- ment program multi-family groups, ANAD support groups and other “co-ed” gather- ings for friends and family. However, they admit that their discussions are far more restrained in those settings than in our male-only groups. Our participants report feeling impotent in the presence of an illness they describe as irrational, unpredictable, cunning, powerful, stubborn, clever, baffling, devi- ous, unfair and unjust. They struggle to understand and articulate how the eating disorder crisis affects their own lives. They are angry and grieving over how the illness’s arrival altered relationships with their loved ones and hijacked their families. These MLOs want to know how (and if) it is possible to make their loved ones get better — as well as how (and if) it is pos- sible for a MLO to keep his sanity in the process. They want to master the logical arguments that will convince their loved ones to give up the eating disorder. Their most frequent refrain is: “Tell me what to do.” We men like to solve problems; this is a wonderful trait. We (quite rationally) want a plan that will lead to solutions. When confronting eating disorders, there are things we can do, but we can’t expect those things to “fix” this problem. Unfortunately, there is no silver bullet cure for eating disorders or surefire way to eliminate their impact on concerned bystanders. As eating disorders expert Margo Maine, PhD says about this unreasonable illness, “Logic doesn’t work; love does.” The most effective responses to the dilemmas of living with eating disorders aren’t always obvious. In fact, they are quite counter-intuitive — no surprise, given the paradox and illogic of eating disorders themselves. At the top of my list for MLOs are self- care, loving detachment and radical acceptance. When I introduce these concepts, many MLOs object: “What are you talking about? I need to take care of my loved one and focus on defeating the eating disorder! What good could it possibly do to go off and do ‘self-care,’ or to accept and detach from the problem? I don’t even know what ‘self-care’ means!” For starters, self-care is not self-indul- gent, self-centered or selfish. Instead, it is essential human nourishment fed by simple, rejuvenating activities like taking a walk, dining out with a friend, meditat- ing, reading, shooting hoops and the like. Yes, it means temporarily removing ourselves from the person with the eat- ing disorder, but (paradoxically) this is a good thing. Here’s why: The eating disorder self works hard to pull us loved ones into its distorted way of perceiving and thinking about the world. It thrives on drawing us into arguments, arguments we simply can’t win. It loves having us rise to the bait of reacting in kind to its melodra- matically intense behavior. The challenge for MLOs is to stop react- ing (e.g., attempting to argue with, pun- ish or shout down the eating disorder) and start responding — with calm words and actions which keep our focus where it belongs. For example, self-care is a response that: • Provides perspective by stepping away from a chaotic and manipulative illness • Reminds us that we have a life outside of the eating disorder vortex • Strengthens our connections and fellowship with other loved ones and friends • Clears our head and releases emotional tension • Helps us remember that our struggling loved one is more than an eating disorder; she or he is a genuine person of value • Demonstrates to our loved one’s authentic self that healthy self- nurturance is worth fighting for Now, this approach may not make any sense to you. Or, it may make sense in principle, but appear impossible to pull off. Either way, I ask you to consider whether or not it actually works. Keep- ing in mind our sample size of around 100 men, preliminary results indicate the concrete benefits of learning this self- care approach. For example: we surveyed participants before and after the coach- ing group; in the “post participation” sur-
  • 21. 21 vey, men report feeling 16 percent more competent and 18 percent more hopeful about dealing with the eating disorder. Therapists, physicians and dietitians who refer men for coaching report that nearly every one of the men is more involved in the identified client’s treatment than they were before the coaching began — by bringing the client to appointments, asking questions, emailing the treatment providers, etc. The providers also report that the clients themselves notice a posi- tive difference in how their MLOs are responding to the eating disorder. Men who try self-care, loving detach- ment and radical acceptance see results. These are things we can do, and which produce outcomes like: “I’m much clearer about what’s going on now. I still hate it, but I feel like I finally know what my choices are.” This approach won’t cure an eating disor- der or guarantee that anyone (other than ourselves) will change their behavior. But, as one husband put it, there are payoffs: “It’s an opportunity to learn, to grow, to become closer to your loved one. Even if she isn’t involved in this particular activ- ity, you’re gonna gain an understanding. You discover you’re not alone. It makes it a lot easier to talk about. And as soon as it’s easier to talk about, things are gonna be getting better.”  n Joe Kelly has spoken at several NEDA conferences and wrote the best-seller Dads & Daughters®: How to Inspire, Understand, and Support Your Daughter and (with NEDA Past President Dr. Margo Maine) The Body Myth: Adult Women and The Pressure to Be Perfect. He coaches men who have a loved one with eating disorders — via the Internet — to develop skills to reduce their stress and support their loved one’s recovery (www.joekelly.org/coaching-for-men). Joe also consults with treatment providers on how to mobilize and utilize men in families. Contact him at joe@joekelly.org or 510.423.0553. Calling all Dads: Roll out the rolo- dex! I am betting many of you have sold Girl Scout cookies for your daughter’s troops. After all, you were the one with the list of contacts, and your daughter needed your help. Did you bring the sign-up sheet into work? Cart in cases of cookies and distribute them across your office? Maybe the first year you were a little hesitant, not wanting to ask your co- workers to put up the money, but it became easier the second year, once you had seen that people were willing to contribute. More importantly, it became easier once you saw how happy, and how proud of you, your daughter was. Selling Girl Scout cookies for my daugh- ter’s troop was the last time I had asked anyone to contribute to anything until recently. After the first five years of my youngest daughter’s battle with anorexia I was compelled to raise money for the New York City NEDA Walk. That first year I was hesitant; hesitant to tell her story and even more hesitant to reach out to others for contributions. I persevered because I was touched and motivated by what I had seen my daugh- ter and so many others suffer through year after year. I sent emails to several hundred people: grammar school class- mates; coworkers from years ago; friends from the different towns we have lived in; contacts from my current job and count- less others. The response was incredible. The first year I was fortunate enough to raise close to $10,000. Donations ranged from $25 to a few as high as $500. More importantly, it was apparent that many of the people I had emailed knew someone who suffered from an eating disorder. Others were moved by my daughter’s story and were appreciative of the glimpse into what this insidious disease can do to someone and their family. I felt proud that I had accomplished my goals, both raising money for and rais- ing awareness around eating disorders. While enduring the realization that I could not “fix it” for my daughter, for once I was able to actually do something positive for the cause. Similar to selling Girl Scout cookies, the second, third and fourth years were much easier. As I have continued to support the NYC Walk, I expand my contact list to include people I have met in the past year. Last year I raised $15,000 for NEDA’s programs and its research funding. NEDA, in addition to creating many fan- tastic programs for those affected by eat- ing disorders and their families, donates money through the Feeding Hope Fund for eating disorders research. Those of you who have been living with someone suffering from an eating disorder know its baffling power and are all too aware of the need for research and the need for funding. NEDA Walks are essential to meeting the organization’s funding and research goals. The annual New York City Walk raises $160,000–$175,000 and I believe it has an even greater potential. Many of the NEDA Walk team captains are the patients who have suffered and they reach to their friends and family for contributions. I applaud them to no end. Today, however, I am asking you, the DADs, to reach into your rolodexes, your email address books, your Linked In contacts and your Facebook accounts. Reach out, spread the word about eating disorders and raise some funds. We can foster research to prevent this disease from impacting our children’s children. We are the ones with the long list of contacts. We are the ones who can make a difference. Believe me, many of your contacts will have an extremely positive reaction if you reach out to them…at least as positively as that first time you sold them those Girl Scout Cookies. This is your chance to help.  n Calling All Dads By Steve Sexton, New Jersey  Dilemmas of Men  continued
  • 22. 22 Upcoming 2014 NEDA Walks: bring communities together to increase eating disorders awareness and raise funds for NEDA in a fun way. They not only work to support the mission of NEDA, but also work to bring awareness and education to the local communities in which they take place. NEDA Walks that are coordinated by NEDA Network Members return a majority of the funds back to the local community and 2013 was the first year of the NEDA Walks scholarship program, which sent local Walk Coordinators to the NEDA Conference free of charge. Help NEDA support individuals and families affected by eating disorders in local communities around the country by registering for a walk near you!  n NEDA Walks The first-ever Vermont NEDA walk was a long time coming. I had been hanker- ing to participate in a walk for ages; I had been following NEDA social media and email, hoping that I would get a notice one day that someone was planning an event in Burlington. But that’s the key: if you want to show support for something you care about, you can’t wait for someone else to start the planning. I was fortunate enough to serve, over the past academic year, as the president of the University of Vermont chapter of Mortar Board Senior National Honor Society. With that responsibility NEDA Walk Volunteer Spotlight By Bronwen Hudson, NEDA Walk Coordinator, Vermont came the incredible opportunity to gather together the mem- bers, lead the group in an organizational initiative, and plan the first NEDA Walk to ever occur in our state. As we began to advertise the event, more and more volunteers popped up; many people reached out, letting me know how excited they were for the walk, and to tell me that they had also been waiting a long time for an event in the area. There is a phe- nomenal and extremely supportive community in Vermont; we had a turnout of over 100 people, raised almost $8,000, and our speaker Annie Cressy’s words moved and inspired the crowd. All that was needed was a single decision to make it happen. I only wish all my choices in life could be so meaningful.  n Louisville, KY NEDA Walk University of Louisville Lacrosse Stadium Louisville, KY Saturday, September 20, 2014 Albany, NY NEDA Walk The Crossings of Colonie Albany, NY Saturday, September 27, 2014 Hartford, CT NEDA Walk University of Connecticut Greater Hartford Campus Hartford, CT Saturday, September 27, 2014 Jefferson City, MO NEDA Walk Cole County Park Jefferson City, MO Saturday, September 27, 2014 Terre Haute, IN NEDA Walk Indiana State University – Michael Simmons Student Activity Center Terre Haute, IN Saturday, September 27, 2014 Wilmington, NC NEDA Walk Hugh MacRae Park Wilmington, NC Saturday, September 27, 2014 Iowa City, IA NEDA Walk Willow Creek Park Iowa City, IA Saturday, October 4, 2014 Lancaster, PA NEDA Walk Long’s Park Lancaster, PA Saturday, October 4, 2014 Denver, CO NEDA Walk City Park Denver, CO Sunday, October 5, 2014 New York City NEDA Walk Foley Square New York, NY Sunday, October 5, 2014 Baton Rouge, LA NEDA Walk North Boulevard Town Square Baton Rouge, LA Saturday, October 11, 2014 Virginia Beach, VA NEDA Walk Mount Trashmore Virginia Beach, VA Saturday, October 11, 2014 NEDAWALK NATIONAL EATING DISORDERS ASSOCIATION Save a Life
  • 23. 23 Everyone has his or her own special reason for participat- ing in a NEDA Walk: it could be to celebrate personal recovery, to support a friend or family member, or to honor the memory of a loved one. Sharing our stories of strength, recovery and hope brings us together as a commu- nity and shines the spotlight on eating disorders. NEDA Walks are about building a supportive community, and NEDA Walkers can now spread that message online by using the #WhyINEDAWalk hashtag. By sharing our personal reasons for walking we are spreading the word and inviting others to join the movement. Because everyone has a reason: #WhyINEDAWalk Here’s a few #WhyINEDAWalk reasons we’ve heard recently: “I walk to show people recovery IS possible and they are not alone.” —@MAEH82 “I walk because I deserve to be happy healthy :) I am saying no to my ED and choosing recovery instead!” — @1975trumxn “I walk because eating disorders are significant public health concerns that demand attention and urgent action.” — Rachael Baltimore, MD NEDA Walk W Chesapeake Avenue and Washington Avenue Towson, MD Sunday, October 12, 2014 Cleveland, OH NEDA Walk The Holden Arboretum Willoughby, OH Saturday, October 18, 2014 Houston, TX NEDA Walk T.C. Jester Park Houston, TX Saturday, October 25, 2014 Mullica Hill, NJ NEDA Walk Ella Harris Park Mullica Hill, NJ Sunday, October 26, 2014 Asheville, NC NEDA Walk Pack Square Park Asheville, NC Saturday, November 8, 2014 Summerville, SC NEDA Walk Town Square Summerville, SC Saturday, November 8, 2014 Twin Cities, MN NEDA Walk Mall of America Bloomington, MN Sunday, February 22, 2015 San Diego, CA NEDA Walk NTC at Liberty Station San Diego, CA Saturday, February 28, 2015 Phoenix, AZ NEDA Walk Phoenix Zoo Phoenix, AZ Sunday, March 1, 2014  Upcoming 2014 NEDA Walks  continued NEDAWALK NATIONAL EATING DISORDERS ASSOCIATION Save a Life NYCNEDAWALK.ORG NYC NEDA Walk October 5, 2014 Foley Square REGISTER RAISE:
  • 24. 24 eating disorders, as well as increase awareness about the signs and symp­toms of eating disorders. In Pennsylvania, legislation was intro- duced calling for schools to educate parents about the signs and symptoms of eating disorders, as well as designing an optional school screening program. Several volunteers from across the state gathered in Harrisburg for a Pennsylvania Eating Disorders Lobby Day, where they were given the opportunity to educate legislators on the bill’s importance. Emily Rosenberg, a college student and Pennsylvania resident, spoke about her personal struggle with an eating disorder at a Lobby Day press conference and at an August hearing of the Pennsylvania House Democratic Policy Committee. The bill has garnered bipartisan support, which we will continue to build upon over the next several months. In 2015 NEDA’s STAR Program plans to introduce legislation in several states across the country, focusing on building support for school-based screenings for eating disorders; improving access to care; and limiting barriers to treatment, such as insurance complications. These legislative reforms made possible through the efforts of STAR Program advocates, and we hope that in 2015 even more advocates will get involved and take action in their states. Your legislators want to hear from you, and you can make a difference by becoming a NEDA STAR Program advocate. If you are interested in getting involved or learning more, contact NEDA’s STAR Program Manager Kerry Dolan at star@myneda.org.  n Working Toward Legislative Reforms: NEDA’s STAR Advocates Make Strides Across the Nation By Kerry Dolan, STAR Program Manager, New York Solutions Through Advocacy Reform (STAR) Program NEDA established the STAR Program to legislatively advocate for aware­ness, education, early intervention and prevention programs, funding for research, and improved access to treatment of eating disorders by speaking with legislators, mobilizing members, and forging alliances with other groups who share our vision. STAR is driven by passionate volun­teers. You don’t need experience to make a difference. Contact star@myneda.org for more information.  n was a busy year for NEDA’s Solutions Through Advocacy and Reform (STAR) Program. With major legislative victories in New York and Missouri, a successful lobby day in Pennsylvania and an awareness resolu- tion introduced in Arizona, our STAR advocates made a huge difference and paved the way for future reforms. In Arizona, Senator Katie Hobbs introduced a resolution on the Senate floor to officially declare National Eating Disorders Awareness Week in Arizona. Dedicated STAR advocates met with Senator Hobbs at the Capitol to discuss eating disorders reforms, and the group was recognized on the senate floor as Senator Hobbs read the resolution. This was a big step in educating Arizona legislators about the importance and seriousness of eating disorders. The group hopes to build on this success by introducing legislation next year to create a statewide school-based screening program for eating disorders. Our Missouri advocates saw yet another victory this year, when legislation was passed to establish the Joint Commit- tee on Eating Disorders. The Committee will review the regulation of insurance and other matters impacting the care and treatment of eating disorders and will make recommendations for future legislative action. In the coming months the Committee will travel throughout the state to gain a better understanding of the needs of Missourians who are im- pacted by eating disorders. This is an im- portant victory in the fight against eating disorders, and we hope that it will pave the way for additional insurance reform legislation. NEDA thanks Annie Seal and our STAR Program advocates in Missouri for their tireless efforts and dedication to fighting eating disorders. In New York, the State Senate and Assembly passed S2530/A5294, legis­ lation amending the public health law to establish the Eating Disorders Awareness and Prevention Program within the New York State Department of Health. This program will promote available resources and services to those who suffer from 2014
  • 25. 25 ARTS FOCUS To be a ballerina is to be disciplined. Every day we wake up sore, tired and inspired for our day’s work. We take class, beginning at the barre, going through a sequence of exercises (always in the same order), then into the center with our tendus, bettements and pirouettes, then small, medium and large jumps. We wear a specific pointe shoe that fits our feet personally. All dancers have their own style – a way we like to do their hair, our favorite stretching routines and, of course, our diets. Yes, ballerinas are disciplined, and with that discipline comes an inherent desire for control. Many of us find comfort in these daily routines; but when it comes to food, that ritualization can hurt us. I love dancing — that’s never been the issue. Feeling strength, control and freedom in movement is an amazing thing. But at times it’s hard to look at myself in the mirror for so long every day. Sometimes I find the slightest flaw and obsess over it. Standing next to my peers, I sometimes view our differences – I’m curvy, others are not – as negative. But sometimes I realize that my curves are powerful – literally. Are my hips bigger than those of some other girls? Sure, and that means I can jump higher because of all that muscle. It’s the ability to capture this thinking in my darkest moments that has helped me to stay positive, but this doesn’t happen for everyone. I want other dancers to find their strength and embrace their bodies. Take Back the Tutu By Brittany Adams, Minnesota we as a company had done something to really help the students. To have a ballet studio be the place where you are comfortable speaking openly about body image? That’s amazing! We also wanted to open the public’s mind to the many ways that professional dancing can affect artists’ eating habits. While some dancers remain unaffected, others struggle with eating disorders. Many dancers are under pressure from their companies, their mentors and their role models, while others do not find the same pressure. To “Take Back the Tutu” is to be empowered to take ownership of our art and to throw away the idea that we have to look a certain way to wear the tutu. We invite you to join us: take back your own tutu.  n To read our reflections in full and to see the accompanying photos by Caroline Yang, visit http://www.emilyprogram. com/blog/take-back-the-tutu/ For more of Caroline’s work with Saint Paul City Ballet, visit her Instagram: @carolineyangphoto. The concept of “Take Back the Tutu” came about during a small meeting of some of Saint Paul City Ballet’s dancers and board members. I wanted to illuminate two truths about the dance world: firstly, many dancers do struggle with body image – it can be an obsession due to constant scrutiny of their bodies. Secondly, dancers do not have to starve themselves to make it to the top. We decided to use social media to raise awareness, and we brought our company together to write reflections on healthy body image. What we created was thoughtful, heartfelt, and honest. Each individual brought personal perspective and insight to the project. The reflections were topped off with beautiful pictures by photojournalist Caroline Yang. She showed us as athletic, strong and powerful dancers. It was an uplifting and therapeutic week for all of us as we posted one reflection and photo per day, and positive feedback poured in. We partnered with The Emily Program of St. Paul, Minnesota for guidance and education. They read and approved our statements. They loved the campaign so much they posted the project in a blog. Sarah Hrudka, Outreach Specialist at The Emily Program, came to the studio and gave an informational talk to our older students. The girls were engaged in and inspired by all that Sarah had to say, and they huddled around her, asking ques- tions for almost an hour following the talk. It warmed my heart to know that PFN Webinars Series: Upcoming and Recently Archived LEVELS OF TREATMENT – Led by Zoe Bisbing, LMSW Thursday, September 25, 2014, 2:30 to 4:00 PM EST The Role of Nutrition Therapy in Treating Eating Disorders Recorded live on August 14, 2014 Obtaining Treatment Authorization in Complex World of Insurance Recorded live on July 10, 2014 To register for an upcoming webinar, or view a recorded webinar, visit www.nationaleatingdisorders.org/webinars
  • 26. 26 BLOG REVIEW The Eating Disorders Hope (EDH) blog offers a unique digital space that visitors can rely on for informed, well-sourced eating disorders informa- tion. Each featured post serves to rein- force EDH’s mission: “to foster apprecia- tion of one’s uniqueness and value in the world, unrelated to appearance, achieve- ment or applause.” Contributors include psychologists, specialists, therapists and EDH affiliates, so visitors to the site can expect reliable sources, helpful statistics and supporting references throughout the blog. EDH explores a range of sub- jects, including book excerpts, authors’ personal accounts and recent ED studies. Eating Disorders Hope is particularly successful when discussing the diversity of those who are affected by eating disorders. Posts illustrate the impact of EDs on adolescents (Impact of Eating Disorders on Younger Generations), highlight the scarcity of resources available for men (Men and Eating Disorders: The Struggle for Treatment), explore eating disorders and pregnancy (Pregnancy, Body Image, and Eating Disorders and Pregorexia and How Eating Disorders Impact Pregnancy), discuss the roles of cultural variables (Ethnicity and Eating Disorders: What Does The Research Say) and explore the factors, including susceptibility to negative body image, that affect gay men and men struggling with their sexual orientations. EDH makes a point of writing about, and for, all individuals, regardless of their gender, age, ethnic background or sexuality. Despite its overall inclusiveness, there are groups whose perspectives are not addressed; there is a lack of posts on intersex, transgender or genderqueer individuals. Additionally, in posts such as Summertime Swimsuits and Body Image Issues, the focus on women’s struggles with their body images during the sum- mer season excludes men, who are just as vulnerable to media messages that advocate obtaining an ideal (and impos- sible) ‘beach body.’ Even so, the blog deserves kudos for representing the often-unrecognized Submit a Book Review Eating Disorders Not Otherwise Specified (EDNOS), which are eating disorders that cannot be categorized as anorexia or bulimia. One particular post calls attention to obsessively exercising (Hypergymnasia – The Eating Disorder that Isn’t). Such an issue may be difficult to identify, as it can be disguised as a normal routine in everyday life. Many of these “hidden” diseases call for serious medical attention. In Body Dysmorphic Disorder (BDD) and Cognitive Behavioral Therapy, the syndrome Body Dysmorphic Disorder (BDD) is profiled; BDD causes individuals to live with a constant, negative perception about their appearance. Like all eating disorders, these illnesses must be spoken about openly, and by publishing articles about EDNOS, EDH succeeds in raising awareness. The Eating Disorders Hope blog provides ample insight and resources for those who wish to enhance their understanding of all eating disorders, and it is especially notable for its attention to marginalized groups and Eating Disorders Not Other­ wise Specified (EDNOS), as some eating disorders blogs tend to overlook EDNOS. The Eating Disorders Hope blog manages to provide accurate and overwhelmingly inclusive information about eating disorders in an accessible, easily navigable archive.  n Eating Disorders Hope http://www.eatingdisorderhope.com/blog reviewed by Christina Colon, Communications Intern, New Jersey In the spirit of our Technology issue, this edition’s book review is a blog review. We would love to hear your thoughts about the inclusion of blogs in our resource reviews; please send feedback to pffnetwork@myneda.org. Have you read a book recently that offered you insights, tools or helpful information? Write a review for the newsletter! All you have to do is submit a 1-page article to pffnetwork@myneda.org that includes: ;; Your name and contact information ;; Title of book, author, publisher and copyright date ;; A brief summary of the content of the book ;; What you gained from the book: Hope, tools for recovery, strategies for self-care, encouragement, educational information, etc. * Book reviews are provided by individual PFN members to share with others what they have gained from reading a book that served as a resource to the reviewer. NEDA does not endorse any specific book or author, but rather provides a space for our constituents to share resources with one another. NEDA reserves the right to edit book review submissions prior to publication. If your review is edited, you will be provided the updated version for your approve prior to publication. Eating Disorders HOPE
  • 27. 27 Staff Spotlight Meet the NEDA Staff! Network Spotlight The National Association for Males with Eating Disorders (NAMED) NEDA Network Spotlights are provided by the partnering organi- zation. The NEDA Network is a collaboration between NEDA and other like-minded organizations dedicated to our cause. Together, we provide a unified voice of strength, advocacy and support in the fight against eating disorders. To learn more and explore member benefits, please contact network@myneda.org NETWORK MEMBER NAMED (www.namedinc.org) is a non- profit organization committed to enhanc- ing professional and public awareness around the male experience of eating disorders. NAMED provides information and support for males affected by eating disorders and promotes the develop- ment of effective clinical intervention and research in this population. NAMED also works to accurately transfer leading scientific advances to the lay public and aims to dispel the stereotypes and stigma surrounding male eating disorders. NAMED advocates for male inclusiveness in access to treatment and interface with national and international media plat- forms. Further, NAMED aims to facilitate research collaboration between clinicians and academic researchers, develop an advisory board, integrate with existing eating disorder organizations and provide liaison and advice to community treat- ment services. Founded in 2011 by Chris Clark, a Florida man recovering from anorexia nervosa, NAMED was until recently a one-man operation. In 2014, the organization was restructured with a new board of directors that includes leading academic and clinical specialists. Tom Wooldridge, PsyD, from Golden Gate University’s Psychology Department and Stuart Murray, PhD, a postdoctoral fellow at UCSD’s Eating Disorders Center for Treatment and Research, share the co-executive directorship. Leigh Cohn, MAT, CEDS, publisher of Gürze Books and coauthor of two highly regarded books on males and eating disorders, is the current president of NAMED and brings 35 years of professional expertise in the eating disorders field.  n Caitlin Hamilton has been an integral part of NEDA’s Communications Department since joining the team in May 2013. As Media Communications Manager, Caitlin ensures that NEDA’s social media, emails and blog stay lively, active and informative and keeps NEDA’s voice prominent both online and in print. Originally from California, Caitlin moved to New York City to attend graduate school at NYU, where she completed her Master’s degree in Media, Culture Communication. Prior to joining NEDA, she worked in Communications for international nonprofits, print publications and television media. Media Communications Manager is not Caitlin’s only title at NEDA; as Deputy Fire Marshall she helps keep the office on schedule for fire drills and as Assistant Fun Czar she created an office-wide “ugly holiday sweater party” and organizes general office frivolity as needed. Outside of NEDA, Caitlin enjoys exploring Brooklyn, practicing yoga, listening to podcasts, making origami and travelling as much as possible.  n Caitlin Hamilton Media Communications Manager The Oklahoma Eating Disorders Associa- tion (OEDA) is a not-for-profit organi- zation dedicated to the prevention of disordered eating, eating disorders and negative body image by raising aware- ness, providing education and serving as the leading resource of support and identification of treatment resources throughout Oklahoma and neighboring states. Founded in 2008, OEDA desires to lead and advocate for both public and professional education and the treatment of eating disorders. OEDA aims to further its mission, vision and values through community and professional events as well as referral services for all comers. In 2014, OEDA increased statewide awareness of eating disorders by participating in numerous National Eating Disorders Awareness Week activities throughout Oklahoma and hosting a NEDA walk. On September 19, 2014 we will host our annual Conversations of Hope event. This event, free to all, is an evening focused on awareness, recovery and hope for all eating disorders sufferers, their friends, family and the community at large. To improve professional awareness and education, OEDA hosts networking luncheons, providing education for the varied pro­ fessionals involved in the treatment of eating disorders. Our second professional symposium, “Making an IMPACT with Eating Disorders,” is planned for September 12, 2014 in Norman, Oklahoma. This event will bring together a group of nationally recognized experts to improve our knowledge of eating disorder prevention and care. OEDA is a proud member of the NEDA Network, joining with our sister organi- zations to promote awareness, healing and the prevention of eating disorders. For more information please visit us at www.okeatingdisorders.org.  n The Oklahoma Eating Disorders Association (OEDA)
  • 28. National Eating Disorders Association 165 W. 46th Street, Suite 402 New York, NY 10036 PHONE: 212.575.6200  FAX: 212.575.1650 HELPLINE: 800-931-2237 info@nationaleatingdisorders.org www.NationalEatingDisorders.org Thank you to our generous Sustaining Sponsors for helping to make our programs and services possible. Gold: Eating Disorder Center of Denver, Eating Recovery Center, Monte Nido and Affiliates, 4Girls Foundation Silver: Remuda Ranch at the Meadows, Rogers Memorial Hospital Steel: The Center for Eating Disorders at Sheppard Pratt, McCallum Place Eating Disorder Centers, The Renfrew Center, Timberline Knolls Bronze: Canopy Cove, Center for Change, Columbus Park Collaborative, CRC Health Group, Fairwinds Treatment Center, Laureate Eating Disorders Program, Oliver-Pyatt Centers, Rader Programs, Rosewood Centers for Eating Disorders, Veritas Collaborative Making Connections offers a place for our members to share their personal experiences and insights to support others. While we value these contributions, please note that the views, beliefs and perspectives expressed do not necessarily represent those of the organization. Share Your Thoughts If you have an idea for an article, a question you’d like us to research, or would simply like to share your story — we’d love to have you participate! Email us at pffnetwork@myneda.org. Be sure to include your full name, email address, and daytime phone numbers so we can contact you. Making Connections is by parents, family and friends for parents, family and friends! Join the NEDA Forums! Connect with fellow siblings, parents, partners/spouses, friends and others pursuing recovery. Whether you are personally affected by an eating disorder or supporting someone who is, the NEDA forums are designed to be a safe and welcoming space to discuss issues related to eating disorders, disordered eating and body image. Check out the community guidelines and join the conversation at www.myneda.org/forum.