Is Recovery From an Eating Disorder Possible?

by Heidi Limbrunner, Psy.D., ABPP

In working with families that have a loved one struggling with an eating disorder, one of the most common questions asked is about recovery. Can a person truly recover? 

The short answer to this question is: Yes, a person can fully recover with appropriate treatment. Research has demonstrated that while some people may struggle lifelong with an eating disorder, a majority of people can make a full recovery.

Here are four factors that can help lead to a full recovery:

1. Early Detection. Like other illnesses, the sooner a person begins treatment, the better likelihood of recovery. The longer a person engages in eating disorder symptoms, the more difficult the recovery can be.

2. Treatment Team Approach. Since eating disorders are complex illnesses that involve both medical and psychological issues, treatment should involve a therapist, physician and dietician. All of your care providers should have experience in treating eating disorders.

3. Type of Therapy. There are many different types of therapy for eating disorders. Choosing a therapy supported by research promotes the best chance for recovery. For children and teens, this therapy is called Family Based Treatment or the Maudsley Method. For adults, Cognitive Behavioral Therapy is the treatment of choice.

4. Appropriate Level of Care.  It’s imperative that a person receive care at the most appropriate level based upon their symptoms. This can be outpatient, day treatment or inpatient care. Your treatment providers should help you determine which level is appropriate.

Intervening early with a treatment team approach using a proven and research-supported therapy model at the appropriate level of care increases a person's chances of a full recovery from an eating disorder.

Dr. Heidi Limbrunner is a licensed psychologist with Southeast Psych in Charlotte. She specializes in the treatment of eating disorders.  You can contact her at 704-970-4791.

Sports Injuries Don’t Just Hurt the Body

by Dr. Nyaka Niilampti

Most of us who play a sport consider “athlete” as one aspect of our identity.  How important playing a sport is to us can greatly affect how we deal with an injury.  While healing the body is important, the injury to our identity as an athlete can be equally significant.  Some of the possible psychological impacts of sport injuries include:

Temporary loss of identity:  Many athletes connect the way people view them (popularity, respect) to their role in sport.  During the rehabilitation process, there may be a constant comparison to things that they could do, and the way that others used to view them.  These negative thoughts may work against them in their efforts to heal the body.

Feelings of isolation and being left out:  Athletics presents an important social role, and as a result, injured athletes may feel left out of the interaction with teammates, both competitively and informally.  This loss may be as significant as what we would consider a true “loss” such that a grieving process may take place. This will be especially true in the situation of a career ending injury.

Decrease in self-esteem:  For many athletes, self-esteem is connected to performance ability and achievement.  Injury for some athletes may have a significant impact on self-image and long term goal achievement.  This decrease in self-esteem may carry over into academic performance and personal relationships. 

Depending on the severity of the injury, other possible psychological impacts include anger, guilt, post-traumatic stress disorder, helplessness, and depression.  Each of these concerns may contribute to an athletes’ ability to recover well and return to post injury performance, which again can result in depressive symptoms and repeat the psychological pattern.

Here are a few things that parents and coaches can do to help injured athletes heal their minds. 

* Help athletes to acknowledge and recognize the trauma and loss that has occurred, and provide support as they experience the grieving process.  Athletes (and even coaches) sometimes engage in denial regarding the true impact of a sports injury.  This denial can result in additional injuries or negative psychological impacts.

* Provide encouragement and support during the rehabilitation process.  Due to many of the psychological impacts of sport injury, athletes may not be as motivated to engage in the rehab process.  Providing support and acknowledging the barriers may be helpful.

* Normalize their experiences of fear of re-injury.  Athletes may be apprehensive to express their concerns and fears.  Allow them to recognize that fear is a normal reaction, and that they are not alone in that experience. 

* Particularly for career-ending injuries, help athletes re-orient to alternative options.  Many athletes, particularly those who have been playing sports since early childhood, have not had the opportunity to fully develop other identities and options.  Exposing them to those possibilities is important in helping them to feel as though they have a path and some direction. 

* Finally, some athletes have such a difficult experience following a sport injury that counseling or professional support may be necessary.  Keep an eye out for signs of more significant psychological concerns such as increased isolation, poor concentration, changes in appetite, and feelings of hopeless or worthlessness.  These signs indicate that there is a need to go beyond the training room in the healing process.   

Dr. Nyaka Niilampti is a licensed psychologist at Southeast Psych with a Ph.D. in counseling psychology and a master's in sports psychology.  She sees clients of all ages and specializes in performance enhancement, relationship concerns, diversity issues, and the treatment of anxiety and depression.  She can be contacted at 704-552-0116.

Helping Your Teen Through Dialectical Behavior Therapy (DBT)

by Dr. Amanda McGough

Many of us know, or remember from our own teen years, that being a teenager isn’t easy.  Developmentally, adolescence is a time of growing independence, developing a sense of self, learning to navigate social relationships, and increasing responsibility.  On top of these developmental tasks, teens face pressures from school, peers and family responsibilities.  Teens can be under a significant amount of stress and that requires them to find ways to cope.  

Some teens may lack adequate coping skills, which leads to trying to cope with their stress in unhealthy, even harmful ways.  For example, they may have difficulties with self-injurious and life-threatening behaviors, suicidal ideation, poor impulse control, running away, stealing, lying, low frustration tolerance, interpersonal conflict, poor sense of self, high-risk sexualized behaviors, disordered eating, and substance abuse.  

However, the problems that teens face can be successfully navigated if they have healthy coping skills and support from caring adults.  Dialectical Behavior Therapy (DBT) is a form of therapy that has been widely researched for approximately 30 years.  It has proven to be effective in helping teens to reduce risky behaviors, manage emotions more effectively, create a more balanced life, and improve the overall quality of life.

What coping skills can DBT teach your teen?  DBT focuses on skills in five main areas:

1)    Mindfulness: Learning how to be focused in the present moment, how to balance emotions with rational thought and how to do what is effective in the moment.

2)    Distress Tolerance: Developing skills to help teens cope with stress in healthy ways through distraction, self-soothing and looking at the pros versus cons of choices in each situation.

3)    Emotion Regulation: Helping teens better understand emotions, reduce the intensity of their emotions, and learn how to ride the wave of emotions without acting out on them.

4)    Interpersonal Effectiveness: Developing strong relationship skills, learning how to communicate and listen in a way that is respectful towards others and themselves, learning how to say no, how to deal with difficult people and how to repair relationships.

5)    Walking the Middle Path: Learning how to validate one’s self and others, how to find the kernel of truth in different points of view, create a more balanced way of thinking and living, and how to reinforce behaviors in both self and others.

Learning effective, healthy coping skills now can benefit teens in their present life and in the future.

Dr. Amanda McGough is a psychologist at Southeast Psych who specializes in using DBT.

Top 10 Things that Make for a Stellar Psycho-Educational Assessment

by Dr. Kyra Grosman 

As kids head back to school, we start to notice some struggle to learn more than others. Parents who take a closer look can make a big difference in the childrens’ education. Psychologists can give parents peace of mind through a psycho-educational assessment to help figure out why a little boy or girl is struggling in school. Such assessments or “testing” can help kids learn more effectively.

Not all assessments are equal. A good assessment should do the following:

1) Provide a neurodevelopmental profile, and not a label. Just giving a child a label is not helpful. It’s too easy to say that a child who struggles with reading has a Reading Disorder. That label doesn’t really tell us why the child has difficulty in that area. It’s really more important to figure out why he or she is struggling in a particular area. Is reading difficult for a learner because of weak active working memory (the size of a person’s mental desk) or because they struggle with phonological processing (oral language function involving identifying, distinguishing, and manipulating the individual sounds in words)? Obviously, different learning profiles are going to be helped by different strategies which should be designed by a good assessment.

2) Must include strengths as well as weaknesses. Too many kids who struggle in school don’t get to hear enough about the awesome tasks they can complete. These strengths need to be incorporated into the feedback session, so kids, parents, and teachers have a realistic sense of hope.

3) Assessments should incorporate multiple sources of information. They should include a broad range of qualitative information (review of work samples, interview with students, information gleaned from discussion with parents and teachers), integrated with quantitative information (such as one gets from psycho-educational tests). The person writing the report must look for a pattern of strengths and weaknesses that emerge across several tests.

4) The feedback provided should give both you and your child a much clearer understanding of what’s causing his or her difficulties in school. Students need to be given age-appropriate feedback about how they learn.

5) Must include specific learning strategies based on each child’s individual profile. This should include a customized learning plan. Avoid clinicians who provide boiler plate learning plans. If they’re giving boiler plate learning plans, they’re probably not really understanding the unique aspects of your child, and they’re not helping you, either.

6) The feedback must connect neurodevelopmental function and academic skills. It should explain why Johnny can’t read and why he’s so good at math.

7) For public school children, assessment should not be so focused on determining eligibility for services that the child’s profile isn’t revealed.

8) The process of assessment should be an ongoing process of consultation. The goal is to find strategies for better success. There’s the need for on-going follow-up and tweaking of strategies as needed. Your assessor should be available to help you with this process and make sure that you, your child, and the school stay on track.

9) It’s great when the assessor can provide feedback directly with the child’s school—their teachers, learning support teachers, school psychologist, etc. This helps ensure that everybody is on the same page and allows for brainstorming what is feasable within a particular school.

10) Prioritization of weaknesses. If a child has several weak areas, it can be overwhelming to try to address them all. A good assessment should let you know what are the really important areas to address first.

And another for good measure...Make sure the report has clear explanation of the technical jargon.  It's especially helpful if it uses metaphors to help explain the concepts.

Dr. Kyra Grosman is on staff at Southeast Psych and we think she does stellar psycho-educational assessments.  She also sees clients for therapy for a range of issues.

The Problem of Perfectionism: Part 2

by Nyaka Niilampti, Ph.D.

Last week, I talked about the problem of perfectionism and this week, I want to give you some practical tools for overcoming it.  There are a number of ways to begin to break the cycle of perfectionism:

· Knowing is half the battle: If you find yourself identifying with some of these symptoms, that’s the first step. Awareness is necessary in order to begin to change.

· Stop worrying and start doing: Many times, it is taking that first small step that seems to be an insurmountable task. Usually, once a task is started, much of the anxiety and worry decreases.

· Start small: Break the task into “bite size” pieces. This will actually help you to “stop worrying and start doing”, and makes the task as a whole more manageable and less overwhelming. If your challenge is beginning, convince yourself to sit down for 20 minutes rather than the entire three hours that the task will take to complete.

· Encourage acceptance of limitations, performance, and mistakes: Perfection is an impossible goal. There will always be areas of possible improvement, and there will be days when “good enough” is often “more than okay”.

· Be mindful of the conversations in your head: Our self-talk contributes to anxiety and depression and the internal drive for perfection more than we often realize. If the discussions in your head suggest that your entire self-worth (or my future, etc.) is based on how well you complete a task, your internal dialogue needs to be adjusted.

· Ask yourself, “Is it worth this amount of effort?”: Put your tasks into perspective. Is the paper that may be worth 10% of my grade really worth the significant number of hours I have already put into it? The effort put out should match the significance of the task at hand.

· Increase mindfulness: Finally, there is a great deal of talk about the benefits of mindfulness. Mindfulness allows us to be present and in the moment, less worried about yesterday (and the mistakes of the past) and tomorrow (and the fears about what may or may not happen). Being mindful will allow you to focus on the process rather than the outcome. Increasing mindfulness will help you begin, accept your limitations, and enjoy the process.

Perfectionism at it’s best may help you get the job done…eventually…but at it’s worst can contribute to depression, anxiety, and failure, and make the process of completing even a simple task much more difficult than it needs to be.

Dr. Nyaka Niilampti is a licensed psychologist at Southeast Psych who specializes in performance enhancement, as well as the treatment of anxiety and depression in teens and adults.

The Problem of Perfectionism: Part 1

by Nyaka Niilampti, Ph.D.

Today’s society continues to demand increasingly high standards in virtually every arena. Unfortunately, we often interpret “achieving excellence” as “it must be perfect”. While maintaining a high standard is important, when it becomes confused with perfectionism it actually fails to lead to the desired consequences of success. The idea of achieving perfection is a goal that is impossible to meet, and the more we demand perfection from ourselves, the more the “finish line” moves, and the more overwhelming the task becomes.

It can be difficult to find the line between ‘perfectionism’ and ‘excellence’, and healthy motivation and striving. Burns (1980) defines a perfectionist as someone “whose standards are beyond reach or reason”, and “who strain compulsively and unremittingly toward impossible goals and who measure their own worth entirely in terms of productivity and accomplishment”. For perfectionists, thoughts and behaviors may be maintained by a number of factors, including fear of failure, inadequacy, or fear of disapproval and disappointing others. One way of locating that line is by asking yourself: (1) Is my goal attainable? (2) Are my beliefs in my ability to do this accurate? (3) Am I able to adjust my standards when necessary?

Perfectionism may look different in different individuals. For some, it is the attitude that “I’ll do it by myself…because no one will be able to do it as well as I can”. Other individuals may not take risks or try new things because they may not be good at it, while others become chronic procrastinators. Perfectionism may also look like overcompensating, excessive checking and seeking reassurance from others, difficulties making decisions, and avoidance of some activities and situations all together. The struggle to be perfect makes it difficult to recover from mistakes, and often leads to social and performance anxiety, depression, anger, and/or low motivation. It can also contribute to body image problems and eating disorders. 

Next week, I'll give you seven ways to break the cycle of perfectionism.

Dr. Nyaka Niilampti is a licensed psychologist at Southeast Psych who specializes in performance enhancement, as well as the treatment of anxiety and depression in teens and adults.

The Importance of Early Diagnosis for Autism

by Lauren King, Psy.D.


1 in 110 children have Autism based on a report in December of 2009 (Centers for Disease Control and Prevention.)  Currently there is not a single known cause for Autism, although many theories are being investigated. Additionally, there is not a “cure” for Autism at the present time. Early intervention and diagnosis are the best tools at our disposal. Research reveals repeatedly that early treatment for Autism makes the biggest difference. When therapy is introduced at an early age, due to the brain’s plasticity (ability to change), the child is likely to progress more than if their therapy starts at a later age. 


Obviously, no matter what the age, children can still change and make progress. The issue is really that we now know the earlier the therapy, the more likely it is to have a large impact on the child’s life. For example, research shows that children who are provided intervention before 3-years-old are impacted more than children provided therapy after 5-years-old (Harris & Handleman, 2000). Research also consistently shows that diagnosis of Autism prior to 24 months is not as reliable as it is after 24 months because it can be easily confused with other developmental problems (Lord, 1995). However, some children with more clear markers are diagnosed at earlier ages.  

In order to access early intervention for children with Autism, a prompt diagnosis is needed. If you are concerned about Autism Spectrum behaviors in your child, the first step is a thorough assessment.  Oftentimes, the signposts of Autism are the lack of typically developing behaviors such as coordinating attention between people and objects, sharing emotions with others, following the point or gaze of another person, playing symbolically, using appropriate gestures, and having appropriate language development (Woods & Wetherby, 2003). However, these behaviors can also be signals of other developmental problems besides Autism, which is why it is important to have a professional in the field of Autism conduct a full assessment.  The assessment should include recommendations on where and how to access early intervention for your child. At southeast Psych, we perform such assessments, and we are passionate about getting families in touch with the services and support they need following their testing.  

Dr. Lauren King is a therapist at Southeast Psych who specializes in working with children with autism spectrum disorders and their families.  She also has a specialty in the treatment of eating disorders.  You can contact her directly at lking@southeastpsych.com.  

References

Harris, S.L., & Handleman, J.S. (2000). Age and IQ at intake as predictors of placement for young children with autism: A four to six year follow-up. Journal of Autism & Developmental Disorders, 30, 137-143.

Lord, C. (1995). Follow-up of two-year-olds referred for possible autism. Journal of Child Psychology & Psychology & Psychiatry & Allied Disciplines, 36, 1365-1382.

Woods, J. J., & Wetherby, A. M. (2003). Early identification of and intervention for infants and toddlers who are at risk for autism spectrum disorder. Language, Speech, and Hearing Services in Schools, 34, 180-193.