man with no appetitePeople-pleasing tendencies often arise from a complex interplay of childhood experiences, cultural influences, and family dynamics. While being considerate and accommodating is generally seen as positive, chronic people-pleasing—where individuals prioritize others’ needs at the expense of their own—can contribute to significant mental health challenges. Understanding the roots of people-pleasing and the disorders it is commonly associated with can shed light on why these tendencies develop and how they affect mental health. 

Common Mental Health Disorders in People-Pleasers 

Social Phobia and Anxiety

People-pleasers often experience social phobia or generalized anxiety, driven by a fear of rejection or disapproval. The effort to avoid conflict, gain approval, and ensure others’ happiness can create persistent worry about how they are perceived. These individuals may overanalyze interactions, fear making mistakes in social situations, and feel intense pressure to meet expectations, leading to chronic anxiety and avoidance behaviors. 

Low Self-Esteem

Chronic people-pleasing is closely linked to low self-esteem. These individuals may base their self-worth on how well they meet others’ needs or avoid disappointing others. Over time, neglecting their own desires and sacrificing personal boundaries can deepen feelings of inadequacy, unworthiness, or invisibility. 

Depression

Neglecting personal needs in favor of others’ needs can leave people-pleasers feeling unfulfilled and unseen, contributing to depression. Many internalize feelings of guilt or failure when they cannot meet everyone’s expectations, or they may feel trapped in a cycle of giving without receiving the validation or appreciation they long for. This can lead to feelings of emptiness, hopelessness, and disconnection. 

Perfectionism

People-pleasers often struggle with perfectionism, where they set unrealistically high standards for themselves in their efforts to satisfy others or avoid criticism. This constant drive for flawlessness can lead to emotional exhaustion, self-criticism, and difficulty coping with even minor mistakes, which they may perceive as failures. 

Obsessive-Compulsive Personality Disorder (OCPD)

In some cases, people-pleasers may develop traits of obsessive-compulsive personality disorder. This includes an overwhelming need for control, rigid adherence to routines, or perfectionistic tendencies that align with their desire to avoid mistakes and maintain harmony in relationships. This pattern often stems from a deep fear of disappointing others or losing approval. 

Codependency and Relationship Issues

People-pleasers frequently struggle with codependency, where their sense of self becomes intertwined with their ability to care for or please others. This dynamic can lead to unbalanced relationships, difficulty setting boundaries, and a susceptibility to emotional burnout or manipulation. These patterns often leave people feeling depleted and underappreciated. 

Post-Traumatic Stress Disorder (PTSD) or Complex PTSD (C-PTSD)

For some, people-pleasing behaviors are rooted in trauma. Individuals who grew up in environments where their needs were dismissed or punished may develop hyper-vigilance and people-pleasing tendencies as a survival mechanism. These behaviors persist into adulthood as a response to unresolved fear or conflict, creating difficulty with self-advocacy and boundary setting. 

The Origins of People-Pleasing 

Family Dynamics 

Many people-pleasers grow up in family environments where love or approval was conditional. If caregivers only validated them when they were obedient, accommodating, or high-achieving, they may have learned that their worth depends on meeting others’ expectations. Alternatively, children in chaotic or neglectful households may develop people-pleasing behaviors as a way to maintain harmony or avoid conflict, making it a survival strategy that becomes deeply ingrained. 

Cultural Influences 

Cultural expectations often reinforce people-pleasing tendencies, particularly in societies that emphasize collectivism or traditional gender roles. For instance, women may be socialized to prioritize nurturing and self-sacrifice, while certain cultural backgrounds may emphasize family or community needs over individual desires. These influences often create internalized beliefs that prioritizing oneself is selfish or unacceptable. 

Childhood Experiences 

Childhood trauma, including emotional neglect, abuse, or witnessing conflict, is a common precursor to people-pleasing. Children in these environments may internalize the belief that they must earn love or avoid anger to feel safe or valued. Over time, these survival strategies evolve into patterns of behavior that influence how they relate to others well into adulthood. 

Breaking Free from People-Pleasing 

While people-pleasing can lead to a variety of mental health challenges, it is possible to unlearn these patterns and develop healthier relationships with oneself and others. Therapy can help individuals identify the root causes of their tendencies, build assertiveness skills, overcome self-sabotaging techniques, and practice setting boundaries without guilt. Addressing underlying trauma, reshaping beliefs about self-worth, and learning to tolerate discomfort in relationships are key steps in breaking free from these behaviors. 

The journey toward change may not be easy at first, but it is deeply rewarding. People-pleasers can learn to reclaim their voice, prioritize their own needs, and build lives that reflect their true values and desires. With the right support, they can embrace a more balanced and fulfilling way of relating to themselves and others. The point of improvement is not to care more about the self than others, but it is to develop an equal sense of worthiness to the basic components of life and connection. Once someone feels equally worthy of love, respect, validation, support, and success, they will be able to engage with others more authentically and effortlessly which will not only reduce symptoms of anxiety, but it will also result in relationships and opportunities that flourish. 

A girl looking sadly at her breakfast of a bagel and poached eggSome level of picky eating is generally par for the parenting course. Children of any age might show some selectiveness about the food they eat, but parents often have the most struggles with toddlers and preschool-age children.

Most developmental picky eating will resolve itself by the time your child begins school—we have some tips below to help you manage until then.

In some cases, though, picky eating can be a symptom of something beyond an age-appropriate desire for independence. So, if your child won’t eat anything besides Cheerios or white bread and you don’t know what to do, keep reading. We’ll go over what typical picky eating looks like and offer some guidance on getting help for more serious concerns.

In some cases, picky eating can be a symptom of something beyond an age-appropriate desire for independence.

Why Are Some Kids Picky Eaters?

There are numerous reasons for picky eating, according to a large research review published in 2015. Some possible factors include:

It’s also worth noting that many children simply have a limited range of preferred tastes in early life. Developing a taste for new food is often a lengthy process, so your child may need to try a food multiple times, not just once or twice, before they’re willing to eat it on a more regular basis.

Children begin developing preferences for specific foods as they approach the preschool years. Of course, this is also when they begin to find their sense of independence. Preschoolers don’t have many opportunities to demonstrate this newfound independence, so they often choose the table as their stage. This can lead to any number of battles over food—whether the issue actually involves the food or not.

They also often lack the words to express how they really feel about certain foods. They may not want to eat something for a more specific reason than simply not liking it, but they don’t know how to tell you exactly what they think. Maybe the texture feels uncomfortable in their mouth, or they have an aversion to the smell of the food or the spice you used.

Allergies can also lead to picky eating behavior. Children with a mild allergy to a specific food may not have a serious or life-threatening reaction, but they may associate the food with any minor symptoms they experience and avoid it entirely.

Anxiety and other distress can also contribute to pickiness. Think about what you want to eat after a bad day. Everyone has preferred comfort foods: soup, macaroni and cheese, ice cream, popcorn, etc. Children experience stress and unhappiness, too, even if they don’t know how to talk about it. Confronting a new spiky green vegetable may be the last thing they want to do after a long day that left them tired, cranky, or otherwise out of sorts.

Mealtime Tips for Parents

The battle to get your child to eat may frustrate you, but you can avoid distress (for yourself and your child) by not looking at mealtime as something you need to “win.”

Keeping calm helps. If you’re frustrated or irritated with your child for wasting food or being stubborn, they’ll likely pick up on that. Sometimes, this can provide more incentive for them to push to win the argument. In the end, it boils down to control.

You might feel stressed about your child’s health or believe you’ve “failed” as a parent if you can’t get your child to eat nutritious foods. But try not to let that get to you. If they meet developmental milestones, enjoy general good health, and have energy to play, they’re probably just fine. If you do have specific concerns, your pediatrician can offer more guidance.

Try these tips to help make mealtimes easier:

Don’t force or bribe your child to eat.

This generally only creates more problems later. Offer nutritious foods in small amounts and let your child decide how much to eat.

Promising dessert after so many bites of vegetables may seem like a great way to get your child to eat those vegetables. However, this teaches children that dessert is better than everything else, an idea that can potentially contribute unhealthy eating habits later in life.

When you offer dessert, don’t make it conditional on finishing their dinner, either—this may lead children to eat more than they really need.

Don’t serve separate meals.

If your child refuses lunch, don’t offer to make them something you know they like. This just reinforces their behavior. Similarly, eat the foods you want your child to eat—at least in front of them. If you offer them a lunch of broccoli, apple slices, brown rice, and scrambled eggs while you have pizza, you may not be sending the best message.

Involve your child in food preparation.

Let your child choose vegetables and fruits at the store, then get them involved in the cooking process. You might not always succeed with this approach, but children may have more interest in trying new things when they helped create them.

Try not to get frustrated when they don’t want to take a single bite, even after helping you in the kitchen. They may be testing you, but they also might just need time. Keep calm and continue offering the new food.

Avoidant-Restrictive Food Intake Disorder

Children who don’t seem to grow out of picky eating, or who eat fewer foods as they grow older, may actually have an eating disorder: avoidant restrictive food intake disorder, or ARFID.

Experts aren’t fully certain what causes ARFID, but it often appears related to trauma. These children may have choked previously, had trouble eating as a baby, or experienced birth trauma or trauma in utero. They might refuse to eat new foods because they believe the food may lead to choking or other harm.

ARFID can also relate to sensory distress around the textures of specific foods. People with autism (ASD), attention-deficit hyperactivity (ADHD), or any sensory issues may have a higher risk for ARFID.

Most children will eventually eat the food you offer them when they get hungry. But children with ARFID generally won’t eat foods besides their select “safe” food items. Mealtimes generally become very difficult for them, as they tend to experience anxiety and distress as a result of their inability to eat.

It’s generally best to seek a professional opinion if your child:

ARFID can have serious health consequences, since a child with a severely restricted diet likely isn’t getting the correct nutrients.

Treatment for ARFID

There’s help for picky eaters—even severely picky eaters.

A good first step is to talk to a therapist who specializes in working with children. Depending on your location, you may even be able to find a therapist who treats eating disorders in children.

Just be aware that other mental health concerns beyond ARFID, including obsessive-compulsive tendencies and other anxiety issues, can also contribute to picky eating. Your child’s therapist will start by determining what’s actually going on, since the most effective treatment generally depends on what’s causing their picky eating.

Your child’s treatment plan might include:

If something doesn’t seem typical about your child’s refusal to eat, don’t hesitate to reach out to a counselor. There may be nothing serious going on, but you aren’t overreacting–even if their eating behaviors fall within the range of usual picky eating, it’s generally better to know for sure.

Begin your search for a compassionate, trained counselor at GoodTherapy today.

References:

  1. Avoidant restrictive food intake disorder (ARFID). (n.d.). National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid
  2. Children’s nutrition: 10 tips for picky eaters. (2017, July 28). Mayo Clinic. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/childrens-health/art-20044948
  3. Ehmke, R. (n.d.). More than picky eating. The Child Mind Institute. Retrieved from https://childmind.org/article/more-than-picky-eating
  4. Elliot, S. (n.d.). What exactly is ARFID? National Eating Disorders Association. Retrieved from https://www.nationaleatingdisorders.org/blog/what-exactly-arfid
  5. Knopf, A. (n.d.). When picky eating is a sign of psychological distress. Bradley Hospital. Retrieved from https://www.bradleyhospital.org/when-picky-eating-sign-psychological-distress
  6. Taylor, C. M., Wernimont, S. M., Northstone, K., & Emmett, P. M. (2015, December 1). Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite, 95, 349-359. Retrieved from https://www.sciencedirect.com/science/article/pii/S0195666315003438?via%3Dihub
  7. Tips for picky eaters. (n.d.). United States Department of Agriculture. Retrieved from https://www.choosemyplate.gov/browse-by-audience/view-all-audiences/children/health-and-nutrition-information/preschoolers-picky-eating

Eating disorders, the most lethal of all the mental health disorders, kill and maim 6 to 13% of their victims, 87% of whom are children under the age of 20. “Best practice” treatment strategies for patients with anorexia nervosa, bulimia nervosa, and binge eating disorder all too frequently fall short of achieving timely and sustainable recovery outcomes. Beyond eating lifestyle dysfunction, eating disorders represent impairment of the patient’s Self, as seen in the loss of self-trust, self-control, self-regulation, self-care, and emotional resiliency, so necessary in coping with adversity and engaging in confidence-building life opportunities.

The development and recovery of the re-integrated Self in eating disorder treatment is best facilitated through the mindful and versatile use of the therapist’s self within a quality therapeutic relationship, the inclusion of parents and families in the treatment process where appropriate, and an appreciation of the fact that within the context of clinical treatment, healing changes in the patient’s behaviors and attitudes represent healing changes in the patient’s brain.

Eating Disorders and the Loss of Self

From infancy to adulthood, self-development occurs primarily within the context of human relationships, be they personal, familial, or professional. The loss of the connection with the eating disordered individual’s authentic Self becomes apparent cognitively, emotionally, physiologically, neurologically, and socially, typically rendering victims resistant to accepting diagnosis and engaging in treatment. Losses of connection can be seen in:

Self re-integration, a pivotal predictor in the achievement of positive mental health (Siegel, 2006) and a benchmark of full eating disorder recovery, becomes enhanced by treatment modalities that facilitate connections between people, mind-brain-and-body systems, and brain domains.

Because eating disorders are principally disorders of connection, the healing energy within the success of any treatment methodology occurs within the context of the therapeutic relationship.

Parents and Families As Recovery Advocates

Eating disorders insinuate themselves into relationships between family members. As family system disorders, eating disorders show up everywhere within the context of daily living, side by side with significant others, at kitchen tables, in restaurants, in family bathrooms, at school, and in places of employment. Though generally not responsible for causing eating disorders, which originate in genetic and temperament susceptibilities, parents who participate in their child’s treatment and engage in psychoeducation enjoy the potential to promote disease prevention and/or recovery. Becoming knowledgeable about eating disorders, the complex nature of their treatment and recovery, and their own role in their child’s recovery (particularly when the child remains in outpatient care while residing at home), parents can become ‘most valuable players’ in their child’s treatment team.

Recovering patients, faced with the demands and challenges of eating healthfully throughout each day, average no more than 50 minutes per week in face-to-face contact with helping professionals. Educated parents can become helpful in filling this void. With the understanding that the nature of parental support offered will need to change to align with their child’s changing needs as they progress, family participation in therapy gives both patient and family a voice, and an ear, in expressing and listening to feelings and in resolving conflicts and problems. By reconnecting with their child and learning how to understand, coach, and support their loved one, parents enhance their child’s emotional development and self-care.

The bonding and trust that develops in family treatment greases the path for the patient’s eventual separation and individuation, increasing the child’s capacity for autonomy and healthy self-regulation. Family sessions also diminish the potential for manipulative “splitting” and/or confidentiality breaches that could otherwise jeopardize a multi-disciplinary team treatment process. If not part of the solution, family members risk becoming part of the problem.

The Patient/Therapist Relationship in Research

Because eating disorders are principally disorders of connection, the healing energy within the success of any treatment methodology occurs within the context of the therapeutic relationship. The trust that develops between therapist and patient within the treatment process ultimately re-ignites the patient’s trusting reconnection within their own exiled Self. The mindful therapeutic relationship ideally becomes the prototype for other healthful, quality relationships elsewhere in the patient’s life outside of the treatment system. Dr. Christopher Germer, in Mindfulness and Psychotherapy (Germer, 2005), considers mindfulness in therapeutic practice to be the pathway to establishing a healthy, healing treatment relationship. He speaks of the therapeutic relationship as “an intervention in itself” with empathy accounting for “as much, and probably more outcome variance than does the specific intervention.” He describes good therapeutic relationships as “the most potent of all the treatment interventions for healing within a mental health venue,” (Germer) providing the pathway out of an eating disorder.

According to Dr. Allan Schore, it is through the quality of the human relationship that “deficits in internal working models of the self and the world are gradually repaired” (Schore, 1996). Schore describes a phenomenon that exists between therapist and patient called “empathic resonance” (Schore & Schore, 2008), “which results in the patient’s right brain hemisphere becoming neurophysiologically altered in form and function in response to a mindful, quality connection to the functioning of the therapist’s right brain hemisphere. Right-brain to right-brain human attachments through mindful psychotherapeutic connectedness often result in the patient feeling ‘felt,’ creating a state of neural activation with coherence in the moment that has been shown to improve the patient’s capacity for self regulation” (Siegel, 2006).

A quality patient-therapist connection lays the foundation for the patient’s development of the Self, in addition to the foundation of a complete and lasting eating disorder recovery.

References:

  1. Germer, C. K., Siegel, R .D., & Fulton, P. R. (2005). Mindfulness and psychotherapy. New York, NY: Guilford Press.
  2. National Eating Disorder Association. (n.d.). Retrieved from https://www.nationaleatingdisorders.org
  3. Schore, J. R. & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal, 36(1), 9-20. doi: http://dx.doi.org/10.1007/s10615-007-0111-7
  4. Siegel, D. J. (2006). An interpersonal neurobiology approach to psychotherapy; Awareness, mirror neurons, and neural plasticity in the development of well-being. Psychiatric Annals, 36(4), 248-256. Retrieved from https://www.researchgate.net/publication/241200655_An_Interpersonal_Neurobiology_Approach_to_Psychotherapy_Awareness_Mirror_Neurons_and_Neural_Plasticity_in_the_Development_of_Well-Being

Father and child wash vegetables at sink in small, bright kitchenA few months ago, I identified and acknowledged one of my biggest stressors in raising young children: mealtime. The constant battles during meals, nagging the kids to stay at the table, concerns about whether they are getting enough nutrition, inability to eat in peace amid the many requests, and frustration regarding all the food and spilled drinks on the floor are painful enough.

Worse is managing these things while fielding the judgmental voice of my mom, in person or in my head, critiquing my parenting decisions and expressing disdain over the audacity I would “let the kids go to bed hungry.”

I know I have good instincts when it comes to raising kids. And my training in child development lends itself to having knowledge and tools that prove useful. Yet I found myself second-guessing my decisions and feeling stressed about feeding my children. I began to realize I was allowing unsolicited advice, critical comments, and a stream of perceived judgment to get under my skin and negatively impact my mood.

My mom and her mom—both wonderful mothers and grandmothers—come from a line of women who believe in spoon-feeding and stuffing babies until they are fatter than Thanksgiving turkeys. They’ve spent hours on end tricking toddlers into taking yet another bite. Although my kids were growing normally and were above average in the height and weight percentiles, I found myself falling victim to the suggestion that, somehow, I was not feeding them properly or enough.

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I began to realize how much I dreaded meals, especially dinner, not only because of the tedious routine involved in preparing meals and getting kids to eat them, but also because of the way I wound up feeling like a failure because of my kids’ (ages 4, 2, and 6 months) inability to sit politely at the table while graciously gobbling up every bite. Sick of feeling defeated every evening, I signed up for a lecture on mealtimes with toddlers that was being offered through our preschool.

I listened with relief (and a slight sense of smugness) as the presenter confirmed that much of the advice recommended by the American Academy of Pediatrics was consistent with my line of thinking when it comes to feeding kids. She confirmed it is normal for children to have day-to-day and meal-to-meal appetite changes. Not only do their appetites vary in terms of how much they eat, their interest in certain foods can flip-flop at the drop of a hat. It’s not worth getting frustrated or arguing with your child over the fact he loved black beans last night yet refuses to touch them today. And if your kid eats 10 chicken nuggets for lunch today but nothing all day tomorrow, that’s okay. Experts recommend we look at children’s nutrition over the course of a full month rather than at every meal, daily, or even from week to week.

It was useful for me to be reminded that kids’ stomachs are quite small and don’t need as much food as we may think. Contrary to my well-intended mother’s conviction, a child will not die from skipping a meal; in fact, it’s normal for a child to sometimes be disinterested in food all day. She will eventually make up for it with a huge appetite another time. As long as children eat well at some meals, it’s okay if they barely touch their food during others. Keeping this in mind allows me to let go of much of the frustration that was ruining my meals.

More important than ensuring children eat every bite is avoiding power struggles related to food. When we force children to eat when they are not hungry or interested, or when we insist, “You must be hungry, you need to eat,” we inadvertently set them up to ignore their own body signals. Children need to learn to recognize, trust, and listen to their hunger cues—to eat when they are hungry and stop when they are full. When we force kids to eat, bribe them, or create the expectation they must finish everything on their plates for us to feel proud of them, we set them up for struggles later in life. Eating disorders, overeating, and using food as a coping mechanism may develop as ways to self-soothe and cope with stress.

Rather than nag children about eating, we need to teach them lessons about nutrition and food and then allow them to make choices. This sometimes means learning the consequences of poor decisions. For example, you might explain, “I’m worried that if you don’t eat your dinner, you may be hungry later,” allow them to decide whether they eat, and let them experience the consequence of feeling hungry later if they refuse dinner. This helps them to learn.

When you eliminate ultimatums, micromanaging, pressure, and control issues over food, you can relinquish some of the frustration that comes with parenting a toddler. You can also instill in your children healthier messaging around eating.

Being consistent with meals and snacks helps children to know what to expect and learn to regulate their appetite. Experts recommend that adults eat with children as often as possible and that everyone eat the same meal. No short-order cooking or making separate meals for kids. Caregivers should control the specifics of meals—the what, when, and where regarding food being served—but children should be allowed to control what they eat off their plates and how much. That’s right—children can refuse to eat specific foods and decline taking even one bite. Parents should choose healthy foods and ensure that at least one item per meal is something the child likes.

In our house, I recommend everyone try at least one bite of each food, even if they think they don’t or won’t like it. We talk about how taste buds change, and I allow the kids to spit the bite into a napkin if they don’t like it. Hard as it may be, I also try to remember that it’s normal for them to not sit still, to play with food, and to make a mess. Depending on age, it’s all part of learning about their world, developing hand-eye coordination, testing limits, and becoming independent.

When you eliminate ultimatums, micromanaging, pressure, and control issues over food, you can relinquish some of the frustration that comes with parenting a toddler. You can also instill in your children healthier messaging around eating.

To recap and give some additional advice I found helpful:

It was validating to step outside of the chaos of my kitchen and hear that my “laid-back” way of handling mealtimes was, in fact, in line with recommendations by the “experts.” Following the presentation I attended, my husband and I sat down with our kids and explained we were going to make some family rules around mealtime. Together, we created a list of rules to make meals more enjoyable for us all. In hopes it inspires your own transformation out of chaos into “hectic but good family fun,” I share with you my family’s list of mealtime rules:

Raising toddlers can be a wonderful, though trying, experience. Don’t let mealtimes drag you down. By avoiding tension and frustration related to eating, you can make meals a more pleasant and valuable experience for everyone.

If you’re struggling as a parent, don’t hesitate to contact a licensed counselor who has experience with child and adolescent issues.

Reference:

Toddler – Food and feeding. (n.d.). Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/Age-Specific-Content/Pages/Toddler-Food-and-Feeding.aspx

Two parents and two children sit down at the table to enjoy a meal together, talking and smilingFor many of us, stress is a fundamental part of life. Perhaps we tend to overextend ourselves with work, social commitments, and our personal lives. Or maybe we never turn off our many devices, which can prevent us from being able to simply relax and enjoy each moment. As a result of this overstimulation, we often end up seeking out ways to self-soothe.

Food can be a source of comfort for many people. And while emotional eating can help us feel good in the moment, it can often have negative effects over time.

How can we know if we have an unhealthy relationship with food? Signs that indicate emotional eating may be having a negative impact can include:

You don’t have to change all of your eating habits overnight. It’s often easier to begin by making small changes.

If you believe you might have an unhealthy relationship with food, you may find it helpful to try some of the following techniques:

If you believe your relationship with food has become unhealthy or you find yourself struggling to manage your eating habits, you may find some of the suggestions above to be helpful. Exploring them on your own, or with the help of a qualified professional, can be beneficial as you work to develop healthier eating habits.

Making one small change at a time can help you deal with stress in more effective and productive ways, and eating to self-soothe may become less of a habit as a result. Being able to eat better is not only likely to help us feel better physically, but can also lead to improvements in how we feel about ourselves!

Reference:
Smith, M., Segal, J., & Segal, R. (2018). Emotional eating: How to recognize and stop emotional and stress eating. Retrieved from https://www.helpguide.org/articles/diets/emotional-eating.htm

Rear view of person with long, wavy hair sitting at empty table looking out windowFood is an important element of every culture; the less of it available, the more important the meaning surrounding it. From holiday and traditional celebrations to the ritual of Sunday dinners, almost everyone has memories—happy, comforting memories—tied to food. So it is no surprise that people who are experiencing difficulties sometimes turn to food to try to evoke pleasant feelings.

Everyone is familiar with the idea of self-soothing through food. Eating a pint (or more!) of ice cream after a romantic breakup is a cliché. A cup of tea and a biscuit is an equally iconic response to an upset in English culture. However, this usually harmless form of self-soothing can become a problem for people with serious and persistent emotional challenges such as those occurring as the result of posttraumatic stress (PTSD). These problematic reactions may include:

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What Is Posttraumatic Stress?

Briefly stated, PTSD is the result of experiencing a “shocking, scary, or dangerous event” (Post-Traumatic Stress Disorder, 2016). While not everyone will develop persistent symptoms as the result of such events, some people will go on to feel afraid or anxious even though they are no longer in danger. Symptoms may include flashbacks (intrusive memories), nightmares, avoiding places or things which trigger bad memories, being easily startled, or having difficulty sleeping. Sometimes symptoms don’t appear until months or even years after the experience.

Binge Eating

According to Dr. Cynthia Bulik, an expert on eating disorders at the University of North Carolina, “Binge eating is not just a lot of overeating … there’s this sense of loss of control. You start eating and you feel like you just can’t stop” (When Food Consumes You, 2017). This is the most common eating disorder in the United States. People with this condition eat past the point where they are full; they often feel compelled to go on eating. This may lead to obesity and the problems that come with it.

What is the link between the two? Most of the time, the trauma comes first and binge eating later (Brody, 2017). Research shows both PTSD and binge eating are related to production of stress hormones and mood-boosting brain chemicals. About one in four people who binge eat is believed to have PTSD; about 35% of women with a binge eating disorder have been sexually assaulted. PTSD and binge eating are linked in the body.

Bulimia

Sometimes, people who have indulged in binge eating will follow with an attempt to rid themselves of the excess calories. This may be done through self-induced vomiting; the use of laxatives to help food pass quickly through the body; prolonged exercise; or, paradoxically, periods of fasting. People with this condition (known medically as bulimia nervosa) may be able to maintain a normal weight because of their efforts to counteract the high caloric intake of an eating event. However, the cycle of overeating and purging may cause other health issues, including problems with the digestive system or heart irregularities, along with problems from a poorly balanced diet.

One study found about 25% of women with this condition have PTSD. (Blinder, et al., 2006), In a study of women in a residential treatment program for eating disorders, almost three-quarters had experienced significant trauma, and more than half reported symptoms typical of PTSD (Brewerton, 2008).

Anorexia

The least common eating disorder, but potentially the most deadly, is known as anorexia nervosa medically. People who have this condition typically think of themselves as overweight, leading to chronic under-nutrition. People literally starve themselves to death, thinking the whole time that they are obese. People with anorexia are six times more likely to die prematurely than members of the general population (DeNoon, 2011). People who are diagnosed with anorexia in their 20s are 18 times more likely to die prematurely.

Exactly what causes eating disorders may well be a mix of several factors: genes and family history are considered possible factors, along with environment and culture.

Causes and Treatment Options

Exactly what causes eating disorders may well be a mix of several factors: genes and family history are considered possible factors, along with environment and culture. Physical and emotional health, particularly PTSD, are additional factors which may offer opportunities to influence the course of this condition (When Food Consumes You, 2017). Early diagnosis and treatment are critical.

The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes five evidence-based treatments for PTSD: cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), prolonged exposure therapy (PET), eye movement desensitization and reprocessing (EMDR), and accelerated resolution therapy (ART). However, prolonged exposure therapy may increase the risk of binging at least temporarily (Brody, 2015).

Recent research has suggested that accelerated resolution therapy may be most effective. Walden Behavioral Care, which specializes in treating people with eating disorders, psychiatric conditions, and other comorbid issues, conducted an informal study for purposes of self-improvement. The study, which included 28 people, showed a significant reduction in self-reported levels of stress following treatment with ART. Before intervention, participants reported a mean level of distress of 7.62 (out of 10); after treatment, the level had dropped to 3.16, a reduction of more than half.

For help with problematic eating patterns, contact a therapist.

References:

  1. Blinder B. J., Cumella E. J., & Sanathara V. A. (2006). Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine, 68, 454-462.
  2. Brewerton, T. D. (2008, May 8). The Links Between PTSD and eating disorders. Psychiatric Times, 25(6). Retrieved from http://www.psychiatrictimes.com/articles/links-between-ptsd-and-eating-disorders
  3. Brody, B. (2015, January 24). The link between trauma and binge eating. Retrieved from https://www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/features/ptsd-binge-eating#1
  4. DeNoon, D. J. (2011, July 12). Deadliest psychiatric disorder: Anorexia. Retrieved from https://www.webmd.com/mental-health/eating-disorders/anorexia-nervosa/news/20110711/deadliest-psychiatric-disorder-anorexia
  5. Post-traumatic stress disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
  6. Walden Behavioral Care reports aggregate quality assessment information on patients treated with ART. (n.d.). Retrieved from http://acceleratedresolutiontherapy.com/walden-behavioral-care-pilot-study-art/
  7. When food consumes you. (2017). Retrieved from https://newsinhealth.nih.gov/2017/11/when-food-consumes-you

Person with natural hair looks into mirror smiling widelyAs an eating disorder therapist, I work with people in all stages of their recovery journey. One question I am often asked is, “How do I move from body dissatisfaction to body acceptance?”

To answer, I often remind the person I’m working with to focus on the function of the body instead of its form. I remind them to take note of—and express gratitude for—the everyday motions and actions that are feasible because of their body.

We can all benefit from learning to relish the genuine sparks of affection and admiration we have for ourselves when we get a new haircut, put together a fresh outfit, or put on that one pair of pants we know really make our butt look great. With time and practice, these moments of self-admiration can lead to an internal dialogue that is centered on appreciation and gratitude for our bodies instead of a dialogue that is judgmental and focused on finding our flaws.

While some may have been told to spend time engaging in positive affirmations, forcing ourselves to repeat “I am beautiful” often falls flat. There is certainly a time and a place for positive affirmations, but without a dedicated practice through which we train ourselves to think differently about our bodies, those affirmations are not likely to take us very far. [fat_widget_right]

The ‘Appearance Ideal’ and Cognitive Dissonance

I recently read through The Body Project’s structured group manual, which aims to decrease body dissatisfaction and harmful eating behaviors by increasing cognitive dissonance around the “appearance ideal.” The appearance ideal describes the widely accepted portrayal of the “perfect” female body: a figure that is slim and toned but still curvy (breasts and buttocks). The Body Project intervention, which challenges this ideal through cognitive dissonance, is a fascinating concept that has been tested rigorously over the years with overall positive results. According to the National Eating Disorders Association, this intervention can reduce the risk of eating disorders.

We can all use cognitive dissonance concepts and activities (these might range from verbally combating the appearance ideal to taking personal action against it) in our everyday lives. It is my belief that doing so can do a great deal to help us find that body acceptance we are striving for.

The cover image I see doesn’t depict a person as they are in reality. Rather, it illustrates what society tells me I should look like, despite the fact that such a goal is not realistic or healthfully attainable. By reminding myself of this, I am increasing my cognitive dissonance and ultimately challenging the unspoken belief many of us have unwittingly bought into—the idea that we must look a certain way or, at the very least, be striving to change ourselves, in order to be accepted by society.

Let’s begin by verbalizing statements that counter the appearance ideal. For example, we might maintain an internal dialogue as we confront the daily barrage of advertisements, TV shows, and even people we see who spark that societal idealization of thinness. I have found the checkout line in the grocery stores to be a perfect space for this, as any number of magazines featuring ultra-slender models staring at me (and my cart full of groceries) can usually be found here. When I see these magazines, I find it helpful to remind myself of the amount of effort it likely took to portray those (frequently female) models in that way. “How costly were the clothes?” I might ask myself. “How many pins did it take to make them lay just so?” “How much photo editing went into making sure no creases, dimples, or freckles were visible?”

I then take a deep breath and verbalize what I know is true: The magazine serves no other purpose than to sell itself. The cover image I see doesn’t depict a person as they are in reality. Rather, it illustrates what society tells me I should look like, despite the fact that such a goal is not realistic or healthfully attainable. By reminding myself of this, I am increasing my cognitive dissonance and ultimately challenging the unspoken belief many of us have unwittingly bought into—the idea that we must look a certain way or, at the very least, be striving to change ourselves, in order to be accepted by society.

We can also take action to increase that cognitive dissonance within ourselves. The Body Project’s manual describes an activity that might be a good place to start!

Many find the above exercise to be helpful and empowering, but it can be difficult to enter this space with ourselves. The activity requires women in particular to challenge many social norms, beginning with ideas that women should be modest or humble. Many women may never have been encouraged to (and may have been actively discouraged from) calling attention to things they like about themselves.

If you’re familiar with the movie Mean Girls, this may call to mind the scene where the three friends (Regina, Gretchen, and Karen) dutifully observe and call out their flaws to one another and seem shocked when Cady, the newcomer, struggles to find something negative to say about herself. Developing a vocabulary of positive attributes associated with our bodies tends to make it more difficult to fall into an automatic flaw-finding mentality. Again, this takes practice. I encourage you to try it once a week and see how your list might change. Stop yourself and breathe if you notice only negative attributes, and challenge yourself to see function over form. For example, you might think of your feet as just feet. But consider what purpose they serve in your life. If it feels too daunting to identify 10 items at first, start with one and slowly build up from there.

Maintaining a Practice of Gratitude in Public

It’s one thing to be able to privately have these empowering conversations with ourselves. But it can be quite another to bring these ideas into the light. How can we strive to maintain our practice of gratitude toward our bodies in the public arena? My personal challenge is to change the dialogue if I notice friends getting sucked into “diet” talk or if I hear them highlighting aspects of their bodies they want to change.

I have found that sharing a personal belief, such as “All foods are good foods in my book” can help to shift the conversation into less negative territory. Another tactic you might try is sharing your personal gratitude for your body with others. Notice how amazing it is that your legs can carry you on walks or hikes with friends, or appreciate the dexterity of your fingers as you maneuver chopsticks.

It can also be helpful to publicly state your boundaries around body talk. For example, you might say there’s no negative body talk allowed in your home. Follow through with these boundaries by reinforcing positive body talk and redirecting conversation in a way that challenges the appearance ideal.

These concepts and practices can help us build ourselves up through positive body talk and combat the appearance ideal found in the media and daily life. Ultimately, they can also help us find a path to greater body acceptance. By continuously challenging our society’s unrealistic body ideals, we can internally shift our dialogue about our own bodies and ultimately the environment we find ourselves in.

If you or someone you know is struggling with body image, consider speaking to an compassionate and qualified therapist or eating disorder specialist in your area.

References:

  1. Home/Get involved: The body project. (2016). National Eating Disorder Association. Retrieved from https://www.nationaleatingdisorders.org/get-involved/the-body-project
  2. The body project. (n.d.). Retrieved from http://www.bodyprojectsupport.org
  3. Stice, E., Shaw, H., & Rohde, P. (n.d.). Body acceptance class maunal: Enhanced-dissonance version. Retrieved from http://www.bodyprojectsupport.org/assets/pdf/materials/bodyproject4sessionscriptandhandouts.pdf

Three people with pink shirts embrace outdoors. Rear view photoMost people would agree the media today is inundated with unrealistic portrayals of women’s bodies. Because of practices such as choosing primarily thin, young, white women to sell products and using Photoshop to erase natural “flaws” and “imperfections,” to name a few, we are not exposed to a diverse (one might also say realistic) array of people. Consequently, generations of people grow up believing their appearance is inferior because it is not widely represented or considered to be “ideal.”

In my practice, I frequently work with women who are struggling with anxiety. Concerns related to weight and body image almost always come up as a contributing fact—in no small part, I believe, due to the media messages regarding the “ideal” body. Many people today have a tremendous fear of being judged for weight gain or their size. Fears and insecurities surrounding the body may take many forms. Some may fear being passed up for promotions or being looked down on at work due to weight stigma or sizeist stereotypes. Other individuals might fear never having a romantic relationship because potential love interests consider their size unacceptable.

Fears contributing to general feelings of anxiety may not always be rational, but unfortunately, weight stigma is a real concern in our society. The size-based discrimination and prejudice many people experience is likely to contributes to or exacerbate feelings of anxiety, depression, and other mental health challenges. Thus, these feelings of anxiety in particular may be more difficult to address. Further complications often result when, in an effort to achieve what societal messages suggest to be an “ideal” body, people develop unhealthy relationships with food and their bodies to achieve this ideal. [fat_widget_right]

From one fad diet to the next, the message is often the same: restricting food and ignoring the body’s natural hunger cues will lead to perfection. Instagram and other social media platforms are filled with pictures of plates of vegetables and videos of workouts meant to inspire. Whether a diet is low-fat, low-carb, or sugar-free, it does not often promote the development of a healthy relationship with all foods.

Take the current trend of clean eating as an example. Clean eating moralizes and judges foods by designating some as “clean” (and therefore acceptable to eat) and implying that consuming foods not considered clean results in the ingestion of dirty or toxic substances. Cleanses, or highly restrictive fasts meant to rid the body of perceived impurities, are increasingly popular, and people talk about “cheat days” as if they are committing a crime by eating sweets or processed foods. It is common to see posts in which people apologize for eating “unclean” foods or say they are being “bad” for eating them.

Clean eating has become prevalent enough that the term orthorexia nervosa was developed to help describe it when taken to an extreme. Though orthorexia is not currently listed in the Diagnostic and Statistical Manual, it bears similarities to other eating disorders. People with symptoms of orthorexia are often so fixated on living a “clean life” that they restrict their food intake to certain items and exercise excessively for purported health reasons. This fixation can have a serious impact on a person’s mental and emotional well-being as well as their physical health and social life.

This may seem like a radical idea, but you are perfect just the way you are, regardless of your size. Your worth is not determined by a number on the scale or a size of clothing. Focus on the beauty and strength you find in yourself and build on those aspects.

Of course, there is nothing wrong with wanting to include nutritious foods into our diets or making sure we exercise to keep our heart and bodies healthy. But somewhere along the line, eating became an act that was no longer intuitive. Years of yo-yo dieting, eating on prescribed schedules, or restricting entire food groups has taken its toll on our physical and mental health, to the point where we no longer trust our own bodies to tell us what, when and how to eat. Movement and physical exercise are no longer simply enjoyable activities, but rather the means to a thin end.

So, what is the answer? How can a person combat body anxiety amid internal and external pressures and messages faced on a daily basis?

The following five ways can help you begin to let go of anxiety and become better able to practice self-love.

Start to build trust in yourself.

Instead of constantly fighting your body, learn to trust it. Intuitive Eating is a philosophy that focuses on teaching people to trust their food desires and hunger cues. Many dietitians are teaching the people they work with to listen to the body’s messages, whether they desire “good” food or “bad” food. It is often a long process, but once your body learns you will no longer restrict certain foods or allow it to go hungry, it will tell you exactly what nutrients and type of food it needs.

Embrace yourself as you are today.

So many people put off adventures, shopping, and life events because they are waiting until they reach a certain weight or body shape. Let’s instead learn to love ourselves just as we are today. This may seem like a radical idea, but you are perfect just the way you are, regardless of your size. Your worth is not determined by a number on the scale or a size of clothing. Focus on the beauty and strength you find in yourself and build on those aspects.

Know your triggers.

Just like any other form of anxiety, body anxiety can be triggered by certain words, people, or actions. Become familiar with who or what sends your anxiety about your body skyrocketing, and then develop a plan. Avoid unnecessary triggers and be prepared for those that are unavoidable.

For instance, if you avoid going to the doctor because you become anxious when you are weighed, let the staff know ahead of time that you do not plan on stepping on the scale. If you have family members who make it their business to comment on what you eat or how you look, prepare a response for them and have it ready so you are not flustered or too embarrassed to address their remarks. By taking these actions you can be more proactive in reducing your anxiety.

Change your feed, not your food.

It can feel overwhelming when you are constantly confronted with images of the “ideal” body type or when all you seem to see in your social media feeds are posts about diets and weight loss. But remember, you have the right to remove anything that feels shaming (this includes people who make you feel ashamed!) from your social media feed and replace them with people and messages that inspire you to love yourself just as you are. Consider following body acceptance advocates and people who demonstrate that fitness and self-love do not come in the form of one body shape, size, color, or age. Doing this can help you feel more positive and inspired when you look at Instagram and other social media apps.

Find the right therapist.

If you are seeking help to change the way you perceive your body and reduce body anxiety, the right therapist is essential. It is important to find a therapist who is educated about Health At Every Size (HAES), a movement that encourages people to work on their physical and mental health without focusing on body size. Therapists are people, after all, and they are not immune to the outside messages about what “health” looks like. Mental health professionals may come into sessions with their own implicit biases about weight and food, so finding a therapist who supports your journey to self-love and acceptance without making it about weight loss is instrumental as you work toward these goals.

References:

  1. Bates, L. (2014, October 14). Why is women’s body image anxiety at such devastating levels? The Guardian. Retrieved from https://www.theguardian.com/lifeandstyle/2014/oct/14/women-body-image-anxiety-improve-body-confidence
  2. Bell, L. (2015, July 1). Body image and social anxiety. Eating Disorder Hope. Retrieved from https://www.eatingdisorderhope.com/treatment-for-eating-disorders/co-occurring-dual-diagnosis/anxiety/body-image-and-social-anxiety
  3. Get the facts on eating disorders. (2016). NEDA. Retrieved from https://www.nationaleatingdisorders.org/get-facts-eating-disorders
  4. Kratina, K. (n.d.). Orthorexia nervosa. NEDA. Retrieved from https://www.nationaleatingdisorders.org/orthorexia-nervosa
  5. Multiple anxiety disorders share an elevated concern over physical appearance. (2015, November 4). Anxiety.org. Retrieved from https://www.anxiety.org/body-image-a-common-source-of-anxiety
  6. Orthorexia symptoms and effects. (n.d.). Timberline Knolls. Retrieved from http://www.timberlineknolls.com/eating-disorder/orthorexia/signs-effects/
  7. Puhl, R. (2015, December 11). Stigma and ‘fat shaming’ can fuel depression and increase obesity. WBUR. Retrieved from http://www.wbur.org/hereandnow/2015/12/11/obesity-stigma-fat-shaming

Shelves containing medical filesPeople are generally entitled to access their medical records, including progress notes made by mental health providers to document the progress of treatment. Increased use of online progress notes makes it easier than ever for people to access their mental health records. A small study published in the journal Psychiatric Services suggests these records can both strengthen and harm the relationship between mental health provider and the person in therapy.

Researchers followed 28 people seeking treatment for mental health conditions at the Veterans Affairs (VA) Portland Health Care System in Oregon. Each participant answered interview questions about their reaction to provider progress notes. When records were consistent with what happened in treatment sessions, when notes indicated that providers listened, and when providers openly discussed diagnoses, participants expressed positive feelings about their providers and their medical records.

However, some components of progress notes eroded the relationship. Information gaps, incorrect information, and outdated treatment details were common sources of frustration. Some people said their records contained diagnoses their providers never discussed with them, significantly decreasing trust.

They study’s authors suggest their research provides important clues about how mental health providers can use progress notes and in-session discussions to strengthen their relationships with people in therapy.

Feeling Burned Out at Work? Join the Club

[fat_widget_right]Burnout at work is increasingly common, significantly affecting performance and morale. Most companies are ill-equipped to treat worker burnout. Moreover, issues with company culture—such as job insecurity and pressure to continually do more while working with less—can cause or worsen burnout.

Scientists Test Deep Brain Stimulation as Potential Anorexia Therapy

Deep brain stimulation, which uses electrodes to electrically stimulate the brain, may reduce symptoms of anorexia nervosa, according to a small pilot study of 16 people. Participants’ body mass index (BMI) increased an average of 3.5 points during the study, and some experienced a reduction in anxiety and depression.

Chicago Leaders Use Cognitive Behavioral Therapy to Combat Violent Crime

A violent crime wave in Chicago has sparked international media coverage, with 812 people murdered last year alone. A cognitive behavioral therapy program that supports social skills, encourages trust, and offers healthy outlets for anger and aggression is trying to tackle the crime wave by improving the well-being of Chicago’s at-risk teen boys.

Researchers See Promise in Light Therapy to Treat Chronic Pain

Chronic pain is an intractable and complex issue, affecting as many as 100 million Americans. Many people with chronic pain turn to opioids to manage symptoms, but these drugs can be addictive and are not always effective. New research suggests light therapy might offer relief. Researchers still are not sure how this nonpharmacological remedy works, but they say it does appear to reduce symptoms.

Stressed by Success, a Top Restaurant Turns to Therapy

El Celler de Can Roca consistently ranks among the world’s top restaurants. The competitive restaurant world can be stressful, but the dining establishment’s owners have found a novel way to cope. Weekly staff sessions with an on-site psychologist offer a chance to blow off steam and discuss challenging emotions.

Schools Strained by Kids’ Mental Health Woes

In Wisconsin alone, 175,000 students have an undiagnosed mental health condition. These unmet mental health needs, which are often the product of traumatic experiences or chaotic home lives, can strain school resources.

Fresh produce arranged on a wooden table in the shape of a heartAs more mental health practitioners embrace a holistic view of wellness, the role of food and diet is gaining more attention. Numerous studies show a link between healthier diets and lower incidences of depression, anxiety, and other mental health issues.

In their efforts to develop individualized wellness plans, clinicians often work collaboratively with food professionals who can help a person based on their specific needs. Food professionals may include nutritionists, registered dietitians, and others who promote healthy cooking.

If you think your food may be impacting your mood, start with a food assessment and then discuss it with your therapist.

How to Keep a Food Journal

The idea behind keeping record of what you eat is to notice whether there seems to be a correlation between what you’re eating and how you feel.

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Finding a Nutrition Professional to Work with You

Many traditional counseling programs do not educate practitioners about the role of food in mental health. It’s important to do some research on your own and ask your therapist to explore these issues with you. Ask about your therapist’s credentials, training, and experience working with similar cases to yours.

Tell your therapist you’re concerned about your dietary habits, and are looking for a referral to someone who can guide you on nutrition advice. Your therapist may be able to help find someone with a culinary or nutrition degree to provide counsel or classes.

Just as there are different types of mental health professionals, nutritionists, registered dietitians, and chefs generally have different training.

Practical Applications in Dietary Counseling

Many traditional diets or other means of restrictive eating are not healthy or sustainable ways to live. The following are some food takeaways from the so-called Blue Zones, regions of the world where people have the longest lifespan:

  1. Fill your plate with the rainbow: Eating more colors throughout the day generally means you’re consuming an assortment of phytonutrients and antioxidants.
  2. Eat several pieces of fruit per day and aim for 1 pound of vegetables: Higher consumption of fruits and vegetables is associated with a longer lifespan.
  3. Consume more whole grains instead of processed: Whole grains are often affordable and include quinoa, barley, millet, and brown rice.
  4. Eat 1 cup of beans per day: Whether in a bean salad, hummus, or mixed in with rice, research shows that longevity is linked to eating a cup of beans every day.
  5. Limit sugar consumption: If you have a sweet tooth, keep frozen bananas and berries on hand to make smoothies. You can also indulge in medjool dates or dark chocolate.
  6. Keep healthy frozen soups/meals on hand: Families often find it easier to stick to a pattern when they have healthy options on hand. Keep frozen veggies, healthy soups, and pre-made dinners at the ready for busy evenings.
  7. Have plenty of healthy snacks available: These may include apple slices, pretzels, berries, whole grain toast with peanut butter, and fruit smoothies.

Across studies, people’s levels of mental wellness increased with more whole grains, fruits, and vegetables, and fewer processed foods, meats, and dairy items.

Case Examples: Common Mental Health Issues and Food

In the following accounts, names and other identifying information have been changed to protect confidentiality.

Resources to Help Put Healthy Habits into Practice

Diet changes take time to adjust to. Since behavior changes and modifications can be difficult, here are some resources to help you transition to healthier eating habits.

  1. Cooking courses at your local college: Many community colleges and technical schools offer continuing education courses for adults who want to learn healthier eating habits.
  2. Eating support groups: Many people struggle to eat right on a busy schedule. Find or form a Meetup group or other support group online.
  3. Local library: Find both behavioral change and nutrition books that will help you make informed decisions about eating.

Take it one day at a time and attempt to incorporate a new healthy choice each week. In addition to talking to a therapist and any dietary advisers, always consult a medical doctor before making major changes to your diet or if you have a medical condition that requires medication.

References:

  1. Academy of Nutrition and Dietetics. (2016). Nutrition Care Process. Retrieved from http://www.eatrightpro.org/resources/practice/nutrition-care-process
  2. Baranowski, T. (2012). School-based obesity-prevention interventions in low-and middle-income countries: Do they really work? American Journal of Clinical Nutrition, 96, 227-228.
  3. Gregor, M. (2015). How not to die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease. New York, NY: Flat Iron Books.
  4. Jacka, F.N., Kremer, P.J., Berk, M., de Silva-Sanigorski, A.M., Moodie, M., Leslie, E.R., et al. (2011). A Prospective Study of Diet Quality and Mental Health in Adolescents. PLoS ONE 6(9): e24805. doi:10.1371/journal.pone.0024805.
  5. Lally, P., van Jaarsveld, C.H., Potts, H.W., & Wardle, J. (2010). How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology 6(40), 998-1009.
  6. Murphy, S. (2013). Are You What You Eat? Counseling Today: A Publication of the American Counseling Association. Retrieved from http://ct.counseling.org/2013/02/are-you-what-you-eat/
  7. Natural Gourmet Institute. (2016). Chef Training Program. Retrieved from https://ngihca.edu
  8. Oddy, W. H., Robinson, M., Ambrosini, G.L., O’Sullivan, T.A., et al. (2009). The Association Between Dietary Patterns and Mental Health in Early Adolescence. Preventative Medicine 4(1), 39-44.
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