The fields of behavioral medicine and health psychology are growing and many of our therapists are specialized in these fields.

The field of behavioral medicine and health psychology focus on how thoughts, feelings, and behaviors impact health. From irritable bowel syndrome to insomnia, weight management, diabetes, and chronic pain, our psychologists and dietitians can help you learn how to best manage symptoms associated with these conditions.

Do you have difficulty falling asleep or staying asleep? Are you tossing and turning in the middle of the night?

There is hope. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a highly effective treatment for insomnia. Insomnia can be detrimental to your health for many reasons. Without proper sleep, you could suffer the following negative consequences:

CBT-I is one of the few psychological interventions that directly impacts one’s physiology. It’s highly successful in helping those who have difficulty falling asleep or staying asleep. Clients will fall asleep quickly and stay asleep throughout the night such that they will wake up feeling much more well rested!

1. In our first session, we’ll review your current sleep habits. I'll ask the following questions:
2. What is your bedtime routine like?
3. What time do you get into bed?
4. How long does it take you to fall asleep?
5. How many times do you wake up in the middle of the night?
6. How long are you awake in the middle of the night?
7. What time do you wake up in the morning? How long are you staying in bed awake?
8. Do you nap during the day?
9. Does your sleep look different on weekends vs. weekdays?

Sleep Restriction Therapy
Many individuals get into bed earlier in hopes of getting more sleep throughout the night. Sleep restriction will require clients to stay up later than they might be used to so that they sleep more efficiently throughout the night. It helps to eliminate awakenings in the middle of the night. It may be difficult the first few nights, but eventually clients find they are falling asleep quickly and effortlessly! In therapy, you will complete sleep logs and be prescribed a recommended earliest bedtime and a standard rise time.

Stimulus Control
Do you watch television while in bed? Do you read? Are you checking your email, Twitter, Facebook … right before going to bed? Are you spending a lot of time awake in bed or in your bedroom? We’ll discuss how these behaviors impact your ability to sleep and how to change these habits to improve your sleep!

Sleep Hygiene
Is your bedroom quiet, dark, and cool? Are you drinking alcohol close to bedtime? Are you drinking too much caffeine? Do you have a bedtime routine? All of these factors could be affecting your ability to sleep well. Together we’ll determine what, if any, changes need to be made in this regard such that your sleep improves.

Cognitive Therapy
Do you think, plan, or worry in bed? Do you lay awake worrying about everything you need to do tomorrow? Do you worry about whether or not you’ll be able to sleep and how a lack of sleep will impact you the next day? In treatment, we will use cognitive therapy to help manage these thought processes so that they no longer impact your sleep.

Stop suffering from insomnia. See results and feel better.

Chronic pain and chronic illnesses are the leading presenting problems at doctor offices. Chronic pain and chronic illnesses are complex and often not just physical problems. One’s thoughts, emotions, and behavior have a lot to do with one’s experience of pain and illness. Chronic pain and illness also can create feelings of hopelessness, depression, anxiety, and anger. This is where psychological treatment can be helpful.

We treat clients with various complex chronic pain/illness presentations including, but not limited to, the following:

Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Biofeedback, and Mindfulness Meditation have all been shown through research to be effective in helping clients who are currently suffering from chronic pain and chronic illnesses.

We have several staff members and services that may help you.

Our psychologists have expertise in using Acceptance & Commitment Therapy to help clients learn to live with pain/illness and work on reducing the control it has over their lives. Instead of trying to eliminate pain and discomfort, clients will learn to learn to live a life that is fulfilling for them the best they can with the physical pain/discomfort. Using acceptance-based strategies, clients learn to psychologically manage their pain and discomfort such that it no longer controls their day to day functioning. Instead, clients begin exploring their values and set goals that help them live a life consistently with their values. This helps to improve quality of life.

Our health psychologists have expertise in using Cognitive Behavioral Therapy (CBT) to help clients address their thoughts, emotions, and behaviors in a way that helps them see a reduction in pain/illness severity and improve their quality of life. Chronic pain/illness can lead to anxiety, depression, irritability (emotions), negative thought patterns (thoughts), and increased isolation and withdrawal from day to day activities (behaviors).

These side effects of living with chronic pain/illness can often decrease one’s quality of life and make the experience of pain and discomfort far worse. CBT helps clients get more active, but in a gradual way where one learns to pace oneself so that they are not overdoing it which can lead to increased pain, distress, and withdrawal. Next, our psychologists would review relaxation training with the client focusing on deep breathing, progressive muscle relaxation, and and guided imagery. These strategies have been shown in research to improve chronic pain and illness severity. Lastly, our psychologists will discuss sleep patterns to ensure clients are getting adequate sleep and our psychologists will work with clients to help ensure they are incorporating meaningful, pleasant activities into their days. As a total treatment plan, research supports the efficacy of CBT for those with chronic pain/illness.

Some of our psychologists teach mindfulness meditation to their clients. Their approaches are closely linked to Jon Kabat Zin’s work in mindfulness based stress reduction. Research done using mindfulness based approaches have shown that individuals enrolled in such programs often have reduced pain and illness severity and improved health related quality of life. This is often contingent upon home practice. Our psychologists helps clients learn the various forms of mindfulness meditation they can use at home in between sessions.

Due to the pressures of daily life, many people report high levels of stress and burnout. Chronic stress can lead to a variety of health concerns, and stress reduction is often recommended. However, most people have difficulty fitting self-care and stress reduction techniques into their schedules. Mindfulness training is one effective stress reduction technique that has been found to prevent burnout and improve relationships.

We have psychologists on staff who are experts in mindfulness meditation and stress management. They work with clients in exploring different ways to incorporate self-care into busy schedules. You may have been exposed to meditation in the past, but our health psychologists introduce clients to mindfulness meditation in a way that does not have any religious undertones to it. It is focused more on psychological awareness and our psychologists discuss research behind mindfulness practices.

In working with our psychologists, you’ll learn the following skills:

• Cultivating Self-Awareness
• Learning Skillful Responding, Decreasing Stress Reactivity
• Eating Mindfully
• Practicing Mindful Movement
• Managing Difficult Situations and Emotions
• Increasing Focus and Mental Clarity
• Improving Communication and Connection with Others
• Learning About the Mind-Body Connection

Anxiety can be physically, emotionally, and psychologically draining. Our minds and bodies are hard-wired, from an evolutionary perspective, to make us feel anxious when there is a danger or threat nearby. Anxiety is a key emotion necessary for our survival.

In terms of an evolutionary perspective, our ancestors were glad they had anxiety so that their fight-or-flight system would get activated and help them run for safety when a tiger was coming after them. Fortunately, today we don’t have as many loose tigers roaming the streets. Yet, our minds and bodies still react in a similar ways to non-life threatening sources (work deadlines, relationship troubles, etc).

There are many types of of anxiety disorders and the most recent edition of the Diagnositic & Statistical Manual (DSM5) lists three separate categories of Anxiety Disorders. The first, termed Anxiety Disorders, includes:

Do you find yourself constantly worrying about a number of different things in your life? Do you find it hard to control the worry? If so, you may be suffering from Generalized Anxiety Disorder (GAD). Individuals who suffer from GAD often experience the following symptoms:

Treatment for GAD includes Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT). Both of these treatments target unhelpful thought patterns and provide clients with new skills for managing their worry and anxious thought patterns. Behaviorally, these treatments also work on helping individuals manage physical anxiety symptoms, with treatment including the following:

• Psycho-education for how Generalized Anxiety Disorder (GAD) is formed and maintained in the individual
• Breathing retraining and relaxation training
• Restructuring unhelpful thoughts and distorted thought patterns or working on mindfulness-based approaches to disengage from unhelpful thought patterns
• Behaviorally turning the focus to living a life consistent with values
• Occasionally treatment will involve scheduling “worry time,” problem-solving, and scheduling time to engage in pleasurable activities

Have you ever had spells or attacks when you suddenly felt anxious, frightened, or uneasy to the extent that you began sweating, your heart began to beat rapidly, you were shaking or trembling, your stomach was upset, or you felt dizzy or unsteady, as if you would faint? If so, you may have suffered from a panic attack.

Panic attacks include having a number of physical symptoms such as the following:

Our therapists use Cognitive Behavioral Therapy (CBT) to treat panic disorder. This entails the following:

• Psycho-education about how panic disorder is formed and maintained in individuals
• Acceptance-based approach to physical sensations
• Mindfulness meditation, defusion, and contacting the present moment
• Breathing and relaxation training
• Graded exposure to feared situations
• Cognitive restructuring or reframing unhelpful or distorted thought patterns
• Interoceptive exposure: exposure to bodily sensations that are feared or avoided

Do you get nervous or anxious in situations where you might be negatively evaluated such as meeting new people, giving a speech, calling someone on the phone, ordering off a menu at a restaurant or being around others who might be observing you in some way?

Are you worried people will think of you if they see you becoming anxious (seeing you sweat, shake, or get red in the face)? Do you worry about not knowing what to say to people in social situations … not knowing what to talk about?

Do you feel extremely anxious before having to speak in front of others? Do you avoid face-to-face interactions through the use of technology? You may be struggling with Social Anxiety Disorder.

Social Anxiety Disorder affects nearly 15 million adults in American. Often individuals suffering from Social Anxiety Disorder will develop such a strong fear of certain social situations where they might be evaluated negatively that they avoid them all together.

This is more debilitating than just being shy. Social Anxiety Disorder can negatively impact one’s life. 

Examples and ways in which social anxiety disorder can impact one’s life include:

• Turning down a job promotion because it requires public speaking
• Avoiding or turning down invitations to socialize and build relationships because
• Of the anxiety leading up to social events
• Being isolated and feeling lonely because of avoidance of social situations in which there is fear of being embarrassed

Social Anxiety Disorder can lead to other problematic disorders such as substance use disorders, depression, loneliness, and even difficulty getting a job because of fears and anxiety around interviewing.

Our knowledge of Social Anxiety Disorder and what causes it can be summarized as a mix of social, environmental, and biological/genetic factors. Typically social anxiety disorder emerges around age 13 and can affect individuals well into adulthood.

The good news is that we have very effective evidence-based treatment for social anxiety disorder.

Our psychologists are trained in Cognitive Behavioral Therapy (CBT) for Social Anxiety Disorder. In this treatment we will help clients learn to manage their anxious thoughts in a way that improves their emotional response. The behavioral aspect of treatment will include relaxation training to manage the physical response of anxiety and also exposure therapy which will involve practicing approaching situations that clients are avoiding, now with new tools to use to help cope in the moment.

Have you ever experienced any strong fears? For example, of heights, insects, animals, dirt, attending social events, being in a crowd, being alone, being in places where it may be hard to escape or get help?

Treatment for specific phobias using evidence-based treatment is highly effective. Primarily, our therapists will use a cognitive behavioral therapy (CBT) approach with an emphasis on exposure therapy. Patients work with the therapist on getting practice slowly and gradually with their biggest fears.

Common phobias include the following:

The Diagnositic & Statistical Manual (DSM5) lists three separate categories of Anxiety Disorders. Obsessive-Compulsive Disorders include:

Cleaning/Washing
Excessive or ritualized hand-washing, bathing, or grooming, excessive cleaning of household items, excessive measures to remove contaminants

Checking
Excessive checking of the stove, locks, appliances, checking that there was not harm done to another person, making sure nothing terrible has happened or will happen, excessive checking to make sure mistakes were not made

Repeating
Re-reading or re-writing, repeating daily activities (i.e. going up and down the stairs 4 times before leaving the house)

Counting
Needing to count steps, needing to count the number of times a behavior was performed, doing a checking compulsion a certain number of times

Ordering/Arranging
Excessive need for order or special arrangement of items

Mental Compulsions
Feeling the need to neutralize obsessions by compulsively bringing to the mind a specific number, image, or word

Miscellaneous Compulsions
Excessive list-making, asking for reassurance to ensure something was or wasn’t done, needing to touch, tap, or blink a certain number of times

Harm
Violent images, fear of saying inappropriate or obscenities, fear of acting on harmful impulses (i.e. knocking someone over on the metro platform, stabbing someone), fear of hurting others because of carelessness, fear of being responsible for terrible things happening (fire, burglary)

Contamination
Concern with dirt and germs, fear of contaminating others, concerns about getting ill because of being contaminated, forbidden or unacceptable sexual thoughts/images/impulses, sexual worries about children or incest, worry about acting in sexually inappropriate ways towards others

Symmetry
Obsessive thoughts about the need for things to be symmetrical

What is exposure and response prevention (ERP)?
Exposure and response prevention therapy falls under the umbrella of Cognitive Behavioral Therapy (CBT).

ERP is by far the most effective treatment we have to treat obsessive compulsive disorder (OCD). Patients suffering from OCD often have thoughts, images, objects, or situations that create great anxiety. There is often a desire to escape whatever might be triggering anxiety through compulsive behaviors. Compulsive behaviors often give patients a temporary sense of relief.

For instance, if someone has a great fear of getting sick because of germs, they may often engage in excessive hand washing to be able to escape the fear. This pattern of feeling anxious and engaging in compulsive behaviors to escape feeling anxious is reinforced over time and can result in psychological distress. Often OCD symptoms can be greatly life-interfering causing problems in relationships and work-related responsibilities.

In ERP treatment, our trained psychologists work with clients to confront that which they are avoiding (the exposure part of ERP) and help them to stop engaging in the compulsive behaviors (the response prevention part of ERP). For instance, a psychologist on our team may work with a patient who has germ-related OCD and have them touch door handles around our building without then washing their hands. With repeated exposure to doing this type of exercise, the mind begins to learn that you can be exposed to germs on a door handle everyday, not wash your hands, and nothing terrible happens. As the mind begins to learn this, psychological distress is reduced and OCD symptoms decrease.

OCD is complex and can take on many different forms. Many patients are apprehensive about engaging in this form of treatment. Our compassionate therapists are here to help. Call or email us today to get help from our psychologists who are experts in using Exposure & Response Prevention for OCD.

The Diagnositic & Statistical Manual (DSM5) lists three separate categories of Anxiety Disorders. Trauma & Stress-Related Disorders include:

Many of our clients come to us feeling a little lost as they are transitioning to a different part of their life. In the DSM-V there is a diagnosis called Adjustment Disorder which is often accompanied by symptoms of anxiety and depression.

We are here to help whether it is getting out of a long-term relationship or marriage, adjusting to marriage, moving to a new city, starting a new job, mourning the loss of someone special, being diagnosed with a new medical condition, raising a child for the first time, or wanting to make a career change.

Below are some common complaints clients have as they are going through a life transition or struggling with adjustment disorder:

Depression Symptoms
When life transitions happen, there can be symptoms of depression that come up such as difficult getting motivated, trouble concentrating, feeling sad, feeling a lack of interest in activities one used to enjoy doing, struggles with sleep, feeling hopeless, or feeling fatigued.

Anxiety Symptoms
There can also be symptoms of anxiety that come up such as worrying constantly, struggling with feelings of inadequacy, feeling restless or jittery, experiencing your heart racing more, having sweaty palms, and having trouble focusing or concentrating.

Eating Disorder Symptoms & Weight Changes
When experiencing stress, loneliness, or grief during a transition period, it’s not uncommon for someone to turn to food for comfort. This can lead to emotional eating, binge eating, weight gain, or often not eating enough at all and losing significant amounts of weight.

Insomnia or Hypersomnia
Sometimes adjustment periods and transitions in life lead to difficulty sleeping or sleeping too much.

Nutrition & Physical Activity
During life transitions, normal routines around making good, nutritious food and engaging in physical activity can be disrupted. Two things that can often be tied to good mental health can begin to be pushed to the bottom of the “to-do” list during adjustment periods and transitions which can often lead to increased problems with sleep, depression and anxiety symptoms.

Substance Use
Occasionally when struggling with a new phase of life, the stress will be so great that clients find themselves turning to drugs or alcohol to cope and temporarily escape the emotional pain they may be feeling.

Relationship Deterioration or Loneliness
During life transitions and adjustments, there can be a desire to isolate or irritability that leads to problems in intimate or family relationships. Alternatively some clients often move to the Washington DC metro area wanting to connect with others and struggle with feeling lonely and disconnected, not quite sure how to navigate making new friends as an adult.

Our therapists at Mind Body Health are trained in treating Post-Traumatic Stress Disorder (PTSD) and other trauma-related concerns.

Have you ever had nightmares or flashbacks as a result of being involved in some traumatic or terrible event? For example, warfare, gang fights, fire, domestic violence, rape, incest, car accident, being shot or stabbed?

If you have ever been exposed directly or indirectly to actual or threatened death, serious injury or sexual violence and persistently have intrusive thoughts, nightmares, flashbacks, or emotional or physical distress when confronted with reminders of the trauma, then you may be suffering from PTSD.

Often after trauma, clients may find themselves struggling with the following:

• Avoiding thoughts or feelings associated with the trauma or reminders of the trauma
• Difficulty remembering aspects of the trauma,
• Having overly negative thoughts about themselves or the world
• Blaming themselves for what happened
• Increased isolation
• Increased symptoms of depression or negative affect
• Irritability
• Aggression
• Difficulty concentrating
• Exaggerated startle response
• Difficulty sleeping

Our providers are trained in evidence-based treatments including cognitive processing therapy, prolonged exposure, and cognitive behavioral therapy for trauma. Trauma recovery often requires talking about the trauma that occurred, and helping clients to restructure the cognitive thoughts that developed after the trauma and the physiological ways in which the body responds to certain stimuli after the trauma. Such work is not easily done by oneself, thus we encourage working with one of our trained therapists to help in the recovery process. 

Do you have any of the following symptoms of depression?

There’s hope in evidence-based treatment for depression. The evidence based treatments we use to treat depression range from Behavioral Activation, Cognitive Behavioral Therapy, and Acceptance & Commitment Therapy.

At Mind Body Health, we also know that what you’re putting into your body may be affecting your mood. We recommend working with one of our dietitians alongside our psychologists to ensure that you’re maximizing your efforts to manage depression symptoms.

Behavioral Activation
When feeling depressed, individuals increasingly isolate and stop engaging in activities they used to gain pleasure from. Behavioral activation is a form of behavior therapy that focuses on helping clients reengage in activities that bring a sense of reward to their lives. We focus on the barriers to getting you active and living life again and help you set goals to overcome them. Though it may take everything out of you to commit to engaging in these behaviors, you will likely see an improvement in your depression symptoms.

Cognitive Behavioral Therapy (CBT)
This form of therapy proposes that individuals who struggle with depression have core beliefs about themselves that are often unhelpful (i.e. I am unlovable, worthless, a failure). Cognitive Behavioral Therapy is used by therapists to help clients develop more accurate beliefs about themselves. Developing more accurate beliefs can help change how one feels and engages with their life.

Acceptance & Commitment Therapy (ACT)
This form of therapy is more behavioral in nature, though it is useful in building mindfulness skills and becoming aware of when you are getting caught up in unhelpful thought patterns. This approach helps clients get untangled from that web of unhelpful thoughts and focus on living a life consistent with you personal values.

At Mind Body Health, we treat Reproductive Mood Disorders, including:

Most women experience mood symptoms before the onset of their menstrual cycle (premenstrual syndrome or PMS); however, 5-10% of women experience significant depression and/or anxiety that begins one to two weeks before the onset of menses and completely resolves at the start of the menstrual cycle. Symptoms of PMDD include irritability, depressed mood, anxiety, or mood swings and can cause conflict in relationships and significant impairment.
 

In addition to the categories of service listed on our website, we also have providers on staff who specialize in providing services in the following areas:

• Couples Counseling
• Relationship Problems/Concerns
• Parenting Strategies & Support for Behavioral Problems in Children
• Life Transitions
• Grief
• Infertility
• Military Readjustment
• Workplace Issues & Work Life Balance Difficulties
• ADHD

At Mind Body Health, we are committed to creating an inclusive environment for all.

Whether it is your race, gender, sexual orientation, religion, disability, or any other part of your identity, we are committed to providing compassionate, culturally-sensitive, and culturally-tailored treatment.

As therapists who strive to practice with cultural competency, we are committed to being mindful of our own attitudes, beliefs, and biases as it relates to individuals with different identities and backgrounds from ourselves. We simultaneously commit to meeting our clients with sensitivity, openness, appreciation, and understanding of their unique lived experiences.

Understanding that evidence-based treatments are often founded on research conducted with non-diverse populations, we are committed to tailoring evidence-based treatments to an individual's specific cultural context. 

Our psychologists at Mind Body Health are committed to providing a safe and welcoming environment for all individuals. 

Many of our therapists have had specific work experiences and training in providing culturally competent care to racial/ethnic minorities and immigrants. In our therapy, we often discuss the following:

• Exploration of cultural, ethnic, and/or racial identity concerns
• Racial trauma and race-based traumatic stress
• Processing the impact of microaggressions, racism, discrimination, stigma, and inequalities
• Acculturation stressors 
• Intergenerational conflict
• Interracial dating/relationship concerns
• Migratory trauma
• Intersectionality concerns
• Asylum/refugee/immigration concerns

Research indicates that all of the above can be associated with mental health concerns including, but not limited to anxiety, depression, eating disorder symptoms, substance use, isolation, lack of social support, physical health concerns, bullying, teasing, trauma, being a victim of violence or hate crimes, housing concerns, and inequalities in access to care, education, and employment. 

We are here to help and are committed to providing culturally-sensitive and culturally-tailored treatments.

Our psychologists and dietitians are dedicated to providing a safe, accepting, and affirming environment for those who identify as lesbian, gay, bisexual, transgender, non-binary, queer, questioning, intersex, or asexual.

The impact of stigma and discrimination in individuals identifying as LGBTQ+ can result in a lack of access to services, lack of social support, family rejection, isolation, poverty, unemployment, bullying, teasing, hate crimes and being a victim of violence. 

Research demonstrates that this stigma can impact mental health. LGBTQ+ individuals are at higher risk for experiencing mental health conditions such as anxiety disorders, eating disorders, substance misuse, suicidal ideation, and depression. When there are additional marginalized intersections between sexuality, gender, and race/ethnicity, mental health consequences are often more severe.

Given their past work experiences and specialized training, many of our therapists are particularly suited for working with LGBTQ+ individuals. Our therapists have a history of helping LGBTQ+ clients with the following:

• Identity confusion
• Process of coming out to family and friends
• Relationship, marriage, or dating concerns
• Building supportive networks
• Tailored treatment for eating disorders, body image concerns, substance use disorders, trauma, anxiety, and depression
• Exploration of the intersections of faith, race, ethnicity and gender/sexual identity
• Parent support/family acceptance
• Exploring internalized homophobia, biphobia, and/or transphobia
• Navigating LGBTQ+ communities
• Gender transition support
• Gender affirming treatment evaluations

Surgeons and other healthcare providers may require a Biopsychosocial evaluation and referral letter from a Licensed Clinical Psychologist to provide gender affirming treatments.

Dr. Stephanie Seibert & Dr. Trevor Dun are trained in providing gender affirming psychotherapy as well as Biopsychosocial evaluations to provide referral letters to healthcare providers. Dr. Seibert & Dr. Dunn have experience working with lesbian, gay, bisexual, transgender, and gender non-binary populations. 

Our providers use the World Professional Association for Transgender Health (WPATH) Standards of Care as a flexible guideline in their approach to working with transgender and gender non-binary individuals. Their referral letters follow the WPATH guidelines.

Examples of Gender-Affirming Treatments that may require a referral letter from a Licensed Clinical Psychologist:

• Hormone Replacement Therapy
• Breast/Chest surgery: augmentation mammoplasty (implants/lipofilling), mastectomy, creation of male chest
• Genital surgery: penectomy, orchiectomy, vaginoplasty, clitoroplasty, vulvoplasty, hysterectomy/salpingo-oophorectomy, reconstruction of the fixed part of the urethra, phalloplasty, metoidioplasty, vaginectomy, scrotoplasty, implantation of erection and/or testicular prostheses
• Nongenital, nonbreast surgical interventions: facial feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction, pectoral implants, gluteal augmentation (implants/lipofilling), hair reconstruction, and various aesthetic procedures

Fees

• $300 for the initial 60-minute evaluation and two letters sent directly to providers
• $15 for each additional letter
• $225 per each 45 minute follow-up session

Time Commitment
Evaluations may take anywhere from 1-3 sessions and occasionally additional sessions may be needed.

We have bariatric psychologists on our staff who have extensive knowledge and expertise in helping who are preparing for or who have had weight loss surgery. They have spent years working in weight loss surgery programs and understand some of the difficulties and concerns that people can struggle with both before and after weight loss surgery. Bariatric surgery is a tool rather than a fix, and thus success after surgery depends upon individuals making and maintaining a number of significant changes to lifestyle and habits. Some of those changes may be easier than others.

We are here to help you through it all! We offer individual therapy services to help people make these changes prior to surgery, whether that means addressing concerns like binge eating, developing a new relationship with food, or serving as your coach as you work on putting new habits into place. We also work with people after weight loss surgery who may be struggling to stick with lifestyle changes or are concerned about weight regain after surgery. Surgery can also lead to some unexpected changes in social relationships, body image, and other aspects of life, and we are here to help you to adapt to and cope with change.

Our bariatric psychologists often see clients who are simply contemplating having weight loss surgery. One of the things our psychologists do is help clients understand the different options for weight loss surgery that are available (i.e. Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, Duodenal Switch). Our psychologists can help you understand what each procedure entails, learn more about special considerations for different types of surgery, and think through the pros and cons of surgery so you can determine the right course of action for you.

Our psychologists are also happy to help you navigate the process of weight loss surgery and give you an idea of what you can expect. They also work with clients in improving their relationship with food and their bodies well before surgery. Post-surgery successes are dependent upon exercising regularly, preparing healthy food, eating at regular meal times, quitting smoking, minimizing alcohol intake, managing emotions without turning to food, getting enough water intake, addressing relationship and work-related stressors, and taking supplements and vitamins regularly. The more capable you are of doing these things before weight loss surgery, the easier it will be to maintain these lifestyle changes post-surgery.

Our psychologists on staff will give you a preview of what to expect on the day of weight loss surgery and the weeks directly after surgery too so you’re fully prepared.

Lastly, our weight loss surgery psychologists are happy to conduct your pre-surgical psychological evaluation which most surgical programs require as part of your pre-surgical workup and are often mandatory for insurance coverage of surgery. The goal of the evaluation is to determine readiness for surgery from a psychological and behavioral perspective, and whether any additional changes, supports, or resources could help you be better prepared or equipped to give you the best likelihood of achieving the outcomes you are hoping for.

Our bariatric psychologists often see clients who are simply contemplating having weight loss surgery. One of the things our psychologists do is help clients understand the different options for weight loss surgery that are available (i.e. Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, Duodenal Switch). Our psychologists can help you understand what each procedure entails, learn more about special considerations for different types of surgery, and think through the pros and cons of surgery so you can determine the right course of action for you.

Our psychologists are also happy to help you navigate the process of weight loss surgery and give you an idea of what you can expect. They also work with clients in improving their relationship with food and their bodies well before surgery. Post-surgery successes are dependent upon exercising regularly, preparing healthy food, eating at regular meal times, quitting smoking, minimizing alcohol intake, managing emotions without turning to food, getting enough water intake, addressing relationship and work-related stressors, and taking supplements and vitamins regularly. The more capable you are of doing these things before weight loss surgery, the easier it will be to maintain these lifestyle changes post-surgery.

Our psychologists on staff will give you a preview of what to expect on the day of weight loss surgery and the weeks directly after surgery too so you’re fully prepared.

Lastly, our weight loss surgery psychologists are happy to conduct your pre-surgical psychological evaluation which most surgical programs require as part of your pre-surgical workup and are often mandatory for insurance coverage of surgery. The goal of the evaluation is to determine readiness for surgery from a psychological and behavioral perspective, and whether any additional changes, supports, or resources could help you be better prepared or equipped to give you the best likelihood of achieving the outcomes you are hoping for.

Our psychologists on staff use Cognitive Behavioral Therapy and Acceptance and Commitment Therapy in their work with clients. Clients learn to be aware of their thoughts, feelings, and emotions to better understand how they may be influencing their behavior. We work together with clients to help them understand what gets in the way of living a life consistent with their values.

We have bariatric psychologists on our staff who have extensive knowledge and expertise in helping who are preparing for or who have had weight loss surgery. They have spent years working in weight loss surgery programs and understand some of the difficulties and concerns that people can struggle with both before and after weight loss surgery. Bariatric surgery is a tool rather than a fix, and thus success after surgery depends upon individuals making and maintaining a number of significant changes to lifestyle and habits. Some of those changes may be easier than others.

We are here to help you through it all! We offer individual therapy services to help people make these changes prior to surgery, whether that means addressing concerns like binge eating, developing a new relationship with food, or serving as your coach as you work on putting new habits into place. We also work with people after weight loss surgery who may be struggling to stick with lifestyle changes or are concerned about weight regain after surgery. Surgery can also lead to some unexpected changes in social relationships, body image, and other aspects of life, and we are here to help you to adapt to and cope with change.

Our bariatric psychologists often see clients who are simply contemplating having weight loss surgery. One of the things our psychologists do is help clients understand the different options for weight loss surgery that are available (i.e. Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, Duodenal Switch). Our psychologists can help you understand what each procedure entails, learn more about special considerations for different types of surgery, and think through the pros and cons of surgery so you can determine the right course of action for you.

Our psychologists are also happy to help you navigate the process of weight loss surgery and give you an idea of what you can expect. They also work with clients in improving their relationship with food and their bodies well before surgery. Post-surgery successes are dependent upon exercising regularly, preparing healthy food, eating at regular meal times, quitting smoking, minimizing alcohol intake, managing emotions without turning to food, getting enough water intake, addressing relationship and work-related stressors, and taking supplements and vitamins regularly. The more capable you are of doing these things before weight loss surgery, the easier it will be to maintain these lifestyle changes post-surgery.

Our psychologists on staff will give you a preview of what to expect on the day of weight loss surgery and the weeks directly after surgery too so you’re fully prepared.

Lastly, our weight loss surgery psychologists are happy to conduct your pre-surgical psychological evaluation which most surgical programs require as part of your pre-surgical workup and are often mandatory for insurance coverage of surgery. The goal of the evaluation is to determine readiness for surgery from a psychological and behavioral perspective, and whether any additional changes, supports, or resources could help you be better prepared or equipped to give you the best likelihood of achieving the outcomes you are hoping for.

Our bariatric psychologists often see clients who are simply contemplating having weight loss surgery. One of the things our psychologists do is help clients understand the different options for weight loss surgery that are available (i.e. Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, Duodenal Switch). Our psychologists can help you understand what each procedure entails, learn more about special considerations for different types of surgery, and think through the pros and cons of surgery so you can determine the right course of action for you.

Our psychologists are also happy to help you navigate the process of weight loss surgery and give you an idea of what you can expect. They also work with clients in improving their relationship with food and their bodies well before surgery. Post-surgery successes are dependent upon exercising regularly, preparing healthy food, eating at regular meal times, quitting smoking, minimizing alcohol intake, managing emotions without turning to food, getting enough water intake, addressing relationship and work-related stressors, and taking supplements and vitamins regularly. The more capable you are of doing these things before weight loss surgery, the easier it will be to maintain these lifestyle changes post-surgery.

Our psychologists on staff will give you a preview of what to expect on the day of weight loss surgery and the weeks directly after surgery too so you’re fully prepared.

Lastly, our weight loss surgery psychologists are happy to conduct your pre-surgical psychological evaluation which most surgical programs require as part of your pre-surgical workup and are often mandatory for insurance coverage of surgery. The goal of the evaluation is to determine readiness for surgery from a psychological and behavioral perspective, and whether any additional changes, supports, or resources could help you be better prepared or equipped to give you the best likelihood of achieving the outcomes you are hoping for.

Our psychologists on staff use Cognitive Behavioral Therapy and Acceptance and Commitment Therapy in their work with clients. Clients learn to be aware of their thoughts, feelings, and emotions to better understand how they may be influencing their behavior. We work together with clients to help them understand what gets in the way of living a life consistent with their values.

To schedule an appointment, please call us today at 571.328.7408, Ext. 0 or contact us via our Contact Form and we will get back to you as quickly as possible.

Are you tired of food, exercise, and body image dissatisfaction ruining your life and keeping you from living a life you can fully enjoy? Do you find that you have issues around controlling your weight and appearance such that it is affecting your closest relationships? Do you feel out of control with food or exercising?

Eating disorders affect at least 30 million people in the United States. Even more are affected by disordered eating where an individual may not meet full criteria for an eating disorder in the DSM-5, but still struggle with psychologically unhealthy eating, exercise, or body image related thoughts and behaviors.

Eating disorders do not discriminate amongst body size, type, ethnicity, race, gender, or sexuality. Eating disorders affect individuals of all ages as well.

Eating disorders have classically been thought of as a disorder that affects females. There are also many stereotypes out there that make individuals feel like the only way they would qualify for eating disorder treatment is to look like someone who is very thin.

Today we know that everyone can be affected by eating disorders. Eating disorders vary in presentation and the ways in which they manifest within an individual can be very complex.

Our eating disorder therapists treat disordered eating, anorexia, bulimia, binge eating disorder, avoidant restrictive food intake disorder (ARFID), body image dissatisfaction, body dysmorphic disorder, muscle dysmorphic disorder, and orthorexia.

Cognitive Behavioral Therapy for Eating Disorders & Disordered Eating
Our eating disorder therapists are trained in cognitive behavioral therapy (CBT) for eating disorders. This is the gold standard, evidence-based treatment for eating disorders and disordered eating.

Quite common amongst clients who struggle with eating disorders, we often find that thought patterns become quite rigid and inflexible. Body image perception and thoughts about food and weight become quite distorted as well. Many individuals also struggle with emotion regulation issues where food becomes a way to escape their emotions or a way to give an individual a sense of control.

In CBT treatment, we help clients build mindfulness skills to become more aware of thoughts, feelings, and emotions to more effectively manage them. We help clients identify distorted thought patterns, help them restructure their thought patterns, and help them create experiments in their day to day lives that challenge the pattern of living according to their existing thought patterns. Through this process, clients can begin to feel empowered getting unstuck, knowing that they can overcome hardships, and begin living a healthier life instead of walking through life influenced by their eating disorder thoughts all the time.

Acceptance & Commitment Therapy for Eating Disorders
Very similar to CBT, Acceptance and Commitment Therapy (ACT) has an added piece to address individuals' values. Through ACT, we help clients struggling with eating disorders to better understand what's important to them in their lives, or in other words, we help clients clarify their values. We then assess how the eating disorder, disordered eating, or body image symptoms stand in the way of living a life that is consistent with their values. In ACT therapy, we help clients align their behaviors with their values to again feel empowered that they are living life by their rules vs. the rules of the eating disorder mind.

Overcoming an eating disorder on your own is very difficult. It is not easy work. We are here to help, providing you with compassionate care every step of the way!

Call us today or email us to schedule an appointment with an eating disorder therapist on our staff. We have a number of psychologists who have been highly specialized and trained in evidence based treatments for eating disorders.

Do you struggle with anorexia? If so, then you probably know there’s a problem or someone has told you you have a problem you need to address. But you might be reluctant to change. That’s because anorexia nervosa is what we call an egosyntonic condition. What that means is you might have a certain level of desire in holding on to your symptoms because you feel that the person you are with those symptoms is who you truly want to be. Most other psychological disorders are egodystonic which means individuals feel unlike themselves and are eager to reduce or get rid of their symptoms.

Unfortunately, anorexia can cause significant damage to the body, can be extremely distressing psychologically, can cause significant issues in relationships, work and an overall difficulty in functioning on a day to day basis. Anorexia is also a psychological disorder with the greatest risk of mortality.

The good news is that all of this can be repaired through commitment to treatment (especially the physical consequences of anorexia). Nearly all the physical damage caused by restricting or overexercising in anorexia can be reversed through improved nutrition and dietary intake.

Using the gold standard, evidence-based treatment for anorexia, we will work with you as a team (a physician, psychologist, and dietitian) to help you recover.

Our psychologists will help you cope with the distress you might feel going through the process of recovery from anorexia. They’ll help you identify what the eating disorder has taken away from your life to help you increase motivation and attach meaning to why it’s worthwhile for you to go through the recovery process. Our psychologists will be a voice of reason in a sea of overwhelming eating disorder thoughts convincing you that recovery is just wrong. Our therapists will eventually help you in adopting a stance of your own against the eating disorder to help empower you to be in charge of your own life instead of the anorexia eating disorder mindset dictating what your every move has to be. Psychologists on our staff draw upon cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and dialectical behavioral therapy (DBT) to treat anorexia nervosa.

Our Registered Dietitian Nutritionists will help you nourish yourself in a way that supports repairing your mind and body. Our dietitians on staff will have you track your food through an app called Recovery Record and encourage you to increase your food intake overtime. This is a slow and gradual process as to avoid refeeding syndrome. Refeeding syndrome can occur in individuals struggling with anorexia. It is a set of medical complications that can occur if you gain weight too quickly. Our dietitian nutritionists will help you begin to listen to, appreciate, and honor hunger/fullness cues again. They will help you learn to enjoy a variety of food and reintroduce forbidden foods that the anorexia mindset has not allowed you to. Exposure to these forbidden foods is a necessary part of anorexia treatment to help your mind overcome the initial fear of eating “bad” food once again.

In the treatment of anorexia, we will ask that you be monitored by a physician. We are happy to work with a physician you’ve been seeing for quite some time and/or we have a few physicians we are happy to refer you to. The physician’s role is to ensure your safety in the recovery process to make sure you’re staying out of harms way. Some of the things medical doctors do in monitoring patients with anorexia is using an EKG to ensure your heart is safe, take bloodwork to ensure you’re not at risk for electrolyte imbalances which can lead to cardiac arrest, and use DEXA scans to determine if there is osteopenia or osteoporosis.

What about psychiatrists?
While we don’t have psychiatrists on staff, we are happy to refer you to psychiatrists in the area who can help you manage depression and anxiety symptoms that are often comorbid with anorexia and eating disorders. However, most psychological symptoms associated with anorexia are alleviated through weight restoration and proper nutrition.

What are the physical consequences of undereating and maintaining a low body weight? 
Cardiac complications: When you are undereating and maintaining a low body weight with anorexia, you could potentially be losing heart muscle, blood pressure and heart rate may slow down (bradycardia), and you may have irregular heart beats (arrhythmia).

Bone Density: Many individuals struggling with anorexia will be diagnosed with osteoporosis or osteopenia. Hormonal and dietary changes create more fragile bones and often there are great risks of fractures with falls.

Skin & Hair Problems: Lanugo is a condition where individuals with anorexia will begin to grow fuzz-like hair on their face and other parts of their body. This is the body’s way of trying to retain heat.

Individuals suffering from anorexia may also struggle with hair loss or thinning hair. When your body is at a low body weight, it tries to preserves what is essential in the body for survival. Hair isn’t important to survival.

Yellow-orange skin color can occur in those with anorexia because of elevated levels of beta carotene (primarily due to diet). This condition is called carotenosis.

Gastrointestinal Distress: Clients with anorexia will often complain of being constipated. This is a result of a gastroparesis or gastric delayed emptying due to muscle weakness in the digestive system. When you are undereating, your digestive system moves slower and it takes longer for food to move from the stomach to intestines. This can result in gas, bloating, constipation, and physical pain and discomfort.

Feeling Cold: Individuals with anorexia often experience feeling cold all the time, especially in the hands and feet. This is due to malnutrition and not maintaining a healthy body weight.

Restless, Non-Refreshing Sleep/Insomnia: Because of starvation and being malnourished, individuals with anorexia often describe difficulty falling asleep and having restless sleep. There are decreases in slow wave sleep, sleep efficiency, and overall less hours sleeping amongst those with anorexia.

Loss of Libido: Sex hormones and fertility are non-essential for survival. So many individuals with anorexia will lose their sex drive and have difficulty getting pregnant if their body weight is too low.

What are the psychological/social consequences of undereating and maintaining a low body weight? 
Cognitive: When individuals are malnourished, we see a pattern of very rigid thinking. It becomes harder for individuals with anorexia to make decisions as well. Concentration and ability to focus are also reduced. Clients with anorexia often describe a preoccupation with thinking about food all the time as well.

Mood: Individuals with anorexia often are very irritable and depressed.

Personality: Many individuals with anorexia will not always see this clearly, but loved ones will see that the individual is just not the same in terms of their personality. Individuals’ true personality tends to be restored with weight restoration.

Relationship stressors: Individuals not only become very rigid in their thinking patterns, but in their behaviors as well. They often must do things a certain way or else they will become quite irritable. They may only be able to eat at certain restaurants where they feel there is something “safe” to eat on the menu. Because socializing often involves food, individuals with anorexia may become increasing isolated. Individuals with anorexia may not have an interest in sex and can become more focused on themselves vs. others. All of these behaviors can significantly impact relationships with loved ones.

But I’m getting my period, so I must be okay, right?
Though a loss of periods (amenorrhea) may be indicative of anorexia, it is no longer a criteria for anorexia nervosa. There is a lot of variability in regard to those that get their periods and those that do not in anorexia. An important thing to note, though, is that if you are not menstruating, it doesn’t mean you cannot conceive. Again, fertility is not essential for survival, so many women will struggle with infertility issues if they are underweight. Weight restoration can reverse these issues.

When do you determine if there is a need for a higher level of care? 
We are happy to try outpatient treatment with individuals who struggle with eating disorders. However, if it is medically unsafe for you to be in an outpatient setting, we will recommend a higher level of care where you can be closely monitored by medical staff to ensure your safety.

At Mind Body Health, our registered dietitians and psychologists use the American Psychiatric Association’s Guidelines for Higher Level of Care. These guidelines factor in suicidality, percentage of ideal body weight, motivation, severity of obsessive thinking patterns, severity of co-occuring psychological disorders, ability to complete meals and follow through on nutrition recommendations, ability to follow exercise recommendations provided by the team, and ability to abstain from laxative and purging behaviors, and family/environmental stressors that may stand in the way of recovery.

But I’m purging, so that means I have bulimia, right? 
Anorexia nervosa has two subtypes: restricting type and binge/purge type. It is not uncommon for individuals with anorexia to not only restrict their food intake to reach a low body weight, but also to be exercising excessively and compulsively and/or vomit, use laxatives or diuretics.

Who is affected by anorexia? 
Anorexia can affect individuals of all ages, ethnicities, genders, races, and sexual orientation. Anorexia is more common amongst women, but there are adolescent boys and adult men who also suffer from anorexia nervosa. There are heightened prevalence rates of eating disorders amongst the LGBTQ population. Because there is less awareness about the prevalence of eating disorders amongst men and individuals of various sexual orientations or ethnicities, there can be a reluctance to discuss symptoms and seek treatment. We strongly encourage you to reach out to us! We are well trained in the treatment of eating disorders as it pertains to very specific populations.

What is the typical age of onset for anorexia? 
Teenage and early adulthood years are typically what we see in regard to the onset of anorexia. Puberty and changes in the body can often be a trigger for the onset of anorexia in adolescence.

Is family involved in treatment? 
For adolescents and very young adults, we use Family Based Treatment for Anorexia. You can read more about this treatment here. For adults, we often encourage involving supportive family members in treatment so that in between sessions, you’re having someone hold you accountable and help you through what can be a difficult recovery process.

What causes anorexia? 
As with most psychological disorders, it’s complex! At Mind Body Health, we use a biopsychosocial model in understanding the etiology of psychological disorders. Essentially the answer is often a mix of nature and nurture (biological and environmental factors).

Individuals with anorexia typically have a genetic predisposition. Often there will be another family member in the immediate or extended family that has suffered from an eating disorder. The likelihood of having an eating disorder if a family member has had an eating disorder is significantly higher.

That combined with certain personality traits and environmental stressors can cause anorexia to manifest within an individual.Personality traits often associated with anorexia are perfectionism, neuroticism, harm avoidance, and being an overachiever.

Environmental triggers can include perceived cultural, peer, or familial pressures to be thin, dieting or unhealthy weight control efforts, professions or recreational activities that promote weight loss or being thin (modeling, ballet/dancing/gymnastics, wrestling), sexual abuse, trauma, past history of bullying/teasing.

Call us today to get help. We have six staff members with specialized training in the treatment of eating disorders using evidence-based treatments.

Do you find yourself eating large amounts of food in a short period of time? Do you feel a loss of control over your eating? Do you find yourself trying to compensate for the food you eat by exercising excessively, fasting, vomiting, or using laxatives, diuretics, or diet pills? Do you find that your shape and weight largely influence how you feel about yourself?

If you answered yes to any of the questions above, you may be suffering from bulimia nervosa.

Bulimia nervosa can impact your physical and mental health. Some of the medical complications of bulimia are listed below:

• Esophagitis
• Tearing of the lining of the esophagus, ruptures, bleeding of esophagus lining
• Edema
• Colon damage (due to laxative use)
• Ulcers, acid reflux, constipation, irregular bowel movements, digestive problems
• Dehydration and electrolyte imbalances can lead to heart irregularities or heart failure
• Erosion of tooth enamel
• Infertility

Using evidence based approaches, clients will self-monitor their food intake, regulate eating patterns, and address feared foods, interpersonal problems, and body image concerns. Clients will gain a better understanding of what their personal triggers are for binge eating and purging and develop skills to eliminate or manage emotional distress around triggers.

Do you feel out of control around certain types of food? Do you feel like you eat until you get physically sick in response to certain emotions? When your eating feels out of control are you also finding that you’re eating much more rapidly than normal? Do you sometimes eat alone out of embarrassment? Do you feel depressed or guilty after eating large amounts of food?

You may be suffering from Binge Eating Disorder. Clients often use the following terms to describe binge eating disorder: food addiction, compulsive overeating, loss of control eating.

Who is affected by Binge Eating Disorder?
Binge Eating Disorder is the most common form of an eating disorder diagnosed in the United States. It’s three times more common than bulimia or anorexia. Approximately 3.5 % of women and 2% of men in the United States will develop Binge Eating Disorder in their lifetime.

Adolescents are often affected by binge eating disorder as well starting anywhere from 12 – 14 years old. A study by Stice, Presnell, & Sprangler (2002) found that body image concerns, depression symptoms, appearance-oriented emphasis on self evaluation, dieting, and feeling pressure to be thin often predicted the onset of binge eating. There are adolescents who develop a loss of control of eating even before dieting begins. These adolescents often develop binge eating disorder at an earlier age.

Clients struggling with binge eating or compulsive overeating will benefit from an evidence-based treatment approach. Below are approaches we take to help those with binge eating disorder:

Most of our clients make the most progress with binge eating disorder treatment when working with our nutritionist and a psychologist on staff.

To maximize efforts, our Registered Dietitian works with you to normalize your eating patterns (see below) and the eating disorder therapist will work to target the underlying psychological triggers for binge eating episodes.

Normalizing eating patterns. Many people struggling with binge eating disorder go very long periods of time without eating or are highly restrictive and have a long history of chronic dieting. In working with our eating disorder nutritionists, clients begin binge eating treatment by practicing eating something every 3-4 hours.

Targeting chronic dieting and all-or-nothing thinking around food. Part of the work with our registered dietitian nutritionists is targeting long held beliefs about “good” and “bad” foods. Often creating strict rules around food can create all-or-nothing patterns of thinking and behavior. When breaking a rule, a client can feel extremely guilty or upset which can often lead to binge eating. The cycle of restricting and then binge eating can continue for a long time to come. Instead, we’ll help you gain skills to be able to eat all foods in moderation.

Manage emotional and life stressors that trigger binge eating. Clients struggle with binge eating disorder typically are not reaching for celery sticks and carrot sticks when they have an urge to binge. Typically the food is high in refined carbs and sugar. These types of food tend to light up the reward centers of our brain. It makes sense if you were feeling upset, stressed, lonely, etc. that you’d want to find an escape from feeling those painful emotions. An easy, reliable way to do that can become food. Our psychologists use a variety of psychological interventions to help our clients become mindful of their emotions and observe them without judgement. We help them build distress tolerance in being able to sit with their emotions without feeling the need to run from them or suppress them. Food, then, becomes less of a tempting option to escape emotions.

Approximately 25% of those suffering from obesity report binge eating. Binge eating disorder complications are similar to medical complications associated with obesity:

Because we don’t believe in fad diets and because chronic dieting often results in binge eating in the first place, we have to work with our clients in helping them change their relationship with food and their body such that their body gets to the place it’s naturally intended to be at. Instead of talking to you about what to cut out of your diet so that you can begin losing weight, we will talk to you about becoming more mindful and keeping track of how much you’re eating, what you’re eating, and how you’re feeling physically after. With mindfulness, you’ll begin to learn what your body wants you to be eating more of and less of or what quantity of certain foods it can tolerate. Sound complicated? It can be. That’s why we encourage finding the right balance and harmony with your body working with our registered dietitian nutritionists and psychologists.

At Mind Body Health, we treat Avoidant/Restrictive Food Intake Disorder (ARFID) in children, adolescents, and adults.

ARFID often begins in childhood, but can be prolonged into adulthood if not treated early on. Clients struggling with ARFID often have difficulty swallowing foods or digesting foods not for organic reasons, but psychological reasons (mainly anxiety). They often have had a negative experience or have a fear of vomiting, choking, or having food poisoning around the food that they avoid. Many clients with ARFID may have difficulty with eating foods that have different textures, smells, or tastes than the foods they are used to eating. Clients with ARFID may only eat a very select few foods that they feel comfortable around. This can lead to nutritional deficiencies or lack of adequate weight gain for children if they are not eating enough in quantity and quality.

Treatment for ARFID involves cognitive behavioral therapy (CBT) and mindfulness training for clients of all ages. With CBT, we will work on helping clients learn relaxation strategies to manage their physiological anxiety response to new foods. We will also work on addressing the anxious thoughts by using mindfulness training. Instead of getting caught up in the anxious thoughts about food, clients will learn to shift their attention to think more about the taste, texture, and flavor of food. In this way, clients connect more with food instead of avoiding it. In treatment, we create a hierarchy where we gradually expose clients to difficult or challenging foods they may be avoiding.

Treatment also involves family members of young children. Parents will learn not to cater specifically to what the client prefers in terms of food, but learn techniques that help foster trying new foods vs. reinforcing the avoidance of different foods. Families will learn to eat together at the dinner table with no other distractions to help facilitate connection with food vs. being distracted from the experience of food.

Lastly, another important part of therapy with clients suffering from ARFID is assessing for other forms of anxiety. Often if there is a diagnosis of generalized anxiety disorder or trauma, for instance, food can be a mechanism used to help clients feel more in control of their day-to-day environment and their emotions. Helping clients feel better about managing their anxiety creates less of a need to depend on control of the food that they eat. This will help foster exposure around new foods.

Do you feel like you or a loved one doesn't necessarily meet criteria for an eating disorder, but still struggles with a difficult relationship with food and your body?

We encourage you to reach out anyway. Body image dissatisfaction and behaviors such as chronic dieting, "clean" eating, skipping meals, fasting, vomiting, taking diet pills or laxative, and compulsive exercising can be a precursor to developing a more severe eating disorder. These behaviors can also be related to deeper concerns such as feeling out of control, major life changes occurring, identity-related concerns, and interpersonal distress. These concerns can be worked on in therapy such that clients are not reliant on disordered behaviors to feel a sense of control. 

Prevention is key and we love working with clients who are beginning to see the warning signs of developing an unhealthy relationship with food and their bodies. 

Though not formal diagnoses in the DSM-V, orthorexia is a condition that can cause significant distress and harm psychologically and physically.

Orthrexia is when someone becomes so fixated or obsessed with eating "clean," "healthy," or living such a lifestyle to the point of it actually becoming harmful to one's own well-being.

Symptoms of orthorexia may look like the following: 

• Obsessively checking ingredients on food labels and obsessively thinking about eating healthy
• The desire to eat only pure or safe foods begins interfering with personal, social, and work life
• Judgement and preoccupation of others and what they are eating
• Cutting out many groups of foods all at once (i.e. no sugar, no carbs, no meat, no dairy)
• Eating only a narrow range of foods that are deemed"pure" or "clean" foods
• Avoiding social interactions for fear of no healthy food being available
• Getting distressed, anxious, or preoccupied in situations where no "safe" foods are available to eat
• There is an obsession about following a healthy lifestyle and includes an obsession around following "healthy" and "clean eating" social media accounts
• Experiencing the physical and psychological signs of malnutrition (see more under the anorexia tab)

Knowing how to support a loved one who has an eating disorder can be difficult and confusing. 

• Are you concerned and don't know how to help a loved one get to an appropriate level of care?
• Are you confused about levels of care (outpatient, intensive outpatient, partial hospitalization, residential, inpatient)?
 
• Are you unsure how to talk about food or body weight around a loved one?
 
• Are you confused about what to say all together when it comes to helping a loved one get better?

Our therapists have years of experience working with clients with eating disorders and helping loved ones learn how they can be effective in their efforts to support their loved ones. We can provide consultation to you so that you can be in the best position to provide support to your loved one.