EATING DISORDERS

Most children, in particular teens, are self-conscious about how they look and appear to others. This is especially true as their bodies change and develop during their teenage years, coupled with social pressures. Unfortunately, for about 1 to 2 in 100 individuals, these concerns can become obsessions that can impact on weight fluctuations, impairing daily functioning and affecting their health and body functioning.

According to the National Institutes of Mental Health (NIMH), girls and women are much more likely to have an eating disorder. Teenage girls who regularly diet are especially vulnerable. Societal pressure to be thin, emotional distress and family attitudes toward food can all lead a young woman toward unhealthy eating patterns.

An eating disorder is a serious disease that affects both mind and body. Eating disorders are characterized by a persistent pattern in eating behaviors such as extreme and unhealthy reduction of food intake, dysfunctional dieting, or severe overeating, as well as feelings of distress or extreme concern about body shape or weight. Eating disorders in teenagers and adults affect both females and males. Unfortunately, there is a rise for the number of teens and eating disorders. Although most of the research and literature focuses on females, there is a significant and growing number of males battling with food issues. Dr. Cherwony has seen many males with anorexia and other eating disorders in her practice.

Anorexia Nervosa is characterized by self induced starvation and excessive weight loss. Individuals that are battling Anorexia have an intense fear of gaining weight and being “fat” even though they are often underweight. They have a distorted body image, meaning that they see themselves as bigger than they actually are. As a result, they strive to maintain a very low body weight. Most commonly, they restrict their food intake by eating minimal amounts of food (extreme dieting), not allowing themselves any food (fasting), or engaging in excessive amounts of exercise with the goal to burn calories taken in. Anorexia is a serious and life-threatening disease. According to Dr. Thomas Insel, Director of National Institute of Mental Health, “Research tells us that Anorexia is a brain disease with severe metabolic effects on the entire body.” Anorexia is the leading cause of death among all psychological disorders.

Bulimia Nervosa is a serious eating disorder that is characterized by consuming large quantities of food in a short period of time (bingeing) followed by inappropriate compensatory behaviors to “get rid of” the calories just consumed (purging), in order to prevent weight gain. Purging can take on many forms. For example, purging can include self-induced vomiting and laxative use. Symptoms include repeated episodes of bingeing and purging; eating beyond the point of fullness and feeling out of control during a binge; purging after a binge; frequent dieting; and extreme concern with body weight and shape. Research shows that 18 percent of college-aged girls struggle with Bulimia

Binge Eating Disorder (BED) is characterized by frequent episodes of eating large quantities of food in a short period of time also known as binge eating. However, in BED, the individual does not then engage in some type of purging behavior as in Bulimia. Individuals will typically eat these large quantities when alone, and then feel guilty, depressed and ashamed after overeating. Some refer to BED as obsessive eating. Binge Eating Disorder is the most common form of eating disorder in the United States today.

Eating Disorder Not Otherwise Specified (EDNOS) is a serious eating disorder that does not necessarily fall into the specific category of anorexia, bulimia, or binge eating. Many individuals fall into this category and may include those who restrict as in Anorexia but are within normal ranges for their body weight, an individual who chews their food but then spits it out before swallowing, an individual who engages in bingeing and purging but less than the required frequency for a diagnosis of Bulimia.

Compulsive Overeating, sometimes referred to as emotional eating disorder, indicates that the individual struggles with a food addiction. People feel a temporary relief to their stressful days or painful emotions by eating without regard to whether or not they are hungry. In order to stop emotional eating, it is imperative that an individual understands that no matter how much they consume, they will not feel full until they address their reasons for feeling empty/deprived. Food and eating are a way to hide from their emotions, to fill a void they feel inside, and to cope with daily stressors and problems in their lives.

Binge eating can take place at one time during the day or an individual can snack or graze on small amounts constantly throughout the day. Regardless, they are taking in a large number of calories. For many, night eating is common. Left untreated, compulsive overeating can lead to medical problems such as diabetes, hypertension, sleep apnea, GI problems, kidney failure, anemia, high cholesterol, gallbladder disease, cancer, obesity, joint pain, anxiety and depression, among others.

A compulsive overeater may also have an alcohol or drug addiction. According to the National Center on Addiction and Substance Abuse at Columbia University (CASA), people with eating disorders are 5 times more likely to also abuse drugs and alcohol. Also, addicts are 11 times more likely to have an eating disorder.

Eating disorders are serious and can be life-threatening. Dysfunctional eating habits may start out as a diet but can lead to a full-blown eating disorder. Although eating disorders manifest as issues with food and body weight, they are in fact not really about food or weight. Eating disorders are much more complicated than that. The food and weight-related issues are symptoms of something deeper such as depression, loneliness, insecurity, pressure to be perfect, or feeling out of control. These are psychological struggles that no amount of dieting or weight loss can cure. Focusing on one’s weight and obsessing about calories are really just distractions from the real negative emotions and struggles that an individual is facing. In our society, it is much more acceptable to speak about what diet you are on rather than on how poorly or insecure you are feeling. Many people ask if and whether overcoming eating disorders is possible. Treatment for eating disorders is multifaceted. While the treatment for Anorexia may be different from the treatment for Bulimia or the treatment for Binge eating disorder, all are serious food disorders that require a multifaceted treatment plan with an eating disorder specialist. Help with eating disorders is available.

Treatment with a professional who specializes in eating disorders is critical. It may be extremely difficult for loved ones to believe that the individual is capable of the behavior associated with eating disorders. Seek your own support so that you can accept that your loved one needs help. Do not deny that an eating problem exists. Early intervention can make a world of difference. Eating disorder treatment focuses first and foremost on restoring the individual to healthy eating with normal body weight through mechanical and later intuitive eating AND on addressing the psychological factors. Treatment helps individuals to attain a positive body image, free from preoccupation with one’s body. Dr. Cherwony takes on an empowerment approach with her clients, helping to promote positive body image and instilling a sense of self-acceptance, increasing self-esteem and self-love. Dr. Cherwony has extensive experience with all eating, food and weight issues, and works closely with dieticians and other healthcare providers in the treatment of eating disorders. There is help for Anorexia. There is help for Bulimia and Binge Eating disorder. There is help to stop compulsive eating or emotional eating. Eating disorder support is available!

Most eating disorders share a great number of common causes and emotional aspects. An individual may be suffering from an eating disorder even though she may appear healthy. Some individuals go undetected because they may even be at normal body weight.

Signs and symptoms of eating disorders:

  • Distorted body image
  • Significant weight fluctuation
  • Intense fear of gaining weight
  • Preoccupation with food, weight, calories
  • Dramatic mood swings, increase in depression and anxiety
  • Denial of hunger
  • Withdrawal from friends
  • Excuses about not being hungry or having eaten earlier
  • Excessive exercise
  • Food rituals such as playing with food on plate
  • Wearing loose clothing
  • Secretive eating and missing food
  • Intense self-criticism
  • Swollen parotid glands in neck
  • Calluses on hands (from self-induced vomiting)
  • Eating late at night
  • Disappears into bathroom after meals
  • Dental problems
  • Complaints of being cold
  • Avoids eating in public
  • Hair loss, pale skin color, broken blood vessels in eyes

DEPRESSION

Being human means experiencing a wide array of emotions. Sadness is just one of many feelings. This means that we ALL feel sad at times and it a very normal and appropriate response to unsettling events, losses, life transitions, and disappointments, no matter how big or small. It is important to allow yourself to feel sad and to try and express your sadness to someone close to you. Keeping your sad feelings to yourself can actually make you feel worse. Crying is not a weakness, but an expression of your inner self. We can learn a lot about ourselves if we listen to our feelings.

Once you allow yourself to experience and express your sadness, your sad feelings will likely resolve themselves with some time. However, if you find yourself experiencing persistent feelings of sadness and/or difficulty engaging in regular functions or activities, it may be helpful to make an appointment.

Depression is a much deeper level of sadness that can be very overwhelming and interferes with a person’s level of functioning. Research suggests that one out of six adults in North America suffer from Depression. There are also tremendous variations in the way that people experience Depression. There are also those many people who are depressed, yet are not aware that they do not have to live their lives feeling this way. For some people, depression can be experienced as irritability. Depression and Anxiety often go hand in hand. You may find yourself worrying or feeling distressed more often than not. Here are some of the signs that you may be experiencing clinical depression:

  • Persistent and profound feelings of sadness, irritability or ‘numbness’
  • A loss of interest in pleasurable activities that you have enjoyed in the past
  • Social isolation and withdrawal
  • Loss of energy or feeling tired often
  • Feelings of hopelessness and helplessness
  • Feelings of guilt and/or worthlessness
  • Sleeping too much or not sleeping at all
  • Loss or gain of weight and appetite
  • Difficulty concentrating and making decisions
  • Thoughts of wanting to die, recurrent thoughts of death, or a suicide attempt or plan of death
  • Physical symptoms such as unexplained headaches, ulcers, and pain that do not respond to treatment

Please reach out to a professional for help. Life does not have to be so difficult. There are ways to help you live a happier and more carefree life. Reaching out for help may seem like the most impossible thing to do when life feels so dark. But there is a light and things can get better

Many individuals who struggle with depression also struggle with anxiety. The two conditions often go hand in hand.

Click here to learn more about anxiety and stress management.

BARIATRIC (WEIGHT LOSS) SURGERY

More than 60 percent of the U.S. population is overweight with about 30 percent classified as being obese. Obesity is a life-threatening condition and can result in physical, psychological and social co-morbidities as well as poor quality of life. With over 12 years as a clinical psychologist, Dr. Cherwony has extensive experience working with patients who struggle with obesity and with those who have chosen to pursue weight loss surgery. Dr. Cherwony understands the heart-felt issues of obesity such as the pain, frustration, challenges and unfortunate discrimination, and will help you to be emotionally prepared for the amazing, exciting and challenging life transformation of long term weight loss and better health. Whether you are looking for surgical or non-surgical options to better health, Dr. Cherwony can help you!

Bariatric or weight loss surgery is a life-changing event. For those individuals who have struggled with weight and food issues their whole life, they can finally have the opportunity to lose a lot of weight and drastically improve their health and overall quality of life. Both bariatric patients and professionals will tell you that the surgery as remarkable as it is, is only a medical tool. I have seen firsthand the improvements in a patient’s overall quality of life following surgery. However, there are also many struggles that bariatric patients experience. Once the surgery is over, the work begins and the psychological factors come into play. Despite what some may think, there is nothing easy about this life-altering surgery. Patients must enter into a new relationship with food because eating patterns must change. For example, patients are expected to change their lifestyle in terms of how, what and when they eat as well as introducing new exercise habits. Ultimately you are being asked to change years of habits and behaviors. Your eating habits are not an isolated event. During individual therapy sessions, Bariatric patients report experiencing an emotional loss when food is taken away. Patients must learn healthy coping skills to replace the use of food. They must learn to put their own needs ahead of others. Years of old habits do not disappear because of a surgery. In addition to the value of learning new habits to replace the use of food it is also important to understand the emotional hurdles that have blocked attempts at successful weight loss in the past. The majority of my patients know more about food and diets than most. Yet they continue to sabotage their weight loss efforts. The psychological component of weight loss surgery is a key component to your recovery and can greatly impact your long term success.

Bariatric surgery includes several medical options, such as Roux en-Y gastric bypass (RYGB), the sleeve gastrectomy and lap band to help patients struggling with obesity to lose weight. Preoperative bariatric evaluations are conducted prior to undergoing weight loss surgery. Many insurance companies want to see that the individual is a suitable candidate for compliance following surgery. Bariatric practices that have met the standards for Centers of Excellence expect that all of their patients will undergo a thorough psychological bariatric evaluation before being considered for surgery.

Dr. Cherwony views the preoperative bariatric psychological evaluation as the first opportunity to educate her patients on the lifestyle requirements following surgery. An open dialogue begins between you and Dr. Cherwony, where you can feel comfortable sharing any concerns or ambivalence that you may have. Dr. Cherwony has watched her patients transform their lives from obesity to good health. It is a second chance for living a healthy and normal lifestyle. For this reason, it is her goal to help all her patients who are looking toward the surgery to gain clearance from the psychological evaluation and follow through this life changing event with the best possible results. The number one reason that Dr. Cherwony conducts a thorough evaluation is to help prepare her patients for long term success. I want to see you lose the weight but more importantly, I want to see you keep it off for good. Following the evaluation, she will discuss the steps that you can take to greatly increase the odds that you will be successful long-term. Just thinking that you will be successful is not enough. Psychological support helps you to keep it off for good.

Individual therapy is recommended for bariatric patients. Many psychological issues specific to bariatric surgery surface in the months and years following the surgery. Dr. Cherwony has the expertise necessary to identify and address the psychological issues that manifest as related to bariatric surgery. Dr. Cherwony works with her South Florida clients to help them set their lives up in such a way to be successful no matter what. Her basic philosophy is that when you start to take care of your own needs first, everything else falls into place. She has witnessed this become a reality for all of her patients who are willing to take the necessary steps to take care of themselves.

Dr. Cherwony works hand in hand with her bariatric patients, from the preoperative preparation through the surgery itself and for many years preoperatively. Dr. Cherwony’s services include the pre-operative bariatric evaluation, pre-and post-operative individual counseling, support groups, and consultation. She has been a leading expert in this field. She has seen thousands of bariatric patients over the years for both evaluations and therapy. She has also presented at bariatric conferences and has trained other psychologists and members of the multidisciplinary team on understanding the specific needs and how to help these patients. Dr. Cherwony helped develop the psychological component of the aftercare program for US Bariatric in Ft. Lauderdale. She continues to run their support group and provides patient consultation for them.

ANXIETY & STRESS MANAGEMENT

We all know what it is like to feel anxious. Natural anxiety reactions to stressful situations include: Those butterflies in your stomach before an interview, test or a date. Your heart pounding when you hear bad news or before speaking before a group of people. Sharing concerns or asserting yourself at work and with friends can cause you to feel worry, fidgety or sweaty. In addition, when people feel “stressed out” they typically report difficulty concentrating and report a mind block. Behavioral signs of stress and anxiety are teeth clenching, nail biting, pacing, and heavy breathing.

It is normal to feel these reactions when dealing with challenging, stressful or new situations such as death of a loved one, being sick, being a caregiver, divorce, job loss or new job, relationships and others. Anxiety is your body’s way of speaking to you. Your body is telling you that something is either not right or needs attention. If you listen to your body, the anxiety can be positive. For example, anxiety before taking an exam is a signal to your mind that you need to study. Anxiety can help motivate you to get done what is needed. So a moderate amount of anxiety can help you to stay alert, focused, motivated and on task.

When you feel anxious or scared, your body automatically shifts into survival mode. Stress is an unpleasant state of emotional and physiological arousal that people experience in situations that they perceive as dangerous or threatening to their well-being. Hormones are released and your body is at a heightened state of alarm. Anxiety becomes problematic when a person is constantly in this heightened state. For those who constantly feel overwhelmed by the worry, fear or anxiety to the point that the worry interferes with their daily functioning, relationships and sleep, then anxiety is no longer adaptive. Rather than being productive, the anxiety is harmful and seeps into the area of an anxiety disorder. The characteristic symptom of an anxiety disorder is a chronic or persistent fear or worry in situations where most other people would not feel the same way.

Are you constantly worried, on edge and feel tension? Does your anxiety prevent you from being productive or attending school, work or family responsibilities? Do you avoid activities, people or places because you are worried? Do you behave in a certain manner because you fear that if you don’t, something bad will happen? Do you experience sudden bursts of heart palpitations and panic?

Symptoms of Anxiety Disorders can be physical, emotional and/or mental. Anxiety disorder is a general term for many different anxiety conditions and therefore symptoms vary from person to person. The good news is that there is help available. Anxiety treatment can help you to take back control of your life so that you can feel empowered rather than defeated. Dr. Cherwony can help you reduce your anxiety and learn to live your life in the way you hoped it would be.

How do peace, calm, serenity, balance and happiness sound? If your methods of coping with stress are unhealthy meaning that they do not contribute to your greater emotional and physical health, it is time to find healthier ways. Dr. Cherwony works with patients to help them learn to establish balance in their lives thereby eliminating stress. She will also teach you healthier ways to manage stress, your emotions and the world around you. Some people do not realize that there are healthier alternatives to smoking, alcohol, over or under eating, pills and drug use, oversleeping, and withdrawal. Some may also think that it is okay to distract oneself by over scheduling activities for each moment of the day.

Bills may still come in and family members may continue to be demanding. However, Dr. Cherwony can teach you how best to manage your stress by learning to relax your mind, listen to your body and nurture your soul. In doing so, you will be taking charge of your thoughts, emotions and schedule, leaving you in control of the way you deal with those challenging, stressful and anxiety producing situations.

Many individuals who struggle with anxiety also struggle with depression. The two conditions often go hand in hand.

Click here to learn more about depression.