Why Habits are Hard to Let Go

Our thoughts become our words

Our words become our actions

Our actions become our habits

Our habits become our character

Our character becomes our destiny

As we grow up, we create routines and habits. They make our life easier – can you imagine having to consciously think about how to brush your teeth every day? Certain things become automatic, whether it’s making our coffee in a sleepy state or eating food in front of our favorite show. These habits normally reserve our brain power for other tasks that are more challenging or allow us to get more done; however, sometimes our habits become detrimental. Sometimes we create habits that can hurt us instead of help us, like the habit of needing a drink after every work shift or denying ourselves food for fear of gaining weight. There are a lot of habits that can be good, but when it comes to changing harmful habits, it often feels next to impossible. Why?


Think of snow on top of a mountain. As the snow melts, it cascades down the mountain toward a river. As the snow melts year after year, that water begins to carve a path in the side of the mountain, making its journey down to the river easier. But what if some of that snow melts and the water slides a different way? Then the water slides away from the river toward homes, causing floods. So how does the water reroute back to the river? Well it has to go against the engraved path and attempt to carve a new path. This is the path of creating a good habit and avoiding a harmful one. It feels so much easier to go back to that old path we carved in the mountain in the short term, but long term it will lead to floods. It’s difficult short term for the water to take the new path, but it will eventually reach the river. The answer? Practice. Practice, practice, practice.

Over time, the mountain will rebuild over the old path, and water will carve a new path. Then the old path feels difficult, and the new one feels a little easier. The old path is never erased – sometimes we will fall back on detrimental habits. But our new path is still present, we can still rely on our new paths even if every so often we slip into that old path. We can help ourselves and others by pursuing that new path, and supporting others on their way. Don’t be afraid – ask people. Often, when we are struggling, we recognize the support that would help us most, so don’t be afraid to ask a loved one or friend, “How can I help you carve your new path?”

Written By: Vivianne Swart, MPH, RYT-500, Dietetic Intern for Inner Door Center

Healing Through Gratitude

“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.” — John F Kennedy

In a recovery environment, gratitude is used as a healing modality in itself.  According to Wikipedia, the definition of gratitude, thankfulness, or appreciation is a positive emotion or attitude in acknowledgment of a benefit that one has received or will receive. Gratitude is an emotion that occurs after people receive help, depending on how they interpret the situation. Specifically, gratitude is experienced if people perceive the help they receive as (a) valuable to them, (b) costly to their benefactor, and (c) given by the benefactor with benevolent intentions (rather than ulterior motives).


Leaders in the healing arena have indicated that people who are more grateful have higher levels of well-being. Grateful people are happier, less depressed, less stressed, and more satisfied with their lives and social relationships.  Grateful people also have higher levels of control of their environments, personal growth, purpose in life, and self-acceptance.

These leaders have also suggested that grateful individuals have more positive ways of coping with the difficulties they experience in life, being more likely to seek support from other people, reinterpret and grow from  experiences, and spend more time planning how to deal with problems.  Grateful people also have less negative coping strategies, being less likely to try and avoid the problem, deny there is a problem, blame themselves, or cope through substance use.  Grateful people sleep better, due to thinking less negative and more positive thoughts just before going to sleep.

So when you find yourself criticizing others or feeling/saying that, “It is never good enough,” look at how your thoughts parallel your relationship with your body, your perfectionism and perhaps your unrealistic expectations of others.  Coming back to a sense of gratitude can help put things in perspective.

“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos into order, confusion into clarity…. It turns problems into gifts, failures into success, the unexpected into perfect timing, and mistakes into important events. Gratitude makes sense of our past, brings peace for today and creates a vision for tomorrow.“– Melodie Beattie

Written by Beverly Price RD, MA, E-RYT 200, CEDS and David Price MA, LPC, CAADC


Nutrition Musings from a Vagabond Dietitian

It felt like a daunting task to tackle a topic that seemed as broad as “nutrition philosophy,” especially speaking as a Registered Dietitian Nutritionist working in eating disorder recovery.  I began reflecting on my own journey in an effort to orient myself in this sea of vast opinions and differing experiences.  I have wandered through and tried a myriad of ideas on healthy eating, wellness, healing, cleansing, and detoxing all in an effort to “feel better.”  There came a point, though, when I was tired of living my life based around what I could, couldn’t, should, and shouldn’t eat for that elusive moment of final absolution from any physical, mental, and emotional ailment I might be trying to solve.

One day, I had an epiphany that all of the stress I might be incurring from trying to maintain whichever diet I was pinning my hope of salvation on and the guilt I experienced when I “transgressed” that said philosophy, was likely worse than any possible threat I might be experiencing from my food choices.


In his book, Nourishing Wisdom, Marc David explores the psychology of eating and notes a similar finding, “Ironically, any benefits of the diet are often outweighed by the tension and anxiety built up in maintaining it.  The guilt experienced when eating forbidden food creates more toxins in the system than the actual food.  Furthermore, the tension caused by resisting forbidden food can be equally toxic.”

We each inherently view life through the lens of our own ideas, experiences, goals, and vulnerabilities.  When we combine this with the constant barrage of various diet trends and fads, nutrition information, and misinformation, and marketed images of what is deemed “beautiful” for the moment, it is easy to see how one can feel like they are lost at sea when approaching their own nutrition philosophy.

Opinions on what “healthy eating” is varies greatly from one person to the next and are undoubtedly influenced by trendy diets and fads, societal body image pressures, and personal desires or even fears.  We strike out on each new diet journey made more buoyant by the promise or hope of health, happiness, love, acceptance, and whatever other word or idea one might attach to those things.

As a Registered Dietitian Nutritionist, most people think I’m supposed to teach them “how to eat healthy;” meaning their perception of what healthy foods are, and only these foods.  I have often been approached in a “won’t you please slap a meal plan on me and fix me” manner by friends, colleagues, and clients alike.  It’s no secret that the foods and beverages we choose to ingest influence us on every level – physical, mental, emotional, and spiritual.  In fact, that is one of the things that drew me to the field of nutrition.  It was the concept that Hippocrates elucidated near 500 B.C., “Let food be your medicine and medicine be your food.”

Food can be wonderfully healing, nourishing, pleasurable, and supportive.  However, there is another aspect to eating that tends to go often unaddressed in this country and especially for those in the grip of an eating disorder, and that is how we relate to our food.  It is the concept that what we bring to the table – physically, mentally, emotionally, and spiritually – matters just as much, if not more than, the foods we choose to eat.

Marc David further expands this concept in Nourishing Wisdom: “Many of us are concerned about health and search for ways to prevent disease through diet and supplements, yet we often overlook the importance of an ingredient consumed at each meal – attitude.  If you eat something ‘bad’ for you with an attitude of guilt and self-punishment, the experience of the food will certainly be unnourishing – any toxins in the meal are made doubly potent simply by adding fear.  Yet the same food eaten with an attitude of celebration may have a very different reaction in the body.  Likewise, the healthiest foods may prove unhealthy if the motivation for eating them is based on a fear of disease rather than a love of life.”

As a Registered Dietitian Nutritionist working in the field of eating disorder recovery, I begin by meeting my clients where they are at.  We start to build a healing plan together by first learning what a meal plan looks like to acclimatize their bodies and minds to regular nourishment.  Next, we start to explore their fears and usual pitfalls and learn how to bravely approach the uncomfortable for the sake of their recovery.  On the journey from an eating disorder to healing we will redefine what healthy is for each client.  Along their journey, we will likely talk about Intuitive Eating, what it means to be an intuitive eater, and how they can move toward being one.

Evelyn Tribole and Elyse Resch, Dietitians and nutrition therapists, wrote a book about Intuitive Eating.  They have been able to define and scientifically support certain traits that characterize people who are able to eat intuitively.  On Tribole’s website it is stated, “Intuitive eating is an approach that teaches you how to create a healthy relationship with your food, mind, and body – where you ultimately become the expert of your own body…It’s also a process of making peace with food.”  When struggling with an eating disorder, you may not have some or even any of these traits or skills, but the good news is that you can gain these skills by practicing them.

Client can begin to work toward being an intuitive eater through these concepts: moving toward unconditional permission to eat – eating whatever your body is desiring with attunement, eating for physical rather than emotional reasons – learning to cope with emotions in ways other than with food or the lack thereof, reliance on internal cues of hunger and satiety – learning to trust themselves, and body-food choice congruence – meaning that the desire for nutritious food is present along with permission to eat the fun stuff.

I have personally found that healthy eating isn’t so much about the should’s or shouldn’t, rather, it is about permission with attunement and mindfulness.  I have also professionally witnessed clients who have bravely dismantled their previous definitions of “healthy” and learned to embrace a more expansive and inclusive definition of what “healthy” means to them.  Though the path isn’t as clear-cut, it certainly brings more freedom from food and weight obsession to the things in life that truly matter to them – they begin to live their lives again and more fully.

If you are struggling with an eating disorder and would like more information on how we can help you, please reach out to Inner Door Center at www.innerdoorcenter.com or by phone (248) 336-2868.  We offer many levels of care as well as some free support groups.  We would love to partner with you on your journey toward healing and freedom.

Written by Erika Schwan, RDN, LMT, RYT-200

Sports & Eating Disorders

Participation in organized sports has many benefits including: accountability, and determination. Improved self-esteem and body image for many is also common.  The environment often fosters a sense of community, and increases communication and teambuilding skills. However, there are many factors of a team sport environment which can contribute to an increased risk for developing an eating disorder. A 2004 study[1] found that eating disorder symptoms are more prevalent in elite athletes than the general population (13.5% compared with 4.6%). Competitive team sports and pressure to perform increases the risk for eating disorders among athletes. This intense drive to achieve paired with a culture that glorifies thinness, puts female athletes in particular at an even greater risk. Though eating disorders are more common in female athletes, males are also susceptible.  Sports which focusing on an athlete’s diet, appearance, size, and weight requirements, such as wrestling, bodybuilding, crew, and running are risk factors for both male and female athletes.


Other risk factors to keep in mind include sports that focus on the individual rather than a team. These include sports like figure skating, diving, gymnastics, and running versus team sports like baseball or soccer. Sports emphasizing appearance or a weight requirement also may contribute to disordered eating beliefs and behaviors including: wrestling, and body building. Low self-esteem, family discord, and pressure to be thin from others in and outside of the sport are just a few of the many warning signs to look out for. Social influences emphasizing a thin ideal, performance anxiety, and negative self-appraisal of athletic achievement are three top risk factors noted by the National Eating Disorder Association, [2] and are thought to predominantly contribute to a female athlete’s vulnerability to developing an eating disorder.

The Female Athlete Triad

When engaged in competitive sports ignoring the needs of our bodies in the service of our sport can have severe consequences. The female athlete triad [3] is a dangerous combination of three conditions including: amenorrhea (loss of one’s menstrual cycle), chronic insufficient fueling one’s body to meet the intense needs of athletic training, and osteoporosis (weakening of the bones due to loss of bone density). The consequences of just one of these factors can be severe ranging from increased irritability and anxiety to stress fractures and “overuse injuries” which interfere with success in your sport as well as your life.

The above mentioned symptoms can be treated by medical professionals. To avoid long standing health issues seek medical attention quickly, even if only one component of the triad is present.  Warning signs or symptoms to look out for include: the presence of a stress fracture, shin splints that do not heal, or decreased interest in your sport due to a preoccupation with food and weight.

How to prevent the triad:

  1. Keep track of your periods by writing the number of days between cycles, discussing them with your physician if there is significant fluctuation.
  2. Eat every three to four hours. Plan ahead to adequately fuel your workouts and help you recover afterwards.
  3. Account for the amount of exercise you get in a day. More food/fuel is needed with increased exercise.

Protective Factors

In addition to warning signs and risk factors, protective factors for athletes are equally important. Having friends, family, and coaches who support and influence healthy attitudes towards shape and size can be very beneficial. Emphasizing factors that contribute to personal success such as motivation and enthusiasm can be much more beneficial than body weight or shape to promote healthy body image and self-esteem. Finally, having access to coaches or trainers who educate and discuss the negative effects of chronic malnutrition on performance reduce the risk of developing an eating disorder or eating disorder symptoms.

Treatment of Athletes With Eating Disorders

When treating competitive athletes with eating disorders it is important to take into account the length and time the eating disorder has been present, one’s physical health at the start of treatment, and what their exercise level will look like after treatment. Collaboration with a medical professional is essential to address the long terms effects of amenorrhea and osteoporosis. Overarching goals include: learning appropriate types of training and implementing healthy and individualized meal plans with a registered dietitian. In therapy continual focus on the function or motivation for excessive exercise and calorie restriction/monitoring is essential. Learning skills to increase psychological flexibility and gaining the tools to challenge long held beliefs and internal rules created around how much to exercise or consume at a time are imperative.

In summary, participation in sports and general exercise has many psychological and physiological benefits including increased energy and self-esteem. Unfortunately, it can also increase one’s risk to develop an eating disorder, particularly when emphasis is placed on an individual’s performance versus that of a team. Healthy social support, medical consultation, and education are preventive/protective factors to counteract much of the negative messaging consumed through the media. Regular consultation is recommended with medical professionals and registered dieticians concerning irregular menstrual cycles, excessive/lingering injuries, and questions surrounding proper nutrition. This is true especially when engaging in competitive sports and activities.

Inner Door Center is a JCAHO accredited eating disorder treatment center that offers multiple levels of care to fit your specific needs. If you, a loved one, or someone you know are suffering from an eating disorder, or any other mental health concern, please contact Inner Door Center at (248) 336-2868.

  1. Sundgot-Borgen, J., & Torstveit, M. K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sports Medicine, 14(1), 25-32.
  2. https://www.nationaleatingdisorders.org/athletes-and-eating-disorders
  3. http://www.olympic.org/hbi

Please call Inner Door Center for any inquiries you may have at (248) 336-2868 or check out our website at www.innerdoorcenter.com.

Managing Your Eating Disorder During The Holidays

We’re well into the holiday season as we’ve already experienced Thanksgiving and move expectantly toward Christmas and the New Year.  This time of year evokes a lot of thoughts and feelings for people – some easier and pleasant and some not so easy and not as pleasant.  For many, the holidays evoke warm thoughts and memories, anticipation of familiar holiday meals, and traditions that give their lives a rhythm and sense of meaning.  While for others, this can be a stressful and anxiety provoking time – whether it’s about the abundance of food, challenging family relationships, or the loss and grief experienced from missing a loved one.  They may struggle to experience a rhythm and sense of meaning in their limages (7)ives in the wake of these stresses and heartaches.  For anyone struggling with an eating disorder, these feelings can be amplified.   Eating disorders are a multi-faceted disease that takes hard work, commitment, and courage to overcome.  If you are struggling with an eating disorder, preparation and planning ahead can be helpful to combat the anxiety and concerns you may have during this holiday season.  Here are some tips that may help to safely guide you through the holidays.

  • If you are currently working with an eating disorder recovery team, be sure to discuss any concerns you are anticipating – problem solving together can help ease some of that tension
  • If you are working with a registered dietitian and following a meal plan, try to stick to it over the holidays – unusual schedules and traveling can interrupt a regular eating pattern that is meant to keep you healthy and on track to recovery
  • If you are traveling any great distance, it is wise to pack snacks that you are familiar and comfortable with for ease of following your meal plan
  • Tell the food police to go away! and allow yourself to enjoy that special food item (or items) that you may not see again for another year – practice giving yourself permission
  • If you have a family member or a friend involved in your recovery already, enlist their support to be a reality check with food portions and to share in eating with you
  • Identify a support person ahead of time – someone you can call or to talk to if you are struggling with your eating disorder, addictive behaviors, negative thoughts, or difficult emotions
  • Take advantage of support groups or join one if you are not currently involved – just knowing you are not alone in your struggle can help ease the burden you bear
  • Make a list of coping skills that you can utilize when faced a difficult thought, emotion, or circumstance – take a break and some time away when you need it, without over-isolating
  • Give yourself the gift of a vacation from the scale – this is often very triggering and fans the flame of eating disorder thoughts instead of being recovery-minded
  • Don’t overload your schedule – set boundaries when you need to and enjoy the things you decide to engage in
  • Take time for self-care – this never gets old and never loses its importance in recovery or life
  • Shift the focus away from food when you can – celebrate and enjoy the relationships that surround you, tell someone how much they mean to you
  • Make time to serve others – whether it’s the homeless, toys for children, or a neighbor in need
  • Have a vision for where you would like your mind and heart to be during this holiday season – take time to recalibrate and attune to your vision whenever needed

For family and friends of those struggling with an eating disorder:

  • Express that you care about your loved one and want to support them
  • Be patient and ask them what they think would be most helpful for them
  • Acknowledge any progress or hard-work you see your loved one doing
  • Avoid making comments on appearance, body image, and size
  • Avoid indulging in conversation about the richness of food and “having to work it off”
  • Help to curb any unhealthy talk that arises in conversation surrounding food and body image
  • Compliment qualities that you appreciate about your loved one – personality, character, etc.
  • Recognize and support when your loved one may need a break for a few moments
  • Remember that they are not their eating disorder – find other ways to engage with your loved one by catching up, playing games, watching a good movie, or enlisting them to help out in some way

Remember to take the holiday season one day at a time and remind yourself that “this too shall pass” when you find yourself experiencing a challenging moment.  Practicing an attitude of gratitude can also be helpful to saturate your mind, body, and spirit in the richness that already surrounds you in your daily life.  “The purpose of life, after all, is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experiences.” –Eleanor Roosevelt.

Inner Door Center is here to support you on your journey to wholeness and offers support groups as well as different levels of care for your individualized needs:

  • Weekly on Tuesdays from 7-8 pm we offer a free and open support group to anyone struggling with an eating disorder – discussions will be recovery focused & led by a licensed therapist.
  • Reconnect with Recovery is a free support group on the 3rd Saturdays of each month from 11 am – 1 pm; connect with those in the recovery community as you are led through an hour of yoga followed by an hour of discussion and support.
  • For a limited time, we are offering a Holiday Partial Hospitalization Program (PHP) for college students who are on winter break. If you are needing extra support while home from college, you can participate in our PHP program for a shorter time period.

Please call Inner Door Center for any inquiries you may have at (248) 336-2868 or check out our website at www.innerdoorcenter.com.  May you each find peace, love, and support throughout your holiday season.

Written by: Erika Schwan RDN, LMT, RYT 200

Eating Disorders and Healthy Sports Nutrition for Adolescents

It is estimated that nearly 38 million children and adolescents in the United States participate in organized sports each year and it is widely recognized that participating in sports can be beneficial for healthy growth and development.1, 2 Sport helps to build self-esteem, improve physical conditioning, allow space to practice unique skill sets, teach the value of teamwork, build healthy bones and muscles, control weight, and potentially improve blood pressure and cholesterol levels. 1, 2 However, for adolescents who struggle with anxiety, depression and perfectionism, the pressure of athletic competition can cause severe mental and physical stress. When paired with the cultural ideals for thinness and achieving an ideal body type, adolescent athletes can be at a higher risk for developing disordered eating.111542033_984826828203847_5447071866058583464_n

In recent years, it has become more known that body image problems and eating disorders are common among young athletes. As discovered in a study of Division 1 NCAA athletes, more than one-third of female athletes reported attitudes and symptoms that placed them at risk for the development of an eating disorder.1 Most times these disordered behaviors and symptoms are related to misinformation, preoccupation or restriction of food in the hopes of improving athletic performance or controlling body type. For this reason, screening, early diagnosis, aggressive management and most importantly prevention of eating disorders in adolescent athletes is very important.2

One group of people that have close contact with adolescent athletes, are their coaches. According to literature by Bonnie Spear, as many as 90% of coaches have no formal training on the nutritional needs of athletes. She writes, “misinformation, as well as heavy marketing by supplement manufacturers often cause coaches and parents to recommend unhealthy and potentially dangerous nutritional practices.”2 Given that the development of disordered eating in adolescents can be influenced by the messaging that they are surrounded by, it is important for the athletes themselves, their coaches and their parents to have basic knowledge of proper needs for active adolescents.

What does proper nutrition look like for an adolescent athlete? Overall, if adolescents are well hydrated and properly fueled, they will be able to get more out of their practice and daily physical activity than if they are not nutritionally prepared. Below are couple of nutrition categories that contribute to the proper fueling of an active adolescent.

Energy – In order to meet the nutritional needs for physical activity, health, growth and development, the diet of a training adolescent should consist of 55% of the total energy coming from carbohydrates, 12-15% from protein and 25-35% coming from fat.2

Carbohydrates – Energy from carbohydrates can be released into exercising muscles up to three times as fast as energy from fat, and therefore carbohydrates are the preferred fuel for working muscles. 2 As we are active, our bodies convert carbohydrates into glucose for immediate usage, yet only a limited amount of carbohydrates can be stored as glycogen in the liver and muscles. When we engage in brief, intense exercise (for example sprinting or jumping in basketball, football or volleyball) our bodies use glycogen (glucose stores) to provide energy.2 Sports that require more endurance, such as long-distance running, use glycogen stores initially and then turn to body fat for energy.2 Eating or drinking carbohydrates immediately following the event, and then at 2-hour intervals afterwards help to replenish the glycogen stores in our muscles.2 On the other hand, our bodies store glycogen up to 48 hours before an event. The main goal of a pre-event meal is to provide the body with foods high in carbohydrates (especially complex carbohydrates), with moderate amounts of protein and fat.2

Protein – Protein is a very important part of an adolescent athlete’s diet. Protein functions to build, maintain and repair muscles, produce hemoglobin, and form antibodies, enzymes and hormones – all of which are things that young athletes need to be healthy. On average, the protein recommendation for adolescents is 0.9g of protein for every 1 kg body weight per day.2 It is important to note that eating significantly more than the recommended amount of protein per day does not improve the bodies’ functions nor work to make the body stronger.2 Rather, excess protein is stored as fat, not muscle.2 For that reason, protein supplements have not been shown to enhance muscle development, strength or endurance.

Fat – Fat is an important fuel for light to moderate intensity exercise and for muscle activity during longer periods of exercise. Severe fat restriction may limit an adolescent’s performance by not allowing the body to retain adequate stores of fat triglycerides for energy.2

Fluids – One of the most important functions of fluids is to cool the body while it is working hard. Working muscles generate heat, which raise the temperature of the entire body. The goal of drinking water before, during and after physical activity is to prevent dehydration. It is recommended that active athletes drink 10-14 ounces of water 1-2 hours before the event, 4-6 ounces of water every 15-20 minutes during activity, and about 10-14 ounces of water after the sport.2

Dietary supplements – Given that there is no scientific data that supports that dietary supplements can improve performance, their use can be dangerous.2 As Spear reports, “supplements can give young athletes a false sense of security and any performance improvement will be credited to the supplement, and not the hard work and practice.”

With this information, coaches, parents and athletes can have a better understanding of what a balanced and healthy diet looks like for active adolescent athletes. It is important to keep in mind that eating a diet to support athletic performance is not about perfection, but rather about understanding what works best for each individual athlete.

  1. “NEDA TOOLKIT for coaches and trainers” <http://www.nationaleatingdisorders.org/sites/default/files/Toolkits/CoachandTrainerToolkit.pdf&gt;
  2. Stang J, Story M. eds. Guidelines for adolescent nutrition services. Minneapolis, MN: Center for Leadership, Education and Training in Maternal and Child Nutrition, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota; Chapter 16: Sports Nutrition, 2005.

Photo: Exposure Skate

Forgiveness: A Necessary Step To Healing

We all have issues from our past that still cause unwanted pain and suffering. These unresolved feelings are often manifested in various ways. Some people become angry, resentful and bitter and others become withdrawn, hopeless and helpless. Ultimately, we end up hurting ourselves by how we cope with these unresolved feelings, such as addiction, turning to or away from food, self-injury or isolating from others. Holding onto past hurts can cause tremendous anxiety and depression that come from feelings of hurt, shame and sometimes self-loathing. In working with individuals that have difficulty letting go, I have found that lack of forgiveness can cause a tremendous barrier to healing and recdownload (1)overy.

Forgiveness can mean different things for many of us. People automatically assume that forgiveness is about another person, that it is necessary so that they, the person that wronged you, can move on, feel better and forget about what happened. For others, forgiveness is about finding compassion for yourself. Most people spend their lives blaming, shaming and bullying themselves for things they have done or did not do in their lives.

So, the difficult question is often “to forgive or not to forgive”? When working with people in therapy, it can be helpful to weigh the pros and cons of this concept. If someone has hurt you, betrayed you, or wronged you in any way that you have found unforgivable, sometimes these questions are important to answer if true healing, and thus recovery, can happen. What do you think the effect of your not forgiving this person, or yourself, is costing you?

As mentioned earlier, holding onto past hurts can cause sadness, excessive ruminating about the past and also extreme anger and bitterness. People who have difficulty getting beyond these barriers to recovery, it is important to explore what forgiveness is and what forgiveness is not. Forgiveness is not forgetting what happened. It is not attempting to undo the past or denying your feelings about what happened, nor is it condoning or excusing what another person did to you. Forgiveness does not let the other person get away with what they’ve done and it doesn’t mean you have to have a relationship with the person that hurt you. Letting go of past hurts does not mean your hurt will automatically go away.

Most importantly, forgiveness is a process that must come authentically when you are ready. Forgiveness promotes well-being, feelings of tranquility and for some, compassion for yourself and others. So how does one do it? How do we find it in our hearts to just let it go? With this comes and understanding of what forgiveness is: it is something that you do for yourself, a choice and a necessary step in the process of healing. Accepting that the past cannot be changed and acknowledging your feelings, while finding self-compassion. Choosing forgiveness requires finding a place for willingness. Willingness is key in making room for forgiveness. Sometimes when we embrace our pain like we would embrace a child, we are able to find true compassion for ourselves and others. Willingness requires acceptance, which can be tremendously difficult. We do not always want to accept what is happened to us in the past because it is so painful. Willingness and acceptance is not always something that our minds control or fully under understands but the tremendous relief that forgiveness provides, can have profound and rippling affects.

Individuals, who have suffered extreme trauma, obviously will have a lot of emotional work to uncover.  It is important to do so with a trained professional when the time is right. Simply saying that forgiveness will end pain and suffering would be minimizing, to say the least. It is important to have support when working through trauma. Through trauma work, individuals are able to find meaning in their story, while also finding forgiveness. When people realize that they are “not their story” and that the past is truly in the past, true compassion and healing can take place.

I have found both personally and professionally, that through compassion and forgiveness that gratitude can be activated. When we are able to find gratitude in the many little things in our lives, it is difficult to continue to hold on to anger and hurt. It is difficult to be angry and grateful simultaneously and it helps to reframe the way we look at things. When experiencing the calmness that comes from forgiveness, you may be able to find peace, joy, new insights, freedom and love. Having support is important when considering forgiveness and exploring the hurts of the past. Inner Door Center has many psychotherapists that are clinically trained in trauma work, substance abuse, depression, anxiety, mood and eating disorders.

So, have you made up your mind? Is forgiving yourself, or someone else, something you might want to do for yourself? If the answer is yes, remember forgiveness is a process and it does not happen overnight.  Above all, forgiveness is a gift you give to yourself, not to someone else. What are you the steps that you need to take in order to forgive?

Inner Door Center is a JCAHO accredited eating disorder treatment center that offers multiple levels of care to fit your specific needs. If you, a loved one, or someone you know are suffering from an eating disorder, or any other mental health concern, please contact Inner Door Center at (248) 336-2868.

Men Have Eating Disorders Too.

While many in the mental health field who work with eating disorders are acutely aware that men do in fact suffer from eating disorders, there remains a high degree of stigma and a lack of awareness surrounding this topic in both the general public and among professionals. This was readily apparent as I began to research this article; a search of a popular research database yielded 1,961 results for “eating disorders” and “men”, while a search of “eating disorders” and “women” came up with nearly 10,000. This trend is unfortunately reflected socially, as many still believe that eating disorders are a gender specific problem. While the lifetime prevalence rates of eating disorders in males and females seems to hover at a 1:10 ratio, there is growing and significant evidence that this skew is a result of clinical under-detection and a lack of accurate self-reporting among men with eating disorders, rather than actual prevalence rates.
Recent studies have shown that the likelihood of a male having eating disorder symptoms is far more common than previously thought, and seem to be increasing (Gadalla, 2009). According to nationaleatingdisorders.org, 4-10% of college aged men showed positive screens for eating disorder symptoms. It has also been demonstrated that male body image concerns have dramatically increased over the past three decades, with 15-43% of men being dissatisfied with their body; this is a highly comparable rate to women. When comparing binge eating disorder specifically, the ratio between men and women who meet those criteria is around 1:2, with some studies showing an equal distribution. Even with growing evidence that men suffer from eating disorders much more commonly than previously thought, there is still a significant lack of awareness societally.
What factors into the perception that eating disorders are a gender specific problem and what are the costs of this? As stated above, the perception that males with eating disorders are rare is partly due to a lack of accurate diagnosis and/or inaccurate reporting from those who are experiencing the behaviors. In order to objectively assess the extent of eating disorder behaviors in an individual, clinicians and treatment centers often utilize one of many assessments for this purpose. Unfortunately, studies have shown that males typically score lower on eating disorder assessments than their female counterparts, even when the actual symptoms and behaviors are highly similar. The authors (Darcy, Doyle, Lock, et al., 2012) suggest that the questions used on these assessments reflect symptoms that are atypical for males. This does not mean, however, that their symptoms are any less severe. This makes it likely that even when men do seek help for their eating disorder behaviors, they may have difficulty getting that help because professionals are viewing their symptoms as not as severe as they actually are. Raevuon, Keski-Rahkonen, and Hoek (2014) confirm that there are sex-specific differences in the presentation of eating disorders that have not adequately been described in our diagnostic and assessment procedures, leading to clinical under diagnosis and a lack of treatment services.

Males are also typically less likely to seek help for any form of mental illness or distress. It has been suggested that this is due to cultural and social factors, including the gender norm that men should “man up” and not talk about their problems. Additionally, there is still a mental health stigma in our society that makes people, regardless of gender, hesitant to seek help. For men with eating disorders, these factors create significant barriers to seeking help. Men with eating disorders often experience a “double stigma”, of not only having a mental illness but having what is considered by many to be a “female only” mental illness. According to Raisanen and Hunt (2014), men who have sought treatment reported that health professionals were slow to recognize their behaviors as symptoms of an eating disorder, and that there was a significant lack of resources for men seeking help. To add to this, many treatment centers that focus on eating disorders do not allow men to participate in their programs (Inner Door Center does in fact treat men in our PHP and outpatient eating disorder programs). Keep in mind that eating disorders have the highest mortality rate of any mental illness, and a lack of treatment for any reason has the possibility of resulting in serious health consequences or death.

Raevuon et al., (2014) have identified important differences in risk factors and in the clinical presentation of men with eating disorders. There are significantly higher rates of eating disorders among the LGBTQ population, as well as among males who have been diagnosed with depression or PTSD. Litwick, Mitchell, and Sloan, et al. (2014) report that 45% of male veterans have experience one or more current symptoms of bulimia nervosa or binge eating disorder. Men with eating disorders can experience bodily concerns related to both weight and muscularity, and it is important to distinguish between them. An intense focus on athletic achievement and excessive exercise is also common. Many men report feeling an intense pressure to look a certain (often unrealistic, unobtainable, and potentially unhealthy) way, largely derived from the impact of mass media.

Inner Door Center is a JCAHO accredited eating disorder treatment center that offers multiple levels of care to fit your specific needs. If you, a loved one, or someone you know are suffering from an eating disorder, or any other mental health concern, please contact Inner Door Center at (248) 336-2868.

When Healthy Eating Becomes Harmful

Orthorexia is a condition in which an individual systematically avoids certain foods in the belief they are harmful. While this might seem like a logical mindset for someone concerned with healthy eating, an individual with Orthorexia has an obsession with eating only healthy foods, which can result in devastating consequences in all aspects of one’s life, including medical, social, and psychological.

There is a pervasive focus in the media on physical appearance and health trends, with a strong value on thinness and the promotion of fad diets. Vegetarian diets have become increasingly popular along with these trends. Because society tends to value healthy eating, it can be difficult to understand how this can become harmful. One study (Bardone-Cone, et al, 2012) found that 61% of those with an Eating Disorder who also identified as vegetarian saw a relationship between their vegetarian diet and Eating Disorder. While many who choose some form of vegetarian diet do so for other reasons, those with an Eating Disorder are more likely to follow a vegetarian diet for the purpose of weight loss. In a 2012 U.S. Gallup Poll, close to 5% of Americans followed a vegetarian diet, compared with 50% of those in treatment for Anorexia Nervosa.1

While a vegetarian diet alone does not cause or define an Eating Disorder, a person with Orthorexia is preoccupied with healthy eating to the extent that it has a negative impact on the person’s ability to function in other areas. What starts as an attempt to eat a healthier diet becomes an unhealthy obsession with what is being eaten and how much. The persons’ identity and self-worth become defined by and dependent on eating habits. Rigidity in food choices, specifically avoiding food items that are considered unhealthy, can become a way to gain a feeling of superiority over others. This obsessive and disordered relationship with food is disguised as a false sense of control over one’s behavior. The obsessive thoughts and rigidity in eating habits take up too much of the person’s time and focus. Straying from restrictive diet rules results in feelings of guilt, anxiety, and negative self-image. Orthorexia will eventually lead to isolation from others, difficulty focusing on other aspects of living, and medical complications as the result of a restriction in variety of foods eaten and inadequate caloric intake.

Unlike Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder, Orthorexia is not a separate Psychiatric Diagnosis classified by the DSM-V. The term was first used by Steven Bratman, MD in 1996, and literally translates to ‘fixation on righteous eating.’ The behaviors associated with Orthorexia can be found in individuals with both Anorexia Nervosa and Bulimia Nervosa diagnoses. Treatment for Orthorexia will include a focus on challenging the underlying beliefs about ‘good’ and ‘bad’ foods, with the ultimate goal of developing a normalized, healthy relationship with all foods as part of a meaningful life.

Orthorexia is often difficult to recognize as a problem, because the behaviors can be justified as part of a ‘healthy’ diet, and correlate with values of thinness and weight loss. However, if you recognize some of these disordered thoughts and behaviors in yourself or someone you know, there is help available.

For more information, call 248-336-2868 or visit our website at www.innerdoorcenter.com

“A Doctor Prescribed It, So It Must Be Safe.”

These words are uttered by our nation’s youth at an alarming rate. After marijuana and alcohol, prescription drugs are the most commonly abused substances by Americans age 14 and older. Teens most commonly abuse pain relievers such as OxyCotin, Vicodin, simulants such as Ritlan or Adderall, and sedatives and tranquilizers such as Valium or Xanax. Prescription drug abuse is when someone takes a medication for someone else, or takes their own prescription medication in a way not intended by a doctor, or for a different reason such as getting “high” or “numbing out,” or to help improved focus on schoolwork. It has become a growing issues as the dangers associated with abusing prescription medications, particularly pain medication are severe. When prescription drugs are taken as directed from a physician, they are usually safe. It requires a health care professional, such as a doctor or psychiatrist, to determine if the benefits of the medication outweigh any risk of side effects. However, when taken in different amount or abused, and for purposes other than prescribed, the medication affects the brain and body in ways similar to illicit drugs.

Prescription drugs can be habit forming and addictive and put a person at risk for harmful health issues, such as overdose, especially when taken with other drugs or mixed with alcohol. Mixing different kinds of prescription drugs can be particularly dangerous, for example benzodiazepines interact with opioids and dramatically increase the risk of overdose. More than half the deaths in the United States each year are caused by prescription drug abuse. In the last decade, the number of deaths from abused prescription drugs has amplified. Prescription drugs are easier to obtain that street drugs, and most youth get prescriptions drugs they abuse from friends or relatives.

Prescription drugs are usually common medications family members or friends may be prescribed to deal with a variety of mental or physical health symptoms. Due to the commonality, availability, and thought that prescription drugs come from a doctor, youth have a mistaken belief that prescription drugs are safer than street drugs because they “know where they’re coming from.”images (3)

One way to take action and protect your children and their friends is to secure your medications in a locked cabinet or lock-box. Keeping track of how many pills are in each prescription or pack of medication will allow for accountability of what should remain in the bottle. Also, keeping tabs on how many refills on each medication are left, including your youth’s medications, will ensure for proper distribution of medications. Discussion with family, friends and your children about prescription drug safety and abuse can be a powerful tool to keeping everyone safe. Inner Door Center is a Michigan licensed substance abuse treatment center. We are here to help you and/or your loved one who may be struggling with prescription drug abuse. For more information, call 248-336-2868 or visit our website at www.innerdoorcenter.com

To learn more on this topic or to find tips on how to start hard conversations please visit:

Substance Abuse and Mental Health Service Administration (SAMHSA):


National Institute Health on Drug Abuse (NIH)- Treating Prescription drug addiction:


Oakland County Health Division: Teen Prescription Drug Abuse: