Staff Spotlight: Noura Kejbo

Here at the Inner Door Center, our medical assistants are a vital role to our team. They take care of all the patients as well as help run the front office. Having such a busy office, we rely on our medical assistants heavily and we appreciate all of their hard work!

Noura9375Noura Kejbo, one of our hard-working medical assistants, is a dynamic part of our team. In the mix of doing vitals and tests for patients, she checks in clients, calls insurances and assists our Physician Assistant.

Noura came to the United States in 2011 and started her schooling to become a medical assistant at Dorsey School in 2013. She has an interest in helping people and wanted to be in the medical field in some way. After she graduated, she immediately applied for a position at Inner Door Center.

Inner Door Center is so unique in the programs and services we provide Noura wanted to be a part of that. Eating disorders are becoming more prevalent in the community and she wanted to be a part of that treatment process.

“I love working directly with the patients. Getting to know them and helping them through treatment is very rewarding,” Noura stated. “Also doing vitals, drawing blood and doing EKGs is a fun part of my job.”

After a long day at work, Noura goes home and spends time with her husband and two kids. One of her favorite things to do is to spend time with her family.

If you would like to learn more about our staff at the Inner Door Center, please visit our website at For more information on Inner Door Center and our treatment programs, please contact us at 248-336-2868.

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.

Written by Beth Cotter, MPH, RDN – Registered Dietitian at the Inner Door Center in Royal Oak, Michigan

  1. “NEDA TOOLKIT for coaches and trainers” <;
  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.

Written by Abby Kercorian, LMSW

Staff Spotlight: Abby Kercorian, LMSW

Having hesitations and questions about Inner Door Center’s treatment program? No worries, Abby Kercorian, LMSW has got you covered. Abby is our Clinical Intake Coordinator and helps you transition to program seamlessly.

Abby-Kercorian_newAs the main point person for those coming into program, Abby facilitates every aspect of the beginning coordination of your treatment. She’ll help you weigh the pros and cons of treatment and will help with assessments. Entering program isn’t the last time you’ll see her. Abby also helps with discharge planning by making sure all the evaluations are in and making sure your time here was great.

Abby received her undergrad degree in Psychology from Wayne State University and went on to get her Master’s in Social Work from The University of Michigan. She specializes in family systems, parenting strategies, childhood trauma and clinical diagnosis of depression, anxiety, addictions, mood and eating disorders. With years of experience in the field, Abby is a great asset to our team.

“What I love about my job is creating a family community,” Abby explains. “The people I work with are like my family and the patients become part of that family. I feel at home and so do the clients. I love that.”

Abby originally came to Inner Door Center because of that family atmosphere. After she started working here, she realized how much she was growing clinically. With a staff that is clinically broad and the constant opportunities for training, Abby knew the Inner Door Center was a great place to grow professionally.  “I’ve learned more clinically in two and half years here than I have in my whole career,” says Abby.

One of Abby’s favorite things to do is travel. She’s been all over Europe and her favorite destination is Paris. When she’s not traveling across the world, you can find her hanging out with friends and family.

If you would like to learn more about our staff at the Inner Door Center, please visit our website at For more information on Inner Door Center and our treatment programs, please contact us 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, 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.

Written by Jeff White, LLPC

Staff Spotlight: Jessica Sopczynski

Jessica Sopczynski is the first face you’ll see when you walk into Inner Door Center’s lobby. As a Front Office Supervisor, Jessica’s job is not an easy one, but something she loves.Jessica068

Greeting and scheduling patients is just a tiny aspect of her role. She also updates insurance and patient information, answers questions about our programs and therapy, all while she’s overseeing that the office is running smoothly by making sure all communication is open between the office staff and our clinicians.

Jessica graduated from Delta College with an Associate’s Degree in Business Studies with a completed program in Medical Office Professions. With about 11 years of office experience, she is a great addition to our team. Office work has always come naturally to her and she has a strong interest in medicine, so she thought this would be the perfect fit for her.

When asked why she wanted to work at Inner Door Center®, Jessica responded immediately. “I felt like with the experience I have, I thought it would be a great opportunity to work in the community and help those in need.” Her favorite part of her job is greeting clients who come regularly and the positive changes she sees in them.

When she’s not managing the front office, you can find her managing her home. She loves spending time in her garden and working on her home. Her favorite thing to do is care for her houseful of animals. Jessica has three cats, a rabbit and a chinchilla. You can also find her spending time with her husband outdoors playing disc golf or tennis.

If you would like to learn more about our staff at the Inner Door Center, please visit our website at For more information on Inner Door Center and our treatment programs, please contact us 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

Written by Laura Gross, LMSW