On Remembrance Day, while we remember and honour our fallen soldiers and the sacrifices they made on behalf of all of us, it is also important to reflect on the critical impact mental health continues to play on the well-being of our brave and dedicated soldiers.

A Stats Canada report completed in 2013 revealed about 1 in 6 full-time Regular Force members of the Canadian Armed Forces (CAF) reported symptoms of at least one of the following disorders: major depressive episode, panic disorder, post-traumatic stress disorder, generalized anxiety disorder, and alcohol abuse or depression, with depression being the most common disorder with 8.0% of Regular Force members reporting symptoms with a 12-month period.¹

Eating Disorders remain one of the most stigmatized of all mental health issues and nowhere is this more prevalent than in the military. The strict regimen, rigorous physical training and restrictive dieting to maintain a targeted weight all increase the risk of developing an Eating Disorder. The impact of Eating Disorders on men in the military is often overlooked as Eating Disorders are viewed as a “women’s disease”. The shame associated with having an Eating Disorder stands in the way of an individual seeking help.

Additionally, soldiers might be exposed to trauma, separation from family, and stressful living conditions. Combat and threatening situations coupled with the rigidity and imposed controls of military training can foster harmful coping mechanisms resulting in unhealthy eating behaviors.

Eating Disorders affect personnel in all branches of the military. Statistics from the U.S. military starkly illustrate this point.  According to the National Eating Disorders Association, “A survey of 3,000 women in the military found that over 60% of respondents had an Eating Disorder, with 97.5% meeting the criteria in the Marine Corps alone,”. Other studies have shown that approximately 30% of women in the military suffer from an Eating Disorder.²

I recently had the pleasure of speaking with Richard Piekarcyzk-Vacca, a veteran from the CAF who shed light on his experience in the military and the mental health issues he encountered.

Richard was from a military family, joining the military at the age of 18. He was part of the Regular Forces, initially posted to the Canadian Forces Base in Gagetown, to embark on what he believed to be, at the time, a life of service in the CAF.

One day while serving at 4 Engineer Support Regiment, Richard was the victim of a hit-and-run while crossing the street. He sustained a head injury and was in a coma for 10 days, in Thunder Bay.

Due to his injuries, Richard was medically released from the military in 2016 after serving eight years. His interest in physical and psychological health lead him back to school to become a Registered Psychotherapist treating veterans and individuals who suffer from myriad illnesses including PTSD, depression, anxiety and Eating Disorders.

“Eating Disorders may flourish in a military environment for several reasons. In regards specifically to combat arms, from which I came from, objectification and dissatisfaction with the male body image may be most prevalent,” says Richard. “Many men are confronted with the desire for a nearly impossible physique to achieve let alone maintain. Often, demands placed upon soldiers may also make it easier to engage in problematic eating habits, such as restricted eating patterns or other caloric restrictive behaviours, like fasting, despite intense physical exertion. Moreover, we must understand Eating Disorders as a condition that may not necessarily occur in isolation but instead co-occur with another diagnosis, such as PTSD.”

Richard observed that the assistance provided for soldiers self-identifying with mental health issues is more likely to be disrupted when either the soldier or therapist is moved to another base – exacerbating the soldier’s anxiety and stress.

“Notwithstanding gross limitations, both the Canadian Armed Forces and Veterans Affairs Canada have made improvements regarding the biopsychosocial health of serving and released members,” says Richard.  “However, attempts to address stigma continue to require sincere dialogue at all levels of command. Among these, Eating Disorders remain one of the most stigmatized and potentially lethal mental health disorders. If we expect our soldiers to remain subject to unlimited liability, there is a requirement to properly develop appropriate screening and interventions to maintain demands placed upon them during service and support after release.”

Eating Disorders within the military are far more common than we think, yet the lack of understanding and discussion around mental health prevents many individuals from coming forward to seek treatment.  A better understanding of the risk factors associated with Eating Disorder symptoms and diagnoses in the military may help foster appropriate prevention and treatment approaches to decrease additional risk of injury and death in service members.

It is critical that we continue to work to break down the barriers of silence that shroud mental health so that everyone who struggles can seek the help they need to survive. In terms of the role mental health plays in the Canadian military, Canada’s former Minister of National Defence may have said it best:

“Our Canadian Armed Forces personnel and Veterans have put the safety and well-being of others before their own in many circumstances. Sometimes, the stigma associated with mental health is a barrier to seeking help. The Department of National Defence, the CAF, and Veterans Affairs Canada are working hard to break down this barrier by encouraging open and honest discussions around mental illness.”

—Harjit S. Sajjan, Minister of National Defence 2015 – 2021

1 Stats Canada

2 Eating Disorders in the Military, Center for Discovery Blog Post

In recognition of Osteoporosis Awareness Month each November, NIED asked Dr. Debra Katzman, Professor of Pediatrics, Department of Pediatrics, University of Toronto and Senior Associate Scientist at the Research Institute, Hospital for Sick Children, Toronto, to enlighten us on a condition that can directly affect people with anorexia nervosa.

Anorexia nervosa is a life-threatening mental health disorder that has significant physical consequences. Every organ system in the body is affected. In fact, individuals with anorexia nervosa are known to have low bone density.

There are many reasons for low bone mineral density in young people with anorexia nervosa including malnutrition, low body weight, and hormonal deficiencies (i.e., estrogen and testosterone). Low bone mineral density can occur early in the course of the disorder.

Girls and boys normally increase their bone mineral density during adolescence, with approximately 90% of peak mass achieved by 18-20 years of age. Since adolescents with anorexia nervosa do not accrue bone at the same rate as young people without an Eating Disorder, they are at risk for not attaining their peak bone mass which could result in osteoporosis and fractures.

Importantly, treatments exist to help those individuals with low bone mineral density. First, it is important to diagnose low bone mineral density early. The best and safest approach to increase bone accrual and improve bone density is to regain healthy weight. This can be challenging. This healthy weight may need to be continuously readjusted in adolescents who are growing and developing.  For young adults, it is important to maintain a healthy weight. There is evidence that suggests that bone mineral density improves as weight increases, even before return of menstrual periods. Further, weight restoration should be achieved with a balanced diet rich in calcium and vitamin D intake. Sometimes young people may need calcium and vitamin D supplements. Further, avoiding smoking and alcohol can help maintain healthy bones.

If you have an Eating Disorder, your physician is the best person to diagnose and manage low bone density. Individuals with Eating Disorders should talk with their physician about having bone mineral density (BMD) test that measure their bone density. The most common test is called dual energy x-ray absorptiometry (DEXA). A DEXA is an excellent test at detecting bone loss. Finally, depending on your individual situation (i.e., age, sex at birth), your doctor may have other suggestions to help prevent bone loss.

For those of you who did not know, September is suicide prevention month. An entire month dedicated to talking about this important issue, raising awareness, and fostering hope in individuals who may not know where to turn.

Suicide impacts people of all ages and backgrounds. In Canada, an average of over 10 people die by suicide per day. For each person who dies by suicide, there are many more who contemplate it or attempt it.

Eating Disorders have an extremely negative impact on the mind and body, so it is no shock that people with Eating Disorders may consider taking their own lives. Studies show that 20% of people with anorexia have attempted suicide. 60% of people who purge engage in suicidal thoughts and behaviour.

The purpose of this blog is to show people that there IS hope. Help is available. There are people who care, even though it may not seem like it. The information below was compiled from anonymous individuals who have experienced suicidal thoughts while suffering from an Eating Disorder. These tips and tricks have helped them overcome their suicidal thoughts and urges, and it is our hope that they can help someone else too.

Protective Factors:

If I don’t take action immediately when I feel down, I know that my thoughts can travel in a downward spiral. Here are some protective factors that have helped me:

• Getting out of the space I am in, perhaps going for a walk outside
• Calling a friend or someone you are close to
• Thinking about what would be left behind if you acted on the urge
• Texting or calling a helpline

Coping Mechanisms:

• Creating a distraction plan. This can be in the form of a list, and the items on the list can be as simple as making a cup of tea, watching a movie, or partaking in a hobby that you enjoy, such as playing computer games or a musical instrument. We find that making a small list of some distractions is convenient to have on hand for those distressing moments.
• Talking it out. Similar to what was suggested above, it helps to talk through our feelings. This can look like talking to a friend, a parent, a therapist, or even talking to yourself (as silly as this may seem, it has helped us to speak out our thoughts and feelings!)
• Journaling. When we find it difficult to explain our feelings, we like to journal, and keep the expectation low. It doesn’t have to be perfectly neat or grammatically correct.
• Delay it. It helps us to think of distressing feelings as a train, or a big wave. It passes by, and it stops eventually.
• Find things you can relate to. Sometimes social media can be triggering, see post https://nied.ca/social-media-and-eating-disorders/ but sometimes it can be useful to scroll through some positive Instagram accounts, or to pin some positive or relatable quotes on Pinterest. (In the past we have liked to share relatable posts on Tumblr).
• Crying it out. Don’t be ashamed. We all do it! It’s normal and healthy.

It is tragic that so many people die from suicide, and so many of those deaths by suicide coexist with an ED, that is challenging on its own. Everyone deserves to be happy and to live a fulfilling life, especially those of us incredibly strong individuals who battle with mental health issues every day. Remember that there is always going to be at least one person who cares about you, wants to help you, and would hate to see you suffer. As cliché as this may sound, you are truly not alone. Help is always available; don’t ever hesitate to reach out. Your mental health is a priority.

Canada Suicide Prevention Service

Hours: 24/7/365. Languages: English, French

Learn more

833-456-4566

The new Canada Suicide Prevention Service (CSPS) by Crisis Services Canada, enables callers anywhere in Canada to access crisis support by phone, in French or English: toll-free 1-833-456-4566 Available 24/7

• KidsHelpPhone Ages 25 Years and Under in Canada: 1-800-668-6868
• First Nations and Inuit Hope for Wellness 24/7 Help Line: 1-855-242-3310
• Canadian Indian Residential Schools Crisis Line 1-866-925-4419
• Trans LifeLine – All Ages: 1-877-330-6366
• Alberta Crisis Line – All Ages: 403-266-4357
• British Columbia Crisis Line – All Ages: 1-800-SUICIDE
• Manitoba Crisis Line – All Ages: 1-877-435-7170
• New Brunswick Crisis Line – All Ages: 1-800-667-5005
• Newfoundland and Labrador Line All Ages: 1-888-737-4668
• NWT All Ages 24/7: 1-800-661-0844
• Nova Scotia Crisis Line – All Ages: 1-888-429-8167
• Nunavut Line – All Ages 7 pm-11 pm (EST): 1-800-265-3333
• Ontario Crisis Line – All Ages: 1-866-531-2600
• Ontario College and University Students: 1-866-925-5454
• Crisis Response Ontario – Kenora, Dryden, Fort Frances, Rainy River and everywhere in between: 1-866-888-8988
• Prince Edward Island Crisis Line – All Ages: 1-800-218-2885
• Quebec National Crisis Line – All Ages: 1-866-277-3553
• Saskatchewan Crisis Line – All Ages: 1-306-525-5333
• Yukon Crisis Line – All Ages 7 pm-12 am (PST): 1-844-533-3030

Here we are over 1.5 years into a pandemic that has completely shifted all of our lives. Many of us have still not completely processed this year  Many of us are still getting up every day and living with this background noise that they cannot quite hear or identify. The weight of the world, the weight of the pandemic, the weight of the unknown trajectory of moving forward.

Many people who have followed my work know that a driving force behind what I do and why I started in this field is the desire to bridge the gap in services for people who are touched by Eating Disorders and other related Mental Health concerns. There was a brief sweet spot in my career where I felt empowered, felt hopeful and felt we could do this. Hopeful we could meet the needs and give people the care they needed and deserved.  We were advocating like crazy (my time with NIED) we had resource centres seeing people in person and we were working together with hospital-based programs. It felt good. This unfortunately didn’t last too long as the demand for services kept usurping our ability to make change and keep up to the demand so here we are.

I didn’t think it could get worse.

Anyone who follows NIED’s work will know the devastating state of available care for Eating Disorders. Anyone can read this and think, wow that must be difficult. Similarly, to hearing the headlines in the news saying “this is not just about COVID patients, if we don’t take care of this virus ALL healthcare services will suffer” unless you have been diagnosed with an illness that has had to have treatments postponed during this year – it’s ALL JUST WORDS.

When I get a call from a family who has just faced a diagnosis of an Eating Disorder my stomach drops as I know that that person has likely been suffering for years by the time they are reaching out to me. The pain that person is feeling is so deep. The next step for me is to ask for permission to be honest. This is where the painful part comes in. This is the part where the hopeful tone in their voice shifts as I start to explain a tenth of what they are up against. This is the part where I have to prepare the person with a script of what to say when they are looking for help, how to approach a family doctor and how to advocate for themselves when they are already struggling to stay above water, and lastly to let them know that there is very little help out there (especially accessible help).

I didn’t think it could get worse.

There is nowhere to refer right now. I am a Hamilton based practitioner and myself and everyone at Carly Crawford Psychotherapy (CCP) work hard to provide the care that is needed but we have little to no help. The level of care needed to properly treat an Eating Disorder is just not available – it doesn’t exist right now.  It requires a multidisciplinary team and constant monitoring. Eating Disorder programs that are funded by OHIP are all online (please tell me how this works?) I appreciate that it is better than nothing, but we are talking about a mental illness that has the highest mortality rate! Can you please tell me why there’s not funding to make this a priority? Right, we cannot do that.

I didn’t think it could get worse.

So here we are, and it’s worse. We are without care. We are tired and we are dealing with higher (soaring rates) of Eating Disorders. We are here fighting and screaming and no one is listening. I agreed to write this blog post and I said to myself – Carly you have to be positive. Talk about your recovery, how you saw death and are living a full life but no one needs to hear that right now. We need to make the reality known and although I burnt out from fighting for change in ways I used to. I have now devoted my career to working right directly with patients and it still brings me to tears as I type this.

I didn’t think it could get worse.

If you’re a therapist or therapist in training, this message is for you.

I started out working for not for profit and tried to provide barrier free services at Danielle’s Place, then moved to working at making changes on the policy level. I then moved to (and continue to) provide care for those walking into our doors at CCP and I have realized I need to shift to focus on helping other clinicians feel less afraid and more confident working in this field.

We need more clinicians who are ready and willing to treat Eating Disorders. Just like in our society at large, in the private therapy world there are a lot of misconceptions and misunderstandings when it comes to treating this population. With very few therapists to refer to and a high level of burn out in this line of work, we are left with very few of us who are able to provide care to this population. In the past several years, what I have come to realize is that Eating Disorders and related illness are so prevalent that if you are treating mental illness; just like you should be trauma informed, you really and truly need to be Eating Disorder Informed. If, as a society, we could realize that Eating Disorders are primarily diagnosed in people who are not emaciated. That you CANNOT TELL SOMEONE HAS AN EATING DISORDER BY JUST LOOKING AT THEM. That Binge eating and Bulimia are Eating Disorders that require equal attention and treatment as Anorexia (seems ridiculous to even have to type that). Then we may start to see progress we may start to see people getting help at the first signs of struggle, we may start to see less resistance to talk therapy and more resilience in the face of relapse.

I know it’s scary. I know that the pain that we see in people impacted by this illness can sometimes seem overwhelming. But let me tell you, when you sit across from someone in a therapy session and you help them to see that they are not their symptoms, that they are more than this illness and help them to strip away the shield they have created – it may just feel a bit easier to help them.

I didn’t think it could get worse AND we are still here doing what matters.

This pandemic has highlighted the divide that comes when a public health issue comes to the forefront. You have people on either side, people who are very scared and people who are completely avoidant. You have advice and guidance that doesn’t fully make sense and moments of riding the waves blindly.

When it comes to mental health care, much like the pandemic. You may not realize how broken our health care system is unless you have to access it. Until you are in desperate need of support, until you have been made to feel you have to be sicker to warrant more help, until you have been made to feel that there is no reason to be concerned you may be stuck.

The hopeful part is that Body Brave and I launched an Eating Disorder training for professionals and the first workshop sold out in one day. We have another one launching in January that is already half sold out. So, it means that on the ground we have therapists, nutritionists and social workers who want to learn…who want to help you and will look at making things BETTER instead of worse. Eating Disorders cannot afford to wait and we are doing our best to ensure we have better supports available.

I refuse to sit at this desk in another ten years to write another blog post for my friends at NIED starting with “I didn’t think it could get worse”!

A young woman from Virginia has published a book about her Eating Disorder and the role Jewish faith played in recovery.

Lucie Waldman started struggling with her mental health as a young child. At first restricting her intake was purely to respond to the stomach aches she would get when her anxiety was high, but as she entered adolescence and started becoming more aware of body image and nutrition it quickly spiraled out of control. By the time she was 12 or 13 it had become a full-blown Eating Disorder.

Lucie struggled for several years with her Eating Disorder before she got any professional help. She went to treatment for the first time when she was 15 which was the start of many rounds of unsuccessful attempts at recovery. It wasn’t until she was 19 that she finally decided to fully commit to recovery and give it her all. “It took a lot of pushing from my doctor and treatment team to really have me commit to recovery,” she remembers.

Although her recovery has been far from linear, Lucie now considers herself fully recovered. At almost 21, she no longer struggles with Eating Disorder thoughts or urges and is passionate about telling her story so that other people who are struggling know that full recovery is possible. “It just goes to show that you can have had multiple rounds of treatment but it doesn’t make your case hopeless,” she says.

Lucie attributes her recovery to having a good treatment team, but also to staying committed to the process no matter how uncomfortable it felt. It took her a lot of effort not to revert back into old patterns when life got hard, especially with the onset of the COVID-19 pandemic. “It took me so much tenacity and accountability,” she says. “I remember every time I had a slip or a lapse I wrote a journal entry about when I thought it started, what caused it and read it to may parents and my treatment team, which took a lot of vulnerability. I just sort of had to remember that in order to recover I had to do everything differently. Even if I didn’t like it, I had to make myself do it.”

One thing that really helped Lucie along her recovery journey was connecting to her Jewish faith. She says it was hard having an Eating Disorder in her small Jewish community because there is still stigma around mental health. Lucie says the rate of anxiety is high in Jewish communities because of intergenerational trauma so in that way it is hard to feel heard when being anxious is the norm. The Jewish religion is also one that is based largely around food despite the fact that diet culture is rampant in many Jewish communities. “It’s just a lot of mixed messaging,” she says. “I used to think Jewish people didn’t develop Eating Disorders, that it was just me, until I went to treatment. I think out of like 13 people there were four Jewish clients.”

Lucie says when she was deep in her Eating Disorder she used Jewish holidays as a way to restrict. With Yom Kippur being a fasting holiday and Passover having a lot of dietary restrictions she definitely used the opportunity to limit the types and amounts of food she was eating. When she fully committed herself to recovery, she really started to take the true meaning of these holidays to heart and realized that she was using the holiday to fuel her Eating Disorder and that was not what the scripture intended. “I realized that it would actually be more in spirit of Yom Kippur to do my meal plan exactly as it was written,” she says. “The whole idea of fasting is it’s like a sacrifice that you’re making. It’s supposed to be something that’s hard and it’s supposed to be something that is taking away the distractions from other things so that you can focus on the Torah. For me I know fasting would not do that at all.”

Lucie would recommend that anyone struggling with an Eating Disorder over the holidays remember that their health comes first. “If it’s going to make your Eating Disorder stronger, increase your urges to restrict or heighten thoughts it takes away from the traditions themselves because there is a Jewish law that says do not harm and our health does come first,” she says. “So, it’s actually the more Jewish thing to not do it, to not keep to the traditions if it means sacrificing your health.”

Lucie’s book is called The Jots of Becoming: a journey of hope and recovery, and features many of the journal entries she wrote during her recovery journey. She says she was inspired to write a book that would serve as a helpful companion and guide for recovery that didn’t focus specifically on Eating Disorder behaviours that could be triggering for some people. “When I wrote my book I wanted to try to prove that you can tell an effective story without using numbers or explicitly listing any behaviours,” she says.

The Jots of Becoming is now available on Amazon. For more from Lucie you can find her on Instagram under living.as.lucie.

Did you know that art therapy can be an excellent added support for individuals experiencing Eating Disorders?

We interviewed Lori Market, CTP MSW RSW, professional artist and past clinical therapist for BANA (Bulimia Anorexia Nervosa Association), to tell us about art therapy and how it can help those with Eating Disorders.

A little bit about Lori:

Lori has been a practicing artist for the past 28 years. Later on in her life, she became a social worker and trauma practitioner. This allowed her to combine her love of both art and social work. Lori is also a trauma survivor and uses her art as a way of healing her own trauma.

When she was in a good place with her trauma, Lori realized that a lot of people who were struggling wanted to give back. This is why Lori decided to pursue social work. In Lori’s unique practice, she takes the creative part of the brain and combines it with her social work and trauma practitioner certification to help people express themselves therapeutically through using art.

Questions and Answers:

1. How does art help with healing trauma?

Art therapy combines art and therapeutic ideas. Different from an art class, it improves anger management, stress management, impulse control, and is relaxing for the brain. Art can be seen as a container that holds the therapy inside of it. It is about taking all the pain inside and putting it on a surface. In this way, it helps people visualize and see their pain in a different way. It allows people to separate their difficult emotions and life circumstances from themselves.

2. How can art therapy benefit people with Eating Disorders?

Art therapy can greatly benefit people with Eating Disorders in a number of ways:

• By externalizing and objectifying difficult feelings, art can act as a map for when people feel lost. Art acts as a positive container that holds activities that you love, by putting your emotions on a piece of paper instead of elsewhere. For example, at BANA, many of Lori’s clients struggled with anxiety. She would tell her clients to draw their anxiety, and then draw what helps their anxiety.
• Art is an active mind-body process that can serve as a distraction from an Eating Disorder. While doing art, you are moving your hands and different parts of your body to create.
• There is much research out there on trauma (which can often lead to EDs), showing that art is a helpful support. https://www.arttherapy.org/EatingDisorderToolkit/eatingdisorderstoolkit.pdf

3. What are some benefits of art therapy over conventional psychotherapy?

• Psychotherapy requires a person to talk. Art is a different form of narrative and requires no words. It can be useful if you feel uncomfortable, scared or threatened to open up. Art creates a safe place allowing people to share their stories without speaking a word. The art does the talking.
• Art therapy is a form of anti-oppressive therapy. This is because when partaking in art therapy, the therapist and client art doing something together. In conventional psychotherapy, one person sits across from another. Art therapy is a different, less threatening way of communicating.

4. Who would you recommend art therapy to?

Anyone! In addition to the ED population, Lori has done it with every age group (from children to teens to adults), refugees, Indigenous populations, and youth victims of crime. Another advantage of art is that it is holistic. It can be used to express culture, identity, spirituality, political means, and to draw attention to social justice. It can really be used for anything!

5. What would you say to people who are a little hesitant to try out this form of therapy?

“Just try it a couple of times! Try it twice, and if you don’t like it you never have to come back again”!

When this happens, Lori lowers the expectation and helps the client defy perfectionism. For example, she may tell a client to draw with their eyes closed or to just scribble!

Lori never had a single client who did not enjoy art therapy. Every piece turns out well! It doesn’t have to be picture perfect.

Thank you, Lori Market for this very informative interview!

Healing from an Eating Disorder is a very individual process and what might work for some may not be effective for others. While traditional talk therapy and dietitian services are a great place to start, there are many other alternative therapies that can complement and bolster traditional Eating Disorder treatment.

Sierrah Acres is a centre located in Oro-Medonte (just North of Barrie, Ontario) that offers Equine Assisted Personal Development (EAPD) to people with all types of mental health struggles. EAPD is an experiential, therapeutic approach that involves being in the presence of, and working alongside horses to help uncover truths about the self. Sessions provide a safe and calming environment to help address emotional roadblocks, build confidence, self efficacy and learn new life skills.

Owner Cindy Hoyda founded Sierrah Acres eight years ago after experiencing the healing power of horses first-hand. With a life-long love of horses she found that spending time in the barn really helped her when she was supporting her own daughter through an Eating Disorder. “It was then when I would find myself even more so in the barn, spending endless hours and realizing the clarity that I would feel afterward,” she remembers.

As her daughter went through her recovery journey Cindy felt compelled to share the healing power of horses to others who were struggling. “I just felt that this was a great combination to be able to offer the experience of the healing and the goodness that horses have to offer to those who are suffering, whether it be an Eating Disorder, or any other mental health or emotional issue,” she says.

Through both individual and group sessions the EAPD coaches at Sierrah Acres help clients interact with the horses, creating metaphors that can be used to highlight patterns that are present in their lives. Cindy says many people with Eating Disorders may be able to resonate with many of the traits that horses have including hypervigilance, sensitivity and their need to feel comfortable in their bodies. “That can also resonate back to self care and self compassion, how to care for a horse and what they do to protect themselves and what their day looks like,” Cindy says. “They want to be comfortable emotionally and mentally as well.”

According to Cindy one of the most important things that horses can teach those suffering from Eating Disorders or any other mental health issue is how to be in the moment. They live their lives 100% in the present and are extremely intuitive, reacting quickly to changes in their environment. “That means energy as well,” Cindy says. “They can hear a human heartbeat four feet away. With that energy you’re going to be getting that type of feedback and lots of times there’s questions. I think that’s maybe the uncanny way of how they can bring us into the present moment.”

All treatment at Sierrah Acres is tailored to the individual’s needs and last for four, six or eight sessions in tight succession. The goal of EAPD is for the participant to take what they have learned from the horses and apply it in their everyday lives. Cindy also says it is a great way to explore that ambivalence that is often present in people with Eating Disorders. “When it’s that type of true suffering, when one wants to change and there’s the devil on one side and the angel on the other pulling you in two different directions, that constant ambivalence that goes on is really what inspired me to be able to take the goodness of this place–nature in its finest form and horses who are honest and empowering–and combine it with helping people in any way, shape or form with their struggles emotionally.”

Have you ever heard of Equine Assisted Self Development? Is it something you or a loved on might be interested in trying as a tool in recovery?

Over the past year or so, more and more men have been surfacing in the media revealing that they have struggled with an Eating Disorder. Global pop stars like Sam Smith and Ed Sheeran have given interviews outlining their struggles with food and body image. And earlier this year, UK Cricket star Freddie Flintoff even released a full-length documentary about his almost life-long struggle with Bulimia.

Despite this influx of high-profile men admitting to their struggles with food, Eating Disorders are still often seen as a mental illness that only affects women and girls. Social worker and assistant professor at the University of Toronto, Kyle Ganson, has witnessed this firsthand while working in clinical settings in the U.S. and has now dedicated his research to finding out more about what Eating Disorders can look like in the male population. “Most of my research now is focused on things like excessive exercise or performance enhancing substance use, or muscle enhancing behaviours and sort of those more nuanced behaviours that do occur across the sexes and genders, but particularly among the male population,” he says.

Through his research and seven years of clinical experience Kyle believes that there are definitely more men out there that suffer from Eating Disorders than we think. He says this is because many males don’t present with the typical symptoms that are associated with the more well-known Eating Disorders like Anorexia and Bulimia. “Binge Eating Disorder is certainly pretty common among males and I think it’s probably under-reported,” he says. “I would imagine that there’s levels of Anorexia and Bulimia, like a-typical Anorexia maybe, that’s not as commonly reported as we might want to capture accurate prevalence rates.”

Men are definitely not immune to diet culture with many using diets and disordered eating to gain muscle, reduce body fat and achieve that “perfect” physique that they see in the media and online. Because dieting is so common in our society, Kyle says oftentimes healthcare professionals are not asking the right questions and might miss some tell-tale signs that a male is struggling with disordered eating or a full-blown Eating Disorder. “Males are often trying to gain weight so they might be engaging in a weight gain effort, trying to build more muscle or just in general improve athletic performance or physical performance,” he says. “I think those sort of [focuses] can get wrapped up into disordered eating behaviours.”

Not only is our healthcare system not screening men for Eating Disorders effectively, but it can also be very challenging for a male who is struggling to reach out for help. Often times men don’t even realize they have a problem or don’t know how to communicate that they are struggling. “I don’t think that we in general socialize males to talk about things like body image, talk about things like relationship with food, talk about things like feelings, emotions, experiences with all these different things,” Kyle says. “So I think just mental health literacy…If you don’t know you have a problem you can’t ask for help.”

Kyle says the way our treatment programs are structured can also be a barrier for many men with severe Eating Disorders to get help. As a male, it can be intimidating to enter group treatment with a primarily female patient base, and they may not identify with some of the themes and images that are used in traditional therapy. “That disproportionate sort of gender or sex make-up creates more problems and more barriers.”

Kyle is happy to see that more conversations are happening about males with Eating Disorders, but he believes that more can be done to call out diet culture messages that are fed to males in the media and online. Many men get sucked into stories about people like the billionaire CEO if Twitter, Jack Dorsey, eating only one meal a day…or Will Smith posting on Instagram about needing to get back in shape after his pandemic weight gain. Companies like Dove are creating campaigns geared towards women about the realities of re-touching and filters on social media without realizing that many men and boys are most likely doing the same thing. “They’re probably touching up their face, probably making their shoulders broader, making their muscles more defined or something but you don’t have that same sort of dialogue that’s occurring,” Kyle says.

According to Kyle more education is needed within the healthcare system to alert professionals of what symptoms may be indicative of Eating Disorders among men. The conversation around food and body image should also include young males so that they understand what a healthy relationship with food and their body looks like. Awareness is key when it comes to fighting Eating Disorders in general, but particularly for the male population who often get overlooked. “I think if we can normalize the inevitable experience we have with our bodies, if we can help educate males to have more insight into their own internal experience, that would certainly be encouraging and help move us in the right direction.”

Are you a male who has experienced an Eating Disorder? What barriers have you found to receiving treatment or support?

NIED’s annual Honouring the Journey celebration is just around the corner!

This year it will be held virtually on June 2, to coincide with World Eating Disorders Action Day. This is NIED’s 9^th annual Honouring the Journey, which not only recognizes the founding of NIED in 2012, but also pays tribute to those who have lost their lives and provides hope and encouragement to Eating Disorder sufferers, caregivers and healthcare professionals who are all part of the journey to recovery.

The theme for this year’s Honouring the Journey is Voices of Hope, Tribute, Inspiration and Celebration. NIED is very excited to welcome two keynote speakers to this year’s event who have been dedicated to spreading awareness for Eating Disorders for many years. Karen Flello and Kirk Mason are the sister and partner of Michelle Stewart, who lost her battle with Anorexia and Bulimia in 2014. In the final year of her life Michelle wrote a blog where she detailed her lifelong struggle with the illness and her time in palliative care. After she died Kirk and Karen took those blog posts and published a book called Shell:  One Woman’s Final Year After a Lifelong Struggle with Anorexia and Bulimia. “We always knew that one day we would hold a symposium or something to acknowledge and honour Michelle’s voice,” says NIED Founder and President Wendy Preskow. “So that’s why we’ve called it Voices of Hope, Tribute, Inspiration and Celebration.”

The celebration will also include a panel discussion which will be moderated by the Globe and Mail’s health reporter and columnist, André Picard. The panel will include people with varied backgrounds and experiences with Eating Disorders including:

Kirk Mason, who will be speaking from the perspective of a male caregiver;

Zachary Grant, a queer, trans, gender-non binary Sheena’s Place employee where they started the Greater Toronto Area’s first support group for trans, non-binary and gender questioning individuals with Eating Disorders and;

Tierra Hohn, a person of colour, registered yoga teacher and Eating Disorder survivor.

Part of every Honouring the Journey is a candle lighting ceremony to commemorate those who have lost their battle but also recognize all those involved in Eating Disorder treatment, care and recovery. All the panelists will be lighting a candle, relating to their own journey and experience with Eating Disorders. Everyone participating from home will also be encouraged to light a candle or flashlight to pay tribute, inspire or celebrate.

While this virtual celebration will be different from previous in-person events, NIED is hoping that it will draw participants from all over the world wanting to recognize World Eating Disorders Action Day. Wendy says it is important to NIED to hold Honouring the Journey every year because it brings people together and helps acknowledge the wide variety of people who struggle with Eating Disorders and highlight the different ways they have found success. “[We want to] acknowledge and let people be aware that they are cherished and not forgotten and cared about,” she says. “Everybody’s lives matter, and everybody deserves a life.”

This year’s Honouring the Journey will be held on June 2 from 7:00pm-8:30pm. To register visit our homepage or Eventbrite.ca under Honouring the Journey. Registration is free and the first 100 people to sign up will receive a free copy of Michelle Stewart’s book, Shell.

In recent years, there has been increasing acknowledgement on the importance of early intervention for Eating Disorders. This is so important, given that the recognition, diagnosis, and treatment of an Eating Disorder can be a slow, difficult process. And those who receive treatment early can benefit significantly. Programs like FREED (First Episode Rapid Early Intervention for Eating Disorders) through the NHS in England are exciting for me to see.

And they are also painful for me to see.

As someone who received early intervention before crashing into a decade-long acute Eating Disorder, I am aware that an “intervention” in and of itself is not sufficient. And being a person and loving people for whom “early” no longer exists, I am likewise aware how pressingly necessary it is to have more than that.

Prioritizing early intervention presumes that we have ready to go, evidence-based treatments to offer those who need them. This is not the case. There are no strongly evidence-based treatments for Eating Disorders. And the somewhat evidence-supported treatments that do exist are often not offered in Canada or are very inaccessible – Eating Disorders are severely underfunded across Canada. There are significant gaps in training, services, and capacity; with the services that do exist tending to be patchwork, inaccessible, and inadequate. And many who are in need will not be recognized for these treatments. Misunderstandings of Eating Disorders and size stigma, sexism, and racism combine to make it difficult for those other than white, thin, cisgender girls to receive a diagnosis.

Prioritizing early intervention and championing its success can then, I believe, risk misrepresenting the current, dismal realities of Eating Disorders research and care. Of course policymakers, researchers, and practitioners want to centre and champion success. And looking at how young patients who are brought to treatment early respond well will look more promising than looking to adult patients returning again and again. But this is, in some ways false promise. Take anorexia as an example – estimates of relapse rate range from 25%, up to 54% (and these are often using bare minimum criteria like BMI), and many cases of anorexia last decades to lifetimes (1). A survey of caregivers suggested only 21% of people with anorexia make a full recovery (2). Even if early interventions do exist and help some people, we lack enough effective options for the significant number of people for whom they do not work. And with $2.41 in research funding for each person affected by an Eating Disorder in Canada (3), that lack is unlikely to be filled any time soon.

The second concern I have with the prioritization of early intervention is that as early intervention becomes a priority; repeated intervention or late intervention can become de-prioritized or even devalued.

If early intervention is framed as the priority, then it becomes intuitive to conclude that those who did not receive or did not respond to early intervention are not the priority. If early intervention is evidence-based and effective, then patients whose symptoms relapse or persist have now failed their best shot. This is not hyperbole. When I encountered practitioners at 15, I was met with urgent concern, active responses, and promises of full recovery. As I continued to encounter practitioners at 18, 20, or 23 I was met with resigned nodding, requisitions for bloodwork monitoring, and mentions of adult programming miles away if I wanted to try again. As a newly presenting person with an Eating Disorder, practitioners felt equipped with diagnoses, medications, treatments, supports, and promises. As a returning patient, all practitioners had were the same diagnoses (now with qualifiers of disengaged, uncompliant to tack on); but fewer if any treatments, supports, or promises. Meanwhile, funding and research for prevention, early identification, and early intervention continue apace.

Patients do not fail treatments; treatments fail patients. But rather than receiving compassionate, better suited, new care options, returning patients are too often blamed, sidelined, and neglected. When care is offered, it is often the singularly prioritized and championed early intervention type care.

What we have to offer in terms of diagnoses and treatments tends to be the same, regardless of whether someone has a two month-long or two decade-long Eating Disorder.

Two years ago, I was privileged and lucky enough to be provided with care and support outside of the limited, narrow, harmful treatment of the public Eating Disorder care system in Canada. I have not reached full recovery (back to that 21% thing…) but I’m living fully and well in a place beyond intervention or attrition, early or late, evidence-based or ineffective, success or failure. Meanwhile, I continue to see friends and loved ones with Eating Disorders hit up against our limited, inadequate system over and over again.

Early intervention is important. And so are accessible, supportive, tailored, effective “at this moment now, better late than never, from here on out” interventions. Taking Eating Disorders seriously means facing up to the current gaps in knowledge and services and providing enough research dollars, program funding, practitioner education, and treatment options across the spectrums of illness, experience, and identity so that everyone can be adequately cared for.

1 – https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-017-0145-3#Sec7

2 – https://onlinelibrary.wiley.com/doi/10.1002/eat.23200

3 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608830/