Frequently Asked Questions Friday-Pregnancy and Eating Disorders

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Frequently Asked Questions Friday

FAQ

Pregnant-Woman

This week’s question is:

How do I maintain recovery from my eating disorder during pregnancy?

So this is an interesting question, because I think that the answer very much depends on the individual. I have had friends in recovery who have said that being pregnant saved them, that those nine months were the most carefree nine months ever, because the pressure to maintain an idealized body was gone. Others that I have worked with have told me that pregnancy was the time that their eating disorder was the loudest. Others still have confided that pregnancy sparked a relapse.

What is important to note is, if you have a history of an eating disorder, it’s likely tricky to predict how you will react to all of the physical, psychological, and emotional changes that pregnancy brings. This is why I think this question is good for EVERYONE to consider-not just for those who are currently in recovery and pregnant, but for anyone who ever might become pregnant one day.

Because pregnancy is so personal and individualized, I felt that this question deserved a more well-rounded answer than my sole clinical opinion-so I called in the troops! Two brave, smart, warriors who have experienced pregnancy during recovery agreed to share their feelings, tips, and tricks about this very topic with you all!

 

Veronica:  When we found out we were having a baby we were so excited, but in the back of my mind I was afraid of how I would do with gaining all of the weight that comes along with the blessing. I was afraid that it would trigger old habits and behaviors with the new changes that were about to begin. Throughout the 9 months as my belly grew, I just kept reminding myself of the little miracle that was growing inside of me and how he was depending on me to take care of myself in order to thrive. I was actually a little surprised with how much I loved being pregnant. I loved that I was eating not only for me, but for my baby. For once in my life I didn’t worry about the weight I was gaining, but instead embraced it. Embraced the life that my body was able to nourish. How amazing is that…my body was able to nourish and grow another human being! So wonderful!

I think the hardest part for me was after my son Lane was born. My body had changed, but now I had a tiny human to take care of other than myself. I was nursing so I was starving all the time (even in the middle of the night). So although my body had changed, and I weighed more than I did pre-pregnancy, I knew I needed to eat in order to produce enough milk to feed him. Things were different. It was far more important for me to eat to fuel my body and his than for me to fit back in my clothes. I also knew that once he was older he was going to watch me. I knew that from this day forward I was not just taking care of me; I was taking care of him and setting a good example. That meant having a good relationship with food and exercise.

I am now 24 weeks pregnant with our second son (!) I continue to remind myself not to worry about the changes in my body. It continues to be a daily challenge, but I am using the same coping tools and support systems as I did during my first pregnancy to work through it. I went to the doctor today for my standard check-up and was dreading getting on the scale. I wasn’t going to look-but then I reminded myself that I am more than a number. My weight and body shape does not make or break the woman I have become. Our bodies are amazing, God designed them to grow another human being, and that is a true gift.

Jen: It was surprising to me how quickly my eating disorder voice came back as soon as I found out I was pregnant; I had been in recovery for a solid eight years by the time we got the news. Some of the voice’s content was the same, especially surrounding numbers and perfection. I was quickly obsessed with being a “perfect pregnant woman.” I wanted to gain the perfect amount of weight, no more no less. I wanted to eat only the most “perfect” foods. I was gripped by the thoughts of being a perfect mother and took on so much of the responsibility. Often my thoughts went something like this, “If I do X, then Y would happen to my baby, and I am a terrible mother.”

My first piece of advice and truly the most important is to rally your troops. Tell your support system about the thoughts you are having or that you are concerned you will start having the thoughts. Make a plan before you are “in it.” Second, become informed and educated about your pregnancy. Doctors are good sources, google is not. It is easy to get swept up into new mother forums because it can give us instant gratification (instant gratification is totally not something people with eating disorders like or anything…sigh), but it can almost always give us something else to worry about. Lastly, actively practice awareness, mindfulness, and gratitude. My favorite moments in pregnancy took place in my bathtub. I would be fully immersed in my connection with my daughter. I would be gratefully thinking about the incredible things my body was doing in its efforts to grow a baby. I would accept my anxious thoughts if that came to me but kindly bring my mind back to my baby. Towards the end, this would usually result in sweet reminder from my girl giving me a kick or a roll, as if to say, “I love you.” I was unbelievably grateful that I could be so terrible to my body for so much of my life and it was still willing to give me my most precious gift. You are a goddess, Mama, let your body do what it was made to do.

 

As you can see, Jen and Veronica struggled and triumphed in unique and separate ways with their recovery journeys during pregnancy. Veronica talked about the body negativity that plagued her throughout both of her pregnancies- specifically when it came to gaining the necessary weight. This aspect of pregnancy can actually be upsetting to both recovered and non-eating disordered individuals alike; especially if low body image and self-esteem were a struggle prior to pregnancy (which research tells us is the case for the majority of women).

As Veronica mentioned, it is important to use continuous self-talk when these thoughts pop up. Remind yourself of the miracle that your body is making (despite, as Jen stated, how much you may have put your body through in the past!) Remind yourself of how much this miracle needs the energy from the food that you are providing him/her. Perhaps you may even take on a mantra at this time-something simple like, “Nourish to (help my baby) flourish!”

And of course, if weight gain feels overwhelming to you during your pregnancy, ensure that you have professional support, as well as moral support systems in place to lean into and discuss these concerns.

Contrastingly, Jen struggled with the idea of being the “perfect mom,” and having the “perfect pregnancy.” She referenced how this was most definitely her ED voice, albeit cleverly disguised as thoughts of wanting to be the best for her child. That is the thing about eating disorders. They are wily. And they might not present themselves in a completely overt manner. This is why it is so important, specifically during pregnancy, but also during every other phase of life, to be very mindful and aware of how ED speaks to you. When do these thoughts get loud? How have they tricked you in the past? The more aware you are, the more pitfalls you can pinpoint and avoid-like a true warrior. For example, if you, like Jen, are drawn to instant gratification, but also suffer from anxiety, be sure to avoid things like the mom forums that she mentioned. If you tend to be a perfectionist, and you know that this has triggered your ED in the past, identify one or two point people that you can talk to about this during your pregnancy. People that know this tendency in you, and that you can trust to be honest and empathic. (“Listen I’m feeling a lot of pressure to use only cloth diapers and make all my food for my baby by hand when she is born…Is that doable or is my perfectionism getting on top of me again?”).

Summarily- I don’t know that I can put it better than Jen- “Rally your troops.” Make sure you have a solid professional and personal support system in place for this journey. And, as Veronica mentioned, use your coping tools! Whether that means mantras, daily reminders, journaling, self-talk, mindfulness, gratitude-doesn’t matter which one it is, as long as it clicks in and works for YOU. Because along the way during those nine months, there are a plethora of other triggering situations not addressed here that can arise-feeling sick, feeling very full, comments from others- “You have GOT to be having twins!” “You are getting so big!”-But as long as your have your professional support systems, personal support systems, and coping toolbox, you will likely be able to handle these as they come. Sure, they may not be the most enjoyable situations to endure (seriously, why do we feel it is our right to tell pregnant women how big we perceive their bellies to be-or TOUCH them at that?!) but with the awareness and tools, you will be able to b r e a t h e and utilize healthy coping mechanisms instead of resorting to eating disordered behaviors during these times. Shine on recovery mamas.

 

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Jen Misunas Buckwash is a happy, healthy new mom to a 5 and a half month super girl. She is a practicing professional counselor in PA and will complete her doctoral degree in Psychology in May. She has been in recovery since 2008.

 

 

 

 

 

 

 

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Veronica Carr Yerger is stay at home Mom and online fitness entrepreneur from Dillsburg, Pennsylvania where she lives with her husband Mark, little boy Lane and another boy on the way in March 2017. She shares her 20+ years of experience in coaching, mentoring, and fitness with her clients on a daily basis emphasizing a strong balance of positive body image, family, life, and faith. veronicayerger@gmail.com, FB@verionicahealth, IG @veronicahealth

 

 

 

 

 

 

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Colleen Reichmann is a licensed clinical psychologist, specializing in the treatment of individuals with eating disorders, body image issues, self-esteem issues, and women’s issues. She lives in Virginia Beach with her husband, goldendoodle and (brand new!) sheepadoodle.

Let’s connect!

Email questions to: blog@theprojectheal.org

Instragam @drcolleenreichmann

Facebook Page: Dr. Colleen Reichmann

 

 

 

*The views expressed in this posting are based on this writer’s professional knowledge, training, and experience in accord with current and relevant psychological literature and practice. These views do not indicate that a professional relationship has been established with any recipients. Readers should consult with their primary medical professionals for specific feedback about any and all questions.

FAQ Fridays- Are the Friends I Make in Treatment Good for Me?

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Frequently Asked Questions Friday

FAQ

This weeks question is:

Are my friendships with the people I met in treatment good for me?

 

This is a tough one. I personally do not believe that there is one right answer to this question. I think that it depends on 1. The nature of your friendships, 2. Where you are in your own recovery, 3. Where the other individuals are in their recoveries, and 4. Your personality and friendship dynamics. Did you expect me, the psychologist, to say, “No. These friendships are not good for you. End of story”? Well I cannot, in good faith, say that. And perhaps I diverge from many of my colleagues in my belief on this matter, but I do not consider this to be a black and white issue. I think that there are several themes that apply to friendships formed in treatment, so I will attempt to give this complicated question the multifaceted answer that it deserves:

 

It’s no secret that eating disorders are competitive illnesses. In fact, for a great deal of sufferers, treatment can be made more tricky because the eating disorder becomes triggered to be the “best” when surrounded by others who are also ill. This is why a number of treatment centers have policies ruling against socialization after discharge. However, having an eating disorder can also be incredibly isolating. It can be a welcome change to have a friend who just gets it.

 

But when you both have an eating disorder, and you are both trying to recover, things can easily get dicey. Eating disorders are tricky illnesses. You can want recovery in your heart of hearts, and still feel a twinge of jealousy when you see someone else acting on behaviors. You can be working towards weight restoration with all of your might and still find yourself perusing how to cut calories. It’s difficult enough to manage your own symptoms and tease out if the eating disorder is in control at the moment. Now throw another person in exactly the same boat into the mix. You both want recovery. You both understand the torturous nature of this confusing illness. And you are both dealing with working through the ED thoughts and stopping the behaviors. On one hand, it’s beautiful to feel that type of camaraderie. (In a world where most seem to be shouting “Just eat!” what a breathe of fresh air to sit across from someone shaking just as much when they pick up the sandwich.) On the other hand, you are now vulnerable to a particularly strong type of trigger- the relapse of a friend.

 

Anybody who has been through this can tell you- it’s incredibly difficult to watch a friend go through a relapse. It’s easy for the eating disorder to sneak in during this time and set off those competitive feelings. It’s equally as easy to take it personally. (i.e. How could she do this when we are in this together? Doesn’t she know what this does to me?) Additionally, there is the danger of feeling the responsibility to save her. You might feel the pull to begin to pour all of your time and energy into helping her. The danger here? You begin to neglect your own recovery, and, again, the door is left ajar for the eating disorder to flare up.

 

So what is the solution? Should you, as those aforementioned treatment centers suggest, cut off all relationships with fellow patients after being discharged? Or should you throw caution to the wind and venture on towards the sister/brotherhood of recovery warriors? The truth is, only you can answer what is the right solution for you. I know some people who have felt that they need to keep themselves at arm’s length from fellow patients. These individuals have shared that they sought an identity outside of the eating disorder, and noted that they wanted to surround themselves with the healthiest people possible. One friend told me that she felt it necessary to immerse herself in “normal eater world,” so that she could attempt to emulate her friends who have had historically healthy relationships with food and weight. Another individual told me that she was tired of conversations surrounding triggers and fear foods, and indicated that she felt the need to cut off these relationships if she truly wanted to recover for good. I have also heard the opposite-people who feel that their relationships with their fellow warriors were vital to recovery. Some will hold that the bonds that are created when people go through treatment together are unlike any other. There is sense to this- there will never be another time when you are more raw and vulnerable, so these relationships do have the potential to be very deep. In fact, our fearless Project HEAL leaders have shared that they met in treatment, and that their relationship was indeed important to their recovery processes.

 

So, as I initially stated, similar to most everything about recovery, the answer to the question of whether or not relationships between two people in recovery are healthy is not black and white. I believe the answer is- there is no absolute answer. Just like any friendship- some may flourish and some may become toxic. Certainly, many may find a sense of acceptance and peace in these relationships. Others may feel that it is best to keep a clear boundary between friends and fellow patients. No matter how you feel, it is important to be honest with yourself and others about what is helpful to you during the recovery process. No two journeys to recovery are identical, which means you must pay close attention to what is helpful to you. Listen to your inner voice when it comes to friendships with fellow recovery warriors. It may be that you need to return to you original circle of friends after treatment, and keep fellow patients at arms length to protect your own recovery. Or perhaps these friendships will be better suited for you later on in recovery-when you are feeling strong and have a deep sense of what triggers you and what helps you to cope. At that point, you may just find that these friendships can truly be like no other-just ask our Project Heal co-founders! Whatever the case, you and your recovery must come first, so pay close attention to your inner wisdom. It’s there, I promise.

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Colleen Reichmann is a licensed clinical psychologist, specializing in the treatment of individuals with eating disorders, body image issues, self-esteem issues, and women’s issues. She lives in Virginia Beach with her husband, goldendoodle and sheepadoodle.

Let’s connect!

Email questions to: blog@theprojectheal.org

Instragam @drcolleenreichmann

Facebook Page: Dr. Colleen Reichmann

*The views expressed in this posting are based on this writer’s professional knowledge, training, and experience in accord with current and relevant psychological literature and practice. These views do not indicate that a professional relationship has been established with any recipients. Readers should consult with their primary medical professionals for specific feedback about any and all questions.

Frequently Asked Questions Friday

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Frequently Asked Questions Friday

FAQ

This weeks question is:

How does treatment differ for males?

 

This is a great question, and one that does not receive enough attention or discourse. Males are and have been left out of the eating disorder discussion for far too long. As a society, and sometimes even as health professionals, we tend to hold the mistaken belief that males do not struggle with body image, or that they cannot develop unhealthy relationships with food. This is simply not true. The percentage of males that report struggling with eating disorders has been on the rise for years, but my argument is that our current understanding of percentages and numbers is likely very inaccurate, due to underreporting. There is still that strong societal belief that eating disorders are “female illnesses,” which leads a lot of male sufferers to feel shameful and stay silent about their pain.

 

One important factor to note is that many males develop their eating disorder along their journey to become “fit” versus simply thin. Our society currently holds a different fitness ideal for males than for females. “Fit” for men may imply more of a high muscle-low fat ratio. Currently, the pressure for males to achieve this body-to be “cut”-is astounding. However, this body type is not natural or attainable for the majority of the male population. The term “muscle dysmorphia” has been coined to describe this preoccupation with less fat and greater muscle definition. Hence males can begin to fall prey to the very same behaviors that females do. This shift can be tricky to identify at first, due to the fact that the original intention was not necessarily weight-focused. However, for many of these male eating disordered sufferers, their focus gets lost and the relentless pursuit of thinness takes over. The sport or activity that was once enjoyed then becomes an obsession.

 

Similarly, males tend to struggle more with legal performance-enhancing supplements — things like whey protein, creatine, and L-carnitine. Studies have shown that the use and abuse of such supplements is on the rise, and up to 22% of males stated that they had replaced meals with said supplements in the quest for a lean frame and large muscles. This behavior is dangerous, eating disordered, and rooted in low self-esteem- however it goes largely unnoticed by the majority of our society. In fact, the use and abuse of supplements seems to be considered somewhat normalized behavior at this point. This is quite problematic because these supplements have been linked to the development of eating disorders, and normalizing their abuse contributes to the trend of ignoring male disordered eating behaviors.

 

It is also important to note that, just as the thin ideal does not contribute to all eating disorders among women, current male fitness trends do not factor into all male eating disorders either. Many males report experiencing the very same influences as females- bullying, a drive for perfection, a quest to disappear, a desire for control, a need for numbness, a history of trauma-when conceptualizing their eating disorders in treatment. Therapy and treatment must include room for males to explore this part of their eating disorder, instead of simply focusing on body dissatisfaction with a focus on fitness trends.

 

At the inpatient or outpatient level, male-only groups tend to be helpful. This is because males have concerns regarding social issues, family dynamics, and body image that are vastly different than those of females. Male-only groups are helpful in that they allow males to specifically discuss and lend support around the stigmatization factor to one another. This is not to say that mixed-gender groups cannot be helpful as well. In the end, everyone is suffering with an illness that falls under the same umbrella, so support and camaraderie in general is a healing experience.

 

Research also suggests that a focus on gender dynamics overall in the treatment for males with eating disorders is important. Individual and societal perceptions of masculinity likely affect one’s experience of disordered eating, and must be explored. Masculinity has been correlated with more negative attitudes toward obtaining mental health help, and may contribute to the reason that males make fewer attempts at seeking help. Hence a therapist may identify this as something to explore further.

 

Other parts of treatment are comparable across genders. For example, treatment outcomes are similar. The basic principle of treatment (i.e. weight restoration, disrupting maladaptive behaviors, challenging thoughts related to weight and shape) also remain the same. For a more detailed analysis of this, I would suggest looking into the article “Males and Eating Disorders: Gender-Based Therapy for Eating Disorder Recovery,” found in Professional Psychology: Research and Practice, by Greenburg and Schoen.

 

I believe that if we continue to raise awareness and educate others about the fact that males can and very much do get eating disorders, the intervention and treatment for males will improve drastically. Currently, there are still far fewer treatment center options for males than there are for females. But as awareness continues to spread, more and more centers are beginning to not only accept males, but also provide specific tailored treatment or “male tracks.” This is encouraging progress. There is also NAMAD- The National Association for Males with Eating Disorders, which provides resources, inspiration, support, and articles for males

(http://namedinc.org/)

 

Conclusively, we still have a long way to go in terms of our awareness and inclusion of males in the eating disorder conversation. But the conversation has begun, and this alone is great progress. Lets keep it going!

 

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Colleen Reichmann is a licensed clinical psychologist, specializing in the treatment of individuals with eating disorders, body image issues, self-esteem issues, and women’s issues. She lives in Virginia Beach with her husband, goldendoodle and (brand new!) sheepadoodle.

Let’s connect!

Email questions to: blog@theprojectheal.org

Instragam @drcolleenreichmann

Facebook Page: Dr. Colleen Reichmann

*The views expressed in this posting are based on this writer’s professional knowledge, training, and experience in accord with current and relevant psychological literature and practice. These views do not indicate that a professional relationship has been established with any recipients. Readers should consult with their primary medical professionals for specific feedback about any and all questions.

 

 

Frequently Asked Questions Friday

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Hello! Before I jump into this, let me take an opportunity to introduce myself. My name is Colleen Reichmann. I am a licensed clinical psychologist in Virginia Beach. I am a specialist in the treatment of adolescents and adults with eating disorders (Anorexia, Bulimia, ARFID, Binge Eating Disorder, and OSFED). Before moving to Virginia, I completed my predoctoral internship at The University Medical Center of Princeton at Plainsboro Center for Eating Disorders Care. I then worked as a postdoctoral fellow at The Center for Eating Disorders at Sheppard Pratt. At these centers, I worked across the inpatient, partial hospitalization, and intensive outpatient levels of eating disorders care. I ran groups, provided individual therapy, and conducted psychological assessment. Besides those job duties, I would like to add that I spent a substantial amount of time being inspired by the warriors fighting the good fight on the unit. I am forever grateful for my patients, and for my time spent at these treatment centers.

I am extremely passionate about this subject. Eating disorders are highly misunderstood and complex illnesses, and the stakes are high due to the coinciding medical risks. I believe that we need more players out on the field, raising awareness, advocating, conducting research, etc. Through my time spent doing all of the aforementioned activities, coupled with my own journey and life experiences, I have come to hold a few strong beliefs about the eating disordered (and human) condition:

  1. a) Change and full recovery are possible.
  2. b) There is a warrior that resides within us all.

I’m not here to save people from eating disorders and body image struggles. I couldn’t if I tried. What I am here to do is empower people to save themselves. Empowerment can be accomplished through a variety of avenues. Through this weekly question and answer forum, I hope to offer some knowledge, insight, and maybe even a bit of inspiration!

So, without any further ado, this week’s question is:

“How do we get through the recovery process (when the behaviors are mostly gone but the thoughts are still constant and the fight with ED is still every day)?”

 

Great question! This is so important, because I would argue that this stage of the journey can be even more difficult than when the behaviors were most significant. Hear me out- Your body is physically restored to a safe weight. Or the behaviors that invoked the loudest concern from family and friends are no longer occurring. But your mind is still very much under siege. The eating disorder is still there. The fight is an every day process. But problematically, chances are, you will be receiving less support during this time than when you were at your most severely ill. So while you continue to feel like you are very much in the fight of your life, others around you may begin to assume that you are “good to go,” “healthy,” or, “recovered.”

 

This is where continuing to implement everything that you have learned so far about recovery becomes absolutely crucial. Because it is at this point that the eating disorder might begin to say things like, “better skip breakfast to show them you’re still sick!” Talking back is an absolute must. Because you know, you know, that telling them you are still sick is a more effective long-term solution than showing them with your body or behaviors. So:

  1. Talk back to ED. Continuously Keep journals. Keep writing down the thoughts. Cross them out, then write down your warrior-esque thoughts. Writing them down is important. Don’t just notice the ED thoughts and think the good thoughts-Write them all down.
  2. Continue with treatment. Don’t ditch the treatment team the second you get a handle on the behaviors. If insurance and finances allow-continue on with weekly therapy sessions, continue meeting with your dietician, continue meeting for group therapy. The body heals long before the mind, and therapy is an ongoing process, so stopping when the behaviors stop is like stopping an antibiotic as soon as you start to feel better. (And yes, I realize insurance companies could really smarten up and begin to recognize this fact as well. There is so much to be said on that, it could be a separate blog post entirely.) Keep going!
  3. Surround yourself with positivity. Put positive post-it notes up on your mirror. Follow recovery-oriented instagram accounts. Some of my favorites? @bodiposipanda, @findingbodyfreedom, @recoverywarriors, @effyourbeautystandards, @its_called_recovery, @joannathangiah. Positive vibes are so important right now. Just like diet culture is poisonous, the pro-recovery and bopo community can be a really healing space. Immerse yourself!
  4. Hobbies hobbies hobbies. You must have a hobby. In fact, now might even be the time to try something new. Something to get lost in. It’s time to find something that gives you the feeling of flow-that is, the state of complete immersion in an activity. You see, eating disorders are full time jobs. You can’t expect your brain to quickly snap out of thinking about [food-weight-body] 24-7 just because the behaviors stopped. I kind of see it like this- our brains have two modes- autopilot and emergency break. So when you stop doing something that you used to do on autopilot, you brain pulls the e-brake and says, “HEY! THIS IS WHAT WE DO RIGHT? WE LISTEN TO ED?” Then the ED thoughts get even louder. Hence distraction is key. Fill the time that used to be consumed by the ED with new, cool stuff. Like yarn-bombing. Or upcycling. Or playing the violin. Or podcasting. The possibilities are endless. Again, the body heals long before the mind- your thoughts will take much more training, and hobbies will be your best friend when it comes to that.
  5. A lot of those who have fully recovered from eating disorders say this is one of the main keys that turns, clicks, and takes them from 90% recovered to 100% recovered. Find a purpose- an “other focus.” Find a cause. What social issues are you passionate about? What cause can you take up and begin to become very knowledgeable about? Eating disorders trick us. They make us believe that our worlds are small and that we are powerless. Fight fire with fire- find a cause, open up your world, then begin to make a difference and take your power back!

 

Recovery is a process. That is for sure. The period between cessation of behaviors and full recovery can be brutal, and we likely do not discuss it enough. My final thought? Keep going keep going keep going! Don’t let the difficult valleys stop you short just before the finish line. Just imagine, for a second, what lies beyond. It is possible for you. Yes you! Keep pushing forward, don’t stop, and live the life that you deserve!

 

 

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Colleen Reichmann is a licensed clinical psychologist, specializing in the treatment of individuals with eating disorders, body image issues, self-esteem issues, and women’s issues. She lives in Virginia Beach with her husband, goldendoodle and (brand new!) sheepadoodle.

Let’s connect!

Email questions to: blog@theprojectheal.org

Instragam @drcolleenreichmann

Facebook Page: Dr. Colleen Reichmann

 

*The views expressed in this posting are based on this writer’s professional knowledge, training, and experience in accord with current and relevant psychological literature and practice. These views do not indicate that a professional relationship has been established with any recipients. Readers should consult with their primary medical professionals for specific feedback about any and all questions.