Eating Disorders

Summary

• Obsessed with limiting food and losing weight
• May purge food through diet pills, laxatives, enemas, or forced vomiting
   

Anorexia is a severe eating disorder that affects mostly teen girls and young women. It involves a strict limit of food intake which slowly starves the body. In this way it differs from bulimia and binge-eating disorder (BED). Those illnesses involve extreme over-eating and a normal to high body weight. A person with anorexia will have a low to very low body weight. She will also be in denial about her state. She can be very thin and still believe she is fat. This puts her in great danger.

Signs

Anorexia, also called anorexia nervosa, involves being nervous about food. A person with the illness will try to over control her eating and her weight. He will count calories and eat very precise portions of food. He will be obsessed with losing weight and resort to extreme methods to do so. This often includes doing way too much exercise and dieting. Sometimes the person may take part in binge-eating. He will then purge himself through diet pills, laxatives, enemas, or forced vomiting.

Some of the signs to look for include:

• Being very thin
• Being in denial of one’s state
• Having a distorted body image
• Having an extreme fear of weight gain
• Over exercising
• Eating tiny amounts of food
• Refusing to eat in public
• Binge-eating and purging
• Missing three or more menstrual cycles in a row

Causes

The disease tends to run in families. Having a mother or sister with the illness greatly adds to the chances of developing it. Sometimes it is caused by chemicals or hormones being out of balance.

Culture can also play a large role in developing the illness. Images of women with “perfect” bodies are all over the media. This creates unreal ideals for teens and young women.

Children, older women, and even males can get the disease though it is less common. Models, dancers and certain athletes are at higher risk due to their job demands. Peer pressure, stress, trauma, and a poor self-image can also be triggers.

Risks

The risks of not treating the disorder are many. These include issues that affect both the mind and body.

Some emotional risks are:

• Withdrawal
• Moodiness
• Lack of focus
• Lack of feelings
• Obsession with food and weight control
• Intense fear of weight gain
• Poor self-image
• Thoughts of killing oneself

Some physical risks are:

• Thinning of hair, nails, and bones
• Dried, bruised, or yellow skin
• Growth of fine body hair
• Lowering of blood pressure
• Slowing of heart rate
• Slowed breathing
• Weakened muscles
• Kidney problems
• Dehydration
• Constipation
• Constant cold feeling
• Disruption of menstrual cycles
• Trouble getting pregnant
• Problems with pregnancy

Treatment

People can die from anorexia. Early detection and prompt treatment is vital. Most of the ill effects of the disease can be reversed. The first step is to slowly increase and stabilize the person’s body weight. Talk therapy is the main form of treatment after that. A strong family support system is needed, as well as guidance on healthy eating. Sometimes drug treatment is also used.

Some people with the illness will achieve full recovery. Others may relapse from time to time. With proper treatment and support, most people with the illness can maintain a normal, healthy weight.

Resource

Anorexia Fact Sheet

By Kevin Rizzo

©2015-2019 Carelon Behavioral Health

Source: www.nami.org/Learn-More/Mental-Health-Conditions/Eating-Disorders; Office on Womenﾒs Health, U.S. Department of Health and Human Services, http://womenshealth.gov/publications/our-publications/fact-sheet/anorexia-nervosa.html; National Eating Disorders Association, www.nationaleatingdisorders.org/anorexia-nervosa; National Institute of Mental Health, www.nimh.nih.gov/health/topics/eating-disorders/index.shtml

Reviewed by Laurie Nadal, MD, VP Medical Director, Beacon Health Options

Summary

• Involves a constant cycle of binge-eating and purging
• Early detection and prompt treatment is very important

Bulimia, also called bulimia nervosa, is a severe eating disorder. People with the illness eat large amounts of food in a short period of time. They then try to rid themselves of the food in order to not gain weight. This purging may be done by throwing up or through the over use of exercise. It may also be done by over using diet pills, enemas or laxatives. The guilt that results often leads to the next cycle of binge-eating and purging.

Bulimia vs. anorexia

Like anorexia, people with bulimia have a great fear of gaining weight. They will therefore do what they feel is needed to burn off calories. They have a skewed body image which greatly affects their self-image.

People with bulimia often have a normal body weight. They also may be slightly thin or overweight. No matter what their size or shape, they are not happy with how their body looks. They react by eating too much and then purging. Sometimes people with anorexia also resort to binge-eating followed by purging. For the most part, people with anorexia eat very little despite being very thin.

Causes of bulimia

Bulimia affects mostly teen girls and young women of all races. It also occurs in males, but is far less common. Culture can play a large role in getting the illness. American women above all tend to feel the pressure to be thin. Pictures of women with “perfect” bodies are all over the media. This creates unreal ideals for teens and young women, as well as many older women.

Bulimia tends to run in families. Having a parent or sibling with the illness greatly adds to the chances of getting it. Sometimes it is caused by chemicals or hormones being out of balance. Peer pressure, stress, trauma and a poor self-image can also be triggers.

Signs of bulimia

It is not always easy to spot someone who has bulimia. Her body weight may be normal or at least not very thin like someone with anorexia. Also, she will try to hide her binge-eating and purging due to shame. This same sense of shame will keep her from reaching out for help.

Some of the signs to look for include:

• Constant trips to the bathroom after eating
• Smells of vomit
• Swelling of jaw or cheeks
• Staining of teeth
• Scrapes on knuckles from induced vomiting
• Being obsessed with exercise
• Finding empty food wrappers
• Finding containers of diet pills or laxatives
• Noticing large amounts of food missing
• Withdrawal, anxiety, or depression

Effects of bulimia

A person with this illness lives a life filled with guilt, secrecy, and shame. He does not like his body and has low self-esteem. At times he will feel anxious, depressed, and out of control. The illness does not just affect mood issues. It also takes a heavy toll on the digestive system and other body parts.

Some of the damage to the body includes:

• Tooth decay
• Dehydration
• Bowel movement problems
• Bloating and cramping
• Acid reflux
• Ulcers
• Irritated throat and esophagus
• Swelling of cheeks and jaw
• Skipping heartbeat
• Kidney problems
• Problems with hormones
• Problems getting pregnant
• Problems during pregnancy

Treatment

Bulimia can be a deadly illness. The sooner it is noticed and treated, the better. Talk therapy is the main form of treatment. This includes one-on-one as well as group therapy. A special form of cognitive-behavioral therapy (CBT) designed for bulimia can also be helpful.

Guidance on proper eating and diet will help promote healthier ideas about food. Family support is also a vital part of the healing process. Drug treatment may be used as well. Fluoxetine (Prozac®) is currently the only U.S. Food and Drug Administration-approved drug for treating bulimia.

By Kevin Rizzo

©2015-2021 Carelon Behavioral Health

Source: Office on Womenﾒs Health, U.S. Department of Health and Human Services, http://womenshealth.gov/a-z-topics/bulimia-nervosa; National Eating Disorders Association, www.nationaleatingdisorders.org/bulimia-nervosa; National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Conditions/Eating-Disorders; National Institute of Mental Health, www.nimh.nih.gov/health/topics/eating-disorders/index.shtml

Summary

• Take a friend with you who is aware of your disorder.
• Bring your own meal or snacks if you can.
• Make a list of things to talk about other than food.

The idea of food-filled events excites some people. They enjoy eating tasty foods while talking with family or friends, or meeting new people. If you have an eating disorder though, this thought most likely scares you. What others call a good time, you call a nightmare.

There are ways of getting ready for these events that can really help you. With proper planning, you can learn to cope and maybe even to have some fun.

Be prepared

Whether it’s a wedding, birthday party, music fest, or sporting event, food is likely on the menu. Taking some simple steps ahead of time can keep you from stressing out about it.

Here are some helpful ways to prepare:

• Plan when to arrive at the event and when to leave.
• Have a plan for leaving early if needed.
• Take a friend with you who is aware of your disorder.
• Have your friend help you make good food choices or prepare a plate for you.
• Know what foods you should avoid and which ones are safe.
• Bring your own meal or snacks if you can.
• Do not hang around the food table after you have eaten.
• Spend time getting to know people better.
• Make a list of things to talk about other than food.
• Take part in activities at the event.
• Dress in a way that makes you feel good about yourself.

Have a backup plan

Sometimes best laid plans can get derailed. Realize that some things are simply beyond your control. You cannot always predict the weather or who might show up, for instance. It is a good idea to have a backup plan for such cases.

If you are bringing a friend, have a signal for when you want to leave. If you are alone, have an excuse ready in case you need to leave early. If you just need a break, talk to a friend in person or by phone.

Back out if needed

You may find yourself getting more stressed out the closer it gets to the event. Talk to a counselor or someone else you trust about how you are feeling. Be honest. It may be that you are not ready for such an event.

Do not let yourself be pressured by other people. Only you can decide if you think you can handle the stress or not. If you have to back out, do not feel guilty about it. Tell yourself and others that you will be able to attend future events.

Stay positive

Keeping upbeat is a key to your success. Learn to detect and reject the negative inner voice that tries to put you down. Counter it with positive thoughts of how far you have come. Remind yourself that a few setbacks will not keep you from reaching your goals.

Dealing with holidays

Thanksgiving, Christmas, and other holidays present extra tests. There is more food, more meals, more family, and more stress. Try not to put added pressure on yourself. Relax some of your eating goals. Allow yourself to eat some things you may not normally eat. Do limit your alcohol use however. Do not try to skip meals, which could lead you to binge later. If you are able, bring some of your own favorite foods to eat and share.

Decide to focus on family rather than food during the holidays. Listen to their stories. Ask them questions. Prepare a list ahead of time of topics to discuss. Sit next to someone you enjoy talking with at mealtimes. Be thankful for family and the chance to be together.

By Kevin Rizzo

©2015-2021 Carelon Behavioral Health

Source: National Eating Disorders Association, www.nationaleatingdisorders.org/blog/navigating-4th-july-finding-emotional-freedom-you-deserve, www.nationaleatingdisorders.org/blog/navigating-holiday-season, www.nationaleatingdisorders.org/twelve-ideas-help-people-eating-disorders-negotiate-holidays, www.nationaleatingdisorders.org/slips-lapses-and-relapses

Summary

• Loved ones of adults with binge-eating disorder want to help but don’t know how.
• Pushing an adult with binge-eating disorder to seek help can backfire.
• There are nonthreatening ways to offer support.

“Helpless to help” is how you might feel if you have an adult friend or family member struggling with binge-eating disorder (BED). Of course you want to step in and do all you can to stop your loved one from harmful overeating. But, you must accept that you cannot control your loved one’s behavior or readiness to change. Seeking treatment is a choice only a person with BED can make. So, what can you do to support and encourage someone you care about without giving in to BED? Here are some suggestions:

• Learn about BED. Having a good understanding of BED and your loved one’s painful struggle with food will help you to know what to say and how to be supportive. Seeing BED as a real illness rather than a problem of willpower will help you to be compassionate and avoid making demands for change.
• Avoid placing blame. You cannot pinpoint the cause of an eating disorder. And even if you could, placing blame is pointless. Directing anger or guilt at your loved one, at yourself, or others, does nothing to solve the problem.
• Set boundaries. Think of the ways you have enabled BED to affect your life. Have you made excuses for your loved one’s behavior? Have you changed your routines or given up an activity you once enjoyed because of BED? Have you fought one too many times about overeating? Have you repeatedly allowed your loved one to direct feelings of anger or guilt at you? Setting limits you can control will help you provide the support your loved one needs while protecting the health of your relationship.
• Voice gentle concern without demanding action. It’s OK to express concern about worrisome behaviors or moods. For example, “I noticed lots of food wrappers on the floor of your car. Have you thought about talking to someone?” Or, “The candy I bought for the kids’ class party is gone. Do you want to tell me what’s going on?” Statements like these gently bring the issue to light and give your loved one the freedom to decide how to respond.
• Be present. People with BED often withdraw from friends and family because of shame and guilt. Being present conveys that you desire and value your loved one’s company and that the eating disorder doesn’t change this.
• Remind your loved one why she is special to you. For example, “I love being with you because you make me laugh.” Or, “You have such a beautiful voice—you’re so lucky to have such a great gift.” Comments like these make it clear that you admire and value your loved one for reasons other than appearance. This is especially important for people who struggle with body image and self-esteem.
• Focus on what a healthy body can do; not on what a healthy body looks like. Most people with BED have issues with their weight and body shape, and many wish to lose weight. Although you want to encourage your loved one’s efforts to eat normally and healthily, keep in mind that good health has many dimensions and there are many reasons to adopt a healthy lifestyle.
• Acknowledge your loved one’s feelings. People with BED are most likely to seek help when they are really sad, distressed about their weight, unhappy in their relationship, stressed out, or feeling badly in some other way. If your loved one opens up to you, be sure to validate these feelings. Although revisiting the same issues can be trying on your patience, recognize that such discussions may prompt your loved one to get help. Keep in mind that you can set limits over when these conversations take place and how they play out.

Resources

Binge Eating Disorder Association

National Eating Disorders Association

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: Talking to Eating Disorders: Simple Ways to Support Someone With Anorexia, Bulimia, Binge Eating, or Body Image Issues by Jeanne Albronda Heaton, PhD, and Claudia J. Strauss. New American Library, 2005; Binge Eating Disorder Association

Reviewed by Rose Marie Sime, M.D., VP DABPN, Medical Director, Beacon Health Options

Summary

• Confront the person in a loving but firm manner.
• Help the person to get professional help.
• Learn all you can about the disorder.

When someone you know shows signs of anorexia it can be very scary. You can easily see the damage being done to your friend or loved one. Sadly, she will likely be in denial about her own state. This is what makes the disorder so dangerous. If you think someone you know has anorexia, it is vital that you reach out to her. The illness can be treated but early detection is very important.

Know the signs

Anorexia can be deadly. It slowly starves a person’s body. The person eats very little and therefore has a very low body weight. In this way it differs from bulimia or binge-eating disorder. Those illnesses involve severe over-eating and a normal to high body weight.

Some of the signs of anorexia include:

• Being very thin without knowing it
• Having a distorted body image
• Being obsessed with controlling food intake
• Being very fearful of weight gain
• Cutting food into tiny pieces
• Weighing food
• Weighing oneself throughout the day
• Over exercising
• Vomiting after eating
• Overusing diet pills, laxatives, or enemas
• Missing three or more menstrual cycles in a row
• Having thoughts of killing oneself

You may worry that you are overreacting. Maybe your family member is just going through a phase. Maybe your friend is just taking dieting a little too far. This should not keep you from confronting the person in a loving manner. Even if she does not yet have the disorder, your involvement might prevent her from getting it.

Show your support

Make sure your friend or loved one knows you are there to support him. Take time to talk with him and more importantly, to listen. Do not judge him or say things to make him feel guilty. Do not tell him to just stop exercising so much or to start eating more. Instead, encourage him to seek professional help. Offer to help him make an appointment. If he resists, do not try to force him. Let him know that you will be there for him whenever he is ready.

Another way of helping is to learn all you can about the illness. This will help you better realize what she is going through. It will also allow you to better express your concerns. Search online for articles on the disorder from trusted sources. Beware of websites that promote thinness through purging or extreme exercise and dieting. You can get a lot of good information from the National Eating Disorders Association.

Diagnosis and treatment

A person thought to have the disorder should be checked out thoroughly by a health team. A physical exam and lab tests can make sure there are no other medical issues. A mental health check can see if the person has other things like anxiety or depression. The combined results from these tests will help direct the course of treatment.

One-on-one talk and behavior therapies are the most common treatments. Cognitive-behavioral therapy is used to change unwanted thoughts and actions. Group and family therapy help provide much needed support. Guidance on healthy food and proper diet is also very important. Drug therapy is not used to treat the illness itself. However, it may be helpful in treating anxiety and depression issues that may also be present.

Anorexia is a serious illness. The sooner a person is diagnosed and treated, the better. Some people with the disorder will have to be hospitalized. IVs and feeding tubes may be needed to bring their weight up to a safe level. Once a healthy weight is reached, recovery can begin. Treatment will take time and relapses may occur. A committed health team and strong support from family and friends will go a long way toward healing.

By Kevin Rizzo

©2015-2021 Carelon Behavioral Health

Source: www.nami.org/Learn-More/Mental-Health-Conditions/Eating-Disorders; Office on Womenﾒs Health, U.S. Department of Health and Human Services, http://womenshealth.gov/a-z-topics/anorexia-nervosa; National Eating Disorders Association, www.nationaleatingdisorders.org/anorexia-nervosa, www.nationaleatingdisorders.org/what-should-i-say, www.nationaleatingdisorders.org/how-help-friend-eating-and-body-image-issues; National Institute of Mental Health, www.nimh.nih.gov/health/topics/eating-disorders/index.shtml

Summary

• Confront the person in a loving but firm manner.
• Help the person to get professional help.
• Learn all you can about the disorder.

A person with bulimia feels out of control about food. This is mainly true during times of binge eating. Later, the person feels guilty and will purge the food to prevent weight gain. This is often done through forced vomiting or the over use of laxatives, enemas or diet pills. It may also be done through over exercising. Purging helps the person to feel more in control.

Warning signs of bulimia

Unlike anorexia, most people with bulimia are aware something is wrong. They may even realize they are in danger. They are often too ashamed to seek help, and will try to hide their actions instead. This secrecy makes it hard to spot someone who may have the illness. Also, the person may be normal weight or even slightly heavy. This makes the disorder much harder to detect than anorexia which leaves the person very thin.

Some of the signs to look for include:

• Constant trips to the bathroom after eating
• Smells of vomit
• Swelling of jaw or cheeks
• Staining of teeth
• Scrapes on knuckles from induced vomiting
• Being obsessed with exercise
• Finding empty food wrappers
• Finding containers of diet pills or laxatives
• Noticing large amounts of food missing
• Withdrawal, anxiety, or depression

How to help

If you think someone you know may have bulimia, express your concerns right away. Early detection offers the best chance for healing. Confront the person in a loving but firm manner.

Make sure your friend or loved one knows you are there to support her. Take time to talk with her and more importantly to listen. Do not judge her or say things to make her feel guilty. Do not tell her to just quit binge eating and throwing up. Instead, encourage her to seek professional help. Offer to help her make an appointment with a doctor. If she resists, do not try to force her. Let her know that you will be there for her whenever she is ready.

A further way of helping is to learn all you can about bulimia. This will allow you to better realize what the person is going through. It will also show him that you care and are committed to helping him.

Treatment

Bulimia can be a deadly illness. The sooner the disorder is noticed and treated, the better. Talk therapy is the main form of treatment. This includes one-on-one as well as group therapy. A special form of cognitive-behavioral therapy (CBT) designed for bulimia can also be used. It can help change the way the person thinks and acts regarding food.

Drug treatment may be used as well. Fluoxetine (Prozac®) is currently the only U.S. Food and Drug Administration-approved drug for treating bulimia. It can help with any existing anxiety or depression. It may also help to decrease the cycle of binge eating and purging.

A strong family support system is needed, as well as guidance on healthy eating. Both can help the person overcome feelings of guilt and shame. They can also address the person’s skewed body image and poor self-esteem. Any substance use issues will need to be treated separately.

With proper treatment and support, a person with bulimia can expect to recover. Over time, she will learn to feel better about herself and more in control of her life.

Resources

What Should I Say?
How to Help a Friend with Eating and Body Image Issues
NEDA Toolkits

Bulimia Fact Sheet

By Kevin Rizzo

©2015-2019 Carelon Behavioral Health

Source: Office on Womenﾒs Health, U.S. Department of Health and Human Services, http://womenshealth.gov/a-z-topics/bulimia-nervosa; National Eating Disorders Association, www.nationaleatingdisorders.org/bulimia-nervosa, www.nationaleatingdisorders.org/what-should-i-say, www.nationaleatingdisorders.org/how-help-friend-eating-and-body-image-issues; National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Conditions/Eating-Disorders; National Institute of Mental Health, www.nimh.nih.gov/health/topics/eating-disorders/index.shtml

Reviewed by Laurie Nadal, MD, VP Medical Director, Beacon Health Options

If a loved one needs help for a harmful behavior but refuses it, or denies a problem even exists, you can take action by planning an intervention.

At an intervention, family members, friends and concerned others join forces to engage a person about a problem behavior in a loving and non-confrontational way and invite the person to get help. It can reach people who refuse or are resistant to help for issues such as:

• Substance and alcohol use disorders
• Addictive or compulsive behaviors such as with gambling, sex, internet use, gaming or shopping
• Eating disorders

Planning is vital

A well-carried out intervention involves thoughtful planning and is best done before a crisis happens. These steps can help guide you:

• Mobilize a planning team. Ask a few close friends or family members to help you. Talk about the problem and set a goal. An example goal would be for your loved one to agree to enter a treatment program.
• Research help choices and make all needed arrangements before the intervention. Otherwise your loved one might change their mind before the arrangements are set. Think of every detail, from making reservations to deciding who will drive your loved one from the intervention to a care center.
• Set a time and place. Timing is especially important if your loved one has a drug problem. Pick a time when the person is most likely to be sober and clearheaded, such as after work or first thing in the morning. Choose a comfortable and private location where they would readily go, such as a friend or family member’s home. You also need to decide the approach you will take to get the person to the meeting. Some research suggests that asking a loved one to an intervention works as well if not better than a surprise intervention.
• Decide whom to invite. Participants should be important to or influential to your loved one and might include close friends and family members, a pastor or rabbi, coach, teacher, roommate or employer.
• Plan what to say. Many people find that writing a letter can help them organize their thoughts and make sure the message is delivered in a loving, caring and respectful way. The letter should express your love and concern and cite specific cases of how the behavior has caused problems for you and for your loved one. The letter should end with a request that your loved one get help and an expressed willingness to be involved. Try to anticipate how the person will react and be ready to respond to excuses, objections or attempts to bargain.
• Set consequences. Each participant should be ready to name a consequence should your loved one say no to the group’s terms.  Withholding financial help, restricting contact with children and ending a romantic relationship are some potential consequences.
• Organize the meeting and rehearse. Choose someone to act as a spokesperson for the group and facilitate the meeting. Make sure participants know the goal, how to plan and how much time they will have to speak. Decide seating and the order of speakers. Rehearsing the intervention is a good idea. This gives all participants a chance to hear all the letters and to make sure that the collective message is caring and consistent.

After the intervention

If the intervention is successful, you and others close to your loved one should play an active role in healing. This could involve making changes at home or work or finding a new set of friends to lower the chances of relapse. Family or one-on-one counseling can help you and others work through tough emotions and dysfunctional patterns that get in the way of family healing.

If the goals of the intervention are not met, the consequences must go into effect right away. In time, your loved one might make the choice to get help. But that is unlikely if you or others weaken and fail to stick to your plans for the long term. Look for ways to support and hold each other accountable, which can help keep up the group’s unity over time.

Involving a professional

Consult an interventionist, addiction specialist or other skilled counselor who can help plan and facilitate the intervention. Moreover, a professional can help family members learn better ways to communicate and look at the problem in the context of the family system. Friends and family may contribute to the problem and need to make changes themselves.

Final thoughts

Intervention involves risk. You risk ending a relationship with somebody you care deeply about in the hope that they will accept your offer of help. But doing nothing is also a risk. A successful intervention offers the chance for personal triumph over a harmful behavior and the chance to restore meaningful relationships.

By Christine Martin

©2013-2022 Carelon Behavioral Health

Summary

Signs of eating disorders:

• Odd eating habits
• Limiting food intake
• Binging and purging

Children with an eating disorder will have odd eating habits. For example, anorexia nervosa causes a person to severely limit their eating. This can cause a person’s weight to drop by more than 15 percent of what is considered normal. Bulimia is a disorder where a person binges and then purges. Binging is when a person eats large amounts of food. Purging is when a person forces herself to throw up or takes laxatives to get rid of the food that was just eaten. Some people with an eating disorder only binge.

When eating disorders start

Eating disorders most often start in puberty or during teen years, when other bodily changes begin. Some cases of eating disorders have been noted in children as young as 9. They most often affect girls. But, in 2016, the National Institute of Health suggested that five to 15 percent of persons with anorexia or bulimia are boys, and up to 35 percent of those with binge-eating disorders are boys. Boys with eating disorders show the same symptoms as girls. The family may not know that their child has an eating disorder. This is because these children are experts at hiding their disorders. Left untreated, these disorders can seriously harm a child’s health. In rare cases, people have died from eating disorders.

How eating disorders happen

Eating disorders happen for many reasons. Most often, the child has an unrealistic body image. He believes he is fat when he really isn’t. Some believe that children with eating disorders feel like they have no control over their lives. So, their food intake gives them one way to have control in their life. Other problems may be present in a child with and eating disorder. These can include depression, peer pressure, abuse, and media pressure to be thin.

Because these children are experts at hiding their disorders, you need to trust your own instincts. There are certain behaviors you should note. Be aware if your child complains about being fat all the time. Take notice if she avoids meals, or makes excuses about why she has lost a great deal of weight. Also, be aware if your child spends long periods of time in the bathroom right after a meal. Coaches who find fault with your child’s weight can also add to an eating disorder.

Tips for parents

• If you think your child has an eating disorder, have a doctor see him. Even though eating disorders can be serious, they also are very treatable.
• Don’t force your child to eat. You won’t win this battle. Your child believes that food is the one thing she can control in her life. She won’t give up this control easily.
• Treatment for eating disorders takes time, so be patient. It involves dealing with feelings and changing habits. Your child will be working to change a habit that has taken a long time to develop in the first place.

By Haline Grublak, CPHQ

©2010-2019 Carelon Behavioral Health

Reviewed by Philip Merideth, MD, Peer Advisor, Beacon Health Options

Summary

• People with binge-eating disorder eat more than a normal amount of food in a small amount of time.
• Binge-eating disorder is the most common type of eating disorder.

Many people eat too much now and then, such as on holidays or special events. And many people eat more than their bodies need to keep a healthy weight. This is a main cause of overweight and obesity. But overeating in these ways and binge-eating disorder (BED) are not the same.

What is BED?

BED is a type of eating disorder. Eating disorders involve abnormal eating behaviors. People with BED eat more than a normal amount of food in a small amount of time, often in less than two hours. This behavior occurs at least once a week for at least three months. Stress, depressed mood, feeling badly about one’s weight or body, dieting, and even boredom can start a binge. People with BED feel compelled to keep eating, even if they feel full or want to stop. This unwanted and uncontrolled behavior is deeply troubling to people with BED.

People with BED also have some or all of these symptoms:

• Eating faster than normal
• Eating until uncomfortably full
• Eating a lot of food despite not feeling hungry
• Eating alone to avoid being embarrassed by overeating
• Feeling disgusted, unhappy, or guilty after binging

People with BED do not compensate for eating too much. So, a person with BED will not throw up, fast, or work out to make up for overeating.

Are people with BED overweight?

Most people with BED are overweight or obese, but it affects people of normal weight too. Importantly, most people who are overweight or obese do not have BED.

What causes BED?

Experts know very little about the cause of BED and how it happens. Like other health issues, BED is complex and has many added factors, such as:

• Biology
• Psychology
• Environment
• Societal and cultural factors

Research also suggests that BED tends to run in families.

BED often starts in the teen or young adult years, but loss-of-control eating and binge eating can be seen in children. Experts think that these behaviors may be early signs of BED in some people.

Treatment

Treatment can help people with BED gain control of eating, develop healthy eating behaviors, and have a healthier outlook about their body and self-image. Counseling is a proven method that is widely used. It can address BED, from changing unwanted behaviors, to handling stress, to overcoming interpersonal problems. Medicine is sometimes used in a treatment plan, mostly in people with BED who also have depression or other mental health issues. Learning how to make healthy food choices and become physically active also plays a role in treatment.

By Christine Martin

©2013-2021 Carelon Behavioral Health

Summary

• Talk to your doctor.
• Record what you eat.
• Note circumstances related to overeating.

Name your weakness—is it cookies or chips? Perhaps it’s something more redeeming such as pasta or mashed potatoes. Whatever it may be, if you just can’t seem to stop eating it, even when you are full, it could be making you miserable—and not just from the discomfort in your belly. Out of-control eating can make you feel, well, out of control. This can cause you to feel anxious and depressed, wreaking havoc on your self-esteem. Ultimately, overeating can cause obesity, which carries with it several health risks.

But what if you just can’t stop? First, talk to your doctor about your concerns. He can help you determine whether your overeating is described as:

• Binge-eating disorder: a history of weekly episodes of overeating to the point of discomfort, which you cannot voluntarily control
• Emotional eating: eating when you are not hungry to compensate for feelings such as sadness, anger, anxiety, boredom, etc.
• Poor eating habits and nutrition, in general

Since the causes vary, so might the treatment. You and your doctor must work together to determine if medical attention is warranted. You can, however, help yourself as well. Read on for tips that might improve your eating habits.

Pay attention

Dr. Joyce Nash, clinical psychologist and author of Binge No More, advises you to record your eating habits for a few weeks to help you learn what triggers binges. Try to note what thoughts, emotions, and circumstances you experience just before overeating. Be aware of:

• When you eat—Are you skipping meals all day and then overeating at dinner? Eat three balanced meals and two healthy snacks throughout the day to regulate your appetite.
• Why you eat—Are you bored? Are you really hungry? Try to eat only when you are hungry—if you’re tempted to reach for food outside of your regular schedule, drink a glass of water, and wait 10 minutes to see if the craving passes.
• How you eat—Are you eating very quickly, or while watching TV? Slow down, turn the TV off, and enjoy your regular meals.
• What you eat—What foods do you binge on? Plan nutritious meals and snacks, but don’t deny yourself treats on occasion or you might find yourself bingeing on the food you’re trying to avoid.
• Where you eat—Are you more likely to overeat at a restaurant? Ask if they provide smaller portions, or plan ahead to save half of your meal for a to-go box. Avoid buffets if they sabotage your hard work.

More tips

You might find that recording what you eat gives you a new awareness and motivation to eat better, but here are a few more helpful suggestions:

• Eat healthy fats. Your body needs and craves fat. Try snacking on a handful of nuts and see if that curbs your cravings.
• Fill up on fiber. High-fiber foods such as beans, whole grains, and brown rice are not only filling, but also great for your health.
• Distract yourself. Take a brisk walk, work on a hobby, do something you enjoy to counteract emotions that usually send you to the kitchen.
• Exercise. Working out before a meal can reduce your appetite.

All about portions

As you attend to what you eat, why you eat, and so on, you may realize that it’s how much you eat that really bothers you. Be careful with this one. Obsessing on the exact amount of every morsel you eat might free you from overeating, but it robs you of joy. Worse, it might backfire and worsen your compulsion to binge. Try, instead, to make some subtle changes in your portion habits, without going overboard and measuring every bite. You can:

• Use a smaller plate at lunch and dinner such as a salad plate.
• Pour out a serving of chips on a saucer rather than eating from the bag.
• Serve yourself ice cream in a teacup rather than a bowl.

Be kind to yourself as you strive to get your eating under control. It’s realistic to expect setbacks. Understand that eating habits take time to form. Expect that changes will also take time.

By Laurie M. Stewart

©2003-2019 Carelon Behavioral Health

Summary

To remain valuable in any organization, you must be able to contribute and achieve your goals without antagonizing others.

Many people dream of making it big, whether that means becoming company CEO or winning over a crucial client. But ambition alone won’t land a corner office with a view.

Often, success at work comes only with success in dealing with colleagues, clients, and other professionals. Promoting your skills and ideas using an effective, non-abrasive approach can make all the difference.

If you’re having trouble moving ahead in your job, spend time assessing your “work style,” and, if necessary, making some adjustments.

Think hard about your experiences at work. Maybe you got that great new job a few years ago, but haven’t been promoted since then. Do you consistently find yourself on the defensive when talking with your boss about work? Or, maybe you’ve noticed that co-workers avoid you. To remain valuable in any organization, you must be able to contribute and achieve your goals without antagonizing others.

Assess your work style

First, take an inventory of your “people” skills. It’s important to keep your technical skills polished, of course, but communication skills are critical no matter what job you hold. Ask yourself:

• Do I often blame others for my problems at work?
• Do I feel that people misunderstand me?
• Do I frequently clash with my boss or colleagues?
• Do I believe that co-workers take advantage of me or take me for granted?

If you think that you’re having problems moving ahead at work because of strained relationships with colleagues, you might want to make some changes. Your college degree and resume don’t necessarily guarantee that you have learned good communications skills.

Consider how you interact with your co-workers. Are you passive or aggressive? While aggressive behavior can provoke resentment and anger, and passivity can convey a lack of confidence, most people react positively to someone who is assertive—direct, open, and honest in their interactions. Assertive people respect others’ opinions, but also realize that they have the right to express themselves and to make mistakes.

Make some “attitude adjustments”

If you decide you need to make some changes in your work style, try these tips for improving your office reputation and your own sense of job satisfaction:

• Stop playing the blame game. Take responsibility for your performance and for the quality of your interactions with others. Instead of pointing fingers when somebody offers criticism, keep in mind that you can use that advice constructively to avoid future problems. Everybody makes mistakes, so don’t be afraid to own up when you do. Co-workers and supervisors probably will react much more positively if you tell them what went wrong promptly and honestly and offer an apology.
• When you disagree with someone, don’t be confrontational. Nobody likes to hear the words “you’re wrong.” Express your opinions calmly and logically. Avoid using loaded words such as “stupid” or “lazy.” And, substitute judgmental phrases that begin with the word “you” for those that begin with “I.” For example, don’t tell a co-worker, “You did this wrong.” That language can cause people to become defensive. Instead, say, “I don’t think I explained this thoroughly enough.”
• Don’t use a middleman to transmit information for you. Deliver your message directly to the recipient. Then, make sure that you expressed your message clearly—ask for specific feedback and avoid ambiguities.
• Express clearly what you want to accomplish at work. Passive people may not believe that their opinions have value or that they can ever come up with a good answer to a question. Lack of confidence shows. So stop letting yourself feel disgruntled when you think that colleagues misunderstand or discount your input. Work on firmly stating your point of view.
• Build allies—don’t make important people angry. Chances are you will find it easier to get ahead in your job if you have a network of supporters rather than a list of people to avoid. Don’t burn your bridges.

By Kristen Knight

©2002-2019 Carelon Behavioral Health

Source: Career Journal from The Wall Street Journal, http://online.wsj.com/public/page/news-career-jobs.html; Same Game, Different Rules: How to Get Ahead Without Being a Bully Broad, Ice Queen or ﾓMs. Understoodﾔ by Jean Hollands. McGraw-Hill, 2002.

Summary

• Identify fears and unrealistic expectations.
• Focus on rational self-talk.
• Try positive self-thoughts.

Like other bad habits, procrastination is hard to kick. It can often undermine success at work as well. The most obvious effects of procrastination include missed opportunities and wasted time. Perhaps more seriously, reinforcement of the habit can decrease self-confidence and lead to poor performance. Start getting on the right track now by challenging the most familiar axiom of procrastination—“I’ll do it later”—and learn how to identify and overcome the causes of this common problem.

Behavioral patterns and distorted thinking often are the two biggest culprits behind procrastination. Examples of distorted thinking can include:

• Anxiety or fear of failure
• Perfectionism and unrealistic expectations
• Self-defeating beliefs or excuses (such as waiting for the right “mood” to start a task)
• Negative self-thoughts (such as “I’m not smart enough”)
• Underestimating the time necessary to complete a task
• Overestimating time available to complete a task
• Reliance on feeling more motivated in the future

Undesirable patterns of behavior also can reinforce procrastination. Unfortunately, these patterns often are self-perpetuating. They include poor time management skills and lack of momentum needed to start and finish a task. As in physics, with procrastination, “a body at rest tends to stay at rest.”

Outside factors, such as family problems or difficulty concentrating because of a distracting or unorganized environment, can play a role, too.

Some causes of procrastination may be beyond our control. But with practice, you can positively change many of them. Try these strategies for overcoming procrastination:

• Identify fears and unrealistic expectations. Try to pin down what’s holding you back. If you can categorize the problem, the solution may become obvious.
• Focus on rational self-talk. Write down all of your excuses and examine the faulty logic behind each. Then, write down a realistic thought next to each excuse.
• Try positive self-thoughts. Replace self-defeating beliefs or negative thoughts with motivators, such as, “The sooner I finish this task, the sooner I can have fun.”
• Set clear, realistic goals. To help make tasks manageable, make a list of every step needed to finish the job. Estimate the time you think you’ll need for each step and then double it. That way, you can pick up where you left off after a break or interruption.
• Discipline yourself. Don’t rely on feeling more motivated later. Once you identify the task and steps needed to complete it, make a commitment to see it through. If necessary, tell a friend or supervisor about your plan.
• Post reminders for yourself in obvious places. Tack them on your car dashboard, computer monitor, or bulletin board.
• Organize your work area. A clean desk can help you clear your mind. Gather all the materials you will need to complete the task before you start. That way, you won’t waste time looking for supplies. Try to eliminate possible distractions.
• Build momentum to see the task through. Try setting a timer for five minutes, then get as much accomplished as you can before the bell rings. If you still can’t find the motivation, make a plan to try again later. But you’ll be surprised at your urge to keep working. Also, try answering all email, text, and telephone messages immediately. This will keep you moving and help you feel that you’re accomplishing something.
• Raise your energy level. It’s hard to feel motivated if you’re tired. Stand up as much as possible during your workday. Make a habit of taking short walks after lunch. And, monitor your sugar and caffeine intake. While these can provide quick bursts of energy, they can often leave you feeling down after the effects wear off.

By Kristen Knight

©2001-2021 Carelon Behavioral Health

Source: Essential Managerﾒs Manual by Robert Heller and Tim Hindle. DK Publishing, 1998.

Summary

• Take full responsibility—avoid blaming others.
• Stay action-oriented.
• Review the system you used.
• Develop a plan to prevent future mistakes.

Are you upset because you’ve made a serious mistake on the job? Perhaps you’ve misquoted financial figures to an important customer. Or did you forget an important deadline?

It’s normal to feel shame when you’re in this situation. But don’t allow fear to traumatize you. Try to figure out why the mistake occurred and how you can avoid repeating it. Your overall goal is to learn from the mistake.

Your immediate goal is to communicate a willingness to take full responsibility, plus do damage control. Talk with your supervisor to assess those individuals who will need to know about the error—such as top management or your customers.

Assess the damage

• Stay focused in reality. Naturally, you’ll imagine the worst that can happen. But instead, try to assess what probably will occur as a result of your mistake.
• Don’t waste energy on melodrama. You’ll use up energy you need to deal with actual issues. You’re not the first human to make a mistake.
• Stay action-oriented. Try to figure out specific steps that could improve the situation. If you don’t know what to do, ask your boss.
• Don’t beat yourself up too much for inconveniencing others. If, however, your mistake could physically harm others or get your employer sued, do everything in your power to prevent the harm.

Talk to your boss

• Avoid becoming defensive. This will only cause you to feel like a victim. Over-explaining or over-apologizing will make you look and feel out of control.
• Ask for feedback. If you know why you made the mistake, confess. Otherwise, ask your boss to help walk through your situation with you. Was it an error of judgment, lack of skill on your part, or lack of information that flubbed you up?  Believe it or not, mistakes can be your ticket to future power. For instance, if co-workers’ negligence helped cause the error, it should be easier to tell them, “In the future, I reserve the right to personally give everyone reminder calls right before important deadlines.”
• Avoid blaming others directly. Although a co-worker may be a part of the problem, let this information surface gradually when you speak with the boss. It’s better not to take on the role of smoothing everything out. This forces others—especially higher ups—to take a look at the role of others. 
• Review the system you used. Did your system fail you? Or, did you fail the system? For example, if you filled out schedules with errors, was it because you failed to hold other co-workers’ feet to the fire? Did you provide them with a sheet requiring them to supply information—with clearly noted deadlines? 

Talking with co-workers and clients

When you must discuss your mistake with others, keep focusing on what actions will help and how the mistake could be avoided in the future. Again, avoid personal attacks on any individual. His reaction will only complicate your stress.

Reassure customers or clients. Expect them to vent some emotions. After all, if they will be largely inconvenienced or lose productivity, they will probably act out emotionally to some degree—maybe even to the point of threatening to get you fired.

Do accept responsibility, but don’t play the victim’s role. Share information appropriately and professionally with co-workers and clients, but maintain your dignity and self-worth in all conversations. Don’t try to fix the emotions of others. You don’t have that kind of power.

Preventing mistakes

Ask your boss to help you develop a specific plan of action to prevent such mistakes in the future. For example, you might do some of the following:

• Use tracking sheets for projects.
• Give reminder phone calls.
• State your boundaries early on.

When someone else discovers your mistake

If others discover your mistake before you do, remember these truths:

• One error seldom makes or breaks anyone. All of us are judged on how we work and what we value over a long period of time. Unless there is a huge breach of ethics on your part—for example, mismanaging company resources on purpose—few people will see you as inept or deserving to be terminated. They know they could easily be in your shoes.
• Some people may try to use your mistake against you. However, stay confident and tough. Don’t hide out in your cubbyhole. Move forward and continue to take risks and conduct business as usual. If others try to define you by a single mistake—rather than your talents, skills, and values—that’s their problem.

By Judi Light Hopson

©2003-2019 Carelon Behavioral Health

Many of us struggle with time management and organization as we try to fit into our lives everything we must do and also everything we would like to do. These skills are essential to keeping up with the busy world we live in. We all strive to be good spouses, parents, and friends, work efficiently and productively and still have time to do the things we enjoy. But sometimes it seems there are not enough hours in the day to accomplish everything. Getting organized and being able to set priorities can be a liberating skill.

Start with a calendar

Add all your business and personal appointments and commitments to a calendar or datebook. Keep it with you all the time and consult it before you make any new commitments.

When you start out, make sure you record not only the special appointments you already have, such as a meeting or a concert, but also the commitments that might seem obvious or unforgettable, such as when you will be away on trips or vacations, when your children have soccer practice or when you have parent-teacher conferences.

Then, before making any further commitments, always consult the calendar, even if you think you will be free at that time. This way you won’t overschedule and inadvertently commit to things you can’t possibly do.

And while you have your calendar open to check for scheduling conflicts, immediately record each new commitment so you won’t forget and then become overscheduled.

Make “to do” lists and prioritize

We all like to think that we won’t forget, but chances are that sometimes we will. Making lists is a useful technique for doing household chores, shopping, going to the bank, picking up the kids and so forth. The things that cannot be put off should be at the top of the list. When possible, group errands together that are near one another so you don’t need to make more than one trip.

Most people also need help in organizing their workspace. Here, too, making lists can be helpful to remind yourself of projects you need to prepare for or responsibilities you need to fulfill.

Keep your workspace neat

Files can be used to organize paperwork and more easily locate what you need to work on next. In/out boxes can help in keeping track of what still needs to be completed. Keeping yourself free of distractions in order to get work done can also help you focus on and organize your work. Aids such as earplugs or ear buds can be helpful for filtering out extraneous noises.

Schedule time for yourself

The hardest part of getting organized may be remembering to allow time to spend with your family and friends and doing things you enjoy. Try to schedule time for yourself (yes, in your calendar) so that your own well-being is not neglected.

Help your child get organized

Start by asking your child how their bedroom works for them—are they frustrated that they can’t get to tennis practice on time because they can’t find their racquet in their messy room?

Point out ways your child is already neat, then tell them that you are ready to help them if they need more help getting organized. With your child, make a list of areas that need organizing and work together, grouping like items together and getting rid of unneeded items. Work project-by-project to keep you both from getting overwhelmed.

By Heather Abrahams, MD

©2022 Carelon Behavioral Health

Summary

• Consider the context in which you will make your decision.
• Create a framework for decision making.

When the alarm clock goes off in the morning, many people make their first decision of the day: whether to get up or sleep a little longer. Many more decisions will follow throughout the day, both big and small. Some, such as deciding how best to handle a client’s request or whether to accept a new job, may be more important than everyday dilemmas. But even decisions that seem unimportant often have long-term effects—for example, choosing to eat lunch at a restaurant every day can end up taking a sizeable chunk out of your budget. It’s important to use a framework for good decision making.

Consider the big picture

Before you start the decision-making process, it’s important to consider the context in which you will make your decision. Do you have enough time to prepare? Who else will be involved? And, remember that different types of decisions require different approaches. Deciding whether to buy a house, for instance, requires different research and resources than making a decision at work.

Keep these basic ideas in mind to help guide you:

• Examine past decisions realistically. Do you have a history of making bad decisions? If so, prepare yourself to overhaul your decision-making process
• The quality of your research and other preparation directly influences the outcome of your decision. The more room you leave for error, the better the chance that your decision will be successful.
• Always make short-term decisions with long-term implications in mind.
• Avoid indecision and making decisions based on insufficient information.
• Don’t make decisions under excessive time pressure.

Create a framework for decision making

Using a step-by-step process is important, especially when making a decision that will have a big impact on your loved ones or colleagues.

• Define the problem or issue to be decided. You should have a clear understanding of the decision at hand before you proceed. Make sure you can describe the situation honestly and objectively, and then determine what your goal is. Plan your objectives realistically, but don’t be pessimistic.
• Identify your options. First, establish criteria against which to measure your choice. What goals must you meet? What resources do you have to reach those goals? If you’re making a big play at work, learn the decision-making culture of the company. Find out what methods or choices are acceptable, and which are not. Then list your alternatives. Call on others to help come up with ideas. Ask colleagues to bring a few ideas to a brainstorming meeting. And remember that people are more likely to support a decision if they’ve been involved in the process.
• Evaluate your options. Do your research, but establish a timetable for your information gathering. Consider the issue from as many different angles as possible. If necessary, ask a specialist on the subject to get involved. For example, you may want to hire a consultant to help create a predictive model to aid a marketing decision.
• Choose the best option. Combine your instincts with your research and analysis. First, try to predict all possible outcomes or problems with each alternative. What’s the worst-case scenario? And, make sure you take into account the impact each choice would have on colleagues or loved ones. Before you finalize your decision, make a checklist of the factors involved to be sure you have covered all your bases.
• Implement your decision. Once your best option is clear, make your decision confidently and quickly. Develop a comprehensive report so you can communicate your decision clearly to those involved. It’s important to keep people informed. But before you present your decision, try to find another person to support it. That can help you provide more perspective.
• Reevaluate your choice if necessary. Listen to feedback from others. Most importantly, be prepared to make timely adjustments if your decision has not worked as planned.

By Kristen Knight

©2001-2021 Carelon Behavioral Health

Summary

• Control your emotional response.
• Stay focused.

How can you keep your cool and maintain productivity when working in a pressure-cooker environment? Try a combination of strategies that help manage both acute and ongoing work pressures.

Dealing with acute pressure

It’s easy to feel overwhelmed when you’re dealing with competing priorities or a fast-approaching deadline—particularly when “surprises” that come up steal your attention away from the task at hand.

These ideas will help you handle immediate crises:

Bust that stress: You might feel like you don’t have time to let off steam. But doing so will help you stay calm and be sensible in your approach to the high-pressure situation.

Quick, stress-busting techniques you can do at your desk include deep breathing, guided imagery, and progressive muscle relaxation.

Control your emotional response: Your thoughts can determine the emotions you experience. So, if you take control of your thoughts, you can control your reaction. For example, self-defeating thoughts such as “I’m never going to get this done” or “I’m not good enough” will serve to delay and hold back productivity.

Stay focused: Give your full attention to one thing at a time. If you are interrupted by something that will take you two minutes or less, take care of it right away.

To help you prioritize and stay focused, ask yourself these questions:

• What is really important in this situation?
• If I could only do one thing, what would it be?
• What does this situation need of me that only I can contribute?
• Can somebody else handle this?

Managing ongoing work pressure

Consider these ideas for keeping stress at bay:

Get organized and clear your head: It’s hard to be productive when our minds are “full.” When you have many deadlines, priorities and to-dos— both at work and at home and of varying levels of importance—you have a steady source of mental stress that interrupts and hinders your productivity at work.

Although there is no single “right” way to get organized, find a system that works for you so you can be a top performer while keeping track of it all.

Maintain work/life balance.:Simple habits such as getting enough sleep and eating right can make a big difference to how you face the workday each morning.

Also, giving serious thought to what renews your spirit—such as spending time with your children—and carving out time for these priorities can reduce job pressure and keep you productive.

By Christine P. Martin

©2007-2021 Carelon Behavioral Health

Source: Getting Things Done: The Art of Stress-free Productivity by David Allen. Penguin, 2001; Crunch Point: The 21 Secrets to Succeeding When It Matters Most by Brian Tracy. AMACOM, 2006; Making Work Work: New Strategies for Surviving and Thriving at the Office by Julie Morgenstern. Simon & Schuster, 2004; Anxious 9 to 5: How to Beat Worry, Stop Second-guessing Yourself, and Work With Confidence by Larina Kase and Joe Vitale. New Harbinger, 2006; The Relaxation and Stress-reduction Workbook by Martha Davis, Elizabeth Robbins Eshelman and Matthew McKay. New Harbinger, 2000.

Summary

• Take small breaks, stretch and readjust your sitting posture
  
• Find recreational outlets outside of work that keep your body toned.

You’re sitting at your computer, deep in thought, preparing a report for this afternoon’s meeting. One hour passes, then two. You’re concentrating so intently that time flies by. You almost miss lunch. As an all-too-familiar ache starts to creep through your back, you suddenly realize that you’ve been bent over your computer for hours without getting up. No wonder your body’s starting to protest.

Working at a desk or computer for hours is a physically demanding job. But that doesn’t mean that pain must accompany a 40-hour workweek. It’s definitely not part of the job. If you learn to set up your workspace to fit your body, how to sit and work at your computer using good posture, and take breaks that incorporate physical activity, you can avoid many aches and pains that come from long hours of sitting.

Are you comfortable?

Ergonomics is the science of arranging and adjusting your work environment to fit you and your body. Ergonomic experts recommend taking an inventory of your workspace to be sure that your chair, computer, and documents are at the proper height and angle. Here’s what they recommend:

Check your chair

• The right chair height helps relieve cramping and stiffness in your legs. It also helps to prevent stress and tension in your neck and shoulders.
• Place your fingers on the middle row of your keyboard, with your upper arms hanging comfortably at your sides. Your forearms should be parallel to the floor. If they’re not, adjust your chair height.
• A properly adjusted backrest reduces pressure on your spine and supports your lower back. Sit at your workstation and lean back slightly with your back firmly against the chair. The backrest should fit snugly against your lower back. If it doesn’t, adjust the backrest until your lower back is fully supported.
• If you can’t adjust the backrest, use a small, thin, firm pillow or rolled-up towel to support your lower back.
• Move your feet forward until your knees are at a 90-degree to 110-degree angle. Your feet should rest firmly on the floor with three inches to six inches of legroom between your lap and desk or keyboard tray. If you have less than three inches of legroom, adjust your desk or keyboard tray height.
• If you can’t adjust your chair height and your feet don’t reach the floor, use a footrest or wedge-shaped item to support your feet. A 3-ring binder should do the trick.

Monitor your monitor

• With your lower back supported and feet firmly on the floor or footrest, hold your head upright and look straight at your screen. The top of your monitor should be at or below eye level.
• If it isn’t, adjust your monitor until it is at a viewing height that will allow you to maintain your head in an upright posture.
• The screen should be 18 inches to 30 inches from your eyes, or at about arm’s length.

Position your keyboard

• The proper computer keyboard height can help keep you from bending your wrists while typing. This improves the comfort of your hands, wrists, and forearms, and helps you avoid injury.
• Place your fingers on the middle row of your keyboard. Your wrists should be straight and relaxed.
• To help keep your wrists relaxed, try a wrist rest or padded support.

Eliminate glare

• Make sure your computer screen is free of glare from light coming through outside windows. Adjust the angle of your desk lamp to aim the light at your documents instead of your screen.
• To help improve viewing comfort, you may also need to adjust your computer screen’s contrast and brightness.

Take small breaks

Throughout the day, it’s important to take small breaks, stretch and readjust your sitting posture. The best thing you can do for yourself is get up and walk around. Get away from your work mentally and physically. It’s good for the circulation and it relieves the pressure that naturally builds up in the back when we sit, thus reducing the accumulation of pressure in the spine over time and decreasing the risk of back pain and injury. The exercises below can help energize your body and relieve muscle tension.

Find recreational outlets outside of work that keep your body toned. Get plenty of sleep and maintain a healthy diet. By learning to take care of your body, you can successfully meet the physical challenges of an office job.

Rest your eyes

• Lean your elbows on your desk. Cup your hands and place them lightly over your closed eyes.
• Hold for a minute, while breathing deeply in and out. Slowly uncover your eyes.

Squeeze your shoulders

• Put your hands up, with your forearms raised.
• Push your arms back, squeezing your shoulder blades. Hold for a few seconds.
• Relax and repeat three times.

Stretch your back

• Sit up straight and imagine you have a cable attached to the top of your head.
• Feel the cable slowly pull you up higher and higher. Hold for a few seconds.
• Relax and repeat three times.

Shake your arms

• While seated, drop your arms and hands to your side.
• Shake them out gently for a few seconds.
• Relax and repeat three times.

Shoulder circles and shrugs

• While standing, lift your shoulders toward your ears. Hold for two seconds.
• Let them fall and release completely.
• Repeat two to four times.
• Still standing, move your shoulders in a backward arc five to 10 times.
• Repeat several times a day.

By Rosalyn Kulick

©2001-2019 Carelon Behavioral Health

Summary

For the meeting facilitator:

• Meet with all (and only) those necessary to do the job.
• Start the meeting at the designated time.
• Introduce meeting participants.

Meetings are a great way to share info and come up with ideas with members of your team about job developments. But, if they are not led well, they can be a waste of time. The success of a meeting depends not only on the skill of the leader, but also on the attentiveness of the listener.

Leaders

Here are guidelines for a meeting leader:

• Meet with all (and only) those needed to do the job.
• Start on time and make sure the meeting ends on time.
• Introduce meeting participants. Have nametags if needed.
• Make an agenda and stick to it. Use handouts if applicable.
• Set up meeting rules (for example, no side conversations; stress promptness for all attendees).
• Limit agenda items.
• Avoid the urge to solve problems in the meeting (unless that is the agenda item).
• Project your voice so that everyone can hear you.
• Ask if anyone has questions at different points throughout the meeting. Look at the person who is speaking.
• Involve everyone in the group. Turn to people who haven’t offered an opinion and ask for one.
• Encourage other points of view, critical thinking, and constructive disagreement.
• Keep visual aids simple.
• Stay focused.
• Record follow-up items.
• Verify the next meeting date, time, place, and participants. Let everyone know that you have kept a list of items not covered that day, and that you will talk to them later.

For a meeting that has people joining by phone or video, remember to include them, too. Keep in mind that people who are on the phone can’t see what’s going on in the room, so they can’t see your gestures or visual aids.

As the meeting is ending, press for a conclusion. Use the last few moments to sum up highlights and decisions and restate all assignments and deadlines. End on a good note by thanking participants for being there and their contributions.

Attendees

Do

• Be on time
• Pay attention
• Be prepared and know what it is you are expected to contribute
• Take part in in the discussion
• Be brief, to the point, focused, and polite in your comments

Don’t

• Carry on side conversations
• Make jokes that not everyone can understand. This is especially important if there are people on the phone. Remember that humor doesn’t always translate across phone lines.

Resources

Presentation Zen: Simple Ideas on Presentation Design and Delivery, second edition, by Garr Reynolds. New Riders Press, 2011.

Mind Tools
www.mindtools.com

Toastmasters International
www.toastmasters.org

By Amy Daugherty

©2001-2019 Carelon Behavioral Health

Source: Communicating at Work: Improve Your Speaking, Listening, Presentation and Correspondence Skills to Get More Done and Get What You Want at Work by Tony Alessandra and Phil Hunsaker. Fireside Books, 1993; Making Successful Presentations: A Self-teaching Guide (second edition) by Terry C. Smith. John Wiley & Sons Inc., 1991.

Summary

• Make a “to do” list for the next few months.
• Get a large calendar and mark all deadlines and obligations.
• Include ongoing/upcoming projects, business trips, meetings, etc.

Have you noticed your job description lengthening and your list of responsibilities growing? Many companies are reorganizing or expanding quickly, and employees are racing to keep up. If you’re juggling multiple projects and struggling to meet deadlines, then it’s time to establish clear priorities at work.  

Clarifying your priorities will help you organize each day more efficiently. Your work priorities should include any ongoing or upcoming projects as well as business trips, meetings of professional associations, and the obligations of work-related boards or organizations.

Get out a calendar and make a “to do” list for the next few months. Now that you know what you’ve got to get done, try to establish weekly priorities. Here are some tips for deciding what’s most important.

Deadlines

Deadlines have a way of creeping up when your back is turned. Anything with a deadline will become a top priority as the date approaches, so make sure you’ve got a calendar or app with all deadlines and obligations marked. If your schedule is unrealistically busy, you can call for help in advance rather than waiting for the situation to become a crisis.

Ask your boss

You may be working on several projects for different people. Don’t avoid prioritizing because you don’t know which is considered most important. Find out! Your supervisor may need to redistribute work, change deadlines or talk to clients. If you’re already swamped and get assigned yet another “urgent” project, ask whether it takes priority over your other work. Talk to your boss about your workload and ask for help in assessing your priorities.

Urgent!

Ask for clarification when colleagues use adjectives such as “important,” “urgent,” or “critical.” If possible, request a deadline so you have a clear idea of the assignment’s time frame. Make sure you know just how “urgent” the assignment is.

Change your list

Your priorities shift constantly, so don’t consider any list permanent. As deadlines loom or unexpected projects arise, you’ll find flexibility invaluable. By establishing work priorities—and asking for help when you don’t know what they are—you’ll lower your stress level and improve your job performance.

Remember yourself

Make sure to include a yearly vacation as a “work priority.” Reserve time for yourself and your family. When you come back to the office, you’ll have more energy and even better ideas.

Managing priorities may not be easy, but it’s often essential. Try keeping a list at your desk. Does time spent at the office reflect the priorities you’ve established? All tasks are not created equal, so make sure you know which are the most important.

By Lauren Greenwood

©2000-2021 Carelon Behavioral Health

Summary

• Try not to overlap work-related and home-related tasks.
• Plan specific time slots for each job.

Odds are you’re reading this while taking a short break from another task—or maybe even while you’re working on another task. And, chances are that trying to do everything has left you feeling overworked and overwhelmed.

Multitasking is possible. But you may want to concentrate on this one task for just a few minutes. You’ll pick up a few reminders about how to do it all without losing it all.

Make sure every duty has its day

The key to remember is that you have to make time for multiple tasks. You may be able to do it all by multitasking—but not all at exactly the same time. Give each job the respect it deserves.

Rather than rushing to exercise, cook dinner, plan the family reunion, pay bills, and vacuum the house all in the space of several hours, plan specific time slots for each job. Avoid cramming in an impossible number of tasks. Otherwise, you’ll set yourself up for disappointment and stress when you can’t accomplish everything—and you may make big mistakes or oversights. Schedule one evening for exercise after dinner, for example. Devote the next evening to a family reunion planning session. The following night you might pay bills, and another afternoon you can aim to get your cleaning done. For routine tasks, plan and stick to a regular, consistent schedule.

Try not to overlap work-related and home-related tasks. You may feel more stressed (or guilty) when you try to squeeze in lots of personal business during work hours. If you need to accomplish private tasks during the day, regularly schedule an hour before you head into the office to make phone calls. Or take part of your lunch break to plan what you’ll do that evening.

Avoid the temptation to start a second job in the middle of working on something. That can be hard to remember, as we’ve become accustomed to instant gratification in so many other ways. At times you may feel like you’re moving in slow motion, but it’s important to take one step at a time. You’ll feel more relaxed, and more satisfied as you cross each task off your list.

Keep it real. Especially when creating your daily or weekly schedule, maintain a realistic view of how long it will take to finish each task.

It may be nice to think that you’ll be able to prepare for a meeting and find a new day care provider all before lunch, but force yourself to factor in time for contingencies and extra time to pay attention to all of the important details. If you plan conservatively, you’ll be thrilled at those times when you find you have extra time to relax and savor your accomplishments. 

Don’t be a pack rat

Less is often more. Multitasking should not involve accumulating a multitude of items that aren’t required to accomplish your goals. Sorting through tons of useless stuff to find the items you really need can be time consuming and stressful—and add yet another task to your list.

When in doubt, you may want to throw it out—or recycle it, or donate it. This applies to junk mail, too. Do you really think that a year from now, you’ll be desperately searching for that credit card offer that includes four free steaks and a chance to win a time share in Orlando? Weed out things you don’t need before they start building up and becoming unmanageable. It may be tough emotionally at first to part with belongings, but it will pay off in the long run.

Compartmentalize: don’t mix and match

Keep the materials related to each task separate. Don’t keep household bills in the same mail pile as magazines or newspapers, for instance. Create a system where different bills have their own file, and put the magazines in the rack. With electronic files, keep every document related to a specific job in a labeled folder for that job—that goes for email messages as well.

This idea goes hand-in-hand with the previous points. Every task should have its own time and place. If you have to sort through one unorganized file containing every email message or document you’ve ever created or received, you’ll spend a great deal of time just searching for the materials you need to finish the job.

Avoid overloading

Don’t bite off more than you can chew. If you’ve already taken on as many tasks as you can handle, don’t feel compelled to take on more. Even if the boss requests that you take on a prestigious project, ask if you can get started on it when you’ve made more room on your plate. Let your manager know you’d like to do your best. You need to be able to devote your full attention to a project, especially an important one, in order to avoid mistakes and meet expectations.

By Kristen Knight

©2007-2019 Carelon Behavioral Health

Source: How to Handle 1,000 Things At Once by Don Aslett. Marsh Creek Press, 1997; Time Management: Get More Done With Less Stress by Efficiently Managing Your Time by Marshall Cook. Adams Media Corporation, 1999; Time Management: Increase Your Personal Productivity and Effectiveness by Harvard Business Essentials. Harvard Business School Press, 2005; The Overwhelmed Person’s Guide to Time Management by Ronni Eisenberg with Kate Kelly. Plume, 1997; Time Management From the Inside Out by Julie Morgenstern. Henry Holt and Company, 2000.

Summary

• Think long term first.
• Set goals that you can attain and believe in.
• Be specific.
• Establish a timeline.

Although people often toss the word around carelessly, goals are not the same as wishes, vows, or hollow resolutions. Don’t treat your goals like inspirational slogans, to be framed and glanced at once in a while. Before you set goals for yourself, establish some ground rules to help you make realistic, actionable choices.

Know the difference between a goal and a wish

People often “wish on stars,” or blow out their birthday candles and make a wish. Maybe you’ve seen people on television or in movies you wish you could be like. A wish is a daydream—a fantasy.

Some people tend to treat goals with the same lack of real urgency. For them, setting a goal is the desired result. Making a resolution to quit smoking or lose weight, for example, can make people feel better temporarily and garner pats on the back. In contrast, goals should be well thought out. Realistic goals include a desired outcome attached to a plan of action.

Plan your goals

• Think long-term first. When everything feels like it has to be done now, how do you determine your priorities? The key is to think long term. Figure out what you ultimately want to accomplish. Let that guide you to your short-term goals, right down to a daily “to do” list.
• Set goals that you can attain and believe in. If you set goals you know you can’t reach, you’re setting yourself up for failure. You must believe in your goals to reach them. Don’t let the advice or plans of other people unduly influence what you think you need to do. And on the opposite end of the spectrum, don’t set goals too low. Have confidence in your ability to achieve realistic goals.
• Be specific. You’ll make the process difficult for yourself if you’re striving for something you haven’t defined. Rather than telling yourself, “I want to make $1 million,” for instance, narrow your focus: “I will grow my client base over the next five years to increase profits by 10 percent each year. By the end of year five I will have saved $1 million.”
• Make your goals actionable. You need to know how you will accomplish your goals when you set them. In other words, convert your goals into a process. For example, don’t simply decide you want to lose weight. Define the steps you will take to get there. In this case, the process might sound something like this: “Tomorrow I will get up at 6 a.m. and put on my sneakers. I will eat a light breakfast and walk or run for one hour. I will pack my lunch every day to avoid eating fast food. I will monitor my caloric intake and the fat content of everything I eat.”
• Establish a timeline. You are more likely to make progress toward your goals if you set deadlines for yourself. Have a timeline that includes benchmarks for your short-term goals within the bigger picture. Reward yourself when you meet those benchmarks.

Stay flexible

In working toward your goals, you need to be able to adapt to changes outside of your control. Review and update your goals on a regular basis. If you don’t maintain flexibility, you may end up feeling frustrated and disappointed. If you stay on track, your hard work will translate into satisfaction.

By Kristen Knight

©2003-2019 Carelon Behavioral Health

Summary

Taking a short break several times a day can help keep you focused, energized and productive.

Feeling stressed out? This catch phrase has become all too common in everyday life—especially at work. Stress can cause more than a little anxiety or discomfort, however. Making time for healthy stress breaks at work can help combat the long-term health and psychological effects of stress, which can include decreased self-confidence and an increased risk of heart disease and other illnesses. Taking a short break several times a day also can help keep you focused, energized and productive.

Your breaks can last just a few seconds or several minutes, depending on the circumstances. If you feel particularly stressed, you might want to take a few minutes to regroup.

For a quick pick-up

If you just need to catch your breath, a few seconds’ pause could do the trick. To avoid burnout, make sure you take time to recharge when you need it.

For a quick pick-up, take several seconds to change position. Close your eyes and breathe deeply. Try thinking about something funny or an activity you enjoy. Repeat this pause at strategic times throughout the day.

A longer break

Taking a few longer breaks of up to about five minutes can help overcome mid-morning and mid-afternoon lows. Use these tips to make the most of your break time:

• Close your eyes and relax. If you have an office, shut the door and daydream for a couple minutes. If you sit in a cubicle or other work space, turn your chair toward a quiet area.
• Meditate. If you don’t know how to get started, many websites and books can offer guidance. Or, try five minutes of deep relaxation. Concentrate on breathing deeply and rhythmically to release tension.
• Talk to a friend. Of course, don’t interrupt a co-worker who’s busy. And remember to keep breaks to a reasonable length. But it is important to develop supportive relationships at work. A good support system can help diffuse stress and boost morale.
• Take snack breaks. Keep healthy snacks such as pretzels or dried fruit on hand to provide extra energy. And stay hydrated. Drink ice water instead of cola or coffee.
• Massage your pressure points. For example, press the pressure points near your jaw joints in front of your ears.

Check your work environment

Keep the big picture in mind as well. What changes can you make in your work environment that could help lower your stress level? Try personalizing your space. A few photographs or colorful posters could brighten your office and make it a place you feel comfortable taking a short break. Also, try arranging your work area so you have to get up and walk to reach your file cabinet or bookshelf. This will help keep you active throughout the day and provide a built-in time for you to pause for a few seconds.

Watch your posture

Posture can play an important role in keeping your stress level under control as well. Sit up straight—don’t slouch. If you catch yourself hunching toward your computer or telephone, take a second to straighten up. If necessary, consider asking for a different chair.

Finally, try to identify your sources of stress at work. Make a list and evaluate each item. Can you eliminate or work around some of those stressors? It could help keep you healthy.

By Kristen Knight

©2022 Carelon Behavioral Health