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Ashley Solomon, Psy.D is a psychologist who specializes in the treatment of eating disorders, body image, trauma, and serious mental illness.

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14 Oct

Eating Disorders in the Ivory Tower: How Colleges Can Help or Hurt

Ideas to Consider 5 Comments by Ashley @ Nourishing the Soul


{image credit :: Matt Katzenberger}

It’s easy to romanticize the college experience. When someone mentions my alma mater, my heart flutters a bit as I recall the excitement of a new syllabus (I am not being ironic, just so you know — I really am a nerd), meeting friends for lunch in the student union, warm spring days spent sitting on my porch curled up with a good… book.

But college isn’t a time of frivolity and freedom for everyone. And even those among us who had a great college experience face our challenges. A deeper look back quickly brings to mind all the things that made this transitionary time challenging: I was alone in a relatively huge place without anyone or thing that was familiar. I didn’t know who I was or exactly what I wanted to become. I was anxious about running out of money and scared I wasn’t wearing the right thing.

Of course, I wasn’t alone. I was surrounded by thousands of other students in the same exact boat, trying to navigate these choppy, unchartered waters. But most people weren’t talking about their fears of fitting in or getting lost in the shuffle. They were too busy drowning their anxieties in the alcohol that was suddenly copiously available or perfecting their AIM away message to sound just busy but available (read: cool) enough.

And, as a recent Huffington Post piece explored, there may be another reason that college kids aren’t talking about their feelings: they don’t want to get kicked out. The story looks at the way that universities are handling college mental health, staring by highlighting the experience of Rachel Williams who faced an eating disorder while at Yale.

The piece struck me because this is an issue that I face on a very regular basis as a psychologist. I’m constantly face to face with students who have been asked to leave their universities, chosen to take a leave, or soon facing the decision (their own or the school’s). I’m also often asked by universities to help provide a recommendation for whether a particular student should be on a medical leave.

What’s been fascinating to me sitting on this side of the couch is that there is so much variability in the way that universities handle issues of mental health. I’ve worked with students who have been in a strong place of recovery for a significant period of time, but their university won’t let them return until a specified period of time has passed. This is often a semester, but has been as long as a year. Other students I’ve treated have been essentially ignored at their schools, despite our best efforts to enlist the help of the university to grant a leave or provide services.

It begs the question of whether there is a best practice for universities in addressing students with eating disorders. While nothing formal exists for the field of eating disorders, it’s heartening to know that 55 universities very recently signed up to take part in The Jed & Clinton Health Matters Campus Program, a program evaluating mental health services on campuses. The universities will take part in self-assessments and commit to improving their practices.

I can only hope that one of the outcomes of such an initiative is to develop effective ways of managing individuals with eating disorders on college campuses. With prevalence rates of eating disorder symptoms nearing 20%, it’s not an issue that can be ignored.

Further, it’s not an issue that can be addressed with a one-size-fits-all approach. Taking the stance that students with eating disorders cannot continue with academic pursuits can be short-sighted. We have to consider the particular student and the potential impact of having them step away from their university. For some students, college can be incredibly helpful in the process of recovery, providing a source of focus and meaningful activity outside of the disorder and the chance to socialize and interact with people not trapped in the grips of their own disorder. Some students find that leaving school sends them into a spiral of depression and anxiety, feeling like all they have left in their lives is their eating disorder.

Of course, this is not the case for all students. Many very much need to step away from the school environment in order to give themselves a chance to really reflect and focus on their recovery process. College campuses aren’t exactly known for promoting great eating and health habits, and the stress of academics can sometimes make it impossible to participate fully in one’s own treatment. For students with severe eating disorders, taking time off to address their health — just as they would do with another health condition — can be life-saving.

The point is that protocols are nice in theory, but cannot forget to take into account the individual needs of individual students. While campus suicides and other deaths are heart-wrenching for a school, colleges also cannot react to student mental health concerns from a place of fear. This only leads to further stigmatization, which students with mental illness already face on a daily basis.

If you struggled with mental health issues during college, how did you university handle things? What kinds of practices do you think would be most effective in getting students the services they need? 

06 Oct

All of the Things that Irk Me in One Single Subway Ad!

Advocacy 1 Comment by Ashley @ Nourishing the Soul

For anyone that knows me in my non-virtual life, you are likely aware of my frustration around Halloween. A few years ago I would have called it my “disdain” for the holiday, but I’m working on modulating my feelings about this day and recognizing that there may be some redeeming qualities. Like adorable children in costumes with chocolate smeared on their faces.

But back to my frustration before I get too sappy about this over-commercialized day that’s become based on things I generally detest: scaring people for fun and the sexual objectification of women and girls.

I’m just really not a fan.

Amazingly, Subway restaurants has managed to take my irritation to the next level by combining this holiday (in fact, the exact aspect of it that I despise) with both unsubstantiated nutrition advice and dieting pressure.

I think my head might explode.

Just watch the commercial:


So what we have here is clearly a case of “how the heck do we get people to continue fretting about their weight now that it’s sweater season?” From that standpoint, it’s a relatively clever marketing effort. But since I’m not a marketer and more on the side of a media literacy advocate, I’m going to tell you how utterly crappy I think this campaign is.

It’s utterly crappy. The woman in the ad explains to her presumable co-workers that you need to stay fit for Halloween costume season, specifically the costumes that all women are obviously dying to wear — attractive nurse (because how could I possibly catheterize you if I’m not a “10″?), a sassy teacher (because we haven’t seen recently in the news various reports of  child sexual abuse by educators), and — oh, yes — the foxy full-back (I mean, how tone-deaf can you possibly be right now?!?).

To stay fit, the trio should obviously be eating Subway sandwiches rather than the dreaded burgers. But when we take a closer look, Subway doesn’t pan out to be a much – if at all – healthier option than McDonalds. A UCLA study showed that adolescents purchasing meals from the two chains consumed about the same number of calories and even more sodium at Subway. So there’s that.

Another ad promoting the objectification of women, unsubstantiated health information, and weight-stigmatization? I know, yawn, right?  But this one really peeves me I think because of the Halloween tie-in. (Call me a cranky Halloween Scrooge — I can take it.)

If you’re as irritated as me, consider speaking up by leaving a message via the website, posting on social media, avoiding Subway, sharing this post, or starting a petition.

Trick or treat!

05 Oct

Programming Note, Part II

Ideas to Consider 1 Comment by Ashley @ Nourishing the Soul

I truly had hoped that the post I wrote back in April explaining my missing person status would be the last of that type of post I would ever have to type.


Call it relatively-new-and-somewhat-still-naive-mom-syndrome, I suppose. That April post gave me a little kick-start and I was able to keep up with posting periodically through the start of the summer, sharing things like my feelings on chocolate milk and my curiosity on the lack of size diversity in our field. But then came a firestorm of transitions.

To name a few: I relocated with my family back to my hometown, and in the process purchased a 130+ year old home. The house is absolutely amazing and perfect for our little family, but doing some important projects and creating a home for ourselves has been a labor of love. We’ve poured most of the moments that we weren’t working (you know, for, like, money) and caring for our son into trying to make our space beautiful and ours. I’m happy to report that it is just about complete — at least, based on what we want to accomplish at this stage.

Just in time for — baby! As I mentioned back in April, I’m expecting a new little one in October. So now it’s October and we’re counting down the days to meet our precious gift. My due date is in one week, meaning baby could come at any time over the next couple weeks, putting me just a teensy bit on edge and in nesting mode. I’ve been working to prepare the baby’s room, making meals to freeze, and doing what I can to get our son prepared for this big transition.

And finally, I’m working on birthing another wonderful being — a new treatment center here in my hometown. I promise to share more details of that soon, but suffice it to say that it has been another labor (no pun intended) of love and an amazing process.

So with a few things going on, it’s been challenging to get myself into a chair to write for the past few months. I’d like to say that maternity leave will afford me some more time to focus, but I’m not that delusional, okay? I’m going to do my best to get back to this space more frequently because it truly inspires me and the work that I do. I love sharing my thoughts and questions with all of you and getting such a thought-provoking feedback. So don’t delete NTS from your Feedly just yet! Also feel free to drop me a line over on the Facebook page or via Twitter anytime.



10 Jul

Where are the fat eating disorder therapists?

Ideas to Consider 7 Comments by Ashley @ Nourishing the Soul

A few weeks ago, a wanted-to-be scientist name Rachel Fox, bravely shared the fat-shaming she’s endured during her years as an undergraduate science major at a prestigious university. The overt and covert discrimination by the scientific community has led her to make the decision to say goodbye to the field altogether.

Her story should make us angry. Not only on her behalf for another human to have to endure insensitivity and harassment based on size, but also for ourselves. We’ve just lost a potential brilliant scientist because our society is so bigoted that we can’t see talent beyond a jean size. She could have been the next scientist to cure a terminal illness or discover a new planet. What if Jonas Salk or Stephen Hawking were told to avoid milkshakes and made to feel less than?

Fox’s op-ed piece left me reflecting on where else larger people are missing. I started to look around at my own field and wondered… how many aspiring therapists have changed course because they didn’t feel welcomed by the community?

In the field of eating disorders, I’d anecdotally suggest that there is a disproportionate number of clinicians with smaller bodies, as compared to the general population. I can take educated guesses as to why this might be. One reason might be that of fields in psychology, those with histories of their own eating disorders are perhaps drawn to working with this population. And while the vast majority of clinicians with their own histories of eating disorders are fully recovered, they may continue to be more aware of their own body size and possibly engage in some weight-control practices. More optimistically, it could be argued that these clinicians may be disproportionately smaller because they tend to be more mindful about their eating, practicing what they preach and not using food in unhealthy ways.

But the cynic in me wonders if there is not something more disheartening going on. Are we losing therapists of larger body sizes because they are not feeling welcomed into this field?

There is some research to suggest that this may have some validity. For starters, patients with eating disorders are often considered to be much more highly attuned to others’ weight and shape, including those of their therapists. While some with eating disorders claim that they “judge” only their own bodies, many others acknowledge feeling hyperaware of others’ bodies and even making assumptions about their therapists based on body size. A recent study (Rance, Clarke, & Moller, 2014) examined patients’ perceptions of therapists bodies and found that some patients assessed a fat therapist as less trust-worthy and more likely to lose control. This study asked patients to report on their experiences, but often the beliefs, assumptions, and feelings are less overt and conscious. It’s not difficult to imagine how a patients’ weight bias, particularly in the midst of an eating disorder in which weight and shape’s importance often gets elevated, can create a seemingly hostile environment for a therapist.

I wonder, though, if more of that hostility and distrust doesn’t actually come from within our own ranks, however. A study by Puhl, Latner, King, and Luedicke (2013) reveled weight bias among eating disorder professionals. In fact, 56% of us reported having observed our colleagues express negative comments about obese individuals. If more than half (and I’d suggest it’s actually much more than half) of us observe these behaviors occurring — and are we addressing them? — it’s easy to imagine how uncomfortable a fat therapist might feel in that setting.

Just as in the STEM field, the eating disorder realm is full of assumptions about what professionals should be doing with food. Insiders and outsides, explicitly and implicitly, seem to assume that someone who treats eating disorders should be of a middle-of-the-road weight, or even thin. If someone deviates from this, the assumption becomes that they must not really know how to manage a relationship with food. Thus, how in the world could they teach or inspire someone else to do the same?

Obviously — or, apparently, maybe not so obviously, these assumptions are unfounded. But they permeate our experience in this field and it’s easy to see why we don’t observe as much diversity in body shape and size among therapists.

Perhaps the best thing that we can do to avoid losing talent and diversity is to become ever more aware of own stereotypes and biases. Once we can acknowledge these, we can take more conscious steps to not allow them to guide our decision making and treatment of others in our field.

Do you think people of larger sizes are underrepresented in the eating disorder field? Why or why not?


**Please note that I don’t believe that there are not fat eating disorder therapists. I personally know many. I do believe that there aren’t as many as one might expect and that there are reasons for this…

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