At around age 14, English McBride started noticing that she had a problem which would come, by her college years, to affect her entire life: an eating disorder.
“A few years ago, my eating disorder blew up,” McBride said. “I had some things happen and I was pretty depressed. I had gone through a pretty bad breakup, and I had quit my job, and so I needed a project. And it turns out I’m good at losing weight. So [weight loss] was a good goal that I thought I could reach. And I started to feel good about that. Then you start noticing the attention that people are giving you. So I dropped a bunch of weight in 2013.”
She felt like she was in a competition with herself.
“You can’t be deep and heavy into an eating disorder, as an adult, and have friends that are going to cosign with my behavior,” McBride said. “So, I slowly started losing friends. I lived alone, with my two dogs, so it was just like me and my dogs and my eating disorder for months and months and months. Last winter was cold, dark and miserable. It was a really dark time. I had all these notes where I would scribble down what I had eaten. And, occasionally, when I would have a meal, I would throw it up,” she said.
“The last two months, before I went to treatment, I had these Hershey white chocolate drops,” she said. “I would constantly be eating those candies. But that’s all I would eat. I knew I had completely lost control. I had no friends left. It was nothing but me.”
She went to an inpatient treatment center, and her first day there was on Valentine’s Day. “I always say that that was the day that I started to love myself,” she said. “I know it sounds kind of cheesy, but it’s my truth, because that’s where the journey begins. I never had any self-love or self-respect as a 14-year-old girl; otherwise, I would have respected my body.”
After a few months at the inpatient center, McBride was looking for an outpatient center, and that’s when she decided to go to ACED — A Center for Eating Disorders.
“I had heard about ACED before,” she said. “They were like chirps in my ear. And now I believe that was like God putting words in my ear. I had just heard it [ACED] mentioned two or three times, and we were like, ‘Let’s try it.’”
By focusing on an integrative approach for treatment, ACED, located on Birmingham’s Southside, tries to help those struggling with anorexia, bulimia and other eating disorders.
How prevalent are eating disorders in this area? The nonprofit National Association of Anorexia Nervosa and Associated Disorders (ANAD) says that, according to 2007 National Comorbidity Survey Replication figures, more than 113,000 women or girls and more than 49,000 men or boys in Alabama suffer from eating disorders.
“Eating disorders are a group of serious conditions in which you’re so preoccupied with food and weight that you can often focus on little else,” according to the Mayo Clinic’s website. “The main types of eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder.
“Eating disorders can cause serious physical problems and, at their most severe, can even be life-threatening. Most people with eating disorders are females, but males can also have eating disorders. An exception is binge-eating disorder, which appears to affect almost as many males as females.
“Treatments for eating disorders usually involve psychotherapy, nutrition education, family counseling, medications and hospitalization.”
By the numbers
Anorexia nervosa has the highest mortality rate of any psychiatric disorder, with the mortality rate for females 15 to 24 years old being 12 times higher than all other causes of mortality, according to data presented on the website of the National Eating Disorders Association (NEDA).
According to facts NEDA compiled from several sources, the rate of development of new eating disorders cases has been increasing since 1950, with increases in the number of anorexia cases in young women 15-19 each decade since 1930. Bulimia cases in girls and women aged 10 t0 39 tripled between 1988 and 1993.
Eating disorders, according to NEDA, are accompanied by elevated incidences of substance abuse, obsessive-compulsive disorder and a wide range of significant health consequences.
“Eating disorders are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships. They are not a fad, phase or lifestyle choice. Eating disorders are serious, potentially life-threatening conditions that affect a person’s emotional and physical health. People struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery,” reads the NEDA website.
There are a number of clinics or centers in Alabama providing treatment for eating disorders. The website of Eating Disorder Hope contains a list, which includes ACED.
“Eating disorders are the manifestation of serious underlying emotional issues and a way to cope with psychological stress,” reads ACED’s website. “We focus on uncovering these issues, addressing them and teaching healthier coping skills. We work to free the human spirit from an eating disorder through healthy relationships, self-empowerment, self-realization and connectivity.”
“I think of [eating disorders] as the cancer of the mental health world,” said ACED founder Renée Miller, a Birmingham native. “Not everybody is going to recover. We don’t know why. But everybody has the option to recover. I think we’re still learning what really works.”
While ACED operates within a standard-care model, its staff members focus on showing clients they believe in them and trust them, Miller said, meaning that each person has the freedom to either recover or fail. But the hope is that with the proper support, clients will be able to deal with failure in such a way that the likelihood of its recurrence will be reduced.
“I want each client’s motto to be ‘living with fierce grace,’” Miller said, “to honor your fear but not be motivated or driven by it.” She hopes the programs at the center will give clients more autonomy, to increase their quality of life so they will have something to move toward. “We’re not helping them find themselves, but remember who they already are,” she said.
When she was younger, Miller herself dealt with an eating disorder. She suffered from chronic anorexia, to varying degrees, for over a decade, being in and out of hospitals and in-patient treatment centers. Experts in the field told her that she would not recover.
However, in her late 20s, she found a treatment center in California that was able to give her the ability to overcome her condition and improve. “I was lucky enough to find a place that, at the time, was sort of pioneering advances in treatment, and doing things very, very differently,” Miller said.
“It was the last time I ever had treatment. They didn’t treat me like a patient. They treated me like a human being with a coping skill issue, as opposed to someone with a number. It was the first time that anyone told me that I could get better,” she said. “In fact, they expected me to get better. Everywhere else I had been, they had just expected me to be sick.”
Miller wanted to take the lessons she learned while in her own treatment and start a place that could help others in similar situations. She earned bachelor’s degree and then a master’s degree to become a licensed marriage and family therapist. After stints helping people with eating disorders in various parts of the country, Miller went on to found ACED in 2009 at its current location.
The treatment programs at ACED are varied and aim at being more holistic in nature, addressing not just the symptoms of an eating disorder, but also the root causes that can become the foundation for the condition to persist. “The worst part of living with an eating disorder is living with this constant conflict in your own soul,” Miller said. “You’re engaging something that goes against our innate nature to nurture and feed ourselves to live. That creates this ongoing anxiety that propels a sense that something is wrong at a very core level that you have to address. In order to heal yourself, you have to re-integrate those two things and live congruently.”
ACED’s offerings include the Intensive Partial Hospital Program, or I-PHP. It is a daytime treatment that lasts anywhere from eight to 12 hours per day. “[The I-PHP] mirrors a residential schedule while allowing a certain amount of autonomy [for clients] to explore the triggers necessary for recovery,” Miller said.
The Standard Partial Hospital Program (Standard PHP), which lasts from five to eight hours a day, “allows people to stay close to home or be less restricted than 24-hour care at half or less of the cost of residential programs, when appropriate,” Miller said. “Oftentimes insurance wants to try PHP levels of care to avoid the more restricted and costly programs unless absolutely necessary.” She said that Standard PHP allows clients to stay in treatment for a longer period as well as to integrate issues along the way.
ACED also provides the Intensive Outpatient Program (IOP), which lasts three to four hours a day, as many as six days a week. “[IOP] is adjunctive to ongoing outpatient therapy when [a] client requires intervention to avoid higher levels of care that may then require removal from daily life functions for a period of time,” Miller said. “[This program] works well for people in school or working who can’t take a leave of absence, etc.”
The center’s Outpatient Program (OP) is composed of weekly, one-hour sessions that take place at different times each week. Some forms of OP will have the client working in a group session, with a therapist or with a dietitian.
ACED also offers free consultations, assessments and referral services, in addition to community support groups. Depending on the type of insurance the client has, some programs and services will be covered, while others will require private payment. “All care is individualized based on each individual client and their need,” Miller said.
Outreach is also important at ACED. At the beginning of next year, the center will be offering a program called “The Living Room,” as well as a monthly outreach brunch with art. “We will be adding adjunctive support for therapists in the community who think their client may not need an actual full program, but perhaps meal support or a few groups a week or time with a dietitian, etc. [We want to] collaborate with what’s already happening out there,” Miller said.
There are individual program components designed to make treatment at ACED more integrative of the patient’s psychological, nutritional, spiritual and medical needs. As a part of that, ACED has a partnership with The Yoga Circle. “We try to get clients out of the gym mentality,” Miller said. “They can go to any of the classes at The Yoga Circle, just to give them an opportunity to cope differently.”
Art is another part of the treatment. Dr. Christianne Strang, who is a behavioral neuroscientist at UAB, works as an art therapist at ACED. She has also worked for Florida’s Renfrew Center, which is the oldest and largest eating disorder center in the nation. “I’m a registered, board-certified art therapist and work part-time at ACED,” Strang said via email. “I work with the clients in art therapy groups and in some cases in individual art therapy sessions.
“The idea behind the use of art therapy, and other experiential approaches, is to use non-verbal methods to support the work that occurs in verbal sessions, to provide alternate methods for expression of emotions, to identify heathy and unhealthy behavioral patterns, and/or to promote the development of alternative coping skills,” Strang said.
“Art therapy is not about making pretty pictures or learning to draw and paint, but about accessing creativity, reinforcing strengths and finding a voice when there are no words,” Strang said. “The art is not always pretty, especially the most powerful art. If what we create and what we do reflects who we are and how we feel, the art provides an alternative voice for experiences and feelings. Sometimes words just aren’t enough.”
At ACED, there are work spaces for clients to create, including a room where there are not only drawings but also footprints on the ceiling. “We use a lot of experiential and art therapy,” Miller said. “We’ve had many clients who have been through treatment so much they could probably run a group. They just know the language, the lingo and how to do it. So, we try to incorporate a lot more experiential and expressive therapies, improv, writing, photography and other things that are much more tactile and internally engaging, rather than just trying to dialogue.”
The art and experimental therapies are important for therapists and clients, she said, “because it highlights how they engage, how they process, where they distort, and what they’re thinking. And while it gives us an opportunity to help them work with one another, it also gets them engaged in things where they’re not overthinking, because they tend to overthink.”
In Miller’s office, several pieces of artwork adorn the walls, made by different clients, past and present. One painting has a molding of a hand on top, appearing to be coming through the portrait. There are dark colors on one side of the hand and lighter tones on the other. The hand appears to be reaching from the dark towards the light, symbolizing the journey that the client had endured. The artist however said that turning the painting upside down, more aptly portrayed what it was like to reach from the light into the dark, Miller pointed out.
Hope and realism
The ACED approach is helping some clients move forward in their struggle against eating disorders.
“I was in a place where I just needed someone to baby me,” said English McBride. “I was very much like a child, even though it’s just a few short months ago. I was just in a place where I was so broken, and I didn’t know who I was, and I didn’t have any concept of what recovery looked like. But Renée always liked me. She always laughed at my jokes and laughed at my honesty.
“I am who I am, and she respected that,” McBride said. “Renée just helps me see the truth in myself. She’s not making stuff up. What’s she good at doing is using her knowledge and seeing the beauty in another individual, and pulling it out.”
The changes that McBride saw in herself echoed Miller’s desire for clients to remember who they already are, instead of trying to become someone different. “I’m not a new person now that I’m in recovery. I’m the same person. But I’m just allowing my spirit to shine and not covering it up with all these distortive behaviors,” McBride said. “I’m not starving myself anymore, so that allows my brain to function properly.”
The staff members at ACED not only have provided McBride with therapy for her eating disorder, but they also have helped her with other important aspects of her life. “I learned how to budget,” she said. “I’m learning how to pay bills. They’re teaching me how to do that. I moved into my own apartment, and they’re teaching me how to deal with that. It’s amazing. They taught me how to do everything. They taught me how to eat. They taught me how to be an adult,” she said.
“But I made a decision,” she said. “I turned it over. My way was not working. I sort of gave it up and I started following rules in a treatment center, immediately. I was out of ideas. I gave up trying to fight the system. ACED is my family now. I got to feel loved and be part of a nuclear family.”
“I feel like I’ve been catapulted into a new dimension of what life can really be like,” McBride said.
“Life isn’t always about a ladder from one thing to the next,” Miller said. “On the playground of recovery, it’s not a ladder, it’s a jungle gym. This person may find their path here, and that person may find their path there; but at the end of the day, they both find their way to the other side of the playground. But every single one of them got there differently.”