Dr. Jordana Mansbacher | Blog

What? You don’t believe that you have value? You are always striving to achieve more; to look better?

It is a viscous cycle and if you do not change the way you think you could be heading for danger.

Amanda Beard, the Olympic swimmer who won 7 medals, suffered from the same damaging thoughts that eventually led her to suffer from an eating disorder, cutting behaviors and depression.  She has been interviewed about the effects of being in the public spotlight that not only focused on her athletic success, but also her body.

She mentions that even though she was in Olympic shape, when she would see photographs of herself there was so much editing done to her body that she began to think differently about herself. She noticed that inches were taken off her body, wrinkles were smoothed and her complexion was changed. This distortion of her body made her try to achieve what the photographs were showing as the image to achieve and as a result she started became bulimic, depressed and used cutting of her skin to feel any kind of relief.

She has been to therapy to treat her self harming behaviors and depression and has found a way out of her misery. But what does this say to those of us who have not achieved Olympic success and still are trying to find ways to be better at something?

We all need to slow down, inject reality into our automatic thought patterns and learn that we have self worth in things we already do. If you are not able to do this on your own, you need to seek out professional help to guide you or you may suffer more deeply than you are currently.

Make a list of the things that you are successful at. Anything can go on this list. For example, list all of the ways you are meeting yours or your family’s needs, or list all of the work or school projects/assignments that you have completed on time. The more specific and nit-picky you are, the better.

You are worth a lot to many people. Sometimes you forget this, but if you stop and take a look around, you may actually begin to start liking yourself again. Remember that? You did once feel you were pretty special!

-Dr. J

 Post Traumatic Stress Disorder is a very real disorder that develops out of exposure to a real or perceived threat of death or some other kind of trauma. Those suffering from PTSD have survived war situations, sexual abuse, physical abuse, rape, threats upon their lives, burglaries, watching a traumatic event unfold before them such as those people who witnessed the 9/11 attacks in New York, years of being the target of bullying and many other terrible disasters that affected them psychologically, mentally and physically.

Once exposure to a traumatic event has occurred, one may develop post traumatic stress disorder. Some of the symptoms of this disorder include:

1. Intrusive memories or thoughts
2. Flashbacks of the event
3. Avoiding places that remind you of the trauma
4. Feeling numb
5. Avoiding activities and social gatherings that you once enjoyed
6. Problems with memory recall
7. Difficulty feeling safe in your personal relationships
8. Feeling on edge all of the time
9. Constantly feeling like you need to be aware of your surroundings, like you are on high alert
10. Sensitivity to touch, sounds and other senses
11. Irritability
12. Feelings of guilt or shame about what happened to you
13. Insomnia or trouble falling back asleep if you wake up in the middle of the night
14. Feeling jumpy or on edge

If not treated, these symptoms can last throughout your life and are very distressing, emotionally exhausting and overwhelming. It is not uncommon to self medicate with alcohol, drugs or prescription medications to calm yourself or to numb yourself. However, that practice can cause other problems such as addiction.

One way you can tackle some of your symptoms is engaging in an exercise described below. Since PTSD is a form of anxiety, and anxiety is about feeling out of control due to things that occurred in the past or fear of things occurring in the future, the goal of this exercise is to bring you back to the present.

Follow the steps listed below to help you gain control.  You can practice these exercises when you are calm so that you can readily remember them when you are triggered. If you are triggered, use these steps to help you lower the severity of your symptoms.

1. Look around and name 5 things that you see. Say them out loud if you can. If you cannot, you can mutter them under your breath or write them down.

For example, you may say the following: “I see a billboard on the street and it is an advertisement for a new television show coming out. I see a woman walking her dog. She is holding onto a red leash and the dog is medium size with patches of brown and white on its body and it looks like it has a pink, wet nose. I see a tall building that has about 14 stories. It is a grayish looking building with tinted windows. I see a house with a big front yard. There are a lot of bushes and flowers. The colors I see are reds, yellows and oranges. I see a couple walking on the sidewalk and they are holding hands. One of the people is wearing a bright blue top and the other person is wearing black pants and a button down shirt.”

2. Next, name five things you can feel or touch and again say these out loud if you can. These can be your pants, your hands, your seat, your bag, your computer, and the soles of your feet in your shoes. Once you identify the things you can feel, say out loud the way these things feel. If you are describing the feel of your pants, you can say “I feel my pants on my legs. Today I am wearing jeans. They feel somewhat rough, but also smooth”. Do this for 4 more items. Try to concentrate on your sense of touch. Again, this will bring you back to the present moment.

3. Finally, name out loud 5 things you can hear. It can be the hum of a motor, traffic outside your window, and rain on the pavement, an airplane in the sky or a conversation between 2 people who are nearby.

4. Once you have completed this process, repeat it from the beginning, naming only 4 things in each category and then repeat the process again naming 3 things. Once you get down to 1 thing in each category, you should feel less emotional reactions to your PTSD symptoms.

The whole point of this exercise is to remind all of your senses that you are in a safe place. When PTSD symptoms occur, they take you back to a place where you are sometimes re-experiencing parts of your trauma situation. You may be smelling an odor, or hearing noises that remind you of what you endured. By concentrating and naming the items that your senses are experiencing in the present, your mind has to compete with the trauma memories. If you work hard at this, you can learn to retrain yourself to begin reminding yourself that you are currently safe.

-Dr. J

I just read a quote that resonated with me and wanted to share it with you. It said “Blowing out someone else’s candle does not make yours burn brighter.”

How often do we find ourselves envious of others?

We think they have better jobs than us, more money, better clothes, more friends, live in a better house or neighborhood, make more money, have a better relationship, look better than us, etc. etc. etc. This is putting yourself in a competitive mode and it is not healthy.

There will always be others who are smarter, better looking, taller, faster, wealthier, skinnier, more popular and the list goes on. But why do we always think the grass is greener on the other side?

Here is the answer.

It has to do with our early experiences as man evolved. It has been proposed that because early man had to compete for resources such as food, water, territory and even light from the sun, competition was just a part of survival. If you had weak members in your group, you would suffer loss of life, loss of resources needed to keep your clan alive and reproductive.

Darwin explained in his theory of natural selection that we are wired to seek out those who are the strongest to ensure our survival and that the weakest beings would die out.

Yet, today our competitiveness has to do with wealth, beauty, ability to purchase material goods, ownership of name brand merchandise, even how fast we drive or if we can “beat” the other person once the light turns green by sneaking up to the side of a car at a red light.

Though many people think that today’s competitive behavior is different since we do not need to fight for food, water or light, I believe that it is just the same as thousands of years ago. What we may be competing against seems different; it is just the same, only for different products.

Add to this the economy problems that we are currently dealing with, we are competing for jobs as many of us had never seen before. Though our economy goes through its ups and downs through the years, some of us are seeing and experiencing people applying for jobs that they feel they are over qualified for in order to have a steady income, benefits and health insurance.

Thus, competition is part of our built in survival instinct. Call it what you want, but when you see a line of people waiting outside a store for 12 plus hours to get their hands on the latest fashion item, you can see that ingrained need to be the first one to get the goods is based in our need to be on top, to be envied and to have the coveted bragging rights that for a moment makes us feel as though we have won.

But did we really win anything important?

You decide.

-Dr. J

According to the Centers for Disease Control, about one third of adults in America are obese. That means that 33.5 percent of people living in America today meet the criteria for obesity, one must have a body mass index of 30.0 or higher.

Body mass index is a measurement of body fat based on a person’s height and weight. Below are some examples of height and weight combinations that set someone in the obesity category.

*A female who is five feet six inches tall and weighs 186 pounds, has a BMI right at the 30.0 point which is considered obese.

*A female who is five feet four inches tall and weighs 175 pounds, has a BMI right at the 30.0 point which is considered obese.

*A female who is five feet two inches tall and weighs 164 pounds has a BMI right at the 30.0 point which is considered obese.

*A male who is five feet nine inches tall and weighs 203 pounds, has a BMI right at the 30.0 point which is considered obese.

*A male who is six feet two inches tall and weighs 234 pounds, has a BMI right at the 30.0 point which is considered obese.

Being obese comes with two times the likelihood versus someone who is of average weight to die prematurely because of illness that are linked to obesity.

These illnesses include:

1. Heart disease and stroke
2. High blood pressure
3. Diabetes
4. Certain types of cancer
5. Gallbladder disease and gallstones
6. Osteoarthritis
7. Gout
8. Breathing problems, such as sleep apnea and asthma.

Many of these illness are chronic and can be managed medically, but are sometimes irreversible.

Another alarming new study found that obese older adults are at a higher risk for memory impairment. The study examined participants between the ages of 70-89 and collected information about their daily caloric intake. Those who ate high caloric meals every day suffered memory impairments.

The researchers suggest that continuous over eating leads to less oxygen in the brain resulting in structural damages and thus leading to memory and cognitive problems.

Thus, the writing is on the wall. If you are overweight, or obese based on your BMI calculation, you are already at a higher risk of developing some of the above illnesses. But, you could also be setting the stage for future memory and cognitive impairments.

-Dr. J

 It has been called the “eating disordered brain”, but what does that mean exactly?

 Below are some examples of studies and research conducted with patients suffering from anorexia and how the disease affects their brain functioning, brain weight, behaviors, the ability to experience pleasure, sleep problems and can even result in death.

*One study, confirmed that anorexic patients cling to familiar behavioral responses more frequently than healthy subjects, thus suppressing alternative behavior. Brain images also showed that in patients with anorexia compared with healthy subjects, a certain network pathway between the cortex and the diencephalon is less activated.

This network pathway plays a decisive role in initiating and controlling actions under rapidly changing environmental demands. This makes decreases one’s ability to plan, concentrate, have motivation, and be able to make quick decisions needed in cases such as driving.

*Another study measured brain volume deficits among underweight patients with the illness to evaluate if the decline is reversible thought short-term weight restoration. The scans indicated that when the women with anorexia nervosa were in a state of starvation they had less grey matter brain volume compared to the healthy women. Those who had the illness the longest had the greatest reductions in brain volume when underweight.

Grey matter called the caudate nucleus, is a network of closely packed neuron cell bodies of the brain. The grey matter includes regions of the brain involved in muscle control, sensory perceptions, such as seeing and hearing, memory, emotions and speech, which is an important nerve center for controlling movement and cognitive processing.

*Persistent brain abnormalities in women with anorexia, even in those recovered (maintaining a healthy weight for a period of a year) show a high relapse rate for this disorder. According to a study at the University of Pittsburg and published in the American Journal of Psychiatry, anorexics show a decreased ability to differentiate between winning and losing, not fully experiencing immediate pleasure and possibly not appreciating the positive feelings associated with food.

*In another instance, people with anorexia performed significantly worse on tasks measuring attention, visuo-spatial ability and memory. Tasks that measured mental flexibility and the ability to learn new things, showed impairment in anorexics. In addition, when assessing the brain through MRIs a most anorexics had enlarged lateral ventricles and dilated sulci. Enlarged lateral ventricles could result in less time spent during stage 4 sleep, headaches, shortness of breath.

The fourth stage of sleep is when our muscles and our brains regenerate. This process is necessary to keep us healthy, and to keep our brains functioning normally. If this stage of sleep is shortened or missed completely, the immune system becomes weak and the brain stops functioning as it should. This can cause serious health problems such as experiencing an abnormal mental state and if one experiences a prolonged deprivation of stage 4 sleep, death is a possibility.

So if you think that your anorexic diagnosis only means that you are restricting caloric intake and may feel slightly tired or some other mild symptoms that you have rationalized or disregarded altogether, you can tell from the information above that you are in serious danger if you do not get help and back to a healthy body weight and mindset.

-Dr. J

Some of the information and studies in this blog were from published sources such as neuropsychiatryreviews, psych central, University Hospital Heidelburg, and Internation Journal of Eating Disorders and the US Library Medicine and the NIH.

Recently, I attended a community program to learn about various ways of giving back to the community.

One of the exercises the facilitator had us work on was to put in order the best ways to give, donate or volunteer and the least effective or least moral ways.

We were given 8 phrases to work with. Below are some of the phrases we used.

• Donating to a recipient with the recipient’s knowledge of the donor’s identity

• Donating to a recipient where the donor knows who the recipient is but the recipient does not know the identity of the donor

• Donating without the recipient or the donor knowing either one’s identity

• Using your time to help someone work on their resume, skill set or some form of education that you can provide

• Donating even when you have very little yourself

Most of us in this group felt that complete anonymity was the highest moral form of giving.

We were wrong. We were educated that helping another person learn skills, increase a knowledge base or mentoring someone to getting back into the work force was more valuable than just anonymously giving.

Why is this? Isn’t the standard we are taught is to give without the ability to trace back where the donation came from? Just the knowledge that you gave something from your own heart without the need to be thanked, validated or known shows a true act of selflessness?

Wrong! This is why. You may have heard the old Chinese proverb “Give a man a fish; you feed him for a day. Teach a man to fish and you feed him for a lifetime”. This speaks to how mentoring someone or teaching them something new will help them go further in life and to be hopefully self reliant. If you just give money or donate goods, then the recipient is not learning anything.

So keep donating and volunteering your time, money, goods, services. It is important to give back. But remember, you will help someone far better if you teach them how to rely on their own skills and brain to fend for themselves.

 -Dr. J

The American Academy of Pediatrics states that the following are behaviors that would indicate a child needs professional help.

• Aggression that causes physical injury to other people or himself/herself.
• Aggression that lasts longer than a few weeks, and you are unable to manage this situation in someone else or your child
• A child attacks you or someone else.
• A child is sent home from school or is barred from playtime as a result of aggression.
• You feel afraid for your safety.

Children are subject to many adult eyes on them in the classroom, on the playground, in the lunchroom, during afterschool activities, in religious activities or services, and so on. Therefore, if there is a consensus among adults, parents, teachers, and others that your child is acting out some of the above listed behaviors, it is time to get them some professional psychological or medical help to understand the reasons for this behavior.

 I also would go further and tell you that if you, even as an adult, suffer consequences of the above behaviors from someone, then you need to re-prioritize your relationship and your reactions.

Staying in a relationship where you do not feel safe, where you suffered physical injury or in which you are unable to manage the situation to bring resolution, then you may need to re-think this relationship.

Romantic relationships, friendships, familial relationships and even professional relationships at work can all result in problems. Not all problems are red flags and need attending to. Yes, people fight, they say mean things in the heat of the moment, they bring up past issues to hurt you when they feel that is their only defense. This happens in most relationships, but when it first occurs, you need to address these fighting tactics and if you cannot, then you may need to set up boundaries, decide to not spend as much time with this person or even cut  them out of your life, depending on the severity of the actions. You also need to learn what and how is the proper way to fight or engage in an argument. Yes, it is true that there is a more correct way of arguing.

What should be most alarming is if your romantic relationship is causing you physical, emotional or mental harm. This is unacceptable and you may not be aware of how this is affecting you. Of course, it takes “2 to tango”, but if you are a direct target of physical harm then I suggest you get help immediately.

For any more information about the correct way to argue or if you have any questions, please email me at drj@drjmansbacher.com

-Dr. J

For those of you who have never been to therapy, or have not had a positive outcome in therapy, I would like to take this opportunity to explain a few things about therapy, its history and some theories used by therapists in treatment.

The beginnings of therapy really started back when people sought out elders, religious disciples and medicinal healers for guidance. This practice dates back thousands of years. But the formal therapy session as we define it today, did not really begin until 1879 when a man named Wilhelm Wundt, developed the first formal laboratory for psychological research at a university to explore the nature of psychological distress to include, brain damage, mental distress and assessment of pschiatric disorders. He was able to establish psychology as a separate science from other bodily sciences and focus mostly on the brain and how we think, react and feel.

In the next 40 years, doctors trained in psychiatry would try to use their skills to not only medically manage psychological distress with prescribing medications, but would also attempt to assess their patients to understand the etiology of their particular mental problems.

Sigmund Freud is the first psychiatrist who developed a theory of the unconscious mind and how personality develops which led to the first type of talking therapy in modern times with set parameters of what a session included and how long it lasted. This was called psychoanalysis and the patient would come to 2-5 sessions per week for years. The patient would lie on a couch and Freud  would take notes as the patient just talked about whatever came to their minds, such as dreams, current feelings, etc. Psychoanalysis consists of set therapeutic goals, but it is a lengthy process and in today’s economy, can be quite costly based on the number of times per week a patient is expected to attend sessions.

Piggy backing on Freud’s theory of psychoanalysis and personality development, many researchers, psychiatrists and psychologists developed their own views of personality development and treatment strategies. Some of these theories are, Neo-Freudian, Gestalt, Adlerian, Eriksonian, Jungian, Rogerian, and the list goes on. From those theories came the development of treatment strategies in which a psychotherapist is trained in one of the above theories and specific interventions and outlines of therapy sessions. Depending on what you believed to be the best theory, you would find someone to train you in a specific set of interventions and conduct therapy based on that theory.

Presently, those of us who want to practice psychotherapy, have a range of academic programs, theories, treatment strategies, degrees and interventions to choose from. Popular treatment strategies are; cognitive-behavioral, solution focused, brief psychodynamic, psychoanalytic, person-centered, Gestalt, Jungian, systems theory, strategic-family, extended-family, humanistic and existential.

But, how do you choose a therapist and a treatment strategy with so many to pick from? The most popular answer would be that you would probably ask your family physician or a friend for a referral based on their experiences either professionally or personally with a particular therapist or theory.

Another answer, which is quite sad, is that you would go to your insurance company’s website and look for a list of providers that take your insurance and mental health benefits. The problem with this is that it limits your choices most of the time of available therapists and treatment modalities. In addition, many health insurance plans do not either have mental health benefits or, if they do, have a set number of times per year that you can be seen.

Another answer is that you have read a particular self help book based on a theory and set about finding a therapist who practices that particular type of therapy.

However, what I want you to know is that no matter whom you choose to see and no matter what degree, license or specific theoretical orientation, I believe it is the therapist’s duty to remain non-judgmental and that the course of therapy is to assist you in your particular goals.

That being said, this is a broad way of looking at therapy. So how I will describe what I just explained is to inform you of how I conduct therapy.

First, I take a few sessions to get to know you, build some sort of trust and rapport, gather and begin to understand your particular history to include how you were raised, any past issues, problems, abuse that you experienced and then discuss the current problems that resulted in your seeking out help. From there, I would explain to you how I see going about dealing with your present issues and that I may even have us engage in some work regarding past issues that were never resolved that could be the culprit of your current distress.

From there, each session unfolds based on what you tell me. I am very directive in my treatment, meaning that I ask questions along the way, ask for clarification and try to offer insight and feedback so that you understand what it is that I am hearing you say. I also work with you to find solutions, answers, new ways of communicating or coping by suggesting things and then working through the pros and cons of each one based on your feedback of how you think each new skill would or would not work for you.

I see myself as a mirror, reflecting back to you what you have told me and then you decide if what you hear from me is something you want to change about yourself or not. It is not up to me to tell you what to do. Though I do know that to change, one has to be vulnerable and ready to hear things about themselves that may not feel good. One also has to trust in the process of therapy to include feeling past pain to work through current problems, confront demons that keep you from moving forward in your life and even confront and understand why you do what you do, why you react the way you react and why you stay in situations that you know are not healthy for you.

Together, we will go through this process and find ways that will help you feel and change what you want to change.

So, in essence, I am an eclectic therapist that takes interventions from all theories and use them according to whom and what I am treating. That makes your own sessions quite personal and different from others that I treat. You are an individual, and yes, you have similar feelings and reactions and histories as many other people, but you also have your individuality and that is what I try to focus on.

In this new year, if there is something that you want to change or are ready to face, call me, email me, Skype me. I do therapy in all of these mediums.

-Dr. J

You probably have noticed that your favorite restaurant chain lists the caloric information on their menu. This is because a new law was passed applying to any restaurant with 20 or more locations to list nutritional information. However, there is some confusing information about the nutritional data listed on those menus and there are some rules that consumers are not aware of.

First, menu items that are called “specials” lasting less than 60 days do not have to have nutritional information listed. Also, if wait staff tells you about something that is off menu for that day, you won’t get any nutritional information either. Many people look forward to seasonal specials especially the BBQ rib sandwich that is popular at a famous fast food chain. Presently, this item is available for short time in some areas. Because this item is occasionally offered it is quite possible you will not see caloric or other nutritional information listed.

Second, researchers did some investigating of about 269 dishes offered at chain restaurants and found that roughly 40 percent of the items had as much as 100 more calories than are listed on the menu.

So beware if you only order foods based on the nutritional information listed on the menus. For those people who are trying to lose weight, a 100 calorie difference can add up to a lot if one is frequently eating out. Also, if you are diabetic and look at nutritional information on menus about sugar and sodium content, you also might be misled. In addition, many salads are very high in calories due to fillers such as nuts, cheese, tortilla strips and dressing. You can have a healthy salad, but when you add dressing you may be consuming as much as an additional 300 calories depending on the dressing.

A way to be more proactive is to choose healthy foods rich in fiber and proteins. You can also ask for dressing on the side so you can monitor how much you really want. And finally, go into these food chains with the knowledge that what you are reading about nutritional data can be skewed, so do not rely only on those numbers to choose your meal.

-Dr. J

As an expert treating eating disorders in my private practice, I am well aware of the physical complications that can interrupt or slow therapeutic treatment. This is why in-patient facilities are a good option for someone who shows physical declines as a result of their eating disorder. Hospital staff is comprised of nurses, MDs, and other professionals who can monitor the physical issues a patient suffers.

In reality though, many people cannot afford in-patient treatment for their eating disorder, or do not even want to be treated in a hospital setting let alone an outpatient therapist’s office. Denial about having a disorder, rationalization about eating practices or weight loss, fear that one will be force fed and having to give up ritualistic behaviors are some of the reasons people do not seek care for their eating disorder.

But eating disorders are the most fatal of all the psychiatric diagnoses! Yes, that is correct. Death from anorexia and/or bulimia is higher than having a lifelong depressive disorder, severe anxiety disorder, even a psychotic disorder such as schizophrenia.

The reason for such high mortality rates is that severe starvation in people who suffer from anorexia cause weakening of the heart muscles and cardiac irregularities. Most of the time a person will suffer a heart attack long before they even admit to others that they want help.  For those suffering from bulimia, death related to severe dehydration and gastrointestinal problems are the cause. Too many times a person will black out after a purging session because of dehydration and changes in the brain.

So if you, or someone you know has an eating disorder, please try to get them help. Gently bring up the fact that you sense there is a problem and offer to assist in finding the right kind of help. You can also mention the statistics that death from an eating disorder is higher than any other mental illness as a means of conveying your concern.

-Dr. J