Many of my clients comment that co-workers, friends and even sometimes family are not understanding of their diagnosis or why they are eating a certain way. It is difficult to be in social settings with food and feel like you aren't eating like everyone else, or able to eat anything at all. I reached out to a licensed mental health counselor, Denise Cutshaw to get her opinion on how individuals can deal with outside pressure when given a diagnosis that effects the foods they can eat. Enjoy! And at the end of her blog are a few extra questions I had for her.

Whether you, or a loved one such as your spouse, child or other family member has been recently diagnosed with any type of gastrointestinal issue, food allergy or intolerance, it can feel very overwhelming. You start with educating yourself on the types of foods that are “safe” and may even reach out to a registered dietitian to help you with a food plan (highly recommended!).

Then…the feelings set in as you begin to navigate through get togethers, parties, celebrations, holidays, office breakfasts/lunches, and traveling. Common feelings that may arise are loneliness, isolation, feeling misunderstood, frustration, anger, defeat, anxiety or even depression. If these feelings are persistent for you, it may be beneficial to talk with a counselor. Counseling can help someone with a recent food allergy/intolerance or autoimmune diagnosis, such as celiac, better cope with these feelings and how to ask for help and support from loved ones and friends. Children can especially find benefit in talking with a counselor and seeking out support groups to help normalize their feelings by being exposed to others with similar circumstances.

Counseling can help an individual process and work through some of these feelings through different modalities of treatment. Cognitive Behavioral Therapy is extremely beneficial in identifying one’s thoughts, feelings, and behaviors as it relates to food and outings with food. Assertiveness skills can be taught and reviewed as a means of making sure you build a safety net around your core people that are aware of restrictions and are sensitive to your needs or the needs of your child. Thirdly, psychoeducation can be provided through the counseling relationship as well as with your dietitian on acquiring knowledge and education on your limitations/diagnosis.

Life transitions and events can certainly contribute to an onset of depression and/or anxiety. When to be concerned or seek out help for depression and/or anxiety symptoms depend on a multitude of factors. Consider these presenting factors for depression and seek counseling to help address these:
1- Depressed mood most of the day (in children and adolescents, they can present as irritable and/or withdrawn
2- Diminished interest in pleasurable activities
3- Weight loss (specific to lack of appetite)
4- Sleeping too much or too little
5- Fatigue or loss of energy
6- Feelings of worthlessness
7- Difficulty concentrating that affect completion of tasks
8- Suicidal thoughts

- These symptoms cause significant impairment in one’s ability to function socially and/or occupationally. Symptoms persist for 2 weeks or more.

Consider these presenting factors for various types of anxiety and seek counseling to help address these:
1- Excessive anxiety and worry about events and activities (such as work or school performance)
2- Difficulty controlling the worry
3- Restlessness, feeling keyed up or on edge
4- Being easily fatigued
5- Difficulty concentrating or mind going blank
6- Irritability
7- Muscle tension
8- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)

​- These symptoms cause significant impairment in one’s ability to function socially and/or occupationally. Symptoms present more days than not in the past 6 months.
- Another aspect that may be affected is social interactions. Consider these presenting factors for social anxiety and seek counseling to help address these:

1- Fear or anxiety specific to social settings, in which a person feels noticed, observed, or scrutinized. (In children, the phobic/avoidant behaviors must occur in settings with peers, rather than adult interactions, and will be expressed in terms of age appropriate distress, such as cringing, crying, or otherwise displaying obvious fear or discomfort).
2- Fear of being anxious or having anxiety symptoms in front of others
3- Social interaction will consistently provoke distress and therefore avoided.

- These symptoms cause significant impairment in one’s ability to function socially and/or occupationally. Symptoms present more days than not in the past 6 months.
- In conclusion, whether it’s you, a friend, family member or a child, counseling can really help address these feelings and provide coping skills and tools to manage these symptoms. The best place to begin is to contact your insurance company as they can help assist in locating a counselor that is convenient to you, accepting new patients, and has experience in the areas you wish to address. Contact your member services number on the back of your card and ask for behavioral health outpatient counseling. Another helpful tool is a website www.psychologytoday.com. There you can search therapists, locations and specialties. If you do not have insurance, many counselors will work with you on a sliding scale fee. Help is available and you are definitely not alone!

Questions for Denise:
Question: How should patients/clients deal with co-workers, friends, etc. that continue to make comments about what they are or aren't eating? Even adults can somewhat "bully" another adult and make them uncomfortable in social situations with food. Often times these individuals avoid situations that involve food because it is uncomfortable, especially around those that don't understand. This comes up with a handful of clients and it is easy for me to tell them to tell their co-workers it is a doctor's order, but this doesn't always make the situation better.

Answer: It's hard to deal with people that don't understand and make comments about food whether they are rude comments or bringing attention to it. Some ways to manage that is to be as educated as you can be on what foods are "ok" for you and why so you can respond with "I've learned so much about what works for me" or "it was a little difficult for me too at first to understand, but I've really educated myself and found what works and it is helping tremendously".

When loved ones that we are very close to continue to make comments, using "I feel" language is also helpful. For example. "When you make comments about my food, it makes me feel anxious and on edge. I need for you to be understanding of my food choices and not make those comments". That type of language allows an openness about how the comments make you feel and if the person is still unable to honor your needs, you can then decide to restrict your time with them, especially around food. You can also invite close loved ones with you to a dietitian or doctor appt. to assist in education on the matter so they have a better understanding.

Question: Do you encourage a significant other (if the person with the diagnosis is an adult) to join them for these professional visits, such as with the dietitian or yourself? Some family members are not supportive, so do you think it helps to have them present or hurt? I see this with individuals that have been dealing with these GI issues for a long time.

Answer: As a counselor, I truly feel that getting as many people involved in your care is so very important. It can assist in the person's support network with education but also insight into the feelings of the person affected and how these food issues impact them on a daily basis. For children, any caregiver that will be caring for the child and feeding them meals or snacks would benefit from attending any appointments as well. Even the parents of friends of your child can be educated and provided a "safe list" of snacks and foods okay to eat while your child is over at their home playing. This helps reduce any potential anxiety for the parent or child and the child doesn't feel "singled out" having to sit out for snacks during play times.

Overall, being assertive and open is always best in the care for yourself or your loved ones who struggle with food issues. If you're finding you're avoiding situations around food either yourself or your child, it could be an indication you may need to be more open and assertive about your needs or the need of your child as well as your feelings so people can better understand and be educated.

Denise Cumshaw, LMHC is on leave at this time and not accepting new patients, but if you need more information or feel like you may benefit from counseling services please contact her at dmcutshaw.lmhc@gmail.com.