Christina Miranda remembers one of the first times she became aware of her weight.
She was in 5th grade gym class when all students were asked to step on the scale and have their Body Mass Index (BMI) measured.
“Mine was higher than my friends’ and I was really upset about it,” said Miranda, who recalled being bullied in elementary school for being “chubby.”
“I had a lot of anxiety,” she said. “I stood out. I was different from other kids.”
Her focus on her weight became an obsession.
She picked up more sports and started running for extra exercise. She avoided going to birthday parties because she didn’t want to have to eat. She logged every bite of food she took, and she began throwing out her lunch at school.
By spring semester of 7th grade, Miranda had become so underweight that she nearly passed out during class and had to be rushed from school to the hospital in an ambulance.
“I didn’t think I had an eating disorder then, I felt like I lost too much weight by accident,” Miranda said. “In hindsight, these were eating disorder behaviors.”
After leaving the hospital, Miranda began seeing a nutritionist, but by then her behaviors were so entrenched that nutritional counseling alone wasn’t enough.
That summer she was admitted to the Princeton Center for Eating Disorders at what is now Penn Medicine Princeton Medical Center in Plainsboro, N.J. Eventually, the experiences she had there would turn out to be a preview of a new perspective on eating disorder recovery — one focused on harnessing hope — that is part of a new treatment program today.
But it didn’t happen right away. That summer after seventh grade was her first time ever away from home.
“I learned a lot during treatment,” Miranda said. “But my mind was not set on recovery, it was set on getting out as soon as possible.”
After spending six weeks at the Center and several more in partial hospital treatment, Miranda returned to school in September. By December, she had relapsed.
“I was so self conscious about all the weight I had gained,” Miranda said. “I stopped eating my lunches. I had to sit out of gym classes, but I would go into the bathroom or locker room and exercise on my own.”
She returned to the Princeton Center for Eating Disorders for four weeks, and decided that she would “give this recovery thing a try.”
“It dawned on me that I didn’t want to spend my whole life like this,” Miranda said. “Sometimes it seemed impossible, but I started to believe I could do it with the help of my treatment team. I started writing down all of the things I wanted to do when I beat my eating disorder.”
A Pathway to Hope
Helping patients like Miranda develop hope for the future is at the core of a new nurse-led program at the Princeton Center for Eating Disorders.
The program shows individuals facing eating disorders that goal setting can offer a renewed sense of hope and improve their everyday lives.
“I am convinced that low levels of hope and hopelessness are among the biggest barriers of recovery for patients,” said Robbi Alexander, PhD, director of the Princeton Center for Eating Disorders. “Any tools we can offer people to engender hope are steps in the right direction.”
Alexander is the co-author of a 2018 study in the Journal of Psychiatric Mental Health Nursing that found while patients with eating disorders have low levels of hope, purposeful and meaningful interactions with nurses can help inspire and engender hope, and consequently, support long-term recovery.
In response to Alexander’s research and a broader literature review, the nursing team at the Princeton Center for Eating Disorders developed a four-week psychoeducation program designed to help patients explore the concept of hope, set goals and identify pathways to reaching those goals.
A goal can be anything from getting accepted to an Ivy League school, like it was for Miranda. Or it could be learning a new skill like how to paint or speak a different language.
Alexander said she recently had a grandmother share that one of her primary goals is to be well enough to safely stay with her grandchildren overnight, watch a movie and share a bowl of popcorn without panic.
The program also empowers participants to develop more flexible goal-directed thought and encourages them to realize that the pathway to hope may not be a straight line. In order to move forward, they may have to consider alternative pathways and second-tier goals.
The curriculum is just one aspect of a multidisciplinary inpatient treatment program offered by Princeton Center for children ages eight and older, teens, and adults of all genders with serious eating disorders.
“Research has shown that goal-directed thinking and goal setting along with finding pathways and renewing motivation can help bring a sense of self and accomplishment to those who feel hopeless,” Nurse Manager Lauren Firman, MHA, said. “As with any illness, finding hope may not be the cure, but it allows you to move forward and get to the next level of healing.”
Keep Telling Yourself You Can
Today, eight years after recovering from her eating disorder, Miranda is a senior at the University of Pennsylvania, majoring in neuroscience.
She has gone from stuffing rolls of quarters in her pockets in order to pass her weekly weight checks to serving as president of Penn’s chapter of Project HEAL, a nonprofit organization dedicated to breaking down barriers to eating disorder treatment.
She takes every opportunity to raise awareness about eating disorders by sharing her story of hope and recovery.
With National Eating Disorders Awareness Week coming up next month, Miranda has a message for individuals struggling with eating disorders.
“You have to be hopeful,” she said. “You have to imagine your life exactly how you want it to be, and if you just keep telling yourself you can, you slowly begin to believe it.”