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Managing Eating Disorders during the Holidays

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Managing Eating Disorders during the Holidays

By: Suzanne Zaugg

Holidays are a described as being, “the most wonderful time of year” filled with joy and love, it is a time when families to come together. Most, people are gathered around in the season of giving celebrating their holiday cheer, while, people with mental health issues, struggle more throughout the holiday season. According to the American Psychological Association, 38% of people tend to feel their stress increase during the holiday season, which can lead to physical and mental health disorders, such as eating disorders. Signs of an eating disorder include feeling stressed around food, fearful of weight gain, guilt after eating, and missing events that are food focused. These signs tend to increase through the holiday season, so it is important to keep an eye out if you or a loved one start to experience these or similar symptoms. Learning ways to manage relationships with food is a great way to feel better through the holidays, for those who have eating disorders.

Strategies to get through the holiday season:

  1. Show self-compassion. Give yourself compassion through the difficult holiday season.
  2. Ask for help. Find a family member or friend as a support person during meal times.
  3. Have a holiday coping plan. Plan out your “fear” foods (ones that make you feel stressed and anxious) and favorite foods, and then give yourself permission to eat them.
  4. Remind yourself that food provides nutrient value. Holiday foods connect us with culture, heritage, loved ones and traditions. Holiday foods are not considered “unhealthy”.
  5. Give yourself permission to feel satisfaction from eating.
  6. Set healthy boundaries. Choosing not to engage in diet talk or leaving a family function early are important ways to manage food anxiety.
  7. Practice self-care. Whether it is cuddling your pet, connecting with loved ones, or just taking time for yourself. Self-care is beneficial to your overall health.
  8. Take one day at a time. Make short term goals, which are easier to achieve and which will boost your overall mood, in order to make the most of gathering with loved ones.

By learning to understand and recognize the signs of an eating disorder, you can help the people in your life who are struggling.

If you or someone you know is seeking therapy for an eating disorder, please contact our psychotherapy offices in New York and New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Source:

https://news.llu.edu/health-wellness/tips-and-tools-for-handling-eating-disorders-around-holidays

Post Traumatic Stress Disorder: Understanding the Diagnostic Criteria

GalleryJudy Gurfein Leave a comment
Post Traumatic Stress Disorder: Understanding the Diagnostic Criteria

By: Abby Erasmus

Post- traumatic stress disorder is a psychiatric disorder that individuals can develop after experiencing a traumatic event. Traumatic events are defined by incidents that have the capacity to provoke fear, helplessness, or horror in response to the threat of injury or death. Further, as stated in the Diagnostic and Statistical Manual of Mental Disorders (5th ed; DSM- 5; American Psychiatric Association, 2013), one must display 4 types of symptoms to be diagnosed with post- traumatic stress disorder.

The first type is symptoms of re-experiencing the event in which the individual has unwanted recollections of the event (i.e. nightmares). The second type is symptoms of avoidance that include avoiding thoughts and feelings in regard to the incident as well as external reminders of the event (i.e. people, places). The next type of symptoms is symptoms of negative alterations in cognition and mood associated with the traumatic event (i.e. exaggerated negative beliefs/ expectations about oneself). Lastly, individuals will experience marked alterations in arousal and reactivity associated with the event (i.e. exaggerated startle response). Additional criteria includes length of symptoms in which symptoms should persist for longer than one month, severity of symptoms in which they should cause significant clinical distress, and cause of disorder such that symptoms should not be linked to the effects of drugs or substances.

It is also important to note that individuals can have a “delayed expression” of post-traumatic stress disorder (PTSD), which, according to the DSM-5, occurs when the “full diagnostic criteria [of PTSD] are not met until at least 6 months after the event” (APA, 2013). To restate, symptoms can manifest long after this 6 month window. The DSM-5 also states that having had a prior psychiatric disorder such as depression, and emotional problems such as anxiety problems, serve as risk factors in developing PTSD after one experiences a traumatic event. This relationship also works in reverse; experiencing a traumatic puts one at an increased risk for developing other psychiatric disorders such as generalized anxiety disorder (GAD), and at risk for the worsening of GAD symptoms if they had been diagnosed prior to the PTSD diagnosis.

If you or someone you know is seeking therapy for post- traumatic stress disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/          

Sources:

https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/

https://www.nejm.org/doi/full/10.1056/NEJMra012941

Eating Disorders Part 5: Eating Disorders among Latina Women

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Eating Disorders Part 5: Eating Disorders among Latina Women

By: Abby Erasmus

Latina women are caught between two cultures and are therefore at risk of experiencing acculturative stress (a term discussed in “Eating Disorders: Part 4”). As mentioned previously, increased acculturative stress is linked to an increase in eating- related pathology, thus disordered eating patterns are not uncommon among Latina women. The rate of occurrence of eating disorders among Latina women is equivalent to the rate of the general population of U.S. females; however, anorexia nervosa (AN) is rarely noted in Eating Disorder (ED) studies in regard to Latina women. This does not mean AN does not exist among Latina Women, AN is just thought to be the least prevalent in the community. Researchers have found that bulimia nervosa (BN) and binge eating disorder (BED) are the most common, with lifetime prevalence rates of 2% to 2.3-2.7% respectively. Further, researchers have identified key differences in the presentation of both dietary restriction and drive for thinness in comparison to European- American white women. Latina women are less likely to engage in dietary restriction, and if they do, it is often followed by a binge- eating episode. Latina women also find themselves caught between the thin ideal belonging to Western culture and the curvy but flat- stomached ideal belonging to the Latinx community, and these conflicting body image ideals can result in disordered eating behaviors. Additionally, and quite similarly to Asian American culture, food is the love language of the Latinx community, yet, similarly to Asian American women, these women will be scrutinized for gaining weight. Latina women also experience the paradox, and providers should keep this paradox in mind to understand root causes of EDs within the Latinx community.

Binge eating within the Latinx community is associated with significant levels of distress as well as psychopathology, and is often accompanied by obesity. Despite reporting significant levels of distress, the majority of Latina women do not seek treatment, and when they do, they often refer to primary care doctors in which obesity is the only thing that gets identified. Their ED goes unnoticed. In order to correctly diagnose EDs among Latina women, providers must understand the high prevalence rates of BED, BN, and binge- eating behaviors within the population which, in turn, can result in obesity. Once the ED is addressed, obesity can be addressed. Again, with cultural competency added into the equation of treatment, Latina women’s EDs will be correctly diagnosed and they will receive proper treatment.

If you or someone you know is seeking therapy for an eating disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

https://yourlatinanutritionist.com/blog/eating-disorders-among-latinas

Identifying Eating Disorders in Latinas

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680162/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078895/

Eating Disorders Part 4: Eating Disorders among Asian- American Women

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Eating Disorders Part 4: Eating Disorders among Asian American Women

By: Abby Erasmus

Unique cultural values and experiences of Asian Americans can lead to the development of an eating disorder for individuals in the community. Similar to Western culture, Asian American (AA) culture idealizes the thin body and individuals face scrutiny from family members if they don’t meet this ideal; paradoxically, food is said to be the love language of Asian culture. Many AAs report being “force fed” by the same family members who criticize their weight. This creates pressure and anxiety around food, and due to this paradox, the complex relationship between food, love, and weight, bulimia nervosa (BN) tends to be the most pervasive ED in the AA community. Furthermore, AAs have to go through the process of acculturation: they must adapt to the practices and values of the dominant culture while maintaining their own. This can result in acculturative stress which is a positive predictor of disordered eating. In turn, research shows that AA college students report higher rates of restrictive eating, purging, and muscle building in comparison to their white counterparts. Also, second generation AA women report more ED behaviors than first and third generation women. This gives us insight into who is more likely to be affected within the community and what the ED behaviors are.

Different cultural values in the AA community such as interdependency, a complete reliance on the family for help rather than a stranger (therapist), and stigma surrounding mental health in general, contribute to the lack of help seeking. Further, some mental health providers are unable to recognize ED- like behaviors in the AA community as they are an under researched group when it comes to this pathology; lack of diagnosis and treatment can thus lead to poor prognosis. Once EDs are officially seen as a disorder that affects all ethnic and demographic groups at similar rates, stigma can be lessened and providers will recognize ED symptoms in this community. Again, cultural competency must be encouraged. Providers should understand the unique stressors AAs face like acculturative stress, as well as the complex relationship between food, showing love, and the idealization of the thin body. Although anorexia nervosa is prominent in the AA community, BN and binge- eating behaviors are the most common in the community; 1.50% are diagnosed with BN and 4.74% experience binge eating behaviors (See Eating Disorders Part 1 for DSM definitions). Once providers are more familiar with BED and BN, as well as the unique factors AAs face, they will be able to have culturally appropriate treatment for AAs with EDs.

If you or someone you know is seeking therapy for an eating disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources

https://www.eater.com/2019/11/19/20955556/my-discomfort-with-comfort-food

https://centerfordiscovery.com/blog/eating-disorders-and-the-api-community/

Eating Disorders in the Asian American Community: A Call for Cultural Consciousness

https://www.nationaleatingdisorders.org/blog/anorexia-for-an-asian-american-a-recovery-story

https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01950/full

https://anad.org/get-informed/about-eating-disorders/eating-disorders-statistics/

https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2014.6b4

How Social Media Affects Mental Health

GalleryJudy Gurfein Leave a comment

By Jillian Hoff

In a world where most individuals are obsessively using social media, it can be detrimental to a person’s mental health.  Some of the most common symptoms that come from excessive use of social media include an increase in anxiety, depression, isolation, and fear of missing out (FOMO). Humans need social interaction, which can be given through social media but only to an extent. Humans need an in person social interaction with the people around them to feel connected. There is a reliance on social media to be able to connect with others now, especially during the pandemic. The convenience that comes from using social media may seem like it is beneficial but it the overuse of it can be the reason for your decline in mental health.

How to know when social media is affecting your mental health:

  • You start spending more time on social media than with your friends in person.
  • You compare yourself to others on social media.
  • You find yourself being distracted while you are at work or school.
  • Using social media is disrupting you sleep.

Ways to improve on mental health after a social media addiction:

  • Turn off your phone at certain times of the day.
  • Keep your phone or tablet in a different room when you are completing a task or going to bed.
  • Use social media in an active way instead of passively. This means you are using social media for a purpose.
  • Take on a new hobby or adventure to new places as a means of meeting new people and getting off of your phone.
  • Interact with others when you go somewhere instead of sitting on your phone.

Know when to put down your phone, it will make all the difference in your mental health!

If you or someone you know is seeking therapy, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources

https://www.riseservices.org/the-impact-of-social-media-on-mental-health/

https://www.helpguide.org/articles/mental-health/social-media-and-mental-health.htm

Unexpected and Unwanted Pregnancy: The Psychological Effects of a Pregnancy One is Not Ready For

GalleryJudy Gurfein Leave a comment

By: Rebecca Fernandez

Unexpected and unwanted pregnancies can end in one of three ways. The first: The pregnant woman carries the fetus to term and keeps the child, putting her previous life on hold to raise a child into a life that is not ready for them. The second: the pregnant woman carries the fetus to term and gives the child up for adoption after birth – at which point she may have grown extremely attached to them. Finally, the third: the pregnant woman undergoes an abortion.

While none of the above options are desirable, it is important to note that none of them are any more emotionally destructive than the others. Thus, contrary to many pro-life arguments, abortion isn’t a particular source of trauma. Rather, abortion is a solution to the broader traumatic issue of unexpected and unwanted pregnancy.

The impossible choice can leave a woman feeling helpless and alone. All of the options can be painful and traumatic. Whether the specific thoughts and feelings revolve around the woman losing her previous life and anticipated future to take care of a child, losing a child that she grew attached to throughout her pregnancy, or undergoing an abortion and losing the opportunity to raise a child because she isn’t ready, the lasting effects – grief and otherwise – can remain for a very long time. The different regrets – what-ifs, guilt, sorrow, grief, self-hatred, self-doubt, etc. – stemming from any of these choices all have the potential to linger for the rest of the woman’s life.

For anyone presented with this impossible crossroads, the most important thing to remember is that whatever decision you make is valid. There is no magic solution, and the best one of the three options varies with each individual woman’s situation. All of the options can lead to pain and trauma. To move forward with life after this point, it is important to work through your feelings by talking to friends or loved ones. Speaking with a therapist can be extremely beneficial as well. You are not alone – help is out there.

If you or someone you know is struggling with mental health after an unexpected or unwanted pregnancy, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

https://www.psychologytoday.com/us/articles/199707/the-effects-abortion

https://www.psychologytoday.com/us/articles/200811/abortion-and-the-emotions-it-brings

https://www.guttmacher.org/gpr/2006/08/abortion-and-mental-health-myths-and-realities#

PTSD in First Responders

GalleryJudy Gurfein Leave a comment

By Jillian Hoff

Post-Traumatic Stress Disorder is extremely common among first responders. This is because of their high exposure rate to traumatic incidents. Some of the common signs and symptoms for PTSD include flashbacks or dreams about the incident, losing interest in activities, refusing to talk about the event and sleep disturbances. Most first responders do tend to avoid seeking treatment for their PTSD. This typically is because of the stigma that surrounds mental health in general. These individuals might feel as though people will see them as weak for seeking the help they need, which is not the case. Often times when the individual does not treat their PTSD it will worsen, which since first responders do not get to just stop working makes their symptoms even worse.

Some ways that first responders can help their PTSD would be to have a support system. This especially could be the people who were also there during the traumatic event, this way they can talk about what happened and how it made them feel with an individual who was also there.  To gain positive coping strategies, it could be extremely helpful to engage in Cognitive Behavioral Therapy. This could help the person manage some of their stress that relates to the incident. Most importantly, the person needs to remember why they love being a first responder and all the positives that come from their job. While the negative times within this profession can be hard to handle, it is important to remember all the good that comes from what first responders do.

If you or someone you know is suffering from PTSD, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources

https://eraseptsdnow.org/first-responder/shining-a-light-on-ptsd-among-first-responders

https://www.suicideinfo.ca/resource/first-responders-trauma-intervention-suicide-prevention/

https://www.jems.com/administration-and-leadership/first-responders-and-ptsd-a-literature-review/

Eating Disorders Part 2: Black Women with Eating Disorders

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Eating Disorders Part 2: Black Women with Eating Disorders

By: Abby Erasmus

Black women in America have a unique experience; their intersecting identities make them one of the most discriminated- against groups in America, resulting in mental health issues. Eating disorders (ED), for example, are not new within the Black community. Black women live with EDs at similar rates to all ethnic and demographic groups- but often times in the shadows. The majority of ED studies focus on white women. This ignores the fact that ED causes and manifestation can be different in other populations. Further, the most commonly researched ED is Anorexia Nervosa (AN), yet AN is not the typical ED experience of Black women. Binge Eating Disorder (BED) and Bulimia nervosa (BN) are the most common EDs among Black women, with Black girls being 50 times more likely to engage in BN behaviors than white girls. Because BED and BN aren’t frequently researched, they’re harder to correctly diagnose in patients; it is thus highly unlikely Black women will be diagnosed with an ED at all. To increase the likelihood that Black women will be correctly diagnosed and receive treatment, it is important to know the key symptoms of BED and BN. Listed here are some key symptoms:

BED: Recurrent, persistent episodes of binge eating & absence of compensatory behaviors like purging. The binge eating episodes are associated with 3 or more of the following: eating more rapidly than normal, eating until uncomfortably full, eating large amounts when not physically hungry, eating alone due to embarrassment of how much one is eating, feeling disgusted with oneself, depressed, or guilty after overeating.

BN: Recurrent episodes of binging that are characterized by eating an amount of food within a 2- hour period that is definitively larger than what most people eat in that time period, accompanied by feeling unable to stop eating/ control the amount one is eating & recurrent compensatory behaviors like: self- induced vomiting, misuse of laxatives, excessive exercise, and more.

Additionally, stigma exists in the Black community in regard to receiving help due to complex stereotypes, histories, etc., and stigma in regard to EDs is dramatized as they are labeled a white woman’s problem. Once we call attention to ED prevalence and manifestation in the community, stigma will be reduced both within and outside of the community. This will then increase the likelihood that Black woman will receive an accurate diagnosis and appropriate treatment for their ED. Further, when providers are made aware of the daily micro and macro aggressions that can result in poor mental health and potentially maladaptive coping mechanisms like an ED, providers will be prepared to address such issues during sessions. The nuanced narrative of EDs within the Black community must be disseminated.

If you or someone you know is seeking therapy for an eating disorder,  please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources:

https://www.nationaleatingdisorders.org/blog/new-dsm-5-binge-eating-disorder

https://www.centralcoasttreatmentcenter.com/blog-1/invisibility-of-eating-disorders-in-the-black-community-its-more-than-the-eating-disorder-stereotype

https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t16/

Beyond “Eating Disorders Don’t Discriminate”

Laziness: The Harmful Effects of the Term “Lazy” on Mental Health

GalleryJudy Gurfein Leave a comment

By: Rebecca Fernandez

               “Lazy” is a common uncomplimentary term in modern vocabulary for when someone is unproductive. Think back to a time a group member failed to pull their weight in a group project, or a time someone procrastinated severely, leaving everything for the last minute and creating a poor final product. Consider even a time where you witnessed someone who, by early afternoon, was seemingly unable to bring themselves to get out of bed to start the day.

Whether it was yourself or someone else that you imagined, it’s easy to write off everyone in those examples as lazy. However, there’s a major issue with doing that – “laziness” is often not the cause of these situations. Rather, many mental health conditions can create issues that simulate behaviors identical to laziness.

Take, for example, disorders such as attention deficit hyperactivity disorder (ADHD), depression and other mood disorders, insomnia and other sleep disorders, and anxiety disorders including obsessive compulsive disorder (OCD) and generalized anxiety disorder (GAD). Each of these conditions can negatively impact a person’s ability to be productive, making them appear lazy. People with ADHD can often find themselves imagining all of the tasks they could be engaging in at once and becoming so overwhelmed they feel almost paralyzed. People with depression and other mood disorders often lack the mental energy to accomplish anything. Similarly, people with insomnia and other sleep disorders often lack the physical energy to accomplish anything. People with GAD may have a crippling fear that they won’t be good enough at something, preventing them from attempting to do the task in question. People with OCD may have a crippling (rational or irrational) fear that something bad will happen if they do specific things, preventing them from doing those things.

               All of these explanations are generalized and therefore may not apply to everyone with each listed disorder, or be the only applicable factor for each disorder’s effect on laziness. However, if you or someone you know has been consistently labeled as lazy, remember that “laziness” is often more than how it appears on the surface, and that actively struggling with mental health does not make a person a failure.

If you or someone you know is exhibiting signs of “laziness” as described above that are getting in the way of day-to-day life, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

https://over-coming-ocd.com/2020/07/20/laziness-does-not-exist-10-reasons-why-we-procrastinate/

https://www.psychologytoday.com/us/blog/hide-and-seek/201410/the-psychology-laziness

Relationships; How to Recognize a Toxic Relationship

GalleryJudy Gurfein Leave a comment

Relationships; How to Recognize a Toxic Relationship

By: Priya Desai

A toxic relationship can be hard to identify, especially when you are in the relationship. There are many instances where the people closest to you will notice first that the relationship you are in is not good for you. Here are signs of a toxic relationship that can help you identify if you are in one.

Signs of a toxic relationship:

  • Lack of trust

When you are in a relationship, both partners should have trust in each other. Trust varies from being loyal to your partner to trusting that they have the best interest in their mind when they are thinking about the relationship. Trust is the foundation of a relationship and without it, it can’t work.

  • Hostile communication

Hostile communication includes verbal abuse and physical abuse. This can be name calling, yelling, constant interruption, or throwing and breaking things.

  • Controlling behaviors

Your partner has no right to control your actions or beliefs. This can include telling you what’s right, secluding you from your closest friends/family, and requiring access to your personal social media accounts and phone.

  • All take, no give

If you feel as if your partner is not doing anything for you, but you are consistently taking orders from him/her, this is another big red flag. This includes always being the first one to text and always being the one to make plans to hang out with your partner. The feelings should be reciprocated all the time.

If you or someone you know is in a toxic relationship, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Citation: https://www.insider.com/toxic-relationship

https://www.healthline.com/health/toxic-relationship

Image Citation : https://www.google.com/search?q=toxic+relationship&sxsrf=AOaemvK-hHlQGKKmgsC6m_XxK_UptZleNA:1631133605274&source=lnms&tbm=isch&sa=X&sqi=2&ved=2ahUKEwjX3_2YnvDyAhUaQfEDHao0DBMQ_AUoAXoECAEQAw&biw=794&bih=639#imgrc=TKmtKNeDMzkEOM