August 31, 2007

Where to read those studies everyone cites

Need data?

Here are three sites to search, all leading to the same papers but with slightly different formats. All these sites allow you to set up “alerts” to email you when new research on your searches is published. If you find a paper of interest, you can find links to view or purchase the full text.

PubMed from the NIH * Highwire Press out of Stanford * From Google

For example, this week notice of the following papers showed up in my email box, among others:

Long-term stability of eating disorder diagnoses.Int J Eat Disord. 2007 Aug 13
Eating one's words: Part III. Mentalisation-based psychotherapy for anorexia nervosa-an outline for a treatment and training manual.Eur Eat Disord Rev. 2007 Aug 13;15(5):323-339
The experience of 'feeling fat' in women with anorexia nervosa, dieting and non-dieting women: an exploratory study. Eur Eat Disord Rev. 2007 Feb 12;15(5):366-372
Are Girls with ADHD at Risk for Eating Disorders? Results from a Controlled, Five-Year Prospective Study.J Dev Behav Pediatr. 2007 Aug;28(4):302-307.
Impact of anorexia nervosa on activation characteristics of lymphocytes.Neuro Endocrinol Lett. 2007 Jul 11;28(4)
Selected auxological aspects of anorexia nervosa - relations of body weight to body height and menstrual cycle.Neuro Endocrinol Lett. 2007 Jul 11;28(4)
Depressive and manic-hypomanic spectrum psychopathology in patients with anorexia nervosa.Compr Psychiatry. 2007 Sep-Oct;48(5):413-8.
Obestatin, Acyl Ghrelin, and Des-acyl Ghrelin Responses to an Oral Glucose Tolerance Test in the Restricting Type of Anorexia Nervosa.Biol Psychiatry. 2007 Aug 14;
Adiponectin and resistin gene polymorphisms in patients with anorexia nervosa and obesity and its influence on metabolic phenotype. Physiol Res. 2007 Jul 26.

August 28, 2007

NEDA Conference San Diego Oct 4

I hope to see as many parents as possible at the upcoming National Eating Disorders Association conference in San Diego, themed "Eating Disorders Come in All Shapes and Sizes." This will be my 4th NEDA conference, and I find it better each time. It is well-organized, well-attended, and broad-based.

I was invited, to my great delight, by the team at the University of California San Diego's Eating Disorder Program to be part of a presentation on Friday afternoon on Family-Based Maudsley treatment. Harriet Brown, the journalist who told her powerful story of her daughter's early recovery in the New York Times Magazine, will also be on the panel.

Led by Dr. Walter Kaye, the UCSD team offers a unique 5-Day Intensive training for the entire family, followed by coordinated support from a team in the patient's home town. I believe this approach to supporting families through the early stages of recovery is an innovation sorely needed.

Early-bird registration for the conference ends August 29. But you can register any time up to the first day. One-day entrance is also available.

If you are coming to the conference, do let me know. Let me shake your hand and hear your story. I'm the curly-haired lady with the little fork on her lapel, asking everyone she meets whether they've ever heard of Maudsley.

August 26, 2007

What IS known about eating disorder treatment results?

For most of the history of eating disorder treatment clinicians did what they were trained to do or what they thought was best based on experience or theory.

These days patients and their families (not to mention insurance companies) are looking for "evidence-based" care guidelines. They want to know what treatments work best, and for whom.

Want to know the state of the art? The Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services, publishes reports on what evidence exists to support one approach as opposed to another. And it is in readable English. And it is available online! Click here: AHRQ report "Management of Eating Disorders"

Among the gems: "Specific forms of family therapy initially focusing on parental control of renutrition is efficacious in treating AN in adolescents and leads to clinically meaningful weight gain and psychological change."

If your child is receiving care that is not evidence-based you have the right to ask why. If you have an adolescent living at home who is getting individual therapy and not family-based "Maudsley" therapy someone has some "splainin" to do. And perhaps I missed it, but I see no evidence to support residential care.

August 21, 2007

Ingredients for treatment

When you take a pill, it has "active ingredients" and then fillers and colors and binders and such. The medicine itself usually doesn't take up that much of the pill.

So, with eating disorders, what are the active ingredients in treatment?

Food. Emotional support. A place to be for 50 minutes of the week where you are not doing eating disordered things. Learning. Coaching. Monitoring. Venting. Projecting. Challenging. Reframing. Transference. Modelling. Communication. Interaction. Lots of things.

Food, oddly enough, is not a big part of most eating disorder treatment. Some approaches literally don't "talk about food" and the patient's eating is left up to them. Even more hands-on treatment, with nutritional counseling, may talk about food but the patient is free to do as they wish where it comes to actually eating. And inpatient care - even the best and longest in duration - does try to keep one completely fed for the duration but sends you home to finish the job on your own. With Family-Based Maudsley treatment the food part of the treatment is the first order of business, isn't optional, is supposed to be fully balanced and enough for steady weight gain, and goes on for 6-12 months.

There are other aspects to treatment; FBT/Maudsley is not "all about food," of course. There are therapy appointments, the parent is put in an authoritative position, the family works together instead of as bystanders, co-morbid conditions that inhibit recovery (e.g. anxiety, OCD, and depression) are identified and addressed, cognitive techniques, behavioral techniques.

FBT/Maudsley also lacks some things that might be the "active ingredients" in other treatments: blame, shame, guilt, separation from family, seeking the "underlying issues," the choice to continue to starve.

What is the active ingredient in FBT/Maudsley? Is it food, only? Is it the way relationships are changed? Is it the duration?

Or is it the lack of other things usually given? Could it be this unique combination of ingredients, or could some of these aspects work with other approaches? Does every patient need all the ingredients, or will some only need one or two?

August 17, 2007

CLOCK gene

One interesting line of research connects mental illness to dysfunction of of circadian rhythms.

Circadian rhythms involve the way the body and brain function at different times of day. We don't simply run like refrigerators or thermometers off and on at will: we shut down some systems for sleep and rev up different systems in the early morning than in the afternoon. It is a complex system and therefore vulnerable to hiccups and major malfunction.

Some researchers think bipolar illness and depression, for example, could be related to problems with how the circadian system operates. And preliminary research is exploring whether certain mutations of the CLOCK gene might lead to more severe cases of anorexia and bulimia.
"These findings, although preliminary, suggest that the 3111T/C polymorphism of the CLOCK gene does not play a major role in the genetic vulnerability to AN and BN, but it seems to predispose eating disorders (EDs) patients to a more severe lifetime body weight loss."

August 14, 2007

Australian TV show discusses Maudsley and Mandometer

Isn't it terrible when siblings argue? If only they knew they've got so much more in common than they have to argue about.

I felt that way when I watched, online, the Australian show "Insight" which featured eating disorders, titled "Starving for Answers." (go down menu at right to see entire show in 3 sections)

The show had a high ratio of sense to nonsense and explored a lot that rarely gets into the media. Of particular interest: an adult male sufferer, interviewees who absolutely refused to take the bait on questions of "how low did your weight go," and Dr. Ken Nunn's wonderful description of the "cascade" of mechanisms in the brain that trigger symptoms and then prevent recovery once malnutrition sets in (the last few minutes of part 2 of 3).

I was overjoyed to see the Oak House and Westmead Hospital staff discussing family-based Maudsley treatment as if it was normal. And I always enjoy hearing more about Mandometer treatment. I was less pleased to see the two put into opposition. Maudsley and Mandometer share more than an initial letter: they both represent a repudiation of the traditional "parentectomy" and "it's all about control" treatments. These philosophical siblings waste time arguing about each other - but the real threat is the 99% of treatments available to families around the world that is unsupported, antiquated, and doesn't work.

Kids, stop fighting. Maybe we need to get them all in for a session of family therapy?

August 11, 2007

Exposure therapy for anorexia

If you've tried to eat with an anorexic you know that phobia is a mild word for what a plate of food engenders in your loved one. A donut is like a pit viper. The thousands of daily calories needed to recover is more like a pit of vipers.

"Exposure" and "fear extinction" are concepts used more often in treatment for anxiety disorders, OCD, and PTSD. The idea is to expose the client to measured amounts of the thing they fear, to desensitize them to it, and normalize behaviors around it.

With an eating disorder, the feared thing is food. Eating normally is the challenge.

It takes enormous bravery on the part of the patient and loving firmness on the part of caregivers to have normal meals, to face the fears, to provide security and structure while the ability to eat normally is re-learned. Meal after meal aftermealaftermeal for a long, long time.

Is there a drug that could help with this process? D-Cycloserine is an interesting creature: an antibiotic drug that used to be used for tuberculosis and more recently has been helping people with phobias to unlearn fear they've associated with benign things.

A small preliminary study, The Application of Exposure Therapy and D-Cycloserine to the Treatment of Anorexia Nervosa: A Preliminary Trial, applied the drug to anorexic patients being exposed to a test meal. And the results were encouraging.

Imagine, parents: an easier time at dinner during early recovery. Less fear and resistance. Faster, safer recovery. Imagine if a donut was just a donut.

August 7, 2007

Oops! I got anorexia!

But, why did my child get an eating disorder?

"Unintentional onset of anorexia nervosa"

"inadvertent weight loss may be as powerful a trigger as intentional dieting to initiating anorexia nervosa in predisposed individuals..."

Since intentional dieting is practically an obligation in modern society if you were not born with the DNA to be a six-foot size 0, I guess that might explain the rest of the cases.

Weight loss causes eating disordered thoughts and behaviors in genetically predisposed people. Whether you "choose" to lose weight or you get a stomach virus or you start running cross country: it is the weight loss that is the common factor.

Why is this one of the most controversial concepts in eating disorders?

August 3, 2007

Chin-up excercises to make the world a better place

Live in eating disorder world, even as a loving bystander, and the world changes.

Years of thinking about eating disorders and body image and weight have left me staring at bodies. I now have a highly disordered tenderness toward everyone. I see an exposed clavicle and I worry. I see a bulge and I worry. "Is it a symptom?" "Is it natural or is it illness?" "Is she comparing herself to others?" "Is he self-conscious?"

I never used to do this. I hate it. It's exhausting.

So I've developed a new exercise: "Chin-ups." I consciously look at everyone from the chin, up. I treat the area below the chin as private and none of my business. I started doing this in airports. I'm working on magazine covers, T.V., and one-on-one situations.

And wow, the benefits:
  • I notice people's expressions, their emotions, their eyes.
  • I make eye contact more often, and since I was trained to smile and nod slightly when you make eye-contact with strangers I now find myself smiling more and feeling friendlier.
  • Hair: fascinating! And so expressive!
  • I hold MY head up, and I feel better.
  • I'm not worrying about people all the time, semi-consciously comparing them, measuring. I'm just enjoying my fellow humans.
  • The number of times I think about my own body image has decreased.
  • People-watching is fun again.

Do me a favor and try it, and let me know how it goes?