How Doctors Think

Once the diagnosis is "eating disorder," a lot of doctors and even many mental health providers scatter - they don't feel qualified to treat these confounding illnesses.

Sadly, some clinicians are all too comfortable with treating EDs, and they shouldn't, because without a broad - and continually updated - understanding of both medical and psychological issues they can do more harm than good.

Patients, and their families, suffer the consequences. We can't get good medical attention because of the psychological symptoms. We can't get good psychological supports because the medical symptoms confuse the issues.

One consequence of all this disconnect is that some people get a diagnosis of an eating disorder before illnesses of other types are ruled out. Cases of undiagnosed celiac disease, diabetic gastroparesis, digestive issues, gallbladder issues...

For a thoughtful look at the anatomy of misdiagnosis - of anorexia nervosa, as it happens, check out this interview of the author of "How Doctors Think"

Our job as healthcare consumers is to be less passive and stop demanding certainties and answers as if clinicians are gods. And clinicians have to let down the cloak of invisibility and say: "we don't know everything." It's okay: no one does.

Facing, flaunting, flirting with the word "fat"

If you don't smile and cheer during this YouTube video: check your pulse.

Tonic for the fat-phobic, this isn't a rant - it is a manifesto for authentic living.

Thank you, Carrie, for turning me on to this!

Media about Maudsley

Daniel le Grange tells it like it is - and don't you want to ask him whose refrigerator that is?

Walter Kaye, yay! "The family needs to understand that they are not the cause of anorexia, but they are definitely part of the solution"

Multi-center study spreads the wealth, and the data.

What about the siblings?

A site update at Maudsley Parents is worth a look!

field guide to anxiety

I did not recognize that my daughter had an anxiety problem.

I thought she had really bad luck, because so many things kept going wrong. I thought she really did "need" to do that sport, go to that event, get along with that friend, get that grade.

I was wrong. She was suffering from a painful anxiety. Her body and brain were stuck on high alert, and the emergency kept changing targets to try to make sense of it. It wasn't her life, it was her brain/body's reaction to it.

Now that she is not so anxious - and she copes well with her anxieties when she feels them, I recognize the difference. I see the irritability, inflexibility, and reactivity as anxiety. And I see it in myself for what it is, as well. This has changed my life.

Now I try to focus on her, not the target of the anxiety. And do the same for myself.

Dr. Walter Kaye, of UCSD's Eating Disorder program, thinks the neurobiology of eating disorders "may be a strategy that some people use to reduce anxiety. That is, extreme eating may blunt anxious feelings."

With that in mind, I read the following headline and wondered if they have it backwards: "Puberty Explains Adolescent Anxiety and Mood Swings."

I am optimistic for the future when I see a fairly simple breathing test may give clues to who is vulnerable for anxiety disorders. See if this sounds familiar: "adolescents who tend to respond anxiously to bodily sensations may perceive the bodily events that occur during puberty as personally threatening" and thus learn to fear bodily sensations, thereby setting the stage for panic development. This learning process might be even more likely to occur when
bodily experiences related to puberty happen unexpectedly."

What can we as parents do? Recognize anxiety for what it is. Model coping. Find and use strategies to head off, deal with, and recover from anxiety.

For the most practical tools to do that, especially in the context of a child's eating disorder, may I suggest Nancy Zucker's amazing book: "Off the CUFF."

Give blood - find a cure?

We don't really believe in things we can't see, measure, and compare. Example: mental illness.

Until we can measure it we can't diagnose, treat, or understand it properly.

Impossible? Well, I think we are getting closer.

I take heart in learning that panic disorder can now be diagnosed with a blood test.

Quietly, the world of genetics research is changing how we understand disease. A French firm says it can identify those with and without Alzheimer's with a fair degree of accuracy. Genetic testing has also identified four possible types of schizophrenia. And a smell test for schizophrenia may soon help with diagnosis. Another test - this one is behavioral - showing promise is used to distinguish even at the age of 3 or 4 who is most likely to develop schizophrenia or bipolar illness.

No more "how are you feeling on a scale of 1-10." An end to the "you don't look sick."

It is time to use biomarkers, as an MIT/Harvard researcher says, to "turn it into a rational science." Amen.

What can you do? Give blood. The National Institute of Mental Health is sponsoring a study that will probably change the way science - and the public - see eating disorders.

Maudsley for bulimia, too

"Well, it doesn't work for everyone" seems to be an almost reflexive phrase for clinicians who don't understand family-based Maudsley therapy. It is meant to disparage and condescend, surely, since: no one said it did, and no other treatments show better results.

Another way Maudsley has been dismissed is by saying it is only researched in adolescents with anorexia.

Good news: there's a new manual for family-based Maudsley therapy for bulimia.

The manual is reviewed in detail in Cris Haltom's monthly newsletter for parents and in Doris Smeltzer's wonderful blog for parents.

Another approach, Cognitive Behavioral Therapy, is also getting research attention.

For an overview of research into bulimia treatment: Treatment of bulimia nervosa: Where are we and where are we going?

Mum rewarded, not reviled, for helping child recover

Feeling unappreciated? Feeling as if all the refeeding and supporting and listening and driving and silent heroism of being a Maudsley parent are unnoticed? Do you often get the feeling people think that you are the one with the "issues?"

I present:

A mother whose family - and television audience - gives her an award!

Don't read this post about suicide and eating disorders

You don't want to read this. This topic freaks you out, brings up your worst fears, and you just can't face it.

You know eating disorders can kill. You've heard that anorexia is the deadliest of psychiatric illnesses. And don't forget: bulimia is under-counted because coroners prefer to write: "cardiac arrest" or "electrolyte abnormality" instead.

But suicide is a leading cause of death for people with eating disorders, and ignoring that fact doesn't help.

And this is gonna hurt - I'll warn you in advance - these suicides do not happen just at the "dangerously low" weights we all titter and point at. In fact, suicide in eating disorders often happens when recovery is under way.

Suicide kills more people in the US than homicide does: 30,000 a year. But I think we tend to have a compassion deficit on the topic because it appears to be self-imposed. Eating disorders and suicidality are not choices; they are symptoms of disease.

Our firm and loving support needs to extend beyond the initial weight gain and the brave initial efforts the patient makes to recover. The hell for them isn't just when they are starving or purging - those activities numb the pain - their hell is reaching and then maintaining a healthy body and active brain. That takes many months of brain-rending work, and may have to be done more than once.

Yet the supports that get a person to "look better" are often withdrawn when they do.

I don't mean worrying, suspecting, snooping, and despairing: I mean maintaining generous and appropriate levels of support. College can wait. Independence can wait. Cutting back on therapy bills can wait. Our normal lives can wait.

If you read this far, you deserve some good news now: research is uncovering clues to who among us is the most vulnerable to suicidality. This may lead to better monitoring in future, and a better understanding of what mechanisms underlying the thoughts and behaviors.

Although anti-depressants have been largely ineffective for underweight ED patients, they may have a role in individual cases. Yes, antidepressants are believed to cause more suicidal thoughts at the beginning of treatment, but did you know that the same effect is found with psychotherapy? Recovery is hard.

Not recovering is harder, though. We can't let our fears of suicide cloud that truth: staying ill isn't an option. Negotiating and giving in to the illness won't prevent suicide: they make it more likely. Early and firm intervention, full recovery, and long term supports are what we CAN do. And must.

Beauty, Health, and my BMI

My BMI is around 25. I recline on the line between what is defined as "normal" and "overweight."

What does this mean?

It means I am unattractive.
(because no one anywhere near my proportions exists in movies, ads for cars, in magazines, and this, my friends, is a picture of a "plus" model:)

It means I am unhealthy.
(because our society believes, wrongly, that weights above that magic number are inherently unhealthy)

It means I should be ashamed.
(in casual conversation it is not only normal to put ourselves down for going up, it is a compliment to tell someone they've lost weight no matter what the original weight)

But here's the truth: I am beautiful, I am healthy, and I'm proud.

I've seen what the low end of the BMI scale does: it kills, it maims, it mangles, it tortures.

Our society's fixation on weight is not about health or virtue. It is about aesthetic bigotry, period.

And the first thing we need to do is stop connecting weight with beauty, health, or virtue.

Our healthy body size and shape is genetically determined. Mucking about with the mechanisms to change our appearance is like chopping off the top of our head to make ourselves shorter: it doesn't work, and what are we going to do with half a brain?

Harry Potter and anorexia - who knew?

Readers of Harry Potter want to know:
Is Snape anorexic?

Gold Fork lovers need to see:
Carrie Arnold turns forks to jewelry - but still eats her dinner.

Inveterate Hallmark card buyers want to buy:
"Welcome to the new normal" Hallmark's new line of cards include ones for eating disordered loved ones.

Why anorexics are more honest than the rest of us:
The difference between denial and anosognosia: one is a defense against something you don't want to be true - the other is the rational reaction to what appears to be true.

Leptin lovers like to learn:
Ways to measure recovery.

Parents doing refeeding need to know:
Insight doesn't have to precede recovery, it is a happy side-effect of a well-fed brain.

Eating disorder research: a la carte

Continuing my mission to serve the tastiest morsels of research I can find:

Got (full-fat) Milk? no? Your ovaries are going to be disappointed.

Interesting thoughts on anxiety, AN and seretonin response.

Still hard to eat? "...delay in insulin release and elevated (pancreatic polypeptide) levels did not correct with short-term refeeding and may contribute to the high relapse rates and maintenance of anorexia nervosa."

Where the smart people will be later this month: "The 8th London International Conference on Eating Disorders"

Are parents being told this? "Oral administration of 14 mg of elemental zinc daily for 2 months in all patients with AN should be routine."

A lot more attention out there these days to "the complex ways in which celiac disease and eating disorders interact"

Have you ever wondered why twin studies are important?

I think of how hard ED patients try to resist restricting and binging when I read that addicts underestimate their cravings .