July 31, 2007

How's your insula today, dear?

Insula, insula... sounds like a flavor of ice cream. Or an elegant brand of shoes. But maybe it is a word worth remembering?

Recent research on the way the anorexic brain - even after recovery - perceives food is worth checking out. (Abstract is free. Full text available online for a fee.)


The paper, published in the poetically named Neuropsychopharmacology journal, discusses "the first evidence that individuals with AN process taste stimuli differently."


The area of the brain they were spying on? The insula. The same place other interesting research has been poking at, and also here in more readable form.

July 19, 2007

Is your insurance paying for eating disorder treatment?

Nice piece on NPR's Marketplace on insurance parity and eating disorders.

If you just want to listen to the part about EDs let it download and then listen to minute marker 2.22-6 minutes into the program.

And if the topic energizes you: get involved with the Eating Disorders Coalition's effort to help all of us get coverage for the one part of our bodies considered separate from ourselves: the brain.

The EDC is really DOING stuff to help us. Let's help them!

July 18, 2007

Wall Street Journal features family-based treatment

The Wall Street Journal featured family-based therapy in an article today and mentions Maudsley Parents: "Letting Your Family In on Your Therapy."

During my interview with Elizabeth Bernstein, the reporter, she chuckled out loud when I mentioned the word "parentectomy." This is a word and a concept we need to talk about - and abolish!

Please cut this piece out to give to family, friends, and doctors!

July 11, 2007

Parents in denial

I hear a lot about parents "in denial" about the seriousness of a child's eating disorder.

And I do see parents who appear to be denying how ill their child is. I meet parents seeming to enable the illness by settling for low weights or resisting high calorie meal plans. I talk with parents who don't want to drive any further, pay any more, sit through any more disheartening meals, attend any more sessions, or just want it to be over.

But I don't call it denial. I call it fear exacerbated by incoherence in the treatment world.

It is too easy to call a parent "in denial" when they don't know which - of all the contradictory, ineffective, unquantifiable options available - treatment direction to pursue.

It is too convenient to say a parent is "in denial" when they do what a seemingly competent and well-meaning professional says to do and when it doesn't work the next professional upbraids them for listening to the first idea.

It is inhumane to observe a parent in distress and fear and worry - this is their child, after all - and assume the parent is choosing the "easier" of the options.

And it is impossible to know, looking at a family new to an eating disorder diagnosis, what that family was like before the illness or what miracles they can perform if offered tools and support and the benefit of the doubt.

The inertia of normal, healthy parenting isn't swept away in a day, a week, or a month of living in the new world we enter when our child is gravely ill. It takes time, training, and compassion.

Let's learn from the tragic history of blaming the parents of autistic children, schizophrenic offspring, asthmatics, and tuberculosis patients. It's an illness, and parents are the best asset a child has.

July 4, 2007

Anorexia does not cause starvation; we do.

You know what? I'm tired of hearing anorexia described by what it does to the body: emaciation, slow heart rate, muscle wasting, bone loss, low temperature.

Actually, anorexia does none of that. Malnutrition does that.

Malnutrition is curable. The physical manifestations of anorexia, and the ravages of bulimia can be stopped and reversed immediately if the environment around the sufferer changes, even if the patient isn't ready. And with physical health, mental health also improves.

The mental symptoms of malnutrition abate with full nutrition over a long period of time even if the patient does it involuntarily.

It isn't the illness that is the problem. We are the problem, and we should know better.

We ask, beg, and demand that eating disordered patients stop what is an involuntary compulsion. We watch eating disordered people continue the behaviors of the illness even when we know their prognosis worsens every day they are not fully fed. Asking for insight and cognitive change of a person who is underfed - even a little underfed - is like demanding a commitment to quit heroin while the person is still high. It is like asking a drowning person to learn to swim while they are still in the water: it is futile and cruel.

None of the physical symptoms of eating disorders are inevitable or necessary. What must change is us: our attitudes, our boundaries, our treatment professionals, our laws, our media, and our insurance policies. The disease isn't going to change, but we can.