September 30, 2007

But, it must be my fault. I saw it on Oprah!

This has been a very exciting week here at EWYA. Hundreds of people have viewed the video of clips from eating disorder experts asked "Do Parents Cause Eating Disorders."

One parent said "naturally, I am crying." another said "I've forwarded this on to someone who needs it. And will do so again and again."

(And by the way, the answer to the question was "No.")

So the next question is: "Do Parents Feel Guilty?" and "Why?"

Parents: please send me your quotes, or audio or video clips, telling me if, and why, you feel or felt guilty about your child's eating disorder. Send me quotes from web sites, books, or clinicians that fed this feeling.

And then tell me what helped you feel better.

September 25, 2007

Do parents cause eating disorders? See the video

Give me 3 minutes and I think I can make you either smile or scream.

Earlier this year, I interviewed a number of eating disorder experts on camera. I've compiled a short video with some clips from those interviews, on the question, "Do parents cause eating disorders?"

There will be more videos to come, and I welcome you to send me video or voice clips describing your experiences with guilt or blaming in eating disorders. Your video can be of you talking, or of your dinner table while you are talking, or hand puppets if you like.

September 24, 2007

New Family-Based Maudsley Treatment available in California

ABC 7 in San Francisco news program spotlights new Family-Based Maudsley treatment available in California.

See video here:
UCSF Changing Treatment For Anorexia (9/24)

Wherever you live, you'll love this piece!

** Post script: Checking out the web site for UCSF's program I am dismayed to read this:

Norman says that struggles with power and independence are the primary underlying emotions driving eating disorders, in addition to pressures from peers, family members and the media. "Many teens feel like they are being held hostage by their parents — they are struggling with power and independence. So family counseling helps family members take a more appropriate stance," says Norman, founder and director ...

That doesn't sound like the Family-Based Maudsley I'm familiar with. Too bad!

September 22, 2007

The margin of choice

If eating disorders are brain diseases does that mean the patient is helpless and there is no hope?

I don't believe that at all. The idea that a biological origin means hopelessness is wrong.

You can't just decide not to be diabetic, but you can learn to accept the illness and take the right precautions and actions to live well despite it. Same with asthma, ADHD, heart disease, depression - all these illnesses have a biological origin and behavioral components.

I believe it is the same with eating disorders. If you have this illness you cannot, for example, diet. You must recover the health you lost before diagnosis, you must learn to protect yourself from restricting/dieting in the future. You must find, with the help of clinicians who understand the disease, a level of nutrition and the body composition your body's DNA and history have designed for you. You must find outside resources to monitor and give feedback on your health. You must learn about your illness and how it works uniquely in you, and learn what qualities in yourself make you vulnerable to the illness (anxiety, depression, unhealthy environments).

That is not helpless. That is not hopeless. That is recovery.

September 20, 2007

"treat people who are living now"

Why I care about gene studies for mental illness:

"We've been stumbling in the dark for most of our history" of bipolar research, said gene expert Dr. Francis McMahon of NIMH. But "these kinds of studies ... will really give us the chance to reason from biological insights back to the patient."

...And not just in some far-distant future. The new gene studies, Sachs said, help give "a great potential to advance the field in our lifetimes and treat people who are living now."

September 18, 2007

I called. Did you?


Help Pass the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424) NOW!CALL TOLL-FREE TODAY from 9am–6pm EasternCall House Speaker Nancy Pelosi at 877.978.9996

The Eating Disorders Coalition does a good job letting us know how to help and when to do it.

I just made the call, I hope you do, too!

September 17, 2007

leptin and hyperactivity

One perplexing symptom of anorexia is the underfed person seems to have more energy than those around them. Parents are perplexed to discover an emaciated child with a compromised heart muscle secretly doing ab crunches in bed.

This is usually seen as just more proof of the person's "desire to be thin." I have always found that condescending implication of "vanity" an insult to sufferers. It says more about the rest of us and our unhealthy attitudes about appearance than it does about anorexia.

Compulsive exercise is clearly a biologically driven compulsion. It isn't a "want" but a "need."

One explanation is evolutionary: if someone in your tribe reacts to famine by running further and faster to get food, those genes are more likely to survive.

One mechanism for the phenomenon: The impact of hyperactivity and leptin on recovery from anorexia nervosa.

And this: more on the intriguing leptin connection.

September 15, 2007


Here's a dirty little secret about psychotherapy: although it may help, it may also waste your time and money and distract you from what will help. It can also do active damage.

In the case of an eating disorder, there is no time to waste.

Even the American Psychological Association acknowledges that too many clinicians practice "psychoquackery," and it may hurt you: "The profession hasn't shown much interest in the problem of treatments that can be harmful,"

No one wants to talk about this. The mantra is: get professional help. My mantra is: get the right professional help. Interview as many people as you can on the phone before making appointments. Learn the vocabulary and controversies of the eating disorder world and be ready to speak up and ask questions. Trust your bravest parental instincts.

The time and thought you invest early on will be repaid many times later. You deserve to feel good about the care your child is in. Your child deserves the best care you can find.

September 14, 2007

Assisted treatment

We know what adults with eating disorders need: a safe environment, nutritional and medical recovery, skills to learn or relearn how to live normally. They need and deserve these things for 6-12 months, or more.

What we don't know is how to make sure sufferers get these things. Even when family is willing to take on the job, and clinical services are available, the patient is often ambivalent, denies a need for care, distrusts loved ones, or cannot follow through long enough to truly recover. has an excellent breakdown of the options for "Assisted Treatment" for mental illness. I think it is time for us in the eating disorder world to consider how to use these tools when needed:
  • Out-patient Commitment
  • Conditional Release
  • Representative Payee
  • Guardianship
  • Benevolent coercion/Court-ordered treatment
  • Assertive Case Management
  • Treatment programs in residential facilities
  • Psychiatric Advance Directives

September 12, 2007

Parent gets APA to drop parent-blaming

Chris, a parent, wrote me yesterday about something I must share.

The American Psychological Association's "Help" page says this:

"Certain psychological factors predispose people to developing eating disorders. Dysfunctional families or relationships are one factor."

But it won't say that for long. Because Chris contacted the authors listed on the page. Two said they don't remember writing it and don't know why their name is on it. One said she believed it but had no evidence aside from clinical experience to support the statement.


This is the kind of kick-a no-nonsense activism we need more of out there. I applaud Chris and everyone else out there trying to dislodge these myths and dangerous, antiquated ideas. Now, who is up for tackling the page on parents and eating disorders?

September 11, 2007

Laugh, cry, rage

If this makes you laugh, then cry, then bang your head on the desk because it is so close to the truth, I'm with you. (Warning: this is SATIRE and R-rated.)

In The Know: Should We Be Shaming Obese Children More?

September 10, 2007

There are really only three choices. No: two.

From the first day of a diagnosis of an eating disorder there are really only two choices:

1) Full nutrition and an end to purging behaviors at home.
2) The same, at a hospital or residential care facility.

There is no third choice. Letting someone remain at home while they restrict or purge is not okay. Our homes must be a safe place to be healthy, period.

What number are you choosing for your loved one?

September 8, 2007

Impersonating their mothers

There is an interesting phenomenon on the popular online Parents Forum I sponsor. Over the years I've gotten pretty good at spotting the pattern: a torrent of very urgent requests for help, reports of rapid weight gain and how scared the child is, minute details on calories and weights, and this phrase: "I don't know what to do."

Usually, the details end up being mostly true. Except the writer is the child, pretending to be their own mom.

I used to be shocked at how popular my site for parents is to sufferers. You would think they would have little interest in a philosophy of making people eat and taking choices away from the sufferer.

But really, it makes sense. Sufferers are starving and obsessed with food as a result. They want someone to save them, and they want to eat. So what could be more attractive than a bunch of parents working so hard to support and feed and save their children? (Aside from the Food Channel)

The irony is, many of these young people make terrific mothers on paper. They are fiercely loving and very engaged. They know food, and they know what patients need. They show terrific insight into the dynamics of love and fear and control. The only thing they don't know is how to stop pretending to be their own mothers and let their real parents take over the job.

Trust your real mom and dad. Just for a moment, long enough to get it all out. They want to help. This is the bravest, most loving, most motherly thing you can do.

(***And a personal note to one of the bravest young women I know of: you did the right thing. They love you so much. Keep trusting them.)

September 7, 2007

The last line scares me

As the parent of a child who suffered from an eating disorder, I'm always interested to learn more about the possible role of leptin in the cause or perpetuation of anorexia. But the thing that makes me saddest in this abstract is this, the last line:

Similar to most previous studies we found a high rate of eating disorders among female students of nutritional sciences.

A clinician I respect called it "the elephant in the room" in the eating disorder treatment field that a high proportion of people treating eating disorders have had - and many still have - eating disorders.

I'm not sure whether this is good or bad, but I am sure it matters. And it really needs to be discussed more.

September 3, 2007

When we're done

How will we know when we are done?

When the following description of the cause of OCDs at is written about eating disorders:

What Causes OCD?
The old belief that OCD was the result of life experiences has been weakened before the growing evidence that biological factors are a primary contributor to the disorder. The fact that OCD patients respond well to specific medications that affect the neurotransmitter serotonin suggests the disorder has a neurobiological basis. For that reason, OCD is no longer attributed only to attitudes a patient learned in childhood--for example, an inordinate emphasis on cleanliness, or a belief that certain thoughts are dangerous or unacceptable. Instead, the search for causes now focuses on the interaction of neurobiological factors and environmental influences, as well as cognitive processes.