May 31, 2008

Media day

It has been a fascinating media week.

A comment about enmeshed moms in the article Is Being Thin Worth Dying? led to parent protest, and a surprising phone conversation with one of the people quoted.

I read the following headline: Half of anorexic kids need force feeding and yearn to say: "No, all anorexic kids need feeding."

As an advocate of Family-Based Maudsley support from clinicians, I feel it is equally important to let criticism also be part of the conversation: Anorexia: a family’s hell

And this broke my heart: "Anorexia is a pretty unusual disease in a young man. in the announcement of a young man's tragic death. Why do we think that because the illness strikes fewer men that it is less devastating TO THOSE MEN?

May 30, 2008

Hear her now

I'm really cautious about recovery blogs and memoirs. I find - like hearing my daughter when she was ill - myself arguing and worrying and troubled by flashbacks of trying to give love and get care for someone who can't see that they need it.

But I make an exception with some people. Like Carrie, and FightingForever. Because we can learn and we can get a lot out of cheering for adults reaching escape velocity from this illness.

Read, and watch FightingForever's video: Can you hear me now?

May 29, 2008

opinions on nearly everything

"Fact is, most people are only well informed on a couple of things, but have opinions on nearly everything."

...my husband's astute assessment as I railed about the futility of convincing people that the current obesity hysteria is a lemming-like march away from science into prejudice and ill health. We were discussing a children's game that measures BMI.

I know nothing about sportfishing, the correct use of the semi-colon, or the Lithuanian language. I know this: Wii Fit is bad science.

May 28, 2008

giraffes

Remember how we used to laugh at people who thought that giraffes developed longer necks because mommy giraffe stretched to reach stuff and that made her babies have longer necks? That was silly: you can't change genes through behaviors, right?

Time to think this through.

The topic of epigenetics is fascinating. Could environment change one's DNA - or more accurately how your DNA is expressed? Could this be part of why the nature/nurture dichotomy is so unsatisfying?

May 27, 2008

inspiring families

I don't know how you can watch this video without feeling optimistic for both recovery and for families:

Families and eating disorders

Deranged, implications, needs

Eight journals, looking at EDs from all angles:

Deranged Secretion of Ghrelin and Obestatin in the Cephalic Phase of Vagal Stimulation in Women with Anorexia Nervosa.Biol Psychiatry. 2008 May 10; PMID: 18474361

Implications of starvation-induced change in right dorsal anterior cingulate volume in anorexia nervosa.Int J Eat Disord. 2008 May 12; PMID: 18473337

The needs of carers: a comparison between eating disorders and schizophrenia.Soc Psychiatry Psychiatr Epidemiol. 2008 May 12; PMID: 18473133

Peptide YY (PYY) levels and bone mineral density (BMD) in women with anorexia nervosa.Bone. 2008 Mar 25; PMID: 18486583

A cross-sectional and follow-up voxel-based morphometric MRI study in adolescent anorexia nervosa.J Psychiatr Res. 2008 May 15; PMID: 18486147

Assessing the heritability of anorexia nervosa symptoms using a marginal maximal likelihood approach.Psychol Med. 2008 May 19;:1-11 PMID: 18485259

Pain, catastrophizing, and depressive symptomatology in eating disorders.Clin J Pain. 2008 Jun;24(5):406-14. PMID: 18496305

Association of NTRK3 and its interaction with NGF suggest an altered cross-regulation of the neurotrophin signaling pathway in eating disorders.Hum Mol Genet. 2008 May 1;17(9):1234-44. PMID: 18203754

May 26, 2008

How can I make him understand?

You can't.

And it doesn't matter right now.

Most of the history of eating disorder treatment, indeed of all psychological symptoms, is the search for insight. Turns out, insight is overrated.

And with eating disorders, expecting insight while a person is still undernourished or caught in a cycle of bingeing or purging is like asking for insight in the midst of a coma or under the influence of a six-pack.

It is also not necessary. Insight is an important part of avoiding relapse, but it isn't necessary or even important until the later stages of recovery. We've had this upside down for so long it seemed to be rational, but think about it: why would a brain that is inadequately or erratically fed be able to think and reason? Do we give swimming lessons to the drowning?

You can't make someone understand, care, be motivated, or be thankful. You can make sure their brain is repairing. You can try to make them feel safe, loved, and moving forward. Insight will come.

May 25, 2008

Eating's evolution

Ever wonder:

Why anorexia makes sense

Listen to this short radio segment that features Dr. Shan Guisinger's evolutionary biology description for anorexia.

Thank you, C, for this link - I had missed it!

May 24, 2008

One liners

What a difference a headline makes:

Anorexia More Severe When Preceded by Overanxious Disorder

Childhood anxiety may worsen anorexia

This is the same study, and they are saying the same thing, sort of. But the second headline's subtle shift makes a crucial error.

The first headline, appropriately, alerts us that the prognosis may be affected by pre-existing anxiety disorder. It does not imply one causes the other, nor does it say it doesn't. Also, by using the word disorder in the title, we are being told this is not garden variety anxiety or a lifestyle choice.

The first headline is helpful. The second, not so much.

May 23, 2008

Mentors needed

I feel comfortable sharing information with, and cheering on, fellow parents. I am a mom, and I believe parents can be valuable resources to one another.

But I also hear a great deal from current and former eating disorder patients. Some are looking for help and support, some are reaching out to help others. This I feel far more cautious about. It seems presumptuous - and even enabling - for me to play that role for someone who deserves support in real life from family and friends.

But here is something helpful: my friend Shannon Cutts is recruiting mentors at her Key-to-Life site.

If you are well into recovery and want to reach out: Key-to-Life by Shannon Cutts

May 22, 2008

The size of the trigger or the speed of the bullet?

If dieting of any kind can trigger an eating disorder does it matter why you dieted?

Everyone else is * you feel fat * dieting makes you cooler, edgier * dieting is an adult activity * you are trying to be healthy * you were sexually abused and are disconnected with your body * your coach thinks it will make you faster * your doctor told you to * your mother paid you $50 to lose ten pounds * a magazine told you how * you heard a fat joke on the radio * you are afraid of being old and frumpy * someone teased you about your baby fat * you are taller and bigger than your peers * Wolf whistle triggered Charmaine's tragic decline * you started growing earlier than your peers * your whole family is fat and you want to avoid that destiny * you want to control something in your chaotic life * you don’t mean to diet, you just aren’t hungry * you’ve been ill, and you have no appetite * you don’t have time to eat

If you have a genetic/biological predisposition to react to dietary restriction (or too much exercise) with a self-perpetuating cycle of restriction then I don’t think it matters why you started. You’ll get an eating disorder no matter why you started pushing away the plate.

The majority of people who get eating disorders just went on a diet, not knowing a trap door was under his or her feet.

An eating disorder is not a sign of deep wounds, but some people do have deep wounds, and it makes recovery harder. You shouldn’t need to have an eating disorder to get help and healing for trauma or abuse. You didn’t deserve to be bullied, teased, excluded, ill, or told that your main value in life is your appearance. None of us should have to live in a world where “you lost weight” is a compliment and “I’m so fat” is an appeal for friendship.

But ED doesn't care why you didn't eat enough. He was waiting there in your DNA for any chance to have at you. And he'll use any excuse to keep you there.

May 19, 2008

Stigma

Maybe we should offer a "Visiting Anorexic" service?

Stereotypes, prejudice and discrimination of women:

"Characteristics attributed to targets were less positive for AN than the targets with schizophrenia and mononucleosis.... Having actual contact with an individual with AN related to a positive predicted outcome of and comfort in interacting with the target with AN."

May 18, 2008

Not THAT kind of family therapy!

Parents new to the world of eating disorder treatment beware: there are two types of "family therapy."

One type of Family Therapy sees the illness as an expression of a problem in the family that must be fixed in order to solve the eating disorder. You can see an example of this kind of thinking in this article: Could Family Therapy Be Key To Treating Anorexia? This kind of therapy is sometimes called the Family Systems approach.

The other type, sometimes called Family-Based or Maudsley approach, treats the illness as the problem and recruits the family to fight the nutritional and behavioral symptoms so the patient can regain stability and health and rejoin the family and normal life.

Big difference. Good explanation HERE. Ask for what you want.

May 17, 2008

PTSD and eating disorders

"a common mistake made by therapists inexperienced in the treatment of eating disorders is to not fully appreciate the need for nutritional rehabilitation before beginning actual exposure work."

May 16, 2008

Throwing out the DSM

We don't need the DSM, or the SCOFF, EAT, EDD, BITE, or any of the various diagnostic tools to measure an eating disorder any more, I'm glad to say.

A wise parent has created the pizza test that will with 100% accuracy diagnose an eating disorder at any stage.

And a wise patient has created the definitive muff-cake-and-on-with-your-day scale for measuring recovery.

We're done!

May 15, 2008

90% of mothers pat themselves on the back this morning

The problem with the sort of "prevention" talk in Moms key to daughters' healthy body image is that it is right: of course we should all give up the silly, fatuous, damaging fat and diet talk. We should, we MUST.

But all the positive body image stuff in the world, the most perfect parenting, the ideal nurturing environment - none of these things will head off an eating disorder (and resultant distorted body image) in a person who has the genetic predisposition and starts skipping meals.

I wish to hell I'd never dieted, never said a negative thing about my appearance, never looked sideways wistfully in a mirror. I know, after my daughter's illness, I never ever will again.

But I didn't cause my daughter's body image problems or eating disorder by my behavior. What my behavior did was make me look like a hypocrite and a fool to that part of my daughter's intellect that was still intact. It made it harder for me to support her recovery. It confused the issues and delayed our response.

Articles like that above feed a self-congratulating hubris to those whose kids don't develop eating disorders. I grieve for every parent of a newly diagnosed ED patient who cries reading that article - and they will.

May 14, 2008

False choices, and older patients

Family-based Maudsley therapy works best for adolescents living at home when they've been ill less than three years.

It doesn't work as well for independent adults who have been ill longer.

This is not hard to understand. No treatment works very well for independent adults. And the longer you are symptomatic, the worse your prognosis.

Attacking Family-Based Maudsley treatment because it doesn't work as well for older patients is like saying we shouldn't operate on small tumors because surgery doesn't work as well when the tumor has spread.

Let's not consign another generation of patients to disability or death.

May 13, 2008

Is an eating disorder just an extreme diet?

Is an eating disorder an extreme diet?

I don't know: is schizophrenia extreme thinking?

May 12, 2008

The other way around

Let's get these basic misunderstandings of eating disorders cleared up:

Feeling fat makes you diet. (For people with certain kinds of brains, dieting makes you feel fat.)

Bingeing is a way to cope with intolerable feelings. (Bingeing is a natural physiological response to dieting.)

Anorexics are dissatisfied with their weight because they want to be thin. (Anorexics are usually already thin. No amount of weight loss will satisfy.)

Purging doesn't feel good. (Bulimics get a temporary good feeling - a relief - after purging.)

Once you are a 'normal' weight the mental symptoms go away. (It takes 6-12 months of stability for the brain to normalize. A lot of habit-forming, skills-building, and cognitive reinforcement has to be done during those months to ward off relapse.)

It's not about the food. (It is if you're not eating enough.)

It's only about the food. (It is a brain disorder that makes lack of food into a self-perpetuating condition.)

You have to choose to be well before you can change your behaviors. (No, you have to change the behaviors and be physically healed to truly choose to be well.)

May 11, 2008

That frustrating question

A very interesting article describing some very interesting research:

Sharing the womb with a brother may influence a girl's development

Which could be translated, I suppose, to: "If only you had a twin brother."

May 10, 2008

Back to the Future

Your Jeans and Your Genes: Taking Eating Disorders Out of the Closet

"Things have changed from the time a friend of mine, whose wife had schizophrenia, would come out of family support meetings, where families were basically blamed, and yelled at. He says that families would walk around after these meetings, wandering to the parking lot, kind of shell shocked. That was part of 'treatment' with families."

Still is, I'm afraid, but the illnesses are anorexia and bulimia. If you and your ill loved one are still getting this sort of "family support" trying to determine your faults and asking you to "search within" for reasons why your child is choosing her symptoms - snap a picture: dinosaurs still walk the earth.

Then find one of the rapidly growing number of clinics and clinicians who no longer cling to antiquated notions*. Your child deserves effective care.

*Start here

May 9, 2008

Risk is a risky word

I guess we're done figuring out what causes eating disorders. We've moved on to what eating disorders cause:

"TEENAGE girls with early signs of anorexia and bulimia are twice as likely to be addicted to drugs, suffer a mental illness or have an abortion

It is time for a campaign against the sloppy use of the word "risk." In popular use, it implies "causes." More often than not, when a headline draws these conclusions they are really talking about correlation; that two things are found together and as one changes the other changes as well.

One may cause the other, or both things might be caused by some other common factor.

Reading the headline above, most people will conclude that messing about with one's eating is a gateway drug to delinquency and ruin. I read it and think, no kidding: anxiety and attentional and affective disorders run in families. Erratic eating patterns may be an early warning of the benefits of a more structured, lower stress, more nurturing environment for this child.

May 8, 2008

OCD symptoms? This might take a while.

If an eating disorder was preceded by OCD symptoms earlier in life, recovery may take longer: Lifetime course of eating disorders

Good to know.

Rat prozac

Can we wonder whether not eating has an emotional effect when even rats can use hunger as a temporary anti-depressant?

Of course, like any addictive substance, it takes bigger and bigger hits to get the same effect (smaller and smaller meals). And meanwhile, your brain loses the ability to cope without a "hit." Easy to see where that goes.

May 7, 2008

I'm tired of the word "controversial"

Evidence-based psychosocial treatments for eating disorders

"At this time, the evidence base is strongest for the Maudsley model of family therapy for anorexia nervosa."

Bullying and mental disorders

Most people reading the article "Father blames bullying for son's eating disorder" will see the issue as "is bullying bad" or "bullying isn't that bad."

It's a false choice. We don't need to blame anyone for the boy's illness, and we certainly don't have to see this child as a helpless victim.

Child with genetic predisposition for anxiety and eating disorders diets. Child's body goes into a self-perpetuating cycle of malnutrition. Mental symptoms ensue. That's the only part of this article that relates to eating disorders in my mind.

Bullying IS bad. But you should not have to have an eating disorder or become suicidally depressed for bullying to be harmful and unacceptable and OUR JOB to address - individually and as a society - period.

May 6, 2008

I'm all over the map, but just south of neurotic



Some fascinating people have made some fascinating maps of personality types that may interest you.

Where do all the neurotics live?

Turns out I live just north of agreeable and conscientiousness. I used to love living right in the middle of neurotic, but these days I'm sadly not as open to experience.

May 5, 2008

So close, but should be put down at the finish line

Eight bells had to be put down at the end of the race, as should this article: Psychology Today: Consuming Passions

So much potential, but the emphasis in the end on weight loss advice dismays and saddens me.

May 4, 2008

Feminist theory

I'm a feminist. I'm as about female equality, empowerment, identity, and authenticity as anyone.

So it was with dismay that I realized my friends were not my friends when it comes to eating disorders.

I don't think eating disorders need a feminist analysis any more than I think cancer or asthma do. In fact, talk of dissonance in treatment and analysis of differing senses of physicality and dualistic constructions strike me as more of the same stuff that got us into the incoherent mess we have in terms of treatment theory.

Here's the challenge: explain to me why the anorexia or bulimia or BED of a man is any different?

We must resist the temptation to use illness to confirm our dogma - or social cause. Feminism does not need eating disorders to prove its case. And eating disorder treatment does not need feminism for good treatment. You can be a feminist - and eschew commercialism, eat organic, believe in family, be non-violent, and hate the diet culture - without believing the lack of those things causes eating disorders.

May 2, 2008

Global warming cures eating disorders

OK, I'm kidding. But is that headline any crazier than ones you see while checking out groceries?

Warming has been proposed and utilized as a therapeutic help to anorexic patients after meals. New research shows that rats who have been turned into activity anorexics by being given running wheels but less food (you know this person in your life) change their behaviors when exposed to higher temperatures.

Ach, I just felt the earth wobble as thousands of families grabbed their ill kids and headed for the equator. May be cheaper than turning up the thermostat.

May 1, 2008

How "healthy" is Health Class?

It used to be "sex ed" that worried parents, but among parents of kids who have suffered with disordered eating, it is "Health" class that scares us.

Many children start dieting, restricting food groups, and moralizing about food and fat after misguided "Nutrition" classes in our age of obesity hysteria. They show "Super Size Me" and assign "Fast Food Nation" to teens already so self-conscious about their appearances they they'd sell their souls and their siblings to achieve an appearance they think their peers will find pleasing.

My son just brought home a sheet from Cub Scouts asking him to track everything he eats and each item's calorie count, something we consider a disordered eating behavior around here. (We won't be doing it. Calls will be made.)

I do not hold to the idea that these influences cause eating disorders - I think the vulnerability is pre-existing and set in motion or triggered by dieting, overexercise, or illness. But these wrong-headed lessons can trigger those triggers, and are particularly counterproductive for children in recovery, and create a hostile environment for them when other kids are taught to parrot this stuff.

My son says "all my teachers talk about calories all the time and getting fat."

Parents of kids with eating disorders often have their children pulled out of health classes, body fat testing, BMI checks, and other "triggering" experiences. I think this isn't enough. We ALL need to pull our kids from these anti-scientific lessons for the sake of all children.

There is no evidence that the kids who take these messages to heart are in need of them in the first place. There is no evidence that these "classes" change weights or behaviors in the long run - except in precipitating unhealthy dieting behaviors. "Do no harm" should apply to education, too.

(postscript: you may want to check out blogger Sandy Szwarc's post on this topic: HERE.)