September 29, 2011

Family dynamics? Really? Still?

I keep being told that the old saw about family dynamics causing eating disorders is dead and gone and stop harping about it.

But, I'm sorry, it still lives. It also causes active harm.

Today I was asked to sign my support to a document created by my own state, one that is supposed to be an up-to-date view of the illness and make recommendations. Unfortunately, the document is poorly sourced (since when is the Huffington Post a scientific citation?), leaves out important information now widely known by researchers and evidence-based clinicians, and includes numerous factual errors.

Among them: that family dynamics cause eating disorders. Why do I care? Because this sort of document, dated in 2011, becomes a reference for OTHER literature. This sort of document becomes government endorsement of ideas and recommendations that cause active harm.

"Factors Influencing the Development of Eating Disorders
Family Dynamics Families used to be viewed as the primary cause of an eating disorder
I.e. an emotionally-distant father or an overly controlling mother While sometimes these dynamics are present, it is most important to
understand how the patient views his or her role in the family (i.e., to be the "good kid")'

This should not go on, and yet it does. Really, this is the total of what you want to say about what causes eating disorders on the topic of family? Really? This is September 2011, right? Not 2001?

Not that I wish to spend time analyzing and refuting and protesting this document - I'd much rather it be a good document that I COULD endorse - but I have to. Not just because it is my state that is affected but because it leads to more.

Please, if you have some time to spare - and mine is very short this week - I could use help with the legwork here. Finding the correct citations and statistics, identifying the most important points.

I plan to focus on the family dynamics issue in this document, myself. Not that some of the other stuff - like the trauma piece - doesn't bother me, but because I am more likely to be successful with a focused protest.

We all need to stand up when we can to bad information. It may not help, but let's not make it any easier for those who would allow weak and faulty information get a government stamp!

Unintended consequences

Being well-meaning and positive is not always the best strategy.

Pink Girly Ads May Not Resonate

I see this in eating disorders advocacy, too, so it resonates for me. While there is a necessity of optimism for this treatable illness, it is dangerous without appropriate alarm and ACTION.

Too much of what passes for advocacy is putting a smiley face on really serious problems: in funding, in resource allocation, in dangerously bad ideas. Too many very well-meaning people are putting themselves out there in work that isn't helping, and in fact is distracting from what might help. There is a lot of financial interest skewing advocacy as well.

Well meaning is not enough. Parents are telling me this every day: well meaning is not enough.

She's not hiding

One of the most alliterative, funny ladies I know is on book tour - no, more like a book rampage - with 500 Acres and No Where To Hide, her second book. Susan's grasp of our lifestyle and foibles here in Virginia is amazing.

You can meet Susan here:

I was honored to get to write the review of 500 Acres for a local magazine: (page 44)

I was one of the adoring fans who attended the "divine and bovine" book signing and I got an extra copy to share. I have a signed copy here on my desk and I'll send it to the first reader who emails me with my blurb quote on the cover. Just email me your mailing address and it's yours, free, just because I think you'll like it!

September 28, 2011

Weight prejudice

It is BEDA's First Annual Weight Stigma Week, and time to really, REALLY look within.

I don't mean do you point and laugh on the street, or think Norbit was funny. I mean it on the most personal level: do you cringe at your own appearance or speak disparagingly of your own body size?

You don't have to answer me, in fact, let's not.

Stigma starts with us. Lamenting our own bodies in secret, in private, it's a form of subtle poison. We can't hope to get rid of weight stigma if we can't truly absorb it ourselves. A woman I really respect in the Health at Any Size movement recently told me about her own weight stigma issues - she confessed to these dark thoughts that we advocates rail against. She told me that admitting these feelings was important, and understandable, and that when she shares her struggles with others they feel better and move forward in letting it go. I realized I need to do this and we all do. Like any prejudice, it doesn't just go away because we realize it is "wrong."

I don't believe hating one's body causes eating disorders, nor do I think that messages from others cause them. I do think that pervasive weight stigma in our society and in our hearts causes untold needless misery and makes us hypocrites and poor caregivers and supports to those who do have mental illness where the symptoms include fat phobia and body dysmorphia.

Join BEDA in challenging weight stigma not just in public but in our private moments.

Our bodies deserve our loving care, respect, nurturing. Our thoughts, too!

September 27, 2011

I'm the 4th one, about to be the 5th!

no, I'm not speaking - it's the day after ours and I'll be sucking my thumb in exhaustion like girl #1 here  - I'm talking about the progress of women on the graphic. This sounds like a really interesting program and I love the attention to women's mental health at all ages - so important. I also love the way Woman #5 is swinging that handbag: you, go, girlfriend!!

Registration is now open for the 7th Annual UNC Conference on Eating Disorders and Women's Mental Health. Please see our conference brochure for more details. The registration deadline is Friday, October 21, 2011.
Registration information is available at: The UNC Office of Continuing Medical Education

Saturday, November 5th, 2011 8:00am – 5:00pm Chapel Hill, North Carolina The William and Ida Friday Center for Continuing Education Course Directors: Cynthia M. Bulik, Ph.D., FAED
Jordan Distinguished Professor and Director of UNC Eating Disorders Program,
UNC Department of Psychiatry
Professor of Nutrition
UNC Gillings School of Global Public Health Samantha Meltzer-Brody, M.D., M.P.H.
Associate Professor and Director of the Perinatal Psychiatry Program, UNC Center for Women's Mood Disorders<
UNC Department of Psychiatry Special Guest Speakers:

September 26, 2011

Things that freak me out a bit

As far as human progress goes, and by that I mean a greater grasp of reality - something we as a species value highly but are actually very flawed perceivers - this week is just big. Really big.

This freaks me out more than I can say: putting visual thoughts on a screen. Not because I fear we'll read people's minds against their will so much but because of the many other implications: for medicine, for forensics, for psychology, for communicating with children and the brain impaired. Not only are we as humans not that great at perceiving reality, we're imperfect communicators as well. Imagine seeing someone's thoughts. Imagine seeing your OWN dreams! I don't know. I don't know if I want to 'go' there. Oh, my.

And my husband is gobsmacked that the world hasn't come to a moment of silence and awe over the news that Einstein's speed of light limit may be wrong. My son's first question: "Does this mean time travel is possible?" I dunno. All bets are off!

I admit I'm still tickled and delighted by remote controls and wireless phones - voice recognition software blows my mind. Things are moving so fast...

Eating for Life goes online

When our daughter became ill with anorexia we couldn't find ay websites that made sense: what we were hearing was incoherent and inconsistent and - we know now - just plain wrong on the facts.

Now, the situation has changed. Most eating disorder-specific websites are more thoughtful and have far more science. While I still haven't found many sites I agree with completely, there are far more that I feel a family is safe to find and a few that are not only safe but SOUND: lacking the foolishness and including the important information.

A new site just launched you should check out:

Eating For Life Alliance focusses on schools, but, you'll notice, considers parents and families important and not an afterthought. Join ELA and let them know that good websites matter to you!

September 24, 2011

September 15, 2011

psychotherapy (and experience) change the brain

Many people think that if they accept the term "brain disorder" for eating disorders then they are saying that eating disorders are just built in, can't be changed, and would only respond to drug treatments. This is a common misunderstanding and leads to what strikes me as unnecessary static in the conversation.

Calling anorexia, binge eating disorder, and bulimia "brain disorder" simply identifies the organ of the body affected. It implies that the problem is with the brain and not the environment, which is an important orientation, but that would be like saying that diabetes is not affected by behaviors and does not affect behaviors just because the pancreas is affected. Of course brain disorders are influenced by and influence the environment!

Therapy is one of the ways environment affects the brain. Therapy is a really important element of treatment that most patients need or benefit from - but not ANY therapy. Just as you can't thrown any drug you want at an illness, at any dose, psychotherapy has risks and benefits and needs individualization. Some therapy, in the wrong doses at the wrong times, can be actively harmful.

I recommend this really good piece in Psychiatric Times

How Psychotherapy Changes the Brain

Understanding the Mechanisms

By Hasse Karlsson, MA, MD, PhD | August 11, 2011

September 14, 2011

September 13, 2011

I love my hair!

Read this, and find out why I will never have to search for the right analogy to explain my thoughts about "the obesity crisis" again!

Redheads and Assumptions

September 9, 2011

Students as teachers

I was on the road yesterday, visiting a classroom of film students at American University. Half of the class will be working with us at the F.E.A.S.T. symposium: filming the events and family stories and generally documenting the event. The professor, Sarah Meinke-Fish, asked the students their ideas on how to approach the project and I got a little verklempt: their creativity and engagement - they asked excellent questions and were quick to see the issues from many angles. That, my friends, is what is needed.

Having these marvelous young people there will "reframe" the experience for us in November and into the future. It is quite an honor to have the help, the eyes, and the ear of this group!

September 7, 2011

Why Maggie's Diet is a Bad Idea

Forgive me for blogging my own blog, but the Maggie Goes On A Diet book prompted me to talk about it on Huffington Post this week:

As always, it is really important to go comment on blogs at Huff Po. One, because that is what determines whether they put it on the main pages so people will see it. Two, because otherwise the frighteningly ill-informed comments lead the conversation.

If you care about this issue, help get the word out by commenting, blogging, tweeting, Facebooking, and "liking." This is how public discourse works and the media operates now - so do your part.

Thank you, Carrie, for this gift

Carrie's post on families and eating disorders is so wonderful, so important, and so well-expressed. I hope people hear it - inside the ED world and outside. This is what the public needs to know:

The real relationship between families and eating disorders

September 4, 2011

A Collaborative Approach to Eating Disorder BOOKS

My mail was SO fun this week!

I received my copy A  Collaborative Approach To Eating Disorders, by June Alexander and Janet Treasure, for one thing. They even let me write a chapter introduction! Such an honor to be part of this project, and getting this up-to-date information out to the world in the form of a textbook.

June wasn't exaggerating when she named this a Collaboration: the contributors are a landscape of great thinkers in the field. I happen to know this was an enormously complicated project requiring detailed coordination, skill, and networking.

No fewer than TEN of the textbook contributors will be at the F.E.A.S.T. Symposium, I want you to know, including June Alexander.

So, it is also appropriate that I also got my prototype of the conference nametag in the mail this week as well - created by our Learning Room coordinator, Denise Clancy.

I shall put on my lanyard, put up my feet, and enjoy my book now! (the junk mail can wait)

F.E.A.S.T. Recipe Book contest!

We're updating, renewing, and republishing the popular F.E.A.S.T. recipe book!

We need your recipes, NOW - your delicious family favorites, your nourishing and healing foods. Share them with the world - and help other families as they restore normal nutrition in their loved ones with anorexia and bulimia and binge eating disorder. This is about wholesome foods - foods with the necessary fats and proteins and vitamins and - dare we say it - FLAVOR - to bring back normal.

 Please help us fill this book with food, and fill families with hope and a bit of your personal flavor!

 Send your recipe today!

September 3, 2011

The good news on college

All right, so I was a bit depressing in yesterday's post. I even committed the great sin of casting doubt on the long-term prognosis for Family-Based Maudsley. I used broad numbers that are anecdotal, which wasn't fair either. So, if you can bear it, the rest of the story.

I'm weary of parents coming back to the ATDT community and my inbox whispering about something that needs to be discussed more openly: the need to remain involved and vigilant during the transition to independent living. There is an acute sense of "what did I do wrong?" when a loved one starts to relapse that needs to be answered.

It also needs to be said that the rates of relapse for those in traditional treatment are well-known: greater than 2/3. The numbers of people I know who have kept a hands-off this is between you and your therapist and don't you want to finish your salad, dear, approach not only see their loved ones relapse it is considered normal and expected! We can't even call it "relapsing" for most patients because they've never actually gained full health: maintained healthy weight and behaviors and thinking for more than brief periods.

I really see a problem out there where families who HAVE done all they can, and well, and worked with outstanding clinicians, drop it all at 17 or 18 during Freshman Orientation. I may be more sensitive to this because I did it myself, but still, the pattern is really common.

I am calling on all of us to "snap out of it." Let's lose the fiction that the ED predisposition goes away with recovery. It doesn't. It certainly seems to lessen and have less control the more time passes in good health but a big factor in that is the habit and structure of living without ED.

Two, to be a bit stronger against the "normal" drumbeat. It isn't normal for someone who has a history of an eating disorder to go off to the greatest transition of their young lives, the greatest exposure to disordered thinking and eating, the off-the-cliff change from family meals to dining hall, an open spigot of alcohol, new routines, mountains of decisions, social uncertainty, and academic competition - without hearing the Siren call.

Three, there IS more most families could be doing but we're afraid to do it. We feel pressured, unsupported, obnoxious, and disloyal - but it may still be the right thing to do. We wait and wonder and worry. I'm saying that having that family-centered approach to treatment and maintenance can and probably SHOULD extend to the college years and we need to give one another permission to do it.

I'll also confess to this, because I know I'm not alone in it and it may comfort others to hear it: I had a bit of a chip on my shoulder. I wanted people to look favorably on our family's approach and to prove that we were not, in fact, overbearing and enmeshed - that our involvement in her treatment had been temporary and that we - more than other families - were able to let go and watch her fly because we were so wonderful. I confess to wanting to be the good, compliant mother.

Dumb hubris. Dumb hubris made easier because we got so little encouragement from other parents or professionals to be more proactive. I'm just one mom out here but I want to be the fellow parent saying to you that your instincts matter and it is okay, if you see fit, to take a more involved role and even to say no. It is okay to go down to school for a visit and, seeing signs of concern, withdraw your loved one kicking and screaming. It is okay to have a contract in place, to require doctor checks and verifiable therapist visits, to require calls home, visits, meeting with RA - whatever YOU need to feel fully confident.

Here's the good news. I see really great results from families who do take a more active role and put protections in place and those who step in without ado as needed. These are the patients who struggle a bit and then get back on track. These are the families who can remain confident and supportive of and the expected wobbles don't turn into full scale protracted relapse.

September 2, 2011

College relapse season

How often do eating disorder patients who have successfully recovered at home struggle with relapse when they go to college? I'm guessing, from the families I know, about half - at least a third. In our family, of course, it was 100%.

Keep in mind that the families I know are primarily those who were pretty clued up. These are parents who generally did a home-based, family-centered, Family-Based Maudsley or something close to it after going the traditional route. These are parents who did some of the most difficult parenting of their lives, and successfully got their kids back to FULL health and functioning.

Yet, college relapse is still happening, and as often as not.

I say this not to be depressing, and not to judge the decision to send your kids to college. I say this because you deserve to know. I don't think that college is out of reach for recovered eating disorder patients, though:  we need to change the way we approach it, what we ask of our kids, what we expect for ourselves, and what we ask of schools.

I think the problem is us: that we think recovery will hold just because we want it to. Because we want to give them "normal." We want normal. We treat this transition as if it isn't the greatest challenge our loved one will face since recovery.


In the US, especially, turning 18 and going off to residential college far from home is nearly a rite of passage. Since many of our kids are already - by virtue of the traits of high anxiety and perfectionism - terrific students it is normal to expect they will go off to the best college or university they can gain entry for - just like their friends.

It is heroic parenting to say no, despite our doubts. It is all-out battle to set limits on how far, how independent, and how little monitoring will go on. It is humiliating to attend the orientations at school where parents are chided and admonished not to be "helicopter parents."It just feels wrong to have your loved one say "you don't trust me?"

But we're a few months from the Thanksgiving break, when invariably the eating disorder treatment world and advocates are inundated by parents who for the first time really see the heartbreaking signs of relapse. Every parent sends their son or daughter off with high hopes but ours are even higher: not to lose the ground we so carefully and painfully gained - and the young person probably doesn't even remember.

What can we do?
  1. Reconsider. Is college the right thing for the child, or is the primary reason because of inertia and social pressure? A gap year is an option. So is forgoing college. And local community college or a school near home. If your parental instincts are nagging at you, listen to them. This may be your last chance to be parental in this way, and your last chance to prevent a life-changing mistake. Each month, each semester, each year into maturity is a stronger guard against relapse.
  2. Who's in charge? Is it ED? Is it your child who doesn't remember recovery well and like any teenager believes she is invincible? Do you believe recovery means the predisposition is gone and your very young adult is now as competent as you are to assess the situation?
  3. Does it have to be all or nothing? It is okay to have a contract, a plan, to start small, to do a test, to start out with lots of protections and ease off later, to "be that parent" who hovers, emails, shows up, requires weigh ins, requires local therapy, requires weekends at home, etc.
  4. No secrets. An eating disorder history is a pretty significant thing. It isn't shameful, and it isn't uncommon. The roommate and the RA and the school deserve to know, to be educated. You deserve to know what THEY think - because a roommate on a diet, a Big Fat Loser contest in the Residence hall, an RA who thinks college students need their privacy except if they are suicidal, the school that thinks the student has to "want" help is an unsafe environment for your college-aged child.
  5. Have an escape plan and don't call it failure. Taking time off is not failure. Being ready to withdraw from school at the most inconvenient, humiliating, GPA-crushing, expensive moment of the semester is a superpower against ED. The goal of college is a better life - not a better college experience. A better life - a life, period - is at risk if an ED is in the picture.
"MY child won't relapse" is a statement no parent should fool him or herself with. The predisposition is there - you know that - and it is our job to make sure it doesn't take hold. College is for healthy people, and supporting college is for parents who are confident and involved.

P.S. Our daughter struggled through freshman year and took a semester off due to relapse. It was a wonderful time, believe it or not, and a relief to all of us including her. She went back STRONG, and all of us with our eyes on ED, rather than averting and avoiding and tip-toeing. She has been healthy ever since - not because everyone stopped worrying about it but because staying recovered is about facing, not avoiding the issue.

Great blog posts on the same theme:
Leaving the Nest: 10 Tips for Parents
Learning from relapse

September 1, 2011

Here's a good rule for avoiding the "blame game"

Here's a good rule:

Don't say anything about parents and eating disorders that you would not say about OCD, autism, asthma, or a broken arm. It's easy. Try it.

Does this rule change anything in how you approach families or change your assumptions? If it does, then why? Why do you NEED these other assumptions?

I've found that every single thing that people say that DOESN'T follow that rule leads to poor treatment, poor response by parents, social stigma, and bad outcomes.

That rule doesn't prevent you from saying anything about the patient in particular - and actual things that person has experienced - but it starts you in the right place.

I still, after years of looking, have not found anything to be true as a group about families of eating disorder patients except that they SUFFER and that all want to help their loved one. Yes, I said "all." I haven't yet met one family that didn't want their loved one to recover, and if their efforts to do so seem wrong-headed or too weak or counterproductive then remember all the conflicting messages they've heard and the absence of support for families and the way the illness itself tries to alienate the very people who would want to help. Families facing cancer and injuries also struggle to respond well, but rarely are they faced with a professional world and a public that STARTS with wrong assumptions about their ability and motivation.

All I'm asking, really, is that one rule.

Great blog posts

Being too busy lately to keep up on writing or reading blog posts, I share some great ones I just read, and a terrific cartoon: