New Treatments for Eating Disorders
http://thedianerehmshow.org/shows/2010-08-26/new-treatments-eating-disorders
New in-home, family-centered options for helping those with eating disorders differ from hospital or treatment centers. Diane and guests discuss these new approaches and their effectiveness.
Guests
Harriet Brown
author of "Brave Girl Eating." She is also assistant professor of magazine journalism at Syracuse University. Her blog, "Feed Me!" covers food, eating disorders, and obesity.
Lynn Grefe
C.E.O. of the National Eating Disorders Association
Dr. Ovidio Bermudez
Medical Director, Eating Disorders Program
Laureate Psychiatric Clinic and Hospital in Tulsa, Oklahoma
Comments
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Diane -
Thank you for doing a show on this very important topic. I am the parent of a 15 year old girl with anorexia. She was diagnosed 2 years ago, after I went through an illness.
Our first experience with treatment was in a residential treatment center - she was 13 at the time and sadly, she learned from older residents how to be a great anorexic (she learned tips like takin cold showers and eatin tabasco sauce raises your metabolism). After discharge (limited by insurance, not her health status), she came back to the DC area. I work in the research field and learned about the Maudsley approach.
I took leave without pay to stay home (I am a single parent) and used a family based approach, supervising each and every meal, taking her to group therapy, individual therapy, nutritionist, medical doctor, and psychiatrist appointments. A full time enterprise. She started gaining weight but her mental state stayed the same. I almost killed myself trying to do the right thing. I felt very pressured to do it myself, guilty for sending her to a residential treatment center, and tried so so hard. But after 3 months, she got a little flu bug, lost all the weight, and it started all over again.
I then took my son out of school, drove across the country to place her in a modified program - she went by day to a hospital based program with a strong family component. I stayed in a Ronald McDonald house with my son, fearing for my job security. Again, she started getting better. Insurance kicked her out - we came home, she got sick again, despite my best efforts. continued....
continued...
She was home for two months - this time, when she lost weight, her life was in danger. When we went to Children's ER (6th time) her heart rate was in the 30's - they considered pediatric ICU. Mental health state by now was terrible. This time the Dr., a well-known Maudsley proponent, suggested long-term residential treatment. I was so relieved - I simply could not run a hospital out of my home.
My daughter is getting better. I have not had my sweet girl with me since March - 6 months. I miss her terribly every minute. This current facility (5 hrs. across the US) treats to outcome - they help the parents advocate for insurance coverage and do not automatically kick the patient out. I have hope but also understand that she will need to watch this disease for the rest of her life. She could still die.
My purpose in writing this is to point out that while family based therapy should be considered, it is not necessarily a perfect fit for families with limited resources and even for families who try their very best. Eating disorders are terrible - thank you again for doing this show!!!!
Mom in DC
Diane,
I am a male, marathon runner, and medical student. I am also married. I've excelled in nearly every task I've undertaken. And then I developed an eating disorder. For six years I have fought a physical and mental battle that has taken a toll on family, friends, and every aspect of my life. I began to withdraw. I failed my first medical school exam. I began to feel helpless. But I had control of my eating, or so I thought. Now I am taking a year leave of absence to focus on my health and marriage.
I have struggled with anorexia/bulimia for six years. I brought the baggage into my marriage and just recently my relationship with my wife nearly ended because of it. I can relate almost all my frustrations and struggles with life, school, religion, family, and friends to my eating disorder. I never imagined I would struggle with this. As a male, I'm in the minority of those with an eating disorder. I think for that reason I felt I needed to overcome it alone. That was my mistake, which nearly cost my marriage...
continued from above...
From the outside looking in, it seems an easy battle to win. Just eat more. But from the inside out, it's a daily, almost hourly war of doubt, depression, addiction, control, helplessness, guilt, and fatigue. There is a reason we are taught in medical school that anorexics have the highest suicide rate amongst psychiatric patients. It's a life of contradiction and defeat, with small moments of hope in a better future. I sought counseling, but it was not until I let my family and friends, and most importantly, my wife into my struggle that I have begun to make the most progress. I am still fighting and relapse might be forthcoming, but it was family, and the prospect of losing them, that has been of most benefit so far. I would just like to share that no matter how long the affliction, you will never kill your true identity if you keep trying to overcome. You will rediscover happiness in a sunrise, a picnic in the park, a jog along the river trail, or at the next family reunion. And the best part is your family can rediscover you. My wife and I have never been closer than we are right now.
Sometimes what is assumed to be anorexia is actually a different disease that is causing extreme weight loss. A recent case reported in the local news in Oklahoma City concerned a teenager who was diagnosed by multiple doctors and at multiple hospitals as anorexic. After many months of persistence by his family, it was finally determined that he had celiac disease. When he went on a gluten free diet he began to gain weight again. A similar experience happened to my own mother in the 1960s. She was never diagnosed with anorexia, but her weight dropped from about 120 pounds to around 80 pounds. She almost died. After many months of testing, including tests at the Univ. of Oklahoma Health Sciences Center, she was finally diagnosed with celiac disease. Once placed on the gluten free diet, she regained her weight and lived in good health to age 88.
Please mention the relationship to diabetes mellitus and older men having undiagnosed eating disorders. Thanks.
Is this Family Based therapy offered for other psychiatric illnesses? Our teen attempted suicide several times. After his second hospitalization we felt that having a 19 yr old with anxiety disorder in with a bunch of psychotic adults was not a good idea. We were offered residential programs, far away, that would have meant he'd have to quit school. He defines himself entirely as a student, and we felt leaving school would be more harmful, esp. as his attempt may have been somewhat medication-induced. Sending him away seemed like punishment, emprisonment rather than helping him! We also faced losing our health insurance, by the way, if he were not enrolled full time!
We do not need expensive neurofunctional mapping studies to conclude that the brain functions differently when we suffer from a behavioral disorder.
The brain does not light up. Read more here:
http://brainmindinst.blogspot.com/2009/03/fmri-mental-processing.html
We do not need expensive neurofunctional mapping studies to conclude that the brain functions differently when we suffer from a behavioral disorder.
The brain does not light up. Read more here:
http://brainmindinst.blogspot.com/2009/03/fmri-mental-processing.html
I'm glad the FBT program worked for the woman on the show. However, I hope that everyone listens carefully to what the doctor says - that treatment must be individualized, and that not all cases will respond in the same way.
I can tell you that I personally suffered from Bulimia for about 10 years, from my mid-teens to my mid-twenties.
Part of my problem was my emotionally and sometimes physically abusive Mother. My Mother had some serious psychiatric issues, which I do not believe she understands even now, despite years of therapy.
"Empowering" her to sit with me and force me to eat, etc. would have absolutely destroyed me.
If this treatment is used, it should be conducted with very well trained staff, who can protect the child when necessary.
(please keep my name anonymous)
Thank you,
TSG
I haven't heard anyone address the true nature of these problems: that girls/women need to realize that they are more than their bodies.
I had bulimia for many years. It wasn't until I began to have some successes unrelated to my looks--while simultaneously developing a spiritual side. I eventually came to the realization that to see myself only through my body was extremely limiting.
I think that building awareness of talents and work toward accomplishment and whatever one can accept regarding spirituality should be the heart of all treatment. It worked for me.
Diane,
First I would like to thank you for this show. Perhaps I caught the show too late but from what I heard there was no discussion about binge eating as an eating disorder. This was very disappointing seeing that your esteemed guests have such knowledgeable guests. I am a 30 year old woman who has been suffering from binge eating during very stressful times in my life for the last ten years. I am now in treatment and using Intuitive Eating with a therapist and nutritionist. What do your guests look as the cause of binging and do they acknowledge it as an ED or are people like me to dismiss something that is so very real for us to battle?
Thank you,
Arwen
Thank you for this show - I think this is a very important topic. My daughter does not have an eating disorder, but I have struggled with my ex telling her that she is fat (and eats too much) repeatedly. I think that it is very important for us all to tell our girls that they are perfect just like they are. She is not fat and not thin, but a strong athletic girl - and she is perfect. We have had many conversations that she will never be rail-thin because genetically she is just not built that way and she should not want to be any other way than the way she is naturally.
So disappointed that the show did not address the idea of an eating disorder as an addiction and the extremely successful use of the 12 steps and 12 step programs in helping those suffering. Please let your listeners know that Overeaters Anonymous is out there for those with both undereating and overeating issues! (Didn't hear the whole show - hopefully Ijust missed it).
Thank you for illuminating this important issue and thank you to your guests, especially Harriet Brown, for leading the way for families. Our story parallels hers except our daughter did lose weight and was dangerously ill. We too decided we wanted to do our best to keep our daughter home. She's now a living testament to the fact that, under the right circumstances, family-based therapy can work. Our daughter is a happy, healthy teenager! While family-based therapy may not work for every situation, every family should be given a spectrum of options to fit their individual situation. Sadly, that is not always the case. In our situation, our physician only recommended residential treatment at 1 residential program half the country away from us. We had to waste precious time researching our other options. Please let other families know they can find wonderful resources at this website: www.feast-ed.org, a parent-driven and parent-supported organization for all families of individuals with eating disorders.
Eating disorders are a topic that need to be discussed. The problem needs to be in the open mostly so people know what to look for as signs and symptoms. The earlier the condition is identified the easier it is to recover. The huge problem with eating disorder is that no one "cure" will work for everyone. Eating disorders occur for a variety of reasons and most times it isn't just body image. It is a control issue, a perfection issue, dealing with broken relationships, the list is endless. For people to heal, they need to learn to cope with the underlying problems in a healthy manner, and most importantly they need to want recovery. I struggled with an eating disorder for almost 5 years and much to my parents dismay there was nothing they could do to convince me to eat. I was in and out of treatment centers throughout the United States and none of them solved my problem. I owe every place I went gratitude for keeping me alive long enough for me to really want recovery myself and realize what steps I needed to take to achieve it. Part of that was realizing that I would take steps backwards during recovery, but it was ok and I just had to recognize what went wrong and move forward (trying not to make that mistake again). continued...
continued... I believe that the family-centered therapy may work for some people--probably younger girls. I had already moved to college and wasn't about to listen to anything my parents said anyway. You can't force another person to accept your help or force another person to eat--my parents learned this quickly. The biggest things my parents had to do was learn what limits they had to set with me so they were not enabling my disease. From our experience this worked the best--although it was very painful from both sides. Again, every person is unique and needs different things for treatment. I believe that society needs to be better at providing treatment for this problem and realize that treatment will not always work--just provide it so people will stay alive long enough to find something that does work for them as an individual.
I had a severe case of anorexia as a 13 year old back in the late 1970s, and had the great good fortune to be treated as an outpatient at the Child Guidance Clinic in Philadelphia. At that time Dr. Salvador Minuchin, who developed ‘family systems therapy’, ran the Clinic. Amazingly, I saw Dr. Minuchin himself on several outpatient visits. My recovery from anorexia did not begin until I started to develop insight into what my therapists were telling me about autonomy—that getting over this disease was something I had a responsibility for, though of course it was my parents’ job to do what they could do also. Although I am remorseful to say this, anorexia was a way of fighting my parents—albeit fighting in a futile and pathetic and potentially deadly way—for some freedom. Dr. Minuchin and his associates helped me to realize that I could do so much better, for myself and for the world, than starving myself, when it came to establishing the beginnings of autonomy.
Eating disorders are the result of disordered thought processes—I worry when people say, too simplistically, that eating disorders are a disease just like cancer is a disease. I agree with their reason for saying something like this—that people with eating disorders need compassion, not anger and blame—but I disagree with the basic premise. If a person changes their thinking and worldview, they will unfortunately not cure their melanoma or brain tumor. But I did eventually beat AN by making fundamental changes in my mind. These changes were made over a long period of time, and resulted from the help of therapists, good writers, true friends, and cultivation of a world view that wasn’t just limited to the hell of focusing only on myself and my own body.
my daughter is in a fbt treatment(maudsley method) at the time she was diagnosed with anorexia she only 11yrs. we were referred to the eating disoder program at the University of Chicago Hospital.. I'm so grateful for this program. my daughter is doing so much better. I think this program works for us because we caught it early enough..thanks to the doctors at the University of Chicago.
Diane,
Thank you for doing this show, it is a relief to hear a voice behind something so many of us suffer from either as the person with the eating disorder or the caregiver.
My daughter is almost 18 and was diagnosed with anorexia and bulimia 6 months ago. I have heard of Maudsley and my daughter has a therapist that has received the training in this type of treatment. I think it is absolutely awesome that there are families out there that are able to implement the Maudsley approach and have success with it. I also appreciate that the intent is to empower families to participate in recovery and not just be blamed for the problem.
On the other hand, I also think that the proponents of Maudsley often don't appreciate the magnitude of the resources available to them. As a single mom, I have tried this approach and have found it to be completely unrealistic and unpractical given my life situation and the needs of my daughter. I think it is a misnomer that any family that loves their child and wants the best for them can do this approach and make it work, I appreciated the comments on the show that expressed as such.
Hopefully there will be continued research and discussions about this important topic by professionals. I think Maudsley is great for some people and situations but the fact that this is the best and newest thing in treatment is disheartening to someone like myself who doesn't have the necessary resources available to make it happen.