A recent article in The Guardian by Joanna Moorhead covers the story of Katie Green, who's recent book "Lighter Than My Shadow" is set to be published this October 3rd, 2013 by Jonathan Cape. Lighter Than My Shadow is a hand-drawn story of Katie's struggle and recovery from her eating disorder.
Here is an exerpt from The Guardian...
Katie Green isn't sure how significant her family's attitude to food was in the development of her eating disorder, but her autobiographical graphic novel opens with an image of them all sitting around the kitchen table. It's dinner time: Dad is reading the paper, Mum is feeding the toddler, and the young Katie is staring glumly at her plate of food, fork in hand.
Over the following pages, Katie's anorexia develops, characterised in her pictures by a thick black cloud of scribbles above her head. And when we see the family round their kitchen table once more, the daughters now in their teens, the thick black cloud is gathered above them all, casting its gloom across the whole family. Katie still isn't eating; and no one else looks happy either.
This, says Katie, is very much how it felt to have an eating disorder. "It affected everyone in the family," she says. But although everyone was right there under Katie's cloud, no one could understand it. They did their best: the pictures show her parents asking her to try to eat. "Can't you just manage a little bit?" asks her mum, hopefully. Katie explodes – "You just don't get it, do you?" – before rushing off in tears.
The truth, as Katie now realises, is that she didn't understand any more than her parents did. All she knew was that a black cloud of enveloping misery had descended on them all. She is full of admiration for the way her parents and sister coped: "It must have been terrible, seeing me basically trying to self-destruct."
At her worst, Katie needed round-the-clock surveillance to stop her from purging and self-harming. Her parents chose to have her treated at home as a specialist told them that the outcomes were better; both had to take leave from their jobs to care for her. They paid a high price: in the book, Katie suggests it would have been better for the family if she'd been hospitalised.
Katie is now 30 and recently moved to Plymouth, which is where we meet. Her graphic novel is published next week and a second book for children, The Crystal Mirror, is due out later this year. She doesn't think about food all the time now, but says you never really escape the mindset. She channels the behaviour that once fuelled her eating disorder into healthier pursuits – especially trying to work out what it was all about, through her novel.
What that means, explains Katie, is that she worked on it compulsively, pushing herself to get the hundreds of illustrations finished for the deadline, and obsessing about it for three years. Interestingly, the fruit of her labours is a whacking 504 pages long – it can't be by chance that this story of how a person almost wasted away to nothing is one of the heaviest books you're ever likely to read. The physical lightness of an anorexic body sits in stark contrast to the emotional weight that invariably surrounds it – although Katie seems unsure about whether the condition is caused by external or internal forces.
She coped by thinking of it as a disease, like cancer, or the result of an accident, like a broken leg. She's in a much better place now than during the period described in the book – although, surprisingly, she says that writing it was not cathartic. She had managed to move on from thinking about food and all the issues involved in her condition, and the project pulled her back into it. But it will have been worth it, she says, if it helps other families to cope with the complexity of living with a teenager with an eating disorder. "When I started reading books about anorexia, I was disappointed – they either seemed overly optimistic about how easy it would be to move on or suggested you would have it for ever. Neither of those points of view seemed correct to me."
Read full article here...
Buy the book here...
Website for "Ligher Than My Shadow"
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Fairwinds Treatment Center helps individuals and their families get their lives back on track. We specialize in helping people overcome dangerous and deadly disorders such as anorexia, bulimia, alcoholism and drug addiction. Being a dually licensed psychiatric facility, Fairwinds physicians and therapists engage an integrated treatment plan, incorporating several treatment models combined with psychiatric methods to identify the root of the disorder in order for specialized treatment to begin and to ensure a lasting recovery.
BEDA’s National Weight Stigma Awareness Week raises awareness of this last socially-acceptable prejudice and one that can do fatal harm to emotional and physical health.
Weight Stigma, also known as weightism, weight bias, and weight-based discrimination, is judgment or stereotyping based on one’s weight, shape and/or size. Weight stigma fuels behaviors and actions by individuals and organizations that include bullying, hate-speech, and exclusions that limit the ability of a person to gain employment, healthcare, and education.
Some common beliefs fueled by weight stigma include: larger-bodied people are lazy, lack self-discipline, have poor willpower, lack intelligence, are diseased, and have the ability to become and remain thin. Thin individuals are also stigmatized by commonly held beliefs that they diet and/or exercise excessively, are healthy, self-absorbed, more attractive, and take better care of their bodies, thus have the ability to exert great will-power.
Weight Stigma is not a strictly external problem. Thoughts about whether or not a person’s own body shape, size, or they themselves are acceptable are pervasive throughout society. People often question whether they are worthwhile, lovable, or deserving of compassion because of these internalized cues which are taken from the inflexible standard of beauty, thin ideal, shaming health policies, and lack of size diversity many in our culture give great importance.
Examples is Weight Stigma:
- Shame placed upon individuals based on weight or body size
- Judgment and biases predetermined by weight, body size, or lifestyle
- Judgment of a person’s character, work ethics, and personality based on weight
- Prejudice and discrimination suffered because of weight
- Can be communicated both directly and indirectly
- Negative attitudes affecting interactions
- Subtle and overt expressions
Who are the Victims of Weight Stigma?
- The lonely child on the playground, who’s always picked last for games
- The highly competent worker who is paid less than his peers and gets bypassed for promotions because he’s larger
- The anxious patient who fears getting regular check-ups because she knows she will be shamed for her weight
- The friend who nervously laughs along as the group laughs at fat jokes, hoping no one will realize she’s who they are laughing at
How are Individuals Stigmatized?
- Through hate speech, both written and verbal
- Negative comments regarding body size
- Negative non-verbal communication, such as looks, stares, and demeanor
- Stereotypes that overweight persons are lazy, stupid, and incompetent, leading to rejection, prejudice, and discrimination
- Inequalities in employment, health-care, and educational settings due to these stereotypes
- Mistreatment by peers (specifically, bullying in children)
Origins of Weight Stigma:
- Media portrayal and societal pressure regarding obesity
- Cultural value of thinness
- Culture blaming victims (overweight/obese people) instead of investigating environmental factors
- General belief that people only fail to lose weight because they lack the will power and discipline (when research tells us that 97% of people who lose weight on a diet, gain it back and sometimes more)
So what can you do to help?
Join The Binge Eating Disorder Association (BEDA) for its 3rd Annual Weight Stigma Awareness Week
September 23-27, 2013
Their goal is to make significant strides in:
- Increasing awareness of the pervasiveness and destructive nature of weight stigma, and
- Providing effective strategies for combating weight stigma
The week will feature a blog conference with tracks addressing:
- Weight Stigma in Diverse Populations
- Health and Weight Stigma
- Consequences of Weight Stigma in Healthcare, Employment and Education
- Weight Stigma Research
- Weight Stigma Viewed Through the Eating Disorders Lens – Clinical
- Combating Weight Stigma
The blog conference will also include an innovative art project, a virtual mixer, Tweetchat, webinars, and more. Click here for more details!
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If you or a loved one are struggling with an eating disorder such as binge-eating, bulimia or anorexia, it is crucial to seek help immediatly. Fairwinds Treatment Center specializes in treating eating disorders for both adolescent and adult females and males with individualized treatment plans for each patient. Our Eating Disorders program is extremely focused on each specific patient. We use different types of treatment and therapy to help facilitate each patient’s recovery process. Each patient follows a treatment schedule and has a specific therapist assigned to their treatment plan and is able to visit with the psychiatrist on a daily basis. To learn more about Fairwinds Treatment Center, call 727-449-0300 or through our website here.
Author Jenni Schaefer, along with Jennifer J. Thomas, Ph.D has just realsed a new book with Harvard Health Publications called "Almost Anorexic: Is My (or My Loved One's) Relationship with Food a Problem?". The Today show covered the book and interviewed Jenni and Jennifer August, 22 2013. Here is the video:
Here is a little information from Jenni's website about this helpful book:
While 1 in 200 adults have experienced full-blown anorexia, at least 1 in 20 (1 in 10 teen girls!) have exhibited some key symptoms of anorexia, bulimia, or binge eating disorder. Many suffer from the effects but never address the issue because they don’t fully meet the diagnostic criteria. If this is the case for you, then you may be “almost anorexic.” Drawing on case studies and the latest research, Almost Anorexic combines a psychologist’s clinical experience with a patient’s personal recovery story to help readers understand and overcome almost anorexia.
- Determine if your (or your loved one’s) relationship with food is a problem
- Gain insight on how to intervene with a loved one
- Discover scientifically proven strategies to change unhealthy eating patterns
- Learn when and how to get professional help when it’s needed
'Almost Anorexic: Is My (or My Loved One's) Relationship with Food a Problem? (The Almost Effect)' is available at most major book stores as well as Amazon, here.
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If you or a loved one feel you have issues with food, weight and/or body image, it is extremely important to discuss this with a qualified specialist as early as possible.
Fairwinds Treatment Center helps individuals and their families get their lives back on track. We specialize in helping people overcome dangerous and deadly disorders such as anorexia, bulimia, alcoholism and drug addiction. Being a dually licensed psychiatric facility, Fairwinds physicians and therapists engage an integrated treatment plan, incorporating several treatment models combined with psychiatric methods to identify the root of the disorder in order for specialized treatment to begin and to ensure a lasting recovery.
This article is based on research published by SAMHSA this past February in their NSDUH Report. According to the study:
- Combined 2002 to 2010 data show that nearly one in seven youths aged 16 to 18 (13.2 percent), or 12th grade aged youths, had dropped out of school
- Substance use rates among 12th grade aged youths who had dropped out of school were higher than among those who were still in school; for example, 56.8 percent of dropouts were current cigarette users compared with 22.4 percent of those still in school
- The pattern of higher use rates among dropouts than those still in school generally held for both males and females, as well as for whites and blacks; however, Hispanic 12th grade aged dropouts and those still in school had similar past month rates of alcohol and illicit drug use
Below is an exerpt from the study...
In the United States, about 75 percent of youths who enter public high school as freshmen eventually graduate from high school in 4 years (or average freshman graduation rate).1 This is an important public health issue because, in general, adults who do not graduate from high school tend to have lower paying jobs than those who do and thus are at greater risk for living in poverty, lacking health insurance, and suffering from poor health.2,3,4 Moreover, high school dropouts typically have higher rates of substance use than high school graduates.5
The National Survey on Drug Use and Health (NSDUH) asks respondents about their age, current school enrollment status, last grade completed, and age when they last attended school. For this report, these respondent characteristics are used to identify 12th grade aged youths and whether they have dropped out of school. Youths aged 16 to 18 are categorized into three groups:
- 12th grade students—youths aged 16 to 18 who were either in or entering the 12th grade;
- 12th grade aged dropouts—youths aged 16 to 18 who had not completed high school or a Graduate Equivalent Degree (GED), were not currently attending or on vacation from school, and were considered 12th grade aged based on the last grade they had completed and their age when they stopped attending school6;
- Other—youths aged 16 to 18 who completed high school or a GED, youths aged 16 to 18 in grade 11 or lower, and youths aged 16 who were not considered "12th grade aged" (based on criteria discussed in group 2).
This issue of The NSDUH Report focuses on the first two of these groups, which are collectively referred to as "12th grade aged youths"; comparisons of past month (current) substance use between 12th grade students and 12th grade aged dropouts are provided. All findings in this report are annual averages from the 2002 to 2010 NSDUH data.
Dropout Status
Nearly one in seven (13.2 percent) 12th grade aged youths had dropped out of school, with males having been more likely than females to have dropped out (14.7 vs. 11.6 percent).7 About one quarter of Hispanic and American Indian or Alaska Native 12th grade aged youths (23.0 and 25.5 percent, respectively) had dropped out of school compared with 12.6 percent of youths of two or more races, 12.1 percent of black or African American youths, 11.2 percent of white youths, and 1.5 percent of Asian youths.
Substance Use by Dropout Status
Twelfth grade aged youths who had dropped out of school were more likely than similarly aged youths who were still in school to engage in current cigarette use, alcohol use, binge alcohol use, marijuana use, nonmedical use of psychotherapeutic drugs, and use of any illicit drugs (Figure 1).8 For example, 56.8 percent of dropouts were current cigarette users compared with 22.4 percent of those still in school, and 27.3 percent of dropouts were current marijuana users compared with 15.3 percent of those still in school.
Substance Use by Dropout Status and Gender
Current substance use rates among 12th grade aged male dropouts were higher than the rates among similar aged males who were still in school (Figure 2). For example, 60.1 percent of male dropouts were current cigarette users compared with 23.8 percent of males who were still in school, and 32.0 percent of male dropouts were current marijuana users compared with 17.9 percent of males who were still in school.
Current substance use rates among 12th grade aged female dropouts were generally higher than the rates for similar aged females who were still in school (Figure 3). One exception was current alcohol use, for which there was no statistical difference between the rates among female dropouts and females who were still in school (34.2 and 33.4 percent, respectively).
Click here to view full report...
Discussion
Dropping out of high school is related to a number of negative socioeconomic and health outcomes. This report shows that one in seven 12th grade aged youths had dropped out of high school and that 12th grade aged dropouts (with a few exceptions) had higher rates of current substance use (e.g., cigarettes, alcohol, binge alcohol, marijuana, nonmedical use of psychotherapeutic drugs, any illicit drugs) than similar aged peers who were still in school. Substance use is a public health problem that is preventable. Thus, prevention efforts targeted to adolescents generally and to those at risk of dropping out of high school more specifically might improve the educational, employment and financial, and health outcomes of many youths.
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Our mission statement at Fairwinds Treatment Center is "As we strengthen families, we strengthen society." If you have a loved one who is struggling with an addiction, contact Fairwinds Treatment Center, our admissions team can assess your situation and guide you to the best course of action to eliminate this disease from your life.
Here is one man's story of his family's struggle with addiction. We wanted to share his experience to make people aware that an addiction not only hurts the individual, but the entire family.
No one can ever quite remember when the unwanted guest arrived. The unexpected house guest, unannounced, no formal introduction.
After a while this unspoken guest was no longer a guest but a disguised, yet familiar face. They had arrived long before the unexpected announcement that dad had yet again lost his job. There were always a thousand and one excuses, and always someone else to blame but the real source of the problem remained, in the house, unspoken as we scrambled to keep life normal or as normal as we knew it. But normal in our house, was, as I learned years later, far from it. The verbal spars between mom and dad, escalated, the accusations for the reasons of the job loss grew but the trusty pill cabinet with the "off limits" door knob continued to dispense brief moments of relief for dad and mom.
In the 1960s pharmaceutical sales jobs offered enticing salaries to those who could "charm" the doctors and nurses of influence. The job also came with some other perks that were not quite so apparent at the beginning. The availability of the latest medication was yours for the taking, literally or exchanging for other meds with other reps. On the surface it could appear quite legit. As a sales rep you had samples to give to doctors and nurses in hopes that these would lead to their prescribing them in the future. But there was also another audience, the unintended audience: the pharmaceutical reps. By swapping samples amongst different reps experimentation was easy and very accessible. The term "controlled substance" was unheard of at that time. It was a new age of innocence. What better way of knowing how the drugs you're selling works than by trying them. Good salesmen doing their job. Addiction didn't seem to be a consideration, as that was only for the illegal stuff like pot and LSD. This was legal medication prescribed by doctors so it couldn't be harmful.
As more new drugs flooded the market the smorgasbord grew. Dad was an incredible salesman, the doctors and nurses loved him. He knew his products, and his good looks, and gracious personality made him a natural for the industry. He quickly climbed the ranks and became a top salesman for his company. His abilities were recognized and soon utilized for the major medical conventions around the country. Now in front of thousands and access to all the other manufacturers was a simple walk to the next booth. Samples flowed as easy as the cocktails. But the samples were flowing a little too freely and little by little began to consume the man who had the Midas touch for pharmaceuticals.
Getting your territory to number one required work and dad knew how to make it happen. Keeping the territory number one proved more problematic. Auto pilot only works for so long.
Then you either regain control or run out of fuel and eventually crash. What once had been simple samples of meds had now turned into daily needs. With drug enforcement agencies still an unheard of, there were ways of working around one's needs. Trading off samples with other reps still worked to a degree but controls were slowly being put in place to monitor samples. Enter the new approach: get to know pharmacists on a personal level, build up a friendship and a trust, a new means of supply.
The vials in the "off limits" cabinet were a marvel, a prized trophy chest for my dad. My brother and I knew what it was, and we knew, like the knob said it was, "off limits." Dad had a pill for everything and he was very knowledgeable. And he loved sharing his knowledge and friendly dispensing with friends. By the early seventies drug abuse had become a hot topic.
We were educated about it in school, we saw public service announcements about it on TV and it all began to click with me, with dreaded fear. I knew what my dad was doing and I lived in fear his "off limits" cabinet would have the cops knocking at our door one day. That never happened, and looking back it might have been a good thing if it had. Instead, that cabinet became the house guest that swelled with power and eventually brought a family and a house to ruin. And through it all to the very end it was never mentioned, that a problem existed in the house in the form of a cabinet that tore a family apart and would pit father against son over a simple pain pill. The ugly despicable face of addiction laughed, mocked and rejoiced in the complete consumption of what was once a thriving middle class family who on the outside looked like the perfect family. Behind closed doors and drawn shades the screaming, the crying, the longing for change never came it only got worse. The excuses grew but the culprit went unnamed.
Keeping the peace in my family would have proved a test for the United Nations. It was next to impossible. You learn to accept that living on edge is the daily norm. From as young as six there was literally not a week that didn't pass without fighting between my parents. At the time, being a kid, you fortunately or unfortunately can't see the entire picture or understand the chemistry behind the constant volatility. Instead you try to be the peacemaker, how can I keep them from fighting. You rack your brain trying to think of ways to stop the fighting.
If I could just find that one key I could turn it all around and we could have a happy family. Years go by and nothing changes, it only gets worse. You know it's not right, but you don't know what to do or who to talk to. It's the 70s who's ever heard of counseling much less intervention? Only crazy people go to treatment centers. You learn to cover up, make up, put up and just live with it. And you live in fear that the house of cards will completely give way and the world will see what a lie your family has been living. You live in fear, you live in shame. And you can't mention it to a soul.
For me, something about age six sticks in my mind as a new sense of awareness came over me. It was at that time that I knew things weren't quite right in my family but I couldn't put my finger on it. Being a pharmaceutical rep, Dad's job had him traveling throughout the Southeast. We often traveled with him during the summer months. What should have been fun family adventures became dreaded road trips. There is nothing quite like being trapped in a moving car while two adults sit in the front seat and wage a constant battle. Sitting in the backseat, I would begin to try and think of ways I could stop this chaos. Every time we'd load up the car we wouldn't be two miles down the road when the fight bell would ring and the next match was under way.
The constant fighting between my mom and dad never stopped, and somehow we grew to accept that that was just how things were going to be. As the fighting continued over the years each family member developed their own coping mechanism and escape plan. Dad's always revolved around the cabinet with the "off limits" nob on the door — the treasure trove of drugs that dad accumulated in his work as a pharmaceutical rep. The great escape was just behind the cabinet door.
As the years passed the cabinet filled with more drugs. The magic door practically fell off its hinges from use. Dad changed, his patience grew non-existent and our family was balancing on a very fragile thread. When dad was doing well, he could sell ice to the Eskimos but when the dark times came, an ever sense of panic fell over the household. And we knew dad's job performance was going to suffer and put everything at stake.
A new twist came into play that strengthened dad's prescription med consumption, an automobile accident. While working in Tampa one Friday, dad was part of a multi-car crash on the downtown interchange. He complained of back pain, found an attorney, won a lawsuit, had back surgery — that proved unsuccessful, and ultimately caused my dad's consumption of pain medicines to increase.
The ups and downs of dad's employment continued and the popping of pain pills seemed unquenchable. Dad's glory days of pharmaceutical sales were starting to fade, he'd leave for work around noon and be home by four. We knew this wasn't right and we knew his job wouldn't last. "How can you work just four hours a day and expect to keep your job," my mother would ask? And with that the screaming matches would ensue. After two years of just barely working, the charade was over and dad was out of work, for good. Dad's once dynamic pharmaceutical career was over, at age 50 he gave up. It all started to crumble and nothing seemed to shake him back to reality. Vehicles were repossessed, jewelry was hocked for quick cash, and then the house was taken away, but he always managed to find the pills. Through all of this — which was years, no one ever uttered a word about dad's problem. It remains undercover.
Now an adult and on my own, I learned of the process known as intervention. I went to counseling to find my own healing as an adult and to see if I could possibly help my family get back to some semblance of normalcy. Though it sounded good in theory it was met with shear fear by my mother and brother, they wouldn't touch it. Afraid of my father's violent response they continued to live with the problem and never said a word. After years of use, my father could tolerate incredible dosages of medication with, what seemed, little effect. Knowing enough to be dangerous not only to himself but to others, the over medicating persisted. And with it the consequences. My dad totaled three vehicles while high on medication and always managed to cover up his impaired state of mind and escape any kind of drug testing. Dad remained the consummate salesman and charmer — even with the police. Every accident was a little worse. The final one, he flipped the car twice and walked away from it. Completely strung out, he claimed the brakes failed and no more was said.
I have always marveled how through it all, the decades of abuse, loss and belittling, my mother stood up for my dad, never once admitting dad had a problem with drugs of any sort. An amazing bond and sense of protection my mother has carried for my dad — that I will never understand. He not only robbed himself of decades but my mother too. In many ways this has been the only normal she has known for 54 years of marriage.
I became the outsider once I left home for college and never returned. I would no longer play the game but challenge it. I was the bad guy. But in the end, I felt I was the only one who had had the strength to save myself from the clutches of a man's addiction that gripped everyone else in its way.
Addiction is a beast, it has no soul, it has no heart and the human destruction it leaves in its aftermath — tattered lives with little left to celebrate. If they only had a pill for that. The healing pill.
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Fairwinds Treatment Center helps individuals and their families get their lives back on track. We specialize in helping people overcome dangerous and deadly disorders such as anorexia, bulimia, alcoholism and drug addiction. Being a dually licensed psychiatric facility, Fairwinds physicians and therapists engage an integrated treatment plan, incorporating several treatment models combined with psychiatric methods to identify the root of the disorder in order for specialized treatment to begin and to ensure a lasting recovery.
If you or a loved one are struggling with an addiction, you can get through it and we are here to help you. Contact Fairwinds Treatment Center today to discuss your situation with one of our admissions counselors. Call 727-449-0300 or via web here.
The Eating Disorders Review recently send out this review of ICED in Montreal. A very insightful look at how necessary it is to consider all variebles leading up to and including the treatment of a patient struggling with an eating disorder.
A few key topics highlighted below:
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A Transdisgnostic Approach
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Emotions Role in Eating Disorders
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Men with Eating Disorders
Reprinted from Eating Disorders Review
July/August Volume 24, Number 4
©2013 Gürze Books
Taking a New Look at Old Boundaries in Eating Disorders
The International Conference on Eating Disorders (ICED) in May offered a program filled with practical and research-oriented presentations. Following this year’s theme, “Crossing Disciplinary Boundaries in Eating Disorders,” sessions included a keynote address reminding the audience about the challenges of overlap and similarities among eating disorders, a look at how emotions can drive eating disorders, and an analysis of why male patients are so infrequently involved in eating disorders treatment.
Developing a Transdiagnostic Approach
In his keynote address, David Barlow, PhD, ABPP, professor of psychology and psychiatry, and founder and director emeritus of the Center for Anxiety and Related Disorders at Boston University, told audience members that a transdiagnostic approach to psychiatric and psychologic disorders is slowly but surely developing.
“We have thousands of protocols,” Dr. Barlow noted, adding that the “time has passed for one protocol after another with only a slight twist.” There is no way that such an approach can ultimately be useful, he said. At the present time there may be effective treatment but there is plenty of room for improvement, he said, adding that there are still too many protocols and manuals, and these protocols are still relatively complex, which interferes with effective dissemination.
He also pointed to work by Dr. Chris Fairburn and colleagues a decade ago, which marked the beginnings of taking a transdiagnostic approach to eating disorders. By honing in on overvaluation of shape and weight and control, the researchers hypothesized that the remaining disorders follow this same pattern. Research on the comorbidity of anxiety with bulimia nervosa is another example. Various researchers showed a high comorbidity rate of anxiety with bulimia nervosa.
Intolerance of uncertainty (IU) is a characteristic predominantly associated with generalized anxiety disorder (GAD); however, emerging evidence indicates that IU may be a shared element of emotional disorders, Dr. Barlow said. He explained that a synergy of several types of vulnerabilities leads to stress, and in turn to generalized anxiety, and depression. It is thought that the vulnerabilities come together, perhaps triggered by stress, to find their phenotypical outlet as anxiety and/or depression, the flip side of generalized anxiety, he said. Dr. Barlow said that emotions are not meant to be suppressed; instead, they are present to motivate us to engage in certain behaviors. If the vulnerability is not present, mood recovers naturally and more quickly in response to stress, he said.
Dr. Barlow also shared a unified protocol approach illustrating the principal of transdiagnostic unified treatment for anxiety. This approach features eight treatment modules, including: motivation enhancement for treatment engagement; psychoeducation and treatment rationale; emotional awareness training; cognitive appraisal and reappraisal; interoceptive awareness and tolerance; situational exposures; and relapse prevention.
Dr. Barlow also addressed a question about the interdependence between biological vulnerability and psychological vulnerability. Splitting apart biological and psychological vulnerability does have empirical support, he said because there are recognizable differences in the brain. The fact that specific brain circuits are activated is an argument for keeping disorders separate, as in the case of obsessive-compulsive disorders. However, he added, his group wonders if these vulnerabilities are continually influencing each other.
Emotion’s Role in Eating Disorders
In a plenary session, Steve Wonderlich, PhD, Director of Clinical Research at the Neuropsychiatric Institute, Fargo, ND, said that the study of emotion may be very important to the diagnosis and treatment of persons with eating disorders. The role of emotion in eating disorders is still being debated, and “emotion” is a slippery term, Dr. Wonderlich said. Very significant questions have to do with the possible functional relationship between emotion and eating disorder behaviors. Do emotions precipitate or modulate disordered eating behaviors?
Dr. Wonderlich, a Past President of the Academy for Eating Disorders and a member of the EDR Editorial Advisory Board, described a technique, ecological momentary assessment (EMA), that his group and others have used to collect data about patients in a real-world environment. Patients use a handheld computer or a cell phone to record current states, events, and emotions and thus are able to record events as they occur.
To gain a richer view of a patient’s life, the device signals the patient to record their behavior and emotions 6 to 10 times a day. Thus binges, components of meals, and emotions can be recorded at or near the time they occur. According to Dr. Wonderlich, the real beauty of such devices is that the connection between emotion and behavior can be studied at a very precise point in time, which will help establish whether emotions are driving the behavior, or vice versa. This method also establishes a record of emotions and behaviors for longitudinal study. In a 2007 study of 131 adult female volunteers diagnosed with DSM-IV criteria for BN, 90% of the time patients responded within 45 minutes or less. Other researchers who examined the trajectories of emotion before and following the bulimic behavior found that during the 6 hours before a binge episode, a steady increase in negative affect occurred, and culminated in a binge.
Do different emotions have specific relationships to bulimic behavior? Dr. Wonderlich also briefly described the work of Dr. Kelly C. Berg et al., who explored the connection between four negative emotions--guilt, fear, sadness, and hostility-- and bulimic behavior. Guilt was linked to the highest degree of negative affect, and was significantly associated with binge eating; this was not the case with the other emotions. Another question concerned individual differences, and whether certain characteristics of people with specific forms of disordered eating made them more vulnerable to behaviors triggered by negative affect. Increasing evidence suggests that negative emotional states may play a role in precipitating eating disorders behavior across diagnoses, he said.
What are the implications for treatment? Some implications for treatment include:
- Consider treatments that directly reduce the intensity of emotion (example, psychotropic drugs).
- Promote more adaptive regulation of high-risk emotion moments. This may be accomplished by targeting events that increase negative affect in persons with eating disorders and\or to enhance their ability to clarify, accept, and tolerate negative affect states (distress tolerance), and...
- Promote inhibition of impulsive behavior, especially in times of heightened negative affect.
Does it matter if the eating disorder behavior reduces the negative affect or produces negative reinforcement? Dr. Wonderlich quoted B. F. Skinner, who said, “Although antecedent conditions help to establish a behavior, consequences maintain it.” However, Dr. Wonderlich asked, if this is true, why does a person who pursues low weight engage in behaviors such as binge-eating, which directly interfere with attaining the goal of low weight? Biologically induced binge eating counteracts a physiological state connected with starving, as Ancel Keys noted.
Binge eating and other disordered eating behaviors are maintained because they help the person escape from or avoid the precipitating negative emotional states. If eating disorder behaviors actually function to reduce/avoid a negative emotional state, clinicians have two treatment options, he said. The first would be to identify and help patients develop alternative behaviors that promote the same emotional reward; the second option would be extinction of the behavior.
He described a 2008 study evaluating extinction as a functional treatment for binge eating (Behavior Modification 2008; 32:556). Dr. Ray Miltenberger and colleagues at the University of South Florida trained bulimic patients first in the lab and then at home. Patients listened to a tape recording they had made after a previous binge, one that made them feel badly about the binge. As a result, some of the trainees became abstinent and remained so, Dr. Wonderlich said. He also cited a very recent paper by Dr. Tim Walsh and colleagues that described AN as a well-entrenched habit and reported that with habit acquisition, rather than reward, the brain shifts. Thus, habit formation appears to be critical to the persistence of the dieting behavior. (Am J Psychiatry. 2013; 170:477-484. doi:10.1176/appi.ajp.2012.12081074 ).
Finally, Dr. Wonderlich offered several conclusions about emotion and eating disorders. First, emotion variables and eating disorder behaviors co-vary at a momentary level. Next, antecedent emotional states may be meaningful clinical targets for eating disorders treatment, but the impact of eating disorder behaviors on emotional states still needs much study. Finally, he noted that eating disorder treatment interventions may benefit from a greater focus on specific situations, affects and actions that occur in a momentary timeframe and promote conditioning or reinforcement that perpetuates eating disorder behaviors.
Where Are All the Men?
Men face a number of barriers to obtaining treatment, according to two clinicians who specialize in treating men with eating disorders. In a special plenary session on eating disorders in men, Roberto Olivardia, PhD, and Mark Warren, MD, PhD, FAED, explored some of the reasons that men with eating disorders are often overlooked or never seek treatment.
First, there is a misperception that only women have eating disorders. According to Dr. Olivardia, clinical instructor of psychology at Harvard Medical School and co-author of one of the first books to deal with eating disorders in men, The Adonis Complex, there is a wide misperception that eating disorders only affect women; another misperception is that eating disorders affect only gay men. Sexual orientation can be a huge issue, he said, noting that shame and secrecy also keep many young men from seeking help for an eating disorder. Gay men are more likely to discuss their disorders with peers, while heterosexual men are far more secretive, and even their spouses are often unaware of the problem.
When men do seek help, they may find themselves in treatment centers that cater to women, and they may have problems dealing with a female physician as well. And, since so many treatment centers cater primarily to women, treatment may not be available for men, even if they do want help.
Dr. Olivardia noted that eating disorders can appear in boys as young as 9 or 10, and disorders very often focus on muscle mass rather than with weight alone. They may see themselves as too thin and scrawny, and seek anabolic steroids to “bulk up.” Just as with women, cultural influences are powerful-- muscularity is seen as a core element of masculinity, dominance, and attractiveness. For example, in the 1980s, a shift in the movies occurred at which time bigger bodies became important commodities and important currency; this was accompanied by an explosion of “muscle magazines,” men’s fitness magazines, and even video games stressing male bulk. He pointed to an extreme example of newer action figures, wherein even Star Wars action figures were re-mastered to be much more muscular. It is estimated that from 4 to 6 million males are affected, and the onset of these disorders is around the time of puberty. He added that much more data are needed about incidence, race, and socioeconomic status.
Men are less likely to seek treatment because of shame about having what is “a female disorder,” according to Dr. Olivardia. Males with eating disorders are often self-conscious and find themselves in settings with few other male patients. The good news is that once these men get into treatment, they do as well if not better than do women, he said.
Men need to be included in the conversation about eating disorders. Dr. Warren, Medical Director of the Cleveland Center for Eating Disorders, traced the history of eating disorders in men, noting that the first two reported cases of anorexia nervosa involved one female and one male. Our culture focuses on gender, food, and bodies, he said. For example, even the story of Adam and Even featured nakedness and food and how genders are affected. He added that men have been excluded from the current narrative of eating disorders because the criteria, screening tools, and treatment have all been based upon the histories of women patients. He added, “For men to be included in the conversation, we have made many attempts to distinguish how eating disorders are different in men. We need to accept that men have eating disorders and then to find how biology and genetics exist to present a different clinical picture in men.”
Dr. Warren also said that there are compelling reasons to improve studies of eating disorders in men; these problems are serious, potentially life-threatening conditions that are extremely challenging to diagnose and treat and they are increasing. He praised Dr. Arnold Andersen, a longtime member of EDR’s Editorial Board, for his pioneering work in the treatment of men with eating disorders. Dr Warren also shared with the audience that he himself had anorexia nervosa in his teens and knew nothing about the disease at the time. He said that his recovery was a matter of luck and that even now most men recover as a matter of luck rather than as a result of clear diagnosis and treatment. Men started “disappearing from the equation when the focus turned to amenorrhea and “hysteria,” neither of which applied to men. In the late 1970s, Dr. Gerald Russell’s work on bulimia brought men back into the eating disorders world, Dr. Warren said. However, even today most research articles are written exclusively about women, he said, showing that we have not progressed in the way we might want to.
What else can be done? Dr. Warren told the audience that one positive step in the future would be to always include men in every eating disorders study. Clinicians can also ask themselves what it is like to be a man with an eating disorder. In most treatment centers, male patients only see women patients, and a woman clinician typically asks a male patient to discuss his body, feeding, and intake. He added that most males are asked if they are gay before they are asked if they are afraid their illness will kill them.
Shame is such a powerful emotion, he said, which keeps men with eating disorders from seeking help. Health care providers can be more mindful and sensitive to eating disorders in males. They can remember to ask male patients more about their body goals and use gender-neutral language. Treatment centers can be more welcoming, for example, by including men in their ads. Men also need to know about the history and sociocultural beliefs that underlie eating disorders and how culture affects us all, he said. Having a male clinician to talk with and to be validated by is also a powerful way to help a man with eating disorder feel more comfortable about seeking treatment and sticking with it. The chemistry of the treatment team is extremely important, Dr. Warren said.
Full article here...
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This article by Jackie Glass of the Chicago Tribune shows the epidemic of prescription drug abuse is in full force.
Prescription drug abuse an American epidemic
Exerpt...
Women, we have a problem. According to a recent study by the Centers for Disease Control, American women are dying from drug overdoses and the misuse of drugs at an alarming rate. As a former judge who presided over a drug court, I have seen firsthand what addiction can do to people, from all of its physical and psychological effects to the collateral damage that it can inflict on someone's life.
Drug abuse often begins with legally prescribed pain medications for legitimate injuries, but so many of these drugs are habit-forming that it doesn't take long for someone to get hooked. Once that happens, it is almost impossible to stop. Although I saw a greater number of men come before my drug court, I saw plenty of women, a significant percentage of whom were hooked on prescription pain relievers. According to that CDC study, from 1999 through 2010, there was a greater percentage increase in drug related deaths among women than men, with the number of women dying because of opioid pain relievers increasing fivefold. And since 2007, more women have died from drug overdoses than from motor vehicle-related incidents.
As a judge, I saw time and time again just how easy it is for people to obtain prescription pain meds, and I was often extremely frustrated with certain members of the medical community. Many of the participants in my drug court sought treatment from the same physicians or clinics, and the lack of attention and responsible care that some doctors exhibited was a significant problem. The CDC reported that women may be more likely than men to engage in "doctor shopping," which involves actively seeking out prescriptions from multiple prescribers to feed an addiction.
Some drug court participants even got their teeth pulled, not because it was necessary but because tooth extractions often come with prescription pain meds. In one particular instance, my court marshall had to confiscate a prescription bottle from a female participant. Her prescription for liquid hydrocodone had been filled the day before, but just one day later, the bottle was already empty. As it turns out, she had gone to the emergency room to complain about vague aches and pains, and her doctor simply sent her home with a prescription. Sometimes, that's all it takes.
Across the country, several states have passed legislation aimed at closing down so-called "pill mills," those doctors offices and clinics that prescribe pain medication indiscriminately. The effects have been mixed. As the Orlando Sentinel reported back in April, Florida's crackdown has succeeded in hampering a significant portion of the pill mills in the state, even decreasing the number of deaths due to prescription drugs. However, many addicts simply turn to neighboring states with laxer pill mill laws, or they just start abusing illegal drugs and the vicious cycle continues.
Read full article...
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If you or a loved one are struggling with an addiction, call Fairwinds Treatment Center at 727-449-0300 to discuss your situation with one of our Admissions Counselors. For 23 years, families have trusted Fairwinds Treatment Center to help their loves ones through our highly effective treatment programs for eating disorders and drug rehab. As one of only a few dually licensed psychiatric and substance abuse centers in the nation to earn accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), we are here to provide the quality care your family needs to achieve a lasting recovery.
Authors Barry Meier and Bill Marsh A very insightful article about the growth of opioid use (legal and illegal) over the past 10 years and the related costs associated was published by the New York Times last week.
"Profiting from Pain" covers the increase of opioid prescriptions to treat long-term pain, while the supporting data in "The Soaring Cost of the Opioid Economy" presents the economy this opioid epidemic has created.
Excerpt...
THE use of narcotic painkillers, or opioids, has boomed over the past decade as drug makers and doctors have promoted them for a new use: treating long-term pain from back injuries, headaches, arthritis and conditions like fibromyalgia. Insurers have also grown to see pills as a cheaper way to treat chronic pain than other methods.
Multimedia
The Soaring Cost of the Opioid Economy
Some patients are greatly helped by opioids, a large family of medications. Among the more widely used opioids are oxycodone, which is found in Percocet and OxyContin, and hydrocodone, which is used in Vicodin. Other potent opioids include fentanyl and methadone. Narcotic painkillers are now the most widely prescribed class of medications in the United States, and prescriptions for the strongest opioids, including OxyContin, have increased nearly fourfold over the past decade.
There is increasing evidence, however, that such drugs, along with being widely abused, are often ineffective in treating long-term pain and can have serious consequences, particularly when used in high doses. Along with the risk of addiction, side effects can include psychological dependence, reduced drive, extreme lethargy and sleep apnea.
The economic costs associated with the painkiller boom have also proved enormous, giving rise to a host of unanticipated medical, legal and social costs. Over the past decade, the legal — and illegal — use of these drugs has given birth to new businesses and expanded existing ones. These include urine-screening tests to make sure patients are taking the drugs properly, added sales of addiction treatment drugs, growing emergency-room expenses, law-enforcement budgets and skyrocketing costs for insurers.
In the short run, treating a patient with an opioid like OxyContin, which costs about $6,000 a year, is less expensive than putting a patient through a pain-treatment program that emphasizes physical therapy and behavior modification. But over time, such programs, which run from $15,000 to $25,000, might yield far lower costs.
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If you or a loved one are struggling with a prescription drug addiction or substance abuse problem, contact the admissions team at Fairwinds to discuss your situation. Call 727-449-0300 or submit the contact form here. For 23 years, families have trusted Fairwinds Treatment Center to help their loves ones through our highly effective treatment programs for eating disorders and drug rehab.
The following story recently ran in the L.A. Times covering the growing number of males struggling with anorexia and the added challenges they face in seeking treatment.
Excerpt...
A survey shows that L.A. male high school students are about as likely as females to use diet aids or laxatives or vomiting to lose weight. The numbers challenge old assumptions.
Bryan Piperno was just 9 years old when he began keeping his secret.
The Simi Valley youngster tossed out lunches or claimed he ate elsewhere. As he grew older, he started purging after eating. Even after his vomiting landed him in the emergency room during college, he lied to hide the truth.
Piperno, now 25, slowly fended off his eating disorder with time and care, including a stay in a residential treatment facility. But surveys show a rising number of teenage boys in Los Angeles now struggle with similar problems.
High school boys in Los Angeles are twice as likely to induce vomiting or use laxatives to control their weight as the national average, with 5.2% of those surveyed saying they had recently done so, according to the most recent survey data gathered by the Centers for Disease Control and Prevention and the Los Angeles Unified School District. They are also more likely to have used diet pills, powders or liquids than boys nationwide.
The numbers challenge old assumptions that boys are immune to a problem better known to afflict teenage girls. Girls still exceed boys in fasting to lose weight, but the latest data, from 2011, showed that Los Angeles boys were nearly as likely as girls to purge through vomiting or laxatives. They were also as likely as girls to use diet pills, powders or liquids without the advice of a doctor — 6.2% said they recently used such substances, compared with 6.1% of girls.
Some experts say boys are starting to face the pressures long placed on girls, as buff, bare men proliferate in pop culture. Boys today watch Channing Tatum strip as "Magic Mike" or weigh themselves against the muscular Dwayne Johnson. The nonstop chatter of Twitter and Facebook has amplified those messages, therapists say.
"Boys are growing up now with the billboard of the guy with perfect pecs and biceps," said Roberto Olivardia, a clinical instructor in the Harvard Medical School psychiatry department. "You just didn't see that years ago."
Teenage boys say abs are prized and ogled. Andrew Shrout, a 19-year-old junior at UC Berkeley, said boys felt they needed to be very lean at his former high school in Long Beach. "Men are pressured to have as little fat as possible — but you've got to pretend like you don't watch what you eat," Shrout said.
He decided to lose weight for his health but also because another guy on the water polo team used to grab his stomach and jiggle it. "I can see why a lot of younger kids get sucked into a vortex and end up doing bad things," Shrout said.
Steroid use is also on the rise among Los Angeles teen boys, the survey found, with roughly one out of 20 saying they have used steroids — only a slightly smaller percentage than those who had recently turned to diet pills, powders or liquids.
Sports can pile on more pressure. Wrestlers, for instance, often aim to lose enough weight to grapple with lighter opponents. For some competitors, throwing up or downing laxatives can be a gateway to a disorder that lasts beyond the sporting event, said Dawn Theodore, clinical director of the Eating Disorder Center of California in Brentwood.
Los Angeles isn't the only city where boys have been increasingly likely to purge or turn to diet substances, with higher-than-average rates also seen in Chicago, Houston, Charlotte, N.C., and elsewhere. Government estimates show that the number of males hospitalized for eating disorders rose 53% between 1999 and 2009. Some experts say they are unsure whether more boys and men are in fact suffering such disorders or whether more are now willing to seek help.
Females remain much more likely to be hospitalized for eating disorders than boys and men, who made up 12% of such hospital stays as of four years ago, the government estimates show. However, researchers say that because men fear coming forward, the rates among males might be higher than the numbers suggest.
When they finally get help, the boys' cases "tend to be especially severe," said clinical psychologist Jennifer Henretty, who directs intensive outpatient programs at the Center for Discovery, a national system of eating disorder programs headquartered in Orange County. "People don't look until it's really out of hand."
Experts say part of the problem is that traditional methods of detecting disorders were made with girls and women in mind.
Benjamin O'Keefe, 18, remembers Googling the word "anorexia" and finding a website that said it halts menstruation. "There was nothing targeted at me," said O'Keefe, who struggled with the disorder in high school in Florida.
He exercised constantly and sometimes ate only a cheese sandwich for days at a time. He suffered massive headaches, slept incessantly and fainted onstage while rehearsing for a play.
While he weakened, "people were saying, 'Wow, you look great,' " O'Keefe remembered.
He began talking about his past struggle with anorexia upon launching a petition earlier this yearurging Abercrombie & Fitch — known for its shirtless models — to carry larger sizes.
Men who battled anorexia or bulimia as teens told The Times that other problems often drove their disorders. Piperno, the Simi Valley man, said it began as a way of exerting control over his body after suffering sexual abuse.
Matthew, a 20-year-old who faced anorexia as a teen in the Pasadena area, first avoided eating to "numb out" the alcoholism of his father and stepmother.
Read full article here...
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Fairwinds Treatment Center is a dual-diagnosis eating disorder facility. We offer personalized treatment for men and adolescent males who are struggling with anorexia nervosa. For more information or to discuss your situation, contact our admissions team at 727-447-0300 or through our website here.
Fox 4 in Kansas City, MO resently ran a story about a mother coping with the lose of her daughter following a long battle with anorexia and bulimia. The story is all to familiar for those of us involved in eating disorders and mental health. The following is an exerpt from the story.
LEE’S SUMMIT, Mo. — Eating disorders are deadlier than any other mental illness. The disorders can result in heart attacks and organ failure, but there’s also a high risk of suicide.
In junior high, friends noticed that Emily Heim was going to the restroom during lunch. They were concerned she was purging. The diagnosis of bulimia came a year later. The Lee’s Summit girl received treatment, but her mom says it was never enough. Insurance limited the days Emily could spend in a treatment center.
“They get you stable and it’s like a band-aid fix, but they really don’t get at the root of the problem,” says Suzi Heim.
Behind Emily’s smile, an agonizing struggle with bulimia and also anorexia went on for seven years.
“I think she came to a point she was just really, really worn out and exhausted,” says Suzi.
Emily took her life two years ago at the age of 21. Suicide is estimated to be 23 times more common in people with an eating disorder compared to the general population.
“The pain never goes away, but you learn to cope and go on and that’s one reason why we’re doing the walk,” says Suzi.
Suzi is an organizer of the first walk in Kansas City for the National Eating Disorders Association. It will be Saturday at Berkley Riverfront Park. For details, click here.
The goal is to raise money for advocacy for better insurance coverage and earlier, more comprehensive treatment. Money also goes for the association’s helpline (1-800-931-2237) and people-to-people support.
Suzi thinks Emily’s message would be this.
“Please try to help others help themselves because I couldn’t help myself.”
A devastated mother wants others to have hope.
Here is the video from ABC affiliate KSHB Action News 41, covering the NEDA Walk Suzi is helping to organize. It's great to see coverage of these types of events in the local media.
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Fairwinds Treatment Center, located in Clearwater Florida specializes in the treatment and recovery of eating disorders, full spectrum. As the article states above, it can be difficult to get the right treatment due to insurance coverage. If you or a loved one are stuggling with an eating disorder such as anorexia and/or bulimia, contact Fairwinds Treatment Center at 727-449-0300 / 800-226-0301 or through our webiste here.
The earlier you seek treatment, the better the results and chances for a lasting recovery.