"EDDigest" via Rachel in Google Reader

Do gyms have responsibilities towards people with eating disorders?

2009-11-07T20:51:55-08:00

That's the question raised by researcher Rony Duncan. In his "News and Views" piece for the British Medical Journal, published this past September, Duncan argues that gyms do have some responsibility, and lays out three main areas in which this could be beneficial.

1) It provides a possibility for intervention.
2) It can help promote a healthy body image.
3) It can help break through the delusional thinking that accompanies EDs.

The possibility for intervention is well-intentioned and will probably fall on deaf ears. It would have for me. This isn't to say that people shouldn't speak up, just that speaking up will not necessarily produce a newly-converted couch potato. Frankly, if someone had spoken up to me, I would have just switched to a new gym. In fact, I was so paranoid about someone noticing that I took all sorts of steps to make sure I never exercise excessively in any one place at any one time. I spread my exercise sessions throughout the day and in several different locations: outside, my apartment, the gym at work, the gym at home. No one knew, of course, that I worked out several times each day.

The second point is almost laughable. First of all, Duncan is making the assumption that anyone who exercises excessively is visibly underweight. I rarely was. And many others aren't, either. Do we not have a problem until you can count our vertebrae? Secondly, preventing the visibly anorexic from exercising will probably not have a large impact on most people's body image, nor is that something that other people can control. Kicking someone out of a gym because they're very thin and giving other people a complex sounds more like playground logic.

There's also the problem that many men have exercise addictions, and also that someone can have a lower BMI (known as being constitutionally thin) and be perfectly healthy.

The third point is, perhaps, the most valuable. Writes Duncan:

...when gyms fail to intervene over members who are below a healthy body weight, they risk becoming complicit in the delusions held by these individuals, strengthening the perception that more exercise and weight loss are needed.

My long experience with anorexia has left me peeved at any number of things, including the paucity of good treatments (and treatment providers!). One of my other peeves is that, other than my mom, no one really spoke up and told me I was exercising too much or losing too much weight. Would the truth have made a bit of difference? Probably not then. But it's very hard to convince yourself you have a problem when everyone else seems to be living in the same delusional world as you are. If I were sick, I thought, surely somebody would say something.

And because they didn't, it only reinforced the idea that I was fine.

I don't necessarily think that speaking up to an exercise addict about his/her gym habits will magically take off the blinders. I don't know that it will decrease his/her overall exercise. I don't know that it will improve others' body image. I don't even know that it will break through the wall of delusion and anosognosia that comes along with eating disorders.

But there is value in speaking the truth, in saying what needs to be said whether the listener wants to hear it or is ready to hear it. I am incredibly angry that so few people said anything to me during my illness, when I ran to the bathroom after meals, when I basically moved into the gym, when I was using binder clips to keep my pants up. I was secretive, yes, but you would have had to be blind to miss some of this stuff.

Speaking up says one incredibly priceless thing to a sufferer: I care about you. And that is a message that sufferers need to hear, over and over and over again.

Fill In The Blanks

2009-11-07T18:24:00-08:00

I sit in the basement of the same church where my children attended preschool, sipping a spiced pumpkin latte', and contemplating the idea of pulling my knitting out of my purse. I need something to focus on besides my nervous attempt to avoid eye contact with the other women in the room. All that I can hear is the sound of my pulse throbbing in my ears. Women stand up to share their stories, but their voices are background noise, competing with my heart. My knitting sits in my lap, needles poised and unmoving. My eyes focus on the stillness of my fingers until they become unrecognizable as my own, and this is when I disconnect. When I'm uncomfortable or afraid, that is what I do. I separate myself from the fear, filling the space that exists with emptiness. My life is riddled with holes. The frayed memories, torn and faded, haphazardly patched and sewn. I find myself behind the wheel of my car, wondering in what direction I should go, because I'm painfully aware that I don't want to go home. Home means answering questions of which I have no answers. "The meeting was fine," I say.

I'm used to filling in the blanks.

We Can Be Hobbits

2009-11-07T17:23:07-08:00

(Background: Match and I had lunch plans tomorrow, but he had something come up that conflicted.)

Match: Sorry for the last minute change, we can just push lunch back to 3:30 or 4?

Cammy: Does it still count as lunch if the little old ladies at the next table are ordering supper at the same time?

Match: Well, we can be hobbits? Second Lunch. I do it all the time, except when it conflicts with my Pre-Dinner.

One of the things I appreciate about him is that he acts completely normal about food even though he's aware of my ED. I hate it when I feel like people constantly walk on eggshells about it. He never makes an issue of it, although he lets me call the shots if I'm not comfortable with what he suggests. Anywho, this exchange made me smile and I wanted to share. In this case, we decided to do breakfast instead, which is actually way less anxiety-inducing for me anyway.

Just a note to follow up my last post too. I was afraid I came across as naive when I mentioned the whole "spark" business. I guess I am just comparing this relationship to both my high school boyfriend (full on teen infatuation) and the little whatever I had with....I can't even remember what letter pseudonym I assigned him....earlier this year, which was pretty much infatuation without the excuse of being teenagers. With Match, I have a lot of comfortable but none of the infatuation. Which is why I'm confused about whether this should be a friends situation, or if this is actually healthier.

Who knows. But Tolkien references do make me smile. ;)

Balance

2009-11-07T02:02:00-08:00

Psychotherapy in the Age of Biological Psychiatry:

“Psychiatrists know about the latest drug trials, but they don’t always know about the latest clinical trials of psychotherapy"

How important it is that we not operate on the extremes, or in little niches. The progress in science and society should result in better outcomes and collaboration, not pendulum shifts that serve no one.

Early satiety in EDs

2009-11-06T21:11:29-08:00

One of the side effects of eating disorders is a rapid sense of satiety; that is, you feel more full when eating less food. Some of this is strictly physical, as the stomach shrinks during starvation, and food empties into the digestive tract slower. The formal medical name for this is delayed gastric emptying or gastroparesis. It almost always reverses upon normalization of eating patterns, but it can take a while. Some of this satiety may be anxiety-based (that stomach-churning feeling really isn't condusive to eating lasagna, let alone with gusto), and sometimes, it was a matter of my believing my own BS. If I just ate X, I damn well better be full!

Then, of course, we have to add neurochemicals to the mix. I've blogged several times on leptin in eating disorders (What's Leptin Got to Do With It?, Leptin and You, and Food and Sex and Leptin- Oh My!), and the protein, which signals satiety, has been much researched in relation to both anorexia and obesity. Gina Kolata's book Rethinking Thin has a great chapter on the discovery of leptin and some of the interesting research going on about the protein.

Ghrelin is kind of the ugly stepsister to leptin--it has the opposite function (ghrelin signals hunger as opposed to satiety), and it's gotten the shorter end of the stick in terms of research (at least recently). Unlike leptin, which is primarily synthesized by adipose tissue, ghrelin is synthesized in the stomach upon eating. A drop in ghrelin levels typically happens after eating and is thought to be linked to the release of insulin, which tells the body's cells to absorb the glucose from the meal.

Considering that people with anorexia are objectively starving, they generally have high levels of ghrelin as their bodies signal them to go get some food, levels that return to normal upon refeeding. However, a new study suggests that the excessive release of insulin by people with AN (known as hyperinsulinemia) also blunts the hunger-signaling effects of ghrelin. That is, the sudden drop in ghrelin upon eating even small amounts of food tells the brain that the person is full and the meal is finished.

The increased insulin sensitivity makes sense from a biological standpoint: the body will want to make the most use out of limited energy intake, so cells would do well to become more sensitive to insulin to slurp up more glucose. Whether the drop in ghrelin is an abnormality completely separate from the insulin sensitivity, or just a really ironic side effect, has yet to be seen. However, it adds another piece to the puzzle of why people with AN find it so difficult to eat more: they really do feel full.

Untitled

2009-11-06T19:39:00-08:00

I would like to hide away from

the world, and not have to face

anyone. Shame is eating away at

all of me. I'm sad and angry,

and sure that I deserve to feel as

bad as I do. I feel like a horrible person

who doesn't deserve anything.

I'm tired of all of the labels,

but what's one more,right?

Who the hell cares anymore?

I'm in a negative, rageful mood, and

dangerously filled with self hatred.

Oh, there are ways to fix these feelings.

I can stuff them down, starve them away,

getting lost in the minutia of the one

label that I hang onto for dear life.

How do I deal?, and maybe I'm not meant to.

Motions vs Emotions

2009-11-06T16:26:53-08:00

So I have been thinking about the Match thing. I like him, I do. But I am starting to wonder how much I like him. I mean, there is nothing to complain about here. He is nice, funny, smart, caring, very attentive. He gets along great with his parents (always a good sign). He has great dogs and lets me bring G. over to his house when we hang out. He is ambitious and hard-working and is totally accepting of every flaw of mine that I've revealed to him thus far. He even went out and bought books on EDs to understand them better after I opened up to him about my history. He texts sweet things and opens car doors for me.

But I'm still not quite how to classify my feelings for him. I enjoy being around him, I like trading e-mails and texts. We have good conversations about a variety of topics, and I appreciate the fact that he is always willing to lend an ear if I need to talk (although I am very careful not to unload on him about ED stuff). But I don't know if I'm really getting a "spark." Sometimes I feel like I am just going through the motions, instead of responding to real emotions, it doesn't feel like a crush or like my previous relationships. Or is it just that I am not a teenager anymore, can you outgrow crushes? Again, he has done nothing wrong and I do care about him. It's not like I am looking for "The One" right now, either, I have no overwhelming desire for marriage or any of that stuff at this point in my life/career.

Maybe I am just making the error of wanting things to be perfect and textbook right away, instead of letting it develop. We have only been "official" for about a month. I do have genuine affection for him, but it is not the kind of thing where I lose sleep thinking about him. Remember back when we first started seeing each other, and I said I didn't know if it would develop into a romantic relationship or just a good friendship? Part of me wonders if my feelings for him might actually be more of the latter, if maybe I told myself I liked him this much just because I so desperately need someone to like me that much. Doesn't that sound awful? But again, I'm not sure, I could be totally wrong.

Maybe I am walling off emotions to prevent getting hurt. Maybe I am freaked out that the scale has inched up infinitesimally and am secretly looking for reasons that I could end things and trade movie nights cuddling on the couch for evening workouts again. Maybe I am just a little too stressed every time he puts his hand on my stomach or thigh. (I'm not prudish about physical aspects of a relationship, it's just casual touching of key points of "image anxiety" that bothers me).

Maybe lots of things, but on thing is definite: I am confused.

Sweets for geeks

2009-11-06T12:28:29-08:00

Only the geekiest among us will love this: The Cellular and Molecular Substrates of Anorexia Nervosa, Part 1 - as it isn't written for the average reader and took me two straight readings (hence my delay in posting it as I lately don't get four straight minutes to concentrate) to really absorb.

But I loved it. We need more of this thoughtful and intelligent higher level explanation of the disparate threads of knowledge out there. We need to get out of the ED world and get others to take up the ED information.

I can't wait for Part 2.

Save me from baby shower hell!

2009-11-06T12:52:47-08:00

Our family is throwing a baby shower for my brother and sister-in-law on Sunday and my mom keeps calling me with yet another mind-numbingly infantilizing game she’s found with names like “guess that baby food,” “the poopy diaper game” or (god forbid) “pin the binky on the baby.” I haven’t been to many baby showers, [...]

Fat Friday - Guns

2009-11-06T09:25:41-08:00

I think I would like to hire this woman as my bodyguard. I wish I felt as strong as she looks. Find more sculptures and paintings of large women by Jed Dougherty here.

Stongwoman by J. Dougherty

Outcomes of Bulimia Nervosa – A Quarter Century of Research…

2009-11-06T08:50:23-08:00

… where are we?

Objective: The present review addresses the outcome of bulimia nervosa, effect variables, and prognostic factors. Method: A total of 79 study series covering 5,653 patients suffering from bulimia nervosa were analyzed with regard to recovery, improvement, chronicity, crossover to another eating disorder, mortality, and comorbid psychiatric disorders at outcome. Forty-nine studies dealt with prognosis only. Final analyses on prognostic factors were based on 4,639 patients. Results: Joint analyses of data were hampered by a lack of standardized outcome criteria. There were large variations in the outcome parameters across studies. Based on 27 studies with three outcome criteria (recovery, improvement, chronicity), close to 45% of the patients on average showed full recovery of bulimia nervosa, whereas 27% on average improved considerably and nearly 23% on average had a chronic protracted course. Crossover to another eating disorder at the follow-up evaluation in 23 studies amounted to a mean of 22.5%. The crude mortality rate was 0.32%, and other psychiatric disorders at outcome were very common. Among various variables of effect, duration of follow-up had the largest effect size. The data suggest a curvilinear course, with highest recovery rates between 4 and 9 years of follow-up evaluation and reverse peaks for both improvement and chronicity, including rates of crossover to another eating disorder, before 4 years and after 10 years of follow-up evaluation. For most prognostic factors, there was only conflicting evidence. Conclusions: One-quarter of a century of specific research in bulimia nervosa shows that the disorder still has an unsatisfactory outcome in many patients. More refined interventions may contribute to more favorable outcomes in the future.

http://ajp.psychiatryonline.org/cgi/content/short/appi.ajp.2009.09040582v1?rss=1

When is enough, enough?

2009-11-06T03:04:45-08:00

The Around the Dinner Table community is, understandably, distraught and taken up with the pain and fear of this family:

When is enough, enough?

What would you say to this mother?

Neigh-sayers

2009-11-05T15:43:10-08:00

Today's edition of Psychotherapy Brown Bag deals with the efficacy for Equine-Assisted Psychotherapy (EAP), specifically in the realm of eating disorders. What did the author, Mike Anestis, find?

EAP does not appear to be harmful, but there is no evidence that it is efficacious in the treatment of mental illnesses. There is a paucity of research on the topic and the research that exists is so full of flaws that it is actually rather remarkable that it was published in the first place. Nonetheless, fancy treatment centers charge outrageous fees to provide this service and make grandiose claims regarding efficacy. Just as we covered in our article on touch field therapy (TFT), such behavior is a prime marker of pseudoscience.

I don't doubt that riding horses is nice and fun and pleasant, but that doesn't mean that it helps treat eating disorders (or any other illness, for that matter). I find many things nice and fun and pleasant and even, in a sense, therapeutic, but that doesn't make it a treatment. I'm a big believer in the power of animals to make us feel better- my cat does it all the time. Nothing beats snuggling her in my lap or watching her silly antics. Spending time with her is often the highlight of my day. But it doesn't help treat my eating disorder. There's a big difference.

I've done some equine therapy while in treatment and maybe I'm just bitter, but I'm not sure what the point of it was. I get the theoretical premises upon which EAP stands (as summarized by Anestis):

•Improving non-verbal communication skills through interactions with a non-verbal creature
•Improvement of acceptance skills and emotional expression through the realization that a person can not make the horse do things it does not want to do (e.g., lift its hoof)
•Improved mood due to positive interactions with an animal
•Increased awareness of connection to nature through outdoor experiences

Which is all well and good, and no doubt there can be valuable lessons learned from equine therapy. (Although I must say that my cat has taught me everything and more that I need to know about point #2. The horse might be larger, but my cat has claws! :) ) Yet that still doesn't mean that EAP is an empirically-supported treatment. I find valuable lessons in coloring mandalas, in watching Grey's Anatomy and House, in crochet, in Sudoku puzzles. Not that these things can't be helpful, but it's a long stretch to say that these actually treat eating disorder symptoms.

I do realize that places like Remuda Ranch don't rely on horses alone for their treatment. But you better believe that EAP is one of the reasons they charge so much. Why pay extra for something that doesn't really work? Why not let your kid take horseback riding lessons or go trail riding once their ED symptoms have improved?

Anestis sums up his thoughts as follows:

I like the idea of using animals to make people feel better. In fact, Joye and I may one day train our sweet playful golden retriever to visit hospital patients in order to provide them with an added moment of happiness. In doing so, however, we will not be under the illusion that such an action would constitute therapy or treat mental illnesses. Our dog would simply provide a positive experience, which can impact mood and perhaps motivate an otherwise ambivalent individual to pursue the type of help capable of addressing the actual problem. When animal-assisted therapy is couched in these terms, it sounds wonderful. When it is presented as a stand alone treatment, however, that is a problem.

I don't think, however, that Aria would be very good at visiting hospital patients. Hiding under their beds and peeing, yes. Therapeutic, not so much.

Question # 12: Turning Away from Self-Hate AND Behaviors

2009-11-05T15:15:54-08:00

Question # 12 comes from Stella. It’s one of two questions she posed, but the second one will come later, as this post is quite lengthy. She asks, “How do you react when you feel hate for yourself and your body? What do you do when you feel overwhelmed, instead of hurting yourself or restricting?” As a woman who loves her body now (or at least likes it most of the time!), trust me when I

Horse sense?

2009-11-05T14:19:52-08:00

Equine-assisted psychotherapy for mental illness: Is there evidence behind the hype?

A Hard Decision

2009-11-05T09:41:00-08:00

My therapist wants me to go to an Alcoholics Anonymous meeting, and I've really had to think hard about it. It was a difficult decision to make, because although I think that at times I do have problems with alcohol, I don't think that I'm an alcoholic. Of course, isn't that what all alcoholics say? I have been to meetings before when I was in treatment at Renfrew for my eating disorder, and I hated them. I was so anxious, and some of the men made me very uncomfortable. I found an all women's group in my area, so I think that I'm going to go on Saturday. For the most part, when I do drink, I think that I'm more of a binge drinker. Alcohol also tends to increase the likely hood that I will dissociate. I want to stop, because I do believe that it is impeding my recovery. I promised my therapist that I would not drink again, and she said that she would not keep me as a client anymore if I continued to drink. I value our relationship so much, and to lose her as my therapist would be devastating to me. I also want to do this for my husband and children. I know that it dissapoints my husband when I drink, and especially when I drink in secret. I feel so ashamed, but it would be even more shameful of me to continue such a damaging pattern of behavior.
Well, that is the latest news from me. It feels like there is always some hurdle for me to jump over, but I refuse to let alcohol control me anymore. I do like to have my control!

Kirstie Alley to get new weight loss reality show

2009-11-05T07:03:00-08:00

Speaking of Jenny Craig spokescelebrities… Oh, Kirstie. Does your masochism know no end? The former Jenny Craig spokescelebrity and once-again fat actress has a new weight loss reality television show coming out next year on A&E. As CNN reports, the yet-unnamed series will follow Kirstie as “she juggles producing a feature film, sticking to a new [...]

What’s wrong with this lineup?

2009-11-05T03:00:39-08:00

So, there’s a lecture series called Smart Talk Connected Conversations and it’s coming to Cincinnati for the 12th year in January. The celebrity-based spoken word series invites intriguing and influential women to present their stories in an intimate setting in what is supposed to be an uplifting, educational and empowering experience for women. Here’s the [...]

Being a friend

2009-11-04T21:31:02-08:00

One of my friends was having a really bad day today, and sent me an email. I didn't really know how to provide email support, so I gave her a call. We talked for about 15 minutes, and I think I helped her feel at least a little bit better. She thanked me many times for calling, and I said I was glad to.

I'm not saying this because I want a pat on the back, or even that I feel that other people need to know how I occupied 15 minutes of my day.

I'm saying this because it's such a normal thing to do: be there for a friend. It's something I wouldn't have done when I was deep into the eating disorder because I wouldn't have had the energy, and I would have been afraid that my friend would end up suggesting we go out for dinner or something. It would have been much easier to write back and say "I'm sorry life sucks right now. Let me know if I can help." Which is fine, but I know when I'm drowning in anxiety and depression, a friendly voice can really help anchor me.

We used to be best friends until the usual time and distance separated us. In the past year or so, we've once again been closer geographically and have reconnected over numerous shared interests. I'm not totally positive why she wrote me, but I'm flattered that she did, and I'm glad the ED is out of my life enough that I was able to respond as a good friend and not a caring, starving anorexic.

mentally exhausted

2009-11-04T19:28:52-08:00

Back to working on the job hunt. I'm expanding my search to include the Twin Cities, Seattle, Portland (Oregon), Washington DC, Baltimore, Philadelphia, and Denver. I've sent out 92 cover letters so far. I still have about 150 to go, I estimate, before I'll get through my list of cities. I've finally convinced my mom that moving to a big city and starting out there will be the best thing for me. Before she was bribing me with their health insurance plan, fearmongering, etc., to get me to stay in Iowa, but I think she knows deep down that it's what will get me the farthest in my career.

Stay tuned...

xoxo
Tori