Wednesday, June 30, 2010

Do dentists know how to recognise and treat patients with eating disorders?

Eating disorders affect dental health in a number of ways that are visible to dentists, but most noticeable are acid reflux effects. The symptoms include swelling of the cheeks and jaw, tooth and gum sensitivity, tooth decay, tooth discolouration, and halitosis. Stomach acid increase due to bulimia erodes teeth and causes sensitivity to the teeth with staining, and irritated gums. Fizzy drinks often used by those with anorexia also contain acid that causes damage to tooth enamel, and the gums. Once dentin becomes exposed and gums irritated, the likelihood of bacterial infection and oral disease is higher.

These acidic reactions in people with eating disorders cause pungent bad breath that peppermints, chewing gum and mouth rinse do not conceal. Besides swelling of the cheeks and jaws, dentists may also notice wounds on the upper hand surface and knuckles caused by excessive purging as a result of bulimia. Dentists are usually the first to notice these warning signs and can act before the damage is irreversible not only to oral health but also to the physical and mental health of the patient.

Eating disorders like anorexia where patients starve themselves or bulimia where patients binge and purge are biological mental illnesses and have to be very sensitively handled for a positive outcome for the patient. Many do not easily acknowledge their illness or accept treatment for the disorder. Dr. Emmett R. Bishop Jr., MD, CEDS, of the Eating Recovery Centre in Colorado suggests direct non-labelling type questions said with concern, such as “Do you make yourself throw up?” Rather than questions like: “Do you have bulimia?” Engaging the patient in a gentle and caring discussion can open the door to a referral for psychological support, such as through the new 2010 NHS Psychological Therapies. Facilitating treatment for the underlying eating disorder is step towards holistically-improved dental health.

Tuesday, June 29, 2010

Project Body Talk: A new site from author Harriet Brown

Check out Harriet's new site!  It features commentaries on a variety of body and health issues in a style similar to This American Life - i..e:  personal vignettes!

From the site:
Body image has become a hot-button topic in contemporary America. For women—and, increasingly, for men—there’s intense pressure to look a certain way: the unattainable thin ideal for women, and the unattainable buff ideal for men. Never before has so much time, energy, and money been spent talking about how we look—and how we think we should look.

Project BodyTalk is a safe place where people can share how they feel about their bodies and body image, their relationship with food and eating, and the cultural pressures that are so much a part of American life today.

We invite you to send us your commentaries—and to listen to other people’s. Record your story and submit it here. Learn about efforts around the country to spread body-positive messages and awareness. Start coming to terms with your body, whatever its size and shape, and see how that simple act can change your life.

Ask the Expert: Can Strep Throat Lead to Anorexia?

Dr. Kathryn Zerbe, professor of psychiatry at Oregon Health and Science University and a longtime expert on eating disorders, previously responded to readers’ questions about anorexia, bulimia, binge eating and related problems. Here, she responds to a reader who developed anorexia after a severe case of strep throat.

Q.A number of years ago, several studies indicated there might be a link between strep infections and the onset of anorexia nervosa. When I was young, my own anorexia began immediately after a severe strep infection, though I was already “ripe” for a.n. beforehand. Have any further studies been done?
Tinytim, France

A.Dr. Kathryn Zerbe responds:

You are referring to a small number of case reports that linked the development of anorexia to a condition called PANDAS, or pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection. Since these reports were published in the late 1990s, there have been studies that specifically link some cases of anorexia to acute strep infection.

There is also ongoing investigation of how tics and obsessive-compulsive disorder, or OCD, may worsen after a strep infection in some children up to the age of puberty. Because anorexia and obsessive-compulsive disorder often occur together, it is possible that antibodies produced by the strep bacteria could affect the brain and trigger or worsen both disorders.

At the present time, however, the National Institute of Mental Health only links the PANDAS syndrome with tics and OCD, attention-deficit hyperactivity disorder, separation anxiety, sleep problems and mood changes. Children who have have OCD and tics associated with PANDAS usually improve once the infection clears, only to get worse if they get another strep infection.

Children without PANDAS but who have tics and OCD tend to have the disorder for a long time, with good days and bad days, but they don’t necessarily get worse when they get a strep infection. The mechanism for PANDAS remains unknown.

Wednesday, June 23, 2010

Pro Ana Versus Pro Recovery Sites: New Study by Johns Hopkins and Stanford University raises concerns

Pro Ana websites are popular, enticing and potentially deadly to young women. They promote thinness at all costs and often disregard health, well being and common sense. The June 17th issue of American Journal of Public Health published a recent study of Pro Ana websites. This innovative study conducted by Johns Hopkins Bloomberg School of Public Health and the Stanford University School of Medicine, has raised questions about how we can meet the needs of these Pro Ana website visitors in healthier ways. It is important that Pro Recovery sites are supported and promoted by leaders and those influential to young woman. Professors, Teachers, Coaches, Physicians, Nurse Practitioners, Parents and Therapists all can help offset the pro ana movement by supporting organizations that emphasize health and self esteem over thinness. It may save a life.

Fort Worth, TX (PRWEB) June 22, 2010 -- A recent study of Pro Ana websites, published in the June 17th issue of American Journal of Public Health, shed some light on why young women are drawn to these sites and what they find there. This illuminating study has created a flurry of discussion and concern in the public.

Pro Ana websites are prolific across the internet. These sites provide tips, advice and encouragement to women on how to become thinner, emaciated or practice anorexia nervosa. Dramatic calorie restriction, fasting, excessive exercise, purging, laxatives and other unhealthy behaviors are often glorified as a magic key to achieving the media glorified waif look that has so deeply influenced women today. Eating disorder treatment is not advised or suggested. Thus, in most cases, these Pro Anorexia websites are promoting a deadly lifestyle and self destruction.

"These Pro Ana sites provide a sense of camaraderie and collaboration among the website visitors. These sites also can create a sense of pursuing a more perfect version of the self, or at least the body" commented Jacquelyn Ekern, MS, LPC, and Director of Eating Disorder Hope. Sadly, the Pro Ana sites are focused on thinness as a status symbol and promise increased confidence and power in the world if one can just become thin enough.

Fortunately, there are Pro Recovery sites that refute these claims and encourage visitors to find a sense of inner value, self esteem and worth in the content of the character - rather than the external image of the individual. Sites such as Eating Disorder Hope promote healthy self care, embracing life and pursuing recovery. This site's mission is to foster appreciation of one's uniqueness and value in the world, unrelated to appearance, achievement or applause.

Eating Disorder Hope and other recovery websites, provide treatment resources such as a Treatment Directory and a Specialist Library. These provide sufferers from anorexia, bulimia, binge eating disorder and compulsive overeating with contacts to professionals who can treat the destructive condition and the underlying issues that led to this maladaptive behavior.

Recovery Tools are provided and explained to offer practical suggestions for developing a healthier lifestyle and self esteem. Tools are given, such as nutrition tips, mindfulness skills, spirituality, improving rational thinking, body image improvement advice and relapse prevention techniques.

Resources are also provided that direct the individual to articles on recovery, inspirational real stories of recovered women, pro recovery newsletters and blogs, support groups, and excellent non profit organizations that support eating disorder awareness and prevention.

If you know of a woman suffering from anorexia, bulimia, binge eating disorder or seemingly becoming far too preoccupied with weight, eating and diet - Please, seek help for them. A good starting point may be to refer them to a resource such as Eating Disorder Hope where they can find eating disorder treatment referrals, recovery tips and resources, and most of all, inspiration to choose a full and meaningful life over the empty existence of anorexia and other related conditions.

Jacquelyn Ekern, MS, LPC is Director and Founder of Eating Disorder Hope.  Eating Disorder Hope is the one stop eating disorder treatment, resource and information site. Eating Disorder Hope promotes ending eating disordered behavior, embracing life and pursuing recovery through implementing the best eating disorder treatment available for the individual with anorexia, bulimia or binge-eating disorder.

Tuesday, June 22, 2010

Around the Dinner Table Plate Drive - June 1 until June 30, 2010

The Around The Dinner Table online forum has been empowering and supporting parents since 2004: offering a 24 hour sounding board for thousands of users. This month we are holding our first annual "Plate Drive" as a fundraiser for our organization. By adding your personal messages to these plates -- created for this project by our graphic designer, Liana Mensh -- you become part of the the legacy of this organization. Your donation of at least $1 (US) for each word on the plate helps us keep the forum and F.E.A.S.T. going. We are a frugal organization - staffed by volunteers and using donated office space and materials - but need donations to pay for expenses like Internet services, telephone, insurance, and travel. By supporting this organization you show us what having this forum means to you and your family.

Anyone can participate: invite your friends and extended family to join in. Make your message anonymous or use your name. Be funny or serious. Use three words or (up to) 50. We want to hear from you and we want to include you!

Ready to add your plate?

Chicago Tribune - Eating with an anorexic child: A controversial treatment

War broke out on the day Rina Ranalli and her husband told their 12-year-old anorexic daughter the strict new house rules: three meals and three snacks a day.

Initially, their bright and previously sweet-natured girl cried, screamed insults and raged. She threw things. Punched holes in the wall. And she pretended to eat while plotting ways to hide the food. But when the seventh-grader realized her parents had her trapped — they would sit with her 24/7 if they had to — she ventured down the only available path. She began eating.

Chicago's Ranalli family was using the little-known Maudsley Approach, a grueling but evidence-based treatment for adolescents suffering from the eating disorder anorexia nervosa. The approach, also called "family-based therapy," flips conventional treatment on its head.

Often parents are advised to put their starving child in therapy or residential treatment, distance themselves to preserve the teen's independence and wait for the day the child decides to resume eating.

But under Maudsley, parents immediately start the daunting task of "re-feeding" their malnourished child. Once weight is restored — and, theoretically, rational thinking returns because the brain has some nourishment — parents step back, and control over eating is gradually returned to the child. The final phase of treatment is the initial step in traditional therapy; it addresses the underlying psychological issues that may have caused the disorder.
Read the full article here

Monday, June 21, 2010

A FREE Workshop & Webinar for Those in Recovery

Home for the Summer:
A FREE Workshop & Webinar for Those in Recovery

Tuesday, July 20, 2010
6:30 PM – 8:00 PM

Locations: Radnor, PA; Coconut Creek, FL; New York, NY; Ridgewood, NJ; Wilton, CT; Bethesda, MD; Charlotte, NC; Nashville, TN, and Dallas, TX.

The summer is a time associated with fun and relaxation, but it also can be a season that brings about its own unique set of challenges in eating disorder recovery. This event will be a time of self-reflection and recharge of your recovery journey. There will be journaling exercises and group discussion on various topics including:

- Assessing where you are in your recovery and stepping up your recovery
- Setting goals for your recovery process
- Body image as it relates to summer attire
- Vacations that may bring about relational and food challenges
- Changes in one’s schedule, such as managing down time

Who Can Attend
The workshop and webinar are open to both Renfrew alumni and anyone who is struggling with disordered eating.

Click here to register online for the Tuesday, July 20th workshop at a Renfrew Center outpatient site.


Tuesday, July 27, 2010
12:00 PM – 1:15 PM EDT
Wednesday, July 28, 2010
8:00 PM - 9:15 PM EDT

If you cannot attend the workshop at one of Renfrew's outpatient sites, a webinar will also be offered that will cover the same topics. Jennifer Nardozzi, PsyD and Alison Smela, a Renfrew Alumna will facilitate the webinar.

Jennifer Nardozzi, PsyD is a psychologist who specializes in treating women with eating disorders. She is the former Assistant Clinical Director of The Renfrew Center of Florida and is currently National Training Manager of The Renfrew Center Foundation and Alumni Representative.

Alison Smela is an alumna of The Renfrew Center of Philadelphia. She is 100% devoted to her recovery of mind, body and spirit. By God's grace, her journey continues in the pursuit of furthering hope for those still suffering. She currently lives with her husband in the suburbs of Chicago and she can be reached via email at

Click here to register online for the Tuesday, July 27th webinar at 12:00 PM EDT.

Click here to register online for the Wednesday, July 28th webinar at 8:00 PM EDT.

The Workshop and Webinar are both FREE.

For more information about the workshop and webinar, please contact Kelly Fieni at 1-877-367-3383, ext. 3299 or

Tuesday, June 15, 2010

Understanding The Connection Between Eating Disorders and Addictions by Jody Smith

Dr. Carolyn Ross observed through her medical practice that many patients were crumbling due to stress and unhealthy lifestyle habits. She began to look into complementary and alternative therapies, learning about the use of herbs and supplements.

She later opened three women's centers offering complementary and alternative therapies. When her mother was diagnosed with Alzheimer's, Dr. Ross studied with Dr. Andrew Weil.

Dr. Ross talks about the differences and similarities between eating disorders and addictions.

Dr. Ross:
Well, eating disorders are very much related to addictions of all kinds and also to mood disorders, but let’s just talk first about addictions. So, about 8 to 20% of people with anorexia also have chemical dependency issues, whether it be alcohol or other substances. An even higher percentage of individuals with bulimia or binge eating disorder also have problems with drug and alcohol abuse or dependence.

So why does that happen? How are those two related? Well there are a number of different reasons. Some of them have to do with what the purpose is that the addiction is serving and many people feel that depression may be the underlying reason why eating disorders and substance use disorders go hand-in-hand or are co-occurring, as we say.

As well, many people with both substance use disorders and eating disorders have a history of a trauma or abuse in their lives and this is another common reason why those go together. So, if you have one, it’s likely that someone in your family has had either depression, chemical dependency, or an eating disorder. So there is a familial risk as well between those disorders.

About Dr. Ross, M.D., M.P.H.:

Dr. Carolyn Ross, M.D., M.P.H., completed her undergraduate degree in Modern Foreign Languages at Purdue University and worked as a full-time mother of her two older sons before returning to school to complete her pre-med requirements. She then went to the University of Michigan Medical School.

Visit Dr. Ross at her website

Sunday, June 13, 2010

Needed: 1000 Constituents to Write Congress

Dr. Jeanine Cogan, Policy Director for the Eating Disorders Coalition, writes:

Inspired by the great success of our 2010 lobby day this Spring, we launched a Letter Writing Campaign with the ambitious goal of having 1,000 constituents write their Members of Congress. The goal is simple: get your Representative and Senators to be a cosponsor of the Federal Response to Eliminate Eating Disorders bill, aka the FREED Act.

In order to reach that goal, we need your help! Here are a few simple steps:
  1. Write a letter to your Representative and Senators. It’s easy—just go to
  2. Tweet it: “Help us eliminate eating disorders by helping to pass the FREED Act! It’s simple; go to:” (107 characters)
  3. Post this as your Facebook status: “Help us eliminate eating disorders by helping to pass the FREED Act! It’s simple; go to:
  4. Encourage your Facebook friends to "share" your status!
  5. Post the message on walls of appropriate Facebook groups/fan pages!
  6. Send the link with a personal note to all your friends and colleagues in your email address book
  7. Ask those friends and colleagues to help spread the word
  8. Send the link to advocacy groups, lists, etc.
  9. Blog about our Letter Writing Campaign
Thank you for your support and dedication to helping us pass the FREED Act. Together we can make this happen—and save lives!

Renfrew Clinic Celebrates 25 Year Anniversary in Philadelphia

by KYW’s Jim Melwert

The nation's leading authority on eating disorders, based right here in Philadelphia is celebrating 25 years.

The Renfrew Center's original facility was opened here in 1985:

"It was the first in the country exclusively devoted to treating eating disorders as clinics go."

Founder and president Sam Menaged says things certainly have changed, since Renfrew began twenty-five years ago:

"In 1985, when we opened there was no eating disorder field. Today, you can say there's a field. There are self help groups around the country, there are family foundations. There are lobby groups."

Renfrew has treated 55,000 women and now has facilities in nine states.

Tuesday, June 8, 2010


The DSM5 first draft has proposed many new diagnoses that would create enormous problems (especially false positive "epidemics" and forensic misuse). Two perceived needs have driven the DSM5 Work Groups in this unhappy direction:1- therapeutic zeal not to miss patients who might benefit from treatment; and, 2-an aversion toward using the Not Otherwise Specified (NOS) categories. I will argue that these NOS categories impart a great deal of useful clinical information and are essential to the flexible and effective use of the manual. Giving every presentation a specific name and code in order to reduce the use of NOS would create much worse problems than it would solve.

The common prejudice against NOS diagnosis is that it puts psychiatry in a bad light. Why should as many as a third of our patients not qualify for anything more definitive? How do we explain this to them, their families, to referral sources, and to ourselves? How can we plan a specific treatment if the patient doesn't have a specific diagnosis? And so on.

It may be useful to answer these questions in the act of exploring the different ways patients actually qualify for a NOS diagnosis:

1-There is simply not enough information to be more specific. Sometimes, this occurs because there was insufficient time for a complete evaluation or the patient is uncooperative and there is no informant or chart. Often, though, it comes from the inherent uncertainties of the situation. I have, for example, rarely felt comfortable with any label other than Psychotic Disorder NOS for psychotic teenagers who have only short track records There is usually just too much uncertainty about the etiology (i.e., role of drugs) and their future course to be more definitive. There is nothing to be defensive about in using NOS in these situations. The designation Psychotic Disorder NOS conveys a great deal of information, while keeping tentative what deserves to be kept tentative. The immediate treatment target is clear without imposing a premature closure on long term treatment needs or prognosis. This can easily and productively be explained to patients and families.

2- The presentation clearly belongs in the section, but does not fit the prototype of any of the specific disorders defined there. For example, in DSM4 we included binge eating disorder as an example of Eating Disorder NOS, rather than elevating it to a separate coded category. This allows the clinician the flexibility to diagnose an individual patient when this is deemed necessary without prematurely reifying a category that has yet to pass its risk benefit test and might have unfortunate unintended consequences.

3-The condition is subthreshold to the specific criteria sets- but nonetheless causes obvious clinically significant distress or impairment. There is no bright line between mental disorder and normality. The decision whether a mental disorder is or is not present inherently has to be made on a case by case basis. The NOS categories provide needed flexibility in diagnosing the many people who present at the boundary with normality. Clinicians can use the appropriate NOS category for the early diagnosis of subthreshold conditions (eg "prepsychotic risk") when this clearly warranted for that particular person. This is far preferable to introducing a specific category for "psychosis risk" that would inevitably misidentify many individuals who would be much better off without diagnosis and treatment.

4-The condition presents a mixture of symptoms from different specific disorders that are individually subthreshold but jointly causative of clinically significant distress or impairment. The proposal for a Mixed Anxiety Depressive Disorder is a perfect example and is best handled as an NOS. If made an official category, it would immediately become one of the most popular diagnoses in DSM5 without any proof that treatment would provide more good than harm for the millions of people who would get the diagnosis. In all these ways, the NOS categories are indispensable. They should be celebrated, rather than denigrated and used whenever they are the best description of the less than typical patient. The designation NOS is never really nonspecific or noninformative because it places the patient in a suitable section of the manual without providing more certainty or specificity than the situation allows.

Advice to DSM5
1-Accept the fact of life that a certain degree of diagnostic uncertainty and heterogeneity is inherent in the definition of mental disorder. Do not seek to attain an unattainable and pseudoprecise total specificity.

2-Appreciate that each NOS designation provides considerable information (for example, Psychotic Disorder NOS is very different in its treatment and prognostic connotations from Mood Disorder NOS or Eating Disorder NOS).

3-List the most common examples under each NOS category and allow these to be subtypes of that NOS- eg "Eating Disorder NOS, binge eating presentation" or "Mood Disorder NOS, premenstrual dysphoric presentation".

4- Clinicians using the NOS diagnoses are dealing with non prototypical boundary cases. They must therefore be especially careful in determining that the presentation is accompanied by sufficient clinically significant distress or impairment to warrant a diagnosis of mental disorder.

5-Do not create new diagnoses in a vain attempt to replace NOS. The suggestions for new DSM5 diagnoses should instead be available as examples under the most appropriate NOS ("minor neurognitive" under Cognitive Disorders NOS etc). There are two exceptions among the proposed new diagnoses- "paraphilic coercive" and "hypersexuality"- both of which are harmful constructs whose use should be discouraged altogether, even within the NOS rubric.

Binge Eating a Psychiatric Disorder, Obesity is Not

Binge eating should be included in the Diagnostic and Statistical Manual of Mental Disorders, but obesity should not, says a group of medical experts.

A group of medical experts is recommending that binge eating be included as an official psychiatric disorder in new mental health guidelines; however, obesity should not.

At the annual meeting of the American Psychiatric Association (APA) last week, the work group revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) offered several recommendations for overhauling the eating disorders category, including adding binge eating as a psychiatric disorder. The DSM lists symptoms and criteria for diagnosing mental disorders, as well as treatments and insurance plan coverage. If the changes are approved, binge eating disorder may become recognized as an illness alongside other disorders, like anorexia and bulimia.

Binge eating is defined as consuming amounts of food larger than most would eat in a period of time under similar circumstances, and feeling a lack of control during the episode, according to the DSM group’s proposed revision. Binge eating is the most common eating disorder in the United States but it is very difficult for doctors to identify and treat.

Researchers found scientific evidence that binge eating tends to run in families and is most common in older males, with a later onset of personality disturbances. According to the DSM work group’s proposed guidelines, the person must feel distressed when eating and the binging must occur at least once a week for three months.

In addition, a binge eating episode meets at least three of these criteria:
- eating much more rapidly than normal
- eating until uncomfortably full
- eating large amounts when not physically hungry
- eating alone due to embarrassment
- feeling depressed or very guilty after overeating

Currently, binge eating falls within the category known as “Eating Disorder Not Otherwise Specified” (EDNOS), which also includes purging disorder (a person vomits after eating without binging before) and night eating syndrome (a person wakes up at night and eats).

Obesity was not recommended as a psychiatric disorder because “it’s a physiological, anatomical abnormality of excess body fat,” said Dr. B. Timothy Walsh, the chair of DSM-V’s eating disorders work group. He feels it should not be categorized as a mental illness.

Noted Dr. Walsh, “There are people who are overweight or obese and have eating disorders, but then there are many people who are overweight or obese and don’t have eating disorders.”

The proposed draft revisions to the DSM disorders and criteria, which include several changes to the EDNOS category, are posted on the DSM website.

Thursday, June 3, 2010

Cheerleaders At Risk For Eating Disorders, Body Image Issues

College cheerleaders are at high risk for body image issues and eating disorders - and may be affected by how revealing their uniforms are, according to a study presented at the American College of Sports Medicine's 57th Annual Meeting in Baltimore.

Toni Torres-McGehee, Ph.D., ATC, studied 136 Division-I and Division-II college cheerleaders to determine if position (base, flyer, etc.) and clothing requirements (daily clothes vs. full or midriff uniforms) affected eating disorder incidence or body image dissatisfaction. Participants were surveyed for weight, height and perceived ideal weight.

Although position did not appear to be a factor, cheerleaders overall were highly disposed to eating disorders: 33.1 percent had some risk of eating disorder characteristics and/or behaviors. Cheerleaders on teams with midriff uniforms were most disposed to body-image issues.

"Maladaptive body image and eating behaviors can form during youth and last a lifetime," Torres-McGehee said. "Teams and coaches should consider the long-term effects of requiring cheerleaders to wear revealing uniforms simply for aesthetic reasons."

Participants were also asked about how they thought their coaches and parents perceived their body image, and appeared most concerned they weren't fitting their coaches' ideals for body composition.

"The point of collegiate cheerleading is to create camaraderie and team spirit and to keep girls active and healthy," Torres-McGehee said. "Cheer coaches should keep these ideals in mind and try to reinforce self-esteem among their team members."

The American College of Sports Medicine is the largest sports medicine and exercise science organization in the world. More than 35,000 international, national and regional members and certified professionals are dedicated to advancing and integrating scientific research to provide educational and practical applications of exercise science and sports medicine.