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.
Showing posts with label anorexia. Show all posts
Showing posts with label anorexia. Show all posts
Tuesday, June 29, 2010
Thursday, May 27, 2010
Brain volume changes following weight gain in anorexics
Adult brain volume, which can be reduced by Anorexia Nervosa, can be regained, a team of American psychologists and neuroscientists have found.
The research, published in the International Journal of Eating Disorders, revealed that through specialist treatment patients with this eating disorder can reverse this symptom and regain grey matter volume.
Anorexia Nervosa (AN) is a serious psychiatric eating disorder of excessive weight loss caused by relentless dieting.
The starvation that results from this illness affects physiological systems throughout the body, including the brain, but until now it has been unclear if and when brain volume reduction can be reversed through specialist treatment.
"Anorexia Nervosa wreaks havoc on many different parts of the body, including the brain," said team leader Christina Roberto, MS, MPhil from Yale University. "In our study we measured brain volume deficits among underweight patients with the illness to evaluate if the decline is reversible thought short-term weight restoration."
The team, based at the Columbia University Center for Eating Disorders used magnetic resonance imaging (MRI) to take pictures of the brains of 32 adult female inpatients with Anorexia Nervosa and 21 healthy women without any psychiatric illnesses.
The scans indicated that when the women with Anorexia Nervosa were in a state of starvation they had less grey matter brain volume compared to the healthy women. Those who had the illness the longest had the greatest reductions in brain volume when underweight.
"The good news is that when women with Anorexia Nervosa received treatment at a specialized eating disorders inpatient unit at Columbia University which helped them gain to a normal weight, the deficits in brain volume began to reverse over the course of only several weeks of weight gain," said Roberto. "This suggests that the reductions in brain matter volume that results from starvation can be reversed with appropriate treatment aimed at weight restoration."
The team's results reveal that underweight adult patients with AN have reduced brain volumes that increase with short-term weight restoration, however important questions still remain surrounding the link between brain volume reduction and anorexia.
The research, published in the International Journal of Eating Disorders, revealed that through specialist treatment patients with this eating disorder can reverse this symptom and regain grey matter volume.
Anorexia Nervosa (AN) is a serious psychiatric eating disorder of excessive weight loss caused by relentless dieting.
The starvation that results from this illness affects physiological systems throughout the body, including the brain, but until now it has been unclear if and when brain volume reduction can be reversed through specialist treatment.
"Anorexia Nervosa wreaks havoc on many different parts of the body, including the brain," said team leader Christina Roberto, MS, MPhil from Yale University. "In our study we measured brain volume deficits among underweight patients with the illness to evaluate if the decline is reversible thought short-term weight restoration."
The team, based at the Columbia University Center for Eating Disorders used magnetic resonance imaging (MRI) to take pictures of the brains of 32 adult female inpatients with Anorexia Nervosa and 21 healthy women without any psychiatric illnesses.
The scans indicated that when the women with Anorexia Nervosa were in a state of starvation they had less grey matter brain volume compared to the healthy women. Those who had the illness the longest had the greatest reductions in brain volume when underweight.
"The good news is that when women with Anorexia Nervosa received treatment at a specialized eating disorders inpatient unit at Columbia University which helped them gain to a normal weight, the deficits in brain volume began to reverse over the course of only several weeks of weight gain," said Roberto. "This suggests that the reductions in brain matter volume that results from starvation can be reversed with appropriate treatment aimed at weight restoration."
The team's results reveal that underweight adult patients with AN have reduced brain volumes that increase with short-term weight restoration, however important questions still remain surrounding the link between brain volume reduction and anorexia.
Friday, March 5, 2010
WaPo Family Almanac: Treating daughter's eating disorder must involve entire family
Q: My lovely daughter, now 24, is bright and personable and she graduated with excellent grades from a private high school and a well-known college, but for the past eight years she has suffered from anxiety, has been in therapy and has struggled with an eating disorder.
She now works full time at a job she loves, shares an apartment with a college friend and lives near us, so we see her often. She is close to us and her siblings and gets support at home and at work, but she seems more anxious and weighs less than she ever has.
We have discussed residential treatment since the beginning, but her doctors thought she would recover and it was never something she wanted to do. It is heartbreaking to watch her decline and we are feeling more and more desperate. How can we help her get over anorexia nervosa?
A: Any parent of an anorexic child would be desperate, because anorexia nervosa is a dangerous illness with the highest death rate of any psychiatric disorder -- if it is, indeed, a psychiatric disorder.
Doctors first documented AN, as it's called, 125 years ago, and knew that it usually struck in the early or mid-teens and that nine out of 10 anorexics were girls, but they didn't know the cause. Nevertheless, they called it a psychiatric illness, put the blame on parents and said that only doctors could make it go away.
Now doctors still don't know the cause, but they aren't blaming parents anymore because most of them think AN is a biological illness because it runs in families; because anorexics often have relatives who are depressed, bipolar or have mood disorders; and because they are usually anxious, like to be in control, are perfectionists, have a shaky self-confidence and are fearful.
Most people with these characteristics can diet easily, but they switch a trigger in others. Suddenly they become terrified of getting fat and they remain terrified, even when their heart rate slows down, their blood pressure drops, their energy sinks, their minds get foggy and their arms and legs look like twigs. None of that matters. They simply can't see themselves as others see them.
With help, your daughter can turn off that trigger, but she'll probably turn it off sooner if you can find a Maudsley-certified therapist who uses family-based treatment (FBT), which was developed to treat anorexic teenagers in London and is used at some of the best U.S. hospitals.
Studies show that anorexics in this intensive outpatient program can usually overcome AN in six to 12 months -- instead of several years -- and that 80 to 90 percent of them will still be fine five years from now. This is a much better outcome than patients have in other therapies, perhaps because parents are part of the treatment, as parents of sick children always should be.
In this three-phase program, the therapist will first assess your family and then teach your daughter how her dizziness, her cold hands and feet, her depression and irritability are actually signs of starvation, although she won't believe it at first. At the same time she will teach you how to use sympathy and compassion -- but not criticism -- to get your daughter to eat three meals and three snacks a day, and to sit beside her until she does, even though she will object vociferously while you're firmly repeating the Maudsley mantra: "Starvation is not an option."
When your daughter begins to eat more and gain some weight, you'll move into phase 2. Here the therapist will encourage you to give your daughter more control over her eating, and when she is about 95 percent of her ideal weight -- and isn't trying to starve herself anymore -- you'll move into phase 3, where she'll help your family correct any lingering problems you might have. After living with AN for eight years, you're bound to have a few.
If FBT doesn't help your daughter, however, you'll have to seek residential treatment. You'll have no choice.
To learn even more about AN than you already know, read "Demystifying Anorexia Nervosa" by Alexander R. Lucas (Oxford, $15) and "Life Without Ed" by Jenni Schaefer and Thom Rutledge (McGraw Hill, $17), a big favorite with recovering anorexics.
And for more about FBT, go to http://www.maudsleyparents.com/ and read "Help Your Teenager Beat an Eating Disorder", by James Lock and Daniel leGrange, (Guilford; $18); "Skills-Based Learning for Caring for a Loved One With an Eating Disorder" by Janet Treasure, Grainne Smith and Anna Crane (Routledge, $25) and "My Kid Is Back" by June Alexander and leGrange (Routledge, $18), which comes out in May.
She now works full time at a job she loves, shares an apartment with a college friend and lives near us, so we see her often. She is close to us and her siblings and gets support at home and at work, but she seems more anxious and weighs less than she ever has.
We have discussed residential treatment since the beginning, but her doctors thought she would recover and it was never something she wanted to do. It is heartbreaking to watch her decline and we are feeling more and more desperate. How can we help her get over anorexia nervosa?
A: Any parent of an anorexic child would be desperate, because anorexia nervosa is a dangerous illness with the highest death rate of any psychiatric disorder -- if it is, indeed, a psychiatric disorder.
Doctors first documented AN, as it's called, 125 years ago, and knew that it usually struck in the early or mid-teens and that nine out of 10 anorexics were girls, but they didn't know the cause. Nevertheless, they called it a psychiatric illness, put the blame on parents and said that only doctors could make it go away.
Now doctors still don't know the cause, but they aren't blaming parents anymore because most of them think AN is a biological illness because it runs in families; because anorexics often have relatives who are depressed, bipolar or have mood disorders; and because they are usually anxious, like to be in control, are perfectionists, have a shaky self-confidence and are fearful.
Most people with these characteristics can diet easily, but they switch a trigger in others. Suddenly they become terrified of getting fat and they remain terrified, even when their heart rate slows down, their blood pressure drops, their energy sinks, their minds get foggy and their arms and legs look like twigs. None of that matters. They simply can't see themselves as others see them.
With help, your daughter can turn off that trigger, but she'll probably turn it off sooner if you can find a Maudsley-certified therapist who uses family-based treatment (FBT), which was developed to treat anorexic teenagers in London and is used at some of the best U.S. hospitals.
Studies show that anorexics in this intensive outpatient program can usually overcome AN in six to 12 months -- instead of several years -- and that 80 to 90 percent of them will still be fine five years from now. This is a much better outcome than patients have in other therapies, perhaps because parents are part of the treatment, as parents of sick children always should be.
In this three-phase program, the therapist will first assess your family and then teach your daughter how her dizziness, her cold hands and feet, her depression and irritability are actually signs of starvation, although she won't believe it at first. At the same time she will teach you how to use sympathy and compassion -- but not criticism -- to get your daughter to eat three meals and three snacks a day, and to sit beside her until she does, even though she will object vociferously while you're firmly repeating the Maudsley mantra: "Starvation is not an option."
When your daughter begins to eat more and gain some weight, you'll move into phase 2. Here the therapist will encourage you to give your daughter more control over her eating, and when she is about 95 percent of her ideal weight -- and isn't trying to starve herself anymore -- you'll move into phase 3, where she'll help your family correct any lingering problems you might have. After living with AN for eight years, you're bound to have a few.
If FBT doesn't help your daughter, however, you'll have to seek residential treatment. You'll have no choice.
To learn even more about AN than you already know, read "Demystifying Anorexia Nervosa" by Alexander R. Lucas (Oxford, $15) and "Life Without Ed" by Jenni Schaefer and Thom Rutledge (McGraw Hill, $17), a big favorite with recovering anorexics.
And for more about FBT, go to http://www.maudsleyparents.com/ and read "Help Your Teenager Beat an Eating Disorder", by James Lock and Daniel leGrange, (Guilford; $18); "Skills-Based Learning for Caring for a Loved One With an Eating Disorder" by Janet Treasure, Grainne Smith and Anna Crane (Routledge, $25) and "My Kid Is Back" by June Alexander and leGrange (Routledge, $18), which comes out in May.
Wednesday, January 20, 2010
For Bulimics and Anorexics, A Doctor Who Thinks Outside the Box by Mary Sornberger
Sornberger: I’d like to reintroduce Dr. Robert McLean a graduate of Howard University’s College of Medicine with an undergraduate degree majoring in Physics form Dartmouth College. He has been practicing complimentary and alternative medicine for the past twenty years and has formed The Preventive Medical Center in Newport News, Virginia.
Sornberger: Dr. McLean continues to answer the question: What supplements would you prescribe to the anorexic or bulimic that has been prescribed Prozac or other antidepressants?
Dr. McLean: A very recent review in The Journal of the American Medical Association (1/6/10 issue of JAMA) of an analysis of the efficacy of antidepressant medication (including the SSRI class) suggests that while these medications have significant benefit in severe depression, there is little if any benefit, compared to placebo, in mild to moderate depression. Serotonin, however, is one of several neurotransmitters that regulate our mood, behavior, and mental function.
A better approach to increasing serotonin (and other neurotransmitters) rather than interfering with its reuptake is, I think, to supply the body with the right precursor molecules to produce more of what is needed.
In the case of the neurotransmitters there are amino acids as well as other nutrients which are needed to produce the end products. Unfortunately, in anorexia and bulimia, we are cutting off the production by reducing the supply of nutrients.
Sornberger: What other supplements would you suggest for the treatment of anorexia or bulimia?
Dr. McLean: In addition to amino acids, there are B vitamins, minerals such as magnesium, zinc, and chromium, and essential fatty acids that play critical roles in glucose and carbohydrate metabolism.
Sornberger: How would you approach treating bulimia and anorexia?
Dr. McLean: My approach would be to do an analysis of nutritional deficiencies, in particular an analysis and correction of amino acid deficiencies and imbalances. There are many supplements which enhance brain, mood, and neurologic function.
In addition, toxins and food sensitivities and intolerances can have profound influences on our health and mental state.
Hormonal imbalances can also be involved.
While there is no doubt, psychological issues may need to be addressed; however, we need to do everything possible to produce good physical health.
Sornberger: Are you aware of research into the benefits of supplements as compared to drugs?
Dr. McLean: Most research in this country has been done to show the safety and efficacy of pharmaceutical medications, which are then marketed for great profit. Supplements, however, are increasingly finding their way into mainstream use as more studies have substantiated their benefit.
Fiber, probiotics, omega 3 fatty acids, and most recently vitamin D are a few examples of substances and supplements that have been embraced by mainstream medicine.
Sornberger: Would you like to add anything more about preventative medicine and the American health care system?
Dr. McLean: The American health care system is considered by many to deliver the best quality of care in the world, yet our outcomes in terms of chronic diseases and life expectancy are far from the best. In terms of cost, it is unsustainable.
We are currently in the process of reforming our health care system. Unless we can reform our personal attitudes toward health, however, and shift the paradigm from simply treating disease after it develops, our efforts will not be successful.
If individuals take more responsibility for health promotion and disease prevention, and government supports this effort instead of promoting more pharmaceutical dependence, our outcomes in terms of health and the cost of health care delivery will improve.
Sornberger: Thank you Dr. McLean for sharing your knowledge on the difficult topic of how to best treat eating disorders.
Sornberger: Dr. McLean continues to answer the question: What supplements would you prescribe to the anorexic or bulimic that has been prescribed Prozac or other antidepressants?
Dr. McLean: A very recent review in The Journal of the American Medical Association (1/6/10 issue of JAMA) of an analysis of the efficacy of antidepressant medication (including the SSRI class) suggests that while these medications have significant benefit in severe depression, there is little if any benefit, compared to placebo, in mild to moderate depression. Serotonin, however, is one of several neurotransmitters that regulate our mood, behavior, and mental function.
A better approach to increasing serotonin (and other neurotransmitters) rather than interfering with its reuptake is, I think, to supply the body with the right precursor molecules to produce more of what is needed.
In the case of the neurotransmitters there are amino acids as well as other nutrients which are needed to produce the end products. Unfortunately, in anorexia and bulimia, we are cutting off the production by reducing the supply of nutrients.
Sornberger: What other supplements would you suggest for the treatment of anorexia or bulimia?
Dr. McLean: In addition to amino acids, there are B vitamins, minerals such as magnesium, zinc, and chromium, and essential fatty acids that play critical roles in glucose and carbohydrate metabolism.
Sornberger: How would you approach treating bulimia and anorexia?
Dr. McLean: My approach would be to do an analysis of nutritional deficiencies, in particular an analysis and correction of amino acid deficiencies and imbalances. There are many supplements which enhance brain, mood, and neurologic function.
In addition, toxins and food sensitivities and intolerances can have profound influences on our health and mental state.
Hormonal imbalances can also be involved.
While there is no doubt, psychological issues may need to be addressed; however, we need to do everything possible to produce good physical health.
Sornberger: Are you aware of research into the benefits of supplements as compared to drugs?
Dr. McLean: Most research in this country has been done to show the safety and efficacy of pharmaceutical medications, which are then marketed for great profit. Supplements, however, are increasingly finding their way into mainstream use as more studies have substantiated their benefit.
Fiber, probiotics, omega 3 fatty acids, and most recently vitamin D are a few examples of substances and supplements that have been embraced by mainstream medicine.
Sornberger: Would you like to add anything more about preventative medicine and the American health care system?
Dr. McLean: The American health care system is considered by many to deliver the best quality of care in the world, yet our outcomes in terms of chronic diseases and life expectancy are far from the best. In terms of cost, it is unsustainable.
We are currently in the process of reforming our health care system. Unless we can reform our personal attitudes toward health, however, and shift the paradigm from simply treating disease after it develops, our efforts will not be successful.
If individuals take more responsibility for health promotion and disease prevention, and government supports this effort instead of promoting more pharmaceutical dependence, our outcomes in terms of health and the cost of health care delivery will improve.
Sornberger: Thank you Dr. McLean for sharing your knowledge on the difficult topic of how to best treat eating disorders.
Thursday, September 17, 2009
Critics Blast Insurers for Poor Coverage of Eating Disorders
More than 11 million people in the United States have eating disorders.
And because an eating disorder can be a life-threatening condition with serious medical consequences, you'd assume that most health insurances polices would cover it. But many people living with eating disorders are falling through the cracks when it comes to health insurance, because in most cases, their treatment is not adequately covered, according to the National Eating Disorders Association.
No one knows that better than the Gomez family. Emily Gomez, 17, is fighting for her life, and her parents are fighting with their insurance company to pay for her treatment.
Emily, who lives on the Outer Banks of North Carolina, is a trained singer who dreams of performing on Broadway one day. But a few months ago, instead of travelling to the Great White Way, she travelled instead to an eating disorder clinic called Timberline Knolls in a quiet suburb of Chicago, more than 1,000 miles from home.
"You know, I'd eat a normal dinner and then afterwards just go through my pantry and anything I could find I'd eat," Emily said. "Then I'd go upstairs to my bathroom and then I'd usually end up purging."
Emily now suffers from bulimia, but when she was first diagnosed with an eating disorder about three and a half years ago, she suffered from anorexia. She tried to hide it from her family, but it soon became obvious that Emily was starving herself.
"She would eat two slices of like deli ham and a couple of pieces of lettuce," recalled her mother, Leigh Gomez. "And she would eat some carrots and some cucumbers up to the 300 calorie level. And that would be it for the whole day."
Emily started passing out in school and several times she wound up in the hospital. Her doctor said something had to be done -- and fast. "Her doctor would look at me and say, 'You have got to do something and quick. … This child is extremely sick, and if you don't do something immediately, you're going to find her dead on the floor,'" Leigh Gomez said.
A team of pediatricians said outpatient care wasn't enough. They said Emily needed long-term residential treatment.
But that treatment is expensive, ranging from $750 to $1,000 a day. Because Emily was so sick, her parents assumed the treatment would be covered by their insurer, but they were wrong.
"Each time I called, they just said I'm sorry, there's nothing we can do for you,'" Leigh Gomez said.
Serious Health Consequences of Eating Disorders
The insurer said nothing could be done, because one section of the family's Blue Cross Blue Shield North Carolina policy -- written in fine print -- caps coverage for mental illnesses at $2,000. And because eating disorders are considered a mental illness by the insurer, that is all it would pay, even though Emily's treatment cost the Gomez family more than $50,000.
"It's not covering my family," Leigh Gomez said. "It is destroying my family."
Lynn Grefe, the CEO of the National Eating Disorders Association, said eating disorders are one of the leading causes of death among young people.
According to the association, 10 percent of people with anorexia nervosa die as a result of complications from the illness. Still, victims struggle for adequate insurance coverage.
"Everything is wrong with this situation," Grefe said. "I mean, you have young people. They're usually very young women, some men, who are just fighting for their lives."
Dr. Tom Insel, director of the National Institute of Mental Health, agrees that eating disorders have dangerous medical consequences.
"In the case of anorexia nervosa, you've got an illness with very severe disability [that] frequently ends up with a long-term hospitalization and high mortality" Insel said. "So for women between the ages of 15 and 24, there's about a 12-fold increase in mortality."
"Good Morning America" talked to the medical director of the Gomez's insurer, Dr. John Bradley.
He acknowledged that while the insurance company won't pay for the treatment of a child like Emily Gomez, it would cover complications that result from an eating disorder, such as a heart condition. He said that policy "absolutely" makes sense.
"This is true for depression, if someone attempts to commit suicide and they end up in the hospital ... we cover that," Bradley said.
When asked if he believes the coverage for eating disorders is inadequate, Bradley said, "I think the coverage of a lot of conditions is inadequate."
"The financial situation that this family finds themselves in is in no small part due to the cost of the care that was delivered," he said.
Hope for Daughter's 'Health and Well-Being'
Emily Gomez is back home now. Her family just submitted a new $20,000 claim for her recent stay at Timberline Knolls, which was also denied. So to pay for Emily's treatment, her family had to do something drastic.
"Well it's just really hard when you have to cash your child's college fund in because you can't get your insurance to help you," Leigh Gomez said.
The Gomez family has complained to the North Carolina Department of Insurance, saying its insurer failed to tell the family about treatment options for Emily when they were most needed. The Gomezes are now considering a lawsuit against their insurer for negligence, but Blue Cross Blue Shield of North Carolina says they handled the Gomez's claims properly and did in fact tell the family about their treatment options.
People suffering from eating disorders have won major settlements against their health insurers in court, after arguing in class action lawsuits that the disease is biologically based and that treatment should be adequately covered.
Forty-eight states have some form of parity laws, which force insurers to cover mental health disorders the same way they cover physical disorders, but only 25 of the states have laws that apply specifically to eating disorders, and the state parity laws don't affect all insurance plans, including the Gomez's.
However, a new bill recently introduced in the House of Representatives, called the FREED Act (Federal Response to End Eating Disorders), if it became law, would require insurers offering group health insurance to specifically cover eating disorders.
While the Gomez's insurer wouldn't pay their claims, after "GMA" called the treatment center Emily first stayed at -- Remuda Ranch -- the center offered free residential treatment to her if she ever needs it again.
Leigh Gomez still has hope for a healthy future for Emily.
"I hope she finds a peace of mind," she said. "That she lays down this burden that she has. That she finds health, well-being, and that she takes Broadway by storm."
On October 11, the National Eating Disorders Association will be holding its first New York City walk to raise awareness in Riverside Park.
Project HEAL is a not-for-profit organization that raises money for people suffering from eating disorders and cannot afford treatment. For more information on this organization CLICK HERE. And CLICK HERE to visit DoSomething.org to find out how you can get involved in Project HEAL.
And because an eating disorder can be a life-threatening condition with serious medical consequences, you'd assume that most health insurances polices would cover it. But many people living with eating disorders are falling through the cracks when it comes to health insurance, because in most cases, their treatment is not adequately covered, according to the National Eating Disorders Association.
No one knows that better than the Gomez family. Emily Gomez, 17, is fighting for her life, and her parents are fighting with their insurance company to pay for her treatment.
Emily, who lives on the Outer Banks of North Carolina, is a trained singer who dreams of performing on Broadway one day. But a few months ago, instead of travelling to the Great White Way, she travelled instead to an eating disorder clinic called Timberline Knolls in a quiet suburb of Chicago, more than 1,000 miles from home.
"You know, I'd eat a normal dinner and then afterwards just go through my pantry and anything I could find I'd eat," Emily said. "Then I'd go upstairs to my bathroom and then I'd usually end up purging."
Emily now suffers from bulimia, but when she was first diagnosed with an eating disorder about three and a half years ago, she suffered from anorexia. She tried to hide it from her family, but it soon became obvious that Emily was starving herself.
"She would eat two slices of like deli ham and a couple of pieces of lettuce," recalled her mother, Leigh Gomez. "And she would eat some carrots and some cucumbers up to the 300 calorie level. And that would be it for the whole day."
Emily started passing out in school and several times she wound up in the hospital. Her doctor said something had to be done -- and fast. "Her doctor would look at me and say, 'You have got to do something and quick. … This child is extremely sick, and if you don't do something immediately, you're going to find her dead on the floor,'" Leigh Gomez said.
A team of pediatricians said outpatient care wasn't enough. They said Emily needed long-term residential treatment.
But that treatment is expensive, ranging from $750 to $1,000 a day. Because Emily was so sick, her parents assumed the treatment would be covered by their insurer, but they were wrong.
"Each time I called, they just said I'm sorry, there's nothing we can do for you,'" Leigh Gomez said.
Serious Health Consequences of Eating Disorders
The insurer said nothing could be done, because one section of the family's Blue Cross Blue Shield North Carolina policy -- written in fine print -- caps coverage for mental illnesses at $2,000. And because eating disorders are considered a mental illness by the insurer, that is all it would pay, even though Emily's treatment cost the Gomez family more than $50,000.
"It's not covering my family," Leigh Gomez said. "It is destroying my family."
Lynn Grefe, the CEO of the National Eating Disorders Association, said eating disorders are one of the leading causes of death among young people.
According to the association, 10 percent of people with anorexia nervosa die as a result of complications from the illness. Still, victims struggle for adequate insurance coverage.
"Everything is wrong with this situation," Grefe said. "I mean, you have young people. They're usually very young women, some men, who are just fighting for their lives."
Dr. Tom Insel, director of the National Institute of Mental Health, agrees that eating disorders have dangerous medical consequences.
"In the case of anorexia nervosa, you've got an illness with very severe disability [that] frequently ends up with a long-term hospitalization and high mortality" Insel said. "So for women between the ages of 15 and 24, there's about a 12-fold increase in mortality."
"Good Morning America" talked to the medical director of the Gomez's insurer, Dr. John Bradley.
He acknowledged that while the insurance company won't pay for the treatment of a child like Emily Gomez, it would cover complications that result from an eating disorder, such as a heart condition. He said that policy "absolutely" makes sense.
"This is true for depression, if someone attempts to commit suicide and they end up in the hospital ... we cover that," Bradley said.
When asked if he believes the coverage for eating disorders is inadequate, Bradley said, "I think the coverage of a lot of conditions is inadequate."
"The financial situation that this family finds themselves in is in no small part due to the cost of the care that was delivered," he said.
Hope for Daughter's 'Health and Well-Being'
Emily Gomez is back home now. Her family just submitted a new $20,000 claim for her recent stay at Timberline Knolls, which was also denied. So to pay for Emily's treatment, her family had to do something drastic.
"Well it's just really hard when you have to cash your child's college fund in because you can't get your insurance to help you," Leigh Gomez said.
The Gomez family has complained to the North Carolina Department of Insurance, saying its insurer failed to tell the family about treatment options for Emily when they were most needed. The Gomezes are now considering a lawsuit against their insurer for negligence, but Blue Cross Blue Shield of North Carolina says they handled the Gomez's claims properly and did in fact tell the family about their treatment options.
People suffering from eating disorders have won major settlements against their health insurers in court, after arguing in class action lawsuits that the disease is biologically based and that treatment should be adequately covered.
Forty-eight states have some form of parity laws, which force insurers to cover mental health disorders the same way they cover physical disorders, but only 25 of the states have laws that apply specifically to eating disorders, and the state parity laws don't affect all insurance plans, including the Gomez's.
However, a new bill recently introduced in the House of Representatives, called the FREED Act (Federal Response to End Eating Disorders), if it became law, would require insurers offering group health insurance to specifically cover eating disorders.
While the Gomez's insurer wouldn't pay their claims, after "GMA" called the treatment center Emily first stayed at -- Remuda Ranch -- the center offered free residential treatment to her if she ever needs it again.
Leigh Gomez still has hope for a healthy future for Emily.
"I hope she finds a peace of mind," she said. "That she lays down this burden that she has. That she finds health, well-being, and that she takes Broadway by storm."
On October 11, the National Eating Disorders Association will be holding its first New York City walk to raise awareness in Riverside Park.
Project HEAL is a not-for-profit organization that raises money for people suffering from eating disorders and cannot afford treatment. For more information on this organization CLICK HERE. And CLICK HERE to visit DoSomething.org to find out how you can get involved in Project HEAL.
Thursday, August 20, 2009
Did Bullying Cause A Girl's Anorexia? From Jezebel
Original Article
In what may be the first lawsuit of its kind, a mom is suing the Pittsburgh Public Schools for failing to stop the bullying she says caused her daughter's anorexia.
The mother says three boys began calling her daughter (identified in the suit by the initials B.G.) "fat" in sixth grade, and that two more boys joined in the daily bullying the next year. Her lawyer Edward A. Olds elaborates: "The offensive comments explicitly and implicitly conveyed the message that B.G. was unattractive and overweight. The comments were sexual in nature or conveyed sexual stereotyping."
B.G.'s mom says a guidance counselor did nothing when told about the bullying, and that school officials began harassing her when she tried to homeschool her daughter. She also says that the boys' actions triggered the anorexia that landed her daughter in an inpatient program in February 2008, at a "dangerously low" weight.
However, Lynn Grefe, CEO of the National Eating Disorders Association, says it's too simplistic to say bullying causes an eating disorder. Rather, she says, "With eating disorders, we say you're born with a gun and life pulls the trigger." Carrie Arnold of ED Bites adds:
"[T]he bullying didn't cause this poor girl's anorexia. It might have triggered it, yes, in the sense that the bullying caused her to throw her lunch away, which led to the energy imbalance, which led to anorexia. But it didn't cause her anorexia. Science shows us that genetics form the biggest risk factor for eating disorders, although many environmental factors can play a role in triggering the disorder. This type of bullying is sadly common, and if every case resulted in anorexia, we would have many more cases of eating disorders than we presently do."
"The causes of eating disorders are extremely complex, and not fully understood — the question of whether skinny models actually "incite thinness," for instance, is still being debated. But the cause-trigger paradigm that Grefe and Arnold cite seems to be the most common one, and if we accept it, we need to ask how severe a trigger has to be in order to merit a lawsuit. Could an anorexia sufferer sue a magazine? Her parents? Since weight loss itself can be a trigger for anorexia, could someone sue the restaurant where she got food poisoning?
Of course, non-anorexic people sue restaurants for giving them food poisoning, and this brings up an important point: many triggers for eating disorders are bad things anyway. Bullying is a good example. Even if it didn't "cause" B.G.'s anorexia, the school should have put a stop to it. Law professor Bruce Ledewitz says the real issue is that bullying "deprives the victim of an educational opportunity." And Arnold writes, "Schools should refuse to tolerate bullying because it's harmful and wrong, not just because someone developed an eating disorder." So while the lawsuit brought by B.G.'s mom may encourage a simplistic understanding of eating disorders, it might also encourage schools to prevent their students from making each other miserable.
In what may be the first lawsuit of its kind, a mom is suing the Pittsburgh Public Schools for failing to stop the bullying she says caused her daughter's anorexia.
The mother says three boys began calling her daughter (identified in the suit by the initials B.G.) "fat" in sixth grade, and that two more boys joined in the daily bullying the next year. Her lawyer Edward A. Olds elaborates: "The offensive comments explicitly and implicitly conveyed the message that B.G. was unattractive and overweight. The comments were sexual in nature or conveyed sexual stereotyping."
B.G.'s mom says a guidance counselor did nothing when told about the bullying, and that school officials began harassing her when she tried to homeschool her daughter. She also says that the boys' actions triggered the anorexia that landed her daughter in an inpatient program in February 2008, at a "dangerously low" weight.
However, Lynn Grefe, CEO of the National Eating Disorders Association, says it's too simplistic to say bullying causes an eating disorder. Rather, she says, "With eating disorders, we say you're born with a gun and life pulls the trigger." Carrie Arnold of ED Bites adds:
"[T]he bullying didn't cause this poor girl's anorexia. It might have triggered it, yes, in the sense that the bullying caused her to throw her lunch away, which led to the energy imbalance, which led to anorexia. But it didn't cause her anorexia. Science shows us that genetics form the biggest risk factor for eating disorders, although many environmental factors can play a role in triggering the disorder. This type of bullying is sadly common, and if every case resulted in anorexia, we would have many more cases of eating disorders than we presently do."
"The causes of eating disorders are extremely complex, and not fully understood — the question of whether skinny models actually "incite thinness," for instance, is still being debated. But the cause-trigger paradigm that Grefe and Arnold cite seems to be the most common one, and if we accept it, we need to ask how severe a trigger has to be in order to merit a lawsuit. Could an anorexia sufferer sue a magazine? Her parents? Since weight loss itself can be a trigger for anorexia, could someone sue the restaurant where she got food poisoning?
Of course, non-anorexic people sue restaurants for giving them food poisoning, and this brings up an important point: many triggers for eating disorders are bad things anyway. Bullying is a good example. Even if it didn't "cause" B.G.'s anorexia, the school should have put a stop to it. Law professor Bruce Ledewitz says the real issue is that bullying "deprives the victim of an educational opportunity." And Arnold writes, "Schools should refuse to tolerate bullying because it's harmful and wrong, not just because someone developed an eating disorder." So while the lawsuit brought by B.G.'s mom may encourage a simplistic understanding of eating disorders, it might also encourage schools to prevent their students from making each other miserable.
Subscribe to:
Posts (Atom)
Posts
