Read the full article here
Documentary Website
ANDREW AVRIN sits on a beige couch in a nondescript room, a fruit still-life partly visible on the wall behind him, twisting his fingers while, off-camera, an unseen interviewer prompts him to talk about his sister, Melissa, who died last year at the age of 19 after a long battle with bulimia.
“There was no food in the house,” he says, looking off to the side as his eyes fill. “If I went out with friends, I could not bring leftovers home because they would be gone by the next morning.”
Once, he explains, in the middle of a bitterly cold night, he looked out the window and saw Melissa on the curb, going through the garbage. “I went outside and I yelled her name,” he recounts in the interview, his voice breaking. “Just the way she looked back at me — it was so empty, vacant. It was a deer in the headlights, but that doesn’t even explain it.”
It is a hard scene for anyone to watch, but even more so for the film’s producer — Judy Avrin, Melissa’s mother, who decided to make a documentary about her daughter’s life and, ultimately, her death.
People deal with grief in their own ways, and those who have been spared the loss of a daughter or a son can only imagine how they would choose to try to cope. For Ms. Avrin, coping meant confronting her anguish and trying to make something good come out of it.
The idea for a film didn’t occur to her immediately. In the weeks following Melissa’s death, Ms. Avrin mostly avoided her daughter’s bedroom, and tried to resume some semblance of normalcy, going back to work three days a week as the coordinator for a consortium of academic libraries in New Jersey. But one day she sat down to read Melissa’s leather-bound journal.
Someday ...
I’ll eat breakfast.
I’ll keep a job for more than 3 weeks.
I’ll have a boyfriend for more than 10 days.
I’ll love someone.
I’ll travel wherever I want.
I’ll make my family proud.
I’ll make a movie that changes lives.
The film, called “Someday Melissa” and now in the editing stages, has become for Ms. Avrin salve, distraction and cause — a way to get the word out to other families grappling with eating disorders that they are not alone; to sound the alarm that eating disorders have the highest mortality rate of any mental illness; to help make sense of the senseless event that was losing her teenage daughter.
“I kept saying, ‘This is an amazing way for me to channel my grief,’ ” Ms. Avrin said. “But it also allowed me to put off grieving.”
Ms. Avrin, 56, got the idea for the film from one of Melissa’s therapists, Danna Markson, who introduced her to Jeffrey Cobelli, 27, a filmmaker. Over the last several months of working on the project, Ms. Avrin has come to know more than she ever intended to about eating disorders — how their seriousness has been underestimated, their treatment underinsured, their deaths underreported.
The process hasn’t been easy, and some, like her ex-husband, initially questioned the impulse to do it at all. Melissa’s best friend since first grade, Nicole Kendrick, who also suffers from an eating disorder, said she was incredulous when she first learned that Ms. Avrin was making the film. “I thought she was crazy,” Ms. Kendrick said. “I guess I didn’t realize how deep a mother’s love can run.”
But Ms. Avrin said that making the film has been easier than doing nothing at all. “I’ve never once thought this was more than I could bear,” she said, in an interview at her home in Totowa, N.J. “If anything, the more I continue, the more I know it’s the right thing to do.”
The difficulty of reliving her daughter’s decline has been mitigated by the public response. “Sometimes I think: ‘I’m a suburban mom. Who am I to think I could make a difference in the world?’ ” Ms. Avrin said. “But then I read the messages that keep coming in from people I know and people I don’t know who say Melissa’s story has motivated them to fight one more day.”
Showing posts with label family. Show all posts
Showing posts with label family. Show all posts
Thursday, April 22, 2010
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.
Monday, March 1, 2010
Psychology Today: What we don't want to know about eating disorders
Five studies. That's the complete scientific literature about the effectiveness of different treatments for eating disorders. The largest of these studies had 165 participants. No wonder patients, parents and professionals flail around when presented with the options.
Dr. Jim Lock presented these and other findings at a Feb. 27 workshop for the public at Lucile Packard Children's Hospital at Stanford.
The good news was that there were sixty people there - and they asked good questions. It's hard to get people to attend a discussion that includes the horrifying list of chronic and acute effects of eating disorders.
I learned a new one, parotid gland swelling, from Dr. Cynthia Kapphahn, who concluded her descriptions with this fact: "Parents and friends don't want to know this." Indeed, we would much rather have been home watching the Olympics.
We don't want to be blamed, a tradition that started with the first doctor to label a condition as anorexia nervosa.
Sir William Gull set the standard of blaming the parents, which just about always means the mother. Later researchers piled on "refrigerator mothers" and "double-binding mothers," Lock said. When Dr. Lock arrived at Stanford in 1993, parents were at best considering a nuisance in the treatment of eating disorders.
From the skimpy available evidence of five studies, Dr. Lock gleaned that family-based treatments are most effective and that cognitive behavioral therapy is "possibly useful." There was no evidence favoring antidepressants, save one small case series involving ten people that came out "possibly useful." Nutritional counseling was of limited usefulness. Psychiatric hospitalization showed "no specific benefit" in treating anorexia. There have been no studies about psychiatric hospitalization and bulimia, nor any documenting day programs and residential facilities.
In the question period, a man whose daughter has been hospitalized three times wondered how much he could push treatment on an unreceptive patient.
Parents must find the place between making threats and not doing anything at all - for fear of making things worse.
Dr. Kara Fitzpatrick attacked that dilemma. "If your child was drinking vodka before school to relieve anxiety, no question you'd intervene," she said. If your child is not eating, again, there should be no question.
Another question was about dual diagnoses, common with eating disorders. What do you treat first? A young adult has a psychotic break and is anorexic. Anorexia trumps even that, Dr. Lock said. It is life-threatening.
He concluded by quoting German philospher Arthur Schoepenhauer: "All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."
As an aside, Sir Gull himself got a little confused.
On Friday, October 24, 1873, at a meeting of the Clinical Society of London, Sir William Gull achieved a coup de maitre by delivering two seminal reports. The first was called, "Anorexia Nervosa, (Apepsia Hysterica, Anorexia Hysterica)". The second was entitled, "On a Cretinoid State supervening in Adult Life in Women." The manuscript on anorexia was regarded by Gull's peers to be significant, but of lesser importance. The essay on hypothyroidism was generally regarded to be Gull's chef d'oeuvre. One hundred and twenty-four years later, the situation has reversed itself: the anorexia paper is heralded, while the other manuscript is all but forgotten.
Dr. Jim Lock presented these and other findings at a Feb. 27 workshop for the public at Lucile Packard Children's Hospital at Stanford.
The good news was that there were sixty people there - and they asked good questions. It's hard to get people to attend a discussion that includes the horrifying list of chronic and acute effects of eating disorders.
I learned a new one, parotid gland swelling, from Dr. Cynthia Kapphahn, who concluded her descriptions with this fact: "Parents and friends don't want to know this." Indeed, we would much rather have been home watching the Olympics.
We don't want to be blamed, a tradition that started with the first doctor to label a condition as anorexia nervosa.
Sir William Gull set the standard of blaming the parents, which just about always means the mother. Later researchers piled on "refrigerator mothers" and "double-binding mothers," Lock said. When Dr. Lock arrived at Stanford in 1993, parents were at best considering a nuisance in the treatment of eating disorders.
From the skimpy available evidence of five studies, Dr. Lock gleaned that family-based treatments are most effective and that cognitive behavioral therapy is "possibly useful." There was no evidence favoring antidepressants, save one small case series involving ten people that came out "possibly useful." Nutritional counseling was of limited usefulness. Psychiatric hospitalization showed "no specific benefit" in treating anorexia. There have been no studies about psychiatric hospitalization and bulimia, nor any documenting day programs and residential facilities.
In the question period, a man whose daughter has been hospitalized three times wondered how much he could push treatment on an unreceptive patient.
Parents must find the place between making threats and not doing anything at all - for fear of making things worse.
Dr. Kara Fitzpatrick attacked that dilemma. "If your child was drinking vodka before school to relieve anxiety, no question you'd intervene," she said. If your child is not eating, again, there should be no question.
Another question was about dual diagnoses, common with eating disorders. What do you treat first? A young adult has a psychotic break and is anorexic. Anorexia trumps even that, Dr. Lock said. It is life-threatening.
He concluded by quoting German philospher Arthur Schoepenhauer: "All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."
As an aside, Sir Gull himself got a little confused.
On Friday, October 24, 1873, at a meeting of the Clinical Society of London, Sir William Gull achieved a coup de maitre by delivering two seminal reports. The first was called, "Anorexia Nervosa, (Apepsia Hysterica, Anorexia Hysterica)". The second was entitled, "On a Cretinoid State supervening in Adult Life in Women." The manuscript on anorexia was regarded by Gull's peers to be significant, but of lesser importance. The essay on hypothyroidism was generally regarded to be Gull's chef d'oeuvre. One hundred and twenty-four years later, the situation has reversed itself: the anorexia paper is heralded, while the other manuscript is all but forgotten.
Tuesday, December 29, 2009
How to Handle My Eating Disorder in Your Home for the Holidays
From the article:
"There are cookies and hams and mashed potatoes everywhere at the moment. You may have noticed this. You may be watching what you eat. If you have a teenage girl or young woman at your table over the holidays, she may be watching it more.
"For those of us who have struggled with eating disorders, being home for this season -- the combination of food and family -- is an incredibly fraught scenario. Factor in this year's debate about health care, and it's a potentially terrifying threat to us, to your daughter or sister or cousin. Her eating disorder, which is all about secrecy, is at risk of being exposed in the worst way."
Interesting perspective on ED's and the holidays. One of the biggest mistakes family members can make is to criticize the food choices of people who are just starting to eat normally again. I remember eating ice cream out of the carton on night after I came home from treatment for the first time, and my mother telling me I "shouldn't eat like that." It took a long time for her to realize that food = medicine.
"There are cookies and hams and mashed potatoes everywhere at the moment. You may have noticed this. You may be watching what you eat. If you have a teenage girl or young woman at your table over the holidays, she may be watching it more.
"For those of us who have struggled with eating disorders, being home for this season -- the combination of food and family -- is an incredibly fraught scenario. Factor in this year's debate about health care, and it's a potentially terrifying threat to us, to your daughter or sister or cousin. Her eating disorder, which is all about secrecy, is at risk of being exposed in the worst way."
Interesting perspective on ED's and the holidays. One of the biggest mistakes family members can make is to criticize the food choices of people who are just starting to eat normally again. I remember eating ice cream out of the carton on night after I came home from treatment for the first time, and my mother telling me I "shouldn't eat like that." It took a long time for her to realize that food = medicine.
Thursday, November 19, 2009
Home for the Holidays: A FREE Webinar and Workshop for Those Recovering from an ED
Home for the Holidays: Shine Your Light
A FREE Webinar and Workshop for Those Recovering from an Eating Disorder from the Renfrew Center
Topics include:
- Eating Challenges During the Holidays
- How to Alleviate Holiday Stress and Pressure
- Taking Responsibility for Your Own Health and Recovery
- Survival Strategies to Stay Focused on Your Recovery
- Creating and Sustaining Relationships at Home, Work, & School
Tuesday, December 15, 2009
12:00pm-1:00pm EST OR 8:00pm-9:00pm EST
Facilitated by Jennifer Nardozzi, PsyD and a Renfrew Alumna
Click here to register for the 12:00pm EST webinar.
Click here to register for the 8:00pm EST webinar.
Workshop at Non-Residential Sites
Tuesday, January 5, 2010
6:00pm-8:00pm
Workshop Locations Include:
Radnor, PA • New York • New Jersey • Connecticut • North Carolina • Tennessee • Texas • Maryland
Click here to register for the Workshop at the Non-Residential Sites (except Florida).
Workshop at Florida Site
Tuesday, January 5, 2010
7:00pm-9:00pm
Click here to register for the Workshop at the Florida site.
For more information, please call Jenna Hoskinson at 1-877-367-3383, ext. 3246 or jhoskinson@renfrewcenter.com
A FREE Webinar and Workshop for Those Recovering from an Eating Disorder from the Renfrew Center
Topics include:
- Eating Challenges During the Holidays
- How to Alleviate Holiday Stress and Pressure
- Taking Responsibility for Your Own Health and Recovery
- Survival Strategies to Stay Focused on Your Recovery
- Creating and Sustaining Relationships at Home, Work, & School
Tuesday, December 15, 2009
12:00pm-1:00pm EST OR 8:00pm-9:00pm EST
Facilitated by Jennifer Nardozzi, PsyD and a Renfrew Alumna
Click here to register for the 12:00pm EST webinar.
Click here to register for the 8:00pm EST webinar.
Workshop at Non-Residential Sites
Tuesday, January 5, 2010
6:00pm-8:00pm
Workshop Locations Include:
Radnor, PA • New York • New Jersey • Connecticut • North Carolina • Tennessee • Texas • Maryland
Click here to register for the Workshop at the Non-Residential Sites (except Florida).
Workshop at Florida Site
Tuesday, January 5, 2010
7:00pm-9:00pm
Click here to register for the Workshop at the Florida site.
For more information, please call Jenna Hoskinson at 1-877-367-3383, ext. 3246 or jhoskinson@renfrewcenter.com
Sunday, October 25, 2009
F.E.A.S.T. Position Statement: Parents do not cause eating disorders, Families are important allies during treatment
Despite all that has been learned in the past decade that dispels old ideas about eating disorders, a lingering history of blaming parents still exists. This assumption, sometimes stated and other times just implied, harms families and recoveries. At a time when families are most needed, this implication of guilt can disable a parent from taking assertive and life-saving action.
F.E.A.S.T., an organization committed to evidence-based care and parent empowerment, calls on the treatment community and society to put a true end to the era of parent blame. Freed of this burden parents can, when professionally supported and coached, be powerful allies during treatment.
"NEDA would like to send the clear message that families are NOT responsible for eating disorders. The National Eating Disorders Association, US, January 2007
"No evidence exists to prove that families cause eating disorders." Treatment of Patients With Eating Disorders, Third Edition, APA Practice Guidelines, May 2006
"FAMILIES DO NOT CAUSE ANOREXIA NERVOSA" Genetics of Anorexia Nervosa collaboration, January 7, 2007
"For a long time the mothers have been blamed, or families have been blamed, and that's been pitiful." Lynn Grefe, National Eating Disorders Association, US.
"This is a brain disorder." Dr. Thomas Insel, Director of the U.S. National Institute of Mental Health.
"I think traditionally, and not just traditionally I think today still a lot of providers would not see the parents as part of the solution but as part of the problem and I think that's been a pervasive attitude among a large number of clinicians in our field." Dr. Daniel le Grange, University of Chicago, US.
"Parents often have this guilt, assuming that because they were the person in charge of their offspring they may have done something wrong, but there's no evidence for that, whatsoever." Dr. Janet Treasure, Maudsley Hospital, UK.
"There are no data to support at this point that parents cause eating disorders." Lucene Wisniewski, Cleveland Center for Eating Disorders, US.
· "Parents don't cause eating disorders." Jeanine Cogan, Eating Disorders Coalition, US
· "Parents don't cause eating disorder." Professor Ivan Eisler, Kings College, London, UK
· "What parents need to know is: eating disorders are biologically based illnesses. They didn't cause it. They need to let go of that guilt." Kitty Westin, The Emily Program, US
· "Parents do not cause eating disorders. Parents suffer just as much as their kids do." Dr. Walter Kaye, University of California at San Diego, US.
If you or your organization would like to support this statement, please fill out the form on the right or contact F.E.A.S.T.
For more information on eating disorders or F.E.A.S.T. please visit our website at www.FEAST-ED.org.
Contact: Laura Collins, Executive Director, F.E.A.S.T.
+1 (540) 227-8518 info@FEAST-ED.org
F.E.A.S.T., an organization committed to evidence-based care and parent empowerment, calls on the treatment community and society to put a true end to the era of parent blame. Freed of this burden parents can, when professionally supported and coached, be powerful allies during treatment.
- Eating disorders are brain disorders, not a choice or a sign of poor parenting.
- Theories of parent causation are often based on now-outdated ideas of the illness.
- Correlation has been confused with causation for symptoms that are often genetically transmitted.
- The risk of developing an eating disorder is 50-80% genetic.
- The presence of an eating disorder or other mental illness in a family can by itself cause temporary dysfunctional reactions and interactions.
- Eating disorder patients come from every type of family, just as the general population does.
- There is no evidence to support eating disorder treatment that is based on repairing dysfunctional families.
- Care-giving families need active assistance and reassurance to do their job well.
- Eating disorder patients often suffer from temporary deficits that may distort memory and perception of family.
- Evidence-based treatment of eating disorders indicates that family empowerment and involvement is one of the most powerful tools for early intervention and improved outcomes.
- While parents do not cause eating disorders, they can be an active part of recovery.
"NEDA would like to send the clear message that families are NOT responsible for eating disorders. The National Eating Disorders Association, US, January 2007
"No evidence exists to prove that families cause eating disorders." Treatment of Patients With Eating Disorders, Third Edition, APA Practice Guidelines, May 2006
"FAMILIES DO NOT CAUSE ANOREXIA NERVOSA" Genetics of Anorexia Nervosa collaboration, January 7, 2007
"For a long time the mothers have been blamed, or families have been blamed, and that's been pitiful." Lynn Grefe, National Eating Disorders Association, US.
"This is a brain disorder." Dr. Thomas Insel, Director of the U.S. National Institute of Mental Health.
"I think traditionally, and not just traditionally I think today still a lot of providers would not see the parents as part of the solution but as part of the problem and I think that's been a pervasive attitude among a large number of clinicians in our field." Dr. Daniel le Grange, University of Chicago, US.
"Parents often have this guilt, assuming that because they were the person in charge of their offspring they may have done something wrong, but there's no evidence for that, whatsoever." Dr. Janet Treasure, Maudsley Hospital, UK.
"There are no data to support at this point that parents cause eating disorders." Lucene Wisniewski, Cleveland Center for Eating Disorders, US.
· "Parents don't cause eating disorders." Jeanine Cogan, Eating Disorders Coalition, US
· "Parents don't cause eating disorder." Professor Ivan Eisler, Kings College, London, UK
· "What parents need to know is: eating disorders are biologically based illnesses. They didn't cause it. They need to let go of that guilt." Kitty Westin, The Emily Program, US
· "Parents do not cause eating disorders. Parents suffer just as much as their kids do." Dr. Walter Kaye, University of California at San Diego, US.
From "Do Parents Cause Eating Disorders" video interviews of eating disorder experts, October 2007
If you or your organization would like to support this statement, please fill out the form on the right or contact F.E.A.S.T.
For more information on eating disorders or F.E.A.S.T. please visit our website at www.FEAST-ED.org.
Contact: Laura Collins, Executive Director, F.E.A.S.T.
+1 (540) 227-8518 info@FEAST-ED.org
Thursday, October 8, 2009
Confidentiality in Adolescent Psychotherapy by Dr. Sarah Ravin
Thank you to Laura Collins for the link.
Confidentiality is a cornerstone of the therapeutic relationship. The ethics of my profession require that all communication between my patients and me remains confidential. In other words, I cannot disclose the information a patient reveals in session, or my own impressions about a patient, to anyone without the patient’s explicit written consent. Of course, there are exceptions to the rule. I am a mandated reporter of child abuse, and if a patient is imminently suicidal or homicidal, I have a duty to notify the appropriate parties in order to save the patient’s life and protect the public. But these scenarios are relatively uncommon.
Undoubtedly, confidentiality is an important, if not essential, therapeutic tool. Patients are far more likely to enter therapy, and to be completely honest and forthcoming in therapy, when they know that “what happens in therapy stays in therapy.” I am honored and humbled, though not necessarily surprised, when a patient tells me that I am the first person she has ever told about a particular trauma, event, thought, or feeling. A therapist’s office is a safe place in which a patient can express anything and everything without fear of judgment, alienation, or other negative repercussions. Through this vulnerability and brutal honesty comes an opportunity for growth and meaningful change.
However, confidentiality is not without its problems. For example, psychologists often struggle with decisions as to whether to disclose information about adolescent patients to their parents. On the one hand, parents have a legal right to obtain health care information regarding their child, and they are technically the “holders” of any privileged communication between their child and her therapist. On the other hand, adolescents can undoubtedly benefit from discussing certain personal issues with a nonjudgmental third party outside their family, and they are less likely to raise such issues with their therapist if they know that the information will get back to mom and dad.
I know of some psychologists who share very little with the parents of their adolescent patients. After all, they argue, the primary developmental tasks of adolescence include separation from family and establishment of an independent identity. These psychologists believe that they are respecting the adolescent’s burgeoning sense of identity by excluding parents from treatment. They also believe that they are nurturing the therapeutic relationship by refusing to disclose all but the most essential information to an adolescent’s parents. Many of these therapists believe that the parents are guilty of causing or contributing to their child’s problems, and thus are best kept out of the treatment picture. As a result, many parents of adolescent patients are relegated to the role of chauffeur. They drive their child to her appointments and pay for her treatment without ever knowing what is going on in those sessions. Imagine how disempowering it must feel for a parent to be relegated to such a role.
To be sure, psychologists who practice this way make many valid points. However, I have a different perspective on my role as a therapist and on the role confidentiality plays in my work with adolescent patients. Consequently, I approach the issue of confidentiality with adolescent patients differently. Empirical research has demonstrated, and my own clinical experience has confirmed, that adolescent treatment generally works best when parents are fully informed and actively involved, and I communicate this point to my adolescent patients and their parents at the start of our work together. I am relatively unconcerned when I meet an adolescent patient who lacks insight or motivation or who resists treatment. I am very concerned when the parents of an adolescent patient are unwilling, unmotivated, or unable to play an active role in their child’s treatment.
When I work with adolescents with relatively normal social or developmental concerns (e.g., grief, problems with friends, sexuality, stress management, body dissatisfaction), parents play an important, though relatively minor, role in treatment. In these cases, the work is primarily between the adolescent and me. Even so, I involve parents in the initial evaluation, treatment planning, and discharge planning; I provide them with empirical literature on their child’s problem and the treatment approach I am using; I provide them with guidance as to how they can support their child at home; and I invite them to call me or schedule an appointment with me at any time if they have questions or concerns about their child.
In my work with adolescents with mental illnesses, parents play a central role as indispensable members of the treatment team. I take an authoritative stance regarding my knowledge of, say, major depression or anorexia nervosa, while also maintaining humility by respecting parents’ judgment and intuition regarding their child. I may be the expert on mental health, but they are the experts on their child.
Adolescents who are struggling with serious mental illnesses, such as bipolar disorder, major depression, anorexia nervosa, and bulimia nervosa, require treatment which is more intensive and more comprehensive. These patients need their parents to play an active role in managing their symptoms and creating an environment which is conducive to recovery. In order for parents to do this, they need to be informed about their child’s symptoms and progress. While I certainly do not share everything a teenage patient says in therapy with her parents, I do provide her parents with the information they need in order to help her get better.
The parents of adolescents with mental illnesses are often overly stressed, worried, isolated, and confused. These parents need considerable support, encouragement, and guidance as they learn to cope with their child’s illness and support her through her recovery. This one of the reasons why I am so fond of family-based treatment: I get to empower the family to support the patient, drawing upon the parents’ intimate knowledge of and investment in their child. Instead of pulling the patient away from her family, I strengthen her natural support system, which makes intuitive sense to me. After all, therapy is time-limited. Family is forever.
Family members are also vital in preventing relapse, as they are generally the first people to notice a change in their child’s mood or behavior. Equipped with the right knowledge and skills, parents can intervene immediately and help to pull their child back from the brink of relapse, often preventing the need for future treatment.
Does involving family members in treatment damage my relationship with my adolescent patients? In the short term, it often does. Keep in mind, though, that some families bring their adolescents to me after an unsuccessful course of traditional individual therapy in which the patient had a very special, exclusive relationship with her therapist (who may have implicated her parents in the etiology of her problems) but made no meaningful progress whatsoever. My therapeutic relationship with adolescent patients is certainly important, but it is far less important than strengthening her relationship with her family and taking the necessary steps to help her recover. As adolescent patients progress through recovery and gain more insight, they gain trust in me and in their parents. They gain faith in the recovery process, and most of them are grateful for the fact that their parents and I worked collaboratively to help them. As much as they may resist it, adolescents need boundaries and limits, and they need adults to work together on their behalf.
By involving parents so heavily in an adolescent’s treatment, am I disrupting the processes of separation and individuation? In the short term, yes. I would argue, however, that cutting, starving oneself, engaging in unprotected sex, and throwing up after meals are not acceptable ways of exerting control or establishing identity. The supposition that a certain unhealthy behavior serves a valuable emotional or developmental purpose does not justify allowing that behavior to go unchecked. It is the mental illness which hinders adolescent development, not the treatment. Adolescents struggling with crippling depression or anxiety, erratic mood swings, self-injury, or life-threatening eating disorders are unlikely to blossom into well-adjusted, independent young adults without significant support. Empowering an adolescent’s parents to help her overcome a mental illness is ultimately very respectful of adolescent development – it allows the patient to recover within the safety and security of her natural environment so that she may one day live independently, unencumbered by mental illness.
For these reasons, my relationship with the parents is just as important as my relationship with the adolescent patient. Parents need to trust my judgment and treatment methods. They are, after all, entrusting me with their child’s health and bright future. I believe that I earn parents’ trust by maintaining open lines of communication between us, by providing them with empirically-sound literature on their child’s condition and the treatment approach we are taking, by respecting their parental instincts and taking seriously their experiences with their child, by supporting them emotionally, by absolving them of guilt and self-blame for their child’s disorder, and by empowering them to take constructive action.
About the Author: In her own words
I am a trained scientist-practitioner, and in 2008 I received my Ph.D. in clinical psychology. A major component of my professional identity is staying informed about recent developments in the field so that I may provide my clients with scientifically sound information and evidence-based treatment.
Confidentiality is a cornerstone of the therapeutic relationship. The ethics of my profession require that all communication between my patients and me remains confidential. In other words, I cannot disclose the information a patient reveals in session, or my own impressions about a patient, to anyone without the patient’s explicit written consent. Of course, there are exceptions to the rule. I am a mandated reporter of child abuse, and if a patient is imminently suicidal or homicidal, I have a duty to notify the appropriate parties in order to save the patient’s life and protect the public. But these scenarios are relatively uncommon.
Undoubtedly, confidentiality is an important, if not essential, therapeutic tool. Patients are far more likely to enter therapy, and to be completely honest and forthcoming in therapy, when they know that “what happens in therapy stays in therapy.” I am honored and humbled, though not necessarily surprised, when a patient tells me that I am the first person she has ever told about a particular trauma, event, thought, or feeling. A therapist’s office is a safe place in which a patient can express anything and everything without fear of judgment, alienation, or other negative repercussions. Through this vulnerability and brutal honesty comes an opportunity for growth and meaningful change.
However, confidentiality is not without its problems. For example, psychologists often struggle with decisions as to whether to disclose information about adolescent patients to their parents. On the one hand, parents have a legal right to obtain health care information regarding their child, and they are technically the “holders” of any privileged communication between their child and her therapist. On the other hand, adolescents can undoubtedly benefit from discussing certain personal issues with a nonjudgmental third party outside their family, and they are less likely to raise such issues with their therapist if they know that the information will get back to mom and dad.
I know of some psychologists who share very little with the parents of their adolescent patients. After all, they argue, the primary developmental tasks of adolescence include separation from family and establishment of an independent identity. These psychologists believe that they are respecting the adolescent’s burgeoning sense of identity by excluding parents from treatment. They also believe that they are nurturing the therapeutic relationship by refusing to disclose all but the most essential information to an adolescent’s parents. Many of these therapists believe that the parents are guilty of causing or contributing to their child’s problems, and thus are best kept out of the treatment picture. As a result, many parents of adolescent patients are relegated to the role of chauffeur. They drive their child to her appointments and pay for her treatment without ever knowing what is going on in those sessions. Imagine how disempowering it must feel for a parent to be relegated to such a role.
To be sure, psychologists who practice this way make many valid points. However, I have a different perspective on my role as a therapist and on the role confidentiality plays in my work with adolescent patients. Consequently, I approach the issue of confidentiality with adolescent patients differently. Empirical research has demonstrated, and my own clinical experience has confirmed, that adolescent treatment generally works best when parents are fully informed and actively involved, and I communicate this point to my adolescent patients and their parents at the start of our work together. I am relatively unconcerned when I meet an adolescent patient who lacks insight or motivation or who resists treatment. I am very concerned when the parents of an adolescent patient are unwilling, unmotivated, or unable to play an active role in their child’s treatment.
When I work with adolescents with relatively normal social or developmental concerns (e.g., grief, problems with friends, sexuality, stress management, body dissatisfaction), parents play an important, though relatively minor, role in treatment. In these cases, the work is primarily between the adolescent and me. Even so, I involve parents in the initial evaluation, treatment planning, and discharge planning; I provide them with empirical literature on their child’s problem and the treatment approach I am using; I provide them with guidance as to how they can support their child at home; and I invite them to call me or schedule an appointment with me at any time if they have questions or concerns about their child.
In my work with adolescents with mental illnesses, parents play a central role as indispensable members of the treatment team. I take an authoritative stance regarding my knowledge of, say, major depression or anorexia nervosa, while also maintaining humility by respecting parents’ judgment and intuition regarding their child. I may be the expert on mental health, but they are the experts on their child.
Adolescents who are struggling with serious mental illnesses, such as bipolar disorder, major depression, anorexia nervosa, and bulimia nervosa, require treatment which is more intensive and more comprehensive. These patients need their parents to play an active role in managing their symptoms and creating an environment which is conducive to recovery. In order for parents to do this, they need to be informed about their child’s symptoms and progress. While I certainly do not share everything a teenage patient says in therapy with her parents, I do provide her parents with the information they need in order to help her get better.
The parents of adolescents with mental illnesses are often overly stressed, worried, isolated, and confused. These parents need considerable support, encouragement, and guidance as they learn to cope with their child’s illness and support her through her recovery. This one of the reasons why I am so fond of family-based treatment: I get to empower the family to support the patient, drawing upon the parents’ intimate knowledge of and investment in their child. Instead of pulling the patient away from her family, I strengthen her natural support system, which makes intuitive sense to me. After all, therapy is time-limited. Family is forever.
Family members are also vital in preventing relapse, as they are generally the first people to notice a change in their child’s mood or behavior. Equipped with the right knowledge and skills, parents can intervene immediately and help to pull their child back from the brink of relapse, often preventing the need for future treatment.
Does involving family members in treatment damage my relationship with my adolescent patients? In the short term, it often does. Keep in mind, though, that some families bring their adolescents to me after an unsuccessful course of traditional individual therapy in which the patient had a very special, exclusive relationship with her therapist (who may have implicated her parents in the etiology of her problems) but made no meaningful progress whatsoever. My therapeutic relationship with adolescent patients is certainly important, but it is far less important than strengthening her relationship with her family and taking the necessary steps to help her recover. As adolescent patients progress through recovery and gain more insight, they gain trust in me and in their parents. They gain faith in the recovery process, and most of them are grateful for the fact that their parents and I worked collaboratively to help them. As much as they may resist it, adolescents need boundaries and limits, and they need adults to work together on their behalf.
By involving parents so heavily in an adolescent’s treatment, am I disrupting the processes of separation and individuation? In the short term, yes. I would argue, however, that cutting, starving oneself, engaging in unprotected sex, and throwing up after meals are not acceptable ways of exerting control or establishing identity. The supposition that a certain unhealthy behavior serves a valuable emotional or developmental purpose does not justify allowing that behavior to go unchecked. It is the mental illness which hinders adolescent development, not the treatment. Adolescents struggling with crippling depression or anxiety, erratic mood swings, self-injury, or life-threatening eating disorders are unlikely to blossom into well-adjusted, independent young adults without significant support. Empowering an adolescent’s parents to help her overcome a mental illness is ultimately very respectful of adolescent development – it allows the patient to recover within the safety and security of her natural environment so that she may one day live independently, unencumbered by mental illness.
For these reasons, my relationship with the parents is just as important as my relationship with the adolescent patient. Parents need to trust my judgment and treatment methods. They are, after all, entrusting me with their child’s health and bright future. I believe that I earn parents’ trust by maintaining open lines of communication between us, by providing them with empirically-sound literature on their child’s condition and the treatment approach we are taking, by respecting their parental instincts and taking seriously their experiences with their child, by supporting them emotionally, by absolving them of guilt and self-blame for their child’s disorder, and by empowering them to take constructive action.
About the Author: In her own words
I am a trained scientist-practitioner, and in 2008 I received my Ph.D. in clinical psychology. A major component of my professional identity is staying informed about recent developments in the field so that I may provide my clients with scientifically sound information and evidence-based treatment.
Monday, September 21, 2009
Girls from educated families more at risk of eating disorders
NEW YORK (Reuters Life!) - Girls from well educated families who do well at school appear to be more at risk of developing an eating disorder, maybe because they feel more pressure to succeed, according to Swedish researchers.
A study which followed more than 13,000 women born in Sweden between 1952 and 1989 found that as parents' or grandmothers' education increased, so did girls' risk of being hospitalized for anorexia or another eating disorder.
The risk also climbed in tandem with the girls' own grades in high school, the researchers from Stockholm's Karolinska Institute reported in the American Journal of Epidemiology.
"It's possible that these girls feel more pressure from family to succeed -- which for some could translate into an obsession with controlling their eating and body weight," the researchers said in a statement.
They added that higher-achieving girls may also be more likely to have certain personality traits, such as perfectionism, that make them relatively more vulnerable to eating disorders.
Such demands likely play an "important role" in eating disorder development, researcher Jennie Ahren-Moonga told Reuters Health.
"This is even more relevant when combined with low self- esteem, as the feeling of not being able to live up to expectations plays a crucial role in both anorexia nervosa and bulimia nervosa," she said.
The vast majority of girls in the study were never treated for an eating disorder, regardless of family education and grades with only 55 out of 13,376 hospitalized during the study period.
The researchers said the findings did not prove that greater education and school achievement lead to eating disorders but suggest that girls from families with higher academic achievement were at relatively greater risk which could help prevent the onset of such problems.
Girls whose parents went to college had about twice the risk of being treated for an eating disorder as those whose parents had only an elementary-school education.
The risk was six times higher among girls whose maternal grandmothers had a college education, compared with those whose grandmothers went only to elementary school.
Similarly, girls with the highest grades at age 15 had twice the risk of hospitalization as girls with the lowest grades.
Ahren-Moonga said parents should be aware of the potential signs of an eating disorder, such as when a child begins to skip meals, routinely goes to the bathroom after a meal or loses weight for no clear reason.
(Reporting by Reuters Health, Editing by Belinda Goldsmith)
A study which followed more than 13,000 women born in Sweden between 1952 and 1989 found that as parents' or grandmothers' education increased, so did girls' risk of being hospitalized for anorexia or another eating disorder.
The risk also climbed in tandem with the girls' own grades in high school, the researchers from Stockholm's Karolinska Institute reported in the American Journal of Epidemiology.
"It's possible that these girls feel more pressure from family to succeed -- which for some could translate into an obsession with controlling their eating and body weight," the researchers said in a statement.
They added that higher-achieving girls may also be more likely to have certain personality traits, such as perfectionism, that make them relatively more vulnerable to eating disorders.
Such demands likely play an "important role" in eating disorder development, researcher Jennie Ahren-Moonga told Reuters Health.
"This is even more relevant when combined with low self- esteem, as the feeling of not being able to live up to expectations plays a crucial role in both anorexia nervosa and bulimia nervosa," she said.
The vast majority of girls in the study were never treated for an eating disorder, regardless of family education and grades with only 55 out of 13,376 hospitalized during the study period.
The researchers said the findings did not prove that greater education and school achievement lead to eating disorders but suggest that girls from families with higher academic achievement were at relatively greater risk which could help prevent the onset of such problems.
Girls whose parents went to college had about twice the risk of being treated for an eating disorder as those whose parents had only an elementary-school education.
The risk was six times higher among girls whose maternal grandmothers had a college education, compared with those whose grandmothers went only to elementary school.
Similarly, girls with the highest grades at age 15 had twice the risk of hospitalization as girls with the lowest grades.
Ahren-Moonga said parents should be aware of the potential signs of an eating disorder, such as when a child begins to skip meals, routinely goes to the bathroom after a meal or loses weight for no clear reason.
(Reporting by Reuters Health, Editing by Belinda Goldsmith)
Monday, August 31, 2009
NYT: Parenting and Food: Eat Your Peas. Or Don’t. Whatever.
The boy sneaks food. I’ve seen him. His appetite is formidable, and he knowingly eats more than he should or must, to the steady concern and occasional consternation of his parents.
Sometimes they keep count: “How many pretzels?” Sometimes they vainly suggest an apple instead. Often they look away, not wanting to aggravate an eating-related anxiety that they can already sense in him on the cusp of adolescence.
The girl treats food warily. Edging into adulthood, she worries about what too many French fries — what any French fries — could do to her, and monitors her waistline even though her own parents have never exhorted her to. Does she monitor it too closely and joylessly? Can parents prevent that? They wonder. So do I.
Neither of these children, with whom I interact occasionally, comes close to being a statistic or case study. He isn’t obese; she isn’t anorexic.
But they represent a larger group of young people between those widely publicized (and much more complicated) extremes. And they speak to a subtler parental challenge: how to coach children away from unhealthy eating without sowing panic; how to make them conscious of their intake without making them too self-conscious about its consequences.
Over recent years, worry about what and how much children eat has intensified, in part because of the regular references to childhood obesity as an epidemic. And right now, as children head back to school, where they graze beyond the gaze of parents, potentially dangerous eating habits are getting fresh attention.
School cafeterias and vending areas have become ground zero in the battle against overweight and poorly nourished children; from coast to coast this fall, students will encounter fewer sugary soft drinks, fewer fried foods, class birthday parties without cupcakes and class bake sales with calorie-reduced brownies.
That may help. But it’s just one piece of a puzzle that health experts and concerned parents are still sorting out. Conflicting information about the fiercest culprits in child weight gain abounds. Beyond genes, which obviously play a fundamental role, is soda pop a major factor? What about too little sleep?
There are hundreds of studies and thousands of opinions, and Tom Baranowski, a professor of pediatric nutrition at the Baylor College of Medicine in Houston, says they’re inconclusive. He has reviewed research suggesting that there are viral prompts for childhood obesity and research suggesting that children fond of fruits and vegetables aren’t any less heavy than those mad for Mountain Dew.
Dr. Baranowski’s verdict? “A lot more work needs to be done.”
Diet, it seems, is a dirty word. A Stanford University study found that a father’s projected attention to and remarks about a daughter’s weight may increase her risk of eating disorders. A University of Minnesota study found that children whose parents encouraged diets were significantly more likely to remain overweight than those whose parents didn’t.
Cynthia M. Bulik, the director of the University of North Carolina Eating Disorders Program, explained that “diet” implies deprivation, “and deprivation goes into that whole mindset that, ‘I deserve something when this is over, and this is short term.’ And it can’t be. It’s got to roll right into a lifestyle.”
Those words ring true for me. As a fat boy who ate expansively and compulsively, I went on the first of many strict diets at age 8 — and thereby commenced decades of untenable regimens and compensatory pig-outs, of binging and purging.
But my outsize hunger seemed flat-out chromosomal, and my insecurity about it predated those early weight-loss schemes. Should my parents have forbidden them? What’s the best course for today’s parent, in a society where fast-food come-ons drown out Alice Waters, and models no thicker than swizzle sticks still rule fashion magazines?
“We get nutrition advice, but that’s not the same as eating advice,” said Rebecca Saidenberg, a Manhattan mother of a 16-year-old girl, referring to child-rearing tips. She said that as her daughter went through puberty, she worked particularly hard to encourage healthy habits — balanced meals, restrained portions — in the hopes of minimizing the chances of a weight problem that might follow her daughter through life.
At the same time, Ms. Saidenberg wanted to push back against “a trend of treating food like medicine.”
“I don’t like that,” she said. “There are a lot of psychological pleasures that come from sitting at a table and enjoying a meal.” She doesn’t want her daughter deprived of those.
So she didn’t despair when the teenager recently returned from a summer trip to Italy during which, it was clear, the joys of gelato were fully explored. But she did get herself and her daughter a membership at a local gym, where they go together.
In my conversations with Ms. Saidenberg and other parents, I was struck by just how much thought they had given to coaxing their children toward sensible eating and away from extreme indulgence or self-denial. They clearly saw that as a parental responsibility akin to giving a child a first-rate education.
But their prescriptions and beliefs diverged, illustrating the elusiveness of a ready consensus about what’s most effective.
Joan Yamini, a mother of one in Austin, Tex., said it was important not to have unhealthy foods around the house, but Andrew Segal, a father of three in Glen Ridge, N.J., said that children who can’t find cookies, ice cream and similar snacks at home can always find them elsewhere — and probably will.
Every parent fretted over the right language to use with children.
Janis Azarela, a mother of three in Sudbury, Mass., recalled the upset her husband caused a few weeks ago when he questioned their 16-year-old daughter’s decision to eat ice cream immediately following a three-mile run.
“He asked because she’d just worked so hard to run and be healthy — why not make a healthier choice?” Ms. Azarela recalled. “And she said, ‘Dad, are you calling me fat?’ ” The teenager abandoned the ice cream, stomped out of the kitchen and didn’t speak to him for a good long while.
Ms. Azarela said that her daughter is, in fact, slim, and gravitates naturally toward less fattening foods. Her 7-year-old son, on the other hand, has the fiercest sweet tooth in the brood. A budding problem? Time will tell, and meanwhile she has vowed to “keep reintroducing foods, because palates change so quickly.”
That’s consistent with advice from diet and nutrition experts, who agree, for the most part, on a few prudent strategies.
They say parents can and should encourage sensible eating and vigorous physical activity by engaging in both themselves; children are likely to imitate those behaviors.
Whether parents allow junk food or not, they should make sure healthier alternatives are even more available — and should promote them. They should also make time for family dinners, the nutritional content of which they can monitor more carefully than they can a quick meal in an economical restaurant.
And by actually involving children in the shopping for, and cooking of, meals, some parents have successfully given them a consciousness about food — and a way to think about it — that guards against an abuse or disregard of it. When it comes to overeaters who clearly thrill to that gluttony, it’s vital for parents to try to find some replacement activity — a hobby, say — that affords similar emotional gratification.
“Food lights some people up more than it lights other people up,” Dr. Bulik said. “We’re not born the same.”
I see that in the boy and girl. If they were merely emulating their parents, he’d be the measured eater and she the exultant one. That the opposite is true underscores the mysteries of appetite — and the tricky task parents face in trying to regulate it.
Frank Bruni is the author of a new memoir, “Born Round: The Secret History of a Full-Time Eater.”
Sometimes they keep count: “How many pretzels?” Sometimes they vainly suggest an apple instead. Often they look away, not wanting to aggravate an eating-related anxiety that they can already sense in him on the cusp of adolescence.
The girl treats food warily. Edging into adulthood, she worries about what too many French fries — what any French fries — could do to her, and monitors her waistline even though her own parents have never exhorted her to. Does she monitor it too closely and joylessly? Can parents prevent that? They wonder. So do I.
Neither of these children, with whom I interact occasionally, comes close to being a statistic or case study. He isn’t obese; she isn’t anorexic.
But they represent a larger group of young people between those widely publicized (and much more complicated) extremes. And they speak to a subtler parental challenge: how to coach children away from unhealthy eating without sowing panic; how to make them conscious of their intake without making them too self-conscious about its consequences.
Over recent years, worry about what and how much children eat has intensified, in part because of the regular references to childhood obesity as an epidemic. And right now, as children head back to school, where they graze beyond the gaze of parents, potentially dangerous eating habits are getting fresh attention.
School cafeterias and vending areas have become ground zero in the battle against overweight and poorly nourished children; from coast to coast this fall, students will encounter fewer sugary soft drinks, fewer fried foods, class birthday parties without cupcakes and class bake sales with calorie-reduced brownies.
That may help. But it’s just one piece of a puzzle that health experts and concerned parents are still sorting out. Conflicting information about the fiercest culprits in child weight gain abounds. Beyond genes, which obviously play a fundamental role, is soda pop a major factor? What about too little sleep?
There are hundreds of studies and thousands of opinions, and Tom Baranowski, a professor of pediatric nutrition at the Baylor College of Medicine in Houston, says they’re inconclusive. He has reviewed research suggesting that there are viral prompts for childhood obesity and research suggesting that children fond of fruits and vegetables aren’t any less heavy than those mad for Mountain Dew.
Dr. Baranowski’s verdict? “A lot more work needs to be done.”
Diet, it seems, is a dirty word. A Stanford University study found that a father’s projected attention to and remarks about a daughter’s weight may increase her risk of eating disorders. A University of Minnesota study found that children whose parents encouraged diets were significantly more likely to remain overweight than those whose parents didn’t.
Cynthia M. Bulik, the director of the University of North Carolina Eating Disorders Program, explained that “diet” implies deprivation, “and deprivation goes into that whole mindset that, ‘I deserve something when this is over, and this is short term.’ And it can’t be. It’s got to roll right into a lifestyle.”
Those words ring true for me. As a fat boy who ate expansively and compulsively, I went on the first of many strict diets at age 8 — and thereby commenced decades of untenable regimens and compensatory pig-outs, of binging and purging.
But my outsize hunger seemed flat-out chromosomal, and my insecurity about it predated those early weight-loss schemes. Should my parents have forbidden them? What’s the best course for today’s parent, in a society where fast-food come-ons drown out Alice Waters, and models no thicker than swizzle sticks still rule fashion magazines?
“We get nutrition advice, but that’s not the same as eating advice,” said Rebecca Saidenberg, a Manhattan mother of a 16-year-old girl, referring to child-rearing tips. She said that as her daughter went through puberty, she worked particularly hard to encourage healthy habits — balanced meals, restrained portions — in the hopes of minimizing the chances of a weight problem that might follow her daughter through life.
At the same time, Ms. Saidenberg wanted to push back against “a trend of treating food like medicine.”
“I don’t like that,” she said. “There are a lot of psychological pleasures that come from sitting at a table and enjoying a meal.” She doesn’t want her daughter deprived of those.
So she didn’t despair when the teenager recently returned from a summer trip to Italy during which, it was clear, the joys of gelato were fully explored. But she did get herself and her daughter a membership at a local gym, where they go together.
In my conversations with Ms. Saidenberg and other parents, I was struck by just how much thought they had given to coaxing their children toward sensible eating and away from extreme indulgence or self-denial. They clearly saw that as a parental responsibility akin to giving a child a first-rate education.
But their prescriptions and beliefs diverged, illustrating the elusiveness of a ready consensus about what’s most effective.
Joan Yamini, a mother of one in Austin, Tex., said it was important not to have unhealthy foods around the house, but Andrew Segal, a father of three in Glen Ridge, N.J., said that children who can’t find cookies, ice cream and similar snacks at home can always find them elsewhere — and probably will.
Every parent fretted over the right language to use with children.
Janis Azarela, a mother of three in Sudbury, Mass., recalled the upset her husband caused a few weeks ago when he questioned their 16-year-old daughter’s decision to eat ice cream immediately following a three-mile run.
“He asked because she’d just worked so hard to run and be healthy — why not make a healthier choice?” Ms. Azarela recalled. “And she said, ‘Dad, are you calling me fat?’ ” The teenager abandoned the ice cream, stomped out of the kitchen and didn’t speak to him for a good long while.
Ms. Azarela said that her daughter is, in fact, slim, and gravitates naturally toward less fattening foods. Her 7-year-old son, on the other hand, has the fiercest sweet tooth in the brood. A budding problem? Time will tell, and meanwhile she has vowed to “keep reintroducing foods, because palates change so quickly.”
That’s consistent with advice from diet and nutrition experts, who agree, for the most part, on a few prudent strategies.
They say parents can and should encourage sensible eating and vigorous physical activity by engaging in both themselves; children are likely to imitate those behaviors.
Whether parents allow junk food or not, they should make sure healthier alternatives are even more available — and should promote them. They should also make time for family dinners, the nutritional content of which they can monitor more carefully than they can a quick meal in an economical restaurant.
And by actually involving children in the shopping for, and cooking of, meals, some parents have successfully given them a consciousness about food — and a way to think about it — that guards against an abuse or disregard of it. When it comes to overeaters who clearly thrill to that gluttony, it’s vital for parents to try to find some replacement activity — a hobby, say — that affords similar emotional gratification.
“Food lights some people up more than it lights other people up,” Dr. Bulik said. “We’re not born the same.”
I see that in the boy and girl. If they were merely emulating their parents, he’d be the measured eater and she the exultant one. That the opposite is true underscores the mysteries of appetite — and the tricky task parents face in trying to regulate it.
Frank Bruni is the author of a new memoir, “Born Round: The Secret History of a Full-Time Eater.”
Friday, August 21, 2009
Ask the Expert - Week 4
Dr. Kathryn Zerbe, professor of psychiatry at Oregon Health and Science University and a longtime expert on eating disorders, recently took readers’ questions on anorexia, bulimia, binge eating and other problems. Here, she responds to one reader’s question about growing up in a household where eating disorders were common.
My mother-in-law is in her 60s and has struggled with bulimia since her early 20s. Both my husband and his sister struggle with food but in different ways. She is very thin, is addicted to exercise and is obsessed with her body image. My husband overeats and is overweight. This is impacting his health. I know that there are many books and resources for adult children of alcoholics. Are there any resources for adults raised by a mother with an eating disorder?
Lisa
Dr. Zerbe responds:
There is only one book that I know of that addresses your question specifically, but I bet there will be more in the future. Take a look at Daniel Becker’s “This Mean Disease: Growing Up in the Shadow of My Mother’s Anorexia.” Mr. Becker describes his mother’s 30 year battle with anorexia in a way that is not only touching and thought provoking but shows how each family member must make changes in his or her life to really deal with the effects of such a severe problem on the life of the family.
Your problem is coming to the attention of more and more therapists because we are seeing eating disorders in older women and men. There are a number of good books and resources out there for loved ones who have a family member with an eating disorder, but nothing takes the place of having those with food issues talk with someone knowledgeable and understanding.
For example, I am thinking of one of my patients, I’ll call him Jeff, whose mother and father both had significant issues with their depression, body image and low weight. Jeff is now in recovery, but we discovered in his therapy that an obsession with thinness went back at least to both of his grandmothers, who could never be too thin and always seemed to be angry and demanding.
As Jeff’s psychiatrist, I could not give a formal diagnosis, such as depression, dysthymia (low mood) or an eating disorder, to any of his family members, since I wasn’t treating them. In fact, they refused all interventions that Jeff asked them to get. But I offered him therapy and medications, and a book I suggested he read, Judith Viorst’s classic 1986 work on adult life transitions called “Necessary Losses: The Loves, Illusions, Dependencies, and Impossible Expectations That All of Us Have to Give Up in Order to Grow,” helped him come to accept what he could and could not do for his mother and father, as much as he wanted to help them.
Jeff gradually embraced more of his own life and faced down his eating problem. He is now married and raising a couple of children, and has become aware through his reading how common eating concerns are becoming in younger and younger children. And though he struggles from time to time with his body image, he is a lot better than when he started his therapy work over six years ago.
As Jeff put it, “I don’t want my parents’ problem to become the problem of my own kids. We will have a ‘no teasing’ policy at the dinner table when it comes to body image, and my wife and I plan to start media awareness of the slender body ideal even when they are in grade school.”
Another resource I recommend for those who grew up or live in a household with eating disorders is the Web site www.bulimia.com from Gurze books, which publishes a catalog of excellent books on the subject. (They can also be reached at (800) 756-7533.) You will likely find something that helps you and perhaps raises the awareness of your loved ones.
My mother-in-law is in her 60s and has struggled with bulimia since her early 20s. Both my husband and his sister struggle with food but in different ways. She is very thin, is addicted to exercise and is obsessed with her body image. My husband overeats and is overweight. This is impacting his health. I know that there are many books and resources for adult children of alcoholics. Are there any resources for adults raised by a mother with an eating disorder?
Lisa
Dr. Zerbe responds:
There is only one book that I know of that addresses your question specifically, but I bet there will be more in the future. Take a look at Daniel Becker’s “This Mean Disease: Growing Up in the Shadow of My Mother’s Anorexia.” Mr. Becker describes his mother’s 30 year battle with anorexia in a way that is not only touching and thought provoking but shows how each family member must make changes in his or her life to really deal with the effects of such a severe problem on the life of the family.
Your problem is coming to the attention of more and more therapists because we are seeing eating disorders in older women and men. There are a number of good books and resources out there for loved ones who have a family member with an eating disorder, but nothing takes the place of having those with food issues talk with someone knowledgeable and understanding.
For example, I am thinking of one of my patients, I’ll call him Jeff, whose mother and father both had significant issues with their depression, body image and low weight. Jeff is now in recovery, but we discovered in his therapy that an obsession with thinness went back at least to both of his grandmothers, who could never be too thin and always seemed to be angry and demanding.
As Jeff’s psychiatrist, I could not give a formal diagnosis, such as depression, dysthymia (low mood) or an eating disorder, to any of his family members, since I wasn’t treating them. In fact, they refused all interventions that Jeff asked them to get. But I offered him therapy and medications, and a book I suggested he read, Judith Viorst’s classic 1986 work on adult life transitions called “Necessary Losses: The Loves, Illusions, Dependencies, and Impossible Expectations That All of Us Have to Give Up in Order to Grow,” helped him come to accept what he could and could not do for his mother and father, as much as he wanted to help them.
Jeff gradually embraced more of his own life and faced down his eating problem. He is now married and raising a couple of children, and has become aware through his reading how common eating concerns are becoming in younger and younger children. And though he struggles from time to time with his body image, he is a lot better than when he started his therapy work over six years ago.
As Jeff put it, “I don’t want my parents’ problem to become the problem of my own kids. We will have a ‘no teasing’ policy at the dinner table when it comes to body image, and my wife and I plan to start media awareness of the slender body ideal even when they are in grade school.”
Another resource I recommend for those who grew up or live in a household with eating disorders is the Web site www.bulimia.com from Gurze books, which publishes a catalog of excellent books on the subject. (They can also be reached at (800) 756-7533.) You will likely find something that helps you and perhaps raises the awareness of your loved ones.
Friday, August 7, 2009
Ask the Expert - Week 3
Each Friday, I will post a question answered by Dr. Kathryn J. Zerbe. The questions are part of an on-going coversation with Dr. Zerbe from the New York Times.
NY Times Bio
Dr. Zerbe is the author of “The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment” (Gurze Books, 1993) and “Integrated Treatment of Eating Disorders: Beyond the Body Betrayed” (Norton, 2008). She has had 25 years of experience working with individuals with eating disorders and directed the Eating Disorder Unit at the Menninger Clinic for five years. She also served on the American Psychiatric Association’s Work Group on Eating Disorders in 2000 and 2006.
Week Three
I am fairly certain that my sister in law (mid-30s) suffers from bulimia–she is extremely thin and looks unhealthy, but eats a lot whenever I see her, typically at family meals/restaurant visits. She always leaves to visit the bathroom fairly obviously not long after we’ve finished eating and I’ve occasionally smelled vomit when I follow her into the bathroom. I understand she had an experience with an eating disorder about 10 years ago but I don’t know that she ever stopped having a problem. The family doesn’t speak openly about it so I don’t feel comfortable approaching her myself, and I’m also not 100% sure of course. Do you have any suggestions on how to handle this situation?
From Dr. Zerbe:
These situations in a family are always difficult to handle. It does sound to me as if your sister-in-law could have relapsed into bulimia based on your observation of her leaving to go to the bathroom after eating large amounts of food and sometimes smelling vomit.
I suggest you talk to her and express your concerns. You might also try to enlist at least one other family member who shares your observations to sit down with you. Because denial of the problem is so common in those with an eating disorder, she may not listen or tell you the truth immediately, but at least you know that you have done what you could. You might also suggest a book or looking at the Academy for Eating Disorders Web site, which has valuable information about these life threatening illnesses.
NY Times Bio
Dr. Zerbe is the author of “The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment” (Gurze Books, 1993) and “Integrated Treatment of Eating Disorders: Beyond the Body Betrayed” (Norton, 2008). She has had 25 years of experience working with individuals with eating disorders and directed the Eating Disorder Unit at the Menninger Clinic for five years. She also served on the American Psychiatric Association’s Work Group on Eating Disorders in 2000 and 2006.
Week Three
I am fairly certain that my sister in law (mid-30s) suffers from bulimia–she is extremely thin and looks unhealthy, but eats a lot whenever I see her, typically at family meals/restaurant visits. She always leaves to visit the bathroom fairly obviously not long after we’ve finished eating and I’ve occasionally smelled vomit when I follow her into the bathroom. I understand she had an experience with an eating disorder about 10 years ago but I don’t know that she ever stopped having a problem. The family doesn’t speak openly about it so I don’t feel comfortable approaching her myself, and I’m also not 100% sure of course. Do you have any suggestions on how to handle this situation?
From Dr. Zerbe:
These situations in a family are always difficult to handle. It does sound to me as if your sister-in-law could have relapsed into bulimia based on your observation of her leaving to go to the bathroom after eating large amounts of food and sometimes smelling vomit.
I suggest you talk to her and express your concerns. You might also try to enlist at least one other family member who shares your observations to sit down with you. Because denial of the problem is so common in those with an eating disorder, she may not listen or tell you the truth immediately, but at least you know that you have done what you could. You might also suggest a book or looking at the Academy for Eating Disorders Web site, which has valuable information about these life threatening illnesses.
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