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.
Friday, March 5, 2010
Monday, March 1, 2010
FREE Webinar: The Transformative Power of Self-Love
The Transformative Power of Self-Love
A FREE Webinar for Those in Recovery
Tuesday, March 23, 2010
12:00pm - 1:15pm EDT
or
Wednesday, March 24, 2010
7:30pm - 8:15pm EDT
What would your day be like if you lived it completely from a place of self-love? Would you hide away from life or would you step out and take risks? Would you engage in eating disorder symptoms or would you be kind and gentle to your body? Would you wear masks or would you reveal your authentic self?
In this webinar, we will explore the topic of self-love and the powerful difference practicing self-love can make in how we experience life. You will have an opportunity to reflect on where you are on your journey to self-love and what it is that may be blocking your way. In addition, you will have the chance to set personal goals for integrating practices into your day that tap into the source of all change in your life—self-love.
This webinar will feature Mary Curtis, Renfrew alumna and founder of Authentic Communication Techniques—a company focused on assisting people in enhancing their interpersonal communication skills from the inside out. She will share personal insights and experiences, as well as tools that continue to support her on her journey to an authentic life.
**Please note that this webinar is for those who are recovering from an eating disorder.**
To register for the Tuesday, March 23rd webinar, visit:
To register for the Wednesday, March 24th webinar, visit:
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.
Monday, February 22, 2010
New Muscles and Pounds Boost an American Ice Dancer’s Outlook
An interesting article about weight and figure skating featuring U.S. ice dancer Tanith Belbin.
"As it turned out, Linichuk also ended up saving Belbin from a problem that has long plagued figure skaters: disordered eating. Often not as severe as eating disorders like anorexia and bulimia, disordered eating involves irregular eating habits that can be fueled by a distorted body image. Belbin said she had struggled with those issues since puberty.
"When she was 16 or 17, Belbin grew several inches and gained weight, which threw off her skating technique. As her body matured, she tried to fight it. As an ice dancer who wears tiny outfits and is often lifted by her partner, Belbin said that every extra pound seemed like 20."
"As it turned out, Linichuk also ended up saving Belbin from a problem that has long plagued figure skaters: disordered eating. Often not as severe as eating disorders like anorexia and bulimia, disordered eating involves irregular eating habits that can be fueled by a distorted body image. Belbin said she had struggled with those issues since puberty.
"When she was 16 or 17, Belbin grew several inches and gained weight, which threw off her skating technique. As her body matured, she tried to fight it. As an ice dancer who wears tiny outfits and is often lifted by her partner, Belbin said that every extra pound seemed like 20."
Sunday, February 14, 2010
N.J. opts out of parity coverage for state workers
About 800,000 New Jersey state workers and school employees won't be covered under the new federal mental health parity law.
State workers and school employees will instead be covered under New Jersey's mental health parity rules, which only require equal coverage for so-called "biologically based" mental illnesses such as depression, schizophrenia and autism. For insured state workers, treatment for illnesses like eating disorders is subject to an annual limit of $15,000 and a lifetime limit of $50,000.
"If somebody has to go into a facility for treatment for an eating disorder, obviously you can run through that pretty quickly," said Dudley Burdge, a representative for the Communications Workers of America AFL-CIO. Burdge is a commission member who voted against the waiver request.
When originally proposed, the federal mental health parity law was intended to apply to everybody, but that's not what happened, the union rep said.
"It's a very abstruse piece of legislation," said Burdge.
State workers and school employees will instead be covered under New Jersey's mental health parity rules, which only require equal coverage for so-called "biologically based" mental illnesses such as depression, schizophrenia and autism. For insured state workers, treatment for illnesses like eating disorders is subject to an annual limit of $15,000 and a lifetime limit of $50,000.
"If somebody has to go into a facility for treatment for an eating disorder, obviously you can run through that pretty quickly," said Dudley Burdge, a representative for the Communications Workers of America AFL-CIO. Burdge is a commission member who voted against the waiver request.
When originally proposed, the federal mental health parity law was intended to apply to everybody, but that's not what happened, the union rep said.
"It's a very abstruse piece of legislation," said Burdge.
Wednesday, February 10, 2010
NPR: Binge Eating Officially Defined As A Mental Disorder
The American Psychiatric Association is releasing a new draft of its book of mental disorders Wednesday. Often described as the bible of psychiatry, this new version of the Diagnostic and Statistical Manual of Mental Disorders proposes some significant changes to classification of bipolar disorder, Asperger's syndrome, "cutting" — and binge eating.
Experts from the APA say there's now enough evidence to call binge eating a mental disorder, adding it to the group of eating disorders that includes anorexia and bulimia.
Binge eating is defined as eating large amounts of food when you're not hungry and then feeling disgusted and depressed afterward. But most people do this from time to time. It's the frequency of a person's binge eating — and the depth of the anguish he or she feels — that raises flags.
Previously the DSM had listed binge eating in the manual's appendix, as a tentative category. Research that has come out since the last major revisions to the DSM 15 years ago justifies the classification of binge eating as a disorder in its own right, says Dr. B. Timothy Walsh, a psychiatry professor at Columbia University Medical Center and chairman of the eating disorders work group for this version of the DSM.
Some doctors treated binge eating with therapy or with medication even before it was recognized as a disorder. In some cases, a binge eater's treatment included a weight-loss regime that basically ignored the psychological aspect of the disorder.
"We're not talking intermittent overeating — that is normal — but this is recurrent, persistent, frequently occurring, accompanied by lots of distress, guilt and unhappiness," Walsh says. "We do have data that this affects a small percentage — 2 to 5 percent — of Americans throughout their lifetime."
Researchers and doctors still don't really know what causes these issues, he says, and various factors appear to contribute.
"There's no consensus as to what is the best treatment," Walsh says. "Several types of medications appear helpful, as do several types of psychological treatment."
Binge eating is associated with middle-aged men and women, and it is not always linked with obesity. That's why treatments that address weight loss alone aren't necessarily helpful, Walsh says. He is hopeful that the categorization of binge eating as a disorder will stimulate further research. In particular, he says, he'd like to see some study of how mental health treatments for binge eating affect a patient's outcome.
Experts from the APA say there's now enough evidence to call binge eating a mental disorder, adding it to the group of eating disorders that includes anorexia and bulimia.
Reworking The Book Of Mental Disorders
When clinicians see a patient with mental health issues, part of their job is to determine if the patient is experiencing temporary emotional struggles or if the patient has an illness. To do this, doctors rely on the bible of psychiatry, a book called the Diagnostic and Statistical Manual of Mental Disorders. The DSM lists all the mental disorders recognized by the American Psychiatric Association.
The book is also used by insurance companies to decide which treatments they'll pay for, and by courts to help determine insanity or other mental conditions.
The APA is releasing a new draft of the DSM Wednesday, the first major revision since 1994. This latest version of the book, the DSM-V, proposes some significant changes to the following disorders:
The book is also used by insurance companies to decide which treatments they'll pay for, and by courts to help determine insanity or other mental conditions.
The APA is releasing a new draft of the DSM Wednesday, the first major revision since 1994. This latest version of the book, the DSM-V, proposes some significant changes to the following disorders:
Binge eating is defined as eating large amounts of food when you're not hungry and then feeling disgusted and depressed afterward. But most people do this from time to time. It's the frequency of a person's binge eating — and the depth of the anguish he or she feels — that raises flags.
Previously the DSM had listed binge eating in the manual's appendix, as a tentative category. Research that has come out since the last major revisions to the DSM 15 years ago justifies the classification of binge eating as a disorder in its own right, says Dr. B. Timothy Walsh, a psychiatry professor at Columbia University Medical Center and chairman of the eating disorders work group for this version of the DSM.
Some doctors treated binge eating with therapy or with medication even before it was recognized as a disorder. In some cases, a binge eater's treatment included a weight-loss regime that basically ignored the psychological aspect of the disorder.
"We're not talking intermittent overeating — that is normal — but this is recurrent, persistent, frequently occurring, accompanied by lots of distress, guilt and unhappiness," Walsh says. "We do have data that this affects a small percentage — 2 to 5 percent — of Americans throughout their lifetime."
Researchers and doctors still don't really know what causes these issues, he says, and various factors appear to contribute.
"There's no consensus as to what is the best treatment," Walsh says. "Several types of medications appear helpful, as do several types of psychological treatment."
Binge eating is associated with middle-aged men and women, and it is not always linked with obesity. That's why treatments that address weight loss alone aren't necessarily helpful, Walsh says. He is hopeful that the categorization of binge eating as a disorder will stimulate further research. In particular, he says, he'd like to see some study of how mental health treatments for binge eating affect a patient's outcome.
‘Top Model’ Becomes Model Spokesperson for National Eating Disorders Association
America’s Next Top Model Winner Whitney Thompson Joins NEDA’s Mission to Promote Positive Body Image and Awareness of Eating Disorders. National Eating Disorders Awareness Week is Feb. 21-27.
Whitney Thompson, winner of Cycle 10, America’s Next Top Model – and the show’s first “full-figured” victor – has become an official ambassador for the National Eating Disorders Association (NEDA), joining the battle against eating disorders and unrealistic “body-perfect” ideals.
Selected by MSNBC as one of 2008’s “12 Most Influential Women of the Year,” Thompson has graced the covers of numerous magazines including Seventeen and Plus. Now under contract with the prestigious Wilhelmina Model Management, she has been a spokesperson for Cover Girl Cosmetics, Fashion Bug Right Fit Jeans and Olitsky Smiles Cosmetic Dentistry, and has modeled for Forever 21, J.C. Penney, Saks Fifth Avenue and Woman Within, among others. She was also a spokesperson for Multiple Sclerosis in 2009 and is a motivational speaker for the promotion of positive body image.
Commented Thompson, “I am thrilled to be an ambassador for the National Eating Disorders Association. Since winning Top Model, I have heard from thousands of people all over the world who are dealing with eating disorders. I want to support those people affected and their families and I want to help people identify and resist the social stereotypes and images that lead to unhealthy behavioral patterns.”
Commented Lynn Grefe, CEO of NEDA. “We welcome the enthusiasm and energy of Whitney to our cause and the ability of her celebrity to bring a spotlight to a very serious and deadly subject. It is a particular concern within the modeling and fashion industries and the support of Whitney and our other ambassadors are key to changing the way people think about body image.”
Thompson joins other NEDA Ambassadors Emme, supermodel, TV personality, author and women’s advocate; fashion designer Bradley Bayou; celebrity jewelry designer Elizabeth Showers; actress Karla Mosley (Guiding Light); former professional tennis player Zina Garrison; motivational speaker and author Jenni Schaefer; author, documentarian and social theorist Jean Kilbourne, Ed. D.; “actionist,” author and advice columnist Jessica Weiner; personal life coach Kristen Moeller; and Matan Uziel, senior executive of Israeli modeling agency Verbmodels and founder of Warmhome Media Group, an international advertising network.
The announcement comes just prior to observance of the 23rd annual National Eating Disorders Awareness Week, Feb. 21-27, and Thompson is supporting the outreach with motivational speaking engagements on college campuses across the country. Additionally, Thompson recently launched Supermodel (www.shopsupermodel.com), a line of scented, soy-based massage oil candles and jewelry, and has committed $1 from each sale as a donation to NEDA.
Themed It’s Time to Talk About it! this year, NEDAwareness Week is the non-profit group’s largest public outreach campaign, held each year to raise consciousness across the country about the potentially life-threatening seriousness of eating disorders and the societal pressures, attitudes and behaviors which contribute to them. Also to spread a message of hope: Help is available, recovery is possible and those affected are not alone in their struggle!
Selected by MSNBC as one of 2008’s “12 Most Influential Women of the Year,” Thompson has graced the covers of numerous magazines including Seventeen and Plus. Now under contract with the prestigious Wilhelmina Model Management, she has been a spokesperson for Cover Girl Cosmetics, Fashion Bug Right Fit Jeans and Olitsky Smiles Cosmetic Dentistry, and has modeled for Forever 21, J.C. Penney, Saks Fifth Avenue and Woman Within, among others. She was also a spokesperson for Multiple Sclerosis in 2009 and is a motivational speaker for the promotion of positive body image.
Commented Thompson, “I am thrilled to be an ambassador for the National Eating Disorders Association. Since winning Top Model, I have heard from thousands of people all over the world who are dealing with eating disorders. I want to support those people affected and their families and I want to help people identify and resist the social stereotypes and images that lead to unhealthy behavioral patterns.”
Commented Lynn Grefe, CEO of NEDA. “We welcome the enthusiasm and energy of Whitney to our cause and the ability of her celebrity to bring a spotlight to a very serious and deadly subject. It is a particular concern within the modeling and fashion industries and the support of Whitney and our other ambassadors are key to changing the way people think about body image.”
Thompson joins other NEDA Ambassadors Emme, supermodel, TV personality, author and women’s advocate; fashion designer Bradley Bayou; celebrity jewelry designer Elizabeth Showers; actress Karla Mosley (Guiding Light); former professional tennis player Zina Garrison; motivational speaker and author Jenni Schaefer; author, documentarian and social theorist Jean Kilbourne, Ed. D.; “actionist,” author and advice columnist Jessica Weiner; personal life coach Kristen Moeller; and Matan Uziel, senior executive of Israeli modeling agency Verbmodels and founder of Warmhome Media Group, an international advertising network.
The announcement comes just prior to observance of the 23rd annual National Eating Disorders Awareness Week, Feb. 21-27, and Thompson is supporting the outreach with motivational speaking engagements on college campuses across the country. Additionally, Thompson recently launched Supermodel (www.shopsupermodel.com), a line of scented, soy-based massage oil candles and jewelry, and has committed $1 from each sale as a donation to NEDA.
Themed It’s Time to Talk About it! this year, NEDAwareness Week is the non-profit group’s largest public outreach campaign, held each year to raise consciousness across the country about the potentially life-threatening seriousness of eating disorders and the societal pressures, attitudes and behaviors which contribute to them. Also to spread a message of hope: Help is available, recovery is possible and those affected are not alone in their struggle!
Revising the book on mental illness
Experts call for listing binge eating and gambling as official disorders, but not sex addiction or obesity.
After years of research, professional infighting and maneuvering from various interest groups, the nation's psychiatrists Tuesday unveiled proposed changes to the manual used to diagnose and treat mental disorders around the world.The draft document, released by the American Psychiatric Assn., for the first time calls for binge-eating and gambling to be considered disorders, opening the way for insurance coverage of these problems. But it refrains from suggesting a formal diagnosis for obesity, Internet addiction or sex addiction, as some professionals had proposed.
The document also recommends a single category for autism spectrum disorders, unifying what has been a multifaceted and complicated diagnostic scale.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders will be published in 2013. The book, which serves mental health professionals, is also used by insurance companies making decisions on treatment coverage and in courtrooms and schools. It was last revised in 1994.
The draft of the document will be displayed for public comment from Wednesday until April 20 at www.dsm5.org, allowing for input from individuals and organizations who may feel they've been left out of the revision process.
"This has been a massive effort on the part of a very dedicated team," Dr. David Kupfer, chairman of the DSM-5 task force, said Tuesday at a Washington news conference. "Their priorities were to make sure the manual is based on scientific evidence, is useful to clinicians and maintains continuity with the previous edition wherever possible."
DSM-5 is likely to list fewer diagnoses than the previous manual. Experts have proposed folding several disorders into single categories based on studies that suggest some disorders have similar origins, symptoms and treatments but only vary in severity.
For example, the four separate diagnoses related to autism -- autistic disorder, Asperger's disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified -- would now be referred to as autism spectrum disorders.
And the current categories of substance abuse and dependence will be referred to as "addiction and related disorders" -- a reflection that these problems cannot be easily categorized as mild or severe but occur on a continuum.
The loss of some categories is expected to be heavily criticized.
People with Asperger's disorder, considered a mild form of autism characterized by difficulty with social relationships, see their condition as distinct, said Geraldine Dawson, chief science officer for Autism Speaks, a research and advocacy organization in New York.
"These different labels become part of a person's identity. I think we need to be sensitive to that," Dawson said.
Similarly, the proposal to place personality disorders in one category will not be welcomed by patient groups such as The Treatment and Research Advancements Assn. for Personality Disorders, which has championed specific research and treatment for one of these, borderline personality disorder.
"This will be a disaster," said Valerie Porr, founder and president of the New York-based organization. "It kind of trivializes the personality disorders."
Another possible point of contention is the suggestion of a category titled "risk syndromes" to describe what may be early signs of a mental disorder.
For example, 25% to 30% of people diagnosed with psychosis have early symptoms that include being suspicious of others and speaking nonsensically.
Some critics fear that categorizing people as "at risk" when they don't yet have a full-blown disorder may lead to misdiagnosis and possible stigmatization.
But the category will not be used to screen the general public, only to diagnose people who are already in some distress and seeking help for their symptoms, said Dr. William T. Carpenter, Jr., chairman of the DSM-5 psychotic disorders work group.
For a person to even receive an "at risk" diagnosis, there must be some treatment known to help, he said.
Flagging and treating people early, Carpenter added, may stop a condition from developing into a serious impairment.
Other proposals, such as the addition of gambling disorder and binge-eating disorder, have been long endorsed.
"About 15 million people have binge-eating disorder," said Lynn Grefe, chief executive of the National Eating Disorders Assn. "Hopefully, [this] would help them get the help that they need."
One new category -- temper dysregulation with dysphoria -- is proposed to prevent misdiagnosis of children who have bursts of rage and can be moody, anxious and irritable. Such children are often diagnosed as having bipolar disorder and treated accordingly, sometimes with powerful medications.
The diagnosis of bipolar "is being given, we believe, too frequently," said Dr. David Shaffer, a member of the work group on disorders in childhood and adolescence. In reality, when such children are tracked into adulthood, very few of them turn out to be bipolar, he said.
In some ways, the manual reflects a disappointing reality for psychiatrists. Despite many scientific advances, there are still no biological tests -- based on genes, blood markers or brain scans -- to help diagnose mental illness. Thus, diagnosis is based on description, a process that is, by its nature, subjective and vulnerable to criticism.
Work on DSM-5 began almost 10 years ago, and the draft reflects the work of 13 subcommittees in different areas of psychiatry. The project has generated criticism for its secrecy.
To limit influence of the pharmaceutical industry, DSM-5 committee members agreed to limit their income from industry sources to $10,000 per year while they work on the manual.
Jenni Schaefer's Goodbye Ed, Hello Me presentation
The Renfrew Center
is pleased to sponsor
Jenni Schaefer's Goodbye Ed, Hello Me presentation
is pleased to sponsor
Jenni Schaefer's Goodbye Ed, Hello Me presentation
at Bryn Mawr College during
National Eating Disorders Awareness Week!
Click on the photo for more details!
National Eating Disorders Awareness Week!
Click on the photo for more details!
Tuesday, February 9, 2010
Anorexics Found to Have Excess Fat -- In Their Bone Marrow
BOSTON, Feb. 8 /PRNewswire-USNewswire/ -- People with anorexia nervosa, paradoxically, have strikingly high levels of fat within their bone marrow, report researchers at Children's Hospital Boston. Their findings, based on MRI imaging of the knees of 20 girls with anorexia and 20 healthy girls of the same age, appear in the February issue of the Journal of Bone and Mineral Research.
"It's counter-intuitive that an emaciated young woman with almost no subcutaneous fat would be storing fat in her marrow," says endocrinologist Catherine Gordon, MD, MSc, director of the Bone Health Program at Children's and the study's senior investigator.
In the study, the knee MRI images were read by radiologists who were unaware of the patient's clinical status. Compared with controls, the patients with anorexia had markedly increased fat content -- visualized as "yellow marrow" -- and less than half as much healthy red marrow in their knees; this was seen both in the lower thigh bone (femur) and upper shinbone (tibia). The findings in these girls and young women, averaging 16 years of age, confirm previous observations in mice with clinical signs similar to anorexia nervosa, reported by study co-author Clifford Rosen, MD, of the Maine Medical Center.
Previous work has shown that hormonal alterations, which are common in states of malnutrition, trigger the bone marrow's mesenchymal stem cells to differentiate into fat cells (adipocytes) rather than bone-forming cells (osteoblasts). Together, the mouse and human studies may explain why people with anorexia nervosa lose bone mass, sometimes to the point of developing osteoporosis and fractures.
"Bone formation is very low in girls with anorexia, and that's a particular problem because they are growing adolescents who should be maximally forming bones," says Gordon. "But because of the hormonal alterations induced by malnutrition, the bone marrow stops yielding the needed cells to form bone. Instead the stem cells are pushed toward fat formation."
Gordon is planning follow-up studies to find out why this happens. One speculation is that it's the body's attempt to store energy and preserve warmth. Anorexics often develop hypothermia because of a lack of insulating fat, and are often hospitalized with extremely low body temperatures.
Gordon also wants to see how closely fat in the bone marrow correlates with bone density, and whether measuring fat with noninvasive MRI scans might serve as one way of testing the efficacy of hormonal therapies aimed at improving bone mass. Gordon has several studies testing such therapies in anorexia and other conditions that lead to bone loss, such as inflammatory bowel disease.
Kirsten Ecklund, MD, of Children's Department of Radiology, was the study's first author. The study was funded by the National Institutes of Health and the Children's Hospital Radiology Foundation, Inc.
Citation:
Ecklund K et al. Bone marrow changes in adolescent girls with anorexia nervosa. J Bone Min Res Feb 2010.
Children's Hospital Boston is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 500 scientists, including eight members of the National Academy of Sciences, 13 members of the Institute of Medicine and 12 members of the Howard Hughes Medical Institute comprise Children's research community. Founded as a 20-bed hospital for children, Children's Hospital Boston today is a 396-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children's also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about the hospital and its research visit:
"It's counter-intuitive that an emaciated young woman with almost no subcutaneous fat would be storing fat in her marrow," says endocrinologist Catherine Gordon, MD, MSc, director of the Bone Health Program at Children's and the study's senior investigator.
In the study, the knee MRI images were read by radiologists who were unaware of the patient's clinical status. Compared with controls, the patients with anorexia had markedly increased fat content -- visualized as "yellow marrow" -- and less than half as much healthy red marrow in their knees; this was seen both in the lower thigh bone (femur) and upper shinbone (tibia). The findings in these girls and young women, averaging 16 years of age, confirm previous observations in mice with clinical signs similar to anorexia nervosa, reported by study co-author Clifford Rosen, MD, of the Maine Medical Center.
Previous work has shown that hormonal alterations, which are common in states of malnutrition, trigger the bone marrow's mesenchymal stem cells to differentiate into fat cells (adipocytes) rather than bone-forming cells (osteoblasts). Together, the mouse and human studies may explain why people with anorexia nervosa lose bone mass, sometimes to the point of developing osteoporosis and fractures.
"Bone formation is very low in girls with anorexia, and that's a particular problem because they are growing adolescents who should be maximally forming bones," says Gordon. "But because of the hormonal alterations induced by malnutrition, the bone marrow stops yielding the needed cells to form bone. Instead the stem cells are pushed toward fat formation."
Gordon is planning follow-up studies to find out why this happens. One speculation is that it's the body's attempt to store energy and preserve warmth. Anorexics often develop hypothermia because of a lack of insulating fat, and are often hospitalized with extremely low body temperatures.
Gordon also wants to see how closely fat in the bone marrow correlates with bone density, and whether measuring fat with noninvasive MRI scans might serve as one way of testing the efficacy of hormonal therapies aimed at improving bone mass. Gordon has several studies testing such therapies in anorexia and other conditions that lead to bone loss, such as inflammatory bowel disease.
Kirsten Ecklund, MD, of Children's Department of Radiology, was the study's first author. The study was funded by the National Institutes of Health and the Children's Hospital Radiology Foundation, Inc.
Citation:
Ecklund K et al. Bone marrow changes in adolescent girls with anorexia nervosa. J Bone Min Res Feb 2010.
Children's Hospital Boston is home to the world's largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 500 scientists, including eight members of the National Academy of Sciences, 13 members of the Institute of Medicine and 12 members of the Howard Hughes Medical Institute comprise Children's research community. Founded as a 20-bed hospital for children, Children's Hospital Boston today is a 396-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children's also is the primary pediatric teaching affiliate of Harvard Medical School. For more information about the hospital and its research visit:
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