When Is It Time To Speak Up?

Nancy Matsumoto (a freelance journalist who has contributed to the New York Times, Newsweek, Time, etc..) and Marcia Herrin (a nutritionist specializing in eating disorders who founded the Dartmouth College Eating Disorders Prevention, Education and Treatment Program), have co-authored a great book called The Parent's Guide to Eating Disorders. They also have a blog called Eating Disorders and Nutritional News. To read a little more about Nancy and Marcia, follow this link! I wanted to share a recent blog post written by Nancy because I think it is a very authentic post that addresses a topic that people often ask and wonder about. The title of the post is 'Knowing When to Express Concern About a Friend's Eating Disorder.' Follow this link to read it, or you can read it below (copy and pasted).

In other fun news, I had the opportunity to ask both Nancy and Marcia some questions recently about some different eating disorder topics which I am excited to share with you soon! :) :) Follow this link to check out their website.

Knowing when to express concern about a friend's eating disorder

A recent experience reminded me that even when we know what the right thing to do is, it’s still hard to know when to do it. Over the course of the past year, I have become friends with a woman, I’ll call her Jane, in my Japanese language class. I recognized the telltale signs of anorexia in her right away: the hollow cheeks, the clothes hanging off her skeletal frame, the way she liked to bring food for others, but didn’t want to eat much herself.

Later, Jane told me that she did not see herself as too thin, she thought she looked normal, maybe even a little bit heavier than she wanted to be. This, too, is a classic symptom of the body dysmorphic disorder that often accompanies anorexia.

I wondered if I should say something, to express concern and find out if Jane was in treatment. Had I been just half as emaciated as Jane was, I would not have been able to think straight; I would have felt dizzy and probably fuzzy-headed from malnourishment. But Jane’s mind was razor sharp. She was an encyclopedia of kanjicharacters, devoured the finer points of grammar that made my eyes glaze over, and read the appendix of our dry text book for fun.

Although she was always the most prepared person in our class, Jane was also always late to class. I thought she had a job that she couldn’t leave early. Later, she told me that she had no job; the digestive problems caused by her anorexia meant that she simply had to wait until she felt well enough to leave her apartment. Often, she didn’t arrive until the last 20 or 30 minutes of our two-hour class.

Then Jane went away to Florida on vacation. It was sunny and warm there, but she returned with a wretched cold and looked thinner than ever. She looked terrible. “Feel my hands,” she told me and another classmate. Even though our classroom was overheated as usual, her hands were icy cold. Suddenly, she had entered crisis mode. Being in Florida surrounded by friends who were healthy, fit, and enjoyed active, outdoor lives had suddenly made her want those things for herself. She looked in the mirror and for a moment saw how different she looked, how starved and unhealthy the woman who stared back at her was. It was a moment of clarity that lasted long enough for Jane to realize she needed help.

For the first time, Jane also opened up to me and a few others in our class about her eating disorder. She was desperately seeking a treatment center, she told me. Even though all the doctors she spoke to felt she should be hospitalized, she hoped to stay at home and find outpatient treatment. I was scared for her life, and I could tell she was, too. I berated myself for not saying anything earlier. Maybe I could have prevented this sudden and horrible downturn. I knew what was happening to her and I didn’t say anything.

I thought that she would think me too pushy, or a know-it-all. I worried that I would be intruding. After Jane spoke openly about her worries, I was able to refer Jane to Marcia, who then recommended a good psychologist in New York for her to see. When I saw Jane at class yesterday, she told me she liked her therapist but was worried that she would not be able to afford many more treatments. She couldn’t afford to spend the $5,000 out-of-pocket minimum her insurance plan required before it would cover 50 percent of the therapist’s bills. Even paying for half of the treatments would be a stretch.

When I asked Jane today whether it would have offended her if I had spoken up, she told me, “I wouldn’t have reacted negatively, because I know what’s going on with me. I’m not sure that I would have done anything about it; you have to be ready.”

The kind of epiphany she had recently, when she recognized what she looked like and how sick she was, Jane told me, has happened before, although it never lasts. “I want to do something, and then I’ll go into hibernation again,” she said. Two weeks ago she had a phone interview with the Renfrew Center in Pennsylvania, but then decided not to go.

Jane said she wanted so much to be healthy and active but added, “I don’t know how to be active, to sleep and to squeeze food in. I can’t eat because it makes me feel bad, and I’m afraid I will get sick. I’m like a child; I want to be taught to eat again.” Then, she added, “I don’t know if I’m going to make it. If this can help someone else, please write about it.”

I asked Marcia if she thought I had done the wrong thing by waiting to voice my concerns to Jane. Marcia responded, “You have to trust your instincts on when to speak up, and it sounds like you did. I have reminded other concerned friends in similar situations that you can trust your instincts if your motives are pure. We all need to remember that we can't force another adult to take action (without taking legal action first). What Jane needs now is encouragement to hang in there long enough to benefit from treatment. Sometimes this is a good time to suggest or lend a book. Maybe Life Without Ed byJenni Schaefer or, Gaining: The Truth About Life After Eating Disorders, byAimee Liu. Good books can lead to good discussions, too. “

As a nutritionist who often sees eating disorders patients who cannot afford professional treatment and/or have difficulties with insurance issues, Marcia told me, “I have lots of thoughts about this.” The first is that Jane’s dilemma is typical of our insurance system, which slaps large deductibles on eating disorders treatment and follows with inadequate reimbursements. The patient goes without treatment and, in the worst cases, ends up hospitalized in an intensive care unit at upwards of $1,000 a day.

Marcia’s second thought was that it is often hard for patients make recovery their number one priority in life; everything else should be secondary. This is not easy in cases where the patient doesn’t have the complete support of loved ones, however.

Jane’s comment about feeling like a child who needs to learn how to eat again, Marcia noted, is a perfect description of what a good nutritionist can help an eating-disordered patient do, and why seeing a nutritionist or dietitian who specializes in eating disorders is so important.

“Another thing that can be inspiring,” Marcia said, “is to help the other person see that her life is important to others—children, spouses, families, friends, even pets, and to you!”

I will tell Jane that she is important to me, and to our class. I hope that if you are concerned about a loved who is in despair over an eating disorder, you will do the same thing.

Take care,

Nancy

Marcia Herrin and Nancy Matsumoto, co-authors, The Parent’s Guide to Eating Disorders, Gūrze Books, (www.childhoodeatingdisorders.com).

A few days ago, I read this article on the Huffington Post by Kimberly Dennis, MD, entitled Eating Disorders: Be the First Line of Defense. I wanted to re-post it here because it includes a lot of educational and statistical information that serves to re-iterate what eating disorders are. It also helps to dispel myths about eating disorders. It seems to me that the goal of this article is to provide a little bit of education to readers to help us become more aware, and possibly apprehend when a friend, loved one, or acquaintance may be exhibiting concerning behaviors related to food. This article is certainly not exhaustive, but I think it provides some basic info that everyone should know! I have copied and pasted the article below.

Eating Disorders: Be The First Line Of Defense

While the majority of us may not work in the emergency room, or even work in the healthcare industry, we can still save lives.

In the United States, as many as 10 million women and one million men are fighting a life-and-death battle with anorexia or bulimia, according to the National Eating Disorders Association. More often than not, dentists can provide the gateway to critical medical treatment for these individuals.

By becoming aware of certain signs and symptoms, you can uncover illness that may otherwise go unnoticed - and untreated. With the right knowledge, you can save a life.

A deadly disease spreads - faster

Eating disorders are potentially deadly, biologically-based psychiatric illnesses. Anorexia nervosa has the highest mortality rate of any psychiatric illness, nearly 12 times greater than any other cause of death among women between the ages of 15 and 24.

What's more, eating disorders among young women are increasing at an alarming rate. Nationally, the incidence of bulimia in women ages 10 to 39 tripled between 1988 and 1993, and continues to grow.

Anorexia typically begins at the start of puberty and is more common among adolescent girls and young adult women. It affects one to two percent of the female population, and 0.1 to 0.2 percent of men. Because more than 90 percent of all those who are affected are adolescents and young women, the disorder has been characterized as primarily a young woman's illness. But it should also be noted that males and children as young as seven years old have been diagnosed with this illness, as well as middle-aged and elderly women.

Patients are diagnosed with anorexia when their body weight falls to 85 percent or less of their normal, healthy weight. Typically, these patients have an obsessive preoccupation with body weight and calories, as well as an intense fear of gaining weight or becoming fat. Their body image is grossly distorted, resulting in an unwarranted psychological impact on how they see and value themselves.

There are two types of anorexia nervosa: the restrictive eating type and the binge-eating/purging type. Binge eaters rapidly consume a large amount of high-calorie food in a very short time - perhaps 1,500 to 3,000 calories or more. Those who purge may do so with self-induced vomiting, excessive exercise or the misuse of laxatives, diuretics or enemas. Approximately 70 to 80 percent of people with bulimia purge by means of self-induced vomiting, while 30 percent use laxatives. Some who purge, however, do so without actually binge-eating first.

Recognizing the danger signs

The physical complications associated with anorexia are potentially life-threatening, since dehydration and malnutrition can damage vital organs. This can result in:

- low blood pressure

- electrolyte imbalance

- cardiac arrhythmias

- thyroid gland deficiencies, which can lead to cold intolerance and constipation

- appearance of fine, baby-like body hair

- bloating or edema

- decrease in white blood cells, leading to increased susceptibility to infection

- osteoporosis

- seizures related to fluid shifts due to excessive diarrhea or vomiting

- kidney damage or failure from chronic use of diuretics

Signs of an eating disorder are:

• Exhibits concern about her weight and attempts to control weight by diet, refusal of food, vomiting or laxative abuse.

• Prolonged exercising despite fatigue and weakness.

• Peculiar patterns regarding handling food.

• Exhibits abnormally fast weight loss, without any other known medical condition.

• Experiences depressive moods and self-deprecating behavior.

If you recognize these signs, fight the urge to remain silent. Remember, denial is a big part of eating disorders - another reason they can become fatal and a major obstacle to recovery. Act in a caring and non-judgmental way, simply stating what you see, and asking how you can help.

Also, you can go to the Web site of the National Eating Disorders Association (www.myneda.org) or call Timberline Knolls at 877-257-9611, and we would be happy to help find a professional in your area. That referral just might save a life.

Kimberly Dennis, M.D., is the medical director at Timberline Knolls (www.timberlineknolls.com). Located in Lemont, Ill., this innovative residential treatment center is designed exclusively for women with emotional disorders, including eating disorders, addiction and self-injury behavior. Dr. Dennis is a member of the American Medical Association, the Academy of Eating Disorders, the American Academy of Addiction Psychiatry and the American Society of Addiction Medicine.

Bruised Body Image??

I came across this picture today and wanted to share it- although unfortunately, I'm having trouble formatting the image so that you can see the entire quote (by Marcia Hutchinson)! Until I can fix it, it says "If you talked to your friends the way you talk to your body, you'd have no friends left." I think it speaks for itself, and I think it speaks volumes. If this quote impacts you, I would encourage you to consider how you might start thinking about your body in a way that might be more kind! Margarita Tartakovsky writes a blog on body image and eating disorders, and she wrote a great post on 'bruised' body image that I want to share with you. While I have posted the majority of it below, I would encourage you to check it out in full here. Not only does she help you to identify if you may be struggling with 'bruised' (or poor) body image, but she also provides some helpful tips for thinking more positively about your body.

Here’s a list of indicators that your image may be suffering more than usual (and ways to fix it below that):

1. You notice only negative things in the mirror, car windows, storefront windows, etc. Instead of seeing your positive physical traits, you’re more likely to be found bashing your body, and nitpicking at every nook and cranny.
2. You have a tough time taking compliments. It isn’t that you’re too polite to take a compliment; it’s that you truly believe you don’t deserve them.
3. You rarely think you look good. Even wearing a favorite outfit doesn’t help you to feel good in your skin. You rarely feel beautiful or even pretty.
4. You compare yourself to everyone. For many of us, comparisons are as natural as breathing. But, while you’re comparing your appearance to everyone else’s, you rarely have anything good to say about yourself. It’s always, “her thighs are so much slimmer than mine.” “Her waist is much smaller.” “I wish I had her body.”
5. It takes you forever to pick out an outfit — more often than not. Do you have a moment — more like many moments — where you’ve been cooped up in your room, trying on tons of clothes? You can’t see your floor, partially because it’s overflowing with clothing and mainly because your face is filled with tears. There’s nothing wrong with your clothes–it’s just that everything is wrong with your body.
6. You skip events because you don’t think you look good enough. How often have you declined an invite to a dinner date, party or other engagement because you felt too fat to leave the house?
7. You criticize your body regularly. “My stomach is gross.” “My thighs are enormous!” Do these phrases resemble your daily mantras?

And the following is a list of some pointers that she gives:

1. Think of the awesome things you can do thanks to your body,whether it’s lifting weights, walking several miles, playing with your child, playing an instrument, riding a bike, helping mom carry groceries, dancing with your significant other, achieving a tough yoga pose or simply wrapping your arms around a loved one.

2. What do you like about yourself, beyond your body? Create a list of your positive qualities and achievements, and if you need extra reminding, put the list on a note card and stash it in your purse.

3. Hang out with positive people, who appreciate and support you, who see beyond appearances to who you really are.

4. View exercise as fulfilling, not punishing. Instead of working out to eliminate calories or fit into some bikini (all things that, unfortunately, many magazines and some so-called experts recommend), choose ways to stay active that you enjoy and that make you feel strong and good about your body. There are tons of options for leading an active lifestyle: walking, hiking, biking, workout DVDs, gym membership, yoga, Pilates, dancing, tennis. There’s nothing wrong with you if you don’t like the latest workout craze. Pick something that resonates with you.

5. Worrying about your weight and body is exhausting and strips you of valuable time. Consider all the good things you miss out on because you’re too busy criticizing yourself. You overlook other opportunities, whether it’s the opportunity to self-reflect (instead of nit-picking at your thighs or waist, focus on being kinder to yourself and others), spend time with loved ones or read a good book.

Happy Monday to everyone and hope you all have a great week!! Think good thoughts about your body and what it can do for you. Be kind to yourselves!

The Body Image Project!

This week has been a really busy one, and it is not over yet- which means that National Eating Disorders Awareness Week is still going strong! I received an email from Tiffany, who is the woman behind the Body Image Project- a really cool website and organization that I have written about before (click here to read my post and here to check out the Body Image Project). The mission of her site is to help people reframe and reshape the way they feel and think about their bodies. I want to quote her because I think she said it best- We want to hit the message home that if you do one thing this week, participate. Share your story. Help spread the word. Encourage positive body image and take control of your own advocacy …your right to be happy, healthy and thrive in your own skin. I love the attitude behind this statement. It starts with each one of us as individuals!

What can you do? Be intentional about reminding yourself what you value and like about your body and yourself each day. I read an interview that Jenni Schaefer gave recently and she said that she encourages people (including herself!) to think about what your body can do for you- instead of focusing on your individual body parts and criticizing them, consider what purpose these body parts serve for you and how lucky we are to have functioning bodies. She also said the following (so great!)-"Realize that your body is just a vehicle for life. I've heard people say it's like an earth suit. It's what you get to wear to walk around and experience the world." I think that is a cute, unique and helpful way to think about our bodies. To read the most recent blog post written by Tiffany at the Body Image Project, follow this link to read her thoughts on National Eating Disorders Awareness Week. And remember, do just one thing this week!! No matter how big or small, you can make a difference by doing one thing.

It's Time to Talk About It!

National Eating Disorders Awareness Week (NEDAw) is in full swing. In my last post, I shared about the mission and goals of NEDAw, so if you missed it, take a look! This year's theme is "It's Time to Talk About It" and the hope is for everyone to do just one thing! If we all do one thing, no matter how small, think about the attention we can bring to highlight a major psychiatric illness in our society that is often very misunderstood! One suggestion for doing one thing (compliments of NEDA- National Eating Disorders Association) is to use your social networking sites (think facebook, twitter, etc...) to post some kind of link or information about eating disorders that may serve to initiate conversations or educate people about eating disorders. Margarita Tartakovsky wrote a blog post on some myths and facts about eating disorders that might be of interest (you might learn something yourself too- this is a great list)! Below is the list that she made with the help of some eating disorder professionals (access it in full here). I would encourage you to read it, but also to pass them on to someone this week in order to raise awareness about the facts behind eating disorders!

Eating Disorder Myths

In honor of NEDA’s theme, let’s talk about eating disorder myths and facts. There are many misconceptions surrounding eating disorders. I’ve asked several clinicians to share a few myths and facts.

Myth: Media is the primary cause for the development of most eating disorders. (Julie Holland, MHS, CEDS, Eating Recovery Center)

Fact: Although recent surveys have confirmed that adolescent girls get much of their health information from the media, media messages themselves are not a primary cause of eating disorders. Messages that promote an unrealistic thin ideal can set unrealistic standards regarding body size and shape. The fact is, media messages have the ability to positively or negatively affect one’s body image and/or self-image based on the message and how it is presented. It is important that we teach individuals critical thinking when looking at media images.

Myth: Eating disorders are triggered by a desire to be thin.(Emmett R. Bishop, Jr., MD, CEDS, Eating Recovery Center)

Fact: Eating disorder behaviors do not develop merely because an individual has a longing to be thin. For instance, an individual who does not know that he or she has wheat or lactose intolerance may develop a fear of food due to the discomfort or pain it causes. Someone in chemotherapy or with a gastrointestinal disorder may stop eating to avoid nausea.

Myth: Eating disorders are a choice. (Julie Holland)

Fact: Although individuals may choose to start a diet or engage in certain behaviors, eating disorders themselves are not a choice. People do not choose to have anorexia or bulimia. These disorders develop over a period of time and require various levels of treatment to address complex symptoms including medical, psychiatric and other underlying issues.

Myth: You can tell if someone has an eating disorder just by looking at them. (Marla Scanzello, MS, RD, Eating Recovery Center)

Fact: Many people with eating disorders are of normal weight, or even overweight. Weight is not a tell-all sign of an eating disorder. Furthermore, eating disorder patients can become quite skilled at hiding their disordered eating behaviors.

Myth: People with eating disorders will eat normally / recover when they choose to do so. (Dr. Ravin)

Fact: This myth implies that EDs are willful behavior and that a patient can simply make a choice to recover. Thus, it blames people with EDs for having an illness that is not their fault. Most people with EDs are not able to eat normally on their own; they require significant outside support (nutritionist, parental support in refeeding, residential tx, etc.) in order to normalize their eating habits.

Myth: Developing a positive body image is not that important in the overall recovery from an eating disorder and should be worked on towards the end of the recovery process. (Carolyn Jones)

Fact: A continued negative body image is one of the main contributing factors to a relapse in the eating recovery process. Improving a person’s body image is one of the hardest and most time-consuming things to change in the healing process and should be undertaken early during treatment.

Myth: Eating disorders are not deadly. (Kenneth L. Weiner, MD, CEDS, Eating Recovery Center)

Fact: In all actuality, it is quite the opposite. Eating disorders are the deadliest mental illness. A woman with anorexia nervosa is 5.6 times more likely to die than another woman of her same age. The most frequent causes of death from eating disorders are suicide (32 percent), complications associated with anorexia (19 percent), and cancer (11 percent). The average age of death for an individual with anorexia is only 34 years.

Myth: You can never fully recover from an eating disorder. (Julie Holland & Sarah Ravin)

Fact: According to Holland, “Recovery takes commitment, dedication, hard work and time. However, full recovery is absolutely possible through finding the appropriate treatment professionals and program.”

According to Dr. Ravin, “The people who believe this are probably those who did not receive treatment, received inadequate or low-quality treatment, lacked the necessary social support, or were never pushed to reach and maintain an ideal body weight and stay there long enough for brain healing to occur.The underlying biological predisposition will always be there, but people can and do recover fully from EDs. I’ve seen it happen many times.”

Of course you are not limited to posting this information on your social networking sites! There is a lot of great information on NEDA's website (follow this link to access their information/resources page) as well as on many other sites. Maybe you can re-post a blog, an article, or the name of a book that you have read and enjoyed about body image, eating disorders, etc... Anything that you can do to help raise awareness is meaningful. We often hear so much in the news about schizophrenia and Alzheimer's (which are both worthy of our attention), but would you be surprised to learn that eating disorders impact five times as many people as schizophrenia? And eating disorders affect double the number of people with Alzheimer's? (These statistics were taken from John Grohol, PsyD, of PsychCentral). This information does not serve to take anything away from either of these illnesses, but rather the purpose is to illustrate the prevalence of eating disorders as psychiatric illness. If you have learned anything new from this blog post (or even if you haven't!), I would encourage you in honor of this week to share something new with your families, friends and loved ones because it's time to talk about it.