Eating Disorders News by Marcia Herrin and Nancy Matsumoto

Hi Everyone,

I've started a dedicated Twitter account for eating disorders- and nutrition-related tweets. Please follow me @ednutrition on www.twitter.com !

Nancy

Marcia Herrin and Nancy Matsumoto are co-authors of The Parent's Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home (www.childhoodeatingdisorders.com).

Motivation: the first step in recovering from an eating disorder

One of the hardest parts of recovering from an eating disorder is finding and maintaining the desire, motivation and will to recover. In March when I blogged about a friend I called “Jane” (Knowing when to express concern about a friend’s eating disorder), her anorexia had taken a turn for the worse and she was scared. She was on the verge of seeking in-patient treatment, but was having a hard time committing to what she knew would be an extremely difficult and destabilizing process.

 

Today, almost three months later, Jane is still struggling with the decision. Last week, she admitted to me, “I kind of lost my way again.” A month before that, she wrote,

 

My doctor is going away for 2 weeks and he wants me to go to Renfrew [treatment center], but it is a very difficult decision to make. Even though I UNDERSTAND that if something/someone can help me, it is me - making a leap and just going there. Honestly, I do not see any other real way out for myself. And it is getting more and more difficult to deal with. I just have to push myself to Renfrew so they will give me a push to start my life all over again. As a different person. It is kind of scary, 'cause I do not know who this person will be. You know what I mean? Too much was invested into the person I am now, even though it was all negative.

 

Jane’s dilemma is wrenching but not uncommon. It got me thinking about motivation, and how we can help motivate family and loved ones to take the leap of faith required to enter treatment. Marcia uses a technique called Motivational Interviewing (MI). I thought that the basic techniques of MI might be of interest to many of you. The idea behind MI is that the impetus to change has to come from the eating-disorder sufferer herself. The best thing you can do is help move her toward positive change by helping resolve the ambivalence she feels about abandoning a behavior that has become who she is.

 

This site, Motivational Interviewing: resources for clinicians, researchers and trainers offers a lot of good information. The “interaction techniques” page offers a handy acronym that captures the fundamental techniques of MI: OARS: (1) Open-ended questions, (2) Affirmations, (3) Reflective listening and (4) Summaries. The rowboat oars image, the site explains, “gives us power to move, yet it is not a powerboat. We don't zip from one place to another, yet with sustained effort OARS can take us a long way.  

 

I like the way this introductory page differentiates between the MI techniques that therapists use and the spirit of MI, which you can absorb and try to keep in mind as you talk to your eating-disordered loved one. Here’s a very condensed version of the information on the site:

· Motivation has to come from the person himself, not from outside. There’s no room for coercion, bribing, cajoling or guilt-tripping. You want to mobilize your loved one’s values and goals to stimulate change.

· It’s your loved one’s task to voice and resolve his ambivalence. You may try to facilitate this process with open-ended questions.

· Your job is not one of direct persuasion. Usually this just leads to increased resistance.

· MI is a quiet asking and listening technique. Forget about aggressive confrontation or arguing: these are the opposite of motivational. This technique may seem slow and passive, but the change comes when your loved one is really ready, not because you’ve forced the issue.

· Your job is directive, meaning you are there to help your loved one zero in on the cause of her ambivalence about healing and resolve that deep divide over wanting and yet being afraid of the task of recovery

· Readiness to change is not always a permanent condition, it comes and goes with different interpersonal interactions. Your loved one’s resistance might be a sign that you’re assuming he’s ready when he’s not yet there. Be patient.

· Think of your relationship to the loved one you are helping not as a parent-child or other hierarchical relationship, but as a partner or companion relationship. Respect your loved one’s freedom of choice. Until she decides she wants to change, it is not going to happen.

Nancy

Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home, Gūrze Books,www.childhoodeatingdisorders.com.

 

Delayed bulimia diagnosis and why you can’t afford to lose precious time

Eating disorders are one of those diseases that can sneak up on a child or adolescent. You may notice a few odd behaviors and not get around to delving deeper into them (after all, isn’t adolescence full of odd behaviors, most of them age appropriate?). Then suddenly you’ve got a very sick person on your hands. This is true of both anorexia and bulimia. While understandable, a delayed bulimia diagnosis can be dangerous—and in cases where purging causes electrolyte imbalances and affects the heart—even life threatening

 

There are many reasons why it can be hard to diagnose bulimia, but one frequent cause is that the patient herself is not forthcoming with information. Lacking access to the whole picture, a doctor may be forced to eliminate a long list of possible other causes for the troubling symptoms.

 

Be alert if your child:

· Complains of more than expected gastrointestinal distress, sore throats, or flu

· Spends a lot of time in the bathroom, especially after meals

· Chooses to shower after meals

· Displays red knuckles or irregular eating patterns (e.g. sometimes overeating, sometimes undereating)

Other signs to watch for are missing food that no one in the family can explain and finding evidence of your child eating in bedroom.

 

Marcia has seen many patients who have been worked up for all sorts of hypothetical diseases and conditions by doctors because the patient cannot or will not admit he is bulimic. “The doctor may say, ‘This looks like x, y, or possibly an eating disorder.’ But if the patient doesn’t come forth and say anything, the doctor is a little bit stuck,” Marcia explains.

 

Often, the patient will keep quiet because she is in denial. Sometimes it is part of a cat-and-mouse game. “This kind of thrill of pulling the wool over a doctor’s eyes is a scary and dangerous one,” says Marcia. “Precious days and weeks can be lost, and the child’s health seriously endangered.” Marcia suggests that you as parents share your concerns and observations in advance of your visit to the doctor with your child.

 

Marcia Herrin and Nancy Matsumoto are the co-authors of The Parent's Guide to Eating Disorders, Supporting Self-Esteem, Healthy Eating & Positive Body Image at Home (www.childhoodeatingdisorders.com)

 

Anorexia: Addicted to Starvation?

Recently, a colleague shared an interesting article by science writer Trisha Gura, PhD (http://www.trishagura.com), author of Lying in Weight, published in 2008 in Scientific American Mind entitled, Addicted to Starvation. A free full-text version of the Scientific American article is at http://www.trishagura.com/articles/samgurastarve.pdf. Gura looked at the science of how the lack of food may be like an addictive drug for people with anorexia. She cites the research of French scientist Valerie Compan who found using animal studies that a refusal to eat arises from abnormal activity in the brain’s reward system. Well known American eating disorder researcher Walter Kaye found that anorexic subjects, like drug addicts, are incapable of feeling pleasure from food. Brain scans of Kaye’s subjects suggest that these women are physically unable to appreciate pleasant taste sensations. Another study that supports this hypothesis is the famous 1944 Ancel Keys study. Keys semi-starved 36 young men for 24 weeks. When the study was over and the men were allowed to eat normally, some became classically anorexic—dieting, feeling fat, etc. Gura concluded that “when a person with anorexia diets, he or she actually feels better—more alert and energetic—when starving.” Basically anorexic patients get hooked on undereating. This could explain why anorexia requires intensive treatment to overcome.

 

Marcia

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

Great news! In about a month, our book, The Parent’s Guide to Eating Disorders: Supporting Self-Esteem, Healthy Eating and Positive Body Image at Home, will be available as an ebook! For those of you with new iPads who don’t know what to do with them, here’s your chance to learn a lot about an important subject while playing with your new toy. Our book will also be available for the Kindle and other electronic readers. We’ll let you know when the e-version is online.

The Good News about Good Nutrition and the Brain

Our hope that nutritional rehabilitation and the resulting weight gain restores the brain cells that are lost in anorexia nervosa is now a scientific fact. Thank goodness!! A new study just published in the International Journal of Eating Disorders proves yet again that women with anorexia lose brain cells and that the longer the illness goes on the more brain cells that are lost. Now for the good news. In this study the anorexic women who gained weight also had a measurable increase in brain cells in less than two months of good eating and weight gain. Other studies have shown that maintaining a healthy weight for at least a year after a bout of anorexia, restores brain cells to normal. Researchers still don’t know how serious these loses of brain cells are, but anyone working with long term anorexia knows that these patients struggle intellectually. There are several studies that show cognitive impairment in those with anorexia nervosa.

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