Treatment Notes by Sari Fine Shepphird

It's Award Season...Will Curves Be Under Fire Again?

It's that time of year again...awards season. You know, the fashion, the dresses, the red carpet, the designers, and of course...the body watchers.

New Study Hilghlights Dangerous Diets and Eating Disorders in the Military

In a  new study reported in Army Times, soldiers are engaging in unhealthy diet behaviors and eating disordered symptoms, reportedly "dangerously starving themselves, gobbling diet pills and laxatives — even going under the knife in costly liposuction surgery — all to meet the Army’s weight standards and avoid losing their careers".

Family-Based Treatment Highly Effective for Recovery from Anorexia

Lots of buzz this week about a new study that appeared in the Archives of General Psychiatry this week which confirms what many Maudsley and Family-Based Treatment (FBT) proponents have been saying: FBT is not only effective for anorexia recovery in teens, it is fast being thought of as a gold-standard in anorexia recovery.

In fact, in a randomized-controlled study, researchers at Stanford University and the University of Chicago found that FBT leads to a faster, more complete, recovery that adolescent-focsed individual therapy. Results showed that recovery rates were nearly twice as high for the patients in the FBT groups, and that patients in FBT also gained weight faster and showed great improvement in attitudes and behaviors surrounding food. Forty-two percent of patients receiving FBT recovered, compared with 23% of those receiving individual therapy.

Another key finding: at both six-month and one-year follow-ups, the FBT group retained a higher number of patients in full remission than did the control group, and the percent of relapse for the FBT group was only 10 percent, compared to 40 percent in individual treatment.

This is indeed a very important study, and sorely needed in a field where anorexia treatment and research has been lacking by many accounts.

You can hear a summary of the study as well as some of my own thoughts, in this clip from npr news:

And you can read more coverage of the study here:

Time.com

Bloomberg Business Week

MSNBC 

Lastly, allow me to take this relevant opportunity to draw you attention to a new FBT resource that tells the story of one family's journey of recovery from anorexia using FBT. Brave Girl Eating is indeed a brave account as told by journalist Harriet Brown. Harriet eloquently shares the often agonizing trials of anorexia as well as the triumphs of FBT. This first-hand account goes far in illuminating the FBT approach, as does the invaluable website co-founded by Harriet MaudsleyParents.org

Visit their website for comprehensive details about family-based treatment.

Celebrating Mom's Choice Awards

I am humbled and thrilled to be able to share with you that the book, 100 Questions and Answers about Anorexia Nervosa has received the honor of being named a Gold award winner by the Mom's Choice Awards!

In the category of Adult books, Health, Nutrition, Fitness & Safety, the esteemed Mom's Choice Awards (MCA) named "100 Q & A about Anorexia" to be named among the best in family-friendly media, products and services.

MCA has a long history of evaluating media, products, and services (including books) that seek to enhance the family and I am truly grateful to their organization.

To learn more about MCA, visit their website here...

Thank you to Gurze books and to our wonderful eating disorders community for the way that we support each other's small efforts to help eradicate eating disorders in our time. We all work together toward this common goal, and the mutual support and encouragement that we share is so valuable.

There is much work to be done to improve research and treatment outcomes for eating disorders. Let's work together to ensure that one day eating disorders will be a thing of the past...

 

Helpful Therapy Resource

When you read the words "Niagara Falls", what comes to mind? Probably an image of a water fall, or of the falls themselves, if you have ever had the opportunity to see them in person.

What about the words cotton candy? I am guessing you can picture the fluffy pink blob of sugar on a white stick.

Words and concepts often illicit visual cues, and visual cues are an important part of memory retrieval and learning...remember learning your times-tables on flashcards? There's a reason why flashcards helped with learning and made it easier than just trying to remember the concepts based strictly on auditory memory.

Seeing something helps you learn and remember.

But what about a concept like "Black and White Thinking"? Does an image come to mind? Probably not. Or how about Resilience? How can you explain that concept to a client in a way that is memorable and enhances learning? What about "Proactive versus Reactive"? Ever wished for a concise way to explain these concepts to your clients?

One of our colleagues, Suzanne Ricklin, MSW, CEDS has devised an innovative, creative, and immensely helpful way to do just that. So, I thought I would take this time to draw your attention to her"InVision Concept Cards".

Suzanne has taken core therapeutic concepts, such as "resilience, black & white thinking, recovery roadblocks, paradigm shift, delayed gratification, and process versus content," and she has beautifully illustrated the meaning and application of these concepts in a visual manner, thereby both helping clients to capture the concepts through enhanced learning, and helping therapists and other professionals dialogue about these concepts in a more meaningful way.

Suzanne's unique "flash cards" are designed to help clients strengthen life skills, explore universal themes, and address complex emotions, and she has equipped each card with helpful explanations and guidelines for professional use.

I highly recommend them. Feel free to check them out and learn  more by clicking here, or by clicking the link above, which will take you back to the Gurze site.

Just passing that along...

Best wishes,

Sari Shepphird

New Eating Disorders Resource on the Web

I recently learned from my colleagues, Michael Levine and Kelsey Chapman of Kenyon College, of a new website that is deserving of attention and interest.

Designed for girls and young women with eating disorders that have found support in the pro-anorexia ("pro-ana") movement, this new site, according to its developers, does the following:

"A. Acknowledges and supports some of the motives for use of pro-ana/mia sites, as well as some of the positive (potentially helpful) features of these sites, while...

B. Divesting the site of (and renouncing) the typical pathogenic/iatrogenic features (e.g., "Thinspiration," "weight loss tips for underweight people"), and...

C. Adding important material about stages of change and recovery, harm avoidance, creative self-expression, etc."

Check out their new site here:

The site's designers encourage you, as do I, if you feel it is appropriate and potentially worthwhile, to recommend the site to your patients, families, and colleagues.

Best,

Sari Shepphird

More on Adult Anorexia Nervosa

I have written a few pieces before about adult anorexia and recently did an interview with More magazine (for women over age 40) on the subject that I think should be appearing soon. It is such an important topic and older women certainly struggle with anorexia in silence. 

But breaking some of that silence this week is an article to which I'd like to draw your attention:" Adult anorexia: the forgotten tragedy of lives lost to illness", which ran in the Sydney Morning Herald.

Here's a quote: ''People who fall into this particular category are not in treatment because they are too scared to seek help - because getting better means putting on weight." And you can read the full article at the link below.

Mentioned in the article are two of my esteemed colleagues, June Alexander and Christine Morgan, chief executive of the highly esteemed Butterfly Foundation. Check out their great website here: http://www.thebutterflyfoundation.org.au/

And here is the link to the full article heralding from Australia.

For more about adult anorexia nervosa as well as both the hope and the challenges of treating this illness, feel free to check out my book, "100 Questions and Answers about Anorexia Nervosa".

What Worked for You?

There has been an interesting discussion taking place among my colleagues recently about what to say to those with eating disorders who do not see the need for treatment or who do not think their eating disorder is severe enough to raise concerns. It is a long-standing issue with eating disorders, as there are far more who never seek treatment than those that do. Some studies indicate that as few of 9% of people with bulimia in community sample ever seek treatment for their illness!

So, I thought I would open the question to you...

If you have been in treatment for an eating disorder but originally resisted getting help, what worked for you? What was it that helped to convince you that getting some help would really help?

Feel free to post a comment, even anonymously, or if you prefer, e-mail me back-channel at mail@drshepp.com and I would be happy to summarize your response for you and post it to this Blog, again anonymous responses are welcome too!

Best wishes,

Sari Shepphird

Proposed Changes to Eating Disorders Diagnoses

The American Psychiatric Association has released a draft of their proposed changes to the Diagnostic and Statistical Manual of Mental Disorders, the standard used in the United States for diagnosing mental illness, including eating disorders.

The proposed changes for the forthcoming version (DSM-V) include the recognition of Binge Eating Disorder as a unique diagnosis. In the current edition (DSM-IV-TR), Binge Eating Disorder is included as a Criteria Set for Further Study in the Appendix of the manual and is not given its own diagnosis, but is rather included under the broader catch-all category of "Eating Disorder: Not otherwise specified"

Proposed changes to the diagnostic criteria for Anorexia Nervosa include the omission of the criteria of amenorrhea and the omission of the word "refusal" with regard to maintaining a normal weight, as the term can be potentially pejorative.

Proposed changes to the diagnostic criteria for Bulimia Nervosa include reducing the required minimum frequency of binge episodes from at least twice per week to a minimum of once per week.

The diagnostic category of Eating Disorder, not otherwise specified would still be included in the updated version of the DSM, with updated descriptions.

In addition, it has been proposed that the diagnostic category "Eating Disorders" be changed to "Eating  and Feeding Disorders" so that Feeding Disorders such as Pica and Rumination Disorder and the more commonly known eating disorders be included in the same diagnostic category (see Treatment Notes dated 02-04-10 for a discussion of Feeding Disorders).

For a more complete discussion of the proposed changes to the DSM with regard to eating disorders, visit this link: http://www.dsm5.org/ProposedRevisions/Pages/EatingDisorders.aspx

Visitors to the site may register and leave their comment regarding the proposed changes to diagnostic criteria.

Feeding Disorders

Are feeding disorders the same thing as eating disorders?