Living With Food: The Science Supporting Eating Disorder Treatment

We often receive calls from individuals who are concerned about their friend or loved one's eating habits or body image. The most common questions are "What should I say to my friend?" and "How can I approach them with my concerns?" While there is no easy answer to these questions, we do suggest checking out the following links from the National Eating Disorders Association for tips on how to approach a friend who may be struggling with an eating disorder or body image disturbance:

How to Help a Friend with Eating and Body Image Issues 

What Can You do to Help Prevent Eating Disorders?

What Should I Say? Tips for Talking to a Friend Who May Be Struggling with an Eating Disorder

Should you have any questions or comments regarding this post, or if you need further guidance on how to approach a loved one with your concerns, please email blog@eatingdisorderscleveland.org or call (216) 765-0500. 

By, Dr. Mark Warren

One of the most common reasons people stop medication or are hesitant to start them in the first place is a fear that they will not be themselves if they take medication. This question has implications that are biological, metaphysical, and spiritual. So therefore, any conversation about this topic will have multiple meanings for everyone. Nonetheless, let us dip our toe into the water of a question that rightfully is on many peoples’ minds. Part of the problem with this question is that it is assumed that there is something called “me” which, off all medications is a real me and somehow is different than any other version of who I am. My sense is that this is not an accurate way to look at who we really are. From a psychological perspective, the concept of the self is a constantly changing thing. I am different in the morning than I am at night. I am different alone than I am with others. I am different when I watch a sad or happy movie. The idea that there is some sort of universal me that is always there, I think, is a misconception.

A second fear is that if I take medications it will emphasize part of me and block out a second part of me. There are situations where this may seem accurate. For instance, if someone is paranoid or psychotic and they wish to not be, one could argue this part of the me is being blocked. At the same time, one can make an equally strong argument that the paranoid or psychotic part is not them in the first place and the medication allows the real me, whoever that is, to express itself beyond the illness of psychosis or paranoia. While people with eating disorders are not typically paranoid or psychotic, they often have thoughts and feelings that seem "not me". 

There are many other ways to look at this issue. In general, a medication that helps to suppress symptoms that make you ineffective in your life, or to promote states of being that will make you more effective in your life, are unlikely to be taking away the real you. Medication works at the biological level on neurotransmitters and the cellular receptors for these transmitters. They do not introduce new or unknown neurotransmitters to your brain and they do not take away functionality that you previously had. If these things do happen then the medication is likely not to be continued and should be reevaluated. The function of medication is to help make you as much "you" as you can possibly can be. It is similar in this way to medication for any other medical illness. Medication taken for heart failure allows that person to become who they were before their heart failed. One could argue that the real “them” has heart failure and the medication alters the real “them”, but I suspect someone in heart failure would prefer medication to treat it.

Because psychiatric medications involve the mind, these questions are not to be taken lightly. The implications of medication should be discussed with great seriousness and great attention to detail. If used correctly and with care, medication can help you become the "you" that you most want to be.

Should you have any questions or comments regarding our post please email blog@eatingdisorderscleveland.org.

Contributions by Sarah Emerman

The Renfrew Center is hosting events for both the public and professionals in Cleveland on body image and eating disorders in the Jewish Community. For more information please see below.

Community
 
The Renfrew Center Foundation invites the public to attend an open forum titled Food, Eating Behaviors and Body Image in the Jewish Community.  This free community event will be held during the evening from 7:00 PM - 8:30 PM on the following dates/locations: Wednesday, May 4 in Cleveland, OH; Wednesday, May 11 in Chicago, IL, and Wednesday, May 18 in Dallas, TX. Featured Speakers: Adrienne Ressler, MA, LMSW, CEDS, National Training Director and Body Image Expert, The Renfrew Center Foundation and Marjorie C. Feinson, PhD, Renfrew Center Foundation Consultant will address the issues of recognizing how Jewish role models can provide healthy images for our daughters; discovering new ways to appreciate and honor our bodies and ourselves; understanding eating problems among Jewish women and the initial steps for change; and raising awareness of how holiday and Sabbath meal preparations contribute to disordered eating. This event is open to all that would like to attend. For more information on this event and to RSVP, please contact Kelly Fieni at 1-877-367-3383 or kfieni@renfrew.org.

Professional
 
REGISTER NOW! The Renfrew Center Foundation presents Food, Body Image and Eating Disorders in the Jewish Community, a half-day conference (4 CEUs), for mental health professionals, educators, and clergy on Thursday, May 5 in Cleveland, OH; Thursday, May 12 in Chicago, IL, and Thursday, May 19 in Dallas, TX.  The conference will address women’s body image issues and eating disorders in the Jewish Community.  Conference objectives are to address the rise in eating disorders and related issues in the Jewish community; develop strategies for using Jewish tradition, culture, spirituality, text, and ritual resources for healing; explore shame, body hatred and eating disorders among Jewish women and girls, and increase understanding of the complex reciprocal relationship between mother, daughter, and a healthy body image. Featured Speakers are Adrienne Ressler, MA, LMSW, CEDS, National Training Director and Body Image Expert, The Renfrew Center Foundation and Marjorie C. Feinson, PhD, Renfrew Center Foundation Consultant. For more information and to register, visit: http://renfrewcenter.com/news-events/Events/jewishedprofessionalseminars.asp or contact Debbie Lucker at 1-877-367-3383 or dlucker@renfrew.org.

By, Dr. Mark Warren

Will I be on medication forever? By the time someone begins a higher level of eating disorder treatment, meaning residential care, in-patient, partial hospitalization, or intensive outpatient, is it fairly common to have taken medication or have medication suggested as part of a treatment plan. This is true despite the fact that medications are not considered to be a primary treatment for eating disorders, except in the use of Prozac for bulimia. Therefore, when medication is used properly, it is often an adjunctive therapy designed to help with depression, anxiety, panic attacks, or overwhelming negative thinking that may accompany an eating disorder or the treatment of an eating disorder. For over 25% of people with an eating disorder, there may be another psychiatric disorder present for which medications are useful. So the answer to the question, “Will I take my medications forever?” is unfortunately “That depends”. It depends if you have another diagnosis, how soon negative thoughts and feelings resolve once in treatment, and how long it takes to feel like you are truly in remission from your illness. 

From a medication perspective people tend to fall in one of three general categories:

1. The client doesn’t like medication and doesn’t ever want to take it. If they have to take it during the acute phase of treatment they will in hopes of stopping as soon as they can. Often there are negative feelings about the use of medications and given that it is not a primary treatment this may be a reasonable position to take. 
2. For a second group almost the opposite happens. The client feels good on medication, and hasn’t felt as relaxed or happy for a long while. Clients in this group will continue to take medication as long as it is tolerable and side effects are not an issue. 
3. The third group of people fall somewhere in-between. There may be a benefit to taking medication, and there may be a concern that once medications are stopped that the benefit will go away. At the same time, there are also feelings present that it will be nice not to have to take medications. There may be a period of time, often years, of seeing what, if any, medications are truly needed, trying to find minimum amounts of medications or perhaps even stopping completely.

So the answer to the question “Will I take medication forever?” is if it’s only for an eating disorder, probably not. If there are other advantages to the medication and the benefits outweigh the risks, you may make that decision.

Should you have any questions or comments concerning this post please email blog@eatingdisorderscleveland.org.

Contributions by Sarah Emerman

By, Dr. Mark Warren

As evidence-based care has progressed over the last 20 years the ways we think about eating disorder treatment have also changed. In the world of eating disorder treatment historically there has been much focus on underlying causes of the eating disorder prior to the cessation of behaviors. The advancement of effective care for eating disorders has shifted the focus of treatment in that medical stability and behavioral control should be the primary focus until the client’s physical health in no longer in danger. After this is accomplished the focus shifts to feeling better about self, body, and life. The reason we think about it in this way is relatively straightforward, although it may not appear as clear if you are the one receiving treatment. From a patient or family perspective it is often the misery of the eating disorder, the associated physical pains, discomfort, and anxiety that drives a person to seek treatment. While these issues will eventually become prioritized, from a treatment perspective, the risk of sudden death or significant organ damage is real and often stays primary for a significant amount of time. Studies on sudden death from an eating disorder, particularly in those who have a restrictive component, tend to be correlated with heart rate and EKG changes. Both of these are likely invisible to patients and family but may be the dominant issue for the treatment team. It is not until medical issues are resolved that it becomes safe to move on to the next phase of treatment.

The best way to handle medical issues related to an eating disorder are typically re-feeding and decreasing life threatening behaviors. So, regardless of what may have brought someone into treatment, this will be the first treatment priority. As medical stability is reached the treatment focus will shift towards specific eating disorder behaviors and urges of the client. The presence of these behaviors presents a forward medical risk and until these behaviors are resolved the risk of relapse and the return of medical instability is a primary concern. This may feel quite frustrating, as the movement away from eating disorder behaviors may be associated with greater distress. Although we will try to manage the distress, the behaviors continue to be the primary focus because they continue to present the life-threatening part of the illness. Only after behaviors are resolved to an extent that the life-threatening component is no longer present can we move to the more quality of life issues and appreciation of what recovery can look like.

Should you have any questions or comments regarding this post please email blog@eatingdisorderscleveland.org.

Contributions by Sarah Emerman

By, Dr. Mark Warren and Sarah Emerman

There are many helpful and informative books in the eating disorder world. They range from autobiographical narratives, to fictional tales, all the way to medical complications and scientific studies. For many patients and families, books on eating disorders can provide a useful source of support and a sense of understanding of the illness, which can ultimately be helpful throughout the therapeutic process. That being said, not all books are created equal. The following will not be a complete review of the books on eating disorders in any way, but are only some of the books we have found to be helpful to our clients. Exclusion of a book from this list does not mean it’s unhelpful, but may mean we think it is helpful to some and not others, or may be a book that we are unaware of. If you are aware of books about eating disorders that you have found helpful, please feel free email blog@eatingdisorderscleveland.org.

For the parents of an adolescent with an eating disorder, the books we most commonly recommend are: Eating with your Anorexic, by Laura Collins and Brave Girl Eating, by Harriet Brown. Both of these books highlight Family Based Treatment and provide a real life introduction to both the experience of having a child with an eating disorder and of getting treatment while surviving the process. In addition, The Treatment Manual for Anorexia Nervosa by Drs James Lock and Daniel LeGrange, although written for professionals, is sometimes read by families and found to be helpful. Help Your Teenager Beat an Eating Disorder, also by Drs Lock and LeGrange, has also proven to be very helpful. The advantage of all of these books is that they focus on evidence-based care and we consider them to be useful to virtually all parents.

For adults, finding books that are helpful may be somewhat more difficult. Many of our patients have found Life Without ED by Jenni Schaefer to be of great support. It has generally received some of the best reviews from our clients. We also recommended Amiee Liu’s book, Gaining, particularly for clients looking for a discussion of the broader topic of recovery. Several patients have been impressed by the honesty of Portia de Rossi’s book, Unbearable Lightness, although we have also received feedback that the book may be more triggering than others. For all autobiographies, it’s important to remember that it is only one person’s story. This means there will be parts of the book that feel supportive, and some may not. No one person’s experience should be seen as a formula for someone else’s path to recovery.

In terms of eating disorder books for males, there are far fewer available than for females. Making Weight, by Dr. Arnold Anderson, Leigh Cohn, and Dr. Tom Holbrook, has been the most helpful book we have found to date.

For binge eating disorder, the Eating Disorder Obesity textbook by Christopher Fairburn and Kelly Brownell is one of the most highly respected books in the field. From a more personal and less evidence-based perspective, many of our staff have recommended Women, Food, and God by Geneen Roth.

When seeking out a book, whether is be for motivation, advice, support, or psycho-education, keep in mind that all books should be discussed in the context of a therapeutic relationship. No book will help you get better by itself. It’s important to discuss the information with members of your treatment team to help integrate the information best into your life.