tag:blogger.com,1999:blog-41867143496774328882024-03-27T02:38:11.907-04:00Dr. Lissak's Treatment PlanA guide to eating disorder treatment and recovery.Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.comBlogger488125tag:blogger.com,1999:blog-4186714349677432888.post-78569864025776036682024-03-23T08:35:00.001-04:002024-03-23T08:35:06.381-04:00Identity Transformation at the Center of Eating Disorder Recovery<p><span style="font-family: Palatino; font-size: 14px;">Most chronic illnesses, medical or psychiatric, have a significant impact on a person’s quality of life. Coming to terms with an illness not easily managed or cured changes how someone sees their life trajectory and future. Although an illness can become a part of the lens through which one sees the world, eating disorders are unusual in how they become tightly woven into one’s sense of self.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">No matter how the eating disorder starts, the symptoms, self-image and behaviors around food become paramount. All decisions center around the convenience or difficulty of eating or around what the eating disorder seems doable or acceptable.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Inevitably, the way one thinks of themselves and leads their lives depends largely on the eating disorder. Social events, professional choices and any personal plans revolve around what is best for the eating disorder.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Since eating disorders—or at a minimum eating disorder thoughts—start at a young age, psychological and emotional development occurs with the strong eating disorder thoughts influencing every decision. One’s identity and eating disorder grow up together, connected in the overarching experience of learning about oneself.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">At its core, eating disorder treatment isn’t just normalizing eating behaviors and regulating body function, nor is it simply relearning new ways to think about hunger and fullness.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Recovery involves breaking down one’s own identity and building a new identity from scratch, no matter your age or personal situation, based solely on one’s own self and not the tenets of an illness.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">It’s hard enough to take the steps towards recovery let alone imagine that recovery involves such a profound and painful emotional process, one that adults rarely if ever need to consider.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Time and again, clinicians working with people with eating disorders see this trajectory. Recovery is hard work starting with eating the food and handling changes in one’s body. Understanding the internal transformation that ensues is the next big step followed by a willingness and ability to forge ahead and find that true self, separate and free of the eating disorder.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-51446365778992892852024-03-16T09:09:00.004-04:002024-03-16T09:09:37.850-04:00One Key Limitation to Expanded Eating Disorder Care<p><span style="font-family: Palatino; font-size: 14px;">Eating disorder treatment and recovery isn’t just about mind over matter. Access to so many types of clinical care, in person and online, doesn’t change the intractability of an eating disorder—illnesses that are physiological as well as emotional.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">The psychological draw of an eating disorder can be powerful in many ways, for example the emotional numbing through the release from overeating/binging or the protection from traumatic symptoms via restriction. Over time, the repeated disordered eating behaviors can engender a physiological response in the body’s gastrointestinal system which adapts to the new disordered eating. Once their bodies get used to this new pattern, people have a much harder time escaping the entrenched behaviors.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Many people use food in emotional ways, but not everyone is wired so that the initial manipulation of food becomes a full-fledged eating disorder. For some normal eating returns, and for others the behaviors lead to an eating disorder.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Any treatment needs to take into account the necessary steps to normalize food, track the healing and regulation of various organ systems and engage the resiliency of the gastrointestinal system both for digestion and for hunger/fullness. The physical healing almost always precedes the emotional healing. The body needs to function first for the mind to follow.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Most of the newer support systems focus on the emotional and psychological healing. In many ways these programs are modeled on the older, more established network of treatments available for substance abuse. The treatments are very educational; patients and families alike are much more informed about eating disorders than ever before. But the programs need to include the medical aspect of eating disorder recovery as well.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Without the focus on physical healing, the risk in treatment is for many people to make emotional strides and remain physically sick, unable to make consistent progress with normal eating and gastrointestinal function.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Treatment programs help to a point, but too many people experience programs as intrusive, as if people have to endure forced eating which they can reverse once discharged back into their lives. All the more recent chatter about weight loss drugs and surgeries in recent years only reinforces the glorification of thinness.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Expanded access to treatment has greatly improved the education about necessary emotional and psychological strides for recovery. These illnesses are known to be intractable for a reason, and the entrenched physiological effects are a major cause. It’s the job of any clinician to recognize this fact and be sure to include physical and psychological needs in any treatment.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-59844239480055171882024-03-09T07:01:00.004-05:002024-03-09T07:01:20.684-05:00What Treatment Loses with Telehealth<p><span style="font-family: Palatino; font-size: 14px;">Telehealth in therapy is here to stay. The abrupt transition to remote treatment in eating disorder work during the pandemic was noteworthy. There won’t be a return to mostly in person appointments. That ship has sailed. We all—clinicians and patients—have agreed to this new method of treatment.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">It’s clear what has been gained from telehealth: increased access, convenience and new programs for in home treatment.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">The practical considerations of treatment work well remotely. Monitoring food, cognitive tools to combat eating disorder thoughts and even group sessions for people with similar recovery experiences are all effective in this new modality.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">However, another equally important question, one that few people are asking, is what have we lost?</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Eating disorders require secrecy, isolation and obfuscation to remain powerful in a person’s life. These behaviors aren’t nefarious. In order to stay sick, people with eating disorders need to hide what they are regularly doing. Remote treatment can’t address the secrecy easily.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The screen provides an easy means for people with eating disorders to hide. They can hide their bodies. They can hide their thoughts and feelings. They can hide their behaviors. They can hide their true selves and create enough of a persona to slide by unnoticed.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">And that’s what people with eating disorders find themselves doing. They remain unseen in the world and feel safe and protected. The thoughts and behaviors that structure their lives stay omnipresent, and the remote work means no one can ever really spend time with them, can fully see them.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">I am an advocate for at least some in person sessions, especially with a therapist. Telehealth will work to a point. Symptoms will improve, but the fundamental emotional and psychological work will lag unless the therapy relationship has an in person component.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-74846769248350604772024-03-02T07:42:00.004-05:002024-03-02T07:42:41.161-05:00The Effect off Social Media Exposure in Eating Disorder Treatment<p><span style="font-family: Palatino; font-size: 14px;">Social media has changed eating disorder diagnosis and recovery greatly in recent years. Long before seeking help, most people these days are aware of their eating disorder, have read, listened to or watched media that explained not only the disorders but various symptoms and the path of recovery. Thus, education about eating disorders is now largely delegated to online platforms so therapists can both clarify what people learn online and individualize treatment for each person.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Patients used to start treatment often more confused about the diagnosis and without much knowledge of treatment. Now any clinician in this field must assume a new patient is aware of diagnoses and has a lot of information at their finger tips. And since social media posts about eating disorders are very specific about thoughts and symptoms, people are often aware of subtle and specific elements of their disorder.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Treatment needs to incorporate this added knowledge into the therapy relationship and also to respect the vantage point of all patients seeking help. They enter the relationship with a lot of exposure matched with the personal knowledge of their own eating disorder. In fact, their experience needs to dictate treatment much more than ever before.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">A therapist can tailor the information the patient has and use their own experience to guide therapy while simultaneously recognizing that this person’s knowledge must play a vital role going forward.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">In many ways, this new entry point into eating disorder treatment is preferable. It levels the playing field. The therapy is immediately a partnership—a crucial element of most successful recovery.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">There are a few caveats. Not all information online is true, but that can be easily discussed. Younger people and adolescents may need more guidance to assimilate the social media exposure into effective therapy. More information to assuage fears of what treatment looks like will be useful to counter the recovery stories with more difficult outcomes.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Ultimately, the therapist needs to respect the knowledge, exposure and introspection that precedes starting treatment. The effect of the availability of information about eating disorder can and should improve treatment and outcomes.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-69927898093846441782024-02-24T11:31:00.003-05:002024-02-24T11:31:18.867-05:00What will the Ozempic World Look Like? Part 2<p><span style="font-family: Palatino; font-size: 14px;">The recent posts in this blog hypothesize about changes in our relationship with food and our bodies after the advent and proliferation of GLP-1 agonists like Ozempic and Mounjaro. To be clear, many beneficial purposes for these drugs exist: diabetes and metabolic issues, to name two important ones.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">But this new class of drugs also lands squarely in the camp of life enhancers, not just medications to treat illness. What I mean by this term is drugs with benefits people deem attractive but not necessarily therapeutic. Stimulants like Adderall are a good example of a drug people use for extended hours of focus or appetite suppression and not always for the medical indication, ADHD.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Right now the craze for these drugs is largely based on how new they are and how inaccessible they can be. Over time, they’ll become cheaper and more available. Doctors will prescribe them even more freely. Like it or not, GLP-1 agonists are going to be part of our culture.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">We need to expect and accept that people won’t have clear hunger cues, will lose and gain weight easily and repeatedly and will raise children who, in a post-GLP-1 agonist world, believe hunger and weight are malleable and controllable factors of life.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Granted, we all have been living in a world trending in this direction for years. There used to be room for changing norms of body shape and size. Industry and capitalism have hardened the glorification of thinness in ways that are going to be next to impossible to undo. With these new drugs and doctors’ obsession with weight loss, the pharmaceutical and medical industries mean these norms are here to stay.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">A concomitant result is the permanence of eating disorders. The nature of these disorders will continue to grow and change in cultural ways as they have in recent decades. Eating disorders caused by GLP-1 agonists are the new frontier.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Since dieting and food restriction are the primary risk factors for eating disorders, we collectively have decided to allow the overvaluation of thinness to continue to condemn people to develop eating disorders.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Going forward, the goal is to catch and treat eating disorders early and aggressively. The clinicians who treat these illnesses can’t contain external factors but can increase education and awareness.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-57426707743728628352024-02-11T10:21:00.003-05:002024-02-11T10:21:18.621-05:00What will the Ozempic World Look Like?<p><span style="font-family: Palatino; font-size: 14px;">Hunger is one the most powerful and essential ways our bodies communicate with us. Put simply, hunger prioritizes the need for food as sustenance and for survival.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">The meaning of hunger has changed greatly due to a transformed food supply for many countries in recent decades. After centuries of food scarcity as the obstacle to survival, humans created societies with bountiful food, more than can be eaten and often with a huge amount of waste.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">We aren’t designed to know how to handle excess food. Hunger is an acute feeling intended to focus all senses and thoughts on procuring food. Subtle hunger cues can be harder to assess, but the plentiful food for many people obfuscates hunger cues altogether.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The new world of excess food opened the door to many new approaches and industries aimed at manipulating our dulled hunger cues with the supposed intention of improved health but mostly aimed at weight loss.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">These factors include diet culture, the obsession with thinness, unsubstantiated nutrition suggestions and ill-researched medical recommendations. Almost all of these ideas infer that our hunger cues are actually misleading. Instead, these new guidelines purport to show us the best way to eat.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Even though medications have suppressed hunger cues for decades, the new GLP-1 agonists practically turn off hunger for prolonged periods of time. No previous intervention has been so powerful. The advent of the medications—in addition to the over-valuation of thinness and limited attention to adequate nutrition—is posing new hazards to our well-being.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Typically, suppressed hunger led to significantly increased appetite, binging and weight gain. The body overreacts to long periods of undereating with a strong hunger response meant to promote survival. Older medications, Bariatric surgery and dieting all triggered subsequent increased and often uncontrolled hunger. Although people experience this reaction when going off these new drugs, what happens if they stay on them indefinitely?</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The jury is out at the moment about long-term outcomes. If there are no unforeseen side effects that lead to pulling these drugs off the market, the GLP-1 agonists and the even more powerful medications coming down the pike are here to stay.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">As physicians, we are likely to see people with similar medical consequences as with Anorexia or with other appetite suppressing interventions. Slowed digestion and gastrointestinal functioning is an inevitable and often a permanent result of decreased eating. Chronic malabsorption of various minerals and micronutrients can cause a host of diseases rarely seen in medicine and thus hard to diagnose. Slowed cognitive functioning almost always results from decreased nutrition. And this is just to name a few.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">My best guess for the results in a society using this new medication routinely is a generally thinner population with chronic medical and psychological effects from the long-term effects of malnutrition. As much as medicine continues to conflate weight and health, we as a population will talk about getting healthier while in many ways we get sicker. It will be up to the country at large to decide if the sacrifice is worth it.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-24504722275380044362024-02-03T06:46:00.003-05:002024-02-03T06:46:52.307-05:00Hunger in the Ozempic Era<p><span style="font-family: Palatino; font-size: 14px;">People with eating disorders are usually afraid of hunger. The advent of the long acting GLP-1 agonists like Ozempic and Mounjaro not only reinforce this fear but create an environment for a more widespread aversion to this basic human function.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Hunger cues represent one crucial way our bodies can communicate with us. The cues can be subtle like a feeling of emptiness in our stomachs or an increased interest in food, moderate like feeling a bit weak or irritable or strong like lightheadedness or a gnawing need to eat now to the exclusion of any other thoughts or desires.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">No matter the level of urgency, hunger cues allow our bodies to tell us what they need. Hunger increases our cognitive focus on food and, historically, ensures an increased likelihood of survival.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">If society values thinness over many other necessities of life, hunger takes on a very different meaning. Hunger can feel like a nuisance, a weakness, a temptation or even a sign of loss of control. People very focused on weight will attempt to find ways to tolerate, avoid or negate hunger without eating.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">To an even greater degree, people with eating disorders seek any way to neglect and ignore hunger cues at all costs. As I have written many times in the blog, people with eating disorders eat what and when they are allowed by the illness, not according to hunger cues.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">There have been many pharmacological and surgical attempts to mitigate hunger, but none of have been nearly as successful as the GLP-1 agonists. Thus far, this new class of medications can suppress hunger for long stretches of time leading to periods of undereating and weight loss without allowing our biology to override the medication with rebound hunger. The jury is out about long term effects, but these medications have introduced a new dimension of medical intervention into modulating hunger.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Although there are many ways our attitudes about hunger, food and weight will change in this new world, my concern in this post is about hunger. The idea that hunger cues can no longer play a large role in daily life for many people is a monumental shift in daily functioning and in eating disorder recovery. Tolerating hunger and learning to read body cues have both been critical parts of eating disorder recovery. Many people may now choose medication over an essential part of recovery.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Just as concerning, children brought up in the world of GLP-1 agonists will believe hunger is a feeling that can be medicated away, not a physical sign that the body needs food.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Fear of hunger is very different from the ability to medicate hunger away. Is it safe to ignore signs of hunger? What are the risks of ignoring such a fundamental aspect of being human? That will be the basis of Part II in the next post.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-42522858707434402922024-01-28T12:24:00.002-05:002024-01-28T12:24:47.190-05:00Chronic Anorexia Vs. Terminal Anorexia<p><br /></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The recent article about Anorexia Nervosa in the <a href="https://www.nytimes.com/2024/01/03/magazine/palliative-psychiatry.html" target="_blank">New York Times</a> informed its readers about the severe medical consequences of this illness. In fact, the article made the case that some people with Anorexia might do best with palliative care, perhaps even assisted suicide.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">For a clinician who treats people with eating disorders, the article did not talk about anything new in the field but focused largely on the most extreme cases.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The two doctors the article highlighted work on the medical floor which treats the most acutely sick patients in the country, aptly names ACUTE. Doctors know to send the patients in need of highly skilled medical care for eating disorders to this ward. I have worked with them many times, and they are uniquely able to shepherd these patients to a medically stable place for residential treatment.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Accordingly, these doctors also see a larger percentage of the sickest patients, including some who are so chronically ill that they may either need care to help manage severe intractable symptoms and may not survive their hospitalization.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Clinicians in private practice also see patients this sick who may refuse to go to ACUTE or be ineligible due to insurance issues. Some of these patients also won’t survive their eating disorder.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Calling the illness these most severe patients have terminal Anorexia as opposed to chronic Anorexia is dangerous. Since the ACUTE doctors don’t follow the most ill patients with Anorexia long term, only during their weeks long hospitalization, they may not have appropriate perspective to coin a new diagnosis.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Some patients with chronic Anorexia do need management of their medical symptoms, without hope of recovery, and some are not able to survive. However, a number of patients I have seen who would have qualified for this new term not only survived but fully recovered, and a few of them went to ACUTE as well.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">I’ll link an old post from this blog about Chronic Anorexia as a counterpoint to the <a href="https://drlissakblog.blogspot.com/2023/11/rethinking-classification-of-anorexia.html" target="_blank">article</a>.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">An article read by many people about the severity of Anorexia is useful for general knowledge and understanding about this illness. However, using the platform to expound on a new diagnosis without consulting doctors in the field is risky.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Any new direction in diagnosis and treatment needs to rely on a consensus of clinicians, not the opinions of a couple of knowledgeable doctors with a narrow lens on the field.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-91770784541459779462024-01-21T19:09:00.003-05:002024-01-21T19:09:59.529-05:00Standardizing Training for Eating Disorder Treatment<p><span style="font-family: Palatino; font-size: 14px;">Training for clinicians to treat people with eating disorders is limited, unregulated and often unsupervised. The result is very uneven clinical care and often treatment that can be as harmful as it is beneficial.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Eating disorders are different from all other psychiatric disorders largely because there are frequent and severe medical consequences.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Psychiatrists typically avoid treating these patients and often take a very limited role in care if they do.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Even more problematically, medical doctors in other specialties who track the progress of these patients are also often limited in their knowledge of the complications of eating disorders. Medically, eating disorder patients have very different issues and need care from doctors who understand these illnesses, but those doctors are hard to find.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Due to the limited medical care, other clinicians worry about seeing eating disorder patients, especially the ones who are more ill. In addition, there is no standard training program to help clinicians learn how to treat people with eating disorders.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The result is that finding the right treatment for an eating disorder can be difficult. Some programs—non-profit organizations or residential programs—offer more training than there used to be. Many clinicians learn some strategies and approaches by working for various programs as well.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">However, there is no standard method or text to instruct clinicians of all types how to treat these patients. And patients suffer because of it.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Despite the rise in prevalence of these illnesses, the increase in treatment has been driven by financial gains, namely venture capital firms buying and expanding treatment programs. The question is who might standardize treatment for the clinical community so there is a way to determine providers with adequate care for these serious illnesses.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">As much as this step is needed, it remains difficult to see how and where the next progress can begin.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-79106570246625663342024-01-13T06:10:00.003-05:002024-01-13T06:10:50.715-05:00The Role of Regular Weighing in Eating Disorder Treatment<p><span style="font-family: Palatino; font-size: 14px;">A standard focus of treatment since the beginning of the eating disorder field is weight. It’s easy to see why weight feels imperative to recovery and health, but the pitfalls of prioritizing weight are equally disruptive, if not counterproductive.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Almost any time someone starts eating disorder treatment, weight is one of the first things to be discussed and monitored. Typically, a dietitian or primary care doctor will weigh the person once weekly, thus establishing a precedent that weight is indeed a—if not the—most important data point in recovery.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">People with eating disorders almost always are very focused on weight. The driving force for the disorder itself is most frequently about lowering or maintaining the number on the scale. By charting weight from the start, the treatment team sends a clear message: weight is the most important factor on treatment.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Unintentionally, the eating disorder thoughts feel vindicated! Someone with an eating disorder can’t easily tell themselves that weight is not important. Look at what the team is making a top priority. Rather than start the process of treatment towards health and meaningful parts of life, instead weight is still paramount.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">How much eating disorder clinicians have gone in the wrong direction.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">In the best case scenario, people in recovery don’t know their weight for years. Over time, they have less and less association with their weight. So when they finally know their weight again, years after they have been doing well, the number does not have much meaning anymore. This does happen often because it’s very hard to measure weight weekly and still tell the person weight does not matter. So the ideal way to manage this data point over time is a very unlikely scenario using the current treatment model.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">A newer method of managing weight is to make the number on the scale an open part of treatment from the start. Patients will know their weight through the entire process of recovery. The goal is immediate exposure to the number, thereby placing weight as an equal measure of recovery along with meal plans, overall health and thoughts and feelings about recovery and life. At least this plan doesn’t make weight a magical number hidden from the patient.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">A final idea is to measure weight much less frequently. Since insurance providers prioritize weight as a means to justify treatment, weighing people less is difficult. But treatment needs to consider how weight can derail care by reinforcing how important and powerful the number on the scale really is. Either making open weights part of recovery or weighing people less often are worthwhile directions in treatment to consider.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-81351544978546240172024-01-06T09:38:00.001-05:002024-01-06T09:38:03.695-05:00 Respect and Autonomy Help Avoid Treatment Trauma<p><span style="font-family: Palatino; font-size: 14px;">The evolution of eating disorder treatment began with adolescent girls with Anorexia Nervosa starting in the 70’s through the early 80’s. The field was new and the symptoms and course of illness confusing. Clinicians were not sure how to approach children in severe medical and psychiatric distress because they were unable to eat. However, the initial population needed to be treated as children because they were for the most part young, very ill and severely impaired by starvation.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Treatment programs in hospitals and later residential programs designed clinical approaches with this population in mind. Systems included a reward/punishment model based on good behavior, chaperoned bathroom visits and passes for any trips outside the program’s designated space.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">It was possible to justify these guidelines because the majority of patients were young, but the larger problem is that programs have not substantially changed their thought process despite the much broader set of patients now seeking care. The varied eating disorders encompass many more types of symptoms, and the patient population spans a much larger age range.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">At this point, patients often avoid treatment programs because they know the approach is not meant for people like them.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Infantilizing patients sends many troubling messages. Patients feel responsible for and ashamed of their illness. It’s impossible to equate eating disorders with other illnesses using this treatment approach. And people struggle to trust clinicians who blame everything on the eating disorder and don’t respect or value the people themselves who are struggling.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Eating disorder recovery needs to be a collaborative process. Certainly, patients need to learn about their disorder, how the thoughts and symptoms work in tandem and why the symptoms are so hard to overcome. At the same time, clinicians and programs need to respect the autonomy and maturity of their patients. People with eating disorders are real valuable people who need to hear that message from any program from the very start of treatment.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The double-barreled destructiveness of a program treating people like children and not showing respect is hard to overcome. The message is to not trust themselves or clinicians. How can this message lead to recovery and health?</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Any program must pay attention both to the immediate welfare of anybody entering their program and chart a reasonable course towards true recovery. Treating people like children who can’t be trusted frankly does the opposite and potentially opens the door to traumatic experiences which only makes the eating disorder more entrenched. Trust, respect and autonomy are the bedrock of starting any eating disorder treatment in any setting.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-61202399009854291902023-12-16T08:03:00.005-05:002023-12-16T08:03:27.133-05:00The Trauma of Forced Treatment for People with Eating Disorders<p><span style="font-family: Palatino; font-size: 14px;">Forced treatment has been a component of eating disorder treatment since its inception. The concept of a treatment intervention began in substance abuse treatment and transferred primarily to severe cases of Anorexia Nervosa.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">The theory behind an intervention is that a central facet of the illness is denial. The person has little if any insight into the problem, minimal desire for change, if any, and significant risk of medical symptoms or even fatality.</p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Forced hospitalization feels like the only option for families in this situation as they fear for the safety, health and even life of their loved one. With encouragement from professionals, families, often reluctantly, agree to take this drastic step.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The intervention undoubtedly leads to short-term relief. The person is temporarily safe. Their medical and psychiatric conditions improve from nutrition, and the family hopes that the intervention predicts healing and recovery.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">However, people with anorexia forced to eat will comply in the short-term, but that nutrition will not change the core beliefs of the disorder about food restriction and weight loss. Rarely, an early intervention can reverse the course of the illness, but much more often this step hardens the eating disorder thoughts and behaviors as a reaction to being trapped to do the action most abhorrent and terrifying to them. Even though families may even not feel like there is a better solution in the moment, interventions are far from a panacea.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">One major risk of forced treatment is the traumatic effect on the patient. They will feel as if they are being forced to do the one thing that every part of their being is fighting. The thoughts are so strong to restrict and each bite, each snack, each meal can cause extremely painful emotional responses. For others who don’t have anorexia, the pain caused by forced eating is hard to imagine.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">As the person endures the food and weight gain that follows, many feel traumatized by the experience. They feel they are forced to do something extraordinarily painful day after day for months with minimal understanding or compassion. They feel abandoned and betrayed by their loved ones and locked up in a tortured environment for months on end.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The younger the patients, often the more traumatic the responses.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The result is not only hardened eating disorder symptoms but trauma symptoms such as constant reminders of the treatment, nightmares and fear of the people they love most.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Seeing patients years out from their experience still having trauma symptoms certainly makes one question the benefit of forced treatment.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The trauma caused by forced treatment is one the eating disorder treatment community needs to grapple with and needs to stop.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">When forced treatment is needed to save someone’s life, then thoughtful steps to mitigate the potential trauma need to be considered. If that means shorter term care to stabilize someone medically rather than months of treatment, that may be a more humane and compassionate step to consider. Any intervention must take into account the risks from the start.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-62036433921974504332023-12-09T08:07:00.003-05:002023-12-09T08:07:27.022-05:00 The Causes of Trauma Caused by Residential Treatment<p><span style="font-family: Palatino; font-size: 14px;">At an eating disorder clinician holiday party last week, an outreach representative from a venture-owned eating disorder treatment program approached me. As she discussed the changes in her program, she focused on how beautiful the new outpatient facility is, as if a new renovation were the best selling point for comprehensive eating disorder care.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">The obvious takeaway is that the monetization of eating disorder treatment has supplanted the need for effective and compassionate treatment.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">But my mind drifted instead to an ignored topic in eating disorder care: trauma caused by residential programs and hospital programs.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">To be clear, many people receive substantive, effective care at these programs, even the ones backed by financial companies.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Many people, especially young people and adolescents, also have traumatic experiences at treatment programs which cement the power of the eating disorder and layer an unnecessary and entrenched mental health issue which makes recovery much harder. A traumatic treatment experience often leads people to stop seeking care completely. Destroying trust in the treatment process forces patients down a path of a chronic eating disorder and little chance for recovery or even relief.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Sometimes a treatment program won’t be helpful and that’s ok. But no treatment should be traumatic and worsen a patient’s illness. That’s unacceptable.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The next few posts will focus on various ways residential and hospital-based programs are traumatic. I’ll also focus on ideas to limit this horrible and avoidable damage.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The posts will discuss the following ideas: forced treatment stays, treating patients like children, relentless focus on weight in recovery, ensuring programs have adequately trained supervisors and creating a standard for adequate education and experience.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-35057704746268243032023-12-02T07:28:00.004-05:002023-12-02T07:28:21.248-05:00The Place of Eating Disorders in the History of Psychiatric Illnesses<p><span style="font-family: Palatino; font-size: 14px;">Psychological maladies have shifted due to cultural changes in the history of the last two centuries. The psychological and emotional struggles are consistent, but the physical symptoms associated with that stress change due to new societal norms and expectations.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">There have been various symptoms over these years as a result of stress and anxiety: fainting spells, prolonged periods of weakness, “hysteria,” mental breakdowns, self-harm and now eating disorders.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">The sharp rise in the incidence of eating disorders in the most recent decades reflects the transition of psychological symptoms in the climate of diet culture. The extreme focus on thinness encouraged young people to diet in order to manage their emotional struggles, and dieting is the number one risk factor for developing an eating disorder.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Like all of the manifestations of emotional issues, addressing the physical issue will uncover the psychological ones. However, eating disorders are different.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">For the other issues, working on the emotional piece can eliminate the physical symptom almost immediately. For eating disorders, the fundamental change in eating disorder behaviors doesn’t change so easily.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The disordered way of eating is often ingrained quickly for people with eating disorders as a way of coping through the numbing effect of the symptoms and the powerful, unconscious eating routines that can be comforting.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Once the mind and body adjust to a new way of eating, even a disordered one, it takes an enormous amount of work to make a new eating pattern stick. As the person finds new ways to cope emotionally with the struggle that led them to the eating disorder itself, they also need to relearn how to eat. The process of figuring out how to eat can take a long time and a lot of effort.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The epidemic of eating disorders stems from the transition of emotional struggles to the newest cultural phenomenon: diet culture. As it turns out, reversing eating disorder symptoms take a lot more time and effort than reversing other physical manifestation of other psychological problems in past generations.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-25197693188744807942023-11-23T08:21:00.004-05:002023-11-23T08:21:47.177-05:00Support for People in Recovery During the Holidays<p><span style="font-family: Palatino; font-size: 14px;">This time of year is among the hardest for people with eating disorders. Holidays focus on food as a central part of the celebration with much fanfare and little escape. The result is extremely high anxiety for people with eating disorders combined with feeling an enormous amount of exposure and pressure.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Since there is no way to change the nature of the holidays, how can people with eating disorders and their family and friends make the time of year more manageable?<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">First, people with eating disorders can try to prepare by telling themselves some facts about this period of time. As hard as it seems, the time is short and will end soon.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Second, the internal pressure is almost always harder and more intense than the external pressure.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Third, have a plan to take breaks and to designate one person at the holiday to be the person to rely on for support. Feeling less alone makes this time a bit easier.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Friends and family can support people with eating disorders first and foremost by being kind and understanding. Eating disorders are so isolating, and any attempt to provide support without judgment goes a long way.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Checking in with the person to see how they are helps a lot as does distracting them by having a conversation about something else or taking a walk.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Ultimately, all support from a kind place is the most important support.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">In the end, preparing for this time of the year can make the holidays more manageable for people in recovery. Now would be the time to strategize how to make things easier during this period.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-27620171585964585802023-11-18T12:39:00.004-05:002023-11-18T12:39:44.127-05:00Rethinking the Classification of Anorexia Nervosa<p><span style="font-family: Palatino; font-size: 14px;">In the last post I mentioned how social media has increased communication and awareness about eating disorders and has led to new ideas about adjunctive diagnoses and treatment. The broader knowledge has also led people to seek help earlier and had a significant impact on the classification of eating disorders, Anorexia Nervosa specifically.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Years ago, I wrote a series of posts about the difference between acute and chronic Anorexia. At the time, those posts reflected the awareness and stigma about eating disorders, both of which limited early diagnosis and treatment.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Overall knowledge about eating disorders is much more broad now, especially for the younger generation. In addition, this generation is very focused on mental health with much decreased stigma about seeking diagnosis and treatment.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Accordingly, people with eating disorders look for treatment much earlier, often before they meet criteria for a full-fledged disorder. Anorexia in particular is much more easily treated before the eating disorder thoughts blend with a person’s own thoughts and before the behaviors become central to one’s well-being.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">People so early in their illness almost never sought diagnosis and treatment so early in the past. As expected, the patients who get help earlier often recover quickly and fully.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">In my mind the phenomenon of earlier diagnosis of Anorexia diagnosis points to a new way of classifying this illness into three stages.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Early stage Anorexia Nervosa can denote patients with symptoms for less than two years and whose eating disorder thought processes are not as entrenched. Immediate and intensive treatment can lead to a faster and long-lasting cure.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Middle stage Anorexia Nervosa identifies people with at least two years of illness and much more defined psychological identification with Anorexia. Disentangling eating disorder thoughts and actions is much more complicated and likely needs more time for treatment and recovery.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Late stage Anorexia Nervosa is a small subset of people with minimal or no change over many years of treatment and no interest in recovery. Management of the disorder keeps medical symptoms stable and helps people function as well as possible.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The middle group is still the largest percentage of people and can itself be broken up into several stages. The first group is the newest and represents the most significant change that arises from the increased communication about eating disorders in social media.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-43218749085063861492023-11-11T07:29:00.003-05:002023-11-11T07:29:59.961-05:00How are Patients Driving Changes in Eating Disorder Treatment<p><span style="font-family: Palatino; font-size: 14px;">The last post reviewed the connections between Anorexia Nervosa and several chronic medical and psychological illnesses. The reason I felt compelled to write the post is that clinical assessment of people with Anorexia now necessitates considering a variety of other concomitant illnesses. It felt important to highlight some of the relatively recent changes in eating disorder treatment.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">However, the driving force for these changes is not from the medical or psychological field. Instead, social media and information by laypeople have opened the door to different avenues for diagnosis and treatment—certainly a new direction for medical care in its entirety.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">One entrenched issue with eating disorder care is the reflexive conclusion clinicians draw to attribute all medical and psychological phenomena to the eating disorder. It’s all too common for eating disorder patients not to be diagnosed with other conditions because clinicians blame everything on the eating disorder. So patients end up searching for ways to explain their medical symptoms since they are often ignored by doctors.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Moreover, the eating disorder community is disjointed enough such that communication about clinical findings tends not to be shared in a useful way. Treatment programs see people for relatively short stays and don’t communicate well with outpatient teams, as I have written about extensively here. Hospitals also function separately. And clinicians in an outpatient setting function for the most part independently. Poor overall communication about diagnostic trends won’t move the needle for new concepts in eating disorder treatment.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">But now patients have a way to communicate with each other, post on social media, create videos for hundreds or thousands of people to see. In other words, patients can much more easily create communities, share ideas and begin to explore connections between eating disorders and other illnesses than clinicians.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Therefore, the clinical community is playing catch-up with laypeople’s theories. We are learning how ADHD works for people with eating disorders, adapting assessment for autism in adults and finding referrals for inflammatory diseases and MCAS. And this feels like only the beginning.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Let’s hope sharing of information helps clinicians chart a course for more successful treatment as well so people don’t have to suffer alone so much anymore.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-87375564458326041542023-11-05T07:46:00.003-05:002023-11-05T07:46:19.487-05:00New Developments in Chronic Anorexia<p><span style="font-family: Palatino; font-size: 14px;">In recent years the correlation between Anorexia Nervosa and several groups of illnesses has become evident. Uncovering these connections, for the most part, can’t be found in medical journals. Most of the discussion occurs in lay writing and especially on social media.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">However, as a clinician treating people with eating disorders, I can’t ignore the clear connections between Anorexia and these illnesses even though a clear path to diagnosis and treatment remains elusive.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">The first set of connections is between Anorexia, Attention Deficit Disorder (ADD) and Autism. There is a set of people with chronic Anorexia who tend to have some if not many symptoms of the latter two disorders. The information often feels validating for people who have struggled with Anorexia and felt unlike many patients and often felt ignored for their differences.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">There is no clear guideline about how to treat these patients differently at the moment other than to treat the ADD and give guidance for understanding autism and looking into ways to understand how and why relationships may feel different for these patients.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">One compelling theory is that these patients with Anorexia may have a specific genetic variant that increases the likelihood of all three disorders. At this point, it is only a theory, but even the possibility of a genetic cause can be helpful for many people.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The second illnesses connected with Anorexia are a set of inflammatory and autoimmune disorders. The inflammatory diseases largely center around MCAS (Mast Cell Activation Syndrome), an illness defined by a hyperactive inflammatory response to stimuli that can cause widespread inflammation, pain and swelling throughout the body.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">For some people, they also develop undefined autoimmune symptoms. Autoimmune disorders are defined by the immune system misidentifying parts of oneself as foreign and then attacking one’s own body. For many people with eating disorders, these symptoms remain undefined rather than turning into common autoimmune disorders such as Rheumatoid Arthritis or Lupus.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Treating MCAS or autoimmune symptoms has standard protocols that can be followed just as for patients who don’t have Anorexia. Diagnosis and treatment can bring a lot of relief which helps patients have energy to focus on recovery.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">There are also many theories about the connection between inflammatory symptoms and Anorexia, but none of these thoughts have any scientific or medical evidence as of yet.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">One critical difference between these two sets of illnesses is how they connect with food restriction. The first set of symptoms are present with or without the eating disorders. However, eating can sometimes unmask inflammatory symptoms which are possibly suppressed by food restriction.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Putting together the information connecting Anorexia and these various illnesses can begin to inform clinicians about the medical and genetic causes for eating disorders. Clinical research will need to take these connections seriously first and begin to study them before there are any clear changes in clinical treatment.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-80556234682192946472023-10-28T07:34:00.000-04:002023-10-28T07:34:01.867-04:00Each Person has a Unique Path to Recovery<p><span style="font-family: Palatino; font-size: 14px;">In many past posts, I have written about important elements to successful eating disorder recovery including food logs for accountability, regular contact with a provider to consistently counteract eating disorder thoughts and a meaningful connection with a therapist.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">These parts of recovery remain essential but also are not a bellwether of success or failure in treatment. They are essential for most treatment but not enough to get well.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Just as central to the process of tackling an eating disorder is the individual and personal component of treatment. After the initial, universal steps of recovery such as stabilizing eating, any road to get well is a very individual experience.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">As comforting as it might be, clear and consistent steps that guarantee recovery don’t exist. Each person needs to use the support they have and the structure they learn to figure out how to get well.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Since an eating disorder becomes the foundation of one’s identity, the process of extricating oneself from an eating disorder must allow for the exploration of who each person is.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">And the individual herself can begin to learn their likes and dislikes, their internal emotional world and their desires in the process of getting well.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">No treatment guidelines or overall recovery plan will dictate how getting well looks for each person. Recovery uncovers who each person truly is, and treatment needs to leave room and freedom to explore, not create a false path to become the person a provider might mold or create.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Therapy which leads to a successful recovery is open ended, creative, free but often frustrating. The therapist must allow for fits and starts, confusion and missteps, anger and connection. What remains constant is acceptance, understanding and freedom without judgment.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Creating space to grow and learn works best in that environment and leaves little room for an eating disorder tho thrive.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-65681603220400825102023-10-21T06:54:00.005-04:002023-10-21T06:54:32.064-04:00The Profound Challenges of Eating Disorder Recovery<p><span style="font-family: Palatino; font-size: 14px;">Clinicians, including me, often lay out the broad strokes of eating disorder recovery when someone is first starting treatment. The steps often include at first some form of higher level treatment like the hospital, residential treatment or outpatient group programs. Following the initial stabilization of food intake and medical health, the longer and more challenging part of recovery involves an outpatient team with one or several appointments per week. This stage of recovery reinforces regular eating and focuses on the emotional and psychological transformation that inevitably comes with meaningful recovery.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">The second part of treatment sounds clear and streamlined. It is anything but. As difficult as the initial food stabilization can be, the personal transformation that accompanies a new life in recovery is inevitably a lot more challenging.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">As a clinician, I know that any new patient who is truly engaged and determined to take the path of recovery will reach many points along the way of frustration, sadness, confusion and loss. And even if I describe what this course may look like, no words can prepare someone for the feelings of going through this existential, deeply felt and often wrenching change.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Eating disorders don’t simply comprise a series of eating behaviors and thoughts about food and weight. They represent a philosophy about how to live, about what feels truly meaningful and a moral guide to what is right and wrong. Since eating disorders usually start at a young age, people tend to develop their understanding of themselves and the world through the lens of the eating disorder beliefs.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Hence, recovery demands shedding one’s full understanding of how to live and necessitates starting fresh almost creating a new sense of identity. It’s hard to conceive of reimagining who we are after years of developing an identity based on the life and values we already know. No other recovery means starting over in quite the same way.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">A clinician’s role is not to devise a new identity, explain new values or imply they know better. Instead, the clinician needs to be along for the ride and ready to embrace any feelings and experiences the person in recovery goes through and concomitantly provide comfort, support and understanding.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Life with an eating disorder will always be limited in scope and devoid of space for true connection and meaning. The eating disorder takes up so much energy and time that there is no room for a more complete life experience. The road to recovery is not an easy one, but it does make possible the ability to create one’s own sense of meaning, not just the eating disorder’s, in one’s life.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-41739732805622948372023-10-05T15:43:00.001-04:002023-10-05T15:43:03.410-04:00What People in Eating Disorder Recovery Value Most<p><span style="font-family: Palatino; font-size: 14px;">Compassion and kindness need to be present in eating disorder treatment. Increased awareness and knowledge about eating disorders have helped lead to earlier diagnosis and treatment but haven’t helped family, friends and sometimes even clinicians remember that eating disorders are psychological illnesses, not merely a measure of willpower.</span></p><p><span style="font-family: Palatino; font-size: 14px;">Many people expect that once someone is getting experienced help for their eating disorder that improvement and recovery aren’t far away. It’s hard to recognize that being in treatment is only a first step.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">For so many medical conditions, treatment leads to improved health and the resumption of normal life. Eating disorder treatment instead results in a long process of recovery and many profound changes not just in how one eats but also to the core being of that person.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Since eating disorders become a focal point for one’s identity, getting better also means unwinding what feels like an inextricable sense of oneself and creating a new identity. That change takes time and enormous effort. Recovery is not a matter of days or weeks but instead months or years.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">True support for someone in recovery needs to be grounded in patience, kindness and compassion.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Patience allows the person to believe getting better isn’t a race against time or a constant feeling of failure. Instead, recovery is a journey of self-discovery and self-care that leads to a new and improved way to live.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Kindness will give the person in recovery a new way to consider treating themselves. Instead of the harsh, critical thoughts of the eating disorder which always reinforce the feeling of not being good enough, kindness can introduce the concept of caring for oneself emotionally in addition to physically.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Compassion reminds everyone that an eating disorder is an illness that happened to someone and was not a choice. Recovery from an illness deserves compassion for the pain and suffering caused by the illness and love and support for the patience needed to find health and internal peace.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant-position: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Frustration, disappointment and struggle are always going to be a part of recovery. For the people truly providing support for someone working hard to get well, patience, kindness and compassion will serve as cornerstones to a path to a new life.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-60204975351192655362023-09-24T07:13:00.005-04:002023-09-24T07:13:55.613-04:00 The Context of Eating Disorder Diagnosis and Treatment<p><span style="font-family: Palatino; font-size: 14px;">The overlap between culture and psychiatry is profound and always has been since the inception of the field. The dearth of scientific information to diagnose and treat mental illness combined with societal bias mean that psychiatry relies heavily on social values and cultural norms to determine treatment. Although other fields of medicine change from social impact, none do so more than psychiatry.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">The definition of mental well being changes through generations. Success can mean many things: professional success, completing an education, a steady job with a family, a thin enough body, the ability to study or work 12 hours per day for weeks and months and years, or spiritual awakening. And the ideal mental state to attain many of these goals is extremely different.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Accordingly, dysfunctional mental states change drastically as social norms change. Odd or unusual behavior that is seen as mental illness now may have been adaptive in smaller, isolated villages centuries ago. A slow and steady temperament may be beneficial in some communities and seem as a sign of a learning disorder in others. Inattention that is a hindrance in school can be more creative and inspirational in times of societal distress. A thinner body may be ideal in certain towns and a sign of illness in a different community even in the same state.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">As these norms change, psychiatry changes as well. Without a clear way to diagnose and treat illness, mental health professionals need to consider the world each patient lives in when thinking about diagnosis. What is considered an eating disorder now may not have been twenty years ago.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The point of this blog post is not to discount psychiatry and mental illness at all. However, we all need to be sure not to conflate psychiatry with clearcut science. The scientific data about the safety and utility of medications or research into best practices when treating eating disorders are sound. The philosophical and moral values about how to proceed in recovery is not only dependent on the person’s medical and psychological state but also on their background and community. Our individual mental health demands context in order to be defined correctly.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-53843398002050850842023-09-14T06:28:00.002-04:002023-09-14T06:28:50.281-04:00 The Broad Changes Occurring in Eating Disorder Treatment<p><span style="font-family: Palatino; font-size: 14px;">The changes in treating people with eating disorders have been dramatic in recent years. Several differences in how we as a culture approach mental health have opened the door to very new ideas about diagnosis and treatment.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">First, mental health is a much more accepted part of overall health. We discuss our psychological and emotional well being as something to be monitored, addressed and taken seriously. The idea that we should tough out difficult experiences and ignore our emotional selves is not the only way to function anymore. Awareness increases the likelihood that family or friends will notice changes in eating behaviors or emotions and say something a lot sooner.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Second, knowledge and education about eating disorders are much more available and prevalent. Mental health awareness is a part of this change, but in addition most people know what eating disorders are and many more people have experienced someone close to them who has struggled with one. Social media exposes people to eating disorders much more regularly, and younger people have a larger breadth of knowledge not just about eating disorders but also diet culture and fat phobia.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Third, the expansion of care with many more treatment programs, virtual programs and clinicians for people with eating disorders makes it possible to be diagnosed and treated much earlier in the course of the illness. Since so more options now accept insurance, many more people have access to care. Treatment options means many people can get help and find a path to recovery sooner in their illness.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">Compared to the relatively recent past, these changes are shocking to consider. The majority of people with eating disorders used to struggle for years before figuring out a diagnosis, let alone find any professional help, but that path is much less common these days. I am much more likely to see a young patient who understands their issue and the help they need than a patient ten years older coming to treatment for the first time.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">This post reflects an important aspect of mental health care, namely how psychiatric diagnosis and treatment changes with cultural changes in our society. I’ll talk more about that in the next post.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-65824339505638726142023-09-02T07:12:00.003-04:002023-09-02T07:12:14.260-04:00 The Contradiction Between Love and Perfectionism in Eating Disorders<p><span style="font-family: Palatino; font-size: 14px;">The last few posts reviewed some central parts of the psychological underpinnings of an eating disorder and, accordingly, aspects of treatment that help people fully recover. Finding purpose, self-worth and a philosophy to make life meaningful are true antidotes to perfectionism, self-hatred and purposelessness.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">At the time, I was very clear about how people with eating disorders often felt unlovable but was unsure as to how to couple this experience more fully with recovery.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">In the last two decades, the pressures on women grave grown and changed in ways that have been instrumental in the explosion in the incidence of eating disorders. The contradictory messages of being both extraordinary and mediocre, perfect and one of the group, exemplary and also humble easily conform to perfectionism around food, body and weight. These impossible expectations both in their behaviors and in their food and bodies for women fit neatly into the paradigm of traits that create an eating disorder.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">What underlies these impossible expectations is the feeling of never being good enough at anything—a tenet of the thought process of an eating disorder. In addition, never feeling allowed to reach a reasonable goal translates into never feeling lovable or worth loving. If love demands perfection, then no love ever seems reasonable or deserved. Love needs to reflect the feeling of being good enough, not being perfect, just as recovery implies doing well enough both with food and in life.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The learning process of understanding love distinct from perfection starts in therapy. Someone in the throes of an eating disorder and the concomitant perfectionism can’t see outside that bubble. Therapy that balances the idea of love for who you are instead of what you accomplish or what you represent can change the fundamental idea of what love is and is a key to recovery.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0tag:blogger.com,1999:blog-4186714349677432888.post-72592467711295541472023-08-24T14:28:00.002-04:002023-08-24T14:28:43.372-04:00Expanded Treatment Options for Eating Disorders<p><span style="font-family: Palatino; font-size: 14px;">Coaching and meal support are two relatively new and important signs of progress in eating disorder treatment. One theme throughout this blog describes the experience that eating disorder thoughts are ever present in a person’s life, and treatment needs to find ways to counter the thoughts and behaviors much more regularly during the day.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">I have written about using daily food logs as a primary way to enable patients to face their thoughts and feelings. This treatment plan continues to work very well.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;">Coaching and meal support offer a different way to provide more help through the day. These modalities focus on extra time with a clinical provider either around daily activities or at meal and snack times.<span class="s1" style="font-kerning: none;"></span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">The provider can interrupt entrenched eating disorder thoughts and behavior patterns and increase the time a patient can try to change these patterns rather than reinforce them. The result is that treatment plans extend into more parts of the day and give the eating disorder less leeway and freedom to dominate a person’s life.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">For coaching and meal support to be effective, the patient needs to be far enough along in recovery to be willing to hear the messages around eating more consistently and why the eating disorder can be so destructive. If a patient is so fixed on staying sick, extra support still won’t make much of a dent.</span></p><p class="p2" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px; min-height: 19px;"><span class="s1" style="font-kerning: none;"></span><br /></p><p class="p1" style="font-family: Palatino; font-feature-settings: normal; font-kerning: auto; font-optical-sizing: auto; font-size: 14px; font-stretch: normal; font-variant-alternates: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variation-settings: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;">These expanded options in treatment allow for providers to create a much more specific plan for each patient. Therapists, dietitians, groups and outpatient programs used to be the only available options. Now coaching, meal supports, online groups, mentors and a variety of mixed programs offer so many more ways to get well.</span></p>Matthew Lissak, M.D.http://www.blogger.com/profile/16514567365841630434noreply@blogger.com0