When Is It Time To Speak Up?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Take care,

Nancy

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

Bring Change 2 Mind

I just started watching a TV show recently called Modern Family. It is hilarious. I've only seen it a few times, so I'm not sure I can do the premise justice, but it's essentially a sitcom that chronicles different members of an extended family and their interactions. (If you're curious, follow this link to check it out.) Anyways, I really do like it, but last week when I was watching, one of the characters made a joke about eating disorders. It's hard to explain what happened since I don't really know any of the characters names, but one of the children was annoyed with his mother and said- "mom, go tend to your eating disorder or something." I'm not sure if this was supposed to be funny, but after the day I had, I was NOT laughing. An eating disorder is a mental illness, and there's nothing funny about that. I didn't turn off the TV and refuse to watch the rest of the episode, but it just struck me that if you replaced 'eating disorder' with any other mental illness- say, schizophrenia- it probably wouldn't be funny either. So why did someone think making a joke about an eating disorder would be funny? This just reminded me that eating disorders aren't widely viewed as psychiatric illness yet.

I think one of the biggest myths about eating disorders is that they are a lifestyle choice- not a mental illness. Yes, there is choice involved in recovery- you have to choose to take steps to recover. But an eating disorder is a mental illness, so it's not as simple as 'just eating'. Glenn Close, the actress famously known for playing Cruella Deville in 101 Dalmatians (ha ha, just kidding- I think she is famous for her role in Fatal Attraction, which I've never seen-- and some other movies too..), started a non-profit called Bring Change 2 Mind. The mission is to raise awareness about mental illness, to work towards de-stigmatizing it while also providing support for those who deal with mental illness. Close's sister and nephew, who both suffer from different mental illnesses, were the inspiration that fueled her to initiate this endeavor. PsychCentral wrote a little article awhile back in October when it launched - to read it, click HERE.

I'd encourage you to check out her site! I'll be honest- right now, there is a slightly annoying pop-up when you access the site, but that's just because Bring Change 2 Mind recently partnered with NAMI (National Alliance on Mental Illness) for NAMIWalks Campaign (a walking campaign to raise money for and awareness of mental illness!). The pop-up is a video, and even though it's slightly annoying, it's actually worth watching :) Once you get past the video, the site is great- there are resources for those who want to learn about mental illness or find support if they are struggling with one, there are videos of people sharing their stories, and there is additional information available that serves to encourage real understanding of mental illness! Right now, eating disorders are not part of their featured mental illnesses- they feature depression, post traumatic stress disorder (PTSD), bipolar, and schizophrenia. However, there are many mental illnesses, eating disorders included, that will hopefully be added as their non-profit grows! At this point, what seems important is that this is an organization that is dedicated to promoting awareness and knowledge about mental illness to de-stigmatize... which is awesome. If you are interested in finding out how you can be involved in any capacity, you can check out the 'be involved' tab on their site!

Maybe the Grinch Was Depressed... ?

Merry late Christmas everyone! Better late than never, right? :) I have been so busy and wish I could have posted sooner, but again... better late than never!!

Even though this post has to do with the holidays, and Christmas is now 364 days away, I think that we are still on the heels of the holiday season. We still have to make it through that awkward week after Christmas/week before New Years- a time that is often used to reflect on the past year while pondering the new one. While we all have things to be thankful for, sometimes the holidays can be overwhelming and the thought of a new year can be daunting.

For this reason, and many others (family stress, financial stress, eating disorder/body image stress), the holidays are not an uncommon time for people to feel sad, grumpy, irritable, ... depressed! I came across an article about depression in which psychologist Cynthia Bulik uses the Grinch as an example of one who exhibits symptoms of depression. In this article (which is titled, Grinch Likely Depressed, Suffers From Lack of Love, Joy) she says, "Everybody's always down on the Grinch. But one of the things I've always asked myself is whether the Grinch himself might be feeling kind of down." She uses him as an example (and it's so cute) which helps to illustrate the different forms that depression can take. What is important to realize is that while often we associate depression with people who are sad, people that are depressed may exhibit little sadness and more irritability, general feelings of misery, and/or social withdrawal.

To read this article, and to find out more about depression, follow this link. And to read a great blog post on assessing depression written by one of my favorite therapist friends,Whitney, follow this link.

Kids, Mental Health and Hope

I like to think that I am a 'glass half full' kind of person. Generally, I try to see the good in people and situations, and am hopeful about change- if I weren't, I'm not so sure that counseling would be the best field for me! All that to say... I noticed the other day that while I was reading an article about young people and mental health, I found myself taking a 'glass half empty' mentality. Why??

Well, according to a survey funded by the National Institute of Mental Health (NIMH) which will soon be published in the journal Pediatrics, 13 percent of all children and young teens have at least one 'mental health disorder.' And of that 13 percent, only half have been evaluated and treated by a mental health professional. These facts indicate that while one half of young people are being treated, one half are not. This is a staggering number when considering that half of all youth with mental illness are receiving no treatment or help at all.

This survey sampled 3, 042 children between the ages of 8 and 15, and the findings were based on assessments of these children for six common mental disorders--anxiety disorder, panic disorder, eating disorders (anorexia and bulimia), depression, ADHD (attention-deficit/hyperactivity disorder) and conduct disorder. For a bit of perspective, imagine if half of young people who deal with diabetes or asthma were living without medical treatment. To think about the number of children and teens who are suffering from untreated mental health issues is alarming. And sad! Research indicates that when mental health issues are not treated, they typically persist and become more severe with age. (I wrote a blog awhile back on teens and depression that addressed this issue- follow this link to read it and to learn some of the symptoms of childhood/teenage depression.) This is concerning because young children and teens who suffer from eating disorders, for example, and are not being treated are at serious risk for many physical and psychological problems. This is a serious issue!

The article suggested that part of this problem is due to the fact that there is a shortage of mental health workers that specialize in treating children, specifically psychiatrists. So what is a parent to do?? Perhaps we need to focus on educating more parents and teachers about the symptoms of anxiety, depression, eating disorders, ADHD, etc.. in children and teens so that they are able to notice the warning signs and advocate for their treatment. While mental health professionals have the tools and knowledge to diagnose and treat, parents and teachers are able to notice patterns of behavior in children over time that a professional is not necessarily capable of seeing when sitting with them for 30 minutes. To read this article in its entirety, follow this link, as well as this one for more info!

The Truth About Dieting..

I have noticed over the last few days that there have been a LOT of advertisements on the radio that have mentioned the so-called 'consequences' of holiday eating and the word diet has been uttered many times in this context. One of the ads that I heard yesterday went something like this: "My pants aren't fitting me.. they are too tight and I can't get them on.. must be all that extra turkey and stuffing I ate. I really need to go on a diet and lose this weight fast. At least jeans are on sale at (-----) for 15$ so I can buy some new jeans until I lose all of this weight." I left out the name of the store not because I have a problem with jeans being 15$, but because the point is not about jeans- it is about how I have been hearing a lot about dieting lately!

Continuing to hear about diets and dieting over the last few days led me to want to post some information about dieting that you may or may not know. This post may be a little long, so bear with me- I think this info will be beneficial. Let me be clear though. I am not saying it is wrong or bad to want to be healthy or to want to feel good about yourself. What I am saying is that there are healthy and appropriate ways to pursue this goal, and drastic measures, unhealthy behaviors, and diets, are not included. Typically, diets promise quick weight loss with no regards to how much weight you actually want to lose, and the end result is that you turn out looking amazing. Diets are deceptions, because they are not capable of such guarantees. Here are some diet myths that help to point out the deception (thanks to Remuda Ranch for providing some of the information below):

Myth #1= You will lose weight. This is why most people pursue a diet in the first place, right? It may surprise you, but research shows that in the long run, 98% of dieters actually end up gaining weight. Why? Because the real issues behind food consumption and understanding metabolism are rarely addressed with a diet. And when unhealthy means are used, the weight loss is usually not maintainable.

Myth #2=You will look amazing as a result of your diet. If your goal is to look like someone else, or to look like some of the images that we regularly see on TV, in magazines, etc.. then you are chasing a goal that is not attainable. These images are altered by computers (check out this video for an example- yikes!). What is more is that a diet will not change your facial features, it will not make you taller, it will not make your legs longer, and it will not make your boobs bigger. Sorry:).

Myth #3=Diets are not dangerous. Whenever you restrict or cut out entire food groups (sugar, carbs, fat, dairy, etc..), this is dangerous-- especially for young people. Our bodies require a variety of foods in order to fuel our organs and keep us functioning effectively. Not to mention that studies show that dieting is an indicator of future eating disorders. A girl who diets before she is 14 is eight times more likely to develop an eating disorder. There are many health risks associated with dieting as well, such as weakened bones, dehydration and decreased heart rate.

Myth #4=Certain foods are bad. Often times, when we diet or approach food with a diet mentality, we label food as 'good' or 'bad.' We may even determine what food we consider to be good or bad based upon which particular diet we are on. The fact of the matter is that all foods are created equal and all foods can fit into a healthy lifestyle. There are no bad foods, only bad diets.

Myth #5= Diets give you control. Having a defined set of rules, especially when it comes to food, may convince you that you will be in control of what you put in your mouth. However, what often happens when you eat the same foods, or follow similar rituals each day with food, you begin to crave foods you have labelled 'bad' or 'outlawed.' This can lead to overeating and binges, which ultimately take you to a place you were trying to avoid to begin with. Also, diets usually make you cranky, they tend to decrease your energy, and they leave you feeling tired and pretty irritable. When you get to this point, the diet is controlling you, and you have little control.

Myth #6= Diets are safe and healthy. Maybe a little repetitive (myth #3), but if you chronically diet, you risk potentially altering the natural weight of your body. Over time, if your body weight fluctuates from higher to lower, and lower to higher, your body generally settles at a higher weight than it would have needed to be if it was not altered in the first place. Our bodies become confused, because they do not know if they will get what they need nutritionally, or if they will not receive any food at all. Our metabolisms slow down because our bodies think we are starving. The irony in this is that the exact opposite of what is intended is likely to end up happening.

Myth #7= You need to follow a diet. Here are some healthy guidelines to follow (compliments of Remuda Ranch) that are not diet-centric. Eat a variety of foods in moderation. Having variety allows for you to meet your nutritional needs; we cannot get all we need from one single food, or from a small number of foods alone. Listen to your body, and your stomach. Eat when you are hungry, stop when you are full. You don't need to eat food just because it is in front of you. Find out if you are eating because you are physically hungry or emotionally hungry (more on this to come..).

To conclude, Karen R. Koenig wrote a book called The Rules of Normal Eating. It is an extremely helpful book for anyone who has struggled with chronic dieting, overeating, undereating, emotional eating and anything in between. I wrote a post on her book awhile back and provided some suggestions that she outlines in her book as they relate to 'normal eating.'. Follow this link for more information.