Childhood Eating Disorders Blog

Dear Readers,

On this blog, Marcia and I have talked about the different ways one can interpret or understand eating disorders. Today, I have a few more for you. One of the hallmarks of a severe adolescent or adult eating disorder is a remarkable lack of joy, an inability to simply be in the moment. Instead, the anorexic or bulimic is always focused on a future outcome, such as “What will happen to me if I cave in to temptation and eat a peanut butter sandwich?” or, “If I don’t exercise every day I will feel like a pig.” Nancy Zucker, Ph.D., director of the Duke Eating Disorder Program at Duke University in Durham, N.C., brought up this singular lack of joy and a few other characteristic eating-disordered traits during a recent interview I conducted with her.  

            Another example: once on the road to recovery, both parents and those who struggled with an eating disorder will often experience what Dr. Zucker calls symptoms of “almost a PTSD [Post-Traumatic Stress Disorder] kind of trauma.” This is understandable because to be locked in the vise of an eating disorder is traumatic, resulting in a loss of identity, control over one’s life, and all too often, the will or physical strength needed to continue living. For the recovered or recovering patient, just the memory of the terrifying power of the disorder or the temptations that could trigger it once again can be disabling, leaving the patient feeling vulnerable and scared. For the parent, fear of an exacerbation of symptoms may lead them to be hypervigiliant to any slight change of eating behavior, an exhausting process for both child and parent.

            Dr. Zucker sees eating disorders as “a disorder of self-regulation, a disorder of self-parenting.” The adolescent is “unable to respond to her own needs” and must be taught how to do that, she explains. Feeling lonely, depressed, hungry, angry or sad are some of the feelings that the eating-disordered child fails to be responsive to. It remains an open question whether it is a failure to decipher these cues, a failure to respond, or both. The individual with an eating disorder knows only that she feels badly, and treats this condition with her default response of self-starvation, or bingeing and purging. 

            To help parents deal with these emotional and behavioral challenges, Dr. Zucker has developed a skills program called Off the C.U.F.F. (Calm, Unwavering, Firm and Funny) that helps them recognize and attend to their own needs, and by example, show their child how to do the same thing. It also helps them react swiftly to signs of impending roadblocks in their child’s recovery. One of Dr. Zucker’s most popular tools is recognizing and mastering the “Eating Disorder wave”. The “wave” refers to a brewing emotional tsunami, the rising wall of intense feeling that can overpower a child and knock her off her feet and back into the disorder if parents don’t intervene in time. Learning to read subtle emotional cues and react swiftly, it turns out, is a highly effective way to prevent relapse or continued self-destructive behavior.

            Dr. Zucker’s program has been so successful that it has been adopted by hospitals and eating disorder treatment centers around the world. A manualized version of Off the C.U.F.F. is also available.

Take care,

Nancy

Dear Readers,

The title of this article in today’s Wall Street Journal says it all: “Silencing a Voice That Says You’re A Fraud.” It turns out that the Inner Critic that tells you on a daily basis that you are fat, disgusting, a pig, etc., isn’t just a trait of those with eating disorders. Physicians, eminent scholars, and executives seemingly immune to self-doubt about their abilities, intelligence, or achievements can all suffer froma sense of inadequacy in one area of life or another. 

Kept in check, the Inner Critic can help a person achieve. The out-of-control Inner Critic, however, can be a destructive force, leading to depression and anxiety. The article, by Melinda Beck, describes how Cognitive Behavioral Therapy (CBT) can help combat this self-critical tendency. This technique is one of the most effective tools for combatting eating disorders, especially bulimia, body dysmorphic and binge-eating disorders. Try completing the 15-item self-criticism questionnare to see where you stand on the spectrum of self-critical behavior,  and see if you can apply some of the CBT techniques the article outlines to your own life!

Take care,

Nancy

 Dear Readers,

                We’ve often heard people say, “Eating disorders aren’t about food at all. They’re about depression, anxiety, or low self-esteem.” This takes away some of the stigma that an eating disorder sufferer feels because it means she’s not just self-involved and superficial for being obsessed with appearance and weight. There are deeper things going on here, which merit doctor’s visits and hospital stays, not to mention insurance reimbursements.

                Another way to telegraph what eating disorders are is a saying that Marcia sometimes uses: “Genetics loads the gun, and environment pulls the trigger.” This refers to current scientific understanding, which holds that eating disorders originate through an interplay of genetic (your mother had an eating disorder, so you are more likely to develop one) and environmental (incessant schoolyard taunting about your size led you to self-starvation) factors.

                These handy  aphorisms are true, but the reason they bear repeating is that when it comes to making an eating-disordered person better a lot of the hard work, fear, pain and suffering the patient has to go through in order to recover revolves around, well, food. Which can be confusing.

                It may help to view eating disorders through the addiction model. An alcoholic or a drug addict drinks or takes drugs as a self-soothing measure. Ingesting them can take the edge off a tragic loss, a blow to one’s confidence, even a bad day.   Walter Kaye, the highly respected director of UCSD’s Eating Disorder Research and Treatment Program, says of the anorexia patient, “These are very anxious people. Not eating is the one thing that makes the anxiety go away. Whereas most people feel pleasure when they eat, the anorexic feels uncomfortable.” Instead of taking something in order to reduce anxiety, as the alcoholic might, the anorexic’s self-soothing trick involves not taking the substance, or not eating.

                Another way to think of an eating disorder is in the context of various fears or phobias, such as fear of flying, fear of public speaking, or if you are Indiana Jones, fear of snakes. The way to overcome such fears is to make oneself face them, over and over.

                As Alicia Hirsch, Psy.D., director of clinical services at Mt. Sinai Eating and Weight Disorders Program in New York City says, there is an “exposure component” to treating eating disorders. “You’re asking a patient to do something incredibly uncomfortable,” which is eating. Repeated exposure to the feared thing, in this case something edible, makes the patient’s anxiety and discomfort level come down.  “The food is the medicine,” Dr. Hirsch explains.

            So, to sum up: It’s not about food. It’s about genetics and environment. Food makes the eating disordered person anxious. Food is the medicine. Any questions?

            Both the UCSD and the Mt. Sinai programs educate families about the complex mix of biological and environmental factors that are involved in the creation of eating disorders. This is an important component of any treatment program, so if you are in the market for one now, make sure it includes this piece. The more you learn, read and understand about eating disorders, the better armed you will be to help your child or loved one recover.

Take care,

Nancy