Thwarting possible triggers

It's interesting in this new job, because I'm actually around people again. For the last 4-5 years, I've pretty much been alone with just the dogs. Luckily, I'm not in an environment where weight is discussed frequently, but occasionally it is brought up.

My boss was saying how she had been trying to eat healthier. She said after her mom died recently, it made her reassess things. The other office person in the room said she noticed that her clothes were baggier too. A. said something along the lines of "yeah, can you imagine me anorexic at my height and weighing XX pounds?" My reply was, "yes, and I've known many similar stories." I kind of gave A. a look and said that it was good to be healthy but that it can easily go overboard, that it is more about moderation than anything else. A. agreed but I still worry.

I've known A. for a long time and a few years ago, she told me about her anorexia plight in high school, and I revealed to her my own struggles as well. A. recovered from her anorexia by essentially having her parents use a "modified" version of the Maudsley Method. They had sit down meals where A. had to finish her meals. They checked her weight often, telling her it had to be an X amount before doing certain socialite activities. The only thing I'd say she did not have was any therapy at all. Amazingly, A. never relapsed, at least not full fledged, but still I know she presents some of the underlying factors that easily contribute to eating disorders.

I did not tell her during this conversation, but what I wanted to say was, "you really do need to be careful, because it is so easy to fall back with just one misstep. She also said to me that there were times when she just simply did not feel like eating or felt physically ill (this was after her mom's death). I understood this and held my tongue in saying, "you really need to try to eat at those times, because you can spiral out of control."

Ironically, after this entire episode, we went out to lunch at a buffet and A. commented that this was the most she'd seen me eat. She added in that she meant that in a healthy way as she's been me pick at food before. Normally, this kind of comment would have thrown me into some tail spin, like "Yes, I really do eat, people!" However, this time, it did not. Instead, I just went on my merry way of eating lunch just like, well, it was lunch and nothing more than that. We went on with other topics of conversation related to work, the dogs, etc. Truly, A. has done a tremendous amount for me, and I feel in a way, I owe it to her to stay healthy as kind of her "right arm" person. There's honestly too much at stake for me to fall ill again and crumble.

Perhaps, that is one incentive for me to continue on the bandwagon in recovery. It is of course for myself too, and there are certainly times I have to remind myself where I once was to where I am now. Life is still not completely fulfilled. I have a long way to go with that, but having a clearer head, feeling less tired, especially driving (yes, there was a massive link for me with undernutrition, sleep deprivation, and driving), learning to feel emotions again feel worth it right now. And so, I continue to trudge along my off-beaten path.

The case of Emily Errico

Several weeks ago, there was a report of a young, anorexic girl named Emily Errico, aged 25, whose mother was indicted of neglect. For whatever reason, I found this case horribly tragic with a variety of thoughts brought up. If you are not familiar with the case, police found Emily in full rigor mortis, in a "completely weakened state" after a 911 call was made by her mother in 2007. The police said it was difficult to navigate the area, because there were trash bags everywhere, including on windows and on Emily. She was found with a fabricated halter top out of a trash bag, sweatpants, and at a very low weight for her height.

Police said her parents were very controlling and fed her a diet of only granola bars and seltzer, allowing her to waste away. Despite the fact that Emily did see a nutritionist back in 2004 and a diagnosis of malnutrition was determined, not much follow up was made, especially since her father canceled her appointments.

Though Emily did complete a college degree and was "exceptionally bright" according to the prosecutor on her case, her parents continued to control her food intake by bringing meals to her. After graduating, she moved back home where they had complete control over her. This control was evident from her birth where she was kept in a crib as a toddler and not permitted to socially interact with peers. Neighbors even say they never saw her leave the house. Most did not even know she was living there at all.

I bring up this, not to point fingers at parents, though I do think her parents are certainly negligible for her death in this case. I know most parents are not like this, and this case is on the rare side. However, I do wonder about the nutritionist who didn't follow up. Did she not follow up, because eating disorder patients are notorious for canceling appointments? Was this just another young, underweight girl in the crowd? To me, (and of course I am only speculating) if these parents were as controlling as they seemed and maybe a bit odd too, weren't any red flags raised? It's really hard to say, and again, I'm not pointing fingers, just asking questions.

This reminds me of the time I was 16 and od'd. I actually called my therapist to cancel my appointment, telling her I was ill. Whatever intuition she may have sensed, she came to my house to check up on me, and of course, after finding me, called my mother, went to the ER, etc. My parents were forever thankful, but I know now that is like a one in a thousand occurrences since there are so many privacy laws nowadays.

I also wonder about the neighbors. These days, we are so afraid of being considered "too nosy," but what happens when a human or animal life is at stake? Where is the line drawn between what is too "private" and out of concern? It's similar to the cases which many of us have witnessed in stores of hearing stupid/hurtful/out of line comments said to young children/teens/adults about their body, their looks, their clothing, etc. We always wonder whether to speak up or stay silent. It really does become difficult to decide what to do. The line has to be treaded so carefully it seems.

Certainly, I don't have the answers to any of these questions, and I doubt professionals do either. I know I have struggled with the issue of what to say or do, whether to intervene or not. Ironically, as this article came out, the story of Jaycee Dugard hit the headlines. Though they are different, there are similar aspects to both cases. There are also many whys as well which may never be answered.

So what are your thoughts? Where do you tread the line?

Side note--father pled guilty of third degree neglect this year and faces three years probation and a psychological evaluation.

Note:--*Other related articles: Mom charged with neglect in adult daughter's death
Ermina Errico of Garwood indicted for neglect in conncetion with the death of her daughter
Invisible life: Learning from Emily Errico's anorexia death in Garwood
Following a hunch, solving a crime (how a mother's intuition helped free Jaycee)

Can anorexia be predicted?

I think we've all asked this question before: can anorexia be predicted?

Several researchers are beginning to look into this more thoroughly. This week, new research on the predictability of anorexia through subtle differences in brain development in children will be revealed at the Institute of London, according to UK paper, The Guardian.

Researchers tested more than 200 people in the UK, US, and Norway who had anorexia. The majority were girls between the ages of 12 and 25, currently receiving treatment.

Through in-depth neuropsychological testing, " they found that about 70% of the patients had suffered damage to their neurotransmitters, which help brain cells communicate with each other, had undergone subtle changes in the structure of their brains, or both."

The researchers go on to say that these results are random and not based on other factors such as the environmental chemicals or poor maternal diet. They also believe that "Imperfect wiring in the brain's insular cortex that may lead to dyslexia, ADHD or depression in other children produces what he calls "an underlying vulnerability" among some young people that makes them more likely to develop anorexia."

The significance of this study is that it can give better understanding to eating disorders as well as to possibly pave a new path for drug treatment, an area of research which has currently been unsuccessful for treating eating disorders. This also takes some of the blame off of parents for causing their child's eating disorder.

Another interesting point made in this study is the implications of the insular cortex. Research has already shown that the insular cortex is involved in a variety of neuropsychiatric illnesses. The insular cortex was also implicated in a study looking at a sense of taste among women with anorexia. There, researchers found that the women who had recovered from anorexia showed differences in processing taste, especially in the feeling of pleasantness/reward of foods, compared to normal controls who never had anorexia.

Stay tuned as this is some interesting research.

Note--I'm hoping the researchers will go more into detail about their "neuropsychological" testing. If more information is presented, I'll update the post as needed.

One mother's mission for male anorexia awareness

I thought this was a moving video piece in the Lansing State Journal about Susan Barry's son, TJ Warschefsky, who died of anorexia Valentine's Day 2007 at the age of 22. He took his last breath while completing his nightly sit-up ritual.

One thing this video reminds me of is how insidious and powerful an eating disorder can be. Even when you have various treatment stints, parents who care and are supportive, there is still such a persistence with the illness. I don't know all the details of this particular story, but like so many others, it wasn't for lack of love or trying.

Susan Barry has now made it her mission to bring about awareness for male anorexia. She is currently writing a book, beginning a support group for parents in the Lansing area, and raising money for research through a 5K race.

I think it is important to have an advocate for males who are suffering from eating disorders. Although there is now more awareness that males too suffer from these illnesses, it is still an area of research and treatment which is lacking. Laura Collins points this out well in the piece.

I hope this advocacy for males with eating disorders continue, because in the end, eating disorders don't discriminate, and it is as much an illness of a woman's as it is a man's.

"Thirty-two kilos"

A new exhibit called "Thirty-Two Kilos" opened tonight at the Goethe- Institut in Washington, D.C. It is a collection of digitally manipulated photos looking like emaciated, anorexic models (posed by her friends, not real models) by German photographer, Ivonne Thein. Thein says this was her response after feeling shocked at pro-ana websites.

However, as with many creative expressions of art, it is not always intended as it is meant to be. You can better believe that the pro-ana websites have taken a liking to these photos, calling them "thinspiration."

One commenter said, "Those pics are beautiful! I want to look like them! They look so fragil [sic] and like an angel."

Thein says, "That's not what I wanted. It's important for me that if I show my pictures, there's a statement that it's a critical position and I don't glamorize anorexia."

Although I know this photographer is not trying to glamorize eating disorders, it is unfortunate that this is part of the outcome. It seems just like another "shock" value content in perhaps preaching to the wrong audience. Then again, maybe I'd feel different if I saw the exhibit in person. There is always a different element with that.

If anyone sees this exhibit in person, I'm interested to hear your thoughts. Do you feel like the photographer made her point? Is shock value the way to go for change?

Sources: Pro-anorexia websites inspire controversial photo exhibit
'Thirty-Two Kilos': A stark look at anorexia

Other photos from the exhibit here

*Thirty-two kilos is about seventy pounds

It takes guts to build bone

The latest issue of the journal Cell has a very interesting report about new findings for bone formation in the body. Researchers at Columbia University learned that bone formation is controlled through the gut chemical serotonin. Yes, this is the same serotonin in your brain which affects mood, appetite, and sleep. In the body, 95% of serotonin is produced by the gastrointestinal tract, while only 5% in the brain.

While studying two rare bone diseases (one which causes very fragile, weak bones, the other which causes very dense bones) affected by mutations of the gene called Lrp5, they found that the Lrp5 gene was responsible for the synthesis of serotonin in the gut. Therefore, by regulating the production of serotonin in the gut, bone formation was controlled. In this case, with mice, once the intestine production of serotonin was turned off , osteoporosis was prevented. There was an opposite effect in making the bone mass decrease when the production of serotonin was activated. (Lrp5 gene inactivated)

According to Dr. Karsenty, lead researcher, the bottom line is, "The findings demonstrate without a doubt that serotonin from the gut is acting as a hormone to regulate bone mass."

This new finding has implications for osteoporosis treatment, because many of the medications only prevent the breakdown of old bone. When osteoporosis is diagnosed, the bone loss is already accelerated, therefore, the possibility to find a drug that depresses the gut's serotonin synthesis, could stimulate bone growth for these individuals.

I'm not sure how this or if it would implicate those with eating disorders who have been diagnosed with osteopenia/osteoporosis, but I think there might be some possibility for treatment. This is especially true since there is no clear evidence for medicinal interventions. Although of course weight restoration and early intervention provide the best possible outcome.

Other source: Bone finding may point to hope for osteoporosis

Diary of an Exercise Addict

image: peachfriedman
I read the book Diary of an Exercise Addict this weekend. I had first read about Peach Friedman in a People magazine article on exercise addiction published a few years ago. I was interested in hearing how her recovery went and found out she was publishing this book.

Overall, I think this is a pretty inspiring book. She considers herself recovered but knows to keep a cautious eye as well. Currently, she is a personal trainer and works with the Summit Eating Disorders program in California.

This memoir is written like a diary but not exactly either. It is not as raw or triggering as some other memoirs on eating disorders have been (not that that should be the point but for some it makes it easier for them to relate), but Peach delves into the physical and emotional aspects of her eating disorder. I really like how she gives opposing views of being eating disordered--being so numbed out to the world and recognizing only small, minute details that most people would not even think about, her movement towards recovery--that it was a lot tougher than she expected but was willing to trust her treatment team, and finally recovery as a beautiful, young woman who learned to accept her body and take care of it.

Peach was lucky in that her eating disorder didn't have the duration as other sufferers, and she was able to receive help with the intervention of her supportive parents, therapist, and dietitian. This is not to take away from the years of pain or suffering from her eating disorder, but moreso a reminder how quickly one can descent into the grips of an eating disorder. She's also a role model in showing that you can recover on an outpatient basis which I really did find remarkable given her malnourished condition. She talks about the book in this interview with a local station and more information about her can be found on her website here.

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Reading this book was interesting for me, especially given the fact that I was familiar with the area she lived and knew of one of the girls she spoke about in the book (someone I knew in elementary school). I did not grow up there but frequented the area while training in gymnastics, so I could relate with what she had to say about the culture and perceptions there. It makes me wonder if I had lived there (at one point, my parents offered to send me to a private school, so I could be closer to my gymnastics center) what the outcome of me would have been.

But more than that, it reminded me of the missing points of intervention that I could have had or maybe should have had, wandering if things would have been different. One friend of mine used to tell me I was always just a step away from inpatient, but ironically no one else really saw it that way--kind of like the not good enough anorexic or bulimic. It's probably one reason why I have such validation issues even to this day.

I know looking into the past and thinking about this stuff isn't helpful--that there are so many people who don't receive any treatment at all, can't get the treatment they really need due to insurance, or they die waiting. I know I should be thankful for even what I've received. And I am. Truly. I know in the end, it is up to me to decide what to do with the tools, knowledge, etc. that the many years of therapy have given me.

I don't know, I'm just feeling a bit mundane, retrospective, and ambivalent. Today was tough and sometimes even though I make a certain amount of progress facing fears, I still feel like I'm ever so slowly slipping too.

Eating disorders among older women

Within the last few years, there has been a growing trend among older women and eating disorders. There have been a number of articles, tv segments, and recently books written about this population. Various eating disorder treatment centers around the country have said there has been an increase in their admission rates of older women. By older, I mean women who are in their 30s and beyond. Last week, there was an article in the UK about a distinguished professor who apparently died from her anorexia or as the coroner said, “The cause of death was contributed to by her self-neglect, her gross failure to provide herself with care that is a part of life."

In another article from UK's The Guardian, (excellent by the way in my opinion) the issue of adult women and anorexia is looked at more closely. While many women develop eating disorders as adults, there are also those who have experienced some form of eating disorder or disordered eating as teens or young adults. Many have not gotten sufficient treatment, so they "grow" with their disease. Others have their eating disorders reoccur at a later stage in life, often triggered by a major life event--pregnancy, divorce, empty nest syndrome, trauma, etc. The article points out how so many become a "functional" eating disordered person and how many people just get used to seeing them like that. They are also very good at being very discrete with their illnesses. Author Margo Maine who wrote The Body Myth talks a lot about his subject and how there is a lot of pressure for adult women to be perfect. If you have not read it, I recommend this book.

These articles come on the heels of a recent study which polled over 4,000 women between the ages of 25 and 45 about their eating behaviors. The online poll by Self magazine in collaboration with UNC Chapel Hill found that "75 percent of all American women endorse some unhealthy thoughts, feelings or behaviors related to food or their bodies." These findings were among all racial lines. The study surprisingly showed that a third of the surveyors had engaged in purging activities during their lifetime. Also, women in their 30s and 40s had similar disordered eating compared to their younger counterparts. In the link above, eating disorder researcher Cynthia Bulik talks about the results of the study.

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It's interesting, as I was reading these article, I was reminded of my aunt, my mother's sister. I have not seen her in quite a long time, but growing up, she was very thin. I remember talking to my mom about this in my teens as I was at the height of the eating disorder. I was actually upset that no one was doing anything for her, but yet, they "cared" so much about me to want me to be fixed. At one point, I called my aunt out on it suggesting she was anorexic. I remember getting through to her and her crying. She said she had read about anorexia but she didn't fit the "textbook" definition.

I don't think she ever received help, but I know there are too many clues that suggest she had/has anorexia. Non-existent to irregular menstrual cycles, her weight never in three digit number despite being an average height for a woman (no, not a genetic thing either), totaling two cars from blacking out (supposedly petit mal seizures though no evidence of that), illnesses, premature aging, and her personality. My mother just always said that J. had been like that growing up--very rigid and stubborn. It's like everyone had just accepted that that was how she was, and that it was now too late for her to receive treatment.

Since I haven't seen her in awhile, I don't know what she looks like, though my instinct is that it is probably similar to how I remembered her. I do know she is happier in her life since she retired from the school system, began volunteering, and is now doing therapy dog work. However, according to my mother, J. says she must get to a certain number of therapy visits to win top honor.

The other thing these articles made me think about is even if I lick the eating disorder at my age, I'm heavily predisposed for relapse or reoccurrence. Though relapse isn't a requirement, eating disorders as a fact have a high rate of relapse. I know there used to be the thought that once you had an eating disorder, you always had an eating disorder. Many people have proved that theory wrong and recovered completely. Still though, how can you not think that the ED isn't there lurking in the shadows just waiting for a vulnerable time? I think this is something that scares me. There was a period in college where I was symptom free, and then one day, just snapped and fell victim to the ED again. I honestly can't remember that time well. I wasn't happy but I was facing other health issues. In essence, the ED just took a backseat and waited.

I want this time to be different. I don't want it lurking in the shadows waiting to take hold of me. I don't want to think about this for my entire life, but at the same time, I'm really afraid of never getting there either.

How do you build the confidence to never turn back?

Genetics and eating disorders

I came across this article today in the Toronto Star, a Canadian paper about eating disorders and genetics. Although this area of research has become more known and accepted, I think it's still important to emphasize, especially when socio-cultural headlines dominate the media. This article gives a nice outline into how the studies evolved and what researchers are looking for today.

This spring, a large National Institutes of Mental Health sponsored study will wrap up. This specific gene study analyzes samples of DNA from families who have two or more members with anorexia. I'm interested to see the outcomes of this study as it could shed more light into the role genetics play in eating disorders and its development.

Anorexia and suicide

This week, a new study out of the University of Vermont was published about anorexia and the intent of suicide. While it is a well established fact that anorexia has the highest mortality rate of any psychiatric disorder of which suicide is particularly high, how seriously is it really taken? Suicidal acts have often been considered a call for help, a wish not really to die but to end the pain. Or for those who have succeeded, a call for help gone wrong. In this study, researchers looked at nine cases of anorexic women who committed suicide through extreme measures--measures where the likelihood to die was insurmountable despite having anorexia. Researchers concluded that their intent was to die by a quick means.

Although I think this is a unique set of research in this field, and I understand where the researchers are headed, I have slight problems with it too besides that the sample size is small. It's either that people do not hear about these types of cases, ie eating disorder individuals hanging themselves, setting themselves on fire, jumping in front of moving objects, etc. which were outlined in the study, or that these are the extreme portion of cases. Recently, we heard about the death of Polly Williams from the documentary "Thin" by an overdose of sleeping pills. Then several years ago, there was Anna Westin who died from an overdose of anti-depressants if I remember correctly. Both of these were more well known cases and used more common methods of suicide. While I agree that overdosing is not a guarantee for success of suicide, I think the intent is still there for many sufferers.

The one thing I do think is very important out of this type of research is to recognize the seriousness of suicidal tendencies among those with eating disorders. Then, perhaps, we can help prevent these type of tragedies, or better yet actually get health insurance to cover treatment costs.

Perception of anorexia differs

This article out of UNC Chapel Hill just published today explains how the perception of anorexia nervosa can differ when people are given information about the biological and possible genetic causation of the disorder. Researchers, led by Cynthia Bulik et. al, (if you keep up with research, she was one of the first people to give the now common "gun" analogy in reference to eating disorders, i.e. "the genes load the gun, the environment pulls the trigger") found that undergraduate nursing students who were given information on the genetic and biological causes of the development of anorexia versus those only given the sociocultural reasons did indeed give less blame to the eating disorder individual.

I think this definitely points out the need for continued education and awareness. This, of course, doesn't mean that one should blame everything on genetics or biology, but just that there is a predisposition. After that, there is some personal responsibility into how to live and cope with your life. In general, however, society still stigmatizes those with eating disorders in thinking it is completely their fault, they chose this, that they only want to be thin, etc. There's just so much more to it, and underneath all that stereotypical thinking are the real reasons.

Something else I think would be interesting is to see whether there would be any differences in brain and/or genetics between those anorexics who are deemed "chronic"and those who do not have a long duration of the illness and recover.

Intervention

I do not watch the A&E show "Intervention" on a daily basis, but I happened to be flipping through channels and saw it was on last night. I was watching something else, so I ended up staying up until 1:00 AM to catch the encore of it. It was about a severely anorectic young woman named Emily. I actually think for the most part, it was okay-- maybe a few too many shots of her body nude, like in a shower, dressing, etc. which I didn't think were necessary.

I could relate with some of her feelings like unworthiness, not feeling like you deserved pleasure, that you didn't measure up to everyone, etc. With this young woman, to me, there were a lot of factors stemming from the family. Not that they were intentional but as always were major contributors to the development of her eating disorder. Since she had an identical twin sister who seemed to have it all, she always felt in her shadow. As one twin grew more confident and self-assured with life, Emily stood by the sidelines and began shrinking. This whole set up reminds me of Shelly from the documentary "Thin." She had similar issues with being an identical twin. I can definitely see how the whole identity crisis can be difficult.

Also, another key factor into Emily's illness was being date raped. It was never said whether she received any counseling for this. I remember reading an article recently that said how trauma changes the way we view the world. Here's an excerpt from the trauma study at Cornell University:

Cornell researchers report that rapes, sudden deaths of loved ones, life-threatening accidents and other such traumas may result in enduring changes on how an individual views the world.

Since the show is called "Intervention," Emily had one with her family around. She eventually accepted treatment at Casa Palmera for 90 days. The last clip of her shows her being very motivated, saying she really wanted to give recovery a chance, that it was like a lightbulb went off. However, the last screen where they tell the progress of each participant said she had lost 7 pounds while there and was discharged to medical care. The remaining part of treatment, she was tube fed and went to Remuda Ranch.

The show ended up bitter sweet I guess. I still have a lot of issue with treatment and eating disorders. Maybe I am very biased, because I feel like I've never truly had an advocate or a professional say "I won't see you anymore unless you go IP," or something to that effect. The worst ultimatum I had was when my college therapist was about to ditch me, because I refused to get a physical for several months due to fear. She was willing to help me get through the door at least, and in the end, it wound up being one of the best moves I made.

It just seems so hard when you don't look the part and you fall under the radar. A part of you feels great that you go undetected, but another part of you screams out for someone to notice, to care, to say "this is not okay." I often wonder what my physical therapist thinks. The PT and PTA just keep asking me if I run everyday which I don't. I just run a minimum of X miles.

Then there is my father. He says I need to stop running for 2-3 months to give my hamstring a chance to heal. Okay, this may be true, but it's not what you say to someone with eating and exercising issues. He's just like "well walk then. You'll be fine, you look great, what's the problem." I just want to shout at him and say "Yeah, I may look great, but it's only due to being very active and probably not eating enough." Oh yeah, that's right, he thinks the average sedentary person really only needs 1200-1500 calories/day and that would solve the obesity problem.

Anyway, I'm going off tangent about this. As I said, it's great that these people on shows like Intervention are getting the help they need, it just feels like the rest of us are left in the dust. Any residential treatment facility is a fortune and most of us do not have that type of money to shell out. It's just a sad reality.

New Brain imaging and Anorexia

In recent years, researchers have been looking at brain images and activity of a variety of illnesses, including eating disorders. Dr. Walter Kaye from University of Pittsburgh and University of California at San Diego has been one of the forerunners in researching the genetics and brain functions of those with eating disorders. In a 2005 study, it was found there was an overactivity of dopamine in the brain in those who had recovered from anorexia. Another study published earlier this fall showed how there were links between starvation and ectasy. This latest one on brain imaging and recovered anorectics using fMRIs is the hot article of the week. What is interesting about this study is that researchers are able to see how anorexia works in the brain in "real time" with the use of fMRI.

Personally, I think this is really helpful in terms of how the brain works with those with eating disorders. Now, this is of course can't be a blank statement until more studies are done are a larger representation sample. Hopefully, more funding will be available for studies like this.

Another model dies

I just saw this article today about an Israeli model who died this past week. Her story isn't like many others who have fought anorexia for many years and was in and out of hospitals. Eventually, she died of heart failure. It's just another sad model story. You begin to wonder if as much as things do change, things stay the same. Although some countries have made regulations, I think for some models it's already too late as the illness has entrenched them. The only hope is for the new models coming into the industry.

Hila Elmalich