The Eating Disorder Chronicles: Learning

Yesterday I attended the opening day of The UCSD Eating Disorder Conference on Learning and Applying New Skills to Treat the Most Difficult Eating Disorders. While it was geared toward researchers and treatment professionals, there was so much for a parent to learn as well. I went with a good friend and made another friend while there. It was an absolute thrill to hear presentations from the top researchers in the field of Family-Based Treatment for Anorexia Nervosa. The presentations definitely contained slides of meta-analysis of research that was way above my pay grade to interpret on my own, but they were skilled at talking through and putting in context what we were seeing.

New things I learned yesterday:

• Normal people get a feeling of well-being when dopamine is released. Anorexics become anxious when dopamine is released. Eating causes dopamine release.
• Most people prefer smaller, immediate rewards to larger, delayed rewards. Anorexics do not prefer smaller, immediate rewards (or even large, immediate rewards apparently--which is why it does not work to offer an anorexic 16-year old a Porsche if she will just eat. As Dr. Kaye pointed, out, the Porsche is a cheaper option than treatment (so if it did work, we could probably get insurance companies to spring for it :))
• Anorexics tend to perseverate on rejection. In the study referenced, healthy controls look away from negative images while anorexics focus on them.
• The timeline for treatment before full-recovery is 24 months. I think this is VERY important to know.

Of course, with the studies underpinning the analysis above, there is no way to determine that correlation equals causation without imaging studies of the same patients before anorexia. So were these traits caused by anorexia or did they cause anorexia? There are so many more studies that are needed and relatively few people that are working on this. 

Dr. La Grange, from The University of Chicago Medical School, had both my favorite statement and my favorite joke of the day. I will open with serious and close with the funny . . .

A therapist asked how a family in which the parents were both working three jobs, had other siblings to take care of, etc. could be expected do Family-Based Treatment (which is, at this point, the evidence-based treatment model that is most successful in treating anorexia). He replied that he was sure that Pediatric Oncologists were never asked how parents were expected to get their child to all the appointments attendant in fighting cancer. He went on to elaborate and soften what he was saying, but I 100% agree with his stance. The family has no choice but to make it work or the child might well die. That said, it would be lovely if society would get a clue about that.

Dr. La Grange's fields of expertise are anorexia and bulimia, but he did a brief foray into exploring whether the same Family-Based treatment model worked with pediatric overweight patients. He has abandoned that line of research (leaving it to others with more experience in that arena) and told the following joke:

If I have a 3:00 appointment for an anorexic patient, the patient and parents will be in the waiting room at 2:45. If the appointment is with a bulimic patient, they will show up at 3:05. If the appointment is with someone that is pediatric overweight, one of the parents will call at 4 and ask, "Did we have an appointment today?"

Sometimes you do just have to laugh out loud.

 

 

 

 

 

 

 

 

Comments

[Jocelyn]

Very valuable tidbits you gleaned. I have to think now about what it would feel like to be made anxious by dopamine...how to turn dopamine into your friend. Hmmm.

The closing joke made this chronically-late, never-a-small-person gal laugh, too.

[lanes]

Until more people stop perceiving eating disorders as a sort of lifestyle choice, I can't see how they're going to understand the necessity of continued, long-term treatment.

But, on the positive side, glad that SB is several months into her journey to recovery.

[Jenn @ Juggling Life]

Not so much with the recovery at this moment. I will blog it later today, but shes starting treatment tomorrow. Unexpected, but this disease is truly crazy.

Sent from my iPhone

[Jenrantsraves]

It is a pretty baffling disease, and one that some people do not take seriously enough. Hope things go well tomorrow and continue to do so.

[lanes]

Sorry for that development, but I hope things go well tomorrow and that they keep getting better.

[Busy Bee Suz]

You need to be applauded for not only being such a good parent to SB during this, but for learning so much and sharing with others.
You rock! Sending good thoughts SB's way.
XO

[suburbancorrespondent]

I'm not sure I understand the rewards thing. Wouldn't it be more accurate to say that an anorexic's idea of reward would be different from normal? The feeling of hunger might be a reward, or the feeling of being so in control that you can refuse the proffered food. At least, that was my experience.

[Jenn @ Juggling Life]

The study was done with money, so it indicates more general personality trait than being food-specific.

Sent from my iPhone

[Green Girl in Wisconsin]

Oh dear, that is funny in a way!
This was interesting--I didn't know about the mental perceptions (rewards, etc.) but it really makes sense when you think about it.

[Karen (formerly kcinnova)]

The joke has, I suspect, a huge dose of truth in it. (Jocelyn wasn't the only one who saw herself!)

I am so sorry for the reasons you are learning this information... but I am glad you are learning it and sharing it with us. You've certainly changed my thinking and attitude about anorexia and I'm grateful to you for that.
The fact that ED effects a change in the brain's response to dopamine is HUGE.
The cancer analogy is especially interesting because it speaks to disease vs. choice. (And in this, I note society's lessened compassion toward those whose addictions lead to cancer and other disease.)
It seems to me that people desire to control their own destiny (and, in a healthy manner, that of others as well). This can be a natural and good thing -- the desire to do well, take care of yourself and your family. But when disease takes over, things go awry and control itself is the goal... I'm thinking "aloud" here, and wondering if I am on track.

[Kim Kasch]

This is very interesting information. Thanks for sharing it with everyone. People don't talk about these issues very often.

[Mrs. G.]

What fries me is most insurance companies do not cover treatment...for a potentially deadly disease.

[gary rith]

Mrs G, really?????

[BrightsideSusan]

Most insurance companies do all kinds of things that are not in the best interest of the patients OR the eventual bottom line.

So glad you are getting all this info and help and wishing SB the best of luck!

[Claudia]

It seems to me that eating disorders, like depression, are unfortunately lumped into the category of not being taken seriously enough as real illnesses/disease. No one would ever deny treatment or even question someone with diabetes or cancer. Time for some serious changes in our health care system. Thanks to people like you for continuing to educate and for being so open. Good thoughts for you and SB!

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