On Living 100 years in Diet Culture

On Living 100 years in Diet Culture

I recently went to visit my 102-year-old grandmother. In 1921, at the age of six, Nana emigrated from Russia to Kansas City.

She entertains her living facility with her piano playing and loves to talk all day. She continues to leave sassy messages on my phone. She sends thoughtful gifts to her great grandkids. With such a full life, the following stands out to me.On Living 100 years in Diet Culture

 

Always concerned about her shape and weight, at 102 this is still a concern as evidenced by her bathroom in assisted living. Although Nana walks with a walker and now requires some assistance with getting dressed, she still steps on her bathroom scale every day. (How exactly she does this without falling, I don’t know!)

She declared to me, “I weigh x. If I could lose 10 pounds, I’d look younger.”

Two years ago, when she turned 100, I actually did a brief interview with her about dieting. After all, how many 100-year-olds are there who can offer a perspective on dieting in the 1930s and into their centenarian years?

Following is an excerpt from my interview with Nana:

How old were you when you first became concerned about your weight and shape?

At 9 years old people wanted me to start appearing on stage playing the piano. My teacher wanted to speak with my parents and told them he thought I was overweight and should lose some weight. He wanted to groom me for concert piano playing. I remembered how he spoke about my being a little heavy. It didn’t set in right with me. It didn’t bother me. I wasn’t obese, but I was heavy.

When was the first time that you dieted?

On January 2, 1935 (at age 19), I started a strict diet (for me) while at the University of Missouri in Columbia. In 3.5 months I lost 45 pounds. I worked very hard at that. Not only did I have a diet plan, but I also read a great deal. Just before that I also bought a powder that I put in tomato juice and it helped reduce hunger. When I came back to college after Christmas I was told by a friend who was a medical student to stop taking it. He said it was harmful. And then I continued on with the diet plans and that was in 1935. That’s when I really lost the weight. I became ever more popular and I noticed that the weight loss was really helpful.

Do you still worry about your weight?

I’m still concerned about my weight. I watch it very carefully. I get on the scale every single morning because I want to get in the clothes I have. I used to measure myself with a tape measure every day. 

Why do you think it is important to be thin?

I think it’s important. I love my clothes and if I don’t hold my weight to the clothing that I’ve bought, I’d feel very sad so I watch my weight carefully and I am able to get into clothing that I’ve had for years. There are some skirts that I can’t fasten at the waist, but I don’t wear skirts anymore. But weight has always been a very important concern. I don’t think you have to be thin but you have to look good in your clothing and for me, I don’t want to have to buy new clothes.

Nana’s Legacy

It is sad to me that after all these years,  the fear of returning to a bigger size still looms over her. When she eventually passes I doubt many will remember Nana for her shape.

Instead, I expect they will remember her for how friendly and caring she is, how she finds the positive in everything, her desire to make everyone around her happy, the sharp dresser she is, and what a great pianist she is (she makes you FEEL the music).

I know I will always hold dear in my heart her tremendous love for so many people, her years of serving the community as a social worker and volunteer for numerous charitable organizations, her delicious pound cake, her witty jokes (mostly from Readers Digest!), her long stories, her piano playing, and for how she knows (and is loved by) everyone in Kansas City.

 

Don’t Diet! 10 Alternative New Year’s Resolutions

Don't Diet in 2018I am skeptical of New Years Resolutions in general because I think they promote all-or-nothing thinking (I also don’t like to categorize entire years as being bad or good for this reason). I don’t feel that one needs to wait for the year to reset to make changes in one’s life. I  am anti-diet and dread the increased obsession with dieting and weight loss that arrives with each January 1st.

So I thought that this year I would offer some alternatives to weight loss goals as potential resolutions for those who will be making some for 2018.

 

Don’t Diet in 2018: Alternative New Year’s Resolutions

  1. Resolve to learn a new skill. Whether you’ve always wanted to learn to rock climb, play the piano, make dumplings, or cross-stitch, now is the time to do it.
  2. Commit to improving one relationship. Whether it’s getting to know that coworker, spending more time with your spouse, or getting back in touch with that childhood friend, do it in 2018.
  3. Pledge to reject self-denigrating body shaming comments. Those negative body comments, often made between friends, make everyone feel worse. Try to avoid saying things like, “My thighs look fat,” “Does this make me look fat?” “I need to lose weight.”
  4. Commit to not dieting. Focus instead on eating intuitively according to your own taste and hunger and satiety cues. Your amazing body will regulate itself if you let it.
  5. Listen to one body positive podcast. Improving your body image will make you feel better than dieting will. Here are a number of great suggestions.
  6. Spend more time in nature. Research shows that spending time in nature is associated with improved mental health. Go on a monthly hike, plan to visit a national park, or just spend some time outside appreciating your surroundings.
  7. Volunteer! So many organizations are in need of volunteers and there are so many important causes. You can devote your time to helping animals, saving the environment, or improving literacy. Volunteering provides health benefits and can boost self-esteem.
  8. Create something. Paint, draw, needlepoint, collage, write a story or a song. Art is a great way to express your feelings and the act of creating something can boost mood and self-esteem.
  9. Expand your cooking repertoire. Whatever your cooking ability, there is room to grow. Learn a new technique, master a new cuisine, and try some new recipes. Cooking is a great way to improve your appreciation for food and can help with mindful eating.
  10. Make no New Year’s resolution at all. After all, the passage from 2017 to 2018 is just a social construct — it affects neither your self-worth nor any progress in your life.

ARFID talk for LACPA Professionals in Los Angeles

Harvard Health Publications, Jennifer Thomas

Date:  Thursday, January 18 at 7:30 PM

Presenter:  Jennifer Thomas, Ph.D.

Title: Avoidant/restrictive food intake disorder: Assessment, neurobiology, and treatment

Description: Avoidant/Restrictive Food Intake Disorder (ARFID) was recently added to the Feeding and Eating Disorders section of DSM-5 to describe children, adolescents, and adults who cannot meet their nutritional needs, typically because of sensory sensitivity, fear of aversive consequences, and/or apparent lack of interest in eating or food. ARFID is so new that there is currently no evidence-based treatment.  This presentation will discuss how to recognize and diagnose ARFID, share preliminary findings from an ongoing NIMH-funded study of its neurobiological underpinnings, and describe a new cognitive-behavioral treatment currently being evaluated in an open trial.  

Bio:  Dr. Jennifer Thomas is the Co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital, and an Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School. Dr. Thomas’s research focuses on atypical eating disorders, as described in her books Almost Anorexic: Is My (or My Loved One’s) Relationship with Food a Problem? and Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults. She is currently principal investigator on several studies investigating the neurobiology and treatment of avoidant/restrictive food intake disorder, funded by the U.S. National Institute of Mental Health and private foundations.  She is also the Director of Annual Meetings for the Academy for Eating Disorders and an Associate Editor for the International Journal of Eating Disorders.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

RSVP to:  drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

 

 

Phobia Exposure Therapy

Phobia Exposure Therapy

We are excited to announce that we are now providing virtual reality phobia exposure therapy –partnering with Psious. Psious is one of the pioneering companies in the development of Virtual Reality for therapeutc purposes. The Spanish company offers immersive 3D simulations designed to treat a variety of mental disorders. A multidisciplinary team of psychologists, 3D artists and engineers worked together to create the first online platform for mental health practitioners, which makes the treatment readily accessible to patients.

Exposure is a critical component for the successful treatment of phobias and anxiety disorders. Standard therapy for phobias typically includes imaginal exposure (using the client’s ability to imagine him or herself in different scenarios such as on an airplane or in an elevator) done in session and in vivo exposure (real-life exposure) assigned as homework. Virtual reality therapy offers a powerful alternative, in that exposure scenarios that feel vivid can be faced with your therapist in session. This provides many benefits including privacy and cost-effectiveness (versus, for example, taking multiple actual plane flights). Virtual reality exposure therapy is effective and it allows the therapist to customize and titrate exposures specifically for each patient.

In VR, the patient wears a headset, which creates a completely 3-dimensional, immersive virtual environment.

Below is a demonstration of virtual reality and augmented reality exposure treatment for spider phobia.

Some of the issues we are able to treat using VR include:

  • Fear of flying
  • Fear of heights
  • Fear of enclosed spaces
  • Fear of driving
  • Fear of insects

Exposure therapy is a component of cognitive-behavioral therapy (CBT) which is the leading treatment for anxiety disorders. You will receive a complete assessment and treatment plan. CBT is a time-limited treatment. Phobias can often be successfully treated in 5 to 15 sessions of psychotherapy. In addition to exposure practice, treatment also includes psychoeducation, cognitive restructuring, and relaxation training.

If you are looking for phobia exposure therapy in Los Angeles, call (323-473-2112) or email us (lmuhlheim@eatingdisordertherapyla.com) today to learn more.

November 2017 LACPA Eating Disorder SIG Event

Date:  Thursday, November 30th at 7:30 PM 

Presenter:  Jamie Feusner, M.D.

Title: Body Image in Anorexia Nervosa and Body Dysmorphic Disorder: Clinical and Neurobiological Features

Description: Anorexia nervosa (AN) and body dysmorphic disorder (BDD) share clinical features related to body image distortion, including distorted perception of appearance and overemphasis on appearance in one’s self-evaluation. In addition, they share obsessive and compulsive tendencies, poor insight, and are frequently comorbid with each other. Despite this, few studies have directly compared the phenomenology or neuropsychological functioning in AN and BDD and even fewer have compared their neurobiology. In this talk I will describe the overlapping and distinct clinical features of these disorders, as well as the neurobiological substrates of visual and emotional processing from our recent lines of research. In our research, we have used functional neuroimaging (electroencephalography – EEG – and functional magnetic resonance imaging – fMRI) to probe the neural basis of visual processing and to uncover the dynamics of brain connectivity related to fear processing. We additionally have used structural neuroimaging to understand white matter network connectivity patterns. I will also discuss our ongoing study in AN of how brain systems involved in anxiety interact with those involve in reward and how this relates to clinical trajectory. Finally, I will discuss ongoing and future studies to develop visual modulation strategies to address dysfunctional neural systems involved in visual processing, as potential tools to remediate perceptual distortions in disorders of body image.

Bio:  Jamie Feusner, M.D. is professor of psychiatry and biobehavioral sciences at UCLA. He obtained his medical degree and completed his psychiatry residency training at UCLA. He then completed a psychopharmacology fellowship followed by a research fellowship in neuroimaging, and joined the UCLA faculty in 2006. Dr. Feusner’s research program seeks to understand phenotypes of perceptual and emotional processing across conditions involving body image and obsessions/compulsions, including body dysmorphic disorder (BDD), eating disorders, OCD, and gender dysphoria. Dr. Feusner published the first functional neuroimaging studies in BDD, and the first studies to directly compare the neurobiology of BDD to anorexia nervosa. He is currently funded by the NIH to study anorexia nervosa, BDD, and gender dysphoria. His clinical work includes Directorship of the UCLA OCD Intensive Treatment program. He teaches cognitive-behavioral therapy and pharmacotherapy, and is a research supervisor for postdoctoral fellows and students.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

RSVP to:  drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

Fall 2017 LACPA Eating Disorder SIG Events

Date:  Wednesday, September 13 at 7:30 PM

Presenter:  Hope Levin, M.D.

Title: Psychopharmacological Treatment of Eating Disorders

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Hope W. Levin, M.D. is a board-certified child, adolescent and adult psychiatrist.  Since 2006, she has worked as a staff psychiatrist at UCLA Counseling and Psychological Services where she serves as the psychiatrist on the eating disorders treatment team.  She co-founded the UCLA Campus-wide Eating Disorders Partnership to collaborate with campus professionals who provide treatment to students with eating disorders.   In addition to her work at UCLA, Dr. Levin is a staff psychiatrist at The Renfrew Center of Los Angeles and maintains a private practice in Santa Monica.

Dr. Levin completed her undergraduate education at Cornell University and medical school at MCP Hahnemann School of Medicine.  She completed general psychiatry residency at University of Pennsylvania where she was Chief Resident, and child and adolescent psychiatry fellowship at the Massachusetts General Hospital/McLean Hospital program, Harvard University where she was also Chief Resident.

Dr. Levin gave this talk previously to our group in March 2012. She will present updated information.

RSVP to:  drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

Tuesday, October 3 at 7:30 PM

Presenter:  Bobbie Eisenstock, Ph.D.

Title: Media and Body Image: How Media Literacy Can Help Counteract Unrealistic Body Ideals

Description: In our media saturated world, it’s hard to escape the onslaught of messages that tell us how we should look, sell us products to achieve the ideal body, and pressure us to reshape our bodies with promises of happiness and success. How can we protect our self-image from media’s narrow and unrealistic ideals that can make us feel less confident and accepting of our bodies? Research demonstrates that media literacy can help counteract media’s role in normalizing cultural body standards that are naturally unattainable for most and can adversely affect body positivity. This mini-workshop highlights essential media literacy strategies and resources for self-care in the digital age.

Location:  LACPA Office, Encino

Bio:  Bobbie Eisenstock, Ph.D. specializes in the social and psychological effects of media and new interactive technologies on children, teens, and families. She facilitates media literacy workshops for parents, educators, and health practitioners to promote healthy child and adolescent development. A recipient of NEDA’s Westin Family Award for Excellence in Activism and Advocacy, Dr. Eisenstock is on the faculty at Syracuse University in Los Angeles and California State University, Northridge where she directs the Proud2Bme civic engagement project about media literacy and body image. Her students developed NEDA’s Get REAL! Digital and Media Literacy Toolkit and How to Spread Body Positivity in Your Community.

Here is a link to media literacy tips Dr. Eisenstock wrote for NEDA that were posted on its website earlier this month:

https://www.nationaleatingdisorders.org/blog/media-body-image-what-you-need-to-know

LACPA ADDRESS and PARKING INSTRUCTIONS: 6345 Balboa Blvd, Bldg 2, Suite 126, Encino 91316. The buildings are on the south-west corner of Victory and Balboa, and Bldg 2 is the second building from Balboa.  If you come from the Westside, take the 405 to the 101 and exit going north on Balboa to just before Victory (park on the street or in the Sepulveda Basin Sports Complex (6201 Balboa Blvd.) on the west side of Balboa, just south of Victory).  Or take the 405 to Victory (past the 101 if you are coming from the Westside) and exit West onto Victory.  Take it to Balboa and turn left, now heading south.  On your right, you will see the buildings.  The LACPA office is right by the entrance off the parking lot, on the left if you walk in from the parking area.

Parking at The Encino Office Park lot between the hours of 9am – 6:30 pm is restricted to building tenants only.  We can park there in the evening and on weekends, but not 9 – 6:30 weekdays.

RSVP to:  drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

 

A Viewing Guide for “To The Bone”

Ten Things I Want Viewers of To the Bone to KnowEating Disorder Film Guide: To The Bone

“To The Bone,” Marti Noxon’s semi-autobiographical film about her experience as a young adult living with anorexia, was released today on Netflix and has already stirred up much controversy within the eating disorder community. As a general rule, I do not see things in black and white. As with anything, I see this film in shades of grey – it handles some things well and some things poorly. Many concerns have already been aired widely in both mainstream and social media.  Foremost among these concerns is the movie’s reinforcement of the anorexia nervosa stereotype by portraying an emaciated white female and the weight loss that lead actress Lily Collins underwent to play the role. I will not rehash these here; instead, I hope to shed light on some other important issues and to provide an educational piece to accompany the film.

  1. This film may be triggering. It shows images of severe emaciation and may either be upsetting to those vulnerable to eating disorders, or inspire a competitive desire to be “as skinny”. Often, people with eating disorders don’t feel “sick enough”; anorexia nervosa can be a competitive illness. (Reports are that pro-ana sites are already using images of Lily from the film. While it’s concerning that the film adds to the available library of these sorts of images, this library is already huge – if they didn’t use this image, it would be easy to find another.) Those susceptible must exercise caution when viewing this film and if they are triggered, they should contact their treatment team or contact an organization such as the National Eating Disorders Association for help.
  2. It is difficult to make a film that accurately portrays eating disorders. To depict eating disorders on film, behaviors must be shown. Yet much of the suffering from an eating disorder is internal and harder to depict. This film is not an educational film – it is a piece of entertainment. Nevertheless, I think it does bring eating disorders into the mainstream. The film portrays some things accurately – with others it takes great liberties. Even with these departures, I do think it has virtues that can do some good. I will discuss these more below.
  3. This is one person’s story. Marti Noxon’s aim is to tell her story and she has a right to do so. She has been public that many years ago she suffered from an eating disorder and wanted to both shed light on and draw more attention to the issue. And that she has done! Based on the talkback I attended with Marti Noxon and actors Lily Collins and Alex Sharp, Marti recognizes that she can neither represent the diversity of all people with eating disorders nor speak for the range of people affected. She hopes that her work will open the door for others to tell their own stories, a hope I share. For those interested in a more diverse story about eating disorders, check out the work of Tchaiko Omwale, who is working to complete her film Solace. If you are committed to helping bring more diverse voices forward, you can contribute to help her complete her film.
  4. To The Bone accurately portrays some of the aspects of living with an eating disorder. I do not believe the film overly glamorizes anorexia. It illustrates the mindset and some of the mental anguish of someone with an eating disorder. The film displays a number of common eating disorder behaviors. We see Ellen and her peers engaging in behaviors such as calorie-counting, dietary restriction, overexercise, bingeing and purging, and chewing and spitting. Chewing and spitting is displayed in a restaurant scene in which Ellen goes out to eat with Lucas, her friend from treatment. Chewing and spitting is a lesser-known, but significant eating disorder behavior that is not commonly talked about or assessed by professionals. It is a frequently associated with more severe eating disorder symptoms and suicidal ideation. However, the behavior is more likely to occur in private than in public. It can occur in the context of anorexia nervosa as well as bulimia nervosa or other disorders.
  1. Eating disorders are serious mental illnesses and can be life-threatening. The movie shows Ellen and some of her peers needing medical attention and carefully balances showing the gravity of their situation with building hope for recovery.
  2. To the Bone paints a very Hollywood picture of recovery. While the movie adequately portrays Ellen’s ambivalence about treatment, it implies that things shift when Ellen “decides” she wants to recover. It disturbs me greatly that Dr. Beckham tells Ellen, “I’m not going to treat you if you aren’t interested in living.” Many people with anorexia nervosa have anosognosia, a symptom that causes patients to deny their illness and refuse treatment as a result. We now know that enough food, weight gain, and a cessation of eating disorder behaviors are prerequisites for recovery from anorexia nervosa. Usually some physical restoration is required before a patient can really want to recover – Dr. Ovidio Bermudez calls this a “brain rescue.”
  3. The movie does not model modern eating disorder treatment practices. But realistic treatment would probably not make a good Hollywood story. For starters, I would never suggest a therapy patient change his/her name! More seriously, in eating disorder treatment we prioritize nutritional recovery. This refers not to specific nutrients, but to the development of healthy eating habits including regular meals and adequate amounts of food. This applies to people with all eating disorders, not just anorexia nervosa. People with eating disorders need as a primary element of treatment food – balanced, sufficient, and regular eating. The movie portrays the patients in the residential treatment center as each able to choose their own food. While some patients eat some portion of the meals served, other patients eat nothing (or the one character with BED repeatedly eats only peanut butter out of the jar). I know of no treatment setting that would not have a primary focus on structured regular meals and patients having requirements for meals that can become less restrictive as they progress in treatment.
  4. I worry that the portrayal of Ellen’s family reinforces old myths about eating disorders being caused by families. To reiterate, families do not cause eating disorders. Ellen’s father is unavailable (and never even appears), her mother has had mental health problems (and is involved in a new relationship) and no one is really there for Ellen, except her stepmother who takes her to treatment and her half-sister. I do love the portrayal of the relationship between Ellen and her half-sister. I think this relationship captures the mixture of love, concern, and anger experienced by siblings.
  5. The movie misses the opportunity to depict the family as important allies in treatment. No one is really involved in Ellen’s treatment beyond the family session, and Dr. Beckham states there is no need for any future family sessions on the basis of how badly it went. None of the young people in this house have their parents involved in their treatment (at least that we see). This is very unrealistic in this day and age. Almost every treatment center involves family members to a greater or lesser degree. In reality, parents can play a central role in the treatment of adolescents and young adults, are usually included in treatment, and can even drive the treatment when their youngsters are incapable of seeking treatment on their own or have anosognosia. Parents can also help with nourishing their youngsters back to health (but not in the dramatic way it was portrayed in the film…with a baby bottle). Family-based treatment (also referred to as the Maudsley method and mentioned in passing in the scene where the moms are in the waiting room waiting for their daughters to have an intake with Dr. Beckham as something they have tried) is actually the leading treatment for adolescents and is also effective for many young adults. It focuses on empowering the family to be an important part of the treatment team and able to fight for recovery on behalf of an unwilling or unmotivated youngster and also provide meal support.
  1. Three Things I really like about the film:
    1. I love that Dr. Beckham says, “There is never one cause.” This is true.
    2. I love that it builds hope for recovery by showing Lucas as doing well and actively working on recovery.
    3. I love that it shows a male and an African-American with eating disorders.

Although I was a consultant for the film, I had no influence on the story.

In conclusion, please View the Nine Truths PSA the cast and crew of To the Bone produced for World Eating Disorders Action Day. While aspects of the film veer far from reality, the filmmakers are committed to the cause and, to support eating disorder education, they made this PSA which aligns with the best current evidence on eating disorders. Most of the messages I would want viewers of the film to come away with would be covered in this fabulous video. You can also read the Nine Truths About Eating Disorders:

Truth #1: Many people with eating disorders look healthy, yet may be extremely ill.

Truth #2: Families are not to blame, and can be the patients’ and providers’ best allies in treatment.

Truth #3: An eating disorder diagnosis is a health crisis that disrupts personal and family functioning.

Truth #4: Eating disorders are not choices, but serious biologically influenced illnesses.

Truth #5: Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.

Truth #6: Eating disorders carry an increased risk for both suicide and medical complications.

Truth #7: Genes and environment play important roles in the development of eating disorders.

Truth #8: Genes alone do not predict who will develop eating disorders.

Truth #9: Full recovery from an eating disorder is possible. Early detection and intervention are important.

Produced in collaboration with Dr. Cynthia Bulik, PhD, FAED, who serves as distinguished Professor of Eating Disorders in the School of Medicine at the University of North Carolina at Chapel Hill and Professor of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Stockholm, Sweden. “Nine Truths” is based on Dr. Bulik’s 2014 “9 Eating Disorders Myths Busted” talk at the National Institute of Mental Health Alliance for Research Progress meeting.

A More Diverse Eating Disorder Film

Eating Disorder Therapy LA film
with Tchaiko

In the wake of the premiere on Netflix of another eating disorder film, my friend, JD Ouellette, reminded me that the frustration over another stereotypical narrative about eating disorders could provide an opportunity. At the NEDA Conference in 2014, both JD and I (as well as many other attendees) were impressed by Tchaiko Omawale’s sharing of her inspiring story of recovery on the Friends and Family Panel. Later, we learned about her work (writing, directing, and producing) on Solace, a coming of age feature film inspired by Tchaiko’s journey with an eating disorder and self-harm. In April, I had the opportunity to attend a fundraiser for Solace and preview a scene. I spoke about the need for more films, stories, and images of people from diverse backgrounds with eating disorders, reading some parts of this article.

Eating Disorder Therapy LA film
Speaking at the fundraiser

As summarized in Truth #5 of the collaborative consensus document, the Nine Truths, “Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.” When I work with people of diverse backgrounds, they consistently tell me they are frustrated that mainstream eating disorder narratives do not portray people who resemble them. Not only the popular media — television, film, print articles, online publications — but even the marketing materials of many eating disorder treatment centers continue to depict eating disorder sufferers mostly as the common stereotype: female, white, and thin.

To those interested in supporting a film that doesn’t reinforce stereotypes, Tchaiko Omawale has made such a film. She needs additional funding to complete the film, which is in post-production. Visit Solace Film page to learn more and, if you are so inclined, join me in supporting this important project. She has a donation page.

Eating Disorder Therapy LA film
Tchaiko speaking with castmembers on her right

How to Communicate With Your Psychiatrist About Medication

How to Communicate With Your Psychiatrist About Medication

In my work with patients who have anxiety and/or depression, I often recommend a consultation with a psychiatrist regarding medication. I believe in the value of psychotherapy; that’s why I became a (non-prescribing) psychologist. However, I find the careful use of psychiatric medications as a helpful aid to psychotherapy. For best results, you must communicate closely and assertively with your psychiatrist about your experience as you try new medications.

It is important to note that I am not a psychiatrist and do not prescribe medication, but I have worked closely alongside psychiatrists in many different settings. I continue to work with patients during the intervals between psychiatry visits. I am intimately familiar with the experiences they have when starting medication. I frequently coach my patients to communicate more with their psychiatrists.

Psychiatric Medicine: an Inexact Science

The selection of an appropriate psychiatric medication is a less exact science than is the choice of medications for other problems. If you have a particular bacterial infection, the specific antibiotic indicated for that infection should work for most people – for example, penicillin for strep throat. However, a medication that works well for one person’s depression may not work for another’s. Unfortunately, we don’t know why that is. Today, there is luckily a large arsenal of medication options from which to choose.  Because some medications work for some and not others, often it takes trial and error to determine which medication works for a particular patient.

Furthermore, the classes of psychiatric medications that are most commonly used for anxiety and mood disorders do not take full effect immediately but rather build up to a therapeutic dose in one’s brain over time. There can be side effects that many people experience before the curative effects kick in. Often patients are started on a lower dose of medication to determine the lowest effective dose as well as to minimize the severity of potential side effects caused by the medication. Further complicating the process, some patients require a higher dosage than others to experience a therapeutic effect.  For example, some may get a benefit from 20 mg of Prozac while others may need 60 mg.

When choosing specific medications, psychiatrists rely on information from drug manufacturers and research trials as well as their own clinical experience of how clients with diagnostic similarities responded to different medications.  These doctors often try to match medication and its side effects with specific symptoms. For example, someone with depression who is very tired may be prescribed an antidepressant that is more energizing, while someone with depression who is more agitated may be prescribed an antidepressant that has a side effect of calming. The side effects often also determine at what time of day the medication should be taken. More activating agents are generally taken in the morning and more sedating medications at night.

Because of the trial-and-error process of matching patients to medications and the lag time it can take to build up to a therapeutic dose, it can take several months to find the right psychiatric medication for a patient. Unfortunately, I too often see clients stop taking medications before they reach a beneficial effect due to some annoying but mild side effect that would have gone away over time.  I have seen patients giving up on medication altogether if the starting dosage of the first medication tried doesn’t help. It is disappointing when this happens because it might have worked.

If a client does not seem to respond to medication, psychiatrists will often first try increasing the dosage to see if a larger dosage produces a positive effect once it has built up, which can take another few weeks. Then if this seems to have no effect, they will usually recommend patients stop or taper the first medication and switch to a different medication, which will take several weeks to ramp up. And then, if necessary, raise that dosage… and so on. Sometimes patients require combinations of different medications, which multiplies the combinations that must be tested.

As you can see, this can be a slow and frustrating process.  Due to the period of time it takes to test the effectiveness of each medication, this can be unavoidable.

What this Means for Patients

When moving to a new medication, it is critical to follow through with the medication plan and communicate closely with your psychiatrist about both the therapeutic effects and any side effects you experience. Your psychiatrist is not a mind-reader.  I have seen many clients who notice no benefit from their medications, wait until the next appointment, which is sometimes months away, to report on a lack of progress. In doing so, they can waste precious time.

Here are some suggestions for working with your psychiatrist and maximizing your chance at more quickly finding the medications(s) and dosages that work for you.

  • Take the medication exactly as your psychiatrist recommends.
  • Keep to the regular appointments requested by your psychiatrist. They typically time these to coincide with the opportune times to gauge whether your medication is working. However, do not hesitate to call them sooner.
  • Take notes on your symptoms and any side effects so you can remember details.
  • Report any severe side effects or suicidal thoughts to your psychiatrist right away (do not wait until the next appointment).
  • Watch for signs of serotonin syndrome, a rare but potentially life-threatening side effect that can occur in response to psychiatric medications. If you experience these symptoms, call your doctor right away or go to the emergency room.
  • Make note of mild side effects (headache, nausea, dry mouth) and try to wait it out. See if the side effects subside after a few days. If not, report to your psychiatrist.
  • Understand how long your psychiatrist has told you it will take to notice a therapeutic effect from the medication. If it takes longer, report to them even if your appointment is still several weeks away. Psychiatrists can sometimes alter a prescription by phone before seeing you again, or they may suggest you come in sooner.

I hope that this information and tips have felt helpful to you. If you are considering medication, it may not be a cure-all, but it can be an incredibly helpful recovery tool. Key is communication!

 

2017 Spring LACPA Eating Disorder SIG Open (to non-LACPA members) events

Date: Tuesday, March 7 at 7:30 pm.

Title: Thinking Critically and Cautiously About the Phrase “Eating Disorders Are Biologically-Based Mental Illnesses

Presenter:  Michael Levine, Ph.D., FAED

Description: It has become a foundational “truth” among many clinicians, researchers, patients, family members, and advocates that, in accordance with the 2009 position statement of the Academy for Eating Disorders (AED), eating disorders are “biologically-based mental illnesses.” In fact, number 4 of the AED’s “Nine Truths about Eating Disorders” is “Eating disorders are not choices, but serious biologically influenced illnesses.”

Dr. Michael Levine has for many years studied sociocultural factors and their relationship to the prevention of eating disorders and disordered eating. In this talk, Levine offers a critical evaluation of this contention, in so far as one meaning of “critical” is “exercising or involving careful judgment or judicious evaluation” (Mirriam-Webster On-Line Dictionary; www.m-w.com).

Levine begins by addressing important general concepts, such as “illness” and “biologically-based,” as well as “scientific,” “evidence-based,” and “risk factor.” This sets the stage for a description of the Biopsychiatric/Neuroscientific paradigm in the eating disorders field. He will then consider the evidence for “biological causes” in the development of eating disorders, and its implications for two important challenges in the field: prevention and talking with patients, families, and the media. Throughout his presentation, Levine will compare and contrast the Biopsychiatric/Neuroscientific paradigm with the Sociocultural paradigm. Thus, his concluding remarks will consider what if anything is gained (and/or lost) by applying phrases such as “biopsychosocial” and “gene-environment interactions.”

Bio: Michael P. Levine, Ph.D., is Emeritus Professor of Psychology at Kenyon College in Gambier, Ohio, where he taught 33 years (1979-2012). In the field of eating disorders, his commitment to research, writing, and activism focuses on the intersection between sociocultural risk factors, prevention, community psychology, and developmental psychology. He has authored two books and three prevention curriculum guides, and he has co-edited three books on prevention. In August 2015, as co-editor with his long-time collaborator and colleague Dr. Linda Smolak, he published a two-volume Handbook of Eating Disorders (Wiley & Sons Publishing). He and Dr. Smolak are currently working on a second, updated edition of their 2006 book The Prevention of Eating Problems and Eating Disorders (Erlbaum/Routledge/Taylor & Francis). In addition, he has authored or co-authored approximately 110 articles and book chapters, and he has presented his work throughout the United States, as well as in Canada, England, Spain, Austria, and Australia. He is a member of the advisory councils of The National Eating Disorders Association (NEDA), the Center for Study of Anorexia and Bulimia (CSAB, NY), the Center for Balanced Living (CBL, Columbus, Ohio) and Monte Nido & Affiliates—Eating Disorder Treatment Centers.

Dr. Levine is a Fellow of the Academy for Eating Disorders (AED), which has awarded him their Meehan-Hartley Award for Leadership in Public Awareness and Advocacy (2006), and their Research-Practice Partnership Award (2008). Dr. Levine is also a member of the Founders Council of the National Eating Disorders Association, which awarded him the Lori Irving Award for Excellence in Eating Disorders Prevention and Awareness (2004) and the Nielsen Award for Lifetime Achievement (2013). After living for 37 years in Mount Vernon, OH, with his wife, Dr. Mary A. Suydam, a retired (as of May 2015) Kenyon religious studies and women and gender studies professor, they moved to California in late June 2016, to live near UC Santa Barbara, where they both obtained all their degrees.

Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

RSVP to: drmuhlheim@gmail.com

March and April SIG meetings are open to all professionals.   During other months SIG meetings are open to all LACPA members.  Non-members wishing to attend may join LACPA by visiting our website www.lapsych.org


Date: Thursday, April 20 at 7:30 pm.

Title: Medical Complications of Eating Disorders

Presenter:  Margherita Mascolo, MD, ACUTE Medical Director

Description:  Dr. Mascolo is the medical director of ACUTE. She will discuss the medical complications of severe restricting as well as purging. The presentation will include a broad review of the pathophysiology of starvation as well as the organ systems affected. There will be case-based discussion and presentation based on real patients seen on the ACUTE unit. Target audience is mental health professionals, dietitians, and allied professionals who need a broad understanding of the medical complications of restricting and purging.

Bio: Dr. Mascolo is the Medical Director at the ACUTE Center for Eating Disorders at Denver Health, where she has been a member of the ACUTE team since its beginning in 2008. She has trained under Dr. Philip S. Mehler for the past 8 years to become one of the country’s leading experts in the medical care of patients with severe eating disorders and served as Associate Medical Director under Dr. Jennifer Gaudiani for the past 3 years.

Dr. Mascolo completed her undergraduate work at the University of St. Thomas in Houston, Texas and earned her medical degree at the University of Texas Health Sciences Center. She completed her residency in Internal Medicine at the University of Colorado in Denver. She is board certified in Internal Medicine, is an Associate Professor in the Department of Medicine at the University of Colorado. Dr. Mascolo has published multiple peer-reviewed articles on the medical complications of eating disorders and is currently working to complete her Certified Eating Disorder Specialist certification.

Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

RSVP to: drmuhlheim@gmail.com

March and April SIG meetings are open to all professionals.   During other months SIG meetings are open to all LACPA members.  Non-members wishing to attend may join LACPA by visiting our website www.lapsych.org