Is Your Young Adult with an Eating Disorder Ready for College?

Is My Young Adult with an Eating Disorder Ready for College?

Dr. Muhlheim is doing a live webinar for parents of high school students with eating disorders on college readiness on Saturday, Feb 25 over zoom. You can register online by clicking here. You may be wondering: is my young adult with an eating disorder ready for college? Starting college is stressful for even the most …

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Presentation at NEDA 2015 conference

Lauren and Katie presenting NEDA 2015

Katie and I had the honor of presenting in the Individual, Family, and Friends track at the National Eating Disorder Association Conference in San Diego yesterday.  The title of our talk was:  Family Based Nutrition Therapy:  Creating A Supportive Environment.  It was a chance to share the way we work to support families who are …

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FBT Insights from the Neonatal Kitten Nursery

FBT Insights from the Kitten Nursery

I recently began volunteering at the Best Friends Neonatal Kitten Nursery. Best Friends Los Angeles opened its neonatal kitten nursery in February 2013.  The nursery is staffed with a dedicated coordinator and supported by volunteers who sign up for two hour feeding shifts 24 hours a day to help the kittens grow and thrive. If …

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Parental direction works, but don’t expect your kid to be happy about it: Research on The Family Meal in FBT

Parents charged with helping their children to recover in Family-Based Treatment often wonder 1) how to actually get their children to eat and 2) whether they will harm their children or the parent-child relationship by requiring them to eat. A recent study addressed these concerns by looking at the family meal.         …

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Recognizing and Managing the Subtler Signs of Starvation in Children with EDs

Signs of Anorexia

This interaction on twitter caught my eye: Watching cooking shows, collecting and reading recipes, and cooking for others (but not eating it oneself) are some of the earliest signs of anorexia that are often missed and misinterpreted by parents.  In Keys’ landmark study “The Biology of Human Starvation” male volunteers were put on starvation diets.  …

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Highlights from #ICED2014: The FBT Debate

Drs. Le Grange and Strober

ICED 2014 in New York provided a wonderful opportunity to connect with colleagues from around the world who share a commitment to providing treatment to those suffering from eating disorders. Among the highlights for me were the well-attended, first-ever tweetUP and my official appointment as Board Director for Outreach of the Academy for Eating Disorders. …

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FBT Meal Strategies Gleaned from Ziplining

FBT Meal Strategies Gleaned from Ziplining

Understanding and Responding to Your Youngster’s Fear: A Metaphor I often explain to parents that for a youngster suffering from an eating disorder, a meal can feel dangerous – like jumping out of an airplane. A couple of years ago I had the opportunity to (almost) live out this metaphor on a family vacation. This …

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Traveling With Your Anorexic

Traveling With Your Anorexic

Traveling With Your Anorexic [image description: photo of person looking out at Machu Picchu]By Lauren Muhlheim, Psy.D. and Therese Waterhous, Ph.D.

Families often ask whether they should proceed with a previously scheduled trip or take a well-deserved “break” during the refeeding process.  We advise that travel during Phase 1 of FBT be avoided if at all possible.  We know several families who have vacationed with a child well along in treatment for anorexia and found their child lost 5 to 10 pounds over the course of a week, erasing months of progress.  Children and young adults with anorexia have difficulty with change; if a child is having difficulty completing meals in the home, it is unlikely that they will be able to do so on vacation, where most meals will be eaten in an unfamiliar setting in the presence of non-family members.

During vacation, parents may be tempted to give in more easily to the anorexic thinking and behaviors because they do not want to upset other diners in a restaurant or because they “don’t want to ruin” the vacation after they’ve invested a lot of money in getting there.  The food may be different than that available at home, or it may be difficult to get the types of foods on which the family has been relying.  Children and young adults with anorexia are inflexible; if the food is different than that to which they are accustomed, they may refuse to eat at all.  Sightseeing often involves a lot of walking, which can burn a lot more calories and require even greater caloric intake to offset.  Many vacations occur in warm climates, where health problems related to malnourishment or dehydration may be magnified.  If families do travel during Phase 1 or Phase 2, they should be cautioned that it may cause a setback and prolong the recovery process.

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Exposure in the treatment of Eating Disorders

Exposure therapy is widely recognized as a necessary (and sometimes sufficient) ingredient of treatment for most of the anxiety disorders including phobias, panic disorder, and obsessive compulsive disorder.  Anxiety is a core psychological feature of anorexia nervosa and bulimia nervosa.  However, instead of being afraid of heights, speaking in public, having a heart attack, or contamination, individuals with eating disorders are primarily afraid of food, eating, and shape and weight.

Both cognitive-behavioral therapy and family based treatment, two empirically validated treatments for eating disorders, employ exposure techniques.  Exposure works through the process of habituation, the natural neurologically-based tendency to get used to things to which you are exposed for a long time.   During exposure, habituation occurs as people acclimate to their fear and come to realize that nothing actually dangerous is occurring. Habituation promotes new learning of safety, tolerance of fear feelings, and extinction of the fear avoidance urge. 

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Surviving the first week of re-feeding

Family-Based-Treatment [image description: sugar cookies frosted with the words "Feed," "Love," and "Heal"]Surviving the first week of re-feeding your child using (Maudsley) Family-Based Treatment

In Family-Based Treatment (FBT), figuring out how to get your starving child to eat and gain weight is a daunting task. Parents often feel overwhelmed and helpless when starting out on a re-feeding program. It is important to remember that your child is literally more afraid of the food than of dying of starvation. But food is the medicine, and it is your job to save her (or his) life.

Anorexia makes children do things they would never normally do and an escalation of behavior is common when parents start to stand up to the anorexia. In fact, an escalation during the first week, although unpleasant and often scary, is usually a good sign that parents are not giving in to the anorexia. Consistent confrontation of the anorexia ultimately brings greater compliance as well as weight gain. It is imperative that parents work together and are well aligned; otherwise the anorexia can split them and gain strength.

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