With a Little Help From My Family: Who is FBT For?

 

Who Is FBT For?
Photo by Zach Reiner on Unsplash

Family-Based Treatment (FBT) is the leading evidence-based treatment for adolescents with anorexia nervosa and bulimia nervosa. One of the common misbeliefs I hear is that it’s “only for kids or younger teens.” However, I think it has a much wider applicability. In fact, I would say that my FBT training has significantly improved my effectiveness in treating eating disorder patients of all ages.

While there have not been studies of FBT that pull it apart and pinpoint the elements that drive its success, I have a few theories. One of the key underpinnings of FBT is meal support. People with eating disorders experience such crippling anxiety before, during, and after meals that it is no wonder they would do anything they can to avoid eating. When the brain is in a state of overwhelming anxiety, a person with an eating disorder cannot make logical decisions about what to eat—or even to eat. And yet, without eating there can be no recovery. Treatment centers understand this—providing regular meals has been the mainstay of residential and partial hospitalization (PHP) eating disorder treatment for some time. FBT is the in-home parallel to this treatment.

In FBT, parents are charged with nourishing their teens back to health by providing regular nutrient-dense meals and preventing purging, excessive exercise, and other eating disorder behaviors. Parents plan, prepare, serve, and supervise meals and after meals, if purging is an issue. They make all the food decisions. They sit with their struggling child during those terrifying meals and help their teens cope with eating amounts sufficient for them to get well. Over time they return control to their teens, building their capacity to fight the eating disorder on their own. It takes effort and time to change brain pathways that have made eating a scary experience. For this reason, even those patients with eating disorders who go on to higher levels of care usually don’t remain there long enough to develop the autonomous ability to eat enough to sustain recovery. They often continue to need meal support for some time after more intensive treatment.

I think FBT has applicability that spreads wider than just children and teens. There is preliminary evidence of its successful use with transition-age youth up to age 25. Many parents have reported successfully using it with their college-age children. I have used it with this age and the primary variation is that the young adult plays a bigger role in their own treatment. They must agree at least in theory to accept their parents’—or other caregivers’—support. The young adult may choose who will support them during meals. Some, for example, may have a college roommate provide support. Some parents do meal support via FaceTime when the young adult lives far away.

I should clarify that FBT is a manualized evidence-based treatment. To be done with fidelity it must comprise certain components, including a therapist who guides the parents in organizing their strategies to fight the eating disorder. Parents refeeding their child without a therapist’s oversight often state they are “doing FBT”. In this case, it is more accurate to say they are providing FBT-informed or carer-supported feeding. Regardless of the words we use to describe this support and whether or not a therapist is involved, I think it provides a core benefit that we can expand to other populations.

These principles can also be applied to adult treatment. I personally have supported an adult who was in PHP during the day and needed more support with meals outside of treatment hours. I applied the skills I learned in my FBT training to provide meal support to this person. It worked just like it did with teens. Obviously this adult was an active participant in their recovery who asked for my support. This does not mean that I did not encounter the same kind of anxiety and resistance that parents meet around meals.

Take another case —a 20-something patient who still lives with her parents. She has been doing so much better since she asked for help, trading in the restrictive foods she had been eating on her own for several years for family meals prepared by her parents. Or the case of a college student who gets support via FaceTime from her parents who live in another city. When working with young adults with eating disorders who are in loving relationships, we often work to help their significant others develop strategies to support them during meals.

My experience is not unusual. Many other FBT-trained clinicians report success with providing FBT-informed treatment to people from all walks of life. One dietitian has reported great progress working with an employed single adult who moved home to live with his parents so they could support with meals. Sadly, previous providers had pathologized his moving home as a sign of enmeshment. One therapist shared, “I am doing FBT with a 79-year old. She is now in phase 2. She can now go out on dates—she just has to send pictures of her food to her adult children who are taking charge of her recovery and have been in charge of plating her food.”

Many have realized that in-home meal support is a common need for patients, and naturally, it is starting to become a big business with several treatment programs now providing this service. Offered as a service, this individualized meal support can be very expensive. Far more convenient, cost-effective, and loving is meal support provided by parents, other family members, or significant others.

I personally see it as a sign of strength when an adult admits they need more help. There is no shame in needing meal support during your recovery no matter what your age. Moving back home to live with family for support is nothing to be embarrassed by. This disorder robs people of their ability to make decisions around food—outside support is needed by definition. If you struggle around mealtimes with deciding what to eat, only feel safe eating a narrow range of food, have been struggling to make progress in your recovery, or cannot manage urges to purge after eating, you are not alone. You may benefit from the addition of meal support. It may feel scary or embarrassing to ask for help and you may worry you are being a burden. But asking for help is a brave step and you will likely find that there are some people in your life who can do this for you. It sometimes requires a little creativity, but you may find that it makes a big difference in your recovery.

The short answer is: FBT can be for people of any age.

Sources

When Your Child With an Eating Disorder is Sick….

Guest post by Dr. Jennifer Johnson

When Your Child with An Eating Disorder is Sick...
Gambar oleh Clker-Free-Vector-Images pada Pixabay

When parents are renourishing a child with an eating disorder and that child gets sick, parents often don’t know what to do. Some families may back off on feeding every time a child gets any illness, which can be a risky practice. Especially during Phase 1 of FBT, ensuring eating is a priority. To help parents, I’ve asked Jennifer Johnson, MD, a medical doctor who specializes in treating patients with eating disorders, to share some advice.

First, let me say that in general, minor illness should not cause a kid with an eating disorder to lose weight. Parents who are refeeding their child know that even missing a meal or a snack makes a difference in their progress. Don’t let illness throw you off course. As you know, failure to gain as expected may occur if nutrition is even a bit compromised. It is absolutely not a given that illness or surgical procedure must cause weight loss. When I hear that someone has lost 3 pounds “because they had a cold” the previous week, I ask a lot of questions – that should not have happened.

Second, plan ahead. After you’ve read through my answers and looked at other parents’ recommendations, be proactive. Make a plan with your child and treatment team about what you will do if they get sick (which they inevitably WILL at some point during recovery). They should know that they WILL still be eating. But talk about what foods they tend to like when they are ill, and think about how to plug maximum nutrition into them. Buy any non-perishable supplies and stock up on over the counter medications for colds, coughs, and fever. (And please have a thermometer on hand! A $10 digital one is plenty good to give us doctors valuable information.)

What should parents do in terms of feeding when a child with an eating disorder has a head cold or sore throat and loses their appetite? Is it necessary to avoid dairy?

If your child is listless and feeling unwell, they will often not be very hungry for a couple of days. A sick child needs care and comfort. Caring for a sick child who has an eating disorder includes keeping up the nutritional intake. You don’t want the eating disorder to think that illness is a good way to sneak through the back door. And, there are other times when your child is not hungry, just from refeeding itself, and they have to eat anyway. So, push ahead, but gently. Present nutrition dense food and beverages that will be particularly appealing to your child. Does a milkshake sound appetizing? You can add a packet of Benecalorie. (There’s nothing wrong with dairy, by the way.) Chicken noodle soup? Maybe add some extra pasta. There are lots of helpful posts from parents on the Around the Dinner Table Parent Forum.

What about if they have a fever?

Having a significant fever (101 or above) increases fluid needs as well as metabolic rate (more calories are burned). Your child will feel better if you control the fever with regular doses of acetaminophen or ibuprofen. Giving the medication at regular intervals, say every 6 hours for acetaminophen, may prevent the fever from getting as high as it otherwise might. This also helps with the headaches that usually accompany fever. Keeping your child hydrated, particularly with something like Gatorade, will also help them feel better – and thus more likely to have some appetite. Some kids maintain their appetite when they have a fever and of course, it’s fine to continue refeeding. Otherwise, know that keeping up nutrition during an illness helps your child feel better sooner, and push on. Again, it’s helpful to adjust what you give them based on their preferences.

What about when kids in recovery have the stomach flu?

What do you do if they’re vomiting?

Generally, vomiting is worst at the onset of an episode of stomach flu and becomes less frequent over the next 24 hours. A parent’s main goal when a kid is vomiting is to keep them hydrated. I recommend not giving anything by mouth for 2 hours after they’ve thrown up. Then you can give them ice chips or a couple of teaspoons of water. This liquid will get absorbed from the mouth. Do this every 5 minutes or so for half an hour. If they haven’t vomited again, you can have them try slightly larger amounts of liquids at less frequent intervals. They should be able to keep down about 2/3 of a cup of liquid, and be hungry, before you try a very small amount of food. Slowly increase the amount you give them. Kids may become ravenous and eat a huge meal, but then throw up everything they’ve just eaten. A kid who throws up a day or two into recuperation may have just overdone it. In that case, you’ll need to let up a bit before pushing back into refeeding.

What about diarrhea?

For kids with diarrhea, we don’t generally recommend giving any medications that are designed to decrease the number of stools (bowel movements). No major food restrictions are needed. There is nothing magical or beneficial about the so-called BRAT diet (bananas, rice, applesauce, toast), which is of low nutritional density. Studies have shown that having diarrhea for a few days does not make someone lactose intolerant. We know that eating when you have a “stomach bug” with diarrhea will generally increase the number of diarrheal stools. But we also know that at the end of the illness, people who have continued to eat will end up better nourished (= digested more calories). And that, of course, is the ultimate goal.

One thought: you may want to speak with your child’s doctor about a proactive prescription for a small number of anti-emetic tablets (that dissolve in the mouth) to have on hand in case your child gets stomach flu. I don’t normally recommend this but refeeding is an exception. We want to minimize the duration of nausea and vomiting to make it easier for your child to eat. Also, many of my patients who have eating disorders are afraid of truly fearful of vomiting (a condition called emetophobia), which only makes stomach flu worse for everyone. If your doctor is willing to do this, they undoubtedly want you to call before you give the medication.

What if your child has no appetite (due to illness)

Biology is on our side. When a kid (or another human being) eats less due to a minor illness, appetite typically returns with a vengeance and we make up for what we’ve missed. For a kid in the early refeeding phase, of course, it is normal to not feel hungry. So you may not know whether your child is not hungry because they’re not feeling well or because they’re refeeding. In either case, your eating disordered child needs you to continue to push forward. Refeeding is the mainstay of treatment and you’re the team leader. Go for it!

Please note that none of the above should be construed as medical advice. If you have concerns about your child’s health, contact their doctor. Some examples of when you should call the doctor are: Bloody diarrhea, high fever (102 or above), vomiting that continues more than 24 hours, weakness, severe dizziness or fainting, or very little urine.

About Jennifer Johnson, M.D., MS, FAAP

Dr. Johnson is a medical doctor. She has more than 20 years’ experience as a pediatrician and adolescent medicine specialist. She practices in Newport Beach (Orange County), California.

Dr. Johnson is certified by the American Board of Pediatrics in Adolescent Medicine as well as in Pediatrics. Dr. Johnson also has an advanced degree in public health. She has been a professor in the Department of Pediatrics at the University of California, Irvine School of Medicine, where she served as director of the adolescent medicine program. Dr. Johnson has taught medical students, residents, faculty, and community physicians, for whom she continues to present educational programs. She has presented at national meetings of many organizations, including the American Academy of Pediatrics and the American Academy of Family Practice. Dr. Johnson has written many research articles and book chapters related to adolescent and young adult medicine.

Dr. Johnson is an advocate for adolescents and young adults. She is a Fellow of the American Academy of Pediatrics (AAP). She has led many activities in the Academy’s Section on Adolescent Health and served as its chairperson. Dr. Johnson is active in the Orange County chapter of the AAP, as well. Current projects include the Teen Safe Driving Initiative and healthcare for GLBTQ teens.

Dr. Johnson has also been active in the Society for Adolescent Medicine. As a member of the medical advisory board for Teengrowth, Dr. Johnson wrote many articles and answers to reader questions. Articles and webcasts by Dr. Johnson are posted at Healthology.com, medbroadcast.com, and the New York Daily News. 

Dr. Johnson is on the medical staff of Hoag Hospital in Newport Beach.

On Empowering Parents—Not Pathologizing Them

Empowering Parents I often write about the importance of including parents in the treatment of adolescents and young adults. My work is informed by my training in Family-based Treatment (FBT), which as a central part of treatment seeks to empower parents to help their ailing children with eating disorders to return to health. When asked why families should be the center of treatment, I usually cite the AED guidelines on the role of the family, The Nine Truths About Eating Disorders, and the vast evidence base underlying FBT. I often discuss how providers who see families with children with eating disorders get a distorted view of the family: they do not have the benefit of having seen how it functioned prior to the eating disorder. Parents’ behaviors are often pathologized when they are actually the normal response of healthy parents to a child in distress.

This post is different—here I will share a more personal perspective.

Recently, one of my children (anonymized here because the story is theirs to tell) stumbled. My child was fighting a mental health issue that was not an eating disorder. The experience of watching my child struggle, and struggling to help my child, has further informed my thinking on this issue.

Sadly, it remains common for parents of children, adolescents, and young adults with mental health problems to be judged, labeled, blamed, and excised from the child’s treatment. This has happened to families with whom I have worked. Parents have sometimes been labeled as “enmeshed” or “overprotective.” This is not productive.

I’m writing this blog to share how beneficial it was personally to be included in my young adult child’s treatment. First, let me give you some background.

For Most of My Parenting Years, I Was Balanced

I care for my children deeply and have chosen a career that has allowed me the flexibility to be present in their lives and to be their primary caretaker. At the same time, I have been anything but a coddler. All three of my children were sleep-trained at less than six months, left at a young age with non-family babysitters, and dropped at preschool on the first day. I shed some tears, but I was not a parent who stayed and watched outside of the classroom for months; I went to work.

I also developed a certain toughness to set limits. During my kids’ early years, I worked at Los Angeles County Jail, where I encountered numerous inmates demanding sleeping medications or “more desirable” housing assignments and then threatening suicide when they didn’t get their way. I became a pro at placing inmates on suicide watch and walking away despite their sometimes yelling at the top of their lungs that they would tell the entire jail, “It’s because of you, Dr. Muhlheim, that I will kill myself.”

I am not a perfect mother, but I am a highly dedicated, devoted one. I have sought to balance my joy in raising my children with time to pursue my own interests and career.

When My Child Started to Struggle I Became Highly Involved

When I work with parents of teens and young adults with eating disorders, I encourage parents to trust their instincts. “Parents know their kids best,” I tell them. During the transition to college, when my child was supposed to be individuating, I knew something was amiss, so I hovered more than usual.

Fortunately, when my child wobbled, I was prepared. I trusted my instincts. I was fully present: watching, standing close, getting my child help. I helped save my child’s life. There are powerful cultural expectations that parents should back off and allow their child to individuate. There is less support for parents who choose to step in at this moment. Observing my behavior at that time, I may have been labeled as overprotective.

Even my child, who recognized the need for parental help, was fighting against it. This was confusing to their therapist, who later wrote in a report, “There is a weird dichotomy between the child and the parents. The child refuses to sign a release of information for the therapist to speak to the parents, but the child appears to reach out to the mother for support.”

Rather than pathologizing hovering parents, we need to recognize that they are doing it for a reason.

Professionals Supporting, Not Blaming Parents

The hardest moments of this whole journey were those times that, on top of his worry for our child and whether they could or would actually recover, my husband blamed himself for causing the problems our child was facing. This tendency of parents—to blame themselves for any problem that befalls a child—is typical, whether or not the problem could be attributed to parenting. I noticed that when my husband started to blame himself, we both became hopeless and lost focus on helping our child. These were dark times—it was hard to have our own faith and be present for our child.

Fortunately, we had the means to seek out high-quality treatment. Our child was treated in a center that specializes in treatment often used for a problem for which parents have historically been blamed. In this program, we as parents were given much-needed support and services as well. Importantly, the clinicians never indicated they believed that we had caused our child’s problems. Instead, we were validated, supported, and given a framework for understanding our child’s problems that did not point the finger at us.

Made/Makes All the Difference

Further, our responses to our struggling child were validated as a reasonable response to experiencing our child’s struggles. We were supported in our child’s recovery, empowered to play a role, included in the treatment, and seen as parents doing our best. This was profound. I think it made all the difference.

Our child worked hard and so did we. With the proper help and our support, our child is now healthy and firmly back on track. My hope for other parents of floundering adolescents and young adults is that they are treated with the same respect that we were.

FBT Insights from the Neonatal Kitten Nursery

Parents feed children in FBT Kitten CollageI 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 you were an abandoned kitten in the Los Angeles area, or even a kitten with a mother, you’d be lucky to make your way to the Best Friends Neonatal Kitten Nursery.

The most vulnerable animals in the Los Angeles shelters are newborn kittens, often abandoned at birth, or turned into shelters from accidental litters. Because the kittens cannot feed themselves, they will die without someone to bottle feed them.

In the mommy and me section of the nursery, mothers nurse their kittens. In the other sections, kittens are bottle-fed, tube-fed, or syringe-fed until they are able to eat gruel on their own. Kittens are weighed before and after each feeding. If their weights are not steadily going up, the interventions increase. They are very fragile at this age.

The other night, the nursery coordinator, Nicole, was tube-feeding some kittens who were ill. As she explained, they were feeling too sick to eat on their own. Although acknowledging that her tube feeding was making them angry, Nicole was resolute. No kitten would starve to death on her watch. Of course, I connected this back to my families working to re-feed their children with anorexia.

In the neonatal nursery, we don’t spend time thinking about why the kitten is not nursing or eating in the expected fashion. If they are sick, they are treated for that, but in the meantime, every kitten is fed around the clock and those who don’t have mothers are bottle fed, those who won’t nurse from their mothers (often when they are too congested) are tube-fed, and those who won’t eat gruel independently are syringe-fed.

How does this relate to parents doing Family Based Treatment (FBT) for Eating Disorders with children who have Anorexia?

Of course, parents do not literally force food down human children’s throats, but they do set up contingencies to require eating even if the child doesn’t feel well and even if they rail and resist and are angry about it.

This is the heart of FBT Phase 1. When children are not able to eat on their own (due to an eating disorder) parents are instructed to nourish their starving child back to health. Parents need to step in and help their children make steady weight gains until they are able to eat on their own. Parents need to be resolute and not worry about their children being angry at them. They also should not spend time exploring why their child is not eating.

For further information on parental direction over eating in FBT, check out this prior blog post.

 

Summer LACPA Eating Disorder SIG meetings

Wednesday, June 17 at 7:15 pm  

Jessica Raymond, MS
Jessica Raymond, MS

Presenter:  Jessica Raymond, MS

Title:   Modernizing Recovery Resources for the Millennial Generation

This presentation will focus on the applications of modern technologies and media to increase support and improve treatment of eating disorders from the perspective of a client.

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

Bio:  Jessica Raymond, MS is the founder and director of Recovery Warriors, a multimedia company whose mission is deeply rooted in connecting treatment, technology and innovative design to the field of eating disorders. Having successful recovered from a 7 year battle with bulimia, Jessica is passionate about designing technologies and meaningful resources that increase access to care and support. Since 2012, she has created an array of resources for all stages of recovery that have been used over 1.4 million times in over 117 countries. When Jessica is not working on the Rise Up + Recover smartphone app, hosting The Recovery Warrior Show podcast, overseeing the award winning online magazine, curating music playlists and guided meditations and reaching out to eating disorder specialists to join ConnectED, the world’s first mobile optimized treatment directory exclusive to eating disorders she can be found surfing the lovely beaches of San Diego, hanging out at the park with her dog, or learning through literature.

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

Nine Truths About Eating Disorders

Slide19 Truths about Eating Disorders

Developed by Cynthia M. Bulik, PhD, FAED, Distinguished Professor of Eating Disorders in the School of Medicine at the University of North Carolina at Chapel Hill, with input from the leading associations in the field of Eating Disorders, listed below.

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.

 

 

 

Late spring 2015 LACPA Eating Disorder SIG meetings

Tuesday, April 14 6:30 pm

Presenter:  Stephanie Knatz, Ph.D.

Stephanie Knatz, Ph.D.
Stephanie Knatz, Ph.D.

Title:  Using neurobiology to improve treatment for anorexia

This presentation will focus on providing a brief overview of the neurobiology underlying anorexia and present new treatment methods developed and used to target the underlying neurobiology.

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

Bio: Dr. Stephanie Knatz is a clinical psychologist and program director for the Intensive Family Treatment Programs at the UCSD Eating Disorders Treatment and Research Center. Alongside colleagues at UCSD, Dr. Knatz is responsible for UCSD’s treatment development initiative to translate contemporary neurobiological findings into applied clinical treatment models. Through this initiative, Dr. Knatz and others at UCSD are in the process of developing a neurobiological framework for the treatment of anorexia. Dr. Knatz is currently overseeing the development, testing and implementation of a novel clinical treatment program for adults with anorexia and their family members, which integrates novel treatment strategies developed at the clinic. In addition to her clinical research, she also directs UCSD’s Intensive Family Treatment Program (IFT), a family-based treatment program for adolescents with eating disorders.

Thursday, May 14 7:00 pm

Jaeline Jaffe, Ph.D., LMFT 
Jaeline Jaffe, Ph.D., LMFT 

Presenter:  Jaeline Jaffe, Ph.D., LMFT 

Title:  What Eating Disorder Clinicians Need to Know About Misophonia 

This presentation will discuss the condition called Misophonia (or 4S – Selective Sound Sensitivity Syndrome), what is known about it at the present time, what theories might explain the condition, how it often relates to OCD, and how it might also relate to eating disorders. Included will be some tools and strategies that are often very helpful with misophonia patients, which might also be useful for ED clinicians. Following the presentation, there will be time for discussion and group-think to explore the possible applications of this information in working with ED patients.

Jaelline Jaffe, PhD, is a California Licensed Marriage and Family Therapist in practice since 1976. Over the past several years, she has developed a sub-specialization in working with the emotional aspects of medical conditions, including Tinnitus and Misophonia. She has presented at all the Misophonia Conferences ever held to date (three International Conferences for Audiologists, and two for patients and families, with the third one coming in October), and is working with probably more misophonia patients, both in-state and across the country, than any other therapist. Using CBT and DBT, she works in person or online to help patients manage the stress of their medical conditions, learn coping strategies, and improve the quality of their personal and family relationships.

Location:  LACPA Office, 17277 Ventura Blvd., #202, Encino, CA  91316, (At the corner of Ventura Blvd. and Louise)  Entrance is in the back of the strip mall and there is free parking in the lot after 5 pm

Please RSVP to drmuhlheim@gmail.com (2 H’s in Muhlheim)

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

 

Fall 2014 LACPA Eating Disorder SIG events

The Los Angeles County Psychological Association Eating Disorder SIG is kicking off the membership year with 2 great events.  Join LACPA now to take advantage of these and other events. 

1)  Date:  Thursday, October 23

Time:  7- 8:30 pm

Presenter:  Dagan VanDemark

T-FFED
T-Ffed: Trans Folx Fighting Eating Disorders

Title: TRANSforming Eating Disorder Recovery: Deconstructing the Overrepresentation of Eating Disorders in Trans and Gender Diverse Individuals, and How Healthcare Professionals Can Better Serve Our Communities

While under-treated and still under-researched, preliminary studies and countless anecdotes demonstrate that transgender people suffer from eating disorders disproportionately. This workshop will introduce how trans and gender-diverse people are vulnerable to and struggle with EDs, and conduct a basic training for health professionals looking to offer more trans-friendly, gender-literate and accessible care.  

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Dagan VanDemark is the Founder and Executive Director of the pending non-profit T-FFED: Trans Folx Fighting Eating Disorders, based in LA but quickly gaining national reach. Dagan, a genderqueer trans boi, battled bulimia/EDNOS for fifteen years. They have a B.A. in Gender Studies from CSULB, a certificate in Grant Writing and Administration from CSUDH, and they are enrolled in both the Non-Profit Management certificate program at UCLA and a transgender leadership initiative through Gender Justice LA. They speak on university panels about gender variance and sexual diversity, and write/blog extensively about transgender communities’ experiences with eating disorders.

Aimee Liu
Aimee Liu

2)  Date:  Wednesday, December 3

Time:  7:15 – 8:45 pm

Presenter:  Aimee Liu

Title: The Stages of Recovery 

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Aimee Liu is the author of Restoring Our Bodies, Reclaiming Our Lives (Trumpeter Books, 2011), a benefit project for the Academy for Eating Disorders, and of Gaining: The Truth About Life After Eating Disorders (Wellness Central, 2007), a sequel to her acclaimed 1979 memoir Solitaire.  Her novels include Flash House (Warner Books, 2003), Cloud Mountain (Warner Books, 1997), and Face (Warner Books, 1994).  She also has co-authored more than seven nonfiction books and written numerous articles on medical, psychological, and political topics. She earned her MFA from Bennington College and now teaches in Goddard College’s  MFA in Creative Writing Program. 

More information is available at www.gainingthetruth.com

Please RSVP to drmuhlheim@gmail.com (2 H’s in Muhlheim)

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

Ten Facts About Weight Stigma – Guest post by Liliana Almeida, Ph.D.

  1. Weight stigma is a bias or discrimination relating directly to weight. Despite the fact that more than half of U.S. citizens are larger-bodied, our society holds a strong negative bias against fatness.
  2. The media reinforces weight stigma. The media, such as news media, displays persons in larger bodies in stigmatizing ways by depicting them sitting and eating unhealthy foods, wearing ill-fitting clothes, headless, or with their abdomens showing.
  3. Weight stigma is based on the belief that weight is under one’s personal control. This belief suggests that larger persons are undisciplined and inactive. However, when weight is attributed to uncontrollable factors such as diabetes or hypertension, people’s attitudes change. 
  4. Weight stigma exists in romantic relationships. Romantically, people in larger bodies are less preferred.  They are less preferred in comparison to those who are in wheelchairs, mentally ill, or those who have sexually transmitted diseases.
  5. Weight stigma starts as early as preschool.  Children ages 3-5 negatively characterize larger children as mean, ugly, stupid and sloppy. As children get older they start believing their larger peers are lazy, less popular, and less happy. College students report that their peers in larger bodies are lazy, self-indulgent, and less attractive, with low self-esteem and deserving less attractive partners.
  6. Teachers have a weight bias towards heavier students. They believe their larger students lack self-control and are less likely to succeed.
  7. Health professionals are also biased. Health professionals treating individuals with eating disorders report believing that larger patients do not comply with treatment recommendations and perceive poor treatment outcomes. Those strongly biased believe larger body sizes are the result of overeating and lack of motivation.
  8. Individuals in larger bodies have internalized stigma. The most common anti-fat bias among larger individuals is the belief that they are lazier and less motivated than thinner individuals. The failed attempts of individuals in larger bodies to lose weight may cause them to begin to internalize society’s beliefs that they are lazy and lack willpower.
  9. Weight stigma increases binge eating. Weight stigma causes psychological distress such as depression, anxiety, and low self-esteem. It is also associated with poor body image and increased fear of fat.
  10. Weight stigma experiences are as common as other forms of discrimination. In women, it is as common as racial discrimination. In some cases, it is more common than gender and age discrimination. 

References 

Ashmore, J.A., Friedman, K.E., Reichmann, S.K., &Musante, G.J. (2008). Weight-based stigmatization, psychological distress, & binge eating behavior among obese treatment-seeking adults. Eating Behaviors, 9, 203-209.

Chen, Eunice & Brown, Molly. (2005). Obesity Stigma in Sexual Relationships.  Obesity Research, 13, 1393-1397.

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LACPA Eating Disorder SIG upcoming events (Fall 2014)

I am excited to announce the next 3 upcoming meetings of the Los Angeles County Psychological Association Eating Disorder Special Interest Group (LACPA ED SIG).  We have amazing speakers lined up.  The LACPA membership year begins in September, so now is the time to join or renew to maximize your benefits.  SIG events are open only to LACPA members, but are FREE.  For information on membership, see the LACPA website. www.lapsych.org.  One does not need to be a psychologist to join LACPA; other professionals may join as well.

Dr. Stacey Rosenfeld
Dr. Stacey Rosenfeld

Date: Thursday, August 28th

Time: 7-8:30

Title: Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight

Presenter: Stacey Rosenfeld, Ph.D.

Location: The office of Stacey Rosenfeld, PhD (2001 S. Barrington Avenue, Suite 114, Los Angeles)

BIO: Stacey Rosenfeld, PhD, is a clinical psychologist, licensed to practice in New York and California, who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly-praised Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight, inspired by her award-winning blog of the same name, she is often interviewed by media outlets as an expert in the field.

Dr. Rosenfeld is also the founder of the LACPA ED SIG but will be leaving the group in the fall due to relocation.  This will be a unique opportunity to hear her speak and also to acknowledge the contributions she has made to the Los Angeles community during her fruitful three years here.

Maggie Baumann, MFT, CEDS
Maggie Baumann, MFT, CEDS

Date: Tuesday, September 16th

Time: 7-8:30pm

Title: Pregnancy & Eating Disorders: Journey Through the Facts and Recovery

Presenter: Maggie Baumann, MFT, CEDS

Location: The office of Stacey Rosenfeld, PhD (2001 S. Barrington Avenue, Suite 114, Los Angeles)

Bio:  Maggie Baumann is a psychotherapist in Newport Beach who specializes in treating people struggling with eating disorders, including pregnant women and moms with eating disorders. She is a former board member for the Orange County Chapter of the International Association of Eating Disorder Professionals (IAEDP) and serves as a committee member on the national IAEDP certification board.

Maggie has been a featured guest on nationwide talk shows and TV segment profiling pregorexia and moms with eating disorders. She was a mental health blogger for Momlogic.com, where she shared her own story of suffering from pregorexia over twenty-five years ago. Additionally, Maggie serves as a guest eating disorder expert for KidsinTheHouse.com, a video parenting resource. She is also authoring a chapter on eating disorders and pregnancy for an upcoming book on Eating Disorders in Special Populations (publication date: 2015). Now, Maggie has partnered with Chicago-based residential treatment center, Timberline Knolls, in hosting their Lift the Shame eating disorder support group the first web-based support group for pregnant women and moms with eating disorders. Lift the Shame, is a free group and has members from across the US and abroad.

T-FFED
T-Ffed: Trans Folx Fighting Eating Disorders

Date:  Thursday, October 23

Time:  7- 8:30 pm

Title: TRANSforming Eating Disorder Recovery: Deconstructing the Overrepresentation of Eating Disorders in Trans and Gender Diverse Individuals, and How Healthcare Professionals Can Better Serve Our Communities

Presenter:  Dagan VanDemark

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Dagan VanDemark is the Founder and Executive Director of the pending non-profit T-FFED: Trans Folx Fighting Eating Disorders, based in LA but quickly gaining national reach. Dagan, a genderqueer trans boi, battled bulimia/EDNOS for fifteen years. They have a B.A. in Gender Studies from CSULB, a certificate in Grant Writing and Administration from CSUDH, and they are enrolled in both the Non-Profit Management certificate program at UCLA and a transgender leadership initiative through Gender Justice LA. They speak on university panels about gender variance and sexual diversity, and write/blog extensively about transgender communities’ experiences with eating disorders.

Please RSVP for any or all of the 3 events to drmuhlheim@gmail.com