August 2018 LACPA Eating Disorder SIG Event

Jaye Azoff, Psy.D., Los AngelesDate: Wednesday, August 22nd at 7:30 pm

Presenter: Jaye Azoff, Psy.D.

Title: The Anatomy of a Recovery

Description: Recovery from anorexia nervosa (AN) follows an unpredictable, windy path. Rarely does it come quick; there is no single trajectory, no infallible indicators of how a treatment will play out. Opinions about the recovery process vary, depending on whose perspective is being sought. The patient—the former patient—sees it one way—but there is no guarantee that the opinions of others, therapists, partners, loved ones, will concur.

This talk addresses the question in a unique fashion. A patient: a former patient, (a doctoral level psychologist) will share her account of a treatment that unfolded over roughly twenty years.

Several points will be discussed. Importantly, the former patient will consider 1) briefly, the etiology of her illness (and we will assume a basic understanding of eating disorders here); 2) briefly, how (some) of the various treatments were directed and integrated across the multi-disciplinary teams (and throughout the years) 3) how her protests and resistances—and there were many— were met, and with what explanations 4) most importantly, looking back, what aspects of this treatment are now recalled as influential, elements seen in a positive light, elements perceived as detrimental.

Perhaps most important for the purposes of this discussion is the concept of the “power struggle” – that all too familiar war our patients learn over years of treatment with us to get into with themselves which then becomes acted out with their caregivers. How can we as treaters do better at not engaging, and shift the power and responsibility back into their hands?

Namely, how can we teach them that if they are to get well, it will be because they choose to get well? How do we teach them that they “win” nothing by restricting their snack for an evening or vomiting their dinner because they feel hurt over something we as clinicians might have said or done to them? These are complicated constructs, but not impossible ones, and by using Dr. Azoff’s past as a case vignette, we might be able to chisel away at some of the answers.

Bio: Jaye Azoff, Psy.D., has been practicing in the fields of clinical psychology and neuropsychology since 2008, when she graduated from the California School of Professional Psychology in Los Angeles, where she trained under the Health Emphasis Track. Dr. Azoff did most of her field training at Children’s Hospital Los Angeles’ Keck School of Medicine, where she practiced in the hematology/oncology neural tumors unit and trained in many roles over nearly eight years, eventually advancing to become the team’s neuropsychology fellow. It was Dr. Azoff’s own recovery from an eating disorder that propelled her forward and launched her into the eating disorders field. Currently, she is an eating disorders consultant, and she is the owner and operator of Basik Concierge, the world’s only boutique concierge firm offering wraparound services for individuals with eating disorders and their families. She is also the In-House Clinical Consultant for the Kantor and Kantor law firm, which fervently works to attain treatment for individuals with eating disorders struggling to gain access to care. Dr. Azoff is a past board member of the Eating Disorders Coalition. She is a sought-after speaker, having formally addressed the United States Congress in the Spring of 2013, and travels nationally to speak to patients and families affected by eating disorders, as well as delivers in-services to clinicians and other individuals eager to learn about various topics related to 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

July 2018 LACPA Eating Disorder SIG Event

Date: Thursday, July 12th at 7:30 pm

Presenter: Ryan Sheldon, Eating Disorder Advocate

Title: Men Struggle, Too: My Journey with Binge Eating Disorder

Description: Description: I’m often asked what’s it like being a guy with Binge-Eating Disorder. It’s sad but true, many view eating disorders as female illnesses. Why is there so much shame about being a guy with an eating disorder? Why did it take so long for me to get diagnosed? Come join me to find out what it’s really like being a guy with Binge Eating Disorder. I will share my story and give you insights into working with males with eating disorders. Here’s a recent article.

Bio: Ryan Sheldon, founder of the blog Mr. Confessions formerly Confessions Of A Binge Eater, a blog he created to not only document his body image and eating disorder struggles but also to promote self love. He is proud to be a much-needed voice for men whose struggles all too often are neglected, while encouraging them to reach out for professional help. Ryan is currently working on a book and has a self-love Instagram account @BingeEaterConfessions

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

May 2018 LACPA Eating Disorder SIG

Gretchen Kubacky, Psy.D. on Polycistic Ovary Syndrome Date: Tuesday, May 15, 2018 at 7 pm

Presenter: Gretchen Kubacky, Psy.D.

Title: Polycystic Ovary Syndrome and Eating Disorders: What’s the Connection?

Description: Polycystic Ovary Syndrome (PCOS) is currently estimated to affect up to 22% of women. It is the primary cause of female infertility and other endocrine disruptions. Women with PCOS have much higher rates of depression, anxiety, and eating disorders, particularly Binge Eating Disorder. Dr. Gretchen will present an overview of the physical and psychological symptoms of PCOS, how those symptoms present clinically, and discuss the challenges of appropriately diagnosing and treating eating disorders in women with PCOS. 

Bio: Gretchen Kubacky, Psy.D. is a health psychologist with a private practice located in West Los Angeles. Dr. Gretchen works primarily with hormonal issues and chronic and invisible illnesses, with a specialty in Polycystic Ovary Syndrome (PCOS). She is the creator of PCOS Wellness, a Certified PCOS Educator, and a member of the PCOS Challenge Health Advisory Board.  She is also a Certified Bereavement Facilitator for children and adults, co-editor of the Los Angeles Psychologist magazine, and a frequent speaker and author on health psychology topics. For more information about her private practice and PCOS education services, see www.DrGretchenKubacky.com and www.PCOSwellness.com.

Location: The meeting will be held in the office of Dr. Gretchen Kubacky, located at The Gardens building, 2001 South Barrington Avenue, Suite 121, Los Angeles, CA  90025 at 7:00 p.m. on Tuesday, May 15, 2018. Suite 121 is on the ground floor, at the north end of the building. After 6:00 p.m., you may park for free on the ground floor of the building. The parking entrance is located on the south end of the building, adjacent to Yoga Raj studio. There is also free and metered parking on the streets surrounding the building. The building and office are wheelchair accessible. 

RSVP: 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

April 2018 LACPA Eating Disorder SIG

BermudezLA area professionals are invited to the April 2018 LACPA Eating Disorder SIG event. This event is open to non-members!

Date: Tuesday, April 24th at 7:00 pm 

Presenter: Ovidio Bermudez, MD, FAAP, FSAHM, FAED, F.iaedp, CEDS 

Title: Understanding Brain Development in the Treatment of Eating Disorders

Description: This presentation will review three concepts of the current understanding of brain development.  The first is proliferation and pruning as the brain grows via enhancement of gray matter and white matter.  The second is sequential maturation and fully coming online of different areas of the brain and how this may help us understand emotion regulation.  Third how environmental and hormonal influences may affect brain development.  In addition, how this may be applied to the treatment of eating disorders in children and adolescents will be discussed.

Bio:  Ovidio Bermudez, M.D. is the Medical Director of Child and Adolescent Services and Chief Clinical Education Officer at Eating Recovery Center in Denver, Colorado. He holds academic appointments as Clinical Professor of Psychiatry and Pediatrics at the University of Colorado School of Medicine and University of Oklahoma College of Medicine. He is Board certified in Pediatrics and Adolescent Medicine.

Dr. Bermudez is a Fellow of the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, the Academy for Eating Disorders, and the International Association of Eating Disorders Professionals. He is Past Chairman and currently Senior Advisor to the Board of Directors of the National Eating Disorders Association, Co-Founder of the Eating Disorders Coalition of Tennessee (EDCT) and Co-founder of the Oklahoma Eating Disorders Association (OEDA). He is a Certified Eating Disorders Specialist and training supervisor by the International Association of Eating Disorders Professionals.

Dr. Bermudez has lectured nationally and internationally on eating pathology across the lifespan, obesity, and other topics related to pediatric and adult healthcare. He has been repeatedly recognized for his dedication, advocacy, professional achievement and clinical excellence in the field 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

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

Who Gets Treated for Eating Disorders in Los Angeles?

low cost eating disorder treatment Los Angeles County This NEDAwareness week, I’ve been thinking a lot about the theme of “Let’s Get Real.” One stubborn myth about eating disorders is that they affect primarily white, upper-middle-class females.

It would take you just one afternoon at my own Los Angeles practice to discover how untrue this is. My clients are all genders, ages, and ethnicities. I accept some private insurance and one public insurance. Among my patients with eating disorders are non-native English speakers, immigrants from low SES backgrounds, and people on public assistance.

The myth that eating disorders affect only the wealthy not only makes it more difficult for patients who don’t meet the stereotype to recognize that they have a problem but affects the entire system of treatment.

Throughout the US, there is a shortage of publicly funded specialized treatment programs for eating disorders. And specialized eating disorder treatment is expensive! The residential treatment complex only serves the economically privileged.

Carolyn Becker, Ph.D. recently brought attention to the presence of eating disorders in food insecure populations. The research on which she collaborated studied adults receiving food at San Antonio area food banks. Those who had hungry children in their households (representing higher levels of food insecurity) had higher levels of binge eating, dietary restraint, weight self-stigma, worry, and overall ED pathology when compared to participants with lower levels of food insecurity

Within Los Angeles County, eating disorders are a covered diagnosis by the Department of Mental Health (DMH). However, according to a DMH district chief, there are no specialized services for eating disorders within the DMH system. I recently led a training on eating disorders at one of the county community mental health centers and a staff member there told me, “Most patients with eating disorders are seen in primary care and none of us are trained specifically in this… What we need is training in evidence-based treatment.”

A clinical staff member at another DMH clinic said, “Honestly, we don’t have a lot of access to resources for people with eating disorders and aren’t equipped to adequately handle serious cases at this clinic. Referrals have always been difficult and there are no reliable referral sources for our patient population. We have really only been able to connect a few of our most severe cases to any treatment at all.”

I searched the Alliance for Eating Disorder Awareness list of Medicare/Medicaid providers and facilities within 50 miles of Los Angeles and came up with only one Medicare provider and no Medicaid providers or facilities.

This blog post was inspired because as a provider for Anthem Medi-Cal, I am receiving calls from county clinics with referrals of other (non-Anthem) Medi-Cal patients with eating disorders that I can’t see. So, when faced with a patient with an eating disorder and no insurance in LA County, what’s a provider to do?  Here’s what I’ve been able to find. If you have other resources, I’d love to hear about them!

Resources

Hospitals

CHLA takes California Medicaid for patients under age 25 needing medical stabilization.

UCLA takes California Medicaid for patients under age 25 needing hospitalization for eating disorders.

General low-fee counseling centers

Southern California Counseling Center

Maple Counseling Center

The Wright Institute

Cal Lutheran Low Fee Counseling Center

Treatment Scholarships

Center for Discovery and Project Heal provide treatment scholarships.

Source

Becker, Carolyn Black, Keesha Middlemass, Brigitte Taylor, Clara Johnson, and Francesca Gomez. 2017. “Food Insecurity and Eating Disorder Pathology.” International Journal of Eating Disorders 50 (9): 1031–40. https://doi.org/10.1002/eat.22735.

 

Thanks to Rosewood Center Santa Monica for help with the referral list.

ARFID talk for LACPA Professionals in Los Angeles

ARFID talk LACPA Jennifer Thomas, Ph.D.
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

 

 

November 2017 LACPA Eating Disorder SIG Event

Jamie Feusner, M.D.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

Hope Levin, M.D. 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 Know

Eating Disorder Film Guide“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.

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

Michael Levine, Ph.D., FAED 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