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Tuesday, 28 August 2012

What Hinders Eating Disorder Recovery

Following from an earlier post about what helps. There are also things that don't work for recovery.

Having a label pinned to your chest.

Too many therapists label you as anorexic or bulimic, or an addict. Having a diagnosis doesn’t fully describe who you are or how you got the problem. We don’t call depressed people “depressives”. The ED is an illness, but you are not the disorder. Discovering the pathway into your disorder and what is keeping you stuck is better than a label for aiding your recovery.

Trivilialising your symptoms and experience.

Some support systems are not supportive, with family members ignoring the eating disorder altogether or not taking it seriously as a difficult issue that needs attention. Some people call it stupid or vain. They might say “Don’t you know better, you are an intelligent girl.” Or they say you are not fat or thin enough to warrant concern.
Families and friends need to understand what an eating disorder is. They may think that if you just eat more, the problem will be fixed. One girl said that if her parents had come and said lets all talk about this, how you are feeling, what is our role in this, it would have been awesome.

Too much focus on food or on weight.

I’ve heard it said, it’s not about food, it’s about feelings. It is both of course. Your weight might be important, but it is not the only thing we have to attend to. Many people say that the scales are too powerful. So many people don’t feel good enough because they are not thin enough according to their value system. So feedback about their weight can be hurtful.

Focus on health trumps focus on weight for sufferers and no-one must make a big deal of small changes in weight. Emma Woolf, writing in the Times said that focus on weight is crazy. Half the population is given brownie points for losing weight, while people with anorexia are told that to gain is good. How is it helpful to have one rule for some and one rule for others? Therapists must pay attention to overall health and wellbeing. Weight is part of that of course because you cannot be healthy too thin or morbidly obese. Moving focus away from weight and weighing fosters self acceptance. You can learn to stop using the scales as a way to gauge if you are OK, or not.

Being secretive.

Some therapists listen to what you have to say without giving you any feedback. They take notes about your story without helping you to make sense of it. Talking on its own isn’t helpful. Practical skills are helpful, like teaching someone how to eat healthfully and, significantly, how to reconnect to their natural appetite. (how many therapists know how to do Appetite Sensitivity Training?)

Isolation hinders recovery.

But I’m not sure if being in a group with other people with an eating disorder is the best company. There are times to stop thinking and talking about eating disorders and get on with life. Relationships suffer as a result with eating disorders and repairing these relationships is one reason why people decide to try and get better. Helping people to make these repairs and especially helping someone to forgive themselves for all the wasted time and family disruptions must be major part of treatment.

It also helps if we can teach our clients to eat with other people, and socialize without having to put on acts with other people. Learning to be comfortable with other people breaks the wall of isolation that can keep someone trapped in an eating problem.

Being stereotyped and stigmatized.

Feeling ashamed puts up a barrier between the sufferer and other people and we know that poor connection makes the disorder even worse. If someone had cancer, people would have been there for them, but people think that an eating disorder is self inflicted. If other people can’t always be kind, start being compassionate toward yourself.
Make sure that everyone around you learns what an eating disorder is and why some people fall ill, not others. Carers and friends all need to have this information so that they can be a source of help.

The wrong treatment.

While some people get good treatment, others get treatment from judgmental professionals who do not know how to work effectively with eating disorders. Being patronized and criticized destroys your confidence that therapy can work. Providers can inadvertently look down on someone who is struggling with food, and even make threats or hurtful comments rather than trying to understand. Working shoulder to shoulder together rather than face to face is how providers should behave.
Therapists who don’t even talk about food (it’s about feelings, not food) aren’t helpful. Patients express appreciation for learning how to start eating safe foods, and how to listen to their bodies for hunger cues. Getting in touch with hunger and satiety in recovery is important, as well as learning how to eat in front of other people, changing eating rules, and learning how to cook.

It’s really sad that very few people know what good treatment really is, they just have to take what they can get. If a sufferer is difficult, angry and combative, this is the disorder speaking. Good therapists should be able to work around this.

Friday, 17 August 2012

The 5:2 Diet? Good, Bad or Mad?

Laura and Miriam asked me to comment about the Intermittent Fasting or 5:2 diet which has been attracting rave reviews on the “inter-web”.

Scientists have long known about some of the benefits of fasting for longevity. Fasting reduces levels of hormones like IGF1 (insulin growth factor), implicated in accelerated ageing and age-related diseases like cancer and diabetes. It also seems important to reduce your protein intake, so calorie reduction can’t be attained by eating lots of protein – a la Dukan.

Scientists at the University of Illinois have trialled a variant of continual fasting, which they describe as Intermittent Fasting. In an 8 week programme,  people eat fewer than 600 calories on 2 days a week with eating what you like on the other 5 days. They have claimed that it improves IGF and other ageing markers as well as enabling weight loss. Here I insert a warning, this trial was only for 8 weeks and we don’t know what happens in the long term.

There is a Fasting For Longevity movement in the USA. Members have been studied extensively. While they claim to have no issues with weight and eating, most show similar personality characteristics to people with anorexia and they display all the signs of people with classical eating disorders, preoccupation with food, cravings and high levels of emotional distress.

The 5:2 way of eating intended for longevity has been captured by the weight loss movement. Now there's a surprise!   For weight loss, this isn’t new. In the 1980’s it was deemed useful to eat sparingly during the week and eat everything you like at the weekend. Many people lost weight on this regime and then- hey - they put it all back on again. Feasting and fasting isn’t the good idea that it is supposed to be.

Behind the hype, even the BBC admits that current medical opinion is ambivalent about the benefits of fasting. Psychological opinion concurs. Fasting and feasting drives people into polarized thinking, good and bad day mentality and catastrophic reactions when dietary rules are breached. Apart for providing fodder for the pro- anorexia movement or the orthorexic community, this insensitive publicity may lead people to thinking that they are doing something that they should be proud of, when they may be doing something which isn’t really very good for them at all.

Let’s take some of the research which was NOT given head space by Michael Molesey and his team. A number of robust studies show that after one month on intermittent feeding, experimental aniamals show a series of behaviours similar to the effects of drugs of abuse. They begin bingeing, and during fasting periods there are withdrawal signs indicated by signs of anxiety and behavioural depression together with enhanced longing for sugar.

Brain imaging shows gross and complex changes in opioid systems such as decreased enkephalin expression in the appetitive system in the nucleus accumbens, with reduced dopamine levels (reward chemicals) and increased acetylcholine (stimulating appetite). The net effect is the creation of sugar dependency together with cross sensitising to other drugs of abuse.

Feasting and fasting thus risks bringing forth long term problems with control of food together with the emergence of compulsive behaviours and emotional problems too.

So with humans as with rats and other primates, it’s useless to test one set of behaviours in a vacuum for 8 weeks and present it as a panacea for weight and other issues. Mr Mosely may have felt good on this diet, but it's pointless for the millions of people out there who have eating disorders and for who this diet could make things considerably worse. I have given this issue lots of head space and I conclude that programmes like this are unbalanced and risk creating false hope for anxious people who are trapped in a poor relationship with food. As the man said, “fasting, like eating, is best done in moderation”

Saturday, 11 August 2012

An Axe To Grind

Today I received this email from a young woman

“I am taking part in a 54 mile cycle ride from London to Brighton on the 16th September!

I have struggled with anorexia since I was 8 years old……. After two lengthy hospital admissions and being pushed to breaking point, I am now fighting back with the help of day care. I am not alone in my struggles, there are an estimated 1.6 million people in the UK suffering from an eating disorder; anorexia has the highest death rate of any psychiatric disorder. However, it doesn't just impact on the sufferer, …………. It isn't only the sufferer who requires help in coping and b-eat acts to provide such support.

I am fundraising to help show that eating disorders can be beaten and give something back to the services to which I owe so much for still being here today! Money will go to Beat the eating disorder charity.”

I struggle to understand how B-Eat can raise money through promoting excessive exercise, being done in particular by people who are struggling to recover from anorexia. Is this how we teach people to B-eat eating disorders and all its symptoms?

B-Eat, are you listening? I will give money to people you encourage to have a rest-in. I don’t think anything else is smart.


Wednesday, 8 August 2012

The Wrong Treatment

Hi to all my bloggees, I've been away for a while just thinking about what I need to be paying attention to and watching the Olympics.
I’ve just had a 65 year old woman on the phone wondering how much we charge for treatment and if we had a helpline for her to pour out her troubles with lifelong binge eating.

I said, yes treatment costs money and a helpline won’t help you, only treatment will help you.

Have you had treatment before?

I hear that she has had some really good treatment. She has had “counselling”. Her counsellor told her to imagine that there was a bowl of sick in the fridge alongside all the other foods. Her counsellor told her that she would lose her toes if she continued overeating and that being fat made her a bad mother. Her counsellor knew bugger-all about nutrition and the brain. Her counsellor told her just to eat cereals whenever she felt cravings. Duuh?

Then she had really good CBT. Among other things this person told her to imagine that hair was all over her favourite foods. Was this CBT person an eating disorder specialist? She didn’t know.

Now she has spent some time at a slimming club. Her leader suggests that she should eat a whole chicken every time she wants to binge and this will cure her.

This poor soul has gone through this counselling travesty believing that she is a hopeless case. I told her that I was sorry for her, having such appalling “professional” help.

People with eating disorders need  Eating Disorder Specialists. They don’t need ex-sufferers or addiction specialists, or generalists, or therapies not grounded in evidence at the very least. Therapists can only play with their toolboxes when they have the right kind of training. This training must be very long and very deep.

I don’t know whether we will hear from this poor soul again. I hope we do. I hope that she can look inside her purse and come to us to change her life.

Have you had lousy treatment?  Tell me all about your rogues galleries of bad therapists. We can put your stories up on the blog and stick pins in them. Or just stick pins in them.