June 15, 2011
Eating disorders: Still on the path to understanding
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People with eating disorders also face a high likelihood of having a concurrent psychological problem. Many suffer from obsessive-compulsive disorder or depression, and a study published in the American Journal of Psychiatry in 2004 found that fully two-thirds of those who suffered from anorexia or bulimia had some type of anxiety disorder.
Dr. Walter Kaye, the director of the eating disorders treatment and research program at the University of California, San Diego, links this finding to what experts call a tendency toward harm avoidance.
“Harm avoidance is a construct that we define as ‘anxiety in addition,’ ” he said.
Bulik believes that this overwhelmingly high rate of anxiety may provide an important insight into what’s going on physiologically for people with anorexia. After observing anorexics in recovery struggling to start eating again, she suggests that starving may in fact soothe their anxiety.
That, she says, may be a large clue as to where genes and culture collide.
“In sixth grade, when all the girls go on their first diet, nine out of 10 find that diet really unpleasant, and they’re like, ‘Forget it,’ ” Bulik said. “That 10th girl has the learning experience that when she reduced her food intake, she felt better — there is the nexus where her biology set her up to be influenced by that environmental fact.”
Using what they know about the workings of the brain, scientists have also been able to identify a difference in the neurological functioning of those with eating disorders. A 2007 study of 15 existing papers found that people with anorexia or bulimia had more difficulty with set shifting — the cognitive ability to switch easily between tasks, activities or ideas — than the average person. This may account, wrote the authors of the study, for the rigidity that often accompanies eating disorders — the strict diet of an anorexic, the ritualistic purging of a bulimic.
Even as characteristics that may lead to eating disorders are identified, experts agree that, like any other personality trait, they can’t be erased; they can only be managed. The goal of recovery, then, is to help patients understand themselves better and learn ways to cope.
Keesha Broome, a marriage and family therapist who works as the clinical director at Monte Nido, an eating disorders treatment facility in Malibu, said that treatment should help patients get back into the real world with both coping skills and living skills — ways to manage their anxiety, for instance, alongside practical proficiencies like shopping for food, cooking and incorporating exercise in a healthy way.
But the primary purpose of therapy, she said, is to delve into how the disorder has been used as a coping mechanism.
“The goal is, in part, to help a client develop insight into what function or functions the eating disorder serves,” Broome said.
For many patients, that means learning how to deal with their feelings in a productive way instead of turning to food for comfort or a sense of control. It could be as simple as knowing when to call a friend to talk, or listening to uplifting music, Broome said.
In order for therapy to work, patients need to be medically stable, and for that reason, treatment may also involve medical interventions to return the person to a healthy weight. From there, patients often work with a nutritionist, as well as a psychotherapist and family or group counseling, if necessary.
No psychiatric medication has been approved yet for the management of eating disorders. Some doctors use Prozac in treating patients with bulimia, but the antidepressant doesn’t have a predictable track record.
For patients under 18, another treatment method that’s gaining popularity is a family-based approach. Developed by researchers at the Maudsley Hospital in England and later popularized in the United States, the method encourages parents to take control of their children’s eating at home.
“Family-based treatment asks parents, initially, to manage restrictive eating and dieting and over-exercise,” said Dr. James Lock, a professor of child psychiatry and pediatrics at Stanford University, “just as we would ask parents to help minimize behaviors around alcohol or substance abuse or conduct problems.”
While the technique has been shown to improve symptoms in about 80 percent of kids, Lock said, it’s not for the faint of heart. In the 2010 memoir “Brave Girl Eating,” Harriet Brown, a mother who used family-based therapy to nurse her anorexic teenage daughter back to health, documented her experience “cajoling, pleading, ordering” her child to eat.
Research into the causes and treatments of eating disorders has a long way to go, but experts believe they are on the right track. Bulik is currently involved in a study that will look at the genetic makeup of more than 4,000 patients from around the world in an ongoing attempt to pinpoint specific DNA at the root of the disease. She hopes to publish the results later this year.
Other researchers, like Kaye, are using brain-scanning technologies to understand what happens neurologically for both those who are in the throes of an eating disorder and those who have recovered.
Pikus, now an active and outspoken member of her New York community, counts herself among the recovered. She is heavily involved with Jewish organizations and women’s health groups, and said that her desire to binge and purge is all but gone. She now shares her experience with the hope that her honesty will reach others who are suffering.
“I’m very open about it,” she said. “If I can help somebody, I want to do that.”
And Jennifer Malvin stresses that while it’s too late for her sister Nancy, others who are struggling with the debilitating and confusing disorder must not lose faith.
“I don’t want to see another child have to go through this,” she said. “There are resources out there — it’s not hopeless.”
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