I've worried before that writing again and again about eating disorders on BlogHer and on my personal blog could turn me into a one-trick pony. I've said I don't want to be ED Girl. I've told people I just want to be me, recovered, and be the proof that it's possible, publically. But then I recently got an email from a woman with whom I'd gone back and forth several times, and she'd decided to check herself into treatment:
It's much easier to ignore a single doctor telling me that I'm in trouble, but hearing it from someone who actually knows what it's like to be my position right now was really helpful. So thanks very much! I'll be working on recovery for the next few months instead of school which will be good I think.
And so here I am, again, writing about eating disorders. If it's helping anyone, it's worth doing.
This time, I'm talking about kids and adolescents with Dr. Bermudez of the Eating Recovery Center in Denver, Colorado.
Background on Diagnosing Eating Disorders in Kids, Adolescents and Adults
Dr. Bermudez is a pediatrician, not a psychologist, and eating disorders have been the focus of his career for the past 22 years. Yet, he seemed surprised when I asked he had any personal experience with eating disorders -- which he has not. In fact, he said no one had ever asked him that before.
It's hard for me to fathom how anyone with no personal experience with eating disorders could successfully treat them, but Dr. Bermudez is tremendously successful. I called him to talk about treatment for eating disorders, certainly for adults but particularly for adolescents.
Dr. Bermudez believes eating disorders are biopsychosocial illnesses. In other words, they are truly mind/body/spirit, with a healthy dose of environmental triggers thrown in. He rejects the idea that they are inevitable based on genetics or society. He rejects the idea of treating just the mind and not the body or vice versa, and he pointed out that as an anorexic restricts, her gastrointestinal tract can develop problems that makes it then difficult to eat normally (I'm paraphrasing), which makes recovery more difficult. As he talked, I sighed, as this communication of truths has become a bit of an obsession for me -- it seems so many eating disorder (ED) sufferers and particularly their families and friends have a tough time wrapping their heads around how the mind and the body negatively and positively impact each other as the anorexic or bulimic or overeater or what have you struggles to recover.
As we talked, I asked Dr. Bermudez how to advise friends and families about this problem. We discussed diabetics -- diabetes is a disease not the "fault" of the diabetic, but the diabetic has control over how ambitious she is in her treatment and control of the disease. It's similar with eating disorders, however, there is a mental illness component of ED that complicates the free will part of recovery.
According to Dr. Bermudez, roughly 2/3 of patients with eating disorders at the time they are diagnosed are also diagnosed with psychiatric comorbidity (they are also diagnosed with another mental illness at the same time). Mood disorders are the most common (depression and anxiety). He's quick to point out that mood disorders are also more common across the board in terms of mental illness, than say, schizophrenia, so it does make sense -- but to me the important part is what comes next.
Half of that 2/3 who are diagnosed with a mood disorder at the same time as the eating disorder had the mood disorder first.
Anxiety is most prevalent, followed by OCD, then depression. The average date of onset of anxiety syndrome is around 11 years old, while depression is a little later than that.
Recognizing Opportunities to Intervene With Eating Disorders
Here's where it got tricky for me, as a recovered anorexic and bulimic and a mother of a seven-year-old girl. I wanted a hard-and-fast, here's-when-to-worry checklist. And I wanted to freak out if my daughter showed any signs of anxiety, because it sounded like Dr. Bermudez was reading me my life story -- undiagnosed early-onset anxiety followed by a perfect storm of environmental triggers. But Dr. Bermudez is not that kind of doctor and refused to let me form that kind of a plan as a mother. Here's what he said:
All human characteristics can be considered part of our traits. You have to differentiate between "trait" and "state." Some of us are more anxious, and that can be adaptive. Just like anger -- no trait is "good" or "bad" -- it's how much and in what context does it serve or hinder us. Once your kid has gone from trait anxiety to a state of dysfunctional anxiety, you need to recognize it and go to work with that quickly. If they're having trouble functioning, having panic attacks or severe separation anxiety, the opportunity for parents is in knowing about their kids' nature and helping them manage their lives so their natural traits enhance their well-being instead of hindering it. Ease them into mastering and overcoming anything that could balloon into a bigger problem before it balloons.
Make their traits assets, not liabilities. Once a trait has become exaggerated or a problem, seek appropriate evaluation and help.
Okay. So anxiety under control or managed correctly doesn't necessarily blossom into an eating disorder. Got it. Anxiety as a trait could be helpful in some ways -- it could spur the child to study for a test instead of winging it, for example. So what to watch for? When the trait becomes a persistent state and the child can't amp down -- then it's time to act. And, from what I took away -- teaching the child to deal with her anxiety before the eating disorder occurs could very well be the sliding door to prevention. It's not a guarantee, but hell, yes, it's worth a whirl, right? I'm finding that to be the case with most of parenting -- nothing is guaranteed, and everything is worth trying if something is really hurting your child.
I asked Dr. Bermudez about antidepressants, since there's been so much in the news about their negative impacts on kids and adolescents. He responded similarly to what I've seen in the PPD and maternal health circles -- you have to analyze if the risk is higher or the benefit is higher. If you have a teen that's so anxious she can't leave the house, the benefit might be higher. It's case-by-case, but it's also a good reason to consult professionals and -- this is my opinion -- more than one. Any time someone wants to medicate your kids, I think it's time to get a second, third and fourth opinion, and none of them should be Dr. Google.
When Is the Right Time for an Eating Disorder Intervention?
Any time is the right time. There is no "too late." Dr. Bermudez said:
Ideally, everybody would be picked up when they're just changing their feelings about their weight -- early intervention is ideal. On the other hand, eating disorders have a window of opportunity to respond to treatment that is enhanced with brain maturity through the late twenties. It's easier to accept and benefit from treatment as an adult. I've seen people recover after forty years of having an eating disorder -- recovering the way you would define recovery in such circumstances. Recovery can look different. We all have the idealized definition of what recovery would be like, but that may not be practical or realistic for everyone.
People have wide variability in their ability to recover, and there are different degrees of anorexia and bulimia. We may see someone who's been at it six months and won't do well even if we intervene right away, and the opposite. Don't give up or define situations as hopeless. Thorough assessment and treatment are always timely, it's never too late.
Eating disorders are defined as serious mental health problems. They're not just physical problems -- they are mental health disorders with a neurobiological components. Very serious medical complications can come about as a downstream effect of the eating disorder itself. And, since the disease is biopsychosocial -- our culture and the way we live play a role. None of those components are determinants -- it's not like 100% of the time you're going to have it, like Down's Syndrome. If you have the genetic code for Down's Syndrome, you have it. Eating disorders are not like that. We inherit vulnerabilities and protective factors.
Summary for Parents Worried About Eating Disorders
Since I started writing about my experience with eating disorders, I've received emails from primarily anorexics and their family members from all over the world. The biggest complaint I've heard in these desperate emails is difficulty with understanding what's causing the problem and how to treat it. I know from experience that eating disorders can present as vanity or overdeveloped normal dieting behaviors. Other people are confused, and eating disorders are such a secretive thing that people around the sufferer don't realize she's gone off the rails until they can see the impacts on her body as it shrinks or puffs out or impacts her in some other way physically. To complicate things, the sufferer will probably not admit or even realize she's got a problem until it's really advanced.
I found Dr. Bermudez's words both frustrating and comforting. As a parent, I want to know THIS MINUTE if my daughter is on the fast-track to bulimia or anorexia just because she inherited half of my genes. I want to know if I can insulate her from it by taking away all media influences and refusing to let her plaster JUICY across the butt of her sweatpants. I want to know, in my worst moments, if we should just pack up and move to a deserted island where we could completely remove the "environment" part of the equation. But I can't. We live here, in America, in 2011.
There are limits to what we can control -- should control -- about our kids' environment. So while I'm frustrated there is no hard-and-fast checklist, I'm comforted by the "trait-to-state" advice Dr. Bermudez gave. I'm relieved in a weird way to hear the mood disorders often predate the eating disorder. I have a mood disorder, and I've been able to manage it once I found the right methodology. Awareness that it existed was extremely helpful. I'm hopeful if I'm watchful of my daughter's traits, I can then help her truly funnel all her energy -- even if she doesn't develop a mood disorder -- into creating assets instead of liabilities with her personality as she moves through the world. Hell, none of us is perfect. But what a world -- if instead of beating ourselves up about our prevailing personality traits -- we instead focused on how to use them to our best advantage?
Eating Disorder Resources
As Dr. Bermudez pointed out, resources can be scanty in some parts of the country. As a parent, I encourage anyone who is suffering herself or has a friend or family member that appears to be suffering to check into these resources. But please also realize that there IS a mental illness component to eating disorders and your friend or family member may be resistant or defensive to insinuations anything is wrong. My offer stands: email@example.com is my email address. I'm not a doctor, but I'm recovered, and I do understand how it feels. If you're reading this post, you might be in pain -- and I wish you the best. Seek help, it's never too
late, and life is easier on the other side.
- AED Academy for Eating Disorders.
- ANAD-National Association of Anorexia Nervosa & Associated Disorders
- The Body Positive
- EDA Eating Disorders Anonymous
- Eating Disorder Coalition for Research, Policy and Action
- Eating Disorder Foundation
- Eating Disorder Hope
- Eating Disorders Information Network
- EDReferral-Eating Disorder Referral
- The Elisa Project
- 5 Reasons Your Girlfriend With an Eating Disorder Probably Hates You Sometimes
- This Ain't My First Rodeo: How Dr. Phil Got Anorexia Wrong
- The Connection Between Eating Disorders and Postpartum Depression
My debut young adult novel is The Obvious Game, published InkSpell Publishing. The Obvious Game is based on my experience with anorexia. I'm represented by Eric Myers of The Spieler Agency.
The Obvious Game is available in paperback and ebook (all formats) online at Kobo, Amazon, Barnes & Noble, InkSpell Publishing and Indiebound. If you are a librarian and are having trouble finding my book, please write me at firstname.lastname@example.org to purchase the book at the 40% author discount price.
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