TIPS FOR PARENTS WITH EATING DISORDERS
By Abigail Natenshon

Disordered parents need to take care of themselves by asking for support from their loved ones, finding professional help for themselves & getting well. Eating disorders are curable.

When parents proactively address these issues & help themselves, they're helping & protecting their children at the same time.

• It's important to actively listen to children & spouse, to recognize & acknowledge the familys questions, fears, misconceptions & wish to become supportive of the healing process.
  
• There's no greater fear than that of the unknown; parents need to talk w/ their children about themselves & the eating disorder.

The age of the child will play a big part in determining how a parent should communicate & what he or she might say.

Parents must speak on a childs level & to the childs needs, creating a forum for discussion that's comfortable, honest & open.

Similarly, such an open forum needs to be created w/ spouse & w/ therapist.

• Parents need to dispel their own & their childrens misconceptions about food & diet, such as . . .eating fat makes a person fat, food is fattening, dieting is the best way to lose weight, etc.

The media confuses us w/ constant & conflicting messages about how to eat, stay thin & be successful & loved. It's important to be discerning & savvy in taking in such messages.

• Having talked the talk, parents must walk that talk. Parents must not be afraid to remain parental, staying emotionally connected with their children & setting appropriate & respectful limits, thereby creating a sense of security & safety that precludes the childs need for an eating disorder to provide internal regulation.

Parents need to model healthy eating, provide nutritious, balanced & regular meals & eat them together w/ the family as often as possible.

• Parents must find clinicians skilled in working with couples & families since eating disorders are family diseases, interactive & systemic in nature & must be treated as such.

One family members changes can be facilitated & sustained through parallel changes made by other members of the family system.

In addition, when one partner in a marriage makes changes independent of spouse or partner, resulting imbalances in the marital system can cause additional problems.

• Recognize that eating disorders are multi-dimensional diseases that are best treated by a team of professionals & loved ones, including medical doctor, psychopharmacologist & nutritionist, as well as individual & family psychotherapists.
  
• Parents with eating disorders must forgive themselves, recognizing that though they have no control over the past, they do have control over their present attempts to get well & stay well.
  
• Parents with eating disorders must learn how to take time out of each day to recognize what they need & to take care of themselves, to feed themselves both literally & figuratively in every way that they can.
  
• Most importantly, parents with eating disorders must be aware that it is not a foregone conclusion that their children will be adversely affected by their problems.

When two parents can be of one mind & present a united front to child, disease & professional, the strengths of one parent can compensate for the weakness of the other. When parents face an eating disorder & conquer it openly, inclusive of their spouses & childrens input & understanding, everyone stands to gain, not only in terms of how they eat, but also in terms of how they face & deal w/ life & the long-term quality of family relationships.

Through their comparison of men with eating disorders to men in the general population, the study authors found that men with eating disorders were more likely to have other mental disorders & were less satisfied with their lives. Dr. Woodside said that these differences could result from side effects of the disorders.

Anorexia Nervosa is a severe, life-threatening disorder in which the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight & exhibits a significant distortion in the perception of the shape or size of his body, as well as dissatisfaction with his body shape and size.

Cover Story 6/10/02 www.usnews.com

The Hunger Artists

Are genes & brain chemistry at the root of eating disorders?

By Emily Sohn

Dinnertime was always stressfulat the Corbett house. Every evening at 6 o'clock precisely, the 5 kids would take their assigned places at the table between Mom & Dad. Food was served family style, & whatever you took, you had to eat. You couldn't have dessert until after you had finished everything on your plate.

"It was not a relaxing time to sit at the table & eat," recalls Cathie Reinard, 35, about her childhood in Rochester, N.Y. But the "rigid rules just added to an underlying tension." As the kids got older, it became clear that most meals would end with Mom's excusing herself, going into the bathroom, &making herself throw up.

Dysfunctional families are still a common target of blame, as is a dysfunctional culture obsessed w/thinness. But as doctors learn more about eating disorders, it is becoming clear that genetics & biology may be equally important causal factors for the estimated 5 million to 10 million Americans who struggle w/anorexia, bulimia & binge-eating disorders.

Although family & culture may provide the ultimate trigger, it seems increasingly likely that hormones & brain chemicals prime a certain group of people to push themselves to starvation.

The hidden killer.

Eating disorders are the deadliest of all psychiatric disorders, killing or contributing to the deaths of thousands every year. An estimated 50,000 people currently suffering from an eating disorder will eventually die as a result of it.

Anorexics, who pursue thinness so relentlessly through diet & exercise that they drop to below 85% of ideal body weight, often suffer heart attacks, arthritis, osteoporosis & other health problems. Bulimics eat uncontrollably, then compensate by throwing up, taking laxatives, or exercising obsessively - behaviors that can upset the body's chemical balance enough that it stops working.

As w/depression & other serious psychiatric illnesses, eating disorders now appear to be a familial curse. Relatives of eating disorder patients are 7 to 12 times as likely to develop an eating disorder as is the general population, studies show. Depression, anxiety disorders, & other related illnesses also appear more frequently in the same families. That doesn't rule out a shared environment as a contributing factor, says psychologist Michael Strober of the University of California - Los Angeles. But, he adds, "anytime you see a disorder that runs in families, you begin to suspect some hereditary influence."

The women in Bailey's family have been fighting a losing battle with food for generations. When Bailey was 18, her 55 pound mother starved herself to death, sneaking laxatives in the hospital until the very end. Other relatives have also suffered from anorexia. "I was always told I was fat and ugly & dumb," recalls Bailey, a 63-year-old retired nurse. She vividly remembers how she & her brothers secreted cans of food because they weren't getting enough to eat at meals. But, she concedes now, the sheer number of eating disorders in her family suggests something deeper going on.

Deadly eating disorders exist in cultures far removed from Hollywood & Madison Avenue & have been around far longer than glossy women's magazines. But if that weren't evidence enough for an underlying biology, the patients themselves are the first to say their eating disorders have a power far greater than peer pressure.

Indeed, Stephanie Rose's illness had such a strong "personality" that she named it "Ed." It started with a diet to lose 8 pounds of weight gain after her freshman year of college. But her success became an obsession that landed her in the hospital 9 times over the next 4 years. She crashed a car & a bicycle, both times after passing out from nutrient deprivation. She chugged bottles of poison-control syrup to make herself throw up, even if she had eaten only a bite of a tuna fish sandwich or a few grains of cereal. Even in the hospital, she shoved batteries in her underwear to fool the nurses when they weighed her. Talking & reading took too much energy, so she stared at the TV instead, gray-skinned, too weak to think.

At her sickest, the 5'5" Needham, Mass., resident weighed 75 pounds. She had a mild heart attack at age 21 as a result of her starved state. Doctors told her bluntly that she was going to die & nurses sat w/her 24 hours a day to make sure she didn't pull out her feeding tube. Now 29, fully recovered & happily married with a 15 month-old baby of her own, Rose can't believe she would flirt w/death for arms that looked like toothpicks. "It was like someone took over my body," she says, "this guy, Ed."

The most convincing evidence for genetics comes from twins. If one twin has an eating disorder, the other is far more likely to have a similar illness if the twins are identical rather than fraternal. Since identical twins are genetic clones of each other, that is powerful evidence that genes play an important role, says psychiatrist Cynthia Bulik of Virginia Commonwealth University: "Until now, people would have said there wasn't a genetic effect in anorexia. And what we're saying is that there really is, & it's not minimal."

Gene hunt.

Several groups of researchers are now hunting for the specific genes involved in eating disorders, w/some promising leads. The first 2 comprehensive scans of the human genome have recently turned up hot spots for anorexia-linked genes on several chromosomes, including Chromosome 1, which seems to harbor genes for the most severe form of anorexia. "We now know the location of several genes in the human genome which increase risk for anorexia nervosa," says University of Pennsylvania psychiatrist Wade Berrettini, a senior author of a study in the March issue of the American Journal of Human Genetics. "Prior to this, we did not." Other preliminary work is pointing to different areas of the genome that may be involved in bulimia, says psychiatrist Walter Kaye of the University of Pittsburgh.

None of the scientists exploring the genome expects to find easy answers or simple genetic switches. Indeed, hundreds of genes are already known to influence appetite and eating regulation in some way, a testament to how complex the eating impulse really is in the grand scheme of human biology.

But some patterns are emerging. The most obvious is that 90% of eating disorders occur in girls & women, most often beginning in adolescence.

This clue has some experts exploring the genes that control hormone production. During the teen years in most girls, estrogen-producing genes kick in, triggering puberty. And there is evidence, says Michigan State psychologist Kelly Klump, suggesting that those genes may also contribute to eating disorders in some girls: Genes appear to be involved in 17-year-old twins with eating disorders but not in 11-year-old twins, who are mostly prepubescent. But even more striking, Klump says, a recent study of 11-year-old twins who had gone through puberty and exhibited warning signs of the illness showed the same genetic pattern as the 17-year-olds. Klump notes, by analogy, that depression hits girls twice as hard after puberty as before.

Other researchers are linking eating disorders to personality traits that are hard-wired into the brain. Anorexics tend to be Type A - anxious, perfectionist, rigid. Those traits can translate into an unhealthy body image: When a driven perfectionist sets her mind on being slender, self-control can become a measure of success. Anorexics also tend to be ritualistic about the food they eat, cutting it into tiny pieces or eating only a specific type of food at only a specific time of day.

Obsessed.

Such an obsessive temperament often appears to be inborn. In Kathryn Carvette DeVito's case, the first signs appeared at age 7. She started having panic attacks on the school playground & became preoccupied w/getting her homework perfect, starting over & over again if necessary. Then she developed some classic symptoms of obsessive-compulsive disorder: "If I touched a doorknob 15 times, everything would be OK," she says. Kathryn hit puberty earlier than her classmates & when a doctor told her she was heavier than the average 6th grader, her ob- sessions turned to food. She dropped to a low of 85 pounds before seeking help when she was 19. Even now, though the 5'foot 2" Boston University senior sees a psychologist weekly & has stabilized her weight at about 100 pounds, she says that she sometimes eats as little as 100 calories a day. She works out every day & does sit-ups in her bed at night.

Brain chemicals may contribute to illnesses such as Kathryn's, says the University of Pittsburgh's Kaye. It may be that people who go on to develop the anxiety & obsessiveness associated w/eating disorders have abnormally high levels of serotonin, one of the brain's major chemical messengers for mood, sexual desire, & food intake. Losing weight lowers serotonin, so anorexics may stop eating in a subconscious attempt to lower their uncomfortably high serotonin levels, says psychiatrist Evelyn Attia of the New York State Psychiatric Institute. But when a person stops eating, her brain churns out even more serotonin, Attia says. So, the anorexic gets caught "in a vicious cycle where the behavior tries to compensate for the uncomfortable feeling of biochemical imbalance but can never catch up."

Kaye also has evidence that the brains of recovered bulimics process serotonin in a way that is different from the brains of healthy people. It's not entirely clear yet if their brains were different before they developed the disease or if dieting caused the changes. Still, such chemi-cal differences suggest that drugs like Prozac, used to treat depression & compulsive behaviors, might be helpful for treating eating disorders as well. In a small study, Kaye found that Prozac, which helps the brain's pathways work better, helped prevent relapses in recovered anorexics.

Despite all these biomedical advances in understanding eating disorders, victims still face a long & uncertain road to recovery. Only about 1/2 of anorexics & bulimics ever recover enough to maintain a healthy weight & positive self-image. 30% of anorexics have residual symptoms that persist long into adulthood & 1 in 10 cases remains chronic & unremitting. Without treatment, up to 20% of cases end in premature death.

Denial & resistance to treatment are fierce psychological obstacles once an eating disorder has taken hold, so scientists are looking more & more to prevention. & ironically, given the move away from cultural explanations for the disorders, the best interventions for now may still be psychosocial. Surveys show that 42% of children in 1st through 3rd grade want to be thinner & that 81% of 10-year-olds are afraid of being fat. Those attitudes are clearly not genetic & they are so pervasive that they could be pushing the genetically vulnerable over the edge. "If people never diet," Bulik says, "they might never enter into the higher-risk category for developing eating disorders."

One of the most striking examples of culture's influence comes from Fiji, where a bulky body has always been a beautiful body. Women on the South Pacific island have traditionally complimented one another for gaining weight. Food is starchy, calorie-dense & plentiful. But when TV came to the island in 1995 w/shows like Melrose Place & commercials celebrating thinnessthe depictions of beauty radically altered Fijians' self-imageespecially the girls'. According to a study published this month by Harvard psychiatrist & anthropologist Anne Becker, by 1998 the proportion of girls at risk for developing eating disorders more than doubled to 29% of the population. The percentage of girls who vomited to lose weight jumped from 0 to 11%. "We actually talked to girls who explicitly said, 'I want to be thin because I watch TV, & everyone on TV has all those things, & they're thin,' " Becker says. Likewise, non-Western immigrants to the US are more likely to develop eating disorders than are their relatives in the homeland.

Cost of starvation. While scientists debate & explore the causes of eating disorders, victims & their families are being hard hit financially. Hospitalization & around-the-clock care to revive a starving patient can cost more than $1,000 a day. Full recovery can take years of therapy, often involving the whole family. But because eating disorders are classified as a mental illness, insurance plans rarely cover the full costs of treatment. Kitty Westin slammed into just that painful wall. Her daughter Anna had struggled w/anorexia as a teenager but seemed healthy when she came home to Chaska, Minn., after her sophomore year at the University of Oregon in Eugene. Within months, depression & anxiety again consumed Anna. She couldn't sleep. She withdrew from her family & friends. She stopped eating & spent hours at the gym every day. By summer's end, Anna, who had always been petite, could barely stand without feeling dizzy. At 5' 4", she weighed 82 pounds & her vital signs were dangerously low. No matter how hard she fought the anorexia, she felt powerless. "It won't leave me alone," she told her mother.

For the next six months, Anna checked in & out of the hospital. She would improve as an inpatient. But as soon as she went home, she'd get sick again, says Kitty Westin, who quit her job as a psychologist to take care of her daughter. The family's health insurance company, Blue Cross & Blue Shield of Minnesota, refused to fully cover the costs of residential treatment, leaving the family to pay for whatever they could. On Feb. 17, 2000, worn out from her struggle, Anna killed herself. She was 21. Her mother, now a full-time advocate for better insurance coverage, says the family's battles with the insurance company exacerbated Anna's illness. "See, I'm not sick," Anna would say. "The insurance company says I'm not sick."

Such attitudes are slowly changing. In June 2001, the state of Minnesota settled a lawsuit against Blue Cross for repeatedly denying coverage to children w/mental health problems. The settlement required the company to pay the state $8.2 million for treating families that had been refused coverage. The company is also becoming more accountable to eating disorder patients via an appointed, independent 3 member panel that must review mental health appeals soon after receiving them. Westin is convinced that such a process would have saved Anna's life. "There is no doubt in my mind," she says, "that a panel would have reversed the [insurance company's] decision."

A legal acknowledgment that eating disorders are real medical illnesses brings hope to families who already know that their problems won't just go away. The grown Corbett women, for example, all still struggle w/body image & health problems related to their eating disorders. Their mother, Margery, was hospitalized recently for dehydration from drinking too much alcohol & not eating enough. Liz sometimes freezes at the thought of going out to parties because she can't figure out what to wear. Cathie, who has a 3-year-old daughter & a 9-month-old son, purged during her 2nd pregnancy & has damaged the enamel surface of her teeth from years of bulimia. Meanwhile, Bonnie continues to struggle w/anorexia, 17 years after it began. She takes vitamins & mineral supplements to avoid anemia. She takes birth control pills to keep her hormone levels up. And she has recently started taking medicine to treat end-stage osteoporosis. At 35, she has the bones of an 86-year-old woman & says her hips would probably shatter if she fell. The whole family takes things one day at a time. "You get the cards you're dealt," says younger brother Rick, 31, the only sibling spared by the illness. Instead of cancer or heart disease, he says, his family got eating disorders. "Everyone has their own battles to fight," Bonnie adds. "This is ours."

Stress Hormones Drive Night Eaters

By Michael Smith,MD - WebMD Medical News Archive
Reviewed By Gary Vogin,MD
Feb. 12, 2002

Find yourself raiding the refrigerator in the middle of the night? Turns out that it may be your body's response to stress that has gone awry, compelling you to eat when you're not even really hungry.

It's not exactly clear how many people have night eating syndrome. Estimates are around 1%-2% of adults, but some have suggested up to a 1/4 of people who are overweight by at least 100 pounds eat this way.

Night eaters typically have little or no appetite for breakfast. They eat more than 1/2 of their daily food after dinner but before breakfast & are often upset about how much was eaten the night before.

Night eaters feel tense, anxious, upset, or guilty while eating & at night. They have trouble falling asleep or staying asleep & often wake frequently to eat. Night-eating syndrome involves continual eating throughout evening hours. This eating produces guilt & shame, not enjoyment.

Night eating syndrome is currently not an official eating disorder. Previous research has indicated that it may be related to a disruption in your body's 24-hour clock, called the circadian rhythm.

Another main regulator in your body is a hormone system called the HPA axis, which also coordinates many of your body's functions, including its response to stress. The association between these 2 systems is not well understood, so researchers wanted to see if a problem w/the HPA axis might also be behind night eating syndrome.

Lead researchers Grethe S. Birketvedt & colleagues studied 5 women w/night eating syndrome. The women consumed over 50% of their daily food after 8 p.m. & woke up at least once during the night to eat. Their hormone levels produced by the HPA axis were compared to women who weren't night eaters.

The study results are featured in the February issue of American Journal of Physiology - Endocrinology & Metabolism.

During the 7 day study, the women identified as night eaters woke up more than 3 times per night, on average. The comparison group did not wake up at night to eat.

During the study, all of the women were given a hormone to stimulate their HPA axis. But in the night eaters, their cortisol levels didn't go as much as the comparison group.

The results suggest that night eaters have an abnormal stress response caused by a hormone abnormality in their HPA axis, according to the researchers.

Plus, they say that the altered sleep & appetite pattern may be explained by this abnormal hormone response. Several other eating disorders, such as obesity, anorexia, & bulimia, have also been linked to abnormalities in the HPA axis.

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