Archive for Anorexia

Anorexia and Professional Women

Can professional school or a high-powered career cause anorexia nervosa in women? Compelling anecdotal evidence suggests an association between advanced degrees and eating disorders, but that is no reason for giving up on your dreams.

What initially got me thinking about this subject was an article posted on one of the discussion boards on this topic page. It was written by Nicole Schlesinger, whose plans for medical school were thwarted by her anorexia. Her poignant story made me wonder whether there were many other young women like her.

“I see the increased pressure of professional school or professional life as a “trigger” that may exacerbate the ED,” observes Rebecca McCulloh in an email. McCulloh is a therapist in private practice with 15 years’ experience treating childhood sex abuse survivors with eating disorders. “It is my experience that the ED typically pre-exists entrance into a graduate program.”

A September 1995 article in The Monitor, a monthly publication of the Tulane School of Medicine, reported an interview with Susan Willard, associate professor of psychiatry and director of Tulane’s Eating Disorders Clinic. She is quoted as follows: “Our patients are generally high-functioning people who are very goal oriented… We see a number of professional women, college students, and graduate students.”

At first blush, it may seem incredible that such highly educated persons like doctors, lawyers, and senior executives could fall victim to anorexia nervosa and related disorders. Doctors have extensive medical training and fully understand the dire threat to health posed by these illnesses. Although other professions may not require scientific expertise, their pressures and responsibilities demand that a person take reasonably good care of her body.

How can this happen to such smart people? Perhaps the phenomenon is better understood when professionalism is considered a subcategory of perfectionism, which is a common characteristic among anorexics. Clearly, giving up one’s aspirations will not solve the problem. Instead, the key to overcoming the condition appears to involve balancing personal and professional life.

“While it is not surprising that high-achieving women in demanding professions (law, medicine, business) frequently develop eating disorders, I don’t believe that there is anything specific about these professions that is causative,” writes Paul Hamburg, M.D. in an email. Dr. Hamburg is a psychiatrist and an associate director of Massachusetts General Hospital’s Eating Disorders Program. “To the extent that eating disorders happen most often to high-achieving, ambitious, perfectionistic young women who feel defined by their accomplishments, but have not found ways to nurture themselves, these professions are natural destinations for them to choose. One might look at eating symptoms as the psychological glue that permits professional and academic accomplishment in the face of inner psychic fragmentation.

“Of course, once a woman has developed an eating disorder along with a professional career, there are a number of difficulties specific to the demands of these professions that affect treatment and recovery. While professional success might continue to be a vital cornerstone in self esteem, the requirement to meet the needs of patients, clients, or start-up businesses regularly interferes with learning to take care of one’s own body and soul.”

Anorexia and Photo Therapy

Veteran actors are familiar with the old adage “the camera never lies.” That’s one reason they always strive to look their best. But the lens has also been used for a very different purpose: to stimulate recovery in anorexics.

According to a June 7, 2000 article in The New York Post [“Photo-therapy helps anorexics overcome obsession with weight”, pp.8-9], anorexics who viewed nude pictures or videotapes of themselves showed improved body image and eating habits. Although skeletal, most anorexics see themselves as fat. However, an anorexic patient quoted in the article said that after viewing her pictures, she thought she looked like she “just got out of a concentration camp.”

The Post reports that Dr. Ira M. Sacker has been using the treatment since 1997. Dr. Sacker is director of the Eating Disorders Program at Brookdale Hospital in Brooklyn, New York and author of Dying To Be Thin, Understanding and Defeating Anorexia Nervosa and Bulimia – A Practical, Lifesaving Guide (Econo-Clad Books 1999).

According to The Post, he was introduced to the technique by New York City photographer Helen Fisher Turk, who has used it to help hundreds of rape and incest victims deal with their trauma. Shortly after learning of her work, Dr. Sacker began sending his eating disordered patients to her. The article observes that Turk photographs or videotapes sufferers nude or semi-nude, and then has them write about the experience. The Post reports that “all of Sacker’s patients have shown marked improvement.”

In an attempt to discern the prevailing attitude among professionals toward this technique, I emailed several eating disorders specialists. Opinions were mixed.

Christine Hartline, M.A., Executive Director of Edreferral.com , an eating disorder referral and information service, believes that the approach shows great promise. “Photo-therapy is a very interesting and compelling topic right now,” she notes in an email. “It has been used in research for years but it seems like it is finally filtering into being used in the private practice sector. I did a research project years ago on body image and that is when I first came across this subject.”

Others are more skeptical. Monika M. Woolsey is a registered dietician, nutrition consultant and author of the American Dietetic Association’s first book on eating disorders, Eating Disorders: Putting It All Together. She emphasizes photo-therapy’s potential for sexual abuse. “I won’t say it is ineffective, but it’s pretty radical, and further research to be sure it’s helpful and not harmful would be a good idea,” wrote Ms. Woolsey in an email. Her 16 years of experience includes work in three different eating disorder treatment centers. “My main concern is that since there is a significant percentage of people with eating disorders who have issues of sexual abuse, this type of therapy could easily attract sexual predators passing themselves off as therapists. Anyone considering this treatment would need to do it in conjunction with traditional psychotherapy and do a thorough background check of the person in charge.”

Joanna Poppink, a licensed psychotherapist in Los Angeles, California, concurred:

I am concerned that talking about so-called photo-therapy can discount the complexity of eating disorders and be disrespectful of the individuals courageous enough to undertake a path to recovery. I’m also concerned about the very real possibility of exploiting the eating disordered person by publishing these photos.
I can see that looking at pictures of themselves provides eating disordered persons more distance and safety than the immediate experience of looking into a mirror. Viewing the picture might help a person wake up to her actual appearance. This could be helpful.

However, I hesitate to support this approach because I think it is fraught with possible negative consequences. People pleasing is a strong aspect of eating disordered behavior. I wonder if the patient is psychologically free to say “no” to a request/suggestion from her therapist that she disrobe before a stranger.

I also wonder about the actual experience the patient has in being photographed nude. Who else is present? Is there someone other than the photographer working the lights? What is the setting? How many photos are taken? How are poses established? What kind of conversation occurs during the photographing session? How respectful is the entire procedure?

Many people with eating disorders have histories of sexual exploitation. Being photographed in the nude could be retraumatizing.

In this light, I wonder why nudity is required. Even a photograph of a hand, arm or leg would show an extreme thinness. Why couldn’t the patient bring in her own photos taken in the context of her life? She may have revealing photos of herself in shorts or a bathing suit that would serve the therapeutic purpose without sensationalism.

I’m also concerned about the patient feeling psychologically invaded because other people are seeing her naked photos. Who sees these pictures? Who develops them? Who owns the negatives?

Furthermore, people suffering from eating disorders have a poor sense of boundaries and limits. I’m concerned that putting them through the experience of being photographed in the nude is taking advantage of their vulnerability. An important part of their therapy is the development of an appreciation and respect for personal boundaries.

People with eating disorders obsess about their bodies. However, the core of the eating disorder is not physical but psychological. Healing has to do with the person developing a genuine respect and appreciation for her true self. When that is accomplished, she understands her genuine needs and lives in a way that adequately nourishes her mind, spirit and body.

Photography may have a place in treatment under specifically defined situations. I think it must be used with great caution, with great sensitivity, and with the patient owning the photos and negatives.

Anorexia and Equine Therapy

When I was 11, I went on a day-long, group horseback riding tour in New York’s Catskill Mountains. We were enjoying a shady trail on a hot, summer afternoon when the dozen horses in our party refused to go any further.

The riding master told us to stay put while he investigated. When he returned, he softly intoned, “I think it’s a bear.” Just then, an angry growl filled the woods, and the twelve horses simultaneously did an about-face.

My horse, a white fifteen-year old, was something of a maverick. He decided to take off alone with me. He galloped so furiously that I could feel a powerful breeze against my face, as if I were in a convertible going over 40 miles an hour.

Having previously taken numerous lessons, I was quite competent in riding basics, but my 11-year-old body was of insufficient strength to stop the horse. But after about a mile of alternately pleading, comforting (“It’s ok now. You’re safe”), and pulling on the reins, he relented.

“That horse never ran that fast in his life,” said the riding master when he finally caught up with us.

Twenty-eight years later, I am still no equestrian expert, but on that day I learned a great deal about these animals. They sensed a danger of which humans were blissfully ignorant, and they took prudent steps to protect themselves. My elderly horse in particular— initially terrified into running like a two-year-old thoroughbred— eventually settled down and listened to me. He may not have understood my words, but I am convinced that he sensed someone relatively calm and capable was on his back.

Trust. Communication. Self-confidence. These are a few of the many benefits of equine therapy. According to a 1998 article by Carol O’Connor (no relation to the actor) of the Capitol Area Therapeutic Riding Association, equine assisted psychotherapy (EAP) was first developed by eighteenth-century German physicians to treat emotional disorders. “EAP goes beyond the activity of riding, and utilizes the tasks of caring for the horse and the bonds that form through that caring as a means of establishing trust, respect, and responsibility,” writes O’Connor.

The treatment, she notes, did not catch on in the United States until about 1970. And only within the last few years has the Equine Facilitated Mental Health Association (EFMHA) begun developing standards for this field.

According to an article by EFMHA co-founder Isabella (Boo) McDaniel, equine therapy in the U.S.A. began as a treatment for the physically and mentally disabled, but the patient population quickly expanded to include troubled teenagers, prisoners, and unwed mothers. The Remuda Ranch, about 60 miles northwest of Phoenix, Arizona, uses it to treat anorexics and bulimics.

Remuda employs instructors certified in EAP who develop programs tailored to each patient’s individual needs and capabilities. Treatment consists of two ninety-minute riding sessions per week and requires the patient to perform such caregiving duties as grooming and saddling the horse.

According to Remuda, equine therapy’s benefits to anorexics and bulimics include the following:

Self-Confidence. Horsemanship helps build the self-esteem necessary for recovery.

Body Image. Although skeletal, anorexics see themselves as fat. The anorexic’s awareness of her size in relation to the horse’s helps to correct her distorted body image.

Communication and Trust. Eating disordered persons have unhealthy communication habits and difficulty trusting people. The non-verbal relationship that develops between patient and horse will help her in future dealings with humans.

The pastoral setting of a ranch is conducive to treatment, according to Greg Kersten, founder of Equine Services, and Lynn Thomas, Residential Director of Aspen Ranch. Aspen runs an adolescent treatment boarding school. Kersten and Thomas note that the open space and physical freedom associated with horseback riding is “much more non-threatening than an office environment, especially with adolescents.” As at Remuda, Aspen patients care for the horses they ride.

According to an article written by Kersten and Thomas, psychotherapists and certified equine instructors team up to treat patients. Therapy at Aspen includes riding a horse guided by an equine instructor who uses a “lunge line,” a 20-foot rope attached to the animal and held by the instructor. To foster concentration, the horse is ridden “bareback” (without a saddle). The instructor works with the horse, while the therapist converses with the patient. Because the rider must focus on the horse’s body language, there is no time for deception or dishonesty. It is in this way, note the authors, that patients are able to get in touch with their feelings while building self-confidence.

O’Connor noted that, as of the date of her writing, few insurers were willing to cover treatment for equine therapy. But if history is any guide, that situation is likely to change. Fifteen years ago, there was little coverage for complementary therapies; now that more industry standards are in place, insurers are far more accommodating.

To be sure, equine therapy is not for everyone. But if you like animals and the outdoors, it could be just the ticket to getting your recovery up and running.

Anorexia and the Workplace

Last week I received an email from an employer who suspects that a woman he recently hired has anorexia. Let’s call him “Charlie.” Although he did not know her well, Charlie was concerned about his employee’s personal well-being but didn’t quite know how to go about offering her help. Aside from occasional sluggishness from sinus medication, the woman’s work performance was “great.”

This important topic cries out for more discussion and study. After exhaustive internet research, I found very little information. I do not know how many of the millions of women suffering from anorexia and other eating disorders hold jobs but suspect that the number is high.

That this state of affairs exists is understandable but not acceptable. An employer unfamiliar with eating disorders would usually feel uncomfortable approaching an employee about so personal a matter, while the employee would strive to keep her condition secret. But when people stand on social niceties, illnesses flourish. We will probably never know how many people could have been helped but lost their lives to venereal disease, AIDS, and cancer because these ailments were not topics for discussion in polite society.

True, it is a tough and delicate issue for both employer and employee. The rights of both parties must be respected. An employer has a right to a productive workforce and an employee should only be terminated for just cause. Joanne Larsen, M.S., a registered dietician at Millville Public Schools in Cumberland County, New Jersey, points out that an employer cannot fire someone merely because of a medical or psychological condition “as that would be discriminatory.”

Especially puzzling is the reticence of experts. I put this question to numerous employee assistance and related organizations via email. One did not feel “comortable having the discussion on the internet.” Most did not respond at all. Three, however, made constructive suggestions.

The Massachussetts Eating Disorders Association offered the following advice to people in Charlie’s position:

He should tell the person that he cares and is concerned about his/her wellbeing and encourage the person to talk to a counselor or therapist. The employer can educate himself/herself and should always remain positive because people do recover from eating disorders. Do not, however, focus on weight or food. These are only symptoms of whatever the real problem is. Do not give the person guilt, threaten, punish, bribe or preach. For more information, you can call our helpline at (617) 558-1881.
Karlynn Baker Scharlau, M.S., President of the Employee Assistance Program of Tucson (Arizona), Inc. says:

The first question I would ask is does he have any documentation or has he seen any changes in her workplace behavior, such as work performance, interpersonal relationships, etc? He does not need to make a suggestion of what the medical problem is but only point out how she may have changed. Has she been absent too much? Does she have any medical insurance that would pay for therapy?
Mary Tantillo, Ph.D., of the University of Rochester (New York) Medical Center, offers the following:

If her work performance is unaffected, you need to be very careful about what, or whether, you say anything. If her work performance is affected, you should consider discussing this, with clear communication about her behaviors that seem affected by weight loss. If there are no performance problems yet, I would ask Human Resources about whether you should approach her as a “concerned friend” and just give her your non-judgemental observations and concerns, or info re: resources– if she wants it. It may be hard for her and you, though, to really separate your employer and “friend” roles. You may have to wait (painfully) until her performance becomes affected.
Patients feel controlled, intruded upon, or ashamed when confronted about their eating disorder. A very caring, non-judgemental approach is necessary. You can validate their position while also stating yours. Their denial does not mean that your words were not effective. She will take them in and mull them over when she feels safe.

Is there anyone besides her employer/supervisor who could state his/her concerns? Someone the new employee trusts, respects or works closely with? Has anyone come to you with similar concerns about her? This might be less complicated because they do not have supervisory power over her.

I have a number of patients in the program here who were confronted gently about their perfomance, and that has been a good leverage for treatment with them. They have support at work to recover. Supervisors weren’t afraid to share concerns with them and design contingencies about what had to happen for them to remain in their jobs. There were clear performance issues discussed, and a great deal of support for the person.

Finally, go to the Eating Disorders Awareness and Prevention, Inc. website, or call them at 206-382-3587. The Mental Health Association here in Rochester also does workshops for employers. Their number is 716-325-3145.

Regarding insurance, a previous article on these pages has already noted the paucity of medical coverage available to anorexics. Under these circumstances, we either need legislation or private sector action to further define the relationship between anorexic employees, their employers, and the medical community. We also need more dialogue.

Light Therapy May Help Anorexics

Sunny days of spring and summer can banish winter blues. Being outdoors at this time of year can greatly brighten your spirits, especially if you are depression-prone. And recent research indicates that light therapy holds particular promise for anorexics and other eating disorder sufferers.

Licensed psychologist and sleep specialist Gila Lindsley, Ph.D. has written a very thoughtful article on this treatment for New Technology Publishing, Inc. According to Lindsley, winter depression or seasonal affective disorder (SAD) is caused by lack of sunlight during the winter months. When days are short and cold, people tend to stay indoors and not get enough full-spectrum illumination. Some winter depressions can drive patients to suicide, notes Lindsley.

According to Whole Healthmd (WHMD), light is essential for maintaining the body’s sleep-wake cycle or circadian rhythms. WHMD explains that light entering the eye becomes electrical impulses which travel from the optic nerve to the brain, releasing chemicals called neurotransmitters. One of these, serotonin, is important to emotional well-being, observes WHMD.

While light triggers the production of serotonin, which is associated with good mental health, it suppresses the release of melatonin, observes Lindsley. Melatonin is a hormone secreted from the pineal gland at the base of the brain. With less light, more melatonin accumulates in the bloodstream. According to Lindsley, lower body temperature, sleep and high levels of melatonin are associated in a way that is not yet fully understood. She notes that melatonin levels rise at night and play a possible role in triggering sleep. Research indicates that people vulnerable to SAD are particularly affected by lack of broad-spectrum light, says Lindsley. When these people do not get outdoors enough, their blood melatonin levels are high during the day, and they appear sluggish and depressed.

American Wholehealth cites research indicating a link between SAD and eating disorders. According to this 1996 study, which was published in the Journal of Psychiatry and Neuroscience, of 47 patients diagnosed with SAD, twelve or 25.5 percent had eating disorders.

According to WHMD, the best way to get light is by staying outside for 30 minutes. WHMD notes that even on an overcast day, the sun provides adequate full-spectrum light.

When getting outdoors is not possible, the next best method, according to WHMD, is use of a light box fitted with high-intensity bulbs which simulate natural sunlight. Light therapy, which has been successfully used since the late 1980’s, can be administered by a physician, physical therapist, psychologist, or— with professional instruction— by the patient herself, notes WHMD. Sessions usually last 15-20 minutes.

WHMD notes that patients should never look directly into the light, which is 15 times brighter than normal home or office illumination. In addition, the site warns that certain people should avoid this therapy. These include persons with highly sensitive skin or eyes, or those with ocular diseases such as cataracts, glaucoma, or retinal detachment.

A 1998 study published in the International Journal of Eating Disorders and reported by Phothera.com followed a 17 year-old girl for two years. She suffered from an anorexia-like illness for which she had to be hospitalized twice. During her second hospitalization, she was treated with light therapy. The researchers reported that within days, her mood and eating significantly improved. Within a month, according to the study, her depression decreased from severe to mild/moderate.

Research reported by American Wholehealth and published in the journal Psychiatry Resident, involved a double-blind study of eighteen bulimic women randomly assigned to an experimental group receiving bright light, or a placebo group receiving dim light, administered in the early evening for one week. Subjects in the experimental group showed significant mood improvement compared with those in the placebo group. The experimental subjects returned to pretreatment depression levels after light therapy was discontinued. However, the study reported that the treatment had no effect on binge eating episodes.

Lindsley offers several suggestions for avoiding the winter blues. These include advance planning of fall and winter activities; exposing yourself to as much light as possible; keeping physically active; and seeking professional help at the first signs of depression.

Virtual Reality May Help Restore Healthy Body Image In Anorexics

A new technology may soon banish an old scourge: body image distortion in anorexics. Using “virtual reality,” researchers are trying to help patients develop healthy ideas about their figures.

Although razor thin, the anorexic sees herself as fat. She, therefore, constantly tries to lose weight in order to obtain an “ideal” physique. But her illusory goalpost is perpetually shifting downward, causing her condition to deteriorate.

The Center On Disabilities notes that the current Diagnostic and Statistical Manual of Mental Disorders used by clinicians (DSM IV) has a body image criterion which is required for diagnosis of anorexia or bulimia. The Center cites studies indicating that anorexics who overestimate their measurements, or are more pleased with their appearance than others, gain less weight after cognitive-behavioral therapy.

According to the European Health Telematics Observatory (EHTO), “virtual” therapies have been used on a variety of psychological disorders since the early 1990’s. Experiments have included people suffering from acrophobia (fear of heights), fear of flying, and autism.

The technique combines two older methods: the cognitive-behavioral and the visual-motorial approaches. According to EHTO, the former involves interviews and visualization techniques, while the latter uses videos and bodily awareness exercises.

Developed by Virtual.sys, of Milano, Italy, the VR system consists of a computer attached to a joystick and a head-mounted display. The joystick allows the user to “move” in “virtual” space, and the headgear controls the direction. The Center On Disabilities cites research by Cioffi (1993) which found that 40% of VR subjects felt detached from their bodies shortly after treatment. This effect, according to the Center, is desirable because it allows the patient to be more aware of the sensorimotor processes associated with physical movement. According to the theory, this detachment facilitates healthy change in body image.

The VR subject “moves” through six “zones.” The first two introduce her to the technology and focus attention on diet. The next four attempt to modify her bodily experience. She is required to navigate through several “rooms” with male and female models, make food choices, and observe a digitized image of her own body. At times, she must weigh herself before advancing to another zone. In order to advance to the last zone, she must choose a door corresponding to her exact “virtual” dimensions. Once there, she can adjust her digitized body as desired by using a morphing tool.

Support For Family And Friends

The physical and psychological effects of anorexia nervosa on eating-disordered persons are well-known. Less obvious is the fact that the illness exacts a similar toll on family and friends. It is important for loved ones to not only educate themselves about this condition, but to seek support and counseling for their own well-being.

Anorexia nervosa does not exist in a vacuum. It is maintained by family dynamics. Previous articles discussing the role of culture have suggested that the concept of “family” can be expanded to include peers and society.

Parents and loved ones should not blame themselves for a child’s anorexia. Dysfunctional families can produce healthy offspring, and the healthiest families sometimes produce anorexics. Most people bring up their daughters as best they can. Everyone makes mistakes. Although there is a natural impulse to feel guilty, punishing yourself for a child’s anorexia solves nothing and is detrimental to your health. It’s like two people with normal eyesight torturing themselves for having a blind baby.

Or take the reverse situation: family members blaming anorexics. I was furious with my anorexic mother for years after her death. I blamed her for many of my personal difficulties. But eventually, I realized that it’s more important to look to the future than dwell on the past.

Blame is easy. Taking practical steps toward health is tough but ultimately rewarding.

In addition to providing referrals to therapists, Edreferral.com offers cogent advice to family members, such as:

1. Maintain normal eating patterns. Do not let the anorexic shop or cook for the family. Although such nurturing behavior seems altruistic, it allows her to deny her own need for food.

2. Set firm but reasonable limits.

3. Show affection and appreciation for each other. Anorexia is driven by low self-esteem. Warmth and caring are effective counterweights.

4. Avoid power struggles and discussions of weight. Let the therapist deal with those issues.

5. Keep a diary. Diaries and other forms of written communication (e.g. letters) provide emotional release and insight. They may also contain material for productive therapy sessions.

Edreferral.com has particularly excellent advice for fathers. Many of these pointers apply equally well to mothers or other close relatives, among them:

1. Listen. Focus on the girl’s hopes, dreams and aspirations instead of on how she looks.

2. Discourage dieting.

3. Participate in physical activities with your girl. Sports— or even long walks— help build personal relationships while having fun. An added bonus, according to the site, is that athletic girls are less likely to get pregnant, drop out of school, or get involved with abusive partners.

4. Get involved in her school. Possibilities include coaching, teaching, helping with a play, and chaperoning.

Another excellent source for family and friends is a site by Cheryl A. Wildes. Canadians will be interested in the information on the Anorexia Bulimia Nervosa Foundation of Victoria.

Ednewsletter.com, in operation since January 1999, is an online publication for parents of eating disordered children. It features interviews with professionals, information about treatment centers, poetry and book reviews. You can read the first issue for free.

Something-fishy has extensive bulletin boards and chatrooms for friends and family of people with eating disorders. There are separate groups for parents, siblings, spouses, friends, and other loved ones. You have to register to be able to post messages, but you can “lurk” by typing in “guest” as your name and password. A new discussion area has just been set up for children, but only those over age 16 can post. Too bad this wasn’t available when I was growing up.

Slim Insurance Coverage for Anorexics

It’s no secret that managed care has made essential medical coverage difficult to obtain. But HMO’s are especially tough on anorexic patients.

A March 27, 1999 Wall Street Journal article, reprinted online by the Kansas City Star reported that insurers frequently refuse to cover the long hospital stays anorexics often require. The article quoted Dr. Walter Kaye, a professor of psychiatry and an anorexia specialist at the University of Pittsburgh, as saying that “we’ve had people die” because anorexics could not be admitted to the hospital due to insurance problems.

According to the article, a person 30 pounds underweight can remain hospitalized for three months. The Journal cited findings of William T. Howard of Johns Hopkins University stating that patients need to be fed in the hospital until their weight is 90 percent normal. Patients below that standard who are discharged have a tenfold risk of relapse. The Journal also noted that each decade of chronic anorexia increases a patient’s chances of dying by five percent. Ailments of long-term anorexics include heart, liver, and kidney problems, the Journal reported.

The story of 18 year-old Emmy Pasternak, reported on May 8, 1998 by the Associated Press, is particularly heart-wrenching. Pasternak was hospitalized five times for anorexia and continues to suffer from heart problems and osteoporosis, according to AP. The article reported that Pasternak’s hospitalizations were “overshadowed by worries about insurance and money.” Her year-long stay in a San Diego clinic cost over $138,000 and depleted her parents’ entire life savings.

Denial of coverage for anorexia nervosa is part of the wider crisis in the treatment of psychological disorders. Because anorexia is considered a mental illness, it is subject to insurance caps. Some HMO’s have caps for anorexia as low as $10,000, according to the AP. The AP noted that anorexia takes an average of three to four years to successfully treat.

What should an anorexic or her family do when she is denied coverage? Drs. Kelly Kearfott Hill and Michael Maloney of the Children’s Hospital Medical Center in Cincinnati stress better physician documentation of life-threatening symptoms, as reported by HealthCentral.com . If you are denied coverage, the Journal article suggests speaking with a supervisor or your plan’s medical director and supporting your claim with information from your doctor. In addition, it recommends consulting an attorney if appeals are not successful.

Anorexia and Abuse

Abuse can take many forms, among them: battering, sexual assault, and emotional harm. Some argue that hurtful words to a child (e.g., “You’re so stupid”) can leave deeper scars than any fist or belt. But one thing is for sure: all these experiences have profound psychological impacts that last years— or even a lifetime. Many victims, most of whom are female, develop eating disorders.

The Something Fishy Website notes a “definite correlation” between abuse and eating disorders.Rader Programs reports that over 80 percent of its patients “have had some type of abusive experience.” Colleen Thompson of the Mirror-Mirror Website observes that obtaining an exact percentage is difficult because many abuse victims repress memories or consciously choose to keep their trauma secret. In any case, the relationship between abuse and eating disorders is strong.

Rader’s website explains that anorexia may develop out of a victim’s unconscious desire to lose her sexuality by reverting to a childlike state without developed breasts, hips, or buttocks. Similarly, Mirror-Mirror notes that the binger may stuff to suppress painful emotions, while a purger may vomit to release pent-up feelings.

According to Rader, an abused girl or woman has suffered the ultimate loss of control. By turning to anorexia, she is attempting to gain control of her life by controlling one of the few things she can: her weight. The effort, of course, is doomed to failure. It is, however, the very understandable response of a person who has survived extreme psychological and/or physical assault. Rader notes that she usually feels inadequate, insecure, and distrustful of others.

Something-Fishy describes anorexia as a defense mechanism. Some abuse victims focus on food to distract themselves from emotional pain. Others think that if they were only thinner, they wouldn’t be abused. The sexually abused may think that if they are emaciated, their tormentors will find them unattractive and lose interest in them, according to Something-Fishy. Conversely, a battered woman may think that being ultra-thin will make her more attractive and prevent beatings. Either way, the logic is faulty because abusers are primarily driven by desire for power and control, not sex. Thus, changes in a victim’s appearance will not protect her.

Most importantly, the survivor must understand that she is not to blame. Good looks or personality cannot prevent or end the violence. Only after she has extricated herself, or has been removed from the harmful environment, can the healing begin.

The Mirror-Mirror site cogently observes that the best way to overcome this pain is for the survivor to be treated in a safe, supportive atmosphere by a qualified therapist she likes and trusts. The site warns that when abuse victims who have blocked memories begin remembering their experiences, they may have nightmares, panic attacks, crying fits, or angry outbursts. The unearthing of these terrifying moments may cause a sharp increase in the severity of the eating disorder, according to Mirror-Mirror. At this time, it is crucial for the survivor to be under the care of a competent and sensitive professional.

As a man, I realize my limitations in understanding the horrors experienced by a rape victim or a battered woman. Perhaps the words of eating disordered women who have undergone these experiences can offer more comfort and hope. The Mirror-Mirror Website has a brief, inspirational writing by abuse survivor Michelle Comeau. A short resource list follows.

Empty-Headed Quick Fixes

Last month ABC News.com reported the death of former British child singing star Lena Zavaroni. According to the report, at the time of her death, Zavaroni, 35, weighed less than 60 pounds. But anorexia nervosa did not kill her. She died of complications following brain surgery.

Zavaroni’s fame began at age 9 on Opportunity Knocks, a nationally televised talent show, according to ABC. She sang for presidents, queens, and luminaries, but her meteoric rise soon came to a screeching halt.

The genesis of her anorexia is a familiar story. When she started to develop, her handlers commented on her weight, and by age 13, according to ABC, she was anorexic.

According to the report, Zavaroni had a procedure called a leukotomy, an operation in which connective fibers are cut, severing the connection between two different areas of the brain. She died four weeks later from an infection brought on by the procedure.

ABC cites Paul Hamburg, associate director of the Eating Disorders Unit at Massachusetts General Hospital, who notes that there is no clinical data showing that leukotomy is an effective treatment for anorexia. Then why did Zavaroni undergo the procedure?

The report suggests she was so desperate for a cure that she was willing to try anything. When people get desperate, they get reckless. And then bad things usually happen.

That point was graphically demonstrated on a recent episode of the ABC television show “20/20”. The program’s lead segment reported on a small group of twentysomethings who wanted to have holes drilled in their heads, a procedure called trephination.

Tulane University’s John Verano explained that trephination is “probably the oldest form of surgery” with a history stretching back to the Incas who used it to cut away parts of a damaged skull. But the young people on this program were all physically healthy. And they planned to perform the operation on themselves without any medical supervision.

Some wanted to “increase their consciousness.” Others were searching for a cure for life’s problems. “Mary” was desperately seeking relief from suicidal depression.

The group had rented a farmhouse in a remote location where the procedure was to be performed. The organizer of this insane event was Peter Halvorson, who had drilled a hole in his head in 1972, and whose website, according to “20/20,” has received tens of thousands of hits.

In the farmhouse basement, “Heather” began to trephan herself using what “20/20” correspondent Chris Cuomo described as “an overgrown corkscrew.” But the online transcript does not capture the horror of what happened next.

The video footage shows a lot of blood and Halvorson clumsily trying to assist the young woman. “The hand tool isn’t penetrating the skull correctly, and they don’t have the right instrument to draw back the scalp,” observes Cuomo.

While this ghastly scene was unfolding, the landlord and other local citizenry suddenly appeared and kicked the group out of the house. According to Cuomo, they were concerned about “trouble” coming from these goings-on. “Heather” finished the procedure at another location, where she began to leak brain fluid.

All medical experts interviewed by “20/20” agreed that trephination is extremely dangerous and confers no medical benefits. Columbia Presbyterian’s Dr. Michael Sisti, who has performed thousands of brain surgeries, called it an “assault.” Sisti said that the chances of improving your lifestyle from trephination are “zero,” and none of his patients reported heightened consciousness after surgery.

These stories recall medieval times when the line between torture chambers and medicine was often blurred. It is also reminiscent of lobotomy, which is discussed in a thoughtful piece at MSNBC.com by Dr. Glenn McGee of the University of Pennsylvania’s Center for Bioethics.

McGee notes that lobotomy was a popular method for controlling fear, anxiety, and violent criminal behavior in the 1950’s. The procedure involved drilling the brain’s frontal lobes. Because it resulted in numerous deaths and injuries, lobotomy was quickly abandoned when drug therapy became widely available.

So how does one prevent desperation? The ABCNews story on Zavaroni suggests an answer: most people feel desperate before they have exhausted all options, such as switching doctors or making adjustments in their relationships. Numerous articles on this topic page have indicated that the best treatment for anorexia is a multifaceted approach involving psychotherapy, medically supervised drug treatment, good nutrition, and social support. No, Virginia, there is no magic bullet— especially when it comes to eating disorders.

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