I am conducting an NIMH-funded, IRB-approved study of adolescents with Bulimia Nervosa (BN). I am recruiting adolescent girls between the ages of 12 and 21. If they decide to participate, they will be asked to fill out surveys and answer questions about their medical history, moods and behavior. At this point, they will also receive a psychiatric interview from an experienced psychiatrist in our Eating Disorders Clinic. A one hour MRI scan of the brain will follow in which we will acquire both anatomical and functional images. The functional images will be acquired while they perform a simple task/game in the scanner. MRI does not involve any radiation exposure; it is an extremely safe and painless imaging modality. The scans, surveys and any other information provided will be kept strictly confidential. In addition, the patients will be compensated for participation with a payment of $100. Participation in this study is entirely voluntary.
Prospective participants can call the research assistant herself at (212)543-5151 and schedule an appointment to come in.
Tuesday, January 23, 2007
Feed Science
Recently, a psychologist at the New York State Psychiatric Institute/Columbia University Medical Center contacted me, seeking participants for a study. I told her I'd post the study information on my site, since I support the scientific exploration of e.d.'s and since it's an opportunity for those who struggle with e.d.'s to learn about themselves and earn a little cash on the side. So, if you're in the NYC area and are 12-21 years old (or know anyone who is), check it out:
Thursday, January 18, 2007
Sure Beats The Swan
Lifetime Television is currently hosting casing calls for a new show, Make My Body Over. The series will focus not on bodies, but on body image--making over the way we look at ourselves. If you're interested in addressing problems with body image or self-esteem (and would like to do so in a public venue), click here for more information.
Finally, television for women.
Finally, television for women.
Tuesday, January 16, 2007
Expansion or Constriction?
According to The New York Times article, “In the Land of Bold Beauty, a Trusted Mirror Cracks,” six Brazilian women have died of anorexia as of late. The article, penned by Larry Rohter, traces the transformation of the Brazilian beauty ideal from the guitar-shaped frame (heavy on the waist, hips, and butt) epitomized by the original “Girl from Ipanema” to the Euro-American shrunken hourglass. Gisele Bundchen, the busty-yet-lanky Brazilian model and ex-Leonardo DiCaprio squeeze, seems to epitomize the shift.
Now, Brazilian girls, instead of wishing for larger bottoms (what Brazilian men have traditionally deemed attractive) are pining for the stick-thin figures popular in the (industrialized) rest of the world. Late model Ana Carolinia Reston went too far, as did a handful of other Brazilian twenty-somethings. As the article suggests, the shift from guitar to twig, aside from begging the question of why we must compare women’s bodies to inanimate objects, signals a “rebellion against machismo,” with Brazilian women eschewing Brazilian men’s standards of beauty. But does it? Is this really cultural growth, or the shift from one standard of beauty (promoted by the men of one culture) to another?
Mary del Priore, a historian quoted in the article suggests:
Now, Brazilian girls, instead of wishing for larger bottoms (what Brazilian men have traditionally deemed attractive) are pining for the stick-thin figures popular in the (industrialized) rest of the world. Late model Ana Carolinia Reston went too far, as did a handful of other Brazilian twenty-somethings. As the article suggests, the shift from guitar to twig, aside from begging the question of why we must compare women’s bodies to inanimate objects, signals a “rebellion against machismo,” with Brazilian women eschewing Brazilian men’s standards of beauty. But does it? Is this really cultural growth, or the shift from one standard of beauty (promoted by the men of one culture) to another?
Mary del Priore, a historian quoted in the article suggests:
“'Men are still resisting and clearly prefer the rounder, fleshier type. But women want to be free and powerful, and one way to reject submission is to adopt these international standards that have nothing to do with Brazilian society.'”True, these women may be bucking cultural tradition, but it seems that now they’re simply playing by a different set of rules, characterized by an alternative submission that proves lethal at times.
Thursday, January 11, 2007
Busted
Last week, the Federal Trade Commission targeted the marketing of four weight-loss pills, fining them $25 million for false advertising claims. Xenadrine EFX, One A Day Weight Smart, CortiSlim and TrimSpa were assessed fines for advertising unproven product efficacy, from claims about swift weight loss to the prevention of cancer and Alzheimer’s disease. The products will remain on shelves but must adjust their marketing campaigns to remove false claims.
FTC chairperson Deborah Platt Majoras suggested that in a study investigating the weight-loss efficacy Xenadrine, for example, those who took the pill actually lost less weight than those taking a placebo. Still, diet pills represent a 1.6 billion dollar industry, fueled largely, as we see, by celebrity endorsements and emotional pipe dreams.
FTC chairperson Deborah Platt Majoras suggested that in a study investigating the weight-loss efficacy Xenadrine, for example, those who took the pill actually lost less weight than those taking a placebo. Still, diet pills represent a 1.6 billion dollar industry, fueled largely, as we see, by celebrity endorsements and emotional pipe dreams.
Monday, January 08, 2007
No Joke
(Eating disorder cartoons from cartoonstock.com)
I visited an ophthalmologist recently, whose suite is across the hall from the office where I work part-time at a university medical center. As he tinkered with bright lights and dilating drops, he asked me if I had any areas of specialty. “I do a lot with addictions and eating disorders,” I said.
“An eating disorder—now that’s something I’d like to have.”
“No, you wouldn’t,” I replied.
“Actually, it would be kind of nice to have an eating disorder for a little while, lose 30 pounds, and then get rid of it,” he parried.
And, here, I found myself in familiar territory, defending why one shouldn’t aspire to an eating disorder, challenging the conversational levity associated with a specific diagnosis. He didn’t, for example, suggest he’d like to dabble in opiate addiction. When I talk about working with anxiety and depression, no one jokes about how appealing a stint as a depressive would be, or how nice it would be to have a panic attack now and then. Eating disorders, however, seem to have attained “class clown” status in the arena of psychiatric diagnosis. Even amongst a medical professional. . .
Why is this? Why not consider the gravity of such conditions? How did one of the most fatal psychiatric diagnoses become convenient fodder for jokes? Is it because the pain and suffering of eating disorders is largely internal and therefore unknown? Is it because eating disorders have become so popular in our current zeitgeist (especially among models and celebrities) that they’re almost considered trendy? Is it because the manifest goal of an eating disorder (to lose weight/be thin) is so noble that we’re willing to overlook the process as means to a coveted end?
Wednesday, December 27, 2006
Stories: Part II
I developed an eating disorder for same reason most other sufferers do. I thought that it worked; I thought that my diet and weight loss were solving my problems. Not a radical belief in this society where weight-loss is touted as the cure-all, food is the ultimate comfort and indulgence, and appearance holds absurd import. The coping mechanisms that snowball into an eating disorder – starving, counting calories, binging and purging – erase shame and guilt, curb feelings of worthlessness, repress confusion and absorb anger. How’s that for a quick fix?
***
My life is about to change drastically. In a few days, I’m moving to a new state, to attend college. I’m leaving my therapist. I’m leaving my acquaintances and my routine. I was only mildly surprised, then, when a few days ago I felt a panicked pining for my old, familiar, sick self. Though my recovery is my greatest and most profound accomplishment, in that moment of panic I needed to see that self: the frail self that deflected all negative emotions; the tiny self insulated from criticism and failure. I tore my room apart looking for pictures. Unlike some survivors I know, I keep few pictures of that years-long period. But suddenly, I wanted to see pictures – I needed to see, again, that it was real.
After a primordially frantic search, I inserted a CD into my computer. Pictures filled the computer screen, one after another. Time stopped; I swam in the digital representation of my past. In one picture, I’m standing in front of a full-length mirror, in my underwear. My upper thighs are no wider than my knees. My chest is a field of ridges and shadows, my bra two flat, droopy triangles. My knee-jerk reaction: that stomach’s not flat! How familiar.
In that picture, my face is hidden behind the camera, which I grip with bony hands. Only the shaded hollow of a cheekbone is visible. That’s what an eating disorder is like: living behind a lens, obscured, clinging to the object of one’s destruction with all of one’s will. No head, no face – the ultimate dehumanization. I needed to share the pictures with someone, to validate my experience; I emailed them to my therapist. “I almost had tears in my eyes,” she wrote back, “to think that that was what you once were.”
***
A very wise friend once told me a story. She’s a larger-than-life character whom I’ll never forget, and this story, thankfully, has stuck with me.
There once was a monastery of monks, high on a foggy mountain in a far-off place where monasteries still exist uninterrupted by documentary filmmakers. The head monk was a prudent and much loved man, but he knew, when his eyes began to curdle with cataracts like frying egg white, and his once pliant hands curled into cold, stiff fists each morning, that he was getting old. It was time to appoint another monk to take his place. To choose his successor, he would submit his monks to the Hall of a Thousand Demons.
There’s a great deal of scholarly controversy surrounding the legendary Hall of a Thousand Demons. Some say its title is more figurative than literal, and the Hall contains only some beasts, a vengeful spirit or two, and a few witchy Slavic peasants. The popular consensus, though, is that the Hall holds one’s thousand greatest fears, infinitely magnified and rendered more real than the beating of your heart.
On a clear evening, the head monk gathered his monastic brothers and explained the task ahead of them. One at a time, the monks would enter the Hall of a Thousand Demons. The monk who reached the back doors of the Hall (and though the head monk seriously doubted that there would be more than one to do so, he figured they’d cross that bridge if and when they got to it) would become the next head monk. The monks nodded. One by one, they entered the front doors, some cocky and strutting, others apprehensive, still others with legs trembling like noodles. And one by one, the monks burst forth from the front doors of the Hall of a Thousand Demons.
“It’s all so real!” they gasped. “We can’t do it! It’s too much!” A defeated crowd congregated around the head monk.
“Ah, my brothers,” the head monk sighed. “Not one of you has cracked the secret of the Hall of a Thousand Demons. With this secret, anyone can pass through. The secret is this: no matter what you see, no matter what you hear, no matter what you feel, just keep putting one foot in front of the other.”
***
The concept of recovery is infuriatingly abstract, especially for a population which tends toward precision and rigidity and control. One of the scariest things about living within the confines of anorexia was my inability – and this seems to be the rule rather than the exception among the eating disorder population – to understand recovery. So I had to have faith. Not necessarily in a higher power – faith in my therapist’s words; faith in my sister’s love for me; faith in my worth as a person, and my capacity to take risks. Faith that I was meant for something greater than this lonely captivity. Like the monks marching through the Hall of a Thousand Demons, the recovering person must persevere, no matter what she sees in the mirror, or feels in her body or mind, or hears from her head. That means unlimited forgiveness and self-acceptance. That means letting go of expectations. That means sitting with uncomfortable emotions instead of fleeing (or starving, or binging). I know very few people who were able to accomplish something so tremendous on their own, and I have unspeakable admiration for everyone who doesn’t give up, who picks up and keeps going.
The saying goes that happiness is the journey rather than the destination, but I take issue in the case of recovering. Recovery isn’t linear progress, and the progress definitely isn’t concerned with happiness. The “journey” of an eating disorder can be full of moments of artificial happiness – the rush, the numbness, the sense of security that comes from dropping pounds, emptying one’s stomach into the toilet or fitting fingers around one’s thigh. An eating disorder is a vaudeville of happiness. Such happiness is not fulfilling, or lasting, or constructive. The more of it that you generate, the more you want next time. So it only makes sense that one would wish to stay in this comfortable fortress, exchanging physical comfort for manufactured emotional OK-ness, rather than leave the fortress and become suddenly vulnerable in so many ways, in pursuit of something intangible and undefined, whose very existence one doubts.
Early in my treatment, I could imagine recovery only as a visual symbol – a great flowing energy. A sort of amorphous life spirit. Getting dressed recently, I caught sight of myself in the mirror – the curve of my spine and my hips, my toned shoulders, my imperfect stomach – and that life spirit is who I saw. Beauty is in the I of the beholder. The I: the being, the identity, the life and energy. My body isn’t perfect. It doesn’t look like anyone else’s – it looks like mine. And my body is perfect because it’s me.
***
My life is about to change drastically. In a few days, I’m moving to a new state, to attend college. I’m leaving my therapist. I’m leaving my acquaintances and my routine. I was only mildly surprised, then, when a few days ago I felt a panicked pining for my old, familiar, sick self. Though my recovery is my greatest and most profound accomplishment, in that moment of panic I needed to see that self: the frail self that deflected all negative emotions; the tiny self insulated from criticism and failure. I tore my room apart looking for pictures. Unlike some survivors I know, I keep few pictures of that years-long period. But suddenly, I wanted to see pictures – I needed to see, again, that it was real.
After a primordially frantic search, I inserted a CD into my computer. Pictures filled the computer screen, one after another. Time stopped; I swam in the digital representation of my past. In one picture, I’m standing in front of a full-length mirror, in my underwear. My upper thighs are no wider than my knees. My chest is a field of ridges and shadows, my bra two flat, droopy triangles. My knee-jerk reaction: that stomach’s not flat! How familiar.
In that picture, my face is hidden behind the camera, which I grip with bony hands. Only the shaded hollow of a cheekbone is visible. That’s what an eating disorder is like: living behind a lens, obscured, clinging to the object of one’s destruction with all of one’s will. No head, no face – the ultimate dehumanization. I needed to share the pictures with someone, to validate my experience; I emailed them to my therapist. “I almost had tears in my eyes,” she wrote back, “to think that that was what you once were.”
***
A very wise friend once told me a story. She’s a larger-than-life character whom I’ll never forget, and this story, thankfully, has stuck with me.
There once was a monastery of monks, high on a foggy mountain in a far-off place where monasteries still exist uninterrupted by documentary filmmakers. The head monk was a prudent and much loved man, but he knew, when his eyes began to curdle with cataracts like frying egg white, and his once pliant hands curled into cold, stiff fists each morning, that he was getting old. It was time to appoint another monk to take his place. To choose his successor, he would submit his monks to the Hall of a Thousand Demons.
There’s a great deal of scholarly controversy surrounding the legendary Hall of a Thousand Demons. Some say its title is more figurative than literal, and the Hall contains only some beasts, a vengeful spirit or two, and a few witchy Slavic peasants. The popular consensus, though, is that the Hall holds one’s thousand greatest fears, infinitely magnified and rendered more real than the beating of your heart.
On a clear evening, the head monk gathered his monastic brothers and explained the task ahead of them. One at a time, the monks would enter the Hall of a Thousand Demons. The monk who reached the back doors of the Hall (and though the head monk seriously doubted that there would be more than one to do so, he figured they’d cross that bridge if and when they got to it) would become the next head monk. The monks nodded. One by one, they entered the front doors, some cocky and strutting, others apprehensive, still others with legs trembling like noodles. And one by one, the monks burst forth from the front doors of the Hall of a Thousand Demons.
“It’s all so real!” they gasped. “We can’t do it! It’s too much!” A defeated crowd congregated around the head monk.
“Ah, my brothers,” the head monk sighed. “Not one of you has cracked the secret of the Hall of a Thousand Demons. With this secret, anyone can pass through. The secret is this: no matter what you see, no matter what you hear, no matter what you feel, just keep putting one foot in front of the other.”
***
The concept of recovery is infuriatingly abstract, especially for a population which tends toward precision and rigidity and control. One of the scariest things about living within the confines of anorexia was my inability – and this seems to be the rule rather than the exception among the eating disorder population – to understand recovery. So I had to have faith. Not necessarily in a higher power – faith in my therapist’s words; faith in my sister’s love for me; faith in my worth as a person, and my capacity to take risks. Faith that I was meant for something greater than this lonely captivity. Like the monks marching through the Hall of a Thousand Demons, the recovering person must persevere, no matter what she sees in the mirror, or feels in her body or mind, or hears from her head. That means unlimited forgiveness and self-acceptance. That means letting go of expectations. That means sitting with uncomfortable emotions instead of fleeing (or starving, or binging). I know very few people who were able to accomplish something so tremendous on their own, and I have unspeakable admiration for everyone who doesn’t give up, who picks up and keeps going.
The saying goes that happiness is the journey rather than the destination, but I take issue in the case of recovering. Recovery isn’t linear progress, and the progress definitely isn’t concerned with happiness. The “journey” of an eating disorder can be full of moments of artificial happiness – the rush, the numbness, the sense of security that comes from dropping pounds, emptying one’s stomach into the toilet or fitting fingers around one’s thigh. An eating disorder is a vaudeville of happiness. Such happiness is not fulfilling, or lasting, or constructive. The more of it that you generate, the more you want next time. So it only makes sense that one would wish to stay in this comfortable fortress, exchanging physical comfort for manufactured emotional OK-ness, rather than leave the fortress and become suddenly vulnerable in so many ways, in pursuit of something intangible and undefined, whose very existence one doubts.
Early in my treatment, I could imagine recovery only as a visual symbol – a great flowing energy. A sort of amorphous life spirit. Getting dressed recently, I caught sight of myself in the mirror – the curve of my spine and my hips, my toned shoulders, my imperfect stomach – and that life spirit is who I saw. Beauty is in the I of the beholder. The I: the being, the identity, the life and energy. My body isn’t perfect. It doesn’t look like anyone else’s – it looks like mine. And my body is perfect because it’s me.
Tuesday, December 26, 2006
Thought Question
Can you love yourself and hate your body?
Or, in a less extreme version, is it possible to achieve self-acceptance, if you haven't accepted the way you look?
Curious as to your thoughts. . .
Or, in a less extreme version, is it possible to achieve self-acceptance, if you haven't accepted the way you look?
Curious as to your thoughts. . .
Thursday, December 21, 2006
Diet Coke
21-year-old Miss USA Tara Conner recently faced the ultimate boardroom challenge--appear before Mr. Trump with the possibility of losing her pageant crown. It seems Ms. Conner has been suspected of alcohol and drug (primarily cocaine) abuse. The verdict? She earned herself a rehab stint but gets to keep her crown.
Just because you test positive for cocaine means you can't be a role model for young girls? Not true (see Kate Moss, Nicole Ritchie, etc.). And, if we're really going to start cracking down on model/celebrity cocaine use, we'll be left with a decimated roster of American royalty--those who remain will likely be a tad more "big-boned" than models past.
So, in keeping Ms. Conner aboard, Trump accomplished quite a bit--he preserved our celebrity culture, reinforced the notion that it's important to do whatever it takes to stay thin (quite discrepant from the idea of substance use in sports), and provided us the opportunity to witness Conner's heartwarming metamorphosis from MADD spokesperson/party girl to recovering addict, reforming her ways and rising above the chaos to bring us all, of course, world peace.
Monday, December 18, 2006
Cada Mujer Tiene un Desorden el Comer
In honor of the upcoming wide release of Dreamgirls, I present to you a
Spanish-language version of an old post I found while browsing on the web. I find this Google-based translation funny, particularly since my Spanish vocabulary is about as paltry as Beyonce's preparatory meals.
Word around town is that Jennifer Hudson's debut is amazing--her performance has been greeted with standing ovations around New York.
Now can we stop talking about her weight?
Thursday, December 14, 2006
ED & OCD
In a recent article in the OCD Newsletter, entitled “OCD and Anorexia,” psychologists Eda Gorbis, Ph.D. and Jenny Yip, Psy.D. highlight the striking similarities between these disorders. Obsessive-compulsive disorder (OCD), an anxiety disorder characterized by obsessive thought patterns and/or behavioral (or mental) compulsions, seems to be linked to the restriction and compulsions around food, typical of eating disorders. In fact, it’s estimated that almost half of those diagnosed with anorexia also meet criteria for OCD. Looking at an eating disorder, it’s hard not to see the components of OCD: ruminations about calories consumed or weight gained, compulsive weighing/mirror-checking/exercise, purging as compulsive compensation for a binge.
Both OCD and EDs have been linked with imbalances in the neurotransmitter, serotonin. As such, selective serotonin reuptake inhibitors (SSRIs) are the psychotropic line of defense for both. And finally, similar therapeutic interventions are effective for both. Cognitive-behavioral therapy, which addresses dysfunctional thought and behavioral patterns works quite well in both group and individual settings with each patient population. Exposure and response prevention, a specific behavioral intervention that involves exposure to anxiety-provoking stimuli with the simultaneous prevention of a target behavioral response (e.g., OCD patients might be instructed to “sit with” feelings of contamination while avoiding hand-washing, ED patients might be instructed to “sit with” feelings of fullness after a meal without purging or running to the scale or mirror for self-evaluation) has demonstrated significant efficacy rates as well.
According to Gorbis and Yip, some researchers are considering the idea of subsuming eating disorders under the OCD diagnosis. Taking a look at the criteria for OCD from the current Diagnostic and Statistical Manual (DSM-IV; APA, 1994) below, it seems clear that if we substitute calorie counting, fears of gaining weight, mirror-checking/weighing, and/or bingeing/purging with some of the behaviors provided, we might just have a good fit. One notable difference is that described under criterion B, which suggests that in OCD, the obsessions or compulsions are recognized to be unreasonable. In some eating disorder constellations, particularly those that are more restrictive in nature, it seems that this criterion may not be met.
______________________________________________________
A. The Person Exhibits Either Obsessions or Compulsions
Obsessions are indicated by the following:
1) The person has recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
2) The thoughts, impulses, or images are not simply excessive worries about real-life problems.
3) The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action.
4) The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion).
Compulsions are indicated by the following:
1) The person has repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2) The behaviors or mental acts are aimed at preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. (Note: this does not apply to children.)
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational/academic functioning, or usual social activities or relationships.
D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with drugs in the presence of a substance abuse disorder).
E. The disturbance is not due to the direct physiologic effects of a substance (e.g., drug abuse, a medication) or a general medical condition.
Both OCD and EDs have been linked with imbalances in the neurotransmitter, serotonin. As such, selective serotonin reuptake inhibitors (SSRIs) are the psychotropic line of defense for both. And finally, similar therapeutic interventions are effective for both. Cognitive-behavioral therapy, which addresses dysfunctional thought and behavioral patterns works quite well in both group and individual settings with each patient population. Exposure and response prevention, a specific behavioral intervention that involves exposure to anxiety-provoking stimuli with the simultaneous prevention of a target behavioral response (e.g., OCD patients might be instructed to “sit with” feelings of contamination while avoiding hand-washing, ED patients might be instructed to “sit with” feelings of fullness after a meal without purging or running to the scale or mirror for self-evaluation) has demonstrated significant efficacy rates as well.
According to Gorbis and Yip, some researchers are considering the idea of subsuming eating disorders under the OCD diagnosis. Taking a look at the criteria for OCD from the current Diagnostic and Statistical Manual (DSM-IV; APA, 1994) below, it seems clear that if we substitute calorie counting, fears of gaining weight, mirror-checking/weighing, and/or bingeing/purging with some of the behaviors provided, we might just have a good fit. One notable difference is that described under criterion B, which suggests that in OCD, the obsessions or compulsions are recognized to be unreasonable. In some eating disorder constellations, particularly those that are more restrictive in nature, it seems that this criterion may not be met.
______________________________________________________
A. The Person Exhibits Either Obsessions or Compulsions
Obsessions are indicated by the following:
1) The person has recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.
2) The thoughts, impulses, or images are not simply excessive worries about real-life problems.
3) The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action.
4) The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion).
Compulsions are indicated by the following:
1) The person has repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2) The behaviors or mental acts are aimed at preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. (Note: this does not apply to children.)
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational/academic functioning, or usual social activities or relationships.
D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with drugs in the presence of a substance abuse disorder).
E. The disturbance is not due to the direct physiologic effects of a substance (e.g., drug abuse, a medication) or a general medical condition.
Monday, December 11, 2006
Size Ate
Size Ate is a one-woman show that captures playwright/actress Margaux Laskey's struggle with eating and body-image concerns. I stumbled upon the show last year and was immediately struck by the sincerity of her story and performance. I contacted Ms. Laskey after seeing Size Ate and talk of professional collaboration ensued. Here is Ms. Laskey's promotional video for Size Ate:
Not too long ago, Ms. Laskey asked me to write a blurb for her promotional materials. Here it was:
Not too long ago, Ms. Laskey asked me to write a blurb for her promotional materials. Here it was:
I saw Size Ate twice and enjoyed it both personally and professionally. Margaux Laskey is a talented actress (and singer) who has penned a touching, autobiographical piece that is alternately funny and serious, personal, insightful, and most of all, heartfelt. While I believe Ms. Laskey’s performance would be enjoyable to any audience, I would especially encourage women who struggle with eating and body-image concerns to see this show.It's possible that Size Ate may go on tour--for now, the greater possibility is another NYC run. If so, I invite you all to come join me in New York for some hot chocolate and a healthy dose of introspective theater.
Thursday, November 30, 2006
A New Blog in Town
Sandy Szwarc, a registered nurse (and researcher), recently sent me a heads-up on her new blog, "Junkfood Science." I've had a chance to review it and have found her presentation of research informative and accessible and her message congruent with mind/body health. The site tackles body/weight issues, but also provides a wealth of information on food science and health policy concerns.
Sandy's blurb: "Junkfood Science -- The truth about food, fat and health. It's not what you’ve been led to believe. Learn the science that mainstream media doesn’t report and how to critically think about the junk they do that's not fit to swallow."
Check it out.
Sandy's blurb: "Junkfood Science -- The truth about food, fat and health. It's not what you’ve been led to believe. Learn the science that mainstream media doesn’t report and how to critically think about the junk they do that's not fit to swallow."
Check it out.
Monday, November 27, 2006
Cultured?
This past weekend's The New York Times Magazine features an article written by a Harriet Brown, the mother of a 14-year-old girl diagnosed with anorexia. Ms. Brown's personal account of healing her daughter describes the Maudsley approach, a family-based approach for treating anorexia, and pays tribute to the genetic factors associated with eating disorders. Brown cautions us against socio-cultural explanations: "If this were true, though, millions of American girls and women would become anorexic instead of the roughly 1 to 3 percent who do. Clearly there are other factors involved." Brown's point is well-taken--a number of factors have been associated with the development of eating disorders; however, when you turn the page after the article's end, it's hard to discount the critical role that cultural images and dialogues play in women's thoughts about their bodies.
(Lest there be any uncertainty, the image illustrates a Times feature subtitled, "An Artful Homage to this Season's All-Important Acessory: The Hat.")
(Lest there be any uncertainty, the image illustrates a Times feature subtitled, "An Artful Homage to this Season's All-Important Acessory: The Hat.")
Monday, November 20, 2006
Calorie Restriction
(from The New York Times: two rhesus monkeys about the same age, one fed a CR diet,left, the other fed a normal diet) A number of people have asked about my thoughts on calorie restriction, the movement that follows the notion that the less you eat, the more years you’ll live. The idea is that giving up those hearty meals, those decadent treats, those full-plate or even half-plate servings, you may up your chances at living a longer, healthier life. And, so on the almost-eve of America’s national overeating challenge, I offer some thoughts on calorie restriction. Please keep in mind that these observations/interpretations are from a psychological, not nutritional or biomedical perspective, and that the fact that a clipping on calorie restriction (CR) that I had saved for this post just caught fire on a candle I’m burning at my desk does in no way reflect on my thoughts about CR.
CR involves consuming about 30% fewer calories per day than is generally recommended for one’s height, weight, and body type. The key, though, is that amounts of vitamins, minerals, and other essential nutrients are kept constant (or even enhanced), resulting in a kitchen laboratory of sorts, where scales, measures, and computer monitoring ensure adequate levels of nutrients on a largely barren plate. From what I understand about nutrition, this may not be the easiest task.
Support for CR dates back to 1935, when Dr. Clive McKay, a researcher at Cornell University found that rats fed a CR diet lived approximately 40% longer than their normally-fed counterparts. Similar results have been found in primate populations, where like in mice, scientists are seeing reduced incidences of diabetes, heart disease, cancer, and other ailments with the introduction of CR.
Does CR work in humans? They’re not so sure. The truth is, the scientific community isn’t exactly sure how CR works at all. Still, several hundred thousand people have swapped their cookbooks for cooking scales, their large serving plates for the ceramic equivalent of “just a little bit.” A New York magazine article focuses on Michael, a bona fine calorie restrictor, who at 6’ feet tall and 115 pounds consumes 1,913 calories per day. Exactly 1,913. His dinner, his girlfriend (also a CR devotee) explains, is “‘always 639 calories.’” Other CR followers profiled in the article skip meals or consume a single meal per day.
A New York Times article reports that scientists at Washington University who have studied a group of calorie restrictors have found that “the dieters had better-functioning hearts and fewer signs of inflammation, which is a precursor to clogged arteries, than similar subjects on regular diets.” According to the Times, research published in JAMA has also suggested that those on CR diets have lower body temperatures, lower insulin levels, and fewer indices of chromosomal damage linked to the aging process.
On other hand, the Times reports that:
A mathematical model published last year by researchers at University of California, Los Angeles, and University of California, Irvine, predicted that the maximum life span gain from calorie restriction for humans would be just 7 percent. A more likely figure, the authors said, was 2 percent.Is it really worth it, to give up (for a lifetime) the decadence, the luxury, the indulgence of food for an extra couple of years? One of the paper’s authors, Dr. Jay Phelan at UCLA says: “‘Calorie restriction is doomed to fail, and will make people miserable in the process of attempting it.’”
As with many enterprises (especially surrounding food and weight), the research may be confounded. People who subscribe to CR are likely to be those who don’t smoke, who don’t drink to excess, who exercise, and who generally engage in a host of other behaviors designed to promote their health. Their results on medical tests do not indicate that CR is ultimately responsible for their good health.
Regarding Phelan’s point above, it’s unclear what the long-term effects of CR in human populations may be. From a psychological perspective, CR does not look much different (at least superficially) from a weight-loss diet. For those who are approaching CR for weight-loss purposes, we may see similar failure rates to other organized approaches that focus on deprivation. CR also looks a lot like the restriction associated with anorexia. Those involved in the CR movement emphasize that the goal is not weight loss and that nutrition takes a paramount role, unlike in anorexia. The Calorie Restriction Society takes a special look at CR vs. anorexia here. Still, eating-disordered thoughts and behaviors may creep up on the unsuspecting CR follower, particularly someone who focuses primarily on the associated weight-loss benefits. We may also see, as Phelan indicates, difficulty adhering to CR and compensatory bingeing, as a result of hunger and a reaction to a constricting, depriving diet without an end in sight.
Your thoughts?
Thursday, November 16, 2006
More or Less
In most aspects of life, we’re always yearning for more: more time, more money, more love, more knowledge, more space, more insight, more sleep, more hope, more light. With regard to weight and shape and size, however, less is more—to weigh less; to have a smaller frame; to approximate zero as best we can; to come, in some cases, as close to nothingness as possible, while still claiming to exist.
“I want to be less.” Deconstructing the sentence, it’s interesting how it maintains meaning as it shrinks:
I want to be less.
I want to be.
I want to.
I want.
I.
.
For women, how did less become a synonym for more?
“I want to be less.” Deconstructing the sentence, it’s interesting how it maintains meaning as it shrinks:
I want to be less.
I want to be.
I want to.
I want.
I.
.
For women, how did less become a synonym for more?
Monday, November 13, 2006
VCR/DVR Alert
Tomorrow night at 9pm ET, HBO airs Thin, a documentary on eating disorders by filmmaker Lauren Greenfield. Click here here for an interview with Ms. Greenfield.
The Fault of the Fat
As if having to endure public ridicule and self-reproach weren’t enough, now the obese population is being blamed for one of our planet’s most harrowing crises—global warming. The New York Times recently reported that in an issue of The Engineering Economist, researchers calculated the extra gasoline costs use to transport our growing nation, to the tune of a billion gallons per year. Similar research regarding airline fuel use was published a year earlier in The American Journal of Public Health, which suggested that the extra 10 pounds Americans now schlep around is responsible for 350 million gallons of fuel, resulting in significant increases in environmental carbon dioxide.
So, does the drama of global warming tip the scales to the point where the obese population will finally have an a-ha moment, the personal turning point, when sudden insight leads to miraculous weight-loss? Not really. As the Times reporter Gina Kolata notes, “It’s not that the obese don’t care. Instead, as science has shown over and over, they have limited personal control over their weight. Genes play a significant role, the science says.” And, we know what typically happens when we raise the stakes in the obesity game—those stigmatized, blamed for their personal (and now environmental and sociopolitical) ills and compelled to lose weight will actually. . . eat more. It’s akin to yelling at a stuttering child. What do we think is going to happen?
So far, scholars are also not taking bait. In the Times article, Kelly Brownell of the Rudd Center for Food Policy and Obesity at Yale says, “‘People are out scouring the landscape for things that make obese people look bad.’” Katherine Flegal of the Centers for Disease Control and Prevention offers a tonge-in-cheek response: “‘Yes, obesity is to blame for all the evils of modern life, except somehow, weirdly, it is not killing people enough. . . . In fact, that’s why there are all these fat people around. They just won’t die.’”
So, does the drama of global warming tip the scales to the point where the obese population will finally have an a-ha moment, the personal turning point, when sudden insight leads to miraculous weight-loss? Not really. As the Times reporter Gina Kolata notes, “It’s not that the obese don’t care. Instead, as science has shown over and over, they have limited personal control over their weight. Genes play a significant role, the science says.” And, we know what typically happens when we raise the stakes in the obesity game—those stigmatized, blamed for their personal (and now environmental and sociopolitical) ills and compelled to lose weight will actually. . . eat more. It’s akin to yelling at a stuttering child. What do we think is going to happen?
So far, scholars are also not taking bait. In the Times article, Kelly Brownell of the Rudd Center for Food Policy and Obesity at Yale says, “‘People are out scouring the landscape for things that make obese people look bad.’” Katherine Flegal of the Centers for Disease Control and Prevention offers a tonge-in-cheek response: “‘Yes, obesity is to blame for all the evils of modern life, except somehow, weirdly, it is not killing people enough. . . . In fact, that’s why there are all these fat people around. They just won’t die.’”
Thursday, November 09, 2006
Addictions
I’ve been thinking a lot recently how eating-disordered thoughts and behaviors mimic other addictions. Just like a drink or drug, an eating-disordered action can be compulsive (or impulsive), can rescue us (temporarily) from difficult feelings, and can create a host of new problems that obscure what originally led us to these behaviors in the first place.
With addictions, we often use functional analyses to understand the patterns associated with alcohol/drug use. In its simplest form, a functional analysis looks like this:
Triggers-->Behaviors-->Consequences
That is, certain situations or events lead us to respond in a certain way, and these responses have various consequences. With alcohol/drugs, we often focus on the triggers (people, places, things) that lead us to drink/use (or not), and the positive and negative consequences of using (or not). To apply this to eating-disordered behaviors, we first need to identify the behaviors in question. Here are some examples:
1) Restricting
2) Bingeing/purging
3) Emotional eating
4) Excessive exercise
5) Excessive weighing/mirror-gazing
6) Engaging in critical thinking about our bodies
7) “Feeling” fat
8) Desperately turning to the next diet
As for triggers, to expand upon people/places/things, they are often thoughts we have, emotions we experience (the concept of “emotional eating” itself addresses 2/3 of the equation above), stimuli we encounter (e.g., a fashion magazine, gaining weight/losing weight, a picture of ourselves, a bad day), physical symptoms (e.g., feeling overly full, tense, lethargic), etc. What other triggers do you experience?
Once we encounter these triggers, we have a number of behavioral responses that we may employ (some repertoires may be larger than others). For the purpose of this discussion, the critical distinction ultimately occurs between engaging in an eating-disordered behavior (see above) or not, instead relying on a more adaptive coping resource. Each option is associated with consequences, good and bad. Bingeing might make us uncomfortable, but having access to unlimited, tasty food feels good in the here-and-now. Berating ourselves for the size of our stomachs may cause us to experience anger or grief, but it potentially distracts us from even more uncomfortable thoughts and feelings. Examining some of the other consequences—good and bad—of engaging in these behaviors may help elucidate our decision-making processes.
With addictions, we often use functional analyses to understand the patterns associated with alcohol/drug use. In its simplest form, a functional analysis looks like this:
Triggers-->Behaviors-->Consequences
That is, certain situations or events lead us to respond in a certain way, and these responses have various consequences. With alcohol/drugs, we often focus on the triggers (people, places, things) that lead us to drink/use (or not), and the positive and negative consequences of using (or not). To apply this to eating-disordered behaviors, we first need to identify the behaviors in question. Here are some examples:
1) Restricting
2) Bingeing/purging
3) Emotional eating
4) Excessive exercise
5) Excessive weighing/mirror-gazing
6) Engaging in critical thinking about our bodies
7) “Feeling” fat
8) Desperately turning to the next diet
As for triggers, to expand upon people/places/things, they are often thoughts we have, emotions we experience (the concept of “emotional eating” itself addresses 2/3 of the equation above), stimuli we encounter (e.g., a fashion magazine, gaining weight/losing weight, a picture of ourselves, a bad day), physical symptoms (e.g., feeling overly full, tense, lethargic), etc. What other triggers do you experience?
Once we encounter these triggers, we have a number of behavioral responses that we may employ (some repertoires may be larger than others). For the purpose of this discussion, the critical distinction ultimately occurs between engaging in an eating-disordered behavior (see above) or not, instead relying on a more adaptive coping resource. Each option is associated with consequences, good and bad. Bingeing might make us uncomfortable, but having access to unlimited, tasty food feels good in the here-and-now. Berating ourselves for the size of our stomachs may cause us to experience anger or grief, but it potentially distracts us from even more uncomfortable thoughts and feelings. Examining some of the other consequences—good and bad—of engaging in these behaviors may help elucidate our decision-making processes.
Tuesday, November 07, 2006
Cheers!
Recent research out of Harvard Medical School and the National Institute on Aging suggests that an ingredient found in red wine, resveratrol, may reduce the incidence of the health-related consequences typically associated with obesity. When obese mice were administered heavy doses of resveratrol, their fat-related deaths dropped by 31%.
As for the resveratrol-enhanced mice? “‘They’re chubby, but inside they look great,’” says study co-author David Sinclair of Harvard in a Metro report. Sinclair’s co-author, Rafael de Cabo, with the National Institutes on Aging, states in a Harvard Medical School News Release, “‘After six months, resveratrol essentially prevented most of the negative effects of the high calorie diet in mice.’”
Preliminary results indicate that resveratrol may be associated with lower incidences of diabetes, heart disease, and liver dysfunction, even in obese populations, when the prevalence of these diseases, historically, has been thought to be directly related to patients’ weight. Again, we’re confronted with data suggesting that it’s impossible to posit a one-to-one correlation between weight and health, that a multitude of factors (e.g., physical fitness, genetics, even mass amounts of red wine consumption) may moderate this relationship.
Thursday, November 02, 2006
BMI Not TMI
A little more on the BMI: The index was “invented” by Belgian man named Adolphe Quetelet, who’s identified as a “polymath.” I’m not exactly certain what a polymath is, but it sure doesn’t sound fun.
During the course of this writing, Lancet medical journal published meta-analytic research (of 40 studies) out of the Mayo Clinic suggesting that those with too-low BMIs were at greater risk for heart disease-related death than those who had BMIs in the normal range. Moreover, those considered “overweight” by classic BMI standards actually had a higher rate of survival (with fewer heart problems) than those in the “normal” BMI range.
Head researcher Francisco Lopez-Jimenez says “Rather than proving that obesity is harmless, our data suggests that alternative methods might be needed to better characterize individuals who truly have excess body fat compared with those in whom BMI is raised because of preserved muscle mass.”
It took the Mayo Clinic until 2006 to come up with this? Our gold standard isn’t so golden, after all.
In another article in the same issue of the Lancet, Maria Grazia Franzosi states, “BMI can definitely be left aside as a clinical and epidemiological measure of cardiovascular risk.” Instead, it seems that waist-to-hip ratios are, for now, the way to go. And Grazia Franzosi’s research suggests that these ratios are good prognostic indicators of cardiovascular health. Still, we seem glued to a number (from pounds to BMI to ratios) that is, at best, a gross estimate of an individual’s unique biology. When it comes down to it, it’s easier to address a number than a person.
During the course of this writing, Lancet medical journal published meta-analytic research (of 40 studies) out of the Mayo Clinic suggesting that those with too-low BMIs were at greater risk for heart disease-related death than those who had BMIs in the normal range. Moreover, those considered “overweight” by classic BMI standards actually had a higher rate of survival (with fewer heart problems) than those in the “normal” BMI range.
Head researcher Francisco Lopez-Jimenez says “Rather than proving that obesity is harmless, our data suggests that alternative methods might be needed to better characterize individuals who truly have excess body fat compared with those in whom BMI is raised because of preserved muscle mass.”
It took the Mayo Clinic until 2006 to come up with this? Our gold standard isn’t so golden, after all.
In another article in the same issue of the Lancet, Maria Grazia Franzosi states, “BMI can definitely be left aside as a clinical and epidemiological measure of cardiovascular risk.” Instead, it seems that waist-to-hip ratios are, for now, the way to go. And Grazia Franzosi’s research suggests that these ratios are good prognostic indicators of cardiovascular health. Still, we seem glued to a number (from pounds to BMI to ratios) that is, at best, a gross estimate of an individual’s unique biology. When it comes down to it, it’s easier to address a number than a person.
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