"Defeating Your Eating Disorder" Conference
with Dr. Ira Sacker

Bob M is the moderator.

BEGINNING

Bob M: Good Evening and welcome everyone. Our topic tonight is "Defeating Your Eating Disorder". Our guest is Dr. Ira Sacker. Dr. Sacker has a "bit" :) of knowledge on the subject of eating disorders. He's the director and founder of HEED--Helping to End Eating Disorders at the Brookdale University and Hospital Medical Center in New York. He's also the author of the well-known book: Dying to Be Thin: Understanding and Defeating Eating Disorders. And he's written numerous articles on all facets of eating disorders--anorexia, bulimia, and compulsive overeating. I'm Bob McMillan, the moderator for tonight's conference. As we proceed through the conference, we'll not only be talking about how to defeat your eating disorder, but I also want to address some new research reports that came out talking about psychological disorders in relatives of women with eating disorders. I want to welcome Dr. Sacker to the Concerned Counseling Website...and maybe we could start with you telling us a bit more about your expertise in the area of eating disorders.

Dr. Sacker: Thank you, Bob. I have been involved in eating disorders for the past 25 years. During that time, I have treated many individuals with anorexia, bulimia and bulimarexia. We are now seeing an increased incidence of second generation eating disorders.

Bob M: And I want to address that issue later in the conference. So we are on the same track tonight, since we are talking about "defeating your eating disorder", can you define what the word "recovered" means when it comes to the various eating disorders?

Dr. Sacker: Well, this is a difficult issue since we see a lot of recurrence with eating disorders. Recovery generally implies that the individual is at a relatively normal weight for height, has greater than 17% body fat and psychologically is able to more effectively deal with his or her issues.

Bob M: What if you've added weight, but you still have some eating disordered behaviors. Are you still considered recovered? And is "cured" the same as "recovered"? Or is a person with an eating disorder never really "cured"?

Dr. Sacker: Most eating disorder patients still have some eating disordered behaviors, i.e., still concerned with portion size, etc. I would still consider them in recovery.

Bob M: What makes it so difficult to recover from an eating disorder?

Dr. Sacker: Eating disorders are not about food, but about underlying issues of control, low self-esteem, underlying depression, obsessive-compulsive behaviors which are being masked by food.

Bob M: For those of you just joining us, I'm glad you could make it. Our guest is Dr. Ira Sacker, eating disorders treatment expert and author of the book: Dying to Be Thin. We're discussing "defeating your eating disorder". So are you saying that for a person really to get on the road to recovery, they have to deal with the other issues first?

Dr. Sacker: Absolutely . Often the eating disorder acts as a protection from the underlying feelings of being overwhelmed. With anorexia and bulimia, the behaviors of restriction as well as bingeing and vomiting causes a release of endorphins which give the individual a false "high". To treat these disorders one needs to have a treatment team composed of a physician, nutritionist and therapist all well versed in eating disorders.

Bob M: Your book talks about "defeating" your eating disorder. What do you think are the most effective ways of treating an eating disorder and defeating it?

Dr. Sacker: The key is forming a relationship with your client. This involves not only an understanding of the illnesses, but also a sensitivity to the individual and the family.

Bob M: So are you saying there's no "magical" cure, no drug that will do it "once and for all"? That really the key to recovery is getting a good therapist who will work with you through your problems?

Dr. Sacker: Cognitive behavioral therapy, oftentimes in conjunction with specific SSRI medications, i.e., Prozac or Paxil etc. has been effective in decreasing the binge-purge cycle. But it is certainly not a magical cure by itself. Finding a good therapist is like going shopping. You must be comfortable with the individual.

Bob M: Here are a couple of audience comments, then onto audience questions:

Horace: I believe that recovery is about healing the eating disordered behaviors plus dealing with the underlying issues. You cannot have one without the other. Recovery is about integrating behavior + emotional healing.

Chelsie: I've been dealing with anorexia for 10 years and my fears just keep winning. HELP!

Dr. Sacker: Chelsie, many of our clients have had anorexia for over 10 years and are presently in recovery. The key here is not to beat yourself up when you have setbacks. It may be a good time to seek out another therapist or eating disorders specialist for a consultation. Sometimes people who have acted as kind and supportive therapists, do not have enough training in eating disorders.

otherpea: I'm on a food plan done by a nutritionist, and have an experienced therapist, and support groups. I would like to know if an ED person with those underlying feelings and emotions that cause the eating disordered behaviors to surface can ever get over or be free from these "horrible" feelings and emotions?

Dr. Sacker: You can certainly get beyond them, but even in recovery eating disorder patients will still compare themselves to other thin individuals. In today's society, everyone does that. So, of course, the eating disorder patient does it more.

Bob M: Are you saying then, that the behaviors and thoughts never really disappear, but in recovery an eating disorder patient learns to control those thoughts and recognize them for what they are?

Dr. Sacker: I could not have said it better myself.

grin: Dr. Sacker, what is the recovery rate based on your practice?

Dr. Sacker: That is always a biased report. We have been very fortunate and have had a very high recovery rate. However, one never knows what happens to those who don't stay with the program. We follow up all our patients for approximately a ten year period of time. The door is always left open so that they can come back to us if things get rough.

Bob M: In your book, Dying to Be Thin, you spoke to many eating disordered people. Some had been suffering for years. Was there something they had in common that made it easier for some to recover vs. the difficulty that many sufferers have in reaching that point?

Dr. Sacker: Those who recovered earlier developed an insight into their underlying problems and felt it safer to move away from the eating disorder. Others were so addicted to the eating disorder behavior that their identity became one and the same.

LMermaid: Is there a difference between recoveries of people who have had eating disordered behaviors and active phases since childhood vs. a person who may have become active with an eating disorder at a later stage in their life?

Dr. Sacker: Individuals who develop eating disorders at a later stage usually have an earlier history which has gone undiagnosed and untreated , therefore many of them have been leading eating disordered lives for many years. The earlier the diagnosis, the younger the age, the better the prognosis.

Marlena: Dr. Sacker, do you find that as a person begins their struggle with recovery, often times the eating disorder is replaced by another "addictive situation", be it replaced by drugs, alcohol, etc.?

Dr. Sacker: Bulimics have a greater tendency for developing other addictive alternatives. The anorexic does not generally develop other addictive disorders.

Bob M: Here's an audience comment on developing other addictions:

Sunflower1: I disagree. I was anorexic for 15 of my 25 years and up until about a year ago, I was a drug addict.

Bry: Is there a method of therapy that has a higher success rate for eating disorders?

Dr. Sacker: I have found that interactive therapy seems to work more effectively than traditional psychotherapy.

Bob M: And what specifically is "interactive therapy"?

Dr. Sacker: Interactive therapy is a combination of cognitive behavioral therapy as well as a direct interaction between client and therapist focusing on the positive aspects of the individual rather than the why's.

Bob M: Dr. Sacker's book is entitled Dying to Be Thin. You can click on the link to purchase it. One of the things I wanted to address tonight is the issue of "passing along" your eating disorder to your children. Is that possible? And if so, what can be done about it, even if one hasn't recovered yet?

Dr. Sacker: Recent studies show that it is possible to pass along your eating disorder to your children. Genetic, biochemical and environmental possibilities have been entertained. I am still a believer in the concept of "teacher by example" and we are seeing younger and younger individuals, as young as five or six with eating disorders whose mothers have been undiagnosed and untreated for their own.

Bob M: But what can one do, even if they haven't recovered, to keep their children from developing an eating disorder?

Dr. Sacker: We are beginning prevention aspects to our program. If they don't develop the disorder, it does not have to be treated. Families must be treated as a whole to this end . We are seeing the effects of media and societal pressures, even in the elementary schools where pre-k and kindergarten children are concerned about their bodies and how it compares to others. We are beginning a puppet project in the elementary schools.

Bob M: As I mentioned earlier, Dr. Sacker is the director and founder of HEED--Helping to End Eating Disorders at the Brookdale University and Hospital Medical Center in New York. We'll be giving you some more information on HEED in just a few minutes.

Bob M: A recent study concludes that the relatives of persons with eating disorders appear to be at increased risk of related disorders. It was found that the risk of major depressive disorders, eating disorders, generalized anxiety disorders, and obsessive compulsive disorders was increased between 2 and 30 times in the family members of women with eating disorders, compared to the risk in relatives of women without the disorders.

Dr. Sacker: That's true, Bob.

Bob M: Authors note that the risks of social phobia and obsessive-compulsive disorders were higher in relatives of anorexics, compared to relatives of other participants, and that the risks of alcohol or drug dependency were higher in relatives of bulimics. To me, that's pretty alarming. As a parent, if I had an eating disorder, I'd want to know specifically what I could do to help my child. What ideas do you have concerning that?

Dr. Sacker: We continue to see this in our own population and have contacted other programs who have likewise reported the same instances. First of all, you must deal with your own disordered eating behavior. Correct the behavior. Children follow by example. We must also learn to accept our children as they are and teach them the same. Parents should seek expert help if they are having difficulty with eating behavior in their child.

SarahAnne: Does that statement include my younger sisters being more prone to anorexia because I have it?

Dr. Sacker: It may, but not always. Don't feel guilty! Try not to make food an issue in the family.

Hopeful: I've tried both one-on-one therapy and group therapy and did not find that either helped. I am on Paxil which seems to lighten my moods a lot, but I'd like to know if you have any suggestions for people trying to recover on their own.

Dr. Sacker: It's very difficult to heal oneself from the inside. I would recommend locating a new therapist.

Gabrielle: Dr. Sacker, you mentioned medications for bulimia. Do you have any medication suggestions that you feel might work for anorexia?

Dr. Sacker: Many individuals with anorexia have ocd, obsessive-compulsive disorder and therefore medications like Luvox or even Prozac have proven somewhat effective. Also SSRI's are helpful when the underlying disorder is depression.

Bob M: As I mentioned earlier, Dr. Sacker is the founder and director of HEED...Helping to End Eating Disorders, at the Brookdale University Hospital and Medical Center in New York. The number there is 718-240-6451. Dr. Sacker, can you talk a bit about HEED and it's purpose?

Dr. Sacker: HEED is a not-for-profit program geared towards the prevention, education, referral, diagnosis and treatment of all eating disorders with the hope of raising enough money to develop HEED HOME, a home for patients to go to in between the hospital and the home or the other way around.

Bob M: That sounds wonderful. And you're having a fundraiser coming up, right?

Dr. Sacker: That's right Bob. It will actually be a great night out at the Woodbury Jewish Center in Long Island. We will have special guests, raffles, auctions and a lot of fun for a great cause. We invite all to call us for further info and join us. You can call at 718-240-6451. It will be on Thursday, November 12 at 7 p.m.

Melbo: Yes, I've been in recovery from anorexia/bulimia for 2 years now and still have a lot of problems with body image. But I can't seem to get help with that. I want to talk to someone about it, but I've never heard of any one who specializes in body image, at least not here in Nashville, TN. Are there specialists for that and where do you find them?

Dr. Sacker: Many nutritionists and eating disorder specialists are well-informed of body image issues. Call me and I'll try to locate the nearest program for you. By the way, we also have an interactive website that does referrals.

Flyaway: Are eating disorders related to obsessive-compulsive disorder?

Dr. Sacker: Obsessive-compulsive disorders often underlie many forms of eating disorders.

expacobadj: I am definitely ocd and social phobic to the extreme and that is what I hate! How do you know that you are not faking yourself into thinking you are recovered?

Dr. Sacker: Please rephrase the question, Bob?

Bob M: If those with eating disorders have distorted body images, let's assume they can distort other things as well. How can you tell if you've really recovered, rather than fooling yourself into thinking you've recovered?

Dr. Sacker: Part of recovery is in learning to trust your own feelings and become aware of others around you. If you are more accepting of yourself, you will find that you are reaching true recovery.

sandrews68: How have you treated people with severe/long-standing eating disorders? I'm at my wits end. Please tell me how other severe cases have been overcome.

Dr. Sacker: We have had some success in the treatment of long-term eating disorders. Please call us or contact us at our web page.

sin: With compulsive binge eating, what is it with the human psyche that makes the feeling of relief from the action of food?

Dr. Sacker: It's not only the human psyche, but specific biochemical changes that cause these feelings. More and more we are finding individuals who are chemically imbalanced. Many of these can be treated nutritionally and with specific medications.

Bob M: I have one last question. Can one recover from an eating disorder on their own, without the help of a professional, or is that next to impossible?

Dr. Sacker: Some individuals remove the symptoms of the eating disorder without dealing with the underlying issues. Therefore, years later the eating disorder may surface again or wind up as another form of addictive behavior.

BobM: Thank you for coming to the site tonight, Dr. Sacker. I appreciate that you stayed late to answer everyone's questions. The transcript of tonight's conference, along with all our other eating disorders conference transcripts, is located here.

Dr. Sacker: Thank you all very much for your interest.

BobM: Thanks again Dr. Sacker and good night everyone. Don't forget tomorrow night's conference (Wed.) is on ADHD in children--our back to school conference with Dr. David Rabiner.

Bob M: A little audience reaction to the conference follows:

Flyaway: Thank you Bob and Dr. Sacker for your conference.

Alisonmp2: I really liked your book. It helped me when I was going to go inpatient to read the stories that you had in there! THANKS

eLCi25: Thank you doctor and Bob. This conference has given me some things to think about.

Bob M: Good Night everyone.

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