Bob M: Good evening. I want to welcome everyone to our EATING DISORDERS RECOVERY conference and to the Concerned Counseling website. I'm Bob McMillan, the moderator. Our topic tonight is EATING DISORDERS RECOVERY. Our two guests are "normal" people, not authors of a book, or some celebrity type. I bring that up because both have "recovered" from their eating disorders, but the ways they did it were very different. Our first guest is Linda. Linda is 29 years old. Our second guest is Debbie, who is 34. I'm going to have each give us a little background on themselves and how their disorder started. And then move quickly into their recovery stories. Because I'm anticipating a large crowd, I'm going to limit the questions to 1 per person. That way, everyone gets a chance. Linda, I'd like to start with you telling us a little about yourself, which eating disorder you had, how it started, etc.

Linda: Well, let's see. I am the youngest and only daughter of two doctors. I went to private schools (girls' schools) and took ballet. I think all of that helped "foster" my eating disorder. I "dabbled" a little in anorexia, but found the restricting very difficult, especially because I needed some energy to dance. I struggled for about seven years with bulimia. It wasn't until I moved out of my house (dysfunctional family - bad relationships) and took a real good look at my life, that I chose recovery. I think I knew that what I was doing was unhealthy and dangerous, and that I couldn't live a long and prosperous life that way. But I think I also knew that I couldn't recover while I still lived with my parents. By the time recovery began, around age 21, I knew that it was what I wanted, needed and that I was ready for it. There were very little resources or knowledge in the medical community. There were no support groups, and only one clinic with four beds. I read books voraciously...books about eating disorders, about recovery, about spirituality...and aside from that, for the first year, all I did was see an MD. When I first told him what was wrong, he said," I'm the doctor. I make the diagnosis." Of course, I knew better about the whole thing than he did. I did join a support group about a year later. I had stopped completely bingeing and purging after one and a half years.

Bob M: At the worst point Linda, how bad was it for you? How much were you bingeing? What was your medical condition like?

Linda: I actually prefer not to mention numbers, even in a forum like this. Binge eating/purging took different forms, and it was very often, many times per day and I was taking laxatives too. I was very lucky. Even today, there is no visible damage to my teeth, digestive tract, etc. At the worst point, when my weight was at the lowest, I was scared. I knew I couldn't maintain that and live. And with my parents being doctors, I had to be creative, trying to keep everything secret.

Bob M: Were you ever hospitalized Linda?

Linda: No. There was a time when my body "shut down" as I call it. I was tube fed at home for two or three days (a "bonus" to having parents as doctors). I couldn't keep anything down even if I tried. My body just voided itself on its own.

Bob M: If you're just coming into the room. Welcome. Our topic tonight is EATING DISORDERS RECOVERY. Linda (age 29) and Debbie (age 34) are our guests tonight. Both recovered from their eating disorder, but used different processes to do that. For tonight, since we have two guests, please type either Linda or Debbie at the front of your question or comment, so we know who it's directed to. Since the audience is so large tonight, I want to ask everyone to only send one question. We are going to try and get to as many as possible. Debbie, tell us a little about yourself please?

Debbie: My story. I'm an executive assistant to a very demanding boss. My eating disorder, anorexia and bulimia (later), started when I was 16. Like many girls that age, I just wanted to be wanted...by boys, of course. And I thought the only way that would happen is if I looked pretty, translated "thin". I don't usually bring up weights, but to put this in context, I was 5'4", 130 pds. Over the course of 3 years, when I was 19, I was down to 103 and thinking that wasn't enough. I was keeping my eating disorder to myself and one day when I was in college, a couple of girls in the dorm were in the bathroom and I heard one throwing up. And that's when I learned about bulimia. As you can imagine, or maybe for some of you, luckily you can't, my life was a wreck. My electrolytes went way down, I was hardly eating, and whatever I ate, I threw up. So my entire body one day just gave out.

Bob M: and this was over what period of time Debbie?

Debbie: I was 20 when I had my first hospitalization.

Bob M: We have a few questions and comments from the audience I want to get to. Then I want to hear your recovery stories.

jelor: Linda, did you ever slide back to your old ways, interrupting recovery? for how long? is that okay?

Linda: Yes. It did take me over a year-and-a-half before I completely stopped binge eating and purging. But it went from numerous times daily to once a week, to once a month, to finally-never. I felt it was a part of recovery, that it took me "xx" years to learn those negative behaviors, that it would take me a while to learn positive coping skills. I tried to make sure that I didn't rip myself apart for it. I forgave myself. It was ok.

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Jenna: Linda and Debbie, what truly *awakened* you to the fact that you suffered from an Eating Disorder? Do you two feel that you truly have to hit bottom before you can accept it?

Debbie: I was at the very bottom. When you can hardly walk because you are so weak, you're whole body aches, your stomach cramps and it feels like someone is ripping your gut from the inside and squeezing it, you don't need someone to tell you something is wrong. It was absolutely horrible. I'll tell you a little about my recovery, quickly, because it relates to this. I was hospitalized for the first time when I was around 20 because my medical condition was so bad. I was in the hospital for 2 weeks and finally able to go home. My parents then sent me to a treatment center in Pennsylvania. I was there for 2 months. And I thought I'd finally gotten control of this. I went home and not 7 months later, I was back doing the same things again. I tell you this, because for some of us with eating disorders, it is very difficult to break the grasp. Between that time, the time I went home, and the age of 28, I was in a treatment center a total of 5 times. The longest time for 6 months.

Bob M: Linda. What about you, did you hit bottom before you were able to get control?

Linda: For me, I hit my own rock bottom. Even below 90 lbs, I knew something was wrong. I gained a few more and stayed there for a few years. At some point, I looked at myself and thought 'what kind of life is this?' I could never please anyone. It didn't really matter to them anyways. I couldn't see myself at 50, buying laxatives or vomiting. I couldn't live like that. But I don't think one has to get that low, to that point of self-hatred, before one can begin recovery.

Bob M: Here are some more audience questions:

symba: Linda I need to know what got you out of this???? Please tell me!!!!

Linda: Symba, when I began eating disorder recovery, for me there was no other choice. I didn't look back. I took back my power from the scale, from the calories, and from everyone else and took ownership of it. I made peace with myself, with food, and with everything else that was once "bad" to me.

Bob M: Can you please describe your recovery process?

Linda: At the time, I had a wonderful partner. He was very supportive. He didn't know about my eating disorder. The day I told him was the first night I went to bed without purging or weighing myself in years. I searched and searched for support and didn't find any "professional" help. I told all of my closest friends, which gave me so much strength and courage. I had a book that was my "bible". I carried it with me for months. It was very inspirational. I was in an eating disorder support group more than a year after I began recovery and went into therapy about a year after that.

Bob M: I invited Linda and Debbie here tonight because they represent opposite ends of the recovery spectrum. Fortunately, Linda was able to recover without a treatment center...but not without help altogether. She was able to use the support from friends and her support group to help her through. I'm saving this question for Debbie.

tennis me: This is the same generic "gently described" type of recovery. What was the struggle like? I struggle to get better and no one understands how hard each minute can be.

Debbie: I do tennis me.

Linda: Me too tennis me.

Debbie: So you don't want me to pull any punches. When I went to the hospital for my medical condition, I was very scared. Imagine being 19 and thinking you're gonna die...that it's too late...and that all the times you said you were going to stop and get help, but didn't. Now it's payback time. I didn't have any friends who had an eating disorder and especially back then, people with eating disorders didn't go around telling anyone. It was really something to be ashamed of. When I went to the treatment center the first time, I can tell you I was very scared. I felt sick, disgusted by myself. I also didn't know what to expect. Was this going to be like a jail? An insane asylum for crazy people?

Bob M: Tell us what it was like inside, Debbie?

Debbie: Well, they watch over you all the time. They want to make sure that you actually eat and then also to make sure you don't throw up. It's not that it's a bad thing because if they didn't do that, you would just continue on with your eating disorder. The people there, the doctors, nurses, nutritionists and everyone were very supportive. I guess the only thing I can compare it to is like going through withdrawal, so to speak. And doing it cold turkey. Although to be honest, I've never had an addiction problem. I'm just trying to make an analogy. But as time went on, it got better. I was able to sort my problems out, define them better and deal with them in a more constructive way. I learned how to use various tools, like journals and support groups, to assist me in my recovery.

Linda: Yes. It is hard to let go. Sorry to interrupt...just had to throw that in.

Debbie: But it was very difficult at first. And for many of us with eating disorders, maybe one trip to the treatment center will not be enough.

terter: Do you think that an eating disorder is ever really cured or is it with us forever?

Linda: Yes, I believe it can be cured. I don't believe it is like an addiction, although I know some others who do feel that way. I think that an eating disorder is part of a huge continuum of disordered eating patterns, and that eating disordered behaviors are negative coping skills. I think we are taught to scrutinize ourselves and our bodies...to find fault, and to work against the body. I think it does take time to end the behaviors, and to learn to think differently and it gets harder as the messages in the media get more prolific. But I do think it is possible to recover 100%.

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Versus: Debbie, can you tell me if your hair fell out at all and if so what on earth did you do for it. Is eating less than 1200 calories going to "not" help?

Debbie: Yes! at one point my hair was very thin and wispy and was falling out. That's because my body wasn't getting the vitamins and minerals it needed. To be honest, there's really nothing you can do but start getting the food and minerals and vitamins you need. And keep in mind, I'm not a dr., but I've got a lot of experience. :)

Jenshouse: Debbie and Linda--I am 19. I am recovering from many different things from childhood as well as trying to get over this eating disorder. I am often depressed or angry, mad when in these states. It is the worst for eating. I can never seem to force myself to eat. I don't want to lose weight. I just feel that I can't eat. That I shouldn't eat. That I don't deserve it. How did you get yourself to eat something?

Linda: Whew.. that's a tough one! For me, I KNEW that my body needed the food. I KNEW I needed food to function, and that if I didn't eat I was no good to anyone, especially myself, in the end. For me, I learned to do it slowly. And I learned to enjoy what I ate; to TASTE it...something I hadn't really done in years. Debbie, what about you?

Debbie: I never felt like I didn't deserve to take care of myself. I started my eating disorder because I was unhappy with my shape and thought I'd be more attractive with the more weight I lost. Jen, I think everyone deserves a good life. If you have low self-esteem, which I found out I did, you need to get help and sort the things out in your life.

Linda: Good point, Debbie.

Debbie: And I noticed you said, you didn't "deserve it", that's a big clue that your thinking isn't the way it should be. And I want to say here, that even now, after 10 years of therapy and eating disorder treatment centers, there are still times when I have to remind myself that I am a worthy person. That I am likeable. That I'm smart and can make good decisions in my life. I think Linda wants to add to this.

Linda: Thanks Debbie. I think Debbie has raised a very good point. We ALL deserve a good and healthy life. No one is ever more deserving than another. But as I said earlier, it is a daily struggle to take care of one's self and look at the positives. As Debbie said, to know that we are all worthy. I think that there are a lot of negative messages out there, that help contribute to low self-esteem.

AlphaDog: I'm so scared. I have been through this many times. I am not doing well now. How do I stop starving myself?

Debbie: Alpha, it is a very difficult process. And for many of us, it takes a long time and a lot of work. I wish I could give you the magic cure, but for each person it can be different and take something different to get over it, to get a handle on it. I would hope that you are getting help, seeing an eating disorders' specialist. And also Linda's way, of going to a support group. It really works and it helps. I think we all need support. Getting over something like this on our own would be very tough.

bean2: Linda, what was the name of the book that you used?

Linda: "Bulimia: A Guide to Recovery" by Lindsey Hall and Leigh Cohn. It truly helped me save my life.

resom: Debbie and Linda -- I'm 21 years old and a former anorexic. I still get really nervous about calories. How do I eat out when I'm terrified of eating too many calories? I want to have a life again.

Linda: Well, as I said earlier, I don't look at numbers. That includes calories. It is important to know that the body needs lots (lots!!) of calories just to function. I gave up counting calories. That's part of how I 'got a life' again. Don't be afraid of food. And don't make it "good" or "bad". It is simply food. Enjoy it because we need it. Give yourself permission to do that, resom. Debbie?

Debbie: I don't weigh myself. I have one mirror in the bathroom which I use in the morning and evening when I clean up. At first, I always kept a book with what foods I needed to eat to make my "calorie count". But then as time went on, I was able to develop more "normal" eating patterns, but I still knew what I needed to stay healthy. Also, if you are having trouble going out, try and get your support group to go with you. That's what we did. Went out as a group. And all supported each other. Sounds silly, but it works.

Shy: Debbie, when a person is recovering, or starts the recovery process, is it important to have a counselor or therapist for help?

Debbie: I think so. I couldn't do it on my own. I needed someone to be there for me and to encourage me and soften the blows. It's very tough Shy. And I know Linda did it on her own, but as she said, she really had support too...right Linda?

Linda: That's right Debbie. I had great friends. Without them, I couldn't have done it alone. And as for therapy, I think it is a necessary step in recovery. There are definitely issues for everyone that go much deeper than food, weight and calories. Having others around, kind of "arms" you with strength.

Debbie: I know that all of us are pretty ashamed of our eating disorders and what they do to us. And that's why we don't tell anyone. But I'm here to say, it's important to tell people who really care about you. Their help and support is very important and will go a long way in helping with your recovery.

Linda: Yes, and their reactions are often not what you expect.

Debbie: And if you can't get to a therapist yourself, your parents or friends may be able to help with money or encouragement.

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Mosegaard: Debbie, did you get medication while you recovered? If yes, are you still on medication today? If no, how did you get off it?

Debbie: Yes, I was on at first, then Prozac later. It helped with controlling my bulimia. But as you can imagine, I was pretty depressed too. But the more therapy I had and the more I was able to work through my problems ("issues" for you professionals out there :), the more I was able to lower my med dosages and finally came off it. But if you have a chemical imbalance, you may not be able to come off. But again, I think that's something for you and your doc to talk about. And one more thing, I think medication without therapy is a rip-off. Medication doesn't get rid of your problems, it just masks the depression for awhile. But even with medications, you still have the problems and they are out there lurking, affecting everything you do. So you can't really "recover" until you resolve your problems.

Jamie: Linda, is three years too long to spend in recovery? Does that mean I am not serious?

Linda: No. I am certainly not one too judge either. As Debbie mentioned earlier, it is different for all people. I think that as long as you are working on recovery and trying to find positives, then that's good. Remember, it's about baby steps, and recovery will definitely not happen overnight. I think it also depends on what issues you may be dealing with, Jamie.

Bob M: If you're just joining us, welcome to the Concerned Counseling website and our conference. Our topic tonight is EATING DISORDERS RECOVERY. Linda (age 29) and Debbie (age 34) are our guests tonight. Both recovered from their eating disorder, but used different processes to do that. Linda utilized support groups and self-help books and had close friends help her. Debbie went to professional therapists and was in various treatment centers a total of 5 times in about 7 years. I think Debbie wants to add to Linda's comments.

Debbie: As youngsters, one of things we learn about medicine is, you go to the doctor, he fixes you, and you are better. What's it going to take-- a few days, two weeks, a couple of months, before I'm back on track? In real life, it's not like that. Some things, like cancer, or maybe an eating disorder, take longer, a lot longer. And there will be good days and bad ones. I think if you can think of eating disorder treatment as a continuum, as Linda said, that's good. And be realistic. You are getting help, you may have relapses, but you are expecting that and you know they have to be dealt with. And I think it's important to tell your friends or those in the support group ahead of time, "if you see I'm going to relapse or I'm having a hard time, please be there for me, don't let me slip too far down into that dark hole." And soon, the relapses are spread apart over longer periods and then eventually you are able to cope on your own. And Linda has another thing to say.

Linda: We've talked about 'relapses'. I think it is very important to repeat that recovery is not going to happen overnight. You may take five steps forward, and go backwards two steps. But then you go forward again. Be proud of those little steps forward, because it counts! And every step backward makes you stronger, gives you strength for the next time you may feel yourself going backwards.

Bob M: Here are some comments about medications:

PCB: I have been in recovery for 11 years. It is a steady process of ups and downs. I have also been on medication during this time due to a chemical imbalance. I was resistant at first, but now I know that I will need my meds for life. I have a quality of life that never existed before. The meds have stabilized my moods so that I can look at reality and face the issues in my life. I am calmer and more rational in my thinking.

Agoen: My doctor gave me a medication. She thought it would be a quick cure but it wasn't. It was hard enough for me to tell her about my eating disorder and I feel in some way she let me down. So I'm afraid to ask for help again.

caricojr: I think meds are necessary in some cases. You can't deal with problems rationally if you are extremely depressed.

froggle08: I don't think medication is a rip-off. For some people who don't need it it is, but for some people it can really help them a lot.

Bob M: Debbie, since you made the comment, how about addressing that.

Debbie: I'm sorry, maybe I didn't make myself clear. I'm not saying medications are a rip-off. What I meant was, if you are taking medication, it's also important to get therapy to help with dealing with your problems. I think that one without the other isn't good. And a lot of doctors today just hand out meds and say good luck. That's what I don't like. But that's my personal opinion.

Linda: I'd like to add something. I think that there is a "trend" today where the medical profession prescribes anti-depressants for eating disorders. I think that this can be dangerous. I agree that there are some cases where medications are needed, but I think it is wrong to automatically prescribe them. I think that if one is at low weight and has been depriving the body of important nutrients, then someone will be cranky and depressed. I also have heard of "natural" anti-depressants.

Bob M: I want to add here, that it is important to discuss these issues with your doctor, so you can make informed decisions. These next questions are all related:

Vortle: What is the best way to be able to tell people that you have an eating disorder? I told one friend who also has eating disorder and she's mad at me for not wanting to get better bad enough. We don't talk anymore. I can't get the courage to tell my family.

ack: What about the people in your life. I have had a terrible time trying to help my boyfriend with this. He just doesn't understand and I don't think he wants to. Is it necessary for your significant other to understand to have a healthy relationship?

Symba: How do I get my husband to understand this eating disorder? He doesn't want to. I try to talk to him and I feel I'm getting blown off.

Bob M: Linda, how were you able to confide in your boyfriend the first time?

Linda: For me, it was hard, and yet it was easy. He was someone that I loved and respected. I knew that our relationship depended on that, and that he loved me no matter what. I don't think all situations are like that. I am very lucky. I know that there are support groups out there for family members and friends of people who struggle with eating disorders. I think that your partner has to be supportive. Understanding ED is hard, and may not happen. I think you both have to work at it on some level from the same or similar view, or the relationship may not withstand it.

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Debbie: Now that I've been through a lot and I've been able to sort of look back, like I said earlier, I think it's difficult for our friends and family. They think "go to the doctor, get better". It's that simple. It isn't. That's why eating disorders support groups are so important. You are around people who do understand and can encourage you. And Linda's right, it can put a lot of tension in a relationship. I had several end "before their time", so to speak. All you can say is "look I need your help and support". And at the treatment center, when they get family therapy going, the therapist tells the parents that this will be very stressful on them and there's no shame if they need support. And usually they do, depending on how difficult things are.

sizeone: I think it goes without saying that family members are just scared and do not know what to do with someone they think is great and in reality, that person hates themselves.

caricojr: A very good book that saved my boyfriend's and mine relationship was "Surviving an Eating Disorder : New Perspectives and Strategies for Family and Friends".

Linda: I'd like to say something about family. I think there are some cases (like mine) where families were not involved in the recovery process. I know some people have huge issues with family. For me, my doctor parents, it was not an option. They knew, but never talked about it. It was scandalous. And that is scary, and it is a shame. I know some people are afraid of disclosing to their families, for whatever reason. And that's ok. You don't have to. If you are in a treatment center, then obviously they know. To this day, I have not talked about it with my parents. I have made peace with that and let go of the fact that they could never understand.

blubberpot: I feel the same way about my parents. They think my eating disorder is a thing in the past, but what they don't know, is that I have lost another 11 pounds.

Rod: Is it wise to attempt to have a relationship while in treatment for an eating disorder, or should we wait until we are better?

Linda: For me, I was in a relationship already, for about two years. It added a new dimension to our relationship. I think that you should do what you feels right. I think that if you want to start a relationship, that you should be honest with that person. Debbie, what do you think?

Debbie: That's a trick question. I found out it was easier for me to deal with my problems when I didn't have a significant person, i.e. boyfriend, in my life. It just got to be too difficult, trying to handle a relationship and it's normal demands and expectations, and deal with my eating disorder. But I'm sure for others, it can be a very supportive and helpful thing. I agree with Linda though, I think you have to be honest with the person and do it up front. Don't wait until you are 3 months into the relationship and say "SURPRISE!!", by the way, did I tell you....because I promise, most won't be happily surprised. That's from experience, by the way.

Monmas: My husband seems to leave the healing to me and my therapist. He never gets involved with my eating. This makes me angry at him sometimes. It makes me think he doesn't care. How can I get him to be supportive, yet not tell me how to eat?

Linda: Tell him what you need. We need to do that in all areas of our relationships. We NEED support, we need space, we need a hug. Sometimes we need to ask for it. Maybe he is scared and confused about it too?

Monmas: Yes, I think he is. I try to tell him how I feel, but he doesn't understand the whole picture, so he doesn't want to say the wrong thing. He loves me very much though.

Bob M: It may be he doesn't know what to do. If he hasn't participated in group therapy or some sessions with you, he may not understand his role in your recovery.

Debbie: It's hard to tell monmas. I would talk with him and tell him what you need. And then see what happens. Make it non-threatening though. Don't say "you never help me." Try, I need your help, could you please do this for me." I hope that helps some.

gutterpunkchic: I am going to be going to my first therapy session on Friday. I am just starting to realize I need help, but I am afraid it will take me a long time to recover. What do I do if therapy doesn't work for me?

Linda: gpc, there are many different kinds of therapy out there, and many, many different therapists. It is important not to give up, even if it feels exhausting. Remember that you are a consumer of the health care system, and you are entitled to get the help you need and want. If you don't like your therapist, find another. Also, as we've said, support groups are very helpful, and are very different than therapy. Debbie?

Debbie: I think it's important to remember gutterpunkchic that it may take awhile. Maybe you will "grow" as time goes along and you will be more receptive to therapy or able to deal with things in a better way. But give it time. It won't happen "just like that". And like Linda said, what works for one, may not for another. So you may have to find another therapist or method of treatment. But give it time.

Bob M: We had over 100 people come tonight. I appreciate everyone being here and to Linda and Debbie thank you for sharing your stories and staying late to answer questions.

Linda: Thanks Bob.

Bob M: I hope that everyone got something positive from tonight's conference and that you feel like there are many ways to recovery. And that you need to find what works for you. It also helps when you have others who care around you.

Debbie: Thank you Bob for inviting me tonight. For everyone out there, I was at death's door. I'm not a rocket scientist and I don't think I was the beneficiary of a miracle. It was a lot of hard work and I cried a lot and thought many times about giving up. I hope you have the strength and energy to do it. It's worth it in the end. That I can tell you.

Linda: Yes. Thanks Bob. And Thanks Debbie. Recovery is hard. And it is worth it.

Bob M: Some audience thank you's:

Monmas: Something I have learned--don't be afraid about how long it will take to recover. Take it one day at a time. There is no schedule to follow on recovery. It will be at your own pace. Thank you Linda and Debbie.

Rod: Thank you for your openness and willingness to use that to be so helpful with your comments. Sometimes the end can be the beginning.

Siteline: Thanks for the insights.

Versus: THANK YOU SO MUCH!

Bob M: Good Night everyone.

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Bob M: Good evening everyone. We are ready to start tonight's conference. I hope everyone had a pleasant holiday. Our first conference of the year, tonight, is "Breaking Free From Your Eating Disorder--Getting the Help You Need". We are always trying to focus on doing positive things and offering things to help with recovery. Our guest is Jonathan Rader, Ph.D. Dr. Rader is the Chief Executive and Clinical Director for Rader Programs, one of the nations leading providers of inpatient, daycare, and outpatient eating disorder services. He has worked in the field of eating disorders for over 17 years. His work has been documented in eating disorder journals. Good evening Dr. Rader and welcome to the Concerned Counseling website. Before we get underway with tonight's topic, could you please tell us a bit more about your expertise and the Rader Centers and where they are located?

Dr. Rader: We, at Rader Programs have been treating anorexia, bulimia, and compulsive overeating since 1979 and we currently have two locations, one in Tulsa, Oklahoma and one in Los Angeles, California.

Bob M: I'm going to assume that most people here know if they, or someone they know, has an eating disorder. The question is: how do you know that it's really time to get professional help?

Dr. Rader: That is a good question, Bob. A person really needs to look at the amount of dysfunction the eating disorder has caused in all areas of their life; physical, emotional, social, family, and work.

Bob M: One of the big questions we always get is what kind of treatment should you get. Outpatient, inpatient, or just see a therapist once a week or so. Can you explain the criteria one should use to evaluate that issue?

Dr. Rader: Unfortunately there is not a simple answer to that question. We, at Rader Programs, try to treat the patient with the least restrictive environment; but since eating disorders affect all aspects of an individual's life, the most effective treatments have included the use of a multi-disciplinary treatment team. It is important not to ignore the nutritional, exercise, and physical components of the eating disorder.

Bob M: If you are just joining us, welcome. Our guest is Dr. Jonathan Rader, of the Rader Programs. Our topic is: "Breaking Free From Your Eating Disorder--Getting the Help You Need". Here are a few audience questions Dr. Rader:

Shanna: After you have recovered (symptom free) and you still get the feelings to purge, what are some good ways to get past the feelings?

Dr. Rader: At Rader, we look at eating disorders as an ongoing recovery process . Even though you may no longer be in the throes of your disordered eating, feelings may still come up around eating disorder issues. It is okay to have these feelings and to realize that you did not develop your eating disorder overnight nor will all of the feelings disappear overnight.

Bob M: Is it possible to prevent a relapse, and if so, how?

Dr. Rader: Sometimes relapse can be part of eating disorder recovery. We often say it is important to never be too hungry, angry, lonely, or tired. ( HALT).

Winkerbean: What do you recommend for getting through denial, even after having completed outpatient treatment and still being in denial?

Dr. Rader: We use a process called our First Step. It gives an individual the opportunity to look how their life has become unmanageable because of the eating disorder. The person writes down the first remembrances of their eating disorder up until the present time. Family members and friends are also good at pointing out the dysfunction the eating disorder has caused.

Bob M: I know that various treatment centers have their own focus, or way to recovery. Some offer 12 step programs, others behavioral therapy. How does one determine what would be best for them?

Dr. Rader: According to the APA (American Psychological Association), eating disorder treatment programs must have a multi-disciplinary treatment team and process. It must be able to address the medical, psychological, nutritional, and behavioral issues associated with having an eating disorder. I would recommend not only going with a treatment center that you feel comfortable with, but one that also has a medical doctor, registered dietician, family counselors, and individual counselors.

Bob M: Here are some more audience questions:

Katiebee: My daughter is bulimic. Now she is gaining so much weight. I'm worried.

Bob M: So what's a parent to do in this situation? and really any situation where they are concerned about their child or relative, but that person is in denial or doesn't want help?

Dr. Rader: Weight fluctuations are common in eating disorders. It is important for both of you to get in contact with an eating disorder professional as eating disorders are a family disorder.

Bob M: One of the most difficult things though is actually getting the person to accept the idea of treatment. Can you give us some insights on how to accomplish that?

Dr. Rader: It is important for the person to look at how the eating disorder has affected their life. If they can look at how their lives could possibly improve for the better, they may be willing to accept the idea of intervention.

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Marion: Dr. Radar, what about a situation where the ED sufferer is ready and willing to begin her recovery process, but the parents are in denial, and basically tell her to smarten up and 'be normal'?

Dr. Rader: If it's possible to get the parents alone without the child, you may be able to deal with their feelings of being responsible for the eating disorder, which they are not. Parents who are reticent to let their children seek treatment often feel guilty and responsible for their child's eating disorder.

Bob M: Our guest is Dr. Rader. We are talking about recovering from your eating disorder. Dr. Rader is a psychologist and CEO of the Rader Programs (Treatment Centers) in California and Oklahoma. They offer in-patient and out- patient treatment. 

Angel: I'm 31 years old have had anorexia for 16 years. Is there hope for me? Can I overcome this or will I have this the rest of my life?

Dr. Rader: Yes, there is definitely hope for you. If you want recovery it is there for the taking. We have seen many patients in your situation come to the other side of this devastating disorder. It won't be easy, but if you want to overcome your eating disorder, you'll need professional help and support.

Bob M: Which eating disorder is easier to overcome, anorexia or bulimia? and why?

Dr. Rader: Both are extremely difficult. People used to believe that anorexia and bulimia were mutually exclusive disorders. It is now known that many individuals bounce between both disorders. Neither should be taken lightly as eating disorders have the highest death rate among psychiatric disorders with 10% succumbing to death.

Bob M: When someone comes to the Rader Programs, how long does treatment usually last, in general, and what is the regimen like?

Dr. Rader: The length of stay varies for all patients, but average length of stay is between 2 and 4 weeks. The regimen is highly structured with treatment beginning early in the morning and lasting until bedtime. Throughout the day our individual and group settings address the eating disorder and the many issues that accompany it.

Bob M: Here's why I ask. Is 2-4 weeks really a realistic time period when it comes to recovery? Can someone truly recover in that short period of time, even if they work hard at it?

Dr. Rader: No. We are not looking at having a person totally recover from their eating disorder in this short time period. What we are doing is addressing the main issues so that the individual can continue their recovery with an individual therapist or support group.

Bob M: Thank you for clarifying that because I think many people believe, you check into the eating disorder treatment center, you should be "cured", and then they have a relapse. But what you are saying is the treatment center is more like "intervention"...trying to break the habits and form new ones. But you still need intensive treatment to continue with your recovery. Am I correct in that?

Dr. Rader: Absolutely correct, Bob. I wish there was a magic cure. Unfortunately, it takes a lot of hard work to overcome an eating disorder, but we have seen thousands of patients truly gain their lives back.

Naia: I've been in recovery and therapy for nearly a year, but whenever I'm under a lot of stress (like during the recent holidays), I return to starving and excessive exercise. How can I stop those old habits?

Dr. Rader: One of the techniques our patients use during the holidays is obtaining a food buddy. This person is someone you can commit your food to prior to a difficult meal such as a family or work party. This person is also available to discuss how the meal or difficult event went. If you still have difficulty I would suggest contacting your therapist.

elizabethsm: What do you do if there isn't anyone on your area qualified to treat eating disorders and you can't afford to go somewhere?

Dr. Rader: We at Rader Programs truly believe in the effectiveness of support groups such as Overeaters Anonymous and ANAD. You can find a listing of OA and ANAD groups by finding their website-we have links to both on our website.

rndochka: I have EXTREME difficulty swallowing. It doesn't matter if it's water or popcorn. I constantly feel like I'm choking. Is this a symptom of anorexia or sexual abuse or both and what can I do about it? I'm getting dehydrated because of this problem.

Dr. Rader: It is important to first rule out a physical problem by seeing your general practitioner. If it is determined that there is nothing physically wrong, it would be recommended to explore these issues with a therapist. Many of our patients have this same symptom as a result of anxiety, sexual abuse or their eating disorder.

Bob M: I also want to explore another eating disorder that people usually don't put in that category of "eating disorders" and that's compulsive overeating. Do you have a program for that? There are many people who come to the site and want help, but don't know where to turn (after failing at many different diet programs).

Dr. Rader: Yes. We treat compulsive overeating just like any other eating disorder. It does not matter whether you are underweight or overweight. If food is being used for something other than nourishment, the person may have an eating disorder.

Debzonfire: If eating disorders patients are so "competitive" in their bid to lose weight, competitive with each other that is, why would you put them all together in a support group?

Dr. Rader: We have found that the power of a group of individuals exploring their dysfunction together can be more effective than in individual therapy. People who are exploring similar issues can often see parts of themselves in others. It is true that there is competition among some patients, but we use this as an issue to address as the same competitive issues happen every day outside of the treatment setting.

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love those carbs: Are there any support groups for families and husbands of someone who has a eating disorder?

Dr. Rader: Yes. Some communities are lucky enough to have co-compulsive  Overeaters Anonymous groups. Many universities also have support groups for family members.

Tiffanie: I am wanting to become pregnant in the near future, but my gyn says I have an infertility problem we need to work with. Can this be caused by my bulimia?

Dr. Rader: The practice of eating disorders can be a cause of infertility. I would recommend always checking with your ob/gyn.

baby butterfly wings: I don't understand how it is possible to have anorexia and bulimia at the same time. Is that just a false piece of information?

Dr. Rader: People usually do not have both eating disorders at the same time although you can have anorexia with bulimic symptoms or vice versa. Also, it is common for an individual to start off with anorexia and then move into bulimia as they may be eating just to satisfy their family members and then purge secretly.

mleland: I was in a program for 7 weeks and wanted to get better, but relapsed immediately. How does your program work faster or differently?

Dr. Rader: Unfortunately, I do not know the specifics of the program you were in. I can only tell you that our multi-disciplinary approach will work if you are willing to put the effort in. Just because you relapsed does not mean that you did not benefit from the treatment. It is important that you work the tools that were given to you. BREAK

Bob M: What about medications Dr. Rader? Is there anything out there that can significantly help someone with an eating disorder?

Dr. Rader: Currently the most commonly used medications for eating disorders are Tofranil, Norpramin, and Prozac. These medications affect the release and uptake of the neurotransmitter serotonin. Some physicians are using naltrexone, a medication that blocks the natural opiods. But medication alone is not as effective without therapy.

Allison: How do eating disorders get worse over time? It seems like somehow they start off as no big deal.

Dr. Rader: Eating disorders are progressive disorders. It may seem as though they are something you can control when you first start practicing them. But like alcoholism, they can become addictive and produce a devastating cycle.

Dr. Rader: I know it's getting late. I want to thank Dr. Rader for being here tonight and for everyone in the audience who attended and those who submitted questions.

Dr. Rader: Thank you for having me as a guest speaker tonight.

Bob M: Good Night everyone.

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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 eating disorders 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 i

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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? (therapy for eating disorder)

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.

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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. Dr. Sacker, can you talk a bit about HEED and its 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 bulimia and anorexia 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 anyone 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 wit's 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.

Bob M: Thank you for coming to the site tonight, Dr. Sacker. I appreciate that you stayed late to answer everyone's questions.

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

Bob M: 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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Bob M: Our topic tonight is Eating Disorders Hospitalization. We have two sets of guests, with two different perspectives on it. Our first guests are Rick and Donna Huddleston. They are from South Carolina. They have a 13-year-old daughter named Sarah, who besides having other medical problems, suffers from a severe eating disorder. During a really difficult period for them, they put up a website and told Sarah's story. There were periodic updates on what was happening. I'm going to start by having Rick and Donna tell us a bit about Sarah's health situation and then we'll get into how difficult it was to get her the proper treatment. Good Evening Rick and Donna. Welcome to the Concerned Counseling Website. I know it's been very difficult for you, as well as Sarah, over these last few months. Can you share with us a bit about Sarah's condition and her eating disorder?

Donna Huddleston: Sarah developed an eating disorder at age 12. It started when she went through a huge surge of hormones. She did not want all the changes that were happening i.e.: curves. She started by watching her diet first. Then she found out she had to have emergency surgery for scoliosis (the result of rapid growth + brittle bone disease). She was told she could not exercise for a year. After surgery she started watching her fat intake, which progressed on to no fat, to angry outbursts about food. Ultimately, that resulted in her hospitalization for the rage. They put her on Zyprexa, a new drug at the time. It is now known it should not be given to those with an eating disorder. She flipped into full blown bulimia. She was taking in 6000+ calories a day. The doctors got her off the Zyprexa, and stable for a bit, but then Sarah proceeded back into the bulimia. Finally, she ended up in the hospital again with 2.0 potassium. It was decided by all that residential treatment was needed. We have no programs avail here in South Carolina. She is now in California at the Montecatini Treatment Center.

Bob M: I want to add here, that Sarah was very ill and desperately in need of treatment for her eating disorder. You had a great deal of trouble getting her hospitalized. Please tell us about that. I think it's very important for many people here to realize how badly you wanted to get Sarah help.

Rick Huddleston: Sarah's problems with eating are very complex, as most are, and here in Columbia, the only type of treatment is what we consider "old typical". They are only there to stabilize and release. Even the local "experts" at Charter Rivers Hospital, were unprepared and incapable of helping. They misdiagnosed her, would not listen to us (marking us as problem parents). This was, in part, due to Sarah's behavior. She would never act out anywhere but home and mostly direct her anger at Donna. After 3-4 hospitalizations, we knew we were in trouble, and had to look elsewhere. Typical treatment there was a "forced" meal (sometimes catered by a food preparation service), full of grease, and not very balanced, followed by a forced sitting at the nurses station for 1 to 2 hours. This would be the extent, with the exception of medications, and counseling. But these groups were mostly comprised of kids with serious drug, alcohol, or ones having been raped or abused. Obviously, this was not a good place for a young girl with no self-image and feeling totally out of control of her life.

Bob M: And, so to clarify, she was not at an eating disorders specialty treatment center at this point. Please continue Rick.

Rick Huddleston: True Bob. But in South Carolina, there are NO specialty centers that really understand and can treat ED. We did find the local expert in Charleston. He looked at Sarah, charted her weight, and said "she is ok".

Bob M: I understand. And, as many in previous audiences for our e.d. conferences mention, there are many places across America, in small and midsize towns, that don't have eating disorders treatment centers, or even specialists, for eating disorders. So what did you do Donna?

Donna Huddleston: Most of the residential facilities we found would not admit teens, or only had an out-patient program wherever the facility was located. That would involve us moving, which we could not do. We contacted Remuda Ranch. Our insurance would pay in full, but they wanted $71,000 up-front, in cash, "then the insurance can reimburse you", I was told. We then located a place called Montecatini in Carlsbad CA. It is usually minimum of 8 months+ for residential, in-patient, treatment.

Bob M: I don't want to gloss over this...you got to Remuda and they asked you for $71,000 cash. Were you expecting that? And what did you do?

Donna Huddleston: No! I was NOT expecting that! We had to go through a fine toothed comb investigation of our finances. They knew we could not afford it out-of-pocket. Even with letters to Remuda from the insurance companies, they asked for the money up-front. I asked if everyone paid this way and I was told "Yes". I later found out they are a for-profit facility. I told them I could not do this and then moved on. We had to get Sarah into the right place quickly. At 5'4" she was down to 88 pounds.

Bob M: If you are just joining us, our guests are Rick and Donna Huddleston. We are talking about the ordeal they had to go through to get their now 13.5-year-old daughter, Sarah, proper in-patient treatment for her eating disorder. I'm Bob McMillan, the moderator. Just thought I'd introduce myself because there are some new people in the audience tonight. I want to welcome everyone to our site. I hope you'll get some useful information from tonight's conference.

Rick Huddleston: We did NOT expect to be told to pay up front! Remuda told us to mortgage the house, borrow from relatives, take a loan, drain retirement, etc. All that, even with letters from our insurance stating they would pay.

Donna Huddleston: They also asked for the names, addresses and phone number of relatives so they could check with them about helping with payment.

Rick Huddleston: In all, we spent around 3 months tracking down every lead for long-term residential eating disorders treatment we could find.

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Bob M: As we continue with this story, I want those of you in the audience who are younger and sometimes point out that your parents wouldn't understand or do anything, to listen to this. And I truly believe, while the Huddleston's are wonderful and inspirational people, there are many good parents like them out there. So you left there and went onto California to a small residential treatment facility where Sarah is today. But before you could get her in, what happened?

Rick Huddleston: We had all areas covered except for one. In California, Montecatini falls under the Community Licensing Bureau. We had to get an approval (exception to age) waiver from them. This had been given before, so we did not expect any problems. We had Sarah hospitalized with her potassium down and knew we had to make the trip and take our chances. Once there, we met the "bureaucrat from hell". She thought she knew better than anyone. Although she has no medical training, and no medical knowledge, and never had been exposed to anyone with an eating disorder, she fought us for a week, basing her rejection on the 48 hours program about the little girl with ED.

Donna Huddleston: Also, keep in mind we were already in California at this point, with Sarah.

Rick Huddleston: She sat across the table from Sarah and told her to her face to go home!

Bob M: So you needed to get this special permission from the state of California for her to be treated there because she was a minor and you were from South Carolina. How did you get it?

Donna Huddleston: Just because she was under 16, it did not matter the state of residence. But they had issued this waiver for 5 others under 16 before Sarah.

Rick Huddleston: Being the way we are, we left the meeting, contacted a few internet friends, and within 48 hours had the Governors from California and South Carolina, as well as officials from Washington, pushing to get her in. Also the local NBC affiliate got involved doing interviews and preparing a story for airing. We were in California for 9 days and finally the Governor's office was on the phone to this lady at 4:45 p.m. on Friday "ordering" her to write the waiver. Sarah was now down to 74 pounds and at the point of turning critically ill.

Donna Huddleston: The licensing board gave us the name of the San Luis Del Rey hospital and told us to take her there. We contacted them by phone, just to check their "program" and was told by the director of SLDR to fight for Montecatini. By this time, Sarah's body had begun to turn on itself. Within a few days, she would have to be hospitalized or dead.

Bob M: I spoke with Donna this afternoon. She told me in detail about Sarah's eating disorder, how bad the bulimia had gotten. At one point, Sarah was binge-purging several times a day. Her binges were so strong, Donna and Rick chained the refrigerator closed.

Donna Huddleston: And padlocked the cabinets.

Bob M: In addition, Sarah is a strong-headed young lady and she constantly fought her parents on the treatment issue. What was it like Rick or Donna, when you first got Sarah to the doors of the eating disorders treatment center?

Rick Huddleston: Bob, you have a way of understating the facts:) At the time we left for Montecatini, Sarah had admitted to herself that she had a problem and was ready to start treatment. She asked us for only one thing. The last day in town, she wanted to go to school (the first day in months), so she could tell her friends goodbye, and tell them why she had been out, where she was going, and just how sick she was. Until this time, we had been visited by DJJ (Dept. Juvenile Justice, or Social Services in South Carolina), after being turned in by Sarah for abuse. We had the police at our house 3 times and Sarah was arrested for Criminal Domestic Violence once.

Donna Huddleston: It was the week of National Eating Disorders Awareness Week when Sarah went to school that day. I had begged the schools here to do something that week and they refused. So Sarah, herself, spent the day telling her friends goodbye and explaining what an eating disorder was.

Rick Huddleston: It was a long and very destructive year, not just for Sarah, and her health, but the emotional and financial toll it took on the entire family.

Bob M: She's been in now for about 11 weeks. What's it been like? Do you hear from her? And by the way, just so everyone knows, this program Sarah is in runs about 9-12 months.

Donna Huddleston: She is allowed to call home every Wed and Sun.

Rick Huddleston: The program at Montecatini is very intense and busy. We hear from her 2 times a week and travel to California for family counseling every 6 weeks and stay a week each time. Her day is filled with exercise, sessions (both group and individual), shopping, cooking, and school. The girls there are completely self sufficient, having to plan everything themselves (of course, under close scrutiny of the staff).

Donna Huddleston: The first 6 weeks, she would not talk in group or to anyone about her feelings. When we got there after the first 6 weeks, we got her to open up and she has been working on her issues now. I did get her call Wed. night though and she was back to the "I want to come home and get back to my "normal" weight" stuff. She weighs ~100 pounds now, with a goal weight of 110. That terrifies her. We got her out of her panic today with a potential compromise. She told the Dr. ALL of her friends are thinner than her. So we are off on a round to do a photo album of her friends now. We will take it to her in two weeks. And if it is okay with the parents, they will tell us their kids' weights. Most are not as thin as Sarah perceives. The Dr. hopes this will help allay some of her fears.

Bob M: So, 6 weeks into the program and she is still struggling. That's how difficult it can be sometimes to tangle with an eating disorder. I also want to mention, that many Eating Disorders Treatment Centers around the country, DO NOT require cash up front if you have insurance coverage. Here are some audience questions:

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BloomBiz: What made her finally WANT treatment?

Donna Huddleston: It came down to going into treatment or the state hospital. Her moods were becoming more violent, and that was not Sarah's real personality. Also, a friend from the net with a long history of struggling through her eating disorder talked to Sarah, encouraging her to get help.

Rick Huddleston: Bob, we did not mean to say all eating disorders treatment centers ask for cash up front. Remuda is a "highly" advertised facility, which I believe leads parent into a false sense of help.

Bob M: I understand your position. I just wanted to clarify that for the audience because I didn't want anyone to think that if they didn't have $71,000, they couldn't get treatment.

HelenSMH: They will not let her leave right? She has to stay for the entire 9 to 12 mo. right?

Rick Huddleston: As a minor, yes, she has to stay, or "run away". This is NOT a lockdown facility, and they keep the girls in public a lot. It is the staff and Sarah who must decide when she is ready to leave, and Sarah (when not engrossed in her disease) agrees.

Donna Huddleston: Also to clarify, all other places we called would accept insurance. The problem was that the other residential programs were of short duration, and we knew Sarah needed a longer, extended stay to deal with her problem.

Bob M: The treatment facility though has a policy about what happens if you go back to your old eating disorder habits. Can you explain that, Donna?

Donna Huddleston: If Sarah skips one meal, she is "out" technically. They are really strict about that. We managed to get her to agree to eat after our conversation today. She was on the verge of refusing. We have had to go to "tough love" at this point. Sarah knows if she does not cooperate she will be escorted home by State Police Marshals and taken to the state hospital here. It is extremely difficult being that "hard", but if we give in, I know we will lose her.

Coral: Do you think that being there for so many months, in the long run, is going to be more help than a shorter program?

Donna Huddleston: Sarah is very stubborn and I hope someday she uses it to her benefit. We knew a 1-2 month program would not work, and we are seeing that already as she is in week 11.

Bob M: And she is still being combative and wanting to get out of there at times. And remember, we are also dealing with a 13-year-old, not an adult who can rationally think things through based on experience.

Donna Huddleston: She is not combative physically with them, just mentally, stating at times she is not going to eat.

Rick Huddleston: It is not only the age, but Sarah has been through more than most adults...medically and emotionally. Her natural father left many scars which are taking their toll as well. If she can get through this in 3 months, or if it takes 3 years, all we want is for her to get well.

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

HelenSMH: Oh god. I've also been to the state hospital in Columbia, South Carolina. I wish she could know that's not a place she wants to be. I was only there for three days. That's the minimum stay. It was awful.

Jordyn: Remuda looks at each case individually and does financial interviews with each case. How did you start your search for a treatment center?

Donna Huddleston: You are right Helen! Right now she is in a plush, beautiful house, on a golf course, in a regular bedroom with a roommate.

Rick Huddleston: We started by searching the web. We called and interviewed many facilities. We called the National Eating Disorders Organization, and also contacted our internet friends who are recovering for their help also. In Columbia, the doctors and hospitals were of no help. We were left to our own devices. Also, my insurance company did a lot of research for us as well.

Gloomy: I don't know if I can ask this, but what started her eating disorder?

Donna Huddleston: Sarah feels abandonment with her natural father. She is now back in touch, but it was a bit too late. There was no other kind of physical abuse. He was just never a "father" to her. Rick has adopted Sarah since we married.

Rick Huddleston: Briefly, problems with her biological father leaving her with a feeling of abandonment, a divorce, a new marriage, a move, medical problems, which together gave her a sense of total loss of control.

Bob M: Well, I have to say the two of you are wonderful parents. I know this must be exhausting, physically and emotionally for you. But you have done everything possible and a whole lot more. By the way, is your insurance covering the whole bill, or are you having to pay out of pocket now. And what do you think the bill will come to when the 9-12 months is over?

Rick Huddleston: Our insurance is paying the bill at Montecatini (which is about 20% the cost of normal hospitalization), but....does anyone have a lot of frequent flyer miles they would like to donate? :)

Donna Huddleston: By the way, we have 4 other kids that have survived all this. We constantly strive to keep communication open, as all of them are feeling the loss of our attention for the last few years.

Rick Huddleston: The stay alone is approximately $20,000 per month, plus our expenses for travel, meals, lodging. I haven't totaled it yet, but I would estimate out-of-pocket will be around $30K. To put that in context. Sarah went thru $12,000 in groceries in less than a year, $4000 in clothing, and several thousand in destruction of property.

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Bob M: For those of you just coming in, we mentioned earlier that Sarah was manic binge-purging to the extent her parents had to chain the refrigerator closed and lock the cabinets. Again, thank you for being here tonight, for being an inspiration to many. We all hope Sarah is able to recover and move on in her life.

Rick Huddleston: Manic binge-purge. I haven't thought of it quite that way, but it seems appropriate.

Donna Huddleston: All of the girls in program ( I say girls, but as of our last trip ranged from Sarah's age to 33, average age 20) told us how lucky we were to get her into treatment early. I just pray it works.

Rick Huddleston: I just hope that others can be helped. There is so little information on the parents side of this, and what the toll on the family is. Perhaps a topic for a future session?

Bob M: I think that's an excellent idea Rick and I plan to do that in the near future. Thanks again for coming.

Bob M: Before I move on, I also want to mention, that Rick and Donna said they were thankful that Sarah was able to get treatment relatively early on. That she didn't suffer with her eating disorder for years before getting treatment. That is so critical. If you've been to our other eating disorders conferences, you know our expert guests, like Dr. Harry Brandt, from the St. Joseph's Center for Eating Disorders, always stress how much easier and more effective the treatment is when you get it early on.

Rick Huddleston: One final comment from me. It is imperative that the patient admits and seeks eating disorders treatment. As with all addictions, if Sarah did not recognize it, there is no way she could be treated by anyone.

Bob M: We have a second guest coming, so please give me one minute to take a break. Our next guest, Diana, has been out of hospitalization and free from her eating disorder for 3 years. She'll be detailing her experiences and taking your questions in a moment.

Bob M: Our next guest is Diana. Diana is 24. She suffered from anorexia, then with bulimia for nearly 6 years, before checking into a residential treatment facility as a last-ditch effort to deal with her eating disorder. When she came out 8 weeks later, it was the start of a new life for her. Good evening Diana and welcome to the Concerned Counseling website.

DianaK: Hi Bob. Thanks for having me. I was here when Rick and Donna were talking. What amazing people! But you made a good point Bob. I think many parents would do what they did for their children. I remember when I was 16 dealing with my situation, I was afraid to tell my parents. Afraid they would be angry, I would be punished in some way, or rejected by them. And I speak with many kids today and I tell them that's because you are angry at yourself for having the eating disorder and you project that your parents will be angry too. In most instances, parents care about their children and will do anything they reasonably, and even beyond reason, that they can do to help. It is very painful for them too.

Bob M: Please tell us very briefly what your condition was like before you checked into the treatment center.

DianaK: I was in very bad shape. I had been a restrictive anorexic for 2 years, before moving onto bulimia, and then thinking, like most of us do, that I could control it. I soon found that I had both and was completely out of control. I know everyone in the audience can't see me in person, so I'm going to mention that I'm 5'-6" and now 130 pounds. I was all the way down to 87 pounds. If that tells you anything.

Bob M: What was it like the first day you went through the doors at the treatment center?

DianaK: I was scared out of my mind. I didn't know what to expect. I was 20 years old. My parents forced me in. I didn't want to be there, but I knew deep inside I had to be. There was a lot of paperwork to fill out. Fortunately, my parents had insurance. Most of the $45,000+ was covered. I think my parents paid about $5,000 from their own pockets. When you get there, it's different from what you might imagine. It was a very nice place. Clean, very residential, like home. I sort of imagined the old movies, where they lock you up inside with the "crazies" and you never get out.

Bob M: Did you start therapy right away?(therapy for eating disorders)

DianaK: I guess you can call it that. The dr. and nurses come out to greet you and then there's that scary moment where you say goodbye to your parents and they begin taking you back into the hospital wing. You just want to grab on and say, "don't leave me here". I met my roommate and like where Sarah is, they had a rule. If you don't eat, you don't stay. So for the first night, I ate very little from my plate. But at least I ate.

Bob M: What was the most helpful part of being in-patient vs. out-patient...seeing a therapist at his/her office.

DianaK: Let me tell you this, and everyone who has an eating disorder knows this: it's like heroin, you will do anything to continue the eating disorder. You will lie to everyone. Tell them whatever they want to hear. I found myself at my worst point, fighting for my anorexia and bulimia. Can you imagine that?! I wanted it so bad, I fought for it. Being inside the treatment center, they were very strict and constantly watched over me. But that's what I needed to break my habit. And they also gave me constant support throughout the day. There were private therapy sessions and group sessions and meetings with the nutritionist and my therapist. So, I was kept pretty busy.

Bob M: Here are a couple of audience questions Diana:

Trina: Huh? So that was helpful- lying in therapy was helpful?

DianaK: Good question Trina. No. It was not helpful. I was only hurting and fooling myself. I guess the point I was trying to get across, is that for some of us out-patient is not enough. If your eating disorder has grabbed a hold of your life and visiting a therapist one or two days a week isn't enough, then you need in-patient treatment.

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Monica: What made you stay and eat instead of not eating and running away?

DianaK: When I first got in, the very first days, there were times when I didn't want to eat, but remembered the policy. It literally made me tremble. Also, having others who were a little further along in the treatment and my therapists there along side me, really helped. I knew this was going to be my last chance. And it took a lot of willpower sometimes to force food down me and then not throw it up again. The other thing was, I was physically ill from my eating disorder and I kept telling myself you have to beat it.

Maigen: I don't think that I'm quite ready to get better yet. How do you know when its time for a treatment center or if there really is any reason for one? I still feel like I can control this most days. Is it when there are more bad days than good or what?

DianaK: That's a difficult question Maigen. For me, I knew going to the therapist's office wasn't helping me. I had tried very hard stopping several times over a 6 year span, but couldn't. I would stop for a few days, my longest was 9 days, then start right back up. Also Maigen, I hope you don't have to learn this the hard way, you never really control your eating disorder. That's your mind fooling you. It always controls you. It's just at the beginning, you think it doesn't. As time moves on, it takes a firmer control.

Shelby: I guess I am confused, but I thought that you are never FREE from the eating disorder....you just learn how to accept yourself. Am I not right?

DianaK: I think you are right Shelby. I think once it gets to the point where I was, there is always a temptation to go back--especially if I get really stressed out or depressed. That's one of the things I learned in therapy. If you know what's going to kick you back into your old habits, you have to look at yourself and your situation and say I can't do that. This is not good for me.

Bob M: What was the most important thing(s) you learned while you were in therapy, in-patient?

DianaK: I learned about myself. Ever since I was very young, I was shy. I always let people boss me around, didn't want to hurt anybody, and felt very intimidated by others. Because of that, I kept all my feelings inside. When you do that to an extreme, your body breaks. I've learned how to care for myself, that I matter. That my feelings and thoughts matter. Also, that if I don't express myself, how can anyone help me or communicate with me, or know what I am thinking. So to sum it up, I learned how to cope better and deal with life better.

Bob M: We are talking with Diana...24 years old now. She suffered for 6 years with anorexia, then bulimia, and a combination of both illnesses. Diana finally went in-patient as a last ditch effort to save herself...and was there for nearly 2 months. Now, it's been 3 years since she came out. When you finished with the in-patient program, how did you feel on that last day as you walked out the door?

DianaK: That's not an easy question. Really, and I'm starting to tear remembering this, I was afraid then too. I remember thinking I can't leave these people, my entire support system, and make it on my own. My first reaction was to think of going back to my old friend--bulimia. The therapist had warned my parents about this. Apparently, it's common for many people with eating disorders. My parents took a month off from work, first my mom for 2 weeks, then my dad. They watched over me day and night. I had therapy with my regular therapist in his office 3 days a week in the beginning. And I joined a very small support group, there were 3 of us in the entire city apparently who had an e.d., and we got together 3 days a week and talked and supported each other. I can't tell you how important having support and people who care about you, around you, really is.

Marti1: Diana, do you still go to an outpatient therapist and what have you learned in terms of relapse prevention?

Bob M: Also, if you are interested in getting in or out of patient treatment at the St. Joseph's Center for Eating Disorders, you can fill out the form on the website and they will contact you and answer all your questions. It is one of the top eating disorders treatment programs in the country. They are located near Baltimore, Md.

DianaK: Yes, I still go even though it's been 3 years since I've been out of the hospital. I go about 2 times a month. That's not just for my eating disorder, but to also deal with my other issues and just to kind of keep me grounded. It helps keep things from building up. As far as relapses, like George Washington said, I cannot tell a lie. I relapsed once, about 4 months after I left the hospital, for a period of about 3 days. I worked up the courage to tell my therapist and I got through it with the help of her and my parents and the others in my support group. What I've learned Trina is that you have to recognize the signs of a relapse and what will lead you back down that path. For instance, if I get into a relationship with someone, and it's not right, I can't continually struggle with it. Or, I can't let work stress me out too much. I have a lot of responsibility at my job. However, I have to say to myself, if I don't get any sleep and I start getting angry or depressed, I'm right back where I started. So you have to be aware of what your mind and body can cope with and not go beyond those limits. The second thing is: if you have a relapse, the important thing to recognize is that you don't have to continue with the behavior. Do something about it right away. And forgive yourself, for you are only human.

Bob M: Here's an audience comment:

JoO: Congratulations Diana K...you sound like you have come a long way and faced up to many of your 'ghosts'. I to have an eating disorder -- different than yours -- but the emotional stuff -- not feeling good enough to say no, and keeping things inside are the same and destroy both body and mind. I admire you very much...keep on fighting your fight -- you're winning!!

Stacy: How do you find a good treatment program/hospital?

Bob M: That's an excellent question. I would talk with your therapists. I would call around to the various eating disorders treatment centers and see what they have to offer. And then I'd talk with other former patients and see what they have to say. They have a national reputation. Several people from our site have gone there and said it's been a wonderful program that has really helped them. If you are interested, visit St. Joseph's link for more info. Once you get to the St. Joseph's page, there's a form to fill out for more info.

Bob M: I just noticed it's nearly 10:30 central, 11:30 eastern. We've been going for 2.5. hours. I want to thank you for coming Diana. The insights you offered are valuable. I think it also let's everyone know that it's alright to be scared of the unknown, what treatment will mean and what's ahead in life.

DianaK: And the other part of it is Bob, you have to fight for yourself. You can't sit around and say this will never happen to me because as time goes on, the eating disorder becomes stronger and life becomes a lot rougher. If there is just one message I could bring tonight it would be: TAKE A CHANCE on yourself. Give yourself the opportunity to work through your eating disorder and do it with a PROFESSIONAL. I know it's tough. I've been there. But it's worth it. Trust me. If you've been to hell, anything else is like being in heaven. Good night everyone and thanks again for having me.

Bob M: I hope tonight's conference was helpful to everyone and there was some good information and good karma you can carry with you.

Bob M: Good Night everyone.

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Bob M: Good evening everyone. I want to welcome everybody here tonight for our Eating Disorders Recovery Conference. Everyday, I get emails from those of you with eating disorders talking about how difficult it is to recover from them. You talk about trying, you talk about getting therapy and relapsing and I want you to know that is not that unusual. Recovering from eating disorders can be a long, difficult and trying process. Our guest tonight is one of the top researchers of eating disorders in the country and we'll be discussing why it's so hard and what you need to know to make your recovery longer lasting and more effective. Our guest is Dr. David Garner, Ph.D. Dr. Garner is the Director of the Toledo Center for Eating Disorders. He has published over 140 scientific articles and book chapters and has co-authored or co-edited 6 books on eating disorders. He is a Founding Member of the Academy for Eating Disorders, a scientific consultant for the National Screening Program for Eating Disorders and a member of the Editorial Board of the International Journal of Eating Disorders. Good evening Dr. Garner and welcome to the Concerned Counseling website. I'd like to start with the question: Why is it so difficult for people with eating disorders to make a full and lasting recovery?

Dr. Garner: Thank you for the introduction. This is a difficult question since there are many reasons for failure to recover; however, most significant is the conflict about weight and weight gain.

Bob M: And what is that conflict?

Dr. Garner: Most people with eating disorders suffer from the "anorexic wish"- the wish to recover but not gain weight. This leads to continued attempts to suppress body weight which leads to increased urges to eat. The key to breaking the cycle is becoming a strong "anti-dieter" - a real problem for those who fear weight gain.

Bob M: Before we get into how to accomplish that, I want to also have you touch on the other reasons for failure to recover.

Dr. Garner: Sometimes the eating disorder is a comment on dysfunctional family international patterns and as long as the patterns continue to exist, recovery is difficult. For instance, the problems in recovery may relate to a trauma, such as sexual abuse, and until this issue is dealt with, recovery is impeded.

Bob M: So is that one of the reasons for failure to recover from an eating disorder...that the issues that led up to it haven't been dealt with completely?

Dr. Garner: That is correct. Another one is that the simple wish to maintain a low weight is in conflict with the biological realities related to the person's set point for body weight and this is simply not accepted and the person continues to diet. This may seem like a straight forward issue, but for women in our society, it is very difficult to accept a body weight higher than one would like.

Bob M: Is it possible then to effectively work through your eating disorder while at the same time dealing with the abuse, or other issues, that may have lead up to it? Or to be really effective, should one work through the other issues before tackling the eating disorder?

Dr. Garner: The order of dealing with the issues varies. Usually, one needs to work on both at the same time. In all cases, it is impossible to make headway on the psychological front while continuing to engage in symptoms. Bingeing and vomiting b/v and strict dieting alter your perceptions so much that it is impossible to work on other issues.

Bob M: At the beginning of the conference, I mentioned that those who have relapses along the way, should not feel alone. What does the research say about the number of people who try and recover and have a relapse...and what are the average number of relapses a person experiences?

Dr. Garner: The percent of people with bulimia who recover at a 7 year follow-up is about 70% with another 15% making significant progress. With anorexia nervosa (AN), there is less research and the treatment phase is longer, but 60-70% of patients recover with treatment from a high quality eating disorders treatment facility. Many patients recover after quite a number of relapses.

Bob M: What is the best form of treatment when it comes to making a significant or lasting recovery?

Dr. Garner: The best studied treatment for both Anorexia and Bulimia is cognitive behavioral treatment (talk and behavioral modification therapy). However, for patients under 18, family therapy must be part of whatever treatment is offered.

Bob M: We get many questions here Dr. Garner from folks who want to know, is hospitalization the most effective way to deal with an eating disorder, followed by intensive outpatient therapy or can you just get therapy on a weekly basis?

Dr. Garner: I do not think that hospitalization is necessary or desirable for most patients- intensive outpatient treatment or day hospitalization has replaced inpatient treatment for the most part. Most bulimic patients benefit from outpatient therapy and severe eating disorders usually require something more than weekly, outpatient therapy.

Bob M: Here are some audience questions:

Rhys: How does one become a strong anti-dieter and not gain weight? It seems like an oxymoron.

Dr. Garner: It is, that is why most people decide on some level to opt for trying to continue to suppress their weight. Modest weight gain may occur even in treatment for bulimia.

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Peppa: What if you really have no other issues and the eating disorder is just in you? Do you think some people may be just born with it and that it can't be cured?

Dr. Garner: I do not believe that. Most people with eating disorders can do very well with treatment. There is little evidence that it can't be cured, if you are willing to follow the advice provided in quality treatment.

Bob M: This is the second time you have used the term "quality treatment". What does that mean exactly?

Dr. Garner: It means treatment that emphasizes both the nutritional rehabilitation as well as dealing with psychological issues. This does not mean, encouraging patients to restrict their food intake to low levels of calories (e.g. 1500) or having them avoid sugars or flour or assuming that their eating disorder is an "addiction".

livesintruth: Do you think that family therapy should be part of the eating disorder recovery process for just those under 18? What do you recommend for those 19-25 year olds who are working through the developmental issues of separating from their parents? What is the best way to help parents understand what is happening? Often the person with the disorder is stuck having to tell their family alone. So how do they go about telling them in order that they can believe her and support her?

Dr. Garner: I agree that family therapy should not be limited to those below 18 yrs- it is just that it is mandatory for those who are living at home or who are financially dependent of their family. Family therapy for those 19-25 can be very helpful.

Donnna: Dr. Garner has touched on an area that I am dealing with now. I have uncovered some severe trauma in my childhood years well into my teens. Could this be the reason I have been dealing with this eating disorder for 26 years? Although I have been in a recovery program since April, I feel like this will never end. It's almost as if it has gotten worse than better. Why is that?

Dr. Garner: Often an eating disorder gets worse when the traumatic issues are uncovered; however, this should subside soon. Treatment should assist you in identifying the issues and then, move beyond them.

Shelby: What if your parents pretend as if everything is fine...they don't seem to care whether you skip meals or not?

Bob M: While Dr. Garner is answering that, I want to mention that Shelby's situation apparently isn't unusual. I get about a dozen emails a week from teens asking what to do because their parents don't believe them, even though the person tells them they've got an eating problem.

Dr. Garner: Then there is something wrong with your parents. Would they do the same thing if you were taking drugs, engaging in other self-harm?? Why are they appearing to be so unconcerned? What do they tell you?

Bob M: Let's take it at face value, Dr. Garner, that the parents are in denial. What is a teenage child to do then to get help?

Dr. Garner: Unfortunately, parents can be inept and it is unfortunate that you are suffering. It is possible to consult school counselors or sometimes, even if parents are in denial, they will agree to allow their teenager seek treatment. Don't let you parents' difficulties discourage you from seeking treatment.

JerrysGrlK: What about people over 25 with a eating disorder? How do you overcome the fear and take the first step to get help?

Dr. Garner: Knowing that eating disorders can be cured is reassuring. You are not alone. A phone call to an experienced therapist, just to ask about what treatment involves, is the first step.

twinkle: We are dealing with Dissociative Identity Disorder/Multiple Personality Disorder and was wondering do you have any advice on how to approach the eating disorder while dealing with so many other issues or should we just wait until we have dealt with the other related issues?

Dr. Garner: As I said earlier, it is impossible for you to make headway with the personality disorder or other significant problems as long as you are bingeing or vomiting or starving. Some people find that their so-called personality disorder goes away once they stop the aforementioned symptoms. So, tackle the eating disorder and see what is left.

Bob M: Here are some audience comments to Shelby's earlier statement about her difficulty in getting her parents to help her:

pumpkin: But what happens if even the counselor can't get through to a parent. I know that happened to me and I felt as though maybe there really wasn't anything wrong with me and I got worse.

livesintruth: I'm sorry, but it just isn't that easy Dr. Garner. I personally have experienced that naivety of parents with children who have eating disorders and other mental health problems. There are some parents out there unfortunately who do not let their children get help. They don't encourage them. The parent-child bond is so strong, usually stronger than the bond between the individual and the eating disorder, that individuals will begin to believe their parents' denial.

HelenSMH: Some parents think that it's just phase. How does one make the parent understand that it's not "just a phase"?

Bob M: I think there's only a limit as to what one can do when they are underage. My suggestion would be to speak with a school counselor, someone associated with your church or synagogue, call your family doctor. See if these people will call your parents and try and make an impact. Dr. Garner just sent me a great comment: "How do we make parents competent?" That's for another conference. Is there is significant difference in the way anorexia and bulimia are treated, Dr. Garner?

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Dr. Garner: I agree, I think that there are people out there whose interest is in helping children, even if parents won't. (to earlier comment). Now I will tackle your question. Anorexia and bulimia nervosa share many features in common, so it is not surprising that approaches to therapy for both disorders overlap to a significant degree. Common approaches are recommended for both disorders to address characteristic attitudes about weight and shape. Education about regular eating patterns, body weight regulation, starvation symptoms, vomiting and laxative abuse, is a strategic element in the treatment of both disorders. Finally, similar behavioral methods are also required, particularly for the binge eating/purging subgroup of anorexia nervosa patients. Nevertheless, there are differences in the treatment recommendations made for these two eating disorders. This may partially reflect differences in the personalities, background and training of the main contributors to the literature for these two eating disorders. However, key distinctions can be made between these disorders based on motivation for treatment and weight gain as a target symptom, both requiring variations in the style, pace, and content of therapy.

Bob M: So then, the key question, if weight concerns are the major issue, and people with eating disorders always talk about the "voices" they hear about how "fat" they are, what is the most effective way of ending those concerns. What should people who want to recover be concentrating on when it comes to that issue?

Dr. Garner: The topic of body weight is approached from an entirely different perspective for anorexia and bulimia nervosa. Experts in the treatment of bulimia nervosa recommend that bulimia nervosa patients should be told that in most cases treatment has little or no effect on body weight, either during treatment itself or afterwards. In anorexia nervosa, this reassurance is not available since weight gain is a major aim of treatment. The significance of this contrast cannot be overemphasized. I do not know how to actually make those voices go away. The first study I did 20 years ago attempted to solve this. Rather, you need to ignore the voices, kind of like a color blind person learning to ignore false signals about color.

Bob M: And when a person feels a relapse or difficult period coming on, what are the most effective ways to deal with that?

Dr. Garner: It should be stressed that vulnerability to eating disorder symptoms can continue for many years, even if there is recovery from eating symptoms. A valuable strategy in avoiding relapse is remaining alert to areas of potential vulnerability. These include vocational stress, holidays, and difficult interpersonal relationships as well as major life transitions. Patients may become distressed if they continue to gain weight. They may also be vulnerable during pregnancy. Patients without any overt symptoms may remain quite sensitive about weight and shape. They need to be prepared for encounters with people who may have seen them at a low body weight. During the termination phase of treatment, patients need to practice adaptive cognitive responses to well intentioned comments like "I see you have gained weight" or "my, how you have changed". Patients may even need to be prepared for occasional callous comments about their weight. Vulnerability to relapse increases during periods of psychological distress. Susceptibility to relapse may also increase with positive life-changes and enhanced self- confidence. Fresh relationships, career advancement, increased physical fitness and overall improvement in self-confidence can activate latent beliefs like "now that things are going so well, maybe I can lose a bit of weight and things will be even better". Patients need to be reminded that weight loss is enticing and insidious in its effects. Initial results may be positive; however, the adverse impact on mood and eating are inevitable over time.

OMC: Why do you think there is no cure for such a deadly disease as anorexia, although it has been researched for generations?

Dr. Garner: Many patients do completely recover from anorexia, just like with other disorders. It has only been carefully researched for the past 20 years.

ZZZ I SHOULD DIE: Which type of eating disorder would you say is the hardest for a person to recover from?

Dr. Garner: Anorexia-- when the person is at a very low weight and is B/V. Starvation effects make it very hard to relate to others and to focus on any aspect of treatment.

Bob M: Here are a few audience comments, then we'll continue with the questions:

Latina: Thank you for making that point Dr. Garner regarding eating disorders being viewed as an addiction. So many individuals with these disorders seem to sell themselves out to the fact that it is a disease or an addiction and that they are untreatable. I understand Donna's point very much. Even recently, I have had family members say that I have only gotten worse over the last five years. But the truth is I had to go to the bottom to rebuild my way back up. I am just surfacing.

ZZZ I SHOULD DIE: I have had an eating disorder for as long as I can remember. I do not remember life without it. I no long want this pain. I am afraid to overcome it for a few reasons. 1) I am afraid to because of the insecurity that I will have; and, 2) I do not want to gain weight (one of my biggest fears).

barbaras: I am 51, raised in an alcoholic and sexually abusive home. I was abducted at the age of 5 by a stranger and raped among other things. I want to quit throwing up, and I have gone as long as 3 weeks, but I always go to another destructive behavior and then back to throwing up and laxatives. I am so tired of fighting this. Is there any hope for recovery?

Aroma: Does Dr. Garner think that nutritional advice is a part of the psychotherapeutic process?

Dr. Garner: Yes. I do think nutritional advice can be helpful. On the subject of relapsing and when to return to treatment: People with eating disorders should have a low threshold for returning to treatment. It is not uncommon for patients to believe that a return to treatment would be a humiliating or unacceptable admission of failure. Common beliefs that interfere with re-initiating therapy are: "I should be able to do this on my own now; if I am having problems again, it means recovery is hopeless; the therapist will be disappointed or angry". Since patients commonly delay the reinitiating of treatment too long, a conservative approach is a good policy. If patients are not sure whether they should return for a follow-up consultation, this means that they should. Sometimes therapists need to define their role as a "family doctor" for eating disorders. Regular "check-ups" are prudent, and meetings at the earliest sign of relapse are the best protection against escalation of symptoms. Remain alert to warning signs of relapse: It is useful to review early signs of relapse with particular attention to weight or shape preoccupation, binge eating, precipitous weight gain, gradual or rapid weight loss and loss of menstrual periods. Patients need to ask themselves periodically: "Am I thinking too much about weight?" Sometimes weight loss occurs for other reasons such as depression or illness.

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HelenSMH: I was wondering, I received treatment called ECT (Electro Convulsive Therapy) for major depression. I don't think it had any effect on my eating disorder, but other inpatient people were getting ECT also for their eating disorder. I was wondering should/can ECT help with eating disorders?

Dr. Garner: ECT is absolutely contraindicated for eating disorders from my reading of the literature.

Suszy: I was wondering why it seems like I'm losing all of my friends over my eating disorder. I'm not hurting anyone but myself?

Dr. Garner: An eating disorder interferes with the ability to maintain social relationships for many reasons. However, unless you have a blueprint for recovery- unless you know how to proceed with recovery, you should not blame yourself for driving others away.

Bob M: Suszy's question brings up another issue: how does one explain their eating disorder to a friend or family member without alienating them?

Dr. Garner: An eating disorder is a problem. Problems can be solved. If it is presented as a solvable problem, rather than an illness, it should help to avoid alienating friends or family members.

Suebee: I recently read that one should not try to lose weight while attempting to recover from bulimia. Is this true?

Dr. Garner: ABSOLUTELY. THIS IS THE KEY!!!!!!

Penny33: Can experiences with bulimia affect bearing children, after a long time of recovery? Also, what areas of your body are affected harshly?

Dr. Garner: As long as recovery is complete, there does not seem to be a problem with bearing children. The long-term effects are unclear. For anorexia, bone loss is a big problem and dental problems can be severe with those who B/V.

clk: What are the side effects of long-term diet pill and laxative abuse and how does an inpatient stay help to gain control over this?

Dr. Garner: Those with eating disorders should be aware of the serious physical complications associated with starvation, self-induced vomiting and purgative abuse. These include electrolyte disturbances, general fatigue, muscle weakness, cramping, edema, constipation, cardiac arrhythmias, paresthesia, kidney disturbances, swollen salivary glands, dental deterioration, finger clubbing, edema, dehydration, bone demineralization, and cerebral atrophy. Laxative abuse is dangerous because it contributes to electrolyte imbalance and other physical complications. Perhaps the most compelling argument for discontinuing their use is that they are an ineffective method of trying to prevent the absorption of calories. An inpatient stay can be helpful in getting you off the laxatives if it is not possible as an outpatient.

Bob M: How common is it for a person to go from anorexia to bulimia or vice versa? And how does having the combination of both affect the chances of a successful recovery?

Dr. Garner: It is very common to move from anorexia to bulimia and less common, but it still occurs, for patients to move the other way. However, the important thing to remember is that the basic issues are similar, a fear of weight gain. Having anorexia and bulimia at the same time is now technically impossible because of the way the diagnositic criteria are worded. However, having anorexia and b/v does not confer a terrible prognosis- the underlying eating disorder is similar regardless of the weight.

hero: What is the treatment used for the compulsive overeater? I have lost and gained my entire life and I'm so tired of a life revolving around food. Can treatment happen without medication?

Dr. Garner: The treatment of choice is 1) not dieting (i.e. 3 meals spaced throughout the day, 2) no less than 2000 calories, and 3) eating former "binge foods" as part of your regular diet. Medication should best be used as an adjucnt to the cognitive behavioral treatments that now have received a great deal of empirical (research testing) support. If you do as I have indicated here, you will NOT continue to gain and will lose weight for the remainder of your life.

Alisonab: When you talked about the weight issue and how we still have a "goal weight"-- well what if we are in a bad medical situation and need to get out of this cycle, but because of the weight issue we cannot. Is there any other way around the weight issue?

Dr. Garner: Almost every bad medical condition is made worse by cycling up and down. I think that the best thing is to aim to stabilize your weight and look for other methods to improve your medical condition.

jbandlow: I've read recently that when an anorexic ingests food, there's a resulting decrease in some brain chemical that can actually cause one to feel worse about having eaten. Is this true? If so, can it be counteracted?

Dr. Garner: I do not think that it is quite this simple. Most anorexia patients feel terrible when they ingest food and this has more to do with feelings about eating and weight gain and loss of control than neurotransmitters. However, we still are in our infancy in our understanding of the effects of eating on brain chemistry.

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luvsmycats: Hi - how do you feel about keeping food diaries?

Dr. Garner: I think that it can be very helpful and meal planning can be even better for those who are really frightened of eating.

JazzyBelle: Why do people sometimes go to cutting themselves if they have an eating disorder?

Bob M: We are talking about self-injury here. And it seems that for some, eating disorders and self-injury go hand-in-hand.

Dr. Garner: Self injury occurs in about 15% of eating disordered patients. There are several reasons. 1) to increase pain to wipe out other feelings. 2) to increase sensations in those who are having trouble experiencing feelings, 3) to control others, since it elicits such strong reactions, and the person does not feel that she has any other way to achieve control.

Bob M: I'm not familiar with this part of the research, but are people genetically predisposed to having an eating disorder and/or does it seem to "run" in families? So, if I have an eating disorder, do I have to worry about my children having one?

Dr. Garner: There is evidence that eating disorders run in families. For example, anorexia occurs in 10% of sisters and fraternal twins, but 50% of identical twins. Moreover, children of those with eating disorders have a greater chance of developing eating disorders, but is this related to genes or to teaching the child things that make an eating disorder more likely? This remains unknown.

Bob M: We haven't touched on this part either yet...what about men with eating disorders. Do they face different issues when it comes to recovery? And is it any harder/easier for men to recover and do they suffer more/fewer relapses? Why?

Dr. Garner: Men face different issues since eating disorders are often thought of as "women's disorders" which can make it more difficult for men to seek treatment for their eating disorder. Also, there has been research suggesting that sexual identity conflict issues are more common among men with eating disorders. Arnold Andersen at the University of Iowa has done a great deal of research on this topic. It does not appear that men are less likely to recover. I just want to say before I sign off that, after working with people with eating disorders for years, I am really optimistic about the prospects for recovery. Every patient should know that recovery is possible, even after many years of serious illness.

Charlene: What can one do when not actively engaging in eating disordered behavior, but you are still constantly bothered by the thoughts? Is there anything besides costly therapy?

Dr. Garner: We have had two patients in our program recently who have had an eating disorder for 20 years and have made extraordinary progress in recovery. Not everyone makes this type of progress, but then, these patients who have made progress did not know they were going to do well until after participating in treatment. Thus, I encourage everyone to keep trying and to keep the faith in the possibility of recovery and a life without an eating disorder. I want to thank Bob and Concerned Counseling for providing this opportunity to discuss recovery- Now to Charlene:

If the thoughts are really intrusive, then I think that continued treatment would be helpful. Consult your Dr. for an opinion and recommendation. One assessment should not be that costly. I would not underestimate the pain caused by thoughts and they may very well warrant treatment. Best wishes, Dr. Garner.

Bob M: We had over 150 people coming in and out of the conference and I know we didn't get to everyone's questions. I want to thank Dr. Garner for being here this evening and for sharing his knowledge and information with us. And thank you to everyone in the audience who came tonight. I hope everyone has a good rest of the week. We have many people with eating disorders, all three, anorexia, bulimia, compulsive overeating who visit our site everyday. So if you are needing or wanting to give support, please stop in.

Dr. Garner: Good night and thanks Bob for providing me with this opportunity.

Bob M: Good Night everyone.

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Bob M: Good evening everyone. Our topic tonight is BODY IMAGE. We are going to be discussing the psychology of body image and why some people have positive one's and others have a negative image. And then, our guest will tell us how we can work towards developing a more positive image of our bodies and ourselves. I'm Bob McMillan, the moderator for tonight's conference. Our guest is Carolyn Costin. Carolyn is the Director of the Monte Nido Treatment Center in California. She has also written several books on the subject of eating disorders. Good evening Carolyn and welcome to the Concerned Counseling website. We appreciate you being our guest tonight. Can you please tell us a bit more about your expertise?

Carolyn Costin: Good evening. Thank you for having me. I have been an eating disorder therapist for approximately 20 years and I am also a recovered anorexic. I have developed and implemented 5 treatment programs, most currently my six-bed residential program in Malibu.

Bob M: Just so we are all on the same track tonight, can you please define "body image" for us?

Carolyn Costin: Body image refers to the body as a psychological experience and focuses on the individual's feelings and attitudes towards their body.

Bob M: I hear all the time that poor body image can lead to an eating disorder. What I want to address tonight is: what creates a poor body image?

Carolyn Costin: There are a variety of causes. We first look at how a person's caregivers treated their body when growing up. For example, was the person attended physically, were they touched, what comments were made about their body, all the way to were they neglected. Then we have cultural issues such as our current "thin is in" society where women are portrayed as unrealistically thin in the media. It is a complicated issue.

Bob M: It is. What I want to do is try and break it down into components, if we can? At what age does a person begin to take notice of their bodies? And at what point does it begin to have an impact on their self-image?

Carolyn Costin: Let's start with the components. We can break down body image into 3 separate aspects. There is perception, attitude, and behavior. Perception is what the person sees when they look at their body. Attitude is their feelings about what they see, and behavior is what they do about their attitude. From birth, babies take notice of their bodies. In fact, this is the way they begin to formulate a separate sense of self.

Bob M: Are you born with a positive body image and then it changes because of external or environmental factors?

Carolyn Costin: That sounds like a good way to describe it, but perhaps it is better to say we are born with a neutral body image and our experiences begin to shape how positive or negative our body image will be.

Bob M: Our topic tonight is BODY IMAGE. For those just joining us, our guest is Carolyn Costin, director of the Monte Nido Eating Disorders Treatment Center in California (Eating Disorders Treatment Centers). I know that many of you in the audience have eating disorders, but we are limiting tonight's conference to Body Image and related questions. Here are a few audience questions Carolyn:

Mick31: How can we change our body image from negative to positive?

Carolyn Costin: First of all, it depends on the roots of the negative body image. For example, if someone grew up in a family with poor boundaries, they may have developed a need to over-control their body. For example, what goes in and what goes out (food/exercise). However, one can begin to focus on what the body does that is positive. For example, I often have clients make a list of the positive things about having a body, or interview their bodies. This begins to reconnect them to owning and appreciating that they have a body. Usually people need to work with someone as this can be very difficult. Traditional body image assignments given to patients such as draw your body, often don't work because they re-enforce our focus on the body's appearance.

Bob M: How is it that a person develops a "warped" sense of their own body? For instance, someone with anorexia, who is very thin, sees and thinks of themselves as being fat.

Carolyn Costin: In anorexia nervosa, body image disturbance increases as the illness progresses. It usually begins when the person feels that their body is too big compared to some standard ideal. We also think that there may be a genetic predisposition in some individuals which causes them to have perceptual distortion. Lastly, it seems that nutritional deficiencies may contribute to body image disturbance. It often appears that the thinner these girls get, the fatter they feel.

Ayah: What is a positive body image? Accepting myself as I am? It's kind of an abstract concept to a lot of us I think.

Carolyn Costin: Yes, I agree it is a very abstract concept. What I try to do in my work is to help people to commit to not doing anything destructive in order to have a "better body." I think it is hard in this society to accept our bodies as we are always told by the media through advertisements and fashion models that we are not good enough. It's one thing to try to improve our bodies in a healthy way, but it is very important not to ever put our health and well-being in jeopardy just to look a certain way.

Celina: How do we view ourselves in a better light, when in reality I'm disgustingly fat!!

Carolyn Costin: The interesting part here is the word: "disgusting". Who told you, or who decides, that one size is disgusting and another size is attractive or ideal? If you want to change your body, and you can do it in a healthy way, for example, increased activity, than that would be fine.

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Froggle08: Carolyn, you are saying why we feel this way and medical explanations, but how do we stop these things? How is one not to feel negative about their bodies when they hear that they are fat?

Carolyn Costin: I admit it is hard. People are in treatment for this. I will not be able to tell you over the internet, but I can make some suggestions. For example, a very good book is When Women Stop Hating Their Bodies. This would be good for men and women to read. You may need to seek professional help. Also, try to find an activity that you enjoy doing where you use your body.

Bob M: Here are a few audience comments:

metaphorical eyeball: How can you change the minds of young girls like myself, when the media is always in our face about losing weight and being the thinnest?

Con: I am not sure if what I have is poor body image or not. I was abused, sexually, as a child and I hate how my body reacted and it seems that hate is so deep within me. I am anorexic and I seem to always be trying to get rid of my body which betrayed me.

JoO: I think what you are telling us is that we have a body. Some of us have become victims of what society tells us is about the kind/shape of body we should have. We have forgotten to look at the people/person we are. What we should be focusing on is the person we are inside and just being the best we can. Keeping up positive attitudes and not going for what everybody else calls normal. BUT -- so saying -- this is hard to do and I would say the problems have to be dealt with first. Does any of this make any sense?

Joan: Carolyn -- you are talking that anorexia body image increases as the illness progresses....I sincerely believe that ALL eating disorders increase, whether it be a perceived weight problem or an actual weight problem. Emotional pain is emotional pain.

Avalon: Even with professional help, it does not help when it's people that are the cause of the problem. When your jeans are not the size that they want for them to be.

Carolyn Costin: I tell all my clients not to buy fashion magazines or any other magazine that only shows thin bodies. Support magazines like "Mode." This is a very good magazine showing bodies of all sizes. Please write to television shows and magazines and tell them how you are affected by seeing only thin bodies. Body image dissatisfaction is rampant in our society. We have 80% of fourth grade girls going on diets and about 11% have used self-induced vomiting. I think we need to start with children very young. We need to focus on their souls and spirits, not their bodies. We need to help children and each other to focus on internal instead of external qualities. This is why I wrote the book, Your Dieting Daughter.

Bob M: But what about professional treatment...is that what it takes to correct a poor body image, or can someone work through that on their own?

Carolyn Costin: Depending on how severe the body image disturbance is, professional help may or may not be required (eating disorders treatment). If it is affecting your behavior, for example, inadequate nutritional intake, vomiting, taking laxatives, or other self-destructive behaviors, you should seek professional help. In some cases, self-help books, participating in sports, and increasing self-esteem in other areas might be enough.

Bob M: Here are a few audience comments, then more questions:

Fazz: Feeling this hate towards the body is so ingrained by our system that it becomes a reflex action. It's then very tough to overcome.

Suey: That's easy to say. Teach the kids when they're young, but it goes so much deeper than just physical looks!!

Freestyle: I think a person can work through it a lot on his/her own. The truth sets you free, no matter where you find it or who points it out. There are some really good books on the market now too to help.

tennis me: What are we supposed to say to our kids so we do not recreate another generation of people with poor body image and eating disorders?

Carolyn Costin: Time is too limited to tell you everything to say, and I want to be helpful, so I'll refer you to some very good books on the subject. Making Peace with Food, by Susan Kano, How to Get Your Kid to Eat But Not too Much, by Ellen Satter, Father Hunger, by Margo Maine, and my book, Your Dieting Daughter, will also help. In addition, it is important for parents to avoid making negative comments about their own bodies, or judgments about other people's bodies in front of their children. I do not think parents should keep scales in their homes. If a child seems to have a problem with being overweight, make sure to focus on health, not looks. Point out to children role models in all shapes and sizes.

Freestyle: I tell my daughters that so much of what society teaches is just plain false. Being thin, in and of itself, won't make you happy. It won't make them rich. It won't find them Mr. Right. It won't get them a perfect job. I try to point them in the direction that will get them these things: being kind and fun-loving and getting an education and caring about others.

macbethany: My mother always praised my good looks and that made me feel very uncomfortable. I was so self-conscious growing up (am 24 now). I also feel she used to stare at my body as I developed. Could this be why I have a bad body-image?

EDSites: Do you feel that the "all or nothing" thinking plays a part in how a person will view themselves? For me, if I fail at something it tends to turn into how I feel about myself physically. How can one change that?

Carolyn Costin: People often turn real feelings into feelings about their body because the body seems easier to control. I ask people to write about any feelings they have prior to engaging in any disordered eating behavior.

Bob M: The Monte Nido Treatment Center is in California. Here is the site address for them: http://www.montenido.com. I know it's getting late Carolyn, so we will wrap it up. We all appreciate you being here tonight. Thank you for coming and being our guest.

Carolyn Costin: This is a tough topic, but I want everyone to know that they can get better if they suffer from a body image problem. It took me a few years, and it may take more time for others, but you can reach a point where what you weigh, or what you look like, is not more important than who you are. Thank you, Bob.

Bob M: Good Night everyone.

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Bob M: Good evening everyone. The conference topic tonight is: "Coming Out. Sharing the news of your eating disorder with significant others in your life." We'll also be discussing other aspects of recovery. Our guest, Monika Ostroff, details her 10-year battle with anorexia in a new book Anorexia Nervosa: A Guide to Recovery. Welcome to the Concerned Counseling website Monika. So our audience can get a sense of what you went through, please tell us a bit about yourself and what qualified you to write a book on recovery.

Monika Ostroff: Good evening everyone. Thank you for inviting me tonight. I struggled with anorexia for about 10 years. I spent approximately 5 years in-and-out of hospitals, mostly in. Recovery for me entailed a lot of soul searching and trial and error. When I finally found some things that worked for me...after such a long time of no luck...I thought it would be important to publish a book. I thought that some of the things that were helpful to me were bound to help others.

Bob M: How old were you when your eating disorder started and how old are you now?

Monika Ostroff: I had "disordered eating" when I was about 18, a little older than most. I'm 31 now. It started innocently enough. After gaining the official "freshman fifteen" in college, I decided that I needed to lose the weight and "get my old body back". My diet ended up being a little extreme and lengthy.

Bob M: Many of the visitors to our site and our conferences always talk about how difficult it is to tell others about their eating disorder (anorexia, bulimia, compulsive overeating) and their need for help. Can you tell us how it was for you?

Monika Ostroff: I spent about four years denying that I even had an eating disorder. To tell you the truth, initially, I don't think I told anyone. Pretty much everyone could look at me and figure it out on their own. When I went into the hospital for my first tube feed, I had to tell some of my friends whom I hadn't seen in awhile. I remember feeling afraid and ashamed. Part of me was afraid that people would look at me differently and that they would watch me more closely, at least in terms of what I ate. Another part of me was embarrassed to have ended up in such bad shape.

Bob M: Did you ever regret not being able to tell someone before it got to the point that you had to be hospitalized?

Monika Ostroff: I haven't ever really regretted it per se. I do wish that I had been able to find a compassionate therapist to work with sooner. It would have been nice to have spared myself some time in the hospital. And I do know that the sooner you catch it and work on it, the smoother your recovery goes.

Bob M: For those just coming into the room, welcome. I'm Bob McMillan, the moderator. Our guest is Monika Ostroff, author of Anorexia Nervosa: A Guide to Recovery. We are talking about sharing the news of your eating disorder with significant others, how to do it, and why. We'll also be discussing eating disorders recovery a bit later. Here are some audience questions Monika:

Gage: What happened to make Monika enter the hospital? How long had she gone without eating and what symptoms did she have?

Monika Ostroff: I had dropped down to the low 80/high 70-pound range. I was weak, shaky, and had begun passing out, particularly when trying to walk up the stairs. At the time, I was eating only a couple hundred calories a day and I would purge anything over that so my potassium level was frighteningly low. I was also in the midst of law school exams and unable to think very clearly. All of that, coupled with a trip to the doctor, sent me to the hospital.

Reni62: Why didn't you stop when you got to your weight goal?

Monika Ostroff: Aaah yes, well...the weight that I wanted kept changing. First it was 105, then 100, then 98, then 97, and so on. Nothing was ever low enough and I was never satisfied with my goal. As soon as I reached it, I set another one.

Violette: How exactly did you tell your family members about your eating disorder?

Monika Ostroff: Well, my mother had been "nagging" me about food for a while. I think I was finally just scared enough to say "I think I have a problem and I want to do something about it."

Bob M: How would you suggest "coming out" to your parents if you are a teenager or a bit older and telling them about your eating disorder?

Monika Ostroff: I would suggest a step before the actual "coming out" and that is a little fear reduction exercise. I think a lot of people are afraid that once they tell someone that that person will then try to make them do things that they are not ready, or even willing, to do. Fear reduction then, would consist of telling ones self that you are asking someone for support which is different from asking someone to "fix it" for you. The most important aspect of this is realizing that we have to teach others how to support us by communicating clearly what it is that we need. We are asking them to walk with us in recovery...not for us. With that in mind, I would approach the family member or friend I trust the most and say "I have something really important that I would like to talk to you about, and this is hard for me..." I don't think that it's necessary to go into a blow-by-blow account of symptoms unless the person would like to. But once the person says, "I'm having trouble around food and my weight," I think it should be followed by a request for support.

Bob M: Many parents don't really know if their child has an eating disorder or not and people with eating disorders are very good at hiding it for quite some time. So it's also important to expect that when you tell a parent or significant other, that they may express surprise, shock, worry, maybe even some anger or extreme concern. If you are going to give someone "the news," be prepared for those reactions too. And then, remember to also reassure them and tell them explicitly that you are asking for their support and professional help. Here are more audience questions:

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Ack: How did you get others to understand?

Tayler: How did you friends react?

Monika Ostroff: Getting others to understand was never easy, and to be honest with you, some people never understood and still don't. Whenever I found a particularly good article or book excerpt, I tried to photocopy it and give it to people and that seemed to help a lot. I also tried to get people to go to panels of recovered people speaking. That was maybe the most helpful. My friends...I lost a few over it. I suppose they were never really true friends. Other friends were concerned and wanted to be helpful, but didn't really know how; so I had to sort of show them how to be supportive.

Lulu Bell: I am 17 and I've been bulimic for about 4 years. There is only one person who knows. The person that I need to tell, but is the most difficult to tell, is my parents. How do you go about that? My parents have already been through a lot with me like date rape, drug addiction, and alcoholism. I don't know how they would be able to handle this too. Plus it costs a lot to go to therapy and I've been in and out of it for about 3 years. I'm just lost. How should I go about it?

Monika Ostroff: With the history that you've briefly described, it isn't surprising that you are struggling with bulimia. I think sitting down with your parents for a true heart-to-heart would be perhaps the best thing. Sometimes doing that armed with some information in the form of books and articles can help. And as Bob said earlier, reassuring them will be helpful too. I think that the human spirit is very strong and very resilient. You have been struggling with this almost all alone for a long time. They will be able to handle it with you and you can all help each other...beginning with open lines of communication that travel both ways.

Mary121: I was wondering if you're considered overweight, but you had bulimia and anorexia symptoms, would it be a good idea to tell someone?

Monika Ostroff: It's a good idea to get support from another person whenever you are struggling with issues that are difficult for you. The number on the scale isn't really what defines the eating disorder. Eating disorders are mosaics made up of all different kinds of things. It sounds like you might be worried that they will doubt you or look at you critically. I think that if you try to make a connection with people, or a person in particular, and you are saying "I'm struggling, I'm hurting," then that person's heart will respond to your heart with support. Be willing to educate people along the way of your journey. That is how we all change and grow.

Bob M: Our guest is Monika Ostroff, author of Anorexia Nervosa: A Guide to Recovery. I'm getting some questions about where to purchase the book. You can click on this book link: Anorexia Nervosa: A Guide to Recovery ($11.00) and it will open a separate browser and you can get the book and still stay tuned to the conference or check your local bookstore. Here's an audience comment:

Crickets: My daughter got a lot of help through counselors when she entered college. It was a good turning point for her

blahblah: I'd like to ask Monika how she worded her "confession" to loved ones. I mean, part of me wants to be "discovered", but I can't imagine saying, "hey, pay attention to me! I'm starving myself!"

Monika Ostroff: Well, our behaviors do sort of say , "hey, pay attention to me," don't they? I like the way you worded that. I really didn't have a whole lot of finesse when I told some people. I think I literally said, "I have an eating disorder." I had to take into account people's personalities. My father is the sort of "give it to me straight" kind of person. He's the one that got the "I have an eating disorder." My mother needs a little more padding. She was the one that got the "you know, I've been thinking a lot about things that I do. I know that they aren't 'normal' and I also know that I can't stop doing certain things. I think I may have a problem with food and my obsessions with weight and exercise."

Bob M: And how did they react to those statements?

Monika Ostroff: My father said something like, "you have a what?! Just go out and get yourself a pizza." My mother on the other hand began talking about the problems in her life at the time. That's just where she was back then. Of course, neither one of those reactions was terribly helpful and hence I lost more weight, got into medical trouble and ended up in the hospital. Not the brightest story, but one I can look back on and use as a marker for how much we have all grown and changed since those days.

Bob M: I want to move onto your recovery. What was the turning point for you?

Monika Ostroff: The literal turning point came with a memory. I was in the hospital for what seemed like my millionth admission, when suddenly I remembered days in high school when I'd had a lot of friends, a lot of respect, and most importantly hopes and dreams for a future. All of that seemed to be gone. I was terribly depressed, had finished a series of ECTs, and somehow had developed an identity as a patient. It was an identity I didn't want. I began to realize that I treated myself harshly, and that the programs that didn't work for me also treated me harshly and pretty rigidly, too. I'd been treated that way a lot in life, and somewhere deep inside was a soft voice begging for comfort, gentleness, and understanding. I managed to find, after a 4 hour admission to a program that was not very user friendly, a program based on the feminist relational model, emphasizing respect, compassion and connection to others. It was really there that the true seeds were planted.

Bob M: Just so everyone in the audience understands, what do you mean by the word "recovery"?

Monika Ostroff: For me, and I'm very clear about this within myself, for me recovery means being back to the way I was before I even knew what a calorie was. I am normal weight, eat three meals a day and I snack when I'm hungry. I don't avoid any food in particular. Well, except for lamb, but I just can't stand the taste. Other than that I eat everything and I eat without fear, without anxiety, without guilt, without shame. For me, that 's recovery.

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Bob M: How long did it take to get to that point?

Monika Ostroff: Well recovery was a process of both discovery and healing. I think that I learned a lot in every program I was in. Even hurtful times were educational. The last program I was in lasted about 9 months and that was the true beginning point for me. After my discharge from the program, I worked on my own, very hard I have to add, for about another 5 months and each day symptoms and fears lessened. I used markers. I remember leaving the program the day before Thanksgiving. Two days after Thanksgiving was the last day I purged or starved. I started counting months of health.

Bob M: Here's an audience comment on your definition of recovery that I'd like you to respond to Monika:

Sunflower22: That seems so farfetched!

Monika Ostroff: I think that it sounds farfetched only if you have been told that "true" recovery is out of reach, only if you've been told that "once you have an eating disorder, you'll always have an eating disorder and that all you have to hope for is that one day it will all be a little more in perspective." Those kinds of things become self-fulfilling prophecies. And those definitions of recovery were not what I wanted for myself. I did not want to always feel tortured. So getting back to how I was was important for me. What you believe. you can become. What you wish for, you can reach. Your inner power is most amazing once you tap into it and follow it.

Bob M: Here are other similar comments, then a question:

Tammy: Monika, do you think that complete recovery is possible? I mean it just seems so hard to believe that I could get to the point where I didn't know what a calorie was or care.

Ack: That is all I have ever heard, that you will always have it.

Dbean: Do you struggle with going back and forth between wanting to get better and wanting to keep the eating disorder?

Monika Ostroff: To respond to the first question: I do honestly believe that complete recovery is possible. Getting there requires some very hard work, a lot of introspection, asking some really tough questions and then going out and really digging for the answers. It is almost invariably connected to discovering and validating your self-worth. When you feel worthless, it's hard to imagine even doing that but it can happen... with time, with patience, with persistence. Going back and forth between an eating disorder and getting better happened in the beginning and in the middle of my recovery. I think that ambivalence is a normal part of recovery. After all, look at all the important things eating disorders can do do for you. They protect you, communicate for you, manage your feelings. The thought of living without one is scary at first. It's like learning to navigate the world in a new ship. But new ships, I have found, can sail a whole lot better than old ones. You learn to make connections, to fill the space your eating disorder filled with people. I think we all deserve the life-affirming connections of healthy relationships. Those relationships can only exist and unfold when we stop befriending anorexia and bulimia and make them move aside. It takes time, it's a process a journey. One well worth the effort.

Bob M: Earlier you mentioned that you attended several treatment programs. How many? Why did you have to do that? And how long was it from the time you started your first program to the point when you said to yourself "I'm recovered"?

Monika Ostroff: Four-and-a-half years, perhaps five, since the start of the first program to the recovered point. I was hospitalized in eating disorder programs and non-eating disorder programs and I'm not sure what the grand total is. Several programs, I was in more than once. I know that there was one year in particular when I was only home for a total of 2 weeks. I was searching for the answer and I was pretty determined to keep searching until I found it...within the limits of my insurance policy, of course.

Bob M: Just to clarify here, are you saying you went from one eating disorder treatment program to another in search of the right one for you? Or was it that you were able to control your eating disordered behaviors for awhile and then you relapsed?

Monika Ostroff: Nine different programs total. I finally did the math. After my first admission, I managed to stay out from July to February, then I went in for a month. Then I was discharged and stayed home until June and then I was inpatient literally all summer. I stayed out two months and went back in. Literally, in and out. I was "barely managing," I'd say. Particularly the year I was just plain old "in the hospital." The treatment part isn't well detailed in the book, but that is pretty much how it goes.

Bob M: Why did it take you five years to recover?

Monika Ostroff: Many reasons, I think. I took me that long to figure out that what I really needed was gentleness and compassion. I had a lot of clinicians give up on me, and the one person who was right there with me, well, her voice was pretty much drowned out by all the clinicians who said "you'll always be this way". It took me a long time to dare to say that I wanted to search for the shreds of worth within me and work towards a healthier life for myself. It took me that long to figure out that to get better I had to like and love myself as much as I liked and loved my friends. To do that I had to learn to listen to and heed the voice in my heart while developing my own authentic voice to express my needs, desires, pain, and dreams. All of that just takes time to cultivate. There is a lot of searching within yourself, a lot of questions to be asked and answered. It took me some time to figure out that sometimes not having an answer was an answer in and of itself. For example, "Why do I not deserve anything?" "How am I different from others?" I always felt different, but I could not define how in specific terms outside of the fact it was a feeling I held within myself. I was bad, different. Why? Couldn't say specifically. I started considering that perhaps I was not all that different, perhaps I did deserve something, perhaps bad things had happened to me by chance and not because I deserved them. All that takes awhile to realize, I guess.

Bob M:Here are some points to remember then: It's important to reach out to others and ask for help and support. That is an important part and you need people who care about you to be there throughout the recovery process. Secondly, it takes a lot of hard work. It's more than just walking into a treatment program and saying to the docs "fix me". And, as many of our previous guests have said, you may have relapses along the way. Don't give up. Deal with them early and work hard to move past them. We have some audience questions focusing on the medical aspects of your eating disorder Monika:

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Gage: I am an older woman and have been suffering with anorexia for years. I know this eating disorder is hard on the heart. I do not want to die, but I also feel I cannot win this fight. Will there be a warning when my heart has had enough?

Monika Ostroff: For some people there are warnings, but for many people there are no warnings at all. In that respect, eating disorders can be like playing Russian Roulette. They are dangerous, life-threatening. Keep struggling, striving, and choosing life. We're all with you in spirit. I believe in you!

Bob M: Gage, I want to add, we are not doctors, but many medical experts have appeared here and stated: you can simply drop dead from your eating disorder without much warning. So I hope you will consult with your doctor. Watch for shortness of breath, chest pain, heart palpitations, sudden sweating, nausea.

Diana9904: Did your body bloat and expand? When does that start to normalize and is there anything you can do to help alleviate it some? It's real hard to make yourself eat normal when you can see yourself expanding.

Monika Ostroff: I definitely experienced bloating and "expanding". My eating disorder gave me some long-lasting gastrointestinal motility problems which contributed to the bloat. The worst of it took about 5 months to pass. I tried to drink as much as possible and I made sure to wear loose clothing. The best thing I did was tell myself that the only way through this was through....if I purged or starved, and then I was just prolonging agony. I had to go through it at some point since I didn't want to keep my eating disorder forever. My body had just about had it. Somehow reassuring myself that it would end, helped. Also have your doctor or nutritionist reassure you. It really is part of the process and as uncomfortable as it is, it really does pass.

goes: Did you ever feel like you just could not fight the fight anymore and just could not see any light at the end of the tunnel?

Monika Ostroff: Yeah, I felt that way about 3000 times, at least. And I think I had a period of more than a year that I was sure that I was living at the bottom of some deep black pit; but somewhere along the way I started to realize that hope wasn't always this intense feeling. I had to search, sometimes, for evidence of hope in what I did. When you are feeling particularly hopeless, look at the fact that you are keeping your doctors' appointments, your therapy appointments, that you are reading and searching for answers. The fact that you are here with us tonight is evidence that somewhere inside yourself is the light of hope. It will grow. Sometimes even finding someone who is recovered to just sit and talk can do wonders for rekindling hope.

Bob M: The other people with eating disorders that you interviewed in your book, did you get a sense from them that eating disorders recovery was extremely difficult to reach, or was it a lot easier for some than others?

Monika Ostroff: It really varied. Some people went into a program and worked in recovery for a year and did fine, others had roller coaster courses and were in and out of the hospital. There are people that I was in treatment with who are still struggling. It is/was very varied.

Bob M: Did most have to go through a treatment program to recover, or were there many who engaged in some sort of self-help?

Monika Ostroff: Pretty much everyone had been in some kind of treatment, whether that was individual therapy, group therapy, day programs, inpatient programs varied widely among people. Most people did say, however, that the most important aspect in their recovery was learning how to respect and care about themselves, and a lot of that work was done through journals and positive self-talk. A combination of self-help and treatment seemed to be the most popular combination.

Bob M: We have some questions relating back to the early part of the conference about "coming out" and sharing the news of your eating disorder with your parents, friends, spouses, significant others.

eLCi25:What advice can you give to family and friends of an anorexic who is well aware of her problem (even gives sound advice to other anorexics on how to achieve a successful recovery) but doesn't seem to be ready or willing to get better herself?

Monika Ostroff: I would strongly encourage them to model for her. By treating her with consistent compassion and respect she will learn to integrate compassion and respect into herself. At the same time, I think it is important for the family to be clear within themselves and with her about what their limits are. For example, how much time can they devote to talking in depth with her? Set that time and commit to it, don't overextend. Are they willing to buy special food for her or not? What I'm trying to say is that we all have limits that we must respect and honor or we won't do anyone any good. I think a big part of that is also being honest and open in communication. Talking honestly and lovingly about what they see and what they are worried about. Hopefully she will be able to hear their concerns and will be able to communicate with them about what her fears are or may be.

Tinkerbelle: I am recovering from anorexia. I have always been ashamed of actually admitting my problem, even to my helpers, because I feel they view it as a weakness. Am I delaying the recovery process?

Monika Ostroff: Tinkerbelle, what you say reminds me a little of myself. I can identify with that feeling of thinking that helpers view it as a weakness or flaw, something we should be ashamed of. In reality, however they do not. I don't think that you intend to delay the recovery process purposefully, but that is the effect your silence is having right now. I think it would be an enormous step to tell your treaters just exactly what you said here tonight. It will feel scary, embarrassing, and intensely uncomfortable. Sit with those feelings, bear them. You will be amazed at how quickly they pass in the presence of your helpers' compassionate response. You will also be surprised at how much strength you will glean from doing this. It takes warrior spirit and a lot of courage to do it. It's within you, you can do it. You deserve to have a companion along the road to your recovery.

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Britany: I've recently been diagnosed with an eating disorder, but I'm overweight. Why are they so concerned? I'm 5'6". As of three weeks ago, I weighed 185. Now I weigh 165. So I'm still like 35 pounds overweight. Why should I be concerned over weight loss with this? I don't want to eat because if I do I'm afraid I'm losing the only control I have over my life. I'm afraid to eat because I really don't know how to eat properly. I know it sounds silly but...

Monika Ostroff: It doesn't sound silly at all. No matter what anyone's weight is, rapid weight loss and purging habits are dangerous and life-threatening. Working closely with a nutritionist to develop a meal plan that is acceptable and tolerable to you may be tremendously comforting. I do mean working WITH a nutritionist, you have a say in your recovery and what happens to you. Control is such a huge issue, a very important, very sensitive issue. But the way I've learned or come to look at it is--can you stop doing what you are doing with food right now? Even for one week straight? If the answer is no, you're not in control, your eating disorder is. It doesn't take long to be chained in behaviors and ways of thinking that are rigid and soon out of our control. You deserve to be free, you deserve a full life, one much fuller than the life anorexia and bulimia can ever offer you.

Bob M: And as many visitors to our site can tell you Britany, their anorexia or bulimia started with a diet. So please be aware of that and be careful.

Yolospat: I have an eating disorder, but it's just the opposite. I weigh 220 pounds, but I still have all the same feelings like the eating disorder is taking over my life. Could a program similar to yours help me?

Monika Ostroff: Absolutely. No matter what the scale reads, the process of cultivating your own unique voice, learning to listen to your heart and be gentle with yourself and your needs is the same for everyone. Learning moderation and acceptance is something that no scale can teach or define.

Jelor:Coming out seems more difficult when you are an adult and no longer with your parents. What can a person do to force them to tell people and ask for help. There aren't friends who are close. The family knows, but does not want to be involved.

Monika Ostroff:Coming out can be more difficult as an adult if you feel that there is no one there to support you, be it friends or family members. I think that attending panels of recovered people speaking and attending eating disorders support groups can be tremendously beneficial at this time. Regarding forcing someone to divulge they have an eating disorder, no, you can't force anyone to come out. That is an individual choice for the person to make on his or her own. The person may not be ready to come out yet, and that is something to consider as well.

Jelor: I'm 36 years old and was diagnosed at 30. I want to be healthy and to get well but I won't tell people or ask for help. My parents have refused. I don't really have close friends here to speak of, just coworkers.

Bob M: Jelor, I would suggest joining a local support group in your community. That way you can feel a bit more comfortable talking with others who have similar issues and hopefully that will encourage you to seek professional treatment for eating disorders.

Monika Ostroff: I also think that it is worth exploring why you refuse to ask for help. Are you afraid that people will not be there for you? That you will get better before you are ready to get better? Just some thoughts to explore.

Bob M: Also remember, recovery isn't meant to please other people. It's for YOU! So YOU can live a healthier, happier, fuller life.

xMagentax:A few people have told me I have an eating disorder, but I've only made myself sick a couple of times. I don't how to tell if I have an eating disorder or not.

Monika Ostroff: Are you preoccupied by thoughts of food and weight? Do you weigh yourself more than once a day? Will you refuse to eat certain foods because they are "bad"? Will you exercise even if you are sick or the weather is beyond bad? Do you feel anxious around food? Do you have trouble eating in front of others? These are just some other signs of an eating disorder. If food and weight take up the majority of your thoughts, chances are an eating disorder is on its way in- if it's not there already.

Debbie: My town is small enough that it doesn't have any support groups. What else do you suggest?

Monika Ostroff: Local colleges in surrounding towns often offer support groups. Many high schools also offer support groups. There are a wealth of resources on the web as well. You can call any of the national eating disorder organizations for referrals, too.

Bob M: Here are a few audience comments about things we've been discussing tonight:

dbean: Every time I go to the doctor, everything seems to be fine. So I continue in my behaviors. I feel exempt from any problems.

Tayler: I agree with Goes. It's too scary to think about recovery. I want to but I feel so completely out of control.

Sunflower22: Loving yourself and learning to cope with life without an eating disorder would be a good thing.

Ack: My boyfriend says, "If you don't like what you see, just go to the gym!" How do you help them to understand?!

Mary121: Yes, I'm really afraid to tell anyone since I haven't gotten "thin enough" yet. I can't let it go.

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Candy: I've been through an inpatient treatment center already, and did okay for a couple of months, but I am completely back into my old behaviors and try to hide them from my husband and other family members. I think they know, but how do I talk to them about it, since I am supposed to be "better"?

Monika Ostroff: An honest heart-to-heart talk. Open communication is always the answer. In the process of letting them know how you are doing, you'll need to educate them that sometimes there are slips and relapses along the way. The road to recovery isn't necessarily linear. It's also important to let them know that recovery is a process, not an event. Sometimes it isn't the precise words we use that make the communication easier, it's the fact that it comes from the heart at a time when we are vulnerable; which is scary, I admit. They may not respond in the way you hope, in which case it is perfectly okay for you to tell them that. It's okay to tell them what you had hoped for and what you continue to hope for. That is all part of learning to communicate clearly and effectively. It's also an important part of getting your needs met.

Bob M: I know it is very difficult to admit our problems. There are a lot of issues involved and certainly fear of the unexpected reactions from others plays a big part. But the other side of that is, if you don't tell the people close to you, if they find out on their own, you can expect them to feel very hurt, deceived, even angry. Imagine thinking you are with a certain type of person, then later finding out that the person didn't tell you the whole truth about themselves. And, if it helps, take the "eating disorder" out and substitute alcohol, drugs, a criminal record from the past. If someone didn't tell you about these and you found out on your own, how would you feel? The other part of it is that you want this person to be on your side, to be helpful and supportive. And being communicative and honest is the best way to accomplish that. What is your reaction to that Monika? And if anyone else in the audience would care to comment, please send it to me so I can post it.

Monika Ostroff: Excellent points. It's hard to be "up front" when you're feeling shame and feeling generally bad about yourself. But you would want to know were the tables turned. It's important to remember that people can only be helpful and supportive when they know the truth. It will be hard for you, but you are well worth the effort!

eLCi25: As a parent, I am often confused and even scared at times to talk to my daughter about the eating problem. I try to persuade her to eat and, from my experience living with an anorectic, I know how that sparks her anger, but its an instinctive response to get my child to move toward more healthy living. How do I treat the problem? Should I just not talk about it with her? I feel like a negligent parent if I don't bring it up. (how to support someone with anorexia)

Monika Ostroff: Again I think honesty is important. Ignoring the problem won't make it go away. Gentle, firm, persistence will show that you care about her, her health, and future well-being. Talking about it will inevitably spark anger. Validate the anger with "I hear that you are angry" or "I understand that you are angry." I think avoiding the anger is what gives it so much power. If you can tolerate her anger and she can tolerate yours, then you will both be able to communicate more effectively which in turn will facilitate her recovery. Of course this all takes some time.

Bob M: You told us earlier how your parents reacted to the news of your eating disorder when you initially told them:

Jackie: What did other family members say?

Monika Ostroff: I'm an only child, so my family members are limited. I have other relatives who were like siblings to me since we grew up together and lived very close. They all sort of ignored it for a long time. Then I found out that they were talking about me behind my back, saying things that were not nice, to put it lightly. I didn't get the supportive, concerned routine by any means. Though to be fair, despite my father's not understanding, he was always there to visit me, always there to care in his own way; though I admit to not appreciating his telling me to "just eat" at the time.

Rosebud2110: I told people close to me after 3 years and I got help for about 2. I just got out of the hospital about a month ago and now I am having a really bad relapse; but I am total denial that I am in trouble and I don't want to be in therapy any longer. Should I stop therapy or keep going?

Monika Ostroff: You may have answered your own question. You are able to recognize that you are having a really bad relapse and you recognize being in denial, which I interpret to mean that you are not completely connected to the severity of the situation in your heart, though your mind is able to recognize it. This alone is a fruitful topic for a therapy discussion. I can understand feeling tired, maybe stuck and a whole host of other things, but I also sense some warrior spirit in you and that part would benefit greatly if you were to keep going to therapy. I recommend going and continuing to work toward the full life that you so richly deserve.

Bob M: Two final questions: You said you have "recovered". Since that point, have you ever worried about falling back into old habits? And, if so, what do you do about it?

Monika Ostroff: In the very very beginning of my eating disorder recovery I worried about it because I'd read so much and heard so much about how eating disorders are your Achilles' heel. And I watched all of my thoughts and all of my behaviors in a way that felt disordered! I remember thinking "this is ridiculous!" Literally. I told myself that I was recovered, that I'd learned new ways to navigate through life without my eating disorder and that if I always led with my heart and followed with my head I would be fine because I knew/know that my heart would never tell me to hurt myself in anyway. I have had some intensely stressful times since being recovered and I've never fallen back into my old habits. I do notice that if I'm particularly sad about something, I'm not usually terribly hungry; but at those times, I'm also very clear within myself that it is not about food, it's about sadness. I guess that is my way of saying that I am mindful.

Bob M: By the way, do you have any lingering medical problems as a result of your eating disorder?

Monika Ostroff: Unfortunately yes. Nothing terribly serious, just incredibly annoying at times. For whatever reason, it is taking my gastrointestinal tract a very long time to regulate. I had to take a motility agent for 3 years which then gave me heart problems. I had to stop taking it. It's not the worst thing in the world and it seems to be getting better. Compared to 5 years ago, it's great! The only other thing I notice is that when I have the flu (only once in 5 years) it's pretty easy for my potassium level to drop, easier than it was before I'd had an eating disorder. That's about it for medical stuff for me. I think I'm pretty lucky in that regard.

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Bob M: What would you say are the biggest differences in your life, comparing life with, and without, the anorexia? Besides the obvious health implication, why would anyone want to give up their eating disorder?

Monika Ostroff: There are lots of reasons to give up an eating disorder (eating disorder information). An eating disorder makes it impossible for you to fully connect with another person in a relationship. The eating disorder is like a glass wall, a barrier that stands between you and the other person. And while that can be protective (if you've been terribly hurt before), it can also be hurtful in that it prevents you from having people really enter into your experience with you to celebrate your triumphs, comfort your pain, and cheer you on in your efforts to reach your dreams. The eating disorder tends to color true emotions. I feel so much more vibrant without anorexia. My emotions are clearly defined, my relationships are deep and meaningful. I am much more in tune to myself and my needs. I think my marriage has benefited enormously since my recovery. My husband and I got to fall in love all over again. When I recovered, I was, for all practical purposes, a new person. And you have so much more energy!!! All that energy that goes into starving, worrying, purging, exercising, when you rechannel that it's absolutely amazing what you can accomplish!!

Bob M: Monika joined us two-and-a-half hours ago and I want to thank her for staying late tonight and answering so many questions. We had about 180 people visit the conference tonight. You've been a wonderful guest and had lot's of good insights and knowledge to share with us. We appreciate it. I also want to thank everyone in the audience for coming tonight. I hope you found it helpful.

Monika Ostroff: Thank you for inviting me tonight! Good night everyone.

Bob M: Monika's book: Anorexia Nervosa: A Guide to Recovery. Here's her description of what the book contains: "Coming from a strengths-based perspective, it is meant to be a compassionate, understanding companion on the journey through recovery from anorexia. It offers a combination of factual information, my own story of abuse and recovery from a ten year battle with anorexia, insights from others who have recovered, practical suggestions for recovery and staying committed, a special section for loved ones, and much more." Thanks again Monika and have a good night everyone. I hope you found tonight's conference helpful and inspiring.

Bob M: Good Night everyone.

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Bob M: Good evening everyone. We are ready to begin tonight's conference on Overeating. My name is Bob McMillan. I'm the moderator. For those of you who aren't aware, this is Eating Disorders Awareness Week. At Concerned Counseling, we consider Overeating, Binge Eating, as important a disorder as Anorexia or Bulimia. Our guest tonight is Glinda West. She authored a book entitled The Fat Fairygodmother's 5 Secrets to Being Thin Forever: End your Addiction to Food and Start Your Life. Good evening Glinda and welcome to the Concerned Counseling website. I'd like to have you start by telling us a bit more about yourself and your own experiences with overeating.

Glinda West: Hello Bob and all. I first had an eating disorder when I was about 14 years old. I was anorexic. By the time I finished high school I was bulimic. A few years later, I was a compulsive overeater. I suffered from compulsive overeating for 10 years.

Bob M: What led to your compulsive overeating?

Glinda West: I absolutely could not control my bingeing. When I was bulimic, I began to vomit blood and have terrible stomach pain. I decided that being thin was not worth dying for. When I began to eat again I was not able to control the bingeing.

Bob M: And you say this went on for 10 years. Would you describe your overeating difficulty as stemming from an emotional or physical problem?

Glinda West: I believe the problem was emotional. Knowing the overeating cause, however, was not all that important in my overcoming it.

Bob M: Before we get into that part though, we're you able to discover what led to your overeating?

Glinda West: I think part of it was the deprivation I had suffered for so long by trying so hard to control what I ate. There was a definite physiological component.

Bob M: For those just coming into the room, Welcome. I'm Bob McMillan, the moderator. Our guest tonight is Glinda West. She authored a book entitled The Fat Fairygodmother's 5 Secrets to Being Thin Forever: End your Addiction to Food and Start Your Life. Tonight's topic is Compulsive Overeating. And I'm already receiving some audience comments, so I want to clarify one thing before we continue. Ms. West's book and this conference are not about "dieting". As we go on, I think you'll be a little surprised by what you hear. When you say that you "tried hard" to control what you ate, can you explain that in further detail please?

Glinda West: Well, as a bulimic and former anorexic I was always trying to control my food intake in one way or another. However, it only led me to binge more. I wasn't fully ready to give up "dieting."

Bob M: Over the 10 years, had you tried diets? or any other solutions to deal with your binge eating?

Glinda West: Oh my gosh! I had tried everything on the planet. I tried diets, diet pills, food supplements, fasting, electric shock... you name it. Nothing worked.

Bob M: Just one other question before we proceed. I would like to know your emotional state as the years progressed and you weren't able to get a handle on your eating.

Glinda West: I became severely depressed, almost suicidal at times.

Bob M: We have a couple of audience questions for you Glinda, then we'll proceed:

cloudburst: I haven't read your book; however, I find the title problematic. The implication being that one must be thin. Please explain. Thanks!

Glinda West: For most people, the ultimate goal is to be thin. Overcoming the obsessive thoughts about food is far more important.

Bob M: And how did you reach that point?

Glinda West: I took it step-by-step. I challenged the obsessive thoughts and my eating patterns on a daily basis.

Bob M: At the opening of your book, you say "You will be liberated from dieting hell! Welcome to your new life". The first thing you say is "food is not the issue". Can you explain that?

Glinda West: Focusing on food will only create more of an obsession. People need to look outside and find a good life while they are challenging the obsession.

Bob M: In fact, you mention that you lost many good years of your life because you were obsessing about food. What did you do to break the obsession?

Glinda West: I tried to take the obsessive thoughts as they would come. I would say "Stop" in my head, and immediately substitute another thought about something else.

Bob M: Did you keep a diary or use some other tool to measure your thoughts?

Glinda West: No. I only tried to be aware of what my thoughts were. As I would begin to have a thought about food, I would immediately substitute another. This is only one technique. The obsession will only go away when you make a minute-to-minute effort to fill yourself with thoughts about your life, not food.

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Bob M: One of the things that I've always heard is that when it comes to "recovery", you have to learn self-acceptance. Did that happen to you? and what did you come to accept?

Glinda West: To be honest, I don't think I am that different now, than when I was suffering from the eating disorders. I think people can often be too cerebral about this. Behavioral changes can make all the difference.

Bob M: Ah...but one of the things you mentioned in your book, which I want to bring up, is that you said "The first thing I had to accept was that I was fat". And secondly that the diets you tried just weren't working. Was that a hard point to get too?

Glinda West: You are correct. You must accept yourself as fat. No, it was not difficult to get to that point. I finally decided that I was a worthwhile person no matter what my size. If people did not want to accept me that way, that was their problem.

Bob M: Here are a few audience comments on what's been said so far, then we'll get to audience questions.

CeeJay: Food is so important to me. I can't imagine what it must be like to be free of its control.

Glinda West: It feels incredible. Like finally being free to live!

cartoongirl: Don't you think it's time for "overweight" people to take a stand and tell everyone to shove it? I mean...it's like telling a person he should feel guilty for being 7 feet tall!!!

Glinda West: Yes, but you could waste your whole life doing that. Some people will never accept fat people. You must get on with your life.

Kaet: How overweight were you when you felt you needed to get a handle on it?

Glinda West: I was approximately 80 or so pounds overweight. The most important thing was that I could barely go a minute without thinking about food. That, was the real problem!

Rob2: Glinda, how do you stop obsessing about food, when you have received numerous counseling sessions and you have more knowledge than you can deal with? Also how do you deal with the shame, especially if you are a registered dietitian?

Glinda West: Ah, 2 problems. First, I believe you can spend your life in counseling and never get over the eating disorder because you just go round and round with the causes. Enough already. There comes a time when you just have to take action. Secondly, I feel for you having an eating disorder with the career you have. Look to the future, you can beat this. Concentrate on that and don't worry what others think.

nbp: So you're saying that you don't feel it's necessary or even beneficial to address underlying emotional/psychological problems? I was under the impression that this was the most "mainstream" method of dealing w/ eating disorders. Why do you feel that your approach is better?

Glinda West: I think you can get lost forever in therapy for eating disorders. If you take action today, you can begin extinguishing the eating disorder in a relatively short time. I may still not be psychologically perfect, but who cares? I beat it that's what matters.

CeeJay: Was secrecy and hiding food part of your struggle? I seem to enjoy the secrecy..like a game.

Glinda West: I used to love the secrecy.

Bob M: Before we go further, because I'm getting some audience questions on where to purchase the book. It is not available in bookstores, but you can get it through Glinda's website. Can you give that to us please Glinda?

Glinda West: Thank you. At the fatfairygodmother site.

Bob M: And while she's typing that out, I read the book. It's about 50 pages.. and a very good read.

Glinda West: I'm glad you liked it.

Bob M: So we've gotten to the point where you decided to stop obsessing about food. What did you do next?

Glinda West: Well, I couldn't stop immediately. It took constant vigilance. Then I began to stock up food. I found by accident, that when I stocked all of my favorite binge foods, so much of them that I couldn't possibly run out, I began to binge less.

Bob M: What was the reason for that?

Glinda West: Because if I wanted to eat cookies and there was half a bag left. Guess how much I would eat? The entire bag. However, if my favorite cookie supply was virtually endless, I would stop on my own.

Bob M: So essentially what you are saying is that your favorite foods were no longer "very special". And when you had everything you wanted around you, food-wise that is, you were able to reach a point where you said "enough is enough".

Glinda West: Well, I still loved them. I still do. But the urgency and deprivation were no longer there. Also, I began to want different foods.

Bob M: And the different foods were lower in calories and healthier for you?

Glinda West: Not always. Counting calories or fat grams was irrelevant to me. I ate what I wanted.

Bob M: So are you saying, you just ate less?

Glinda West: Yes, I did not stuff myself as much because I could have whatever I wanted, whenever I wanted, and I did not let myself feel guilty about what I ate. The important thing was to minimize the obsessing over it. And to lessen the amount of time I thought about food.

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Bob M: The second thing you did...and I can sort of hear a groan from the audience right now...is begin exercising.

Glinda West: Wrong. I hate "exercising." Never exercise to lose weight or burn calories. I found my "inner athlete." I found the sporting life. I found that I liked sports. Even an unathletic, overweight girl like me, found a sport she liked doing. I began doing the sport for the fun and challenge of it - not to lose weight. The side benefit was that my metabolism became more efficient.

Bob M: Your statements are spurring audience comments and questions. Here are a few:

CeeJay: I very much understand the urgency and deprivation feelings. Stocking up on food sort of lessens the panic of it being all gone or taken away, I guess.

Rob2: Exercise is the KEY to it all. I will not talk to my patients at all about weight loss unless they address the activity factor. It changes your whole frame of mind. On the days that I run, I do not overeat.

Connie21: So that is the answer just keep loads and loads of food on hand? So the key to beating obsessing over food is just to allow yourself whatever you want, whenever you want it?

Glinda West: If you keep loads and loads of food on-hand, I guarantee you there will be a calmness that wasn't there before. This is only one aspect. Please don't take it out of context. I cannot condense the entire book in one hour.

nbp: My husband overeats as a means of dealing with stress and depression. He is overweight, continuing to gain, and beginning to experience health difficulties such as high blood pressure. I have expressed to him my concern for his health and happiness, but he refuses to seek counseling. What steps can I take (w/o nagging) to help him?

Glinda West: I don't know if you can do it for him. Sometimes people have to come to this readiness on their own. Even when I knew the secret to overcoming the eating disorder, I took my time, because I was not completely ready to give up food.

Bob M: Was there something, an event, that brought you to that point? Or was it merely a realization, either immediately or over time?

Glinda West: Well, there is that funny story in the book. That kind of did it for me. Supreme humiliation was kind of a good motivator. I was also just plain sick of thinking about food and my weight.

Bob M: Glinda's book is: The Fat Fairygodmother's 5 Secrets to Being Thin Forever: End your Addiction to Food and Start Your Life. 

So far, we've touched on:

• Secret 1: Get a life...don't make food your life.
• Secret 2: Make food and your weight "non-issues". Start thinking about other parts of your life...and take action on the food part.
• Secret 3: STOP DIETING. Get off the dieting yo-yo.

Glinda West: The ultimate goal is to learn to eat like a normal person again according to your body's cues.

Bob M: And you mention Glinda, that dieting is not good for you or your body. Why?

Glinda West: Dieting will only cause obsessive thinking about food. It is always a losing proposition. Also, you will slow your metabolism and end up gaining weight on less food.

Bob M: Secret 4: Find your inner athlete. Find activities that you enjoy doing...and do them for yourself, not to lose weight, but for the challenge and enjoyment of them.

Glinda West: Exactly. Bob

Bob M: And Secret 5: LEARN TO EAT NORMALLY. And this may be the hardest step of all, right Glinda?

Glinda West: Yes. Many people who are compulsive overeaters have no clues about hunger and fullness. This does take some time.

Bob M: How did you rediscover them...the feeling of hunger and fullness? and what did that take to accomplish?

Glinda West: Like I said, I started by allowing myself to eat at will. When the urgency to binge began to subside, when I knew I could eat whatever I wanted for the rest of my life, I began to feel hunger and fullness more often. Also, paying attention to my life, not concentrating on food, but on other activities, helped me feel hunger more often. I wasn't standing in front of the refrigerator as much.

Bob M: At the beginning of tonight's conference, you said you had been through anorexia, bulimia, then compulsive overeating. That last phase, bingeing, went on for 10 years. How long did it take you to get through this 5-Secret process?

Glinda West: It took approximately 6-8 months before I knew the obsession was lessening for good. I was bingeing less frequently and did not have the urge to stuff myself beyond fullness as much. At about the same time, I noticed I was not thinking about food as much. The psychological changes continued for about another 8 months during which I was losing weight gradually, but consistently. I lost almost all of the 80 or so pounds during that 16 months - really without effort. I am currently 5'3" and weigh about 105 pounds or so. My anorexic weight was 86 pounds. I do not obsess about food in any way. It has really become unimportant to me. I don't think the process needs to take this long for everyone. I had to experiment. Remember, I discovered this method, by accident. There was no book for me.

Bob M: Here are a couple of comments:

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Ceejay: Before this is over, I want to say that I admire your will and determination to overcome your problems with food. It gives me the hope that I needed tonight and a renewed will to fight. Thanks.

Glinda West: You are absolutely capable of this. I am no different from you.

cartoongirl: Health clubs and shrinks are capitalizing on your guilt and vanity. It's time for people to see that the real problem lies in prejudice and if society wants its people to be thin, then it had better demand more from genetic medicine! Society WANTS us to feel shame...it controls us...makes us spend money to fix us.

Glinda West: Forget about society, its too big to change. This is your only life. Be happy and work on yourself.

Diane: Even if you have the knowledge to eat normally, it doesn't mean you will do it on a daily basis.

Glinda West: I eat more on some days, less on others. The important thing is not how much I eat, but how much I think about food. Don't forget this.

Bob M: One last question from me tonight. Do you ever worry about slipping back into the overeating habits, or have the new regimens become ingrained...and this is the new you...the everyday you?

Glinda West: I know I will never "slip back" because there is no deprivation in how I eat. I am not drawn to food obsessively. I enjoy it. Anybody want to take me to dinner?

Bob M: I want to thank Glinda for coming tonight and sharing her experiences and knowledge with us. And thank you to everyone in the audience for participating. I hope you found the conference helpful and inspiring.

Glinda West: Thank you Bob for inviting me.

Bob M: Glinda's book can be purchased on her website. It's called "The Fat Fairygodmother's 5 Secrets to Being Thin Forever: End your Addiction to Food and Start Your Life". 

Glinda West: Goodnight, and know there is hope for all of you.

Bob M: Good Night everyone.

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Bob M: Good Evening everyone. Our conference tonight is geared for PARENTS, SPOUSES, RELATIVES, FRIENDS of those with Eating Disorders. Mary Fleming Callaghan, author of Wrinkles on the Heart, is sharing with us a parent's perspective and how she and her family dealt with her daughter's eating disorder. Just a little background, as with many of our conference guests, one of our site visitors recommended that I contact Mary and ask her to be here tonight because she shares a unique perspective that we don't often get here. Although, we get many emails from friends, parents, siblings, spouses on what they should do to help someone with an eating disorder, they don't know where to turn. And they, too, are going through a lot of emotional turmoil. Good evening Mary and welcome to the Concerned Counseling website. Can you please give us an abbreviated version, to start, of who you are and how you came to write a book about your experiences?

Mary Fleming Callaghan: I wrote Wrinkles on the Heart for the thousands of parents out there whom I knew were suffering as we had. I wore myself out going from one bookstore to the next trying to find a book written by a parent. There were none. That's when I began to think about writing my own book, giving at least one parent's perspective on this horrendous disease. The result was Wrinkles on the Heart. Our family learned much during the six years of Kathleen's illness. I hope I can share some of those lessons with people tonight.

Bob M: How old was your daughter when she developed anorexia? and how old is she now?

Mary Fleming Callaghan: She was 15 when she became anorexic (anorexia information). And she is now 36.

Bob M: How did you discover that she had an eating disorder?

Mary Fleming Callaghan: One day she said that she was going to go on a diet and we all laughed at her. She was 5'8" tall and weighed 120 pounds. As time went on, we began to notice her losing weight. (signs of eating disorders)

Bob M: And then, when did you find out this was getting more serious and how did you find out?

Mary Fleming Callaghan: Her sister, Molly, told me she was waking up in the night and exercising in her bedroom. She would do sit ups and running in place. She wore baggy clothes so we didn't realize how thin she was getting. At her worst she got down to 69 pounds.

Bob M: Did she come to you and say "I've got a problem"? Or did you go to her?

Mary Fleming Callaghan: We confronted her. She did not feel that she had a problem. She believed she was too heavy and felt that she had to be thinner.

Bob M: So this is 15-20 years ago. I'm sure not much was known about eating disorders at that time. What was your reaction to what you saw?

Mary Fleming Callaghan: We were appalled because she was so thin to begin with, and were unimpressed with the way we were treated by the professionals.

Bob M: How did you feel as a parent?

Mary Fleming Callaghan: Guilt, at first. Then anger at her, and at the system.

Bob M: For those of you just coming in, Our conference tonight is geared for PARENTS, SPOUSES, RELATIVES, FRIENDS of those with Eating Disorders. Mary Fleming Callaghan, author of Wrinkles on the Heart, is sharing with us a parent's perspective and how she and her family dealt with her daughter's eating disorder. Can you explain why you were feeling guilty?

Mary Fleming Callaghan: I think parents are programmed to feel guilty, wondering where they went wrong, what we might have done to cause this aberration.

Bob M: And for yourself, what did you think you did to cause your daughter's eating disorder?

Mary Fleming Callaghan: After many months of reflection I could not see that we had done anything to cause her to do this to herself and to us. This guilt only lasted for me about 3 or 4 months, then I got angry.

Bob M: We will be taking questions/comments for our guest tonight. To send one, please type it in the regular "send box" at the bottom of the screen and make sure you click on the 'SEND TO MODERATOR' button....not the regular send button. If you don't click the 'SEND TO MODERATOR' button, our guest will not be able to see your question. Before we continue Mary, here are a few audience questions:

Coulleene: At what point did your daughter accept she had a problem?

Mary Fleming Callaghan: After a couple of years and after a great deal of psychotherapy, she finally admitted that she had a problem.

ack: How did you convince her to get help.

Mary Fleming Callaghan: We didn't. We just took her into the Diocesan Child Guidance Center and to the family doctor. We didn't give her a choice.

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Bob M: So let me ask you Mary, is it important then, as a parent, not to negotiate with your child about getting eating disorders help, but just to take matters into your own hands, take action?

Mary Fleming Callaghan: When Kathleen became anorexic, she was 15, but emotionally she was more like a 10-year-old. I wasn't aware of that at the time, but learned later that it was a fact. When a 10 year old needs medical attention, you don't ask their permission.

SpringDancer: You are saying you forced your child into therapy. How did she react to that? Was there a lot of hostility between you?

Mary Fleming Callaghan: Non-communication was her defense, which was extremely frustrating.

Bob M: Just so the audience knows Mary, do you have any other children besides Kathleen?

Mary Fleming Callaghan: Yes, Kathleen is the youngest of four. Two older brothers and an older sister. It was devastating to the whole family.

Bob M: How was your husband reacting to the initial stages of all this?

Mary Fleming Callaghan: Complete denial. He felt it was just a behavior problem and she just needed a swat on the butt.

Bob M: For many families, when a crisis comes up, they either pull together, or it can become very divisive. How did your family react?

Mary Fleming Callaghan: We polarized into two opposing camps. Only when we learned to work together did we see any improvement in Kathleen's behavior.

Bob M: And how did you manage to work together. Please explain the process you went through to get to that point?

Mary Fleming Callaghan: It took years. The divisive atmosphere did not work, so we had to try something else. And that was confrontation, despite the doctor's advice against it. When we did this, we saw an immediate change in Kathleen's behavior. It was almost as if she wanted us to do this.

EmaSue: Mary, what did you say to confront Kathleen, and how did she react?

Mary Fleming Callaghan: She was on a home visit from a hospital stay. She had been home 7 hours and had not eaten anything. We confronted her and asked her if she was going to eat, and she said "No". We told her that we felt that any normal person eats at least once in a 24 hour period, and if she wasn't willing to do that, she wasn't welcome at home. We took her back to the hospital, and we had never done that before. I feel that was a turning point.

Bob M: That's pretty amazing. That takes a lot of strength. I'm wondering if you and/or other members of your family were getting therapy to help you deal with your own feelings and interpersonal relationships while all this was going on?

Mary Fleming Callaghan: No, we didn't. We were very concerned about our insurance running out, which just added to the stress. I was able to write. That helped me. George had a more difficult time. The kids dealt with it according to their different personalities. One freaked out, another refused to get involved. It ran the gamut.

Bob M: How long did it take for Kathleen to recover? (eating disorders recovery)

Mary Fleming Callaghan: Six to seven years.

Bob M: What do you think were the major difficulties you encountered along the way?

Mary Fleming Callaghan: Prior to this event in our lives, I felt a parent should always be there for her children. Wrong. When Kathleen was a minor and so needy emotionally, we saved her from herself on numerous occasions. Each time her weight dipped into the danger zone, we put her back into the hospital. After three years of this, we drew a line in the sand. One of the major difficulties was learning not to focus on the disordered person to the exclusion of the other family members, or you end up with more problems than you started with. Many years after Kathleen recovered, Molly told me she had some problems during that time but never brought them to us because we were so unstrung over Kathleen's eating disorder. I apologized to her, but it was too late to help her at that point. Fortunately, she was able to get through these difficulties on her own. It probably made her a stronger person as a result, but I wish I could have been there for her.

Bob M: I think that's an important point you made about the other children...because if you focus all the attention on one child, the others start to think they are less significant, or their problems are less significant, or that you are already "tortured", so they don't want to burden you with their difficulties. Did your other children become resentful of Kathleen?

Mary Fleming Callaghan: Yes, after it dragged on for six years, we all lost patience with it and the anger was more on the surface.

Bob M: Here are some more audience questions:

HungryHeart: What do you do when you see your child losing weight and you can't stop it.

Mary Fleming Callaghan: See that they get medical attention and counseling. That's all you can do. We are not supernatural creatures, so we shouldn't expect the impossible of ourselves.

Jane3: If she was 15 when she got sick, how long was it before you noticed she was sick and began to seek help?

Mary Fleming Callaghan: Almost immediately, within a month of her announcement that she was going on a diet.

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Connie: Mary, do you have any suggestions to help avoid a long-term recovery?

Mary Fleming Callaghan: Yes I do. I think of it as a triple threat, self-respect, unity, and tough love. To me the flip side of respect is self-loathing and guilt. Dedicate yourself to putting the guilt behind you. It's a gigantic roadblock. On the other side of that roadblock is good health and a bright future for your loved one. You cannot help her reach that goal until you eliminate the barriers to it. Convince yourself that, imperfect as it might be, YOU DID THE VERY BEST YOU COULD IN RAISING YOUR CHILD. Forgive yourself, so you can move forward with confidence. 2. Unity. Call a meeting and invite anyone who has a significant relationship with your daughter. If there are seven people attending this session, they must try to reach a meeting of the minds about how to deal with her problem and her methods of undermining your alliance with each other. If you never worked in tandem before, now is the time to do it. Think of this as "war strategy" because as surely as I am typing this, you are engaged in a war against the tyranny of an eating disorder. 3. Tough love. As soon as you determine that something is not right with your daughter or loved one, see to it that she gets the best health care and counseling that you can provide. After that is established, I suggest you set limits just as you would for any other phase of the child's life. You don't allow a minor child to eat a favorite food until they get sick or to stay out as late as they want. No, you set limits. Well it's the same for an eating disorder. You let them know you love them and want to help, but that there are limits to that help.

EmaSue: I am afraid to confront my daughter!

Mary Fleming Callaghan: What do you think will happen if you do?

Bob M: That's a good question....because I think a lot of parents are afraid their child will reject them. Did you experience that?

Mary Fleming Callaghan: No. I was devastated because we had always been close, and I could no longer talk to her, because she wouldn't talk. But she always knew we loved her.

Bob M: Mary's book, Wrinkles on the Heart, is a diary of her experiences and edited letters she wrote to various people during the times of her daughter's eating disorder. 

Lynell: What do you mean by limits?

Mary Fleming Callaghan: Removal of privileges always worked in our household, but this has to be determined by each family. The age of the child is always a factor as well. When realistic limits are set, no waffling is permitted. The child may beg and promise, but parents must stick by their guns. With Kathleen, after 3 years, we learned that we had to put harsh-sounding boundaries on what we would tolerate regarding her non-eating tendencies. And just one final thought on this subject. I strongly feel that a parent can be TOO understanding. It's not sac religious to think this or even to say it out loud. I know because we twisted ourselves into pretzels trying to be sympathetic and tolerant. Not only did it not work, but she got worse, and we became enablers.

tennisme: Is your daughter really completely recovered or does she still maintain a low weight? Is her mind really quiet?

Mary Fleming Callaghan: She still maintains a low body weight, but she has always been thin since the time she was little. I'm sure she'll always be weight conscious, but aren't we all. She certainly no longer evaluates every piece of food she puts into her mouth.

Bob M: Do you, and other family members, still worry about her Mary? Is that now a part of your emotional life?

Mary Fleming Callaghan: Well, I think that she knows that I think she would look better if she were heavier, but we never talk about it because it's none of my business. I don't worry about her now anymore than I do my other three children.

Emily: Mary, was there ever a conclusion as to why Kathleen became sick with an eating disorder? Did she ever say why?

Mary Fleming Callaghan: I think it was because she was so immature emotionally. She wanted to stay a little girl. She could avoid the stresses of teenage life if she stayed little and protected by family.

tennisme: Mary, are you weight conscious yourself, even after such an ordeal? Really shows how brainwashed we all are.

Mary Fleming Callaghan: Oh definitely! In fact, I started a new diet yesterday.

Bob M: So now, we at least have an understanding of the family dynamics. Can you give us some insight into your experiences with the various doctors and hospitals and eating disorders treatment programs your daughter went through. What was YOUR experience with these people and institutions?

Mary Fleming Callaghan: Twenty years ago, it was entirely different than it is today. They had to find a scapegoat, so the family was convenient, especially mothers. The literature at that time bears this out. Of the twelve doctors and therapists that Kathleen had over the years, we found two that we could work with. I like to think that today it is different, and that parents aren't put under this additional stress of blame by the professionals.

Bob M: But for some, it's hard to find straight answers. I think that one thing that also compounds the emotional difficulty that parent's go through is that sometimes you can't get a concrete answer on "why" your child has developed an eating disorder. How would you suggest that parent's deal with doctors who aren't giving straight answers, Mary?

Mary Fleming Callaghan: I really don't know the answer to that. I think you have to be honest with them and not allow them to send you on a guilt trip. Parents should do what these parents are doing here tonight. They should try to find out as much as they can about the disorder and go from there. I don't know if there are any straight answers, it's such a muddle. So many things are involved.

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Bob M: and for parents and others here, we've held many conferences on eating disorders with all sorts of experts. You can view the transcripts on eating disorders here.

I am interested, how much money did you spend out of your pocket and through insurance to get to the point of recovery? 

Mary Fleming Callaghan: None. We were lucky. My husband, George, had excellent insurance. And we didn't have managed health care then. Through insurance, it was thousands.

Bob M: You are fortunate, because that isn't the way it is today. And many parents are also dealing with the stress of money problems.

WillowGirl: What's it like to be a mom of an anorexic daughter? Now, and especially at the time your daughter was in the throws of her eating disorder? Was their a social stigma attached to that for you?

Mary Fleming Callaghan: It was one of the hardest things I've ever been through, but I don't recall any stigma attached to it. I have always felt tremendous sympathy for the parents of bulimics. I could at least talk about my daughter, but many parents of bulimics don't feel that way because of the nature of the disease.

Bob M: Put yourself in this position Mary...you know a girl who has an eating disorder. If she wouldn't go to her parents and tell them, would you go to her parents?

Mary Fleming Callaghan: I'd talk to the girl first and encourage her to tell her parents. If that is unsuccessful, then I might consider it, but it should be the girl's responsibility, not mine.

Bob M: Thank you Mary for coming tonight and sharing your insights and hard-learned lessons with us. I also want to thank everyone in the audience.

Mary Fleming Callaghan: Thank you for having me, Bob.

Bob M: Here's some audience reaction:

EmaSue: Thank you very much and God bless.

HungryHeart: I found this to be enlightening

Bob M: Good Night.

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Online Conference Transcript with Stacy Evrard on Her "Experiences with Anorexia"
and Dr. Harry Brandt on "Getting on the Road to Recovery"

Ed. Note: This interview with Stacy Edvard was conducted in 1999. On April 15, 2000, Stacy died from medical complications stemming from her eating disorder, anorexia nervosa.

Her sister, Cheryl Wildes, chronicled Stacy's long battle with anorexia on her website. She writes:

"Stacy fought a long, hard battle against this devastating disease. For all of you that have known her in person or through my website, I thought you should know: Eating disorders do kill. Even the toughest people die from them. Please let her story help in warning others of the danger. Get help and get it early. Stacy was on her way to a 6-month treatment program when an infection set in and ended any chance of recovery. Don't allow your chance, or the chance of a loved one, come too late."

Bob M: is the moderator.

Stacy: Hi Bob. Good evening everyone. Thanks for inviting me.

Bob M: How long have you been dealing with anorexia and how did it get started?

Stacy: I have been dealing with anorexia since I was 16. I have had it for 20 years. It got started when I was 16. My mother used to weigh my younger sister and I every Sunday morning. I think that's when my obsession started.

Bob M: Can you tell us how the anorexia has affected you mentally, and then physically, over the years?(complications of anorexia)

Stacy: I have short-term memory loss and tend be depressed a lot. Physically, I had kidney and liver failure, 3 heart attacks and have been hospitalized over 100 times. Now I cannot exercise, or bike, or even rollerblade unless I take it very slow. My heart tends to beat very fast. I also have to be in the hospital 2 days a week to be hydrated and get potassium infusions.

Bob M: When the anorexia started, at the age of 16, were you in denial, or did you not recognize it as "being a problem"?

Stacy: Back then, nobody had ever been trained to deal with eating disorders. I didn't even know what anorexia was.

Bob M: Why do you think it got so out of hand - to the point where you are today?

Stacy: Well, I went to a summer camp when I was sixteen, and I just stopped eating because I wanted to lose weight. Years of abuse take their toll on a body. I was raped when I was 17 two times, and started to really feel that I was not worth much. This time around, I got really sick after an operation and I couldn't keep anything down for a month. It threw me right back into my disease.

Bob M: Now you know, there are people in the audience saying, you are unique. They may be saying "this can't happen to me. I WON'T LET the eating disorder get the best of me". What do you say to them, Stacy?

Stacy: IT WILL HAPPEN IF YOU DON'T GET HELP!

Bob: We are speaking with Stacy Evrard. She is 36 years old and has been dealing with anorexia for 20 YEARS. During that time, she has had 100 hospitalizations, 3 heart attacks, kidney and liver failure and literally been at death's door. A little later, Dr. Harry Brandt, medical director of the St. Joseph's Center for Eating Disorders will be joining us to discuss "getting on the road to recovery". Stacy, here are a few questions from the audience:

want2bthin: Stacy, how much have you recovered?

Stacy: I feel like I am stable right now. I am not as depressed at before, and I try to be a little bit more social. College has really helped me to build up my self-esteem. I haven't lost any weight in the past 2 years. But I am not any better physically. Actually, I am worse.

Heatsara: It seems you have had to acknowledge the need for help and support. Can you talk about how you came to that realization and what you went through when you "admitted" you needed help?

Stacy: I watched a program about anorexia and realized that I was not the only one with anorexia. I went to an eating disorder treatment center, but they kicked me out because I was not compliant. When I was sent to the state hospital and lost 16 pounds in 3 weeks, I realized that there was something wrong in my head.

Jenna: What role did your friends and family play in your eating disorder recovery? How did you reach out for help?

Stacy: My family was too far away to give me any help. Although they were very concerned about me. I have a 16-year-old daughter and I want to live to see her grow and have kids. Some of my friends left me because they couldn't watch me die. Everybody thought that I was going to die when I weighed 84 pounds.

Donnna: Stacy, what really made you decide enough was enough? I've been both anorexic and bulimic for 26 years and am totally sick of it.

Stacy: When I didn't know who my daughter was when she came to visit me at the hospital, my brain finally got the message. Because of my daughter, I have a reason to live. Before, I just wanted to go to sleep and never wake up.

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Bob M: Since you've been dealing with this for 20 years, why has it been so tough to get through recovery?

Stacy: I am not recovered, but I am stable. I have a treatment team, they help me out a lot, but I just can't convince myself that I am terribly underweight. I will get better. SOMEDAY I WILL.

Bob M: You also mentioned that your family lives far away from you. I imagine it must be difficult to get through recovery without the support of family, without them actually being there to help you. Is that true or not?

Stacy: Sorta, I visited a few times last year. I was fearful that they would reject me because they thought that I looked so bad. I try to just give them a: "I am doing fine". I don't want pity from them either.

Kathryn: Stacey, is your memory loss permanent or can it be reversed? My doctor knows a lot about Magnesium, which is what causes the problems in memory and sometimes I have to get infusions. I also know a girl who is on daily infusions of Magnesium.

Stacy: I cannot remember a lot of things. My doctor told me that maybe I don't need to remember. Apparently, I was extremely bad off. I get potassium when my levels are not too low. That helps me remember a little better. I went to college to relearn and to help me store my memories so that I can retrieve them when needed. Chronic malnutrition also has effects on memory.

JYG: I'm 19 and I have battled through this for about 7 years. Even though I have been in recovery for about a year, every once in a while I still find myself throwing up. Stacy, I believe that you can get through this. But I wonder, does it ever really all go away?

Stacy: You know, I guess that those who have recovered would have to tell you that. I think that it sorta hides sometimes only to come out of hiding when we don't expect it.

Bob M: I want to add here JYG, that when Dr. Barton Blinder, an eating disorders expert, was here a month or so ago, he mentioned that research has shown that those with eating disorders, for the most part, suffer relapses at one point or another. Depending on your dedication to treatment the relapses can happen within 5 years of what you might call "recovery". The most important thing is to recognize the relapses and continue to seek eating disorder treatment...so you don't slip all the way back. He also said that research has shown that the most effective way to treat an eating disorder is first with hospitalization, then medications and intensive therapy, followed by continued therapy.

tiggs2: What's the hardest part of your eating disorder recovery?

Stacy: I am not recovered, although I wish I was.

Ranma: How have you managed to explain to other family members and friends what it is like to live every day with an eating disorder?

Stacy: My family has known about this for so long. They have accepted the fact that if they put a big plate of food in front of me, that I won't eat it. I live, I survive, and I try to not think about it a lot. I do presentations at the college so that they can understand what people with eating disorders live with.

Bob M: What are the two most important things you have learned from your experiences?

Stacy: One, never just quit eating to lose weight. Get help as soon as you can. I may not be recovered, but I live with it. I know that I will get better someday. Don't wish an eating disorder on anybody.

Bob M: Here are some more audience questions:

Ranma2: Stacy, I am a 19-year-old anorexic. Most of the time I starve myself and take diet pills. But sometimes I do eat like other people, so I always feel that I am not really anorexic at all. Could this be true?

Stacy: I don't think so. Do you feel weird after you do eat?

Bob M: And let me add, anorexia is not just about weight or being able to eat an occasional meal, it's also about how you see yourself, body-image, self-esteem, and how you deal with eating issues. So, Ranma2, being able to eat "normally" on occasions, does NOT mean that you are not anorexic. I think a licensed doctor would have to help make that determination.

Sel: What sort of therapy/treatment have you had over the years? What if anything are you in now?

Stacy: I see my therapist twice a week, see my medical doctor once a week, and I spend two days a week in the hospital for hydration and potassium. Each member of my treatment team knows what the others are doing.

Kelli: Is it possible, do you think, to talk your family and friends into not worrying about you and constantly expressing their concerns about you having "a possible eating disorder"? In other words, I want them to lay off. How do I accomplish that?

Stacy: I try to. I do not let new friends know that I am sick. I only tell them after we have gotten to know about each other better. Therefore they meet me, not my eating disorder.

Bob M: How do they react, once they know? And, if they are surprised or upset, how do you deal with it for yourself?

Stacy: Most of the time they offer me some of there weight :). Once they know, they don't bother me about eating. For myself, I try not to think about it if I can.

UCLOBO: Stacy, I am a 17-year-old bulimarexic and have suffered for 4 years now. Do you think it is possible to recover without professional help?

Stacy: NO!!!!!!!

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Bob M: I want to post a few audience comments....

Marissa: I have had anorexia since age 10. I am now 38 and just found out 4 months ago that I have it.

Laurie: It's kind of hard Stacy, for fear and threats to health to scare one engaged in self-starvation into changing.

Ellie: College usually makes it worse because of the stress.

Donna: I too have a daughter who is 4 yrs. of age. I want to be here for her. I'm ready to end this battle myself. It seems though that every time I hit an issue in my recovery, I fall back to the behavior

Taime2: I've struggled with this eating disorder for so long, I wonder if there is any hope.

Zonnie: Stacy, do you ever want to go back all the way to how you were before? I'm doing better, but I miss it, however weird that is.

Ranma2: I feel extremely guilty after I eat. Like I have done something shameful Stacy.

Irishgal: I have restricted my calorie intake to 200 calories every other day which I guess turns out to be 100 a day. I am trying to get back to my goal weight of 88 where I was a year ago, but its destroying me now. I passed out and got a bloody nose at swim practice today. I don't know what to do!!!

Julia: I know that my family and friends are worried about me all the time. If I go out for a walk, if I go out for dinner, if I am not feeling well, etc. They seem to make a mountain out of a molehill.

Bob M: Here's a follow-up question to the telling family or friends comment Stacy:

UCLOBO: How, would I go about telling them? See, they would COMPLETELY freak out on me and take me out of b-ball and that is my college tuition. I'm very scared to tell them.

Stacy: They may understand, you cannot just push it at them. Let them know that you are in treatment.

Bob M: You can't force it on them. Let them know you are having difficulties...but that you are, or want to do something about it. UCLOBO, one of the most important keys to recovery is getting the help and support you need. Many people are afraid that if they tell their family or friends, they will be rejected. You are not alone with those feelings. But most family members care about each other and want to help. However, don't expect them not to react to the news. And remember to give them time to digest it. And, if your parents are not the supportive type, then you have to seek treatment on your own. Hopefully, you have a friend or two who can be there for you.

Bob M: Stacy, I want to thank you for coming here tonight and sharing your story with us.

Stacy: You are welcome Bob.

Bob M: The audience has been very receptive to your comments. Our next guest is Dr. Harry Brandt. Dr. Brandt is the medical director at St. Joseph's Center for Eating Disorders near Baltimore, Maryland. It is one of the top treatment facilities in the country for eating disorders. Prior to that, he was head of the eating disorders unit at the National Institutes of Health (NIH) in Washington, D.C. I will mention right now that if you are serious about getting help for your eating disorder, and it doesn't matter where in the country you live, you might want to investigate St. Joseph's. The Center is located in Baltimore, Maryland...but people from all over the country go there for help. After the in or out-patient treatment, they will help you arrange for treatment in your own community. And they will help with sorting out your insurance or medicare/medicaid. They have special financial counselors to help with that. Good evening Dr. Brandt. Welcome back to the Concerned Counseling Website.

Dr. Brandt: Thanks Bob, it is a pleasure to be back.

Bob M: You were here for Stacy's story and her battle with anorexia. How difficult is it to overcome an eating disorder?

Dr. Brandt: Eating disorders are nasty illnesses....and as we could tell from Stacy's story, they are difficult to recover from.

Bob M: What makes it so difficult?

Dr. Brandt: There are many reasons. First and foremost, the dangerous behaviors of the illnesses are highly reinforcing. Our culture tends to drive people to continue these behaviors.

Bob M: But why, once you recognize them as dangerous, is it so difficult to stop them?

Dr. Brandt: I think it varies for the different illnesses. I'll take them one at a time. In anorexia nervosa, starvation itself is a potent perpetuating symptom. As people starve, they want to lose more and more weight. They often describe that after they have lost several pounds, something "clicks in" and they want to lose more and more weight. Similarly, the bingeing and purging of bulimia is also perpetuating. People describe feeling "soothed" by the behavior. Because the anorexia symptoms are gratifying, they are difficult to give up. The longer they progress, the more difficult it is to give up the primary symptoms.

Bob M: So, what you are saying is, if you catch the symptoms early, there is a better chance of recovery and a better chance of a longer-lasting recovery. Am I correct?

Dr. Brandt: Yes, early treatment is important and highly effective. But, I have seen many people like Stacy ultimately recover as well.

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Bob M: For those who want to know: what it is like when you check into the eating disorder treatment center? What is a typical day like?

Dr. Brandt: First, patients undergo a series of psychological and medical assessments. Then, they are engaged in a multi-modality treatment that entails efforts to block the primary symptoms of the disorder while trying intensively to understand the meaning of the symptoms. Most patients are in a combination of various groups, individual therapy, and nutritional counseling. Most are in family therapy as well. If indicated, medication is utilized.

Bob M: Here are some audience questions:

Heatsara: I have restricted my calorie intake to 100 calories a day...but am lucky if I eat 80. I am trying to get back to 88 pounds where I was a year ago. I am 5'8. The thing is I passed out and got a bloody nose at swim practice today. I am scared to death. I don't know what to do? No matter how hard I try, I cannot eat!!!

Dr. Brandt: You need rapid attention. There are serious medical manifestations of your ongoing starvation.

Julia: Whoever can answer, please help me. I have been having huge problems, and I haven't been able to eat right, etc. I am afraid to talk to any of my doctors because they write everything down and they have threatened to admit me. I feel I can not trust anybody. I don't want to be admitted, but I want help. I am really scared.

Dr. Brandt: I suggest you try to get on the same "team" as your physicians. You have a serious problem and you need help.

Trina: Dr. Brandt - It seems like average inpatient or outpatient stays for ED treatment last 3 weeks - are there any actions to change this and force Insurance companies. to allow for longer-term treatment?

Dr. Brandt: The length of inpatient hospitalization can vary widely, but many of our patients are only inpatients for several days. They often then transfer into our partial hospitalization program for longer-term treatment.

Jenna: How difficult is it to get help when you don't fit any "clinical" definitions for eating disorders? I know I'm sick, but I'm afraid no one will help me. I'm not underweight, but I have lost 70pounds since this started last November.

Dr. Brandt: Your rapid loss of weight suggests that something is wrong even if you don't fit into any specific category. You deserve a thorough evaluation and appropriate treatment. No two people are alike.

Bob M: Is there like a cookie-cutter approach to treating someone with an eating disorder or does each person need a separate treatment plan?

Dr. Brandt: Because of the wide variability of symptoms and their origin, each patient needs an individualized treatment plan. Having said that, I would add that there are some common components of most treatment. In our program, we try to focus on providing structure for patients to block their starvation or bingeing and purging, and at the same time work in intensive psychological therapies. It is this approach that we have found to be most effective.

Bob M: I want to post a comment from an audience member. It was a followup to a question about how to let your family/friends know about your eating disorder:

Jenna: In response to UCLOBO...I was afraid of that too. But I was very honest when I told my best friend. I told him what was wrong and what I needed. Simply, I needed someone to listen and a shoulder to cry on. I didn't need someone to force feed me, or nag me...just someone to love me. I helped him get information on the disorder and I let him have a couple of days to deal with the well of emotions that my confession brought forth. Let your friends be there for you...you'd be surprised how strong they will be.

Donna: Why is it that we always feel the need to fall back on the behavior rather than to deal with the real issues?

Dr. Brandt: We feel that the development of a healthy support network is an extremely important component of treatment for an eating disorder. The behaviors become a gratifying, soothing (but potentially deadly) way of dealing with underlying conflicts and issues.

Bob M: Let me go back to telling your family-- mom, dad, husband, wife---can you give us a step-by-step approach to telling your family and friends and how to ask for help? For many people that is a very scary thing!

Dr. Brandt: Yes indeed!!! I think open, honest communication is essential. We have found that it helps if a person with an eating disorder tries to communicate the underlying feelings...as opposed to engaging the family in an overfocus on meals, body weight, shape, appearance, calories etc. I have seen many patients receive a tremendous amount of appropriate support from family and close friends who truly want to help. If there is a lot of apparent conflict and power struggles, then the help of an objective outsider (a therapist) is usually necessary.

Bob M: What about people who are dealing with compulsive overeating? What is treatment like for them?

Dr. Brandt: Treatment for compulsive overeating starts with a complete assessment by a psychiatrist and a nutritionist. Often there are coexisting illnesses like depression or anxiety that require attention. Patients are usually treated in a combination of individual psychotherapy. Nutritional counseling that focuses on healthy, normal eating, and NOT on weight. and if binge eating is a part of the problem, medications might be utilized. We are opposed to the use of diet pills, fen-phen, and other weight loss agents. But we often utilize the proven anti-bulimic medications like the selective serotonin reuptake inhibitor drugs (Prozac, Paxil, etc.).

Julia: What are some of the signs of relapse?

Dr. Brandt: The signs of relapse are often the reemergence of old behaviors...social withdrawal...dieting...bingeing...overfocus on appearance and weight, etc.

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JoO: This sounds weird -- but is it possible to 'walk the walk' and get to a certain point and then step into your own path and stop your healing because it's a safe though painful place to be?

Dr. Brandt: Yes, JoO. I think that is common. Sometimes people get to a place in treatment where they become resistant. They are afraid to take the next steps toward recovery because it is scary to give up what is familiar.

Becca: I have a friend that is showing some signs of an eating disorder, but how can I be sure? She has a list of things that she wants to change i.e..her wrist, her knee, weight in general...long list...but hasn't actually shown signs of not eating, etc.

Dr. Brandt: Becca, it is hard to know what your friend is doing when you are not around. We have had patients who were actually able to conceal their eating disorder symptoms from friends and family for years! The fact that she is so dissatisfied with herself is a sign of a problem.

Bob M: So, how, as a friend or family member, do you confront the person suspected of having an eating disorder?

Dr. Brandt: I think a direct and honest approach is the best method. For example, "I see some things about you that are changing and have me very very concerned. Perhaps we need some help to sort out the reasons that you seem so unhappy with yourself." Open, direct, honest communication of concerns with caring.

Becca: But they get so angry if you say anything. How do you get them to listen?

Dr. Brandt: Unfortunately, anger comes up a lot in people dealing with these illnesses, and in their friends, families, significant others as well. When angry feelings are flaring up a lot, we often find that objective, outside input from a therapist is needed.

Bob M: And so how do you get the person to go to see a therapist if they are in denial? or do you just have to wait until they are ready?

Dr. Brandt: This is an excellent question and a real-life problem. I encourage parents and friends to say things like: "I understand you don't think you have a problem, but people with eating disorders often are the last to know that they do have a serious problem. If you think you are healthy, why not get that checked out by a professional? Your unwillingness to get checked out makes me think that you recognize you have a problem." One needs to systematically confront the patient's denial and defenses. If this doesn't work then one needs to assess the person's current degree of illness and risk.

Tiggs2: If you were diagnosed with anorexia nervosa and gained the weight needed, are you still anorexic?

Dr. Brandt: Gaining weight is an important part of recovering from anorexia, but unfortunately, recovery requires more than weight gain. Dealing with the underlying thoughts, feelings, and ideas that led to the starvation is a critical component of recovery.

livesintruth: Dr. Brandt, I'm suffering from a major relapse with bulimia and anorexia tendencies, but have been unable to get the inpatient or residential treatment that is necessary due to insurance reasons. What are some other intensive methods of treatment or is there a way to deal with insurance companies when the situation gets severe?

Dr. Brandt: We work with insurance companies on a daily basis, explaining to them our rationale for treating our patients. We have found that, in many cases, we are able to help them understand the critical need for appropriate treatment.

Bob M: In addition, I believe, the hospital can outline other medical reasons for admission and not the eating disorder specifically as the cause. There are ways to work with insurance companies and the financial counselors at St. Joseph's are experts at it.

JoO: Dr. Brandt -- saying this is all very well, but often it is the parents who are the problem and will not acknowledge therapists as it is shame-based to see a therapist.

Dr. Brandt: Yes, at times family conflict or issues between parents and children are central. We spend a lot of time trying to convince parents about the need for intensive treatment. But often we have been able to help them "see the light."

Bob M: Good Night

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