Some forms of self-esteem are unhealthy. What makes for low self-esteem, high self-esteem, and achieving unconditional self-acceptance? You may need to change your way of thinking to improve your feelings of self-worth.

Robert F. Sarmiento, Ph. D., our guest, is a licensed psychologist in practice in Houston since 1976. He specializes in short-term results using Rational-Emotive Therapy and has counseled over 2500 individuals and families. He is on the national Board of Directors of S.M.A.R.T. Recovery. Dr. Sarmiento also has extensive experience in psychological and career testing, having evaluated over 4500 people.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts, the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our topic tonight is: "Is Self-Esteem Healthy?" Our guest is Dr. Robert Sarmiento. He is a practicing psychologist in Houston, Texas. Dr. Sarmiento maintains that some forms of self-esteem are not healthy at all.

Good evening, Dr. Sarmiento, and welcome to HealthyPlace.com. Thank you for being our guest tonight. So we are all on the same track, what is your definition of self-esteem?

Dr. Sarmiento: Thanks for having me. There are many ways of defining self-esteem, but the sense in which I mean it being unhealthy is when we rate ourselves highly based on some external criteria, like success.

David: Why would that be unhealthy?

Dr. Sarmiento: Basically, what goes up can come down. High self-esteem and self-downing are the flip sides of the same coin. They are both global ratings of self-worth based on arbitrary and over-generalized criteria. For example, feeling you are a success when you do well, and feeling down on yourself when you fail.

David: But, isn't our self-esteem really based on how others react to us? If someone goes "wow! , you are really successful" (in whatever way that means), then we feel good. Conversely, if we are "put-down", then we feel bad.

Dr. Sarmiento: How others think of us is often a basis for measuring our self-worth, although by no means the only one. People often rate themselves based on success, perfection, attractiveness, wealth, piety, and other "yardsticks".

David: What, then, would be your definition of "healthy" self-esteem?

Dr. Sarmiento: Self-esteem, in the sense we have been talking about it, is conditional self-worth. In other words, I'm okay as long as I am approved or successful or loved, or whatever. The alternative is Unconditional Self-Acceptance (USA), which means you don't rate your total self-worth at all. You simply acknowledge the fact that you are what and who you are - a fallible human being.

David: We have a lot of questions coming in, so I want to get to those in a minute. I'm wondering then what concrete suggestions you have for achieving "healthy" self-esteem.

Dr. Sarmiento: There are many ways to achieve unconditional self-acceptance. Just one simple example is an "Official Human Being License" I give clients. On the back, it says that as a human being, you have the right to make mistakes, not be universally loved and admired, have shortcomings, and so on. The most important thing, though, is to learn emotional management skills. This involves changing how you think.

David: And on that note, we'll start with the audience questions:

teddybear44: So how do you change your way of thinking?

Dr. Sarmiento: It takes learning a number of skills and it takes practice, practice, practice. One set of skills to do this is called Rational-Emotive Behavior Therapy, or REBT.

David: Can you elaborate on that, please?

Dr. Sarmiento: Sure. One skill is identifying your "self-talk". For example, let's say you failed at some task and were feeling down. You might ask yourself, "what am I telling myself that might be making me feel down?" What might be going through your head is a thought like, "I failed at that task, so I am a failure". The underlying belief there, is the idea that to feel successful, I must succeed. This is what I call a "personal stone tablet". The next step is to question your beliefs, as for example, "Why must I do well?" Based on this questioning or disputing, you might change your belief to, "I want to do well, but I won't always, and I'm okay whether I do well or not"

David: Here's one audience member who agrees with you, and then a question:

charlie: You need to think about what are the conclusions that prove the thought.

fishstock: What should we base our self-esteem on?

Dr. Sarmiento: Well, this is a hard concept, but the way out of the self-esteem game is to stop rating your total worth as a human being. It makes sense to rate your performances or qualities, but not your total self-worth. Instead of high self-esteem, which can and will come down, you can strive for unconditional self-acceptance. If you base your self-esteem on any external criteria, you are asking for emotional trouble.

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David: In other words, you are saying it's fine to rate an individual performance, but don't make that single performance equal your total self-worth.

Dr. Sarmiento: Exactly! We have numerous performances and acts in our lives, so rating yourself on one, doesn't make sense.

Juler: I understand and agree with what you are saying, Dr. Sarmiento. I recently had a bout with depression and very low self-esteem. But how exactly do you go about achieving unconditional self-acceptance?

Dr. Sarmiento: That is often tough because we like the self-esteem high we get when we do measure up, albeit temporarily. What I am saying is that to get over self-downing, it is necessary to give up high self-esteem. In a sense, high self-esteem is addictive, or certainly seductive. This comes as a shock to people, but high self-esteem isn't just about feeling good about yourself. It is about feeling superior!

By the way, sorry about the bout of depression. I know that can be very painful. When you feel down on yourself, look for the thoughts behind that and start challenging them. It takes practice, but with some work at it, most people can learn to manage their emotions and "un-depress" themselves. Chasing after self-esteem is often behind anxiety too.

kaylee: How do we let go of say, a mistake, before we start that downward spiral we all know so well?

Dr. Sarmiento: It is common to berate ourselves for our mistakes. The way out of that is to separate the deed from the doer. In other words, you can dislike the mistake, but accept that, as a human being, you are going to make mistakes. The underlying belief here is probably, "I must not make mistakes." Once you have identified that belief, question is, like, "Why must I not?" "Is it possible for a human to never make mistakes? You might then change your belief to, "I prefer not to make mistakes, but I will sometimes." That belief will still make you feel disappointed or sorry, but not depressed and down on yourself.

daffyd: Would it be oversimplified to say that the whole objective here is to "think happy thoughts" and focus on the good we do rather than allowing ourselves to dwell on imperfections?

Dr. Sarmiento: That is a good question. It is often better to think happy thoughts and dwell on the positive, but taken to the extreme, that can lead to a Pollyanna outlook. What I am advocating is not just happy thoughts, but realistic thoughts. For example, you might really regret a mistake you made and acknowledge that is was bad, but still not be down on yourself for the mistake. Rational-Emotive Behavior Therapy is not just positive thinking. It is reality-based thinking, which can include acknowledging the negative things in life. The thought here might be, "What I did was a mistake, and I may be worse off for it, but I'm am still the same person."

David: Here are a few audience comments on what's been said so far, then we'll continue with the questions:

kaylee: Maybe that's why I don't like affirmations. They're just like real sweet icing, but you still have what's underneath.

fishstock: I think it's crazy to think you can control feeling good when you succeed or feeling bad when you fail.

Witchey1: Personally, a thank-you from family does wonders on being validated. My husband has been wrong only once in almost the twenty-four years we've been together.

David: One big issue related to self-esteem is the way one looks at their physical appearance. Here are some questions on that, Dr. Sarmiento:

stacynicole: I feel that I am such an ugly person. I am always comparing myself to other women. Thus, I have very low self-esteem. What can I do to improve that? I can't change my looks.

Dr. Sarmiento: I'm sorry to hear about how you feel about yourself and I understand it. First off, you are probably exaggerating about your looks. Secondly, physical appearance is only part of attractiveness. The most important thing, though, is to stop rating your total self-worth on attractiveness. You probably have many desirable qualities, so why rate yourself on just one issue?

It sounds like you have a belief to the effect that to feel worthwhile, you must be attractive. Attractiveness can be a desirable trait, but it is just one of many traits people have. If you base your self-worth on attractiveness, you will be insecure no matter how attractive you are.

I know many attractive women who feel insecure and down on themselves because they think they should be more attractive. Also, they are often afraid they won't keep their looks, so their self-esteem will go in the toilet.

David: Here are a couple of audience comments regarding looks and self-esteem:

Witchey1: Most people are judged by appearance first, though.

psyduck: Beauty does not last forever. We have to love ourselves for who we are.

kaylee: The stuff I like about myself is all invisible and nothing like the rest of my family's values. So when I'm around them, I feel most uncomfortable.

Helen: Based on an earlier comment of yours, do you think managing our emotions (using REBT, say) can totally cure depression or anxiety?

Dr. Sarmiento: Not necessarily. First off, I wouldn't necessarily call it a cure. One way of thinking about depression, is that it is something we do to ourselves, not something that happens to us, like a cold. It is a verb, not a noun. In that sense, emotional well-being is a life-long habit, not a cure. It is like eating right and exercising. Some cases of depression may have a physiological basis, however, so medications might be necessary. However, even in these cases, learning how to manage your emotions can reduce the dosage needed.

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Talkalot: In the case of people with eating disorders, they cope with "negative voices" that hammer their self-esteem (eating disorder information). What can be done about that?

Dr. Sarmiento: That can be a tough problem. Again, it is largely a matter of how you think. For example, if you believe you must be attractive and thin to feel worthwhile, you will probably never feel thin enough or attractive enough. The way out of this is to unconditionally accept yourself, not rate your worth on your appearance.

David: Here are a few audience comments on depression and self-esteem:

pennyjo: Depression is so hard to get out of, I wake up depressed and have to fight hard to pull out of it. I am on Paxil for depression and Xanax for anxiety.

kaylee: I'm learning to recognize depression earlier, and dealing with it then. It seems to lessen its icy grip.

daffyd: For me, when I feel good about myself, it is validated through the response I receive from others. But it seems like most people think that others should feel good about their accomplishments, so they can validate themselves.

Witchey1: Yes, I am dysthymic, so most of my days are "gray" along with my feelings of self-worth.

We B 100: I've heard that what we call self-esteem is really self-efficacy. Is this true? And if so, what is self-efficacy exactly?

Dr. Sarmiento: Good question. Another related term is self-confidence. Self-efficacy or confidence can mean an objective rating of your ability. For example, I can tell you I am a lousy golfer. Usually, when people talk about not being self-confident, it is not that kind of objective rating. Rather, it is a global rating of one's total self-worth as a person. In my example, I might jump from thinking I am a lousy golfer to thinking I am therefore a failure as a person. The first part of that is self-efficacy, the second self-esteem, in the global sense we have been talking about.

By the way, I understand that depression can be very painful and difficult. It is certainly nothing we do intentionally. However, the good news is that most people can learn to reduce or eliminate it. A good book on this is "Feeling Good" by David Burns.

Brenda1: My self-esteem was so trampled by my parents' negative comments. How do I rise above that talk in my head, now that I'm an adult?

Dr. Sarmiento: It is unfortunate that you had to suffer such negative comments and it is tough to overcome that. However, you can! The past only influences us to the extent that we allow it to. What I would suggest is that you examine your beliefs. You may have started thinking your parents were right when you were a kid. As you point out, you are grown now and you don't have to keep believing what they said. The other thing is that they probably were upset when they said it or, they thought they were motivating you. They may have had their own issues too. I'm not trying to excuse their actions, but just to help you put it in perspective. Regardless of what happened, you can choose to accept yourself unconditionally now.

David: A few more audience comments:

Sabrinax3: In order to love ourselves, we must accept ourselves totally, faults and virtues, quirks, etc.

Helen: I've heard people say REBT is too hard to do when you're depressed.

Dr. Sarmiento: It can be difficult to do anything, including REBT, when depressed. That's when medications can help. However, it isn't "too hard", it is just hard.

Witchey1: Most people are judged by first impressions, that is appearance, which is also a main attractive quality. There's an old joke, "beauty is only skin deep, but ugly goes right to the bone." How do you get past that type of thinking?

Dr. Sarmiento: Others may judge you by your appearance, and that can have some practical implications. However, you don't have to judge yourself based on that.

Talon: What can be done to raise low self-esteem, when one is consistently and persistently abused by people he or she cannot escape?

Dr. Sarmiento: First off, I would want to make sure that the person literally couldn't escape, or just felt that to be so? If you are in a lousy marriage or job, you could get out of it. If you are in a prisoner of war camp, maybe you can't. Either way, you don't have to take the put-downs to heart. There have been people in prisoner of war or concentration camps who did not give in to despair, despite being in very difficult situations. I know this isn't easy under those circumstances, but it is possible.

invraisemblable: No matter what anyone says, you're the only one who can tell you how great you are. I hated myself for so long because I thought everyone else was somehow better.

deejayh: Saying that we need to accept ourselves unconditionally is easy, understanding what that means and how to get there, well, I have no idea.

David: I want to thank Dr. Sarmiento for coming tonight. I know it's getting late. And thank you to everyone in the audience for participating. Self-esteem is not an easy subject to get a handle on, but Dr. Sarmiento, you did a good job. Thank you again.

Dr. Sarmiento: Thank you for having me. The idea of unconditional self-acceptance is tough at first, but it is very empowering. 

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Dr. Deborah Burgard, our guest speaker, specializes in women's issues, particularly eating, weight, and sexuality concerns.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

Everyone says you should have it, the question is -- how do you get it? Our guest, Dr. Debora Burgard will be discussing body image in relation to eating, weight, and sexuality concerns.

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David: Good Evening. I'm David Roberts, the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Positive Body Image". Our guest is psychologist and author, Dr. Debora Burgard.

Dr. Burgard is a psychologist, author, and webmaster. Her practice focuses primarily on women's issues revolving around eating, weight, and sexuality. Her site, www.bodypositive.com, contains a wealth of information on the subject, and her book "Great Shape" is promoted as the first fitness guide for large women.

Good Evening, Dr. Burgard and welcome to HealthyPlace.com. We appreciate you being here tonight. So we have a clear understanding, what is the definition of "body image"?

Dr. Burgard: Thanks for having me! Body image can be how you literally see your body or how you feel about it in a more general sense.

David: I know that many people have difficulty liking their bodies. Why is that?

Dr. Burgard: In our culture, we are trained to have an adversarial relationship with our bodies. Especially for women, we see the fat on our bodies as our bodies betraying us.

David: And how does that affect our outlook on things?

Dr. Burgard: It makes us try to "control" our bodies. Instead of seeing them as our allies or as something to nurture, we spend/waste lots of time being at war.

David: And it affects all aspects of our lives. One of the letters I received prior to your appearance tonight was from a large woman who said: "how can I feel sexy or good about having sex when I look at myself in the mirror and see the fat?" I'm wondering how you might answer that.

Dr. Burgard: We need to understand that just because we are trained to look at ourselves from the outside, we don't have to find that the most salient thing. Being sexual, you need to have the volume turned up on your own internal experience, how it feels to touch and be touched. When your attention is on "how I look from this angle," it means that the situation does not feel really safe to you and, in fact, it might not be - in the sense that your partner may or may not be looking at you that way. But lots of the time, women think their partners are as critical as they themselves are, and that is not true.

David: But, for many, our weight and our body image are tied together. How do you stop from letting your weight define who you are?

Dr. Burgard: Great question, since the whole culture is built around this!

Even our diagnostic categories - anorexia (anorexia information), bulimia (bulimia information), binge-eating disorder - are like small, medium, and large. I wish they were tied instead to behavior because in real life, fat women can be starving and thin women can be stuffing.

I can't tell when someone comes to see me what her relationship with food is, and I try to train other therapists to think that way too. In fact, there are a few situations - like a job interview or a singles bar - where people are going to look at your weight and make some association to it. But in many, if not most situations, we each have the opportunity to "show up" as ourselves regardless of weight. I try to teach these skills to people.

David: We have a lot of questions, Dr. Burgard. Here we go:

Lori Varecka: What is the best way to have my children have a good body image? I have one overweight daughter @ 11, a "just right" daughter @ 9 and a son who will be tall and thin (probably) and he is almost 7.

Dr. Burgard: Lori, all your children are "just right" if they are fulfilling their genetic fates. We are all like breeds of dogs - not everyone will be a greyhound! Give each of your children the experience that their feelings matter and you will go far in "innoculating" them against the "pollution" out there.

This was such a good question, Lori, thanks for asking. We need much more research on how to help kids feel good.

David: How does someone develop a poor body image? Is it internally composed, externally, or a combination of both?

Dr. Burgard: Well, it is a fairly recent phenomenon in western culture, so I think we have to grant that the external world matters. However, one of my research interests is what protects individuals who seem to resist the cultural pressures. If kids believe that their voice matters and that they can be powerful not just by having a certain appearance but also by being smart or competent or caring, they feel more confident. Sometimes people blame their bodies for the violence that happens to them, too.

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David: What do you mean by that?

Dr. Burgard: I'll take a relatively mild example - Say you are teased by your older brother for beginning to develop breasts. And you feel furious and ashamed at the same time - some of your anger is at your brother, but some of it can go toward your own body for "being a target."

David: Here's an audience question:

DottieCom1: I am a mature woman with a nice figure and at the middle range of ideal weight. I'm so afraid of food. If I gain a pound, it ruins my whole day.

David: It's more of a comment, but a lot of women feel that way.

Dr. Burgard: I would wonder, what is the meaning of gaining a pound for her? Maybe it feels like an achievement to keep her weight stable, or maybe it gives her life a feeling of order. We attach all these powerful ideas to these numbers of the scale!

Sharyn: How can we feel good about our body image when "gravity" takes over? Perhaps applying for a job knowing the younger person may have a better chance? I like my body image but not when applying for a job or just those little things we deal with when out in public.

Dr. Burgard: Well, so this is a feeling you are having not about your body itself, but about the stereotypes about what it means to have an older body. The feeling is totally valid, and it may include feelings of loss, especially if you had the power of being seen as very attractive before. I try to remind myself that if I don't die, I'll get old. I'd rather get old! : )

Sidzel: I went to a job interview and they said they weren't hiring, even though I had seen the ads in the paper. Several months later I tried again and I was hired on the spot. The guy who was once doing the hiring was fired. Reason was, he didn't hire what he thought were overweight people. I learned this after I was hired. I was so hurt. I couldn't believe people could be so rude.

Dr. Burgard: Wow, you could have told your story to the San Francisco Board of Supervisors last month when they considered, and eventually did, add height and weight to the anti-discrimination code. People made fun of us out there but as you can vouch for, it happens all the time.

jesse1: We see fat on our bodies as us being too much. So we try to be less. Somewhere in our life, we got the impression that if there was less of me then they would like me.

Dr. Burgard: Yes, Jesse, very good observation. Why do you think anyone would want you to be less?

jesse1: Our culture is built around perfection. We strive for perfection.

David: Here's an audience comment on what's been said so far:

Barbara2: It is interesting that in some cultures fat is considered beautiful and a sign of wealth, so women are fattened up before marriage!

David: What would you suggest, and I'm looking for 2 or 3 concrete ideas that people can take with them tonight, on how to begin to improve your feelings about your body.

Dr. Burgard: Well, the Body Positive tag line says:

1. Change your mind.
2. Change your culture.
3. And let your body be.

So let's go one by one:

First, you have to look at what you say to yourself, all day long. The world may be "polluted" but what most of us hear is our own internal dialogue. Remember that your "body self" hears everything you think. So if you want to feel better about your body, you have to treat it better. You don't have to say things that aren't true, but you can replace the critical comments with descriptive ones; like replacing "I'm so disgusting" with something that you're grateful for, like how your body stayed awake to drive you home safely or any number of the incredible things our bodies do for us every day.

Next, activism helps! Do something, any small step, to speak up to try to change the culture. If your friend starts the "fat talk" ask her what she is really feeling, if she can't use body angst to disguise it.

And then, learn to take better care of this amazing entity that is your body. Remember when we were all finding our "inner children"? We now have to find some "inner parents." That means the part of you who helps you get enough sleep, eat your vegetables, and go out and play. Our bodies need love and care.

David: Now, for those who asked, here are the links to Dr. Burgard's website, www.bodypositive.com and for her book "Great Shape".

aimilub: I gained a lot of weight over the past 2 years, I believe due to medication. My husband refuses to be intimate with me until I'm back down to my old weight, hence bulimia relapse. Now I'm 11 weeks into bulimia recovery, but restricting big time and losing lots of weight. I am afraid to eat for fear of gaining again. How can I feel good when I'm getting these messages from him that I'm not attractive unless I'm thin?

Dr. Burgard: How would the two of you deal with some other kind of change? Partners change all the time, and part of the task of being in a relationship is to be able to keep up. I wonder if you are feeling less attractive and less sexual, and maybe that is affecting his feelings too? But whatever help you need to get, to get yourself more stable again, I would encourage you to focus on that. Maybe there is something that the two of you need to talk about that is being masked by this issue.

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Rosebud: Hi Dr. Burgard, what would you do, if you had a body that doesn't work? I have mild Cerebral Palsy. I used to called myself ugly, reject and retard. And I still do because I don't like my body. How can I improve my self image on this?

Dr. Burgard: Hi, Rosebud. Well, there are a lot of people whose bodies aren't perfect, (can I get a witness?), and we all can do much more to appreciate what our bodies can do. I am glad that your body allows you to be here with us now! But I do understand that you probably face people's prejudices, and that is not easy. It is important to try to remember that the way people react reveals their own fears, and your job is to "show up" with your real self. I am glad you have stopped calling yourself names. We can all learn from you.

David: I'm wondering how many people in the audience tried dieting to make themselves feel better? Send me your comments and whether it actually made you felt better, worse, or the same.

aimilub: I diet to make me feel better but end up feeling worse because the diet always fails.

Nerak: I have tried so many diets. They all make me feel worse cause I fail so bad at them. I believe this plays a part in my depression.

Kello: At first dieting made me feel better, but before long, anorexia began controlling me and I ended up worse.

mickey: My life has been one diet after the other and still can't loose weight to be thin enough.

Cutie: I am always dieting and I love and enjoy the healthy food I eat. I also love the way my body responds to the food choices and work out schedule. However at times I feel I become obsessive and I wish that I did not let my body image greatly affect my mood.

chyna_chick: How can a person w/ an eating disorder who has to gain weight do so when they already feel and look so fat?

Dr. Burgard: This is so hard, I know. It is almost as if the universe is forcing you to face your worst fear in order to recover. But you do have to find out that your body is not really your enemy, that your fear has to be identified and dealt with. For example, if your fear is really how you will be treated if you were seen as fat, you need to develop the tools to defend yourself anyway. You need to feel like you can be OK no matter what you weigh. That is true liberation.

LynneT: I'm a compulsive overeater and incest survivor, I've had a lot of therapy and I'm a member of Overeaters Anonymous. I am considerably overweighed. When my weight drops to a certain weight, I become terrified and usually gain weight, even if my eating is not enough to gain. How do we get past this barrier?

Dr. Burgard: If in fact your genetic weight is below where you are now, and you have to eat when not hungry to maintain it, then you have probably identified that a thinner body size scares you somehow. But of course you know that it is not a thinner body but how you feel in your thinner body that worries you. The people who I have worked with have to develop a pretty unshakable trust in themselves, in their own willingness to advocate for themselves and their safety, with words or with actions (like leaving the scene of an abusive conversation, for example) in order to replace what they see as the "message" of their bigger bodies. But remember that your genetic weight might be higher than you think, and this could also be your body just trying to get back to its set point. It gets confusing, yes?

Taryn: How can a person be happy with their "set" weight when it is heavier than what is acceptable. I hate always having to be dieting just so I can barely be acceptable, not even thin.

Dr. Burgard: Almost all of us have set points that are higher than acceptable! Our culture is crazy - everyone is supposed to be a greyhound. If the average clothing size is a 14-16, and you can't even always find that as a "large" then most of us feel like we're not "acceptable." So my question to you all is, what are we going to do about this, ladies?

Susie3: How much damage do you do to your body when you drop a lot of weight.

Dr. Burgard: I am not a physician but the studies I have seen flag some potential problems for example, loss of lean body mass (including heart tissue), and, with weight re-gain, the potential for high blood pressure, redistribution of the regained fat to more "metabolically active" areas, and so forth. These issues have made many of us in the healthcare field think twice before recommending that people try to lose weight. I am much more comfortable helping people figure out what changes they feel like they can make and sustain for the rest of their lives, and then see what their body size is, and try to accept that body size as their healthy weight - i.e., the weight they are when they are living in a healthy way.

David: One of the things about body image, and I'd like you to comment on this Dr. -- from conversations with other women, I think many women, and guys for that matter, want to have a certain "look" which is tied to lower or moderate weight. And then they think that's going to be the trick that "gets them a man or a women." But if you walk down the street, you'll see all different types (shapes) of couples -- one tall, one large. A tiny guy with a moderate woman. I mean, they're are all mixtures. But yet, many feel like they can't get a mate or a date without having that "look."

Dr. Burgard: Yes, people who want to be attractive to men, especially. Straight women and gay men are more likely to want that "look" maybe because men's sexuality is pretty visual. But you're right, all you have to do is look around to explode that myth. I remember being in junior high and seeing that my friend's older brother, who was one of the best-looking people I had ever seen, was with a really homely girlfriend. And I was fixated on this, I think because I wanted to be able to "talk back" to all the messages I was getting that were myths - and I could use my own feelings as well, because I was drawn to all kinds of people, some of whom were not conventionally attractive, but who I found very appealing. I think that undoubtedly you get more people looking at you, without knowing you, if you are conventionally beautiful, but those people get stereotyped too. And so you still have the same existential dilemma about how to "show up" to someone with your real self.

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BRITTCAMS: I have been doing very well for the last few months and have put on a lot of weight. When will I ever stop feeling "fat"? will I ever be able to look in a mirror again and see my real self?

Dr. Burgard: Good for you to fight back against the disease!

In my experience, people definitely grow stronger and stronger in their sense of themselves, and their comfort with their own bodies. I think if you have seen your real self before, you have not lost her! Fight for her! It is so worth it to have a real life. Good luck to you!

Tessa: Don't you think it's possible to just want to be really thin for the sake of being really thin instead of having some strange past that is causing it?

Dr. Burgard: You may want to be thin in order to have a certain *future*, yes. We are all taught to believe life will be perfect then. But your question reminds me of young women who have come to me for help, who say that their lives are fine and they should be happy and they feel very protective of their families and afraid I'm going to judge their families. There is enough junk in the air to trip up even relatively healthy families, so in a way, my interest is more in what we can do to help you want to have a real life that you own, not a fantasized "perfect" thin future.

David: Here's a comment relating to my earlier question on whether being on a diet made you feel better, worse, or the same about yourself: (dangers of dieting)

mickey: I have been made feel FAT, have been on a diet all my life and always compared to my thin sister.

David: And then a few more comments on what's been said tonight:

Cutie: Everyone wants to feel attractive. I would suggest that people should concentrate on what attracts them to certain individuals they admire. I think many will find that what makes them special and ATTRACTIVE has nothing to do with their weight.

Lori Varecka: I tell my kids that they are just right, the way they are. Not that simple though. Self talk is hard to do day after day after day.

Barbara2: I think many people in many cultures strive for what they define as perfection - but perfection is culturally defined and differs. It does seem ironic that in this culture 55% of people are considered to be overweight.

beth12345: With me, when I eat anything and I don't throw it up, I feel I have to punish myself. I do this by cutting myself. It's not me really, but something in my head that tells me to.

Tink: It is a way of failing.

shell_rn: This is just my opinion, but weight is not the only factor to having a poor body image.

David: Well, it's getting late. I want to thank Dr. Burgard for being our guest tonight and sharing her knowledge and expertise with us.

Dr. Burgard: Thank you all for such great questions and comments!

David: I also want to thank everyone in the audience for coming and participating. I hope you found it helpful.

I would like to invite everyone to visit the Eating Disorders Community at HealthyPlace.com, where you will find hundreds of pages of information about issues that we talked about tonight. You can also sign up for our mailing lists at these, and any other HealthyPlace Communities of your interest.

Dr. Burgard's website is: www.bodypositive.com, and also look for her book "Great Shape", which is promoted as the first fitness guide for large women.

Good Night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Dr. Ted Weltzinjoined us to discuss what you, as a parent, can do for your eating disordered child. Whether it be anorexia or bulimia (binging and purging) that your child suffers from, there are many different treatment options for eating disorders available. These include inpatient, outpatient, and residential. Dr. Weltzin explored the traits and costs of each of these options.

 

We also talked about:

• how to ask your child if she/he is having an eating problem.
• what to do if your child has an eating problem but insists that they don't.
• how parents can better cope with their own concerns, frustration and even anger in dealing with their eating disordered child.
• the relationship between obsessive-compulsive disorder and eating disorders.
• and why, no matter how much money you spend on outpatient treatment for eating disorders, inpatient eating disorders treatment, or weekly therapy, your child may not be ready to get better.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Help For Parents Of Children With Eating Disorders."

Our guest is Dr. Ted Weltzin, Medical Director of The Eating Disorder Center at Rogers Memorial Hospital. Dr. Weltzin is a licensed psychiatrist. Before coming to Rogers Memorial Hospital, he was an assistant clinical professor of psychiatry at the University of Wisconsin Medical School. Prior to that, Dr. Weltzin was the medical director of the Center for Overcoming Problem Eating, an inpatient program at the University of Pittsburgh.

Good evening Dr. Weltzin, and welcome to HealthyPlace.com. Many parents with eating disordered children seem to go through a cycle. First denial, then being scared. Later, if there isn't a relatively quick recovery, some move onto frustration, anger, resentment, and even resignation that things will never get better. These are some of the issues I want to address tonight. For parents who are just getting into the process, what should a parent do when they first think their daughter or son has an eating disorder?

Dr. Weltzin: The first thing to do is to ask him or her if they are having an eating problem. As you mentioned, they may not admit to the eating problems but this begins to open a dialogue about a potential problem. Approaching them in a caring and non-confrontational manner is the best approach unless their disordered eating behavior is very out of control.

David: Let's say the child says that nothing is wrong, but you can tell that something is wrong. What should a parent do at that point? Should the parent press further? Be confrontational?

Dr. Weltzin: Probably the next thing to do is to bring them into see their pediatrician or medical doctor. A lot of times they will admit to their doctor that they have a problem. Also, this is a good start at determining if there are any serious medical problems, which are common in eating disorders.

Persistence is the key in terms of this phase of a problem: the denial phase. Trying to avoid arguments and anger can help the child to talk about the problem. If this does not work, then bringing them to an eating disorder specialist can help to determine how problematic their eating is.

David: There are some parents, I'm sure, who are wondering how long you should try and talk to your child before actually "forcing" them in to be evaluated by a doctor?

Dr. Weltzin: This depends on how serious the eating problem appears. If there are clear medical problems, such as passing out, dizziness, or other medical problems, then it should happen quickly. The same goes for if they are becoming increasingly depressed, isolated, or having problems in school or work. These are also signs that the eating disorder has probably gone on for a while. An interesting fact: the average length of time from the onset of bulimia to seeking help is about 5 years.

David: And that's a good point, Dr. Weltzin. When is an eating problem serious? There are certainly some kids who start cutting down on meals, or throw up once or twice (that the parents know about). At that point, some parents may just say "my child is going through a phase."

Dr. Weltzin: It is true that some children do go through periods of infrequent vomiting to lose weight. However, this often predicts later worsening of symptoms, particularly with a stressful event such as a relationship problem, school stress, moving, etc.

David: So, you've determined that your child has an eating problem. You've tried to talk to your child about it, but that's not working. What about when your child is insistent that nothing is wrong, that they don't have an eating disorder? Then what do you do?

Dr. Weltzin: Get information from the school or other sources that might be available. Sometimes a school counselor, clergy, or friend will be willing to approach them about the problem. If this does not work then they should be taken to see a specialist. Eating disorder specialists see many patients like this and an important part of eating disorders treatment is working on denial and building a relationship in which the patient feels comfortable with talking about the problem.

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David: We all hear about the worst cases of anorexia or bulimia. As far as treatment goes, what should a parent do to help their child? How do you determine if your child just needs weekly therapy, outpatient treatment or inpatient eating disorders treatment?

Dr. Weltzin: This really depends on the severity of the eating disorder symptoms. Often times, this advice will come from a specialist who has done a referral. The majority of patients can improve in an outpatient setting, especially if they are not severely underweight or if they are not severely depressed or unable to control their eating at all. Patients with anorexia, in general, need inpatient and residential treatment as they tend to be unable to correct their eating without specialized help during meals. Patients with bulimia, or those who binge and purge and are at a normal weight, typically fail at outpatient treatment before a more intense treatment like residential is needed. If there are medical problems, which can be life threatening, then inpatient should be done immediately.

David: One of the scariest things for parents, I think, is the idea that their child will either die from an eating disorder or suffer with it for the rest of their lives. Can you speak to that, please?

Dr. Weltzin: It is important to emphasize that the mortality rate for anorexia remains about 10%. People do die from these illness and the majority are not in treatment or have left a treatment program. It is also important that the treatment team includes a physician with some experience in eating disorders, especially their medical complications, a dietitian and therapist.

As to the prognosis for eating disorders, only about 1/3 of anorexic patients recover in general. With intensive treatment this percentage can be increased to over 60%. Therefore, treatment can have a great impact on outcome. As for bulimia, often times patients do have relapses, but with treatment these tend to be time limited and do not lead to a severe loss of function. Over 50% of patients with bulimia will have a significant improvement and often recover with treatment.

David: When you use the word "recover," can you define that?

Dr. Weltzin: Recovery, at its best, means healthy nutrition. This can be defined as healthy meal patterns, such as three meals a day, and maintaining a normal weight. What is a normal weight can vary depending on who you are talking to, but generally this is a weight in which there are no physical problems, including a loss of menstrual function, decreased energy, or feeling run down. More important to recovery, however, is the psychological aspects including body image, self acceptance, improved mood, healthy relationship, and function in school and work. If patients are at a healthy weight and able to junction in their lives, this is recovery, even if there may be brief episodes of abnormal eating or distorted thoughts.

David: We have a lot of audience questions. Let's get to a few of those and then we'll continue:

hwheeler: What do you do when you live in a small town and no one seem to understand eating disorders? My daughter is 20 years old and went to Toronto General Hospital Eating Disorders program, but we live 3 hours away and no doctor here seems to understand how serious this can get.

Dr. Weltzin: Unfortunately, services for these problems cannot be provided in smaller communities. There are a couple of options. First, have a specialist work with a local doctor as a consultant, in which your daughter sees the specialist for updates and progress can sometimes be effective. This can also help the local treaters be able to work with these problems effectively. Alternatively, patients can go to residential programs like the one we have a Rogers and live there and get treatment. This does work, but it also creates some hardship in terms of missing home and also cost.

niko: What do you mean by intensive treatment? Is it normal for people with eating disorders to have periods of seeming normalcy and then slip back into it?

Dr. Weltzin: Intensive treatment is generally more than a weekly therapy session and meeting with a dietitian. An intensive eating disroders treatment program may be a partial hospital program or day treatment program at which the patient may go for most of the day and eat 1-3 meals at the program from 2 to 5 times a week. Residential is the next level of intensity in which patients live in a facility and have 24-hour staff supervision and work in a setting with other patients trying to recover. This has a number of advantages as eating disorders tend to be 24-hour problems. Finally, inpatient treatment, which is very costly, is reserved for those patients who are medically unstable or unable to have any control over their eating. Patients in inpatient programs tend to transition to residential or partial programs.

Regarding the question about people looking like they are doing well, it is true for many patients with anorexia or bulimia. They will have periods of doing well. Under stress, their symptoms tend to worsen and they often have an up and down course because of their illness which can be destructive. If this is the case, they often seek treatment because they are tired of their eating disorder having a negative i: mpact on family, friends, jobs, or school.

David: Approximately how much is outpatient day treatment and inpatient treatment? I'm talking about the cost?

Dr. Weltzin: The cost for outpatient treatment for eating disorders tends to be the cost of the outpatient therapy session (which can vary depending on location or specialist). Typically the cost is between $100 and $150 per session (maybe less in some cases). Inpatient treatment for eating disorders is very costly with daily costs being between $700 to $1,500 and sometimes higher. Residential treatment is about 1/3 the cost of inpatient treatment. Therefore, outpatient, which is often covered by insurance, should be tried first. However, if this is not effective, avoiding inpatient treatment by trying residential or partial can allow many more patients to get treatment for a long enough amount of time to be effective.

David: Here's the link to the HealthyPlace.com Eating Disorders Community.

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David: Dr. Weltzin, is inpatient eating disorders treatment covered by insurance and/or Medicare, or do parents have to pay for it out of pocket?

Dr. Weltzin: This really varies in terms of the policy. Some policies have unlimited coverage; however, this is rare. Often times, families do have to pay, and this is the reason why it is often not possible for people to receive inpatient care. Historically, this change occurred in the mid to late 80's, and at that time, most inpatient units were not able to continue to provide as high quality of care and alternative treatment models were developed that were less costly but effective.

David: The Rogers Memorial Hospital website is here.

Let's get to some more audience questions:

brendajoy: What if your child is over 18. Is there any legal way to force them into treatment?

Dr. Weltzin: They can be forced into eating disorders treatment, depending on state mental health statutes, if their symptoms are so severe as to be life threatening. This generally occurs when they have had the problem for a while. This is the main reason why children tend to have a better chance at recovery. There is more pressure for them to get into or stay in treatment even if they do not want to recover. For patients over 18, it is very important for families to support the eating disorders treatment as much as they can to keep them in treatment. This often boils down to the patient having to make a choice to stay in treatment because of someone else, initially. For those patients who make this choice, they often are able to see the need for treatment after a period of time in treatment.

Jem42: My daughter is getting better in some ways but still holds on to pretty rigid food rituals. She also does not eat any of the food we fix for dinner. Since she is gaining weight slowly by doing it her way, should we press the issue? Also, my daughter was at Rogers. One year ago, we were putting her into the inpatient facility.

Dr. Weltzin: If your daughter is gaining weight, then I would not push the issue of the rigid thinking and some ritualistic eating behavior. If she is gaining weight, then it may take a while for the anorexic thinking to change. Parents often get frustrated that the thinking does not change even with behavior changes, such as weight gain. You need to tolerate this. I encourage you to focus on a few important changes. It sounds like your daughter needs to gain weight. As her weight gets higher, the thinking will change. Also, good luck with your daughter's treatment.

David: Here's the next question:

jerrym: David, our daughter just left Rogers about 6 weeks ago. Great staff and people! She's doing well overall and we're adjusting. What can parents expect to see after treatment?

Dr. Weltzin: The main thing that I emphasize to parents is that they need to try to remove barriers to recovery. This initially means to let go of blaming yourself for the problem and attend therapy sessions, even though they may be difficult. Being able to change how you approach your son or daughter with the help of the treatment team can make a big difference in how things go when they are home. At Rogers, we strongly encourage family involvement for this very reason. Jerry, I am glad to hear that this seems to be going well thus far.

LilstElf: What is the general length of stay for residential treatment?

Dr. Weltzin: It really depends on the problems. For bulimia, in which weight gain is not needed, the stays tend to be 30 to 60 days, while with anorexia it may be 3-4 months, depending on weight. This tends to seem like a long time but usually patients and families have had to experience years of the problem and the sacrifice for what is generally a short period of time, if we look at effective treatment leading to a healthy long life, is justified if possible.

rkhamlett: After hospitalization and being in an institution, what is there left to do for a 13 year old?

Dr. Weltzin: The main thing is whether she was able to function in terms of her eating in the hospital. If she was able to gain healthy eating habits and be motivated to try and recover then setting up a structured treatment (including close monitoring of weight in addition to intensive therapy) is important. The reason for weight monitoring is so that if things are not going well, she can be readmitted without a major loss of ground in terms of recovery. Not letting things get to the point of being as bad as they were before intervening is critical.

David: I'm getting a few comments that fall along this line: If you spend $21K-45K per month for 1-4 months (depending on the seriousness of your child's eating disorder) and then your child comes home and you see the disordered eating behaviors start all over again, it is extremely frustrating and causes a lot of anger. How is a parent supposed to handle that? One parent says she followed her daughter to the bathroom and the child started screaming at her.

Dr. Weltzin: This is very frustrating for parents, as it is often a major sacrifice that affects the whole family when this type of treatment is decided upon. I can say that we are very aware of this. For this reason, when I was the medical director of the inpatient program at Pittsburgh, we followed up our patients and had less than a 10% rehospitalization rate after one year.

As I have been the medical director at Rogers since February of this year, one of my main initiatives is to reduce relapse after treatment so that this story becomes less common for the patients that we treat. It is important to emphasize that planning after an intensive treatment should focus, to a large extent, on what types of things should be done (depending on how the patient is doing at the time of discharge) and how to give parents guidelines to improve the chances that relapse does not occur. Finally, sometimes going back inpatient or residential is needed. Having a discussion with the treaters at the beginning of treatment about this concern and what you, the parent, thinks could have been done differently often helps to avoid this happening again.

David: So are you saying that the inpatient treatment is just the very beginning of the eating disorders treatment process? Do you think a parent shouldn't expect their child to be "healed" or "cured" of the eating disorder, even if they spent $21-200,000 dollars?

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Dr. Weltzin: What parents should expect is that their child and the family knows what it takes to recover from the illness. With an illness, where denial is a major problem, often times the current treatment can be done but if the patient does not want to apply what they have learned, then it will not work. No matter how frustrating it is, it is important to keep in mind that patients often refer to their attitude during a previous treatment and say that "now I am ready to get better." While it can be costly and frustrating that a second or even third treatment is needed, if it is effective, parents will say it was worth it to have their child healthy.

David: That's a very straight answer, Dr. Weltzin. And I guess you are right. If the patient isn't ready to get better, or doesn't want to get better, it doesn't matter how much money you spend, you won't see great results if little or no effort is put into the treatment by the patient.

Here's the next question:

CAS284: Dr. Weltzin, my daughter has been free of bulimia for over a year now, but after the bulimia ended, Obsessive Compulsive Disorder (OCD) has became evident. We are now struggling with this and depression. Is this common and how would you suggest we treat these disorders? Thank you.

Dr. Weltzin: There is a strong link between Obsessive Compulsive Disorder and eating disorders and depression. It also does happen that, as the eating disorder gets better, some of these other problems become more noticeable or, at times, more severe. Depression and OCD are very treatable. Treatment for both OCD and Depression require a combination of therapy and medication (if severe). If moderate to mild, then therapy or medication can be used. Because of the specialized nature of OCD, you may want to seek out a specialist. YOU may want to access our web site to ask for a specialist near you. With depression, if this is still present after the eating disorder is improved, then it should be treated as a separate problem.

David: For those of you who want more info on OCD, please visit the HealthyPlace.com OCD Community.

I know that you have done research on the relationship between eating disorders and OCD. Could you explain how that relationship between eating disorders and OCD works?

Dr. Weltzin: What is more likely the case is that OCD or perfectionism (what we call OCD related symptoms) likely increase the risk for eating disorders. Often there is a family history of OCD or perfectionism in patients with anorexia. There also seems to be a link between bulimia and OCD. This is not surprising as serotonin, a brain chemical linked to appetite and eating disorders, is also a major factor in OCD.

alexand1972: What should someone who has been in and out of hospitals do differently to attempt recovery? What are the chances of that person's niece living in the same household and going through the same thing getting better? Or is it too unhealthy for her to be in that sort of situation?

Dr. Weltzin: Depending on how long the hospital stays are, you may want to consider a residential program that is longer and can help you develop and practice the changes you need to make in your eating, problem solving, and approach to recovery that will allow you to be able to implement these changes in an effective way at home. This often works, although (as I stated above) it requires a significant sacrifice. If you are not doing well, it will likely not help your niece.

David: I just want to post this comment from an audience member who has an eating disorder. I'm posting it to give the parents some insight into what your children may be thinking and I hope Dr. Weltzin might speak to that:

waterlilly: My mom, who is an RN, flipped out when she knew I was making myself vomit. She began hitting me and sent me to my Dad's. I don't understand why she didn't support me.

Dr. Weltzin: The stress that this problem puts on parents is quite intense and often times they say or do things that are quite shocking. It would appear that, at that moment, your mom was not able to support you. This is unfortunate, however, she may feel quite bad about what she did and be able to support you now in your recovery. You need to work through your feelings about this with your therapist, then have family sessions with your mom to express to her how this made your feel and to determine if you want her as a resource for your recovery and if she is willing.

David: Rogers is in what part of Wisconsin, Dr. Weltzin?

Dr. Weltzin: Rogers is in Oconomowoc, which is about 30 minutes from Milwaukee on I94 between Madison and Milwaukee.

muddog: My daughter started at 16 and is now 23. She is seeing a therapist. Do you feel she can get well without being in an eating disorder treatment center? Also, my daughter is considering marriage. He knows about her Bulimia. Is the marriage doomed if she doesn't get well first?

Dr. Weltzin: It really depends on how she is doing with her illness. Often times, the therapist can be of help in this - if your daughter is willing to invite you to a session. It is important to mention that the longer an eating disorder goes on the more difficult it is to recover. People begin to have the eating disorder define their way of life and this is hard to break. If she is not better, then a treatment program should be considered.

As to the marriage, an important part of recovery at our program at Rogers is responsibility. It would seem to me that starting out in a life long relationship should be done with it having the best chance of success. If she is not doing better, then this would likely be a very significant stress on this relationship - one that may be too much. Might it not be better to get her eating under control first?

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hwheeler: Does it put more pressure or stress on the ED person when a parent knows what they are doing in the washroom and nags at them?

Dr. Weltzin: Yes, this is often stressful. However, there may not be any reasonable alternative if the person is not trying to get help. If the person is in eating disorder treatment, then having a family session to discuss this stress and workout compromises to decrease stress is the best way to deal with this, in my opinion.

David: I'm sure it's very difficult to watch your child engage in destructive behaviors and not say ANYTHING. Is that even a reasonable expectation, and is not saying anything a signal to the child that they can either get away with it or that it's okay with the parent?

Dr. Weltzin: That is a good point. Children will often say (after the fact) that their parent must not have cared if they did not do anything. This brings up a very important point in terms of saying or doing things that are aimed at helping a child but make the child angry. In my experience, children are thankful that their parents cared enough to try and help even though it led to arguments and anger. Unfortunately, this thanks may not come for a while and may be years after the fact, but parents need to have faith that trying to help their children, even if it makes the children angry, is the right thing to do when it comes to problems as serious as eating disorders.

David: Thank you, Dr. Weltzin, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people interacting with various sites. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Thanks for staying so late and answering everyone's questions, Dr. Weltzin.

Dr. Weltzin: Thank you for having me and I hope that this was helpful.

David: It was. Good night, everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Joanna Poppink, MFT, our guest, maintains that the biggest blocks to recovery from compulsive overeating are misinformation about the eating disorder, and an over concern about what others think as opposed to a focus on how the eating disordered person thinks, feels and experiences the world.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts, the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our topic tonight is "Recovery From Overeating". Our guest is therapist, Joanna Poppink, MFT. Joanna's site, Triumphant Journey, is located inside the HealthyPlace.com Eating Disorders Community. At her site, you can also find her "Cyberguide to Stop Overeating and Recover From Eating Disorders". Joanna has been in private practice since 1980 in Los Angeles, California.

Good evening, Joanna, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. I think the people in our audience are very interested in recovery from compulsive overeating. You said one of the biggest blocks to accomplishing that is misinformation. What kind of misinformation are you referring to?

Joanna: Hello David and everyone. I'm delighted to be here.

People usually think of eating disorders as having to do with food and eating or non-eating behaviors. If that's the limited perception, then the cure is simple. Just stop doing it.

But I'm sure everyone in this discussion appreciates that recovery is not so simple. Guilt, shame, fear, distorted perceptions, are all symptoms of the disorder as well. The internal life of the person with the eating disorder, needs to be respected and understood with compassion and intelligence. Recovery covers a lot more territory than eating or non-eating behavior.

David: By the way, if anyone in the audience isn't sure if they are a compulsive overeater, Joanna has a questionnaire on her site that may help you.

You also mentioned another big block to recovery from compulsive overeating is an overconcern about what others think vs. how the overeater thinks, feels and experiences the world. Can you explain that?

Joanna: Briefly, I'll try. An aspect of the symptoms of an eating disorder is the desire to be perfect. Perfection is defined by the individual and usually has to do with goals that cannot be achieved, like looking beautiful all the time, having a flat stomach, a four-point grade average, a winning job situation, a "perfect" partner, and so many other attributes.

Often the person struggles to maintain an image of perfection, even to the point of lying and using other forms of subterfuge to convey the perfect image.

Also, people in the eating disordered person's life may come to expect an impossibly high standard to be maintained. Then we've got a painful situation where people are trying to live up to what they believe are standards in other people's minds as well as their own.

Nobody knows anybody, really. The false presentation is a terrible burden to carry. It's a set up for disappointment and painful disillusionment.

David: What causes someone to become a compulsive overeater? (overeating causes)

Joanna: That's the 64,000 dollar question. I can give you a list of possibilities. These possibilities are indeed factors in people becoming compulsive overeaters. BUT, there are many people who experience these stressors and do not become compulsive overeaters.

In my opinion, from my experience, from hearing the stories of many hundreds, perhaps thousands now, of people with eating disorders I have never once heard anyone say they wanted to have an eating disorder. No one chooses it. No one wants to die. No one wants to be fat. No one wants to be skeletal. No one wants a life of lies and deception and isolation.

The person with the eating disorder developed the eating disorder to help them cope with what they could not cope with any other way. This usually has to do with some kind of stress that creates unbearable anxiety. Unbearable anxiety means just that. The person cannot bear to experience their feelings, so the compulsive overeating comes in to numb them out. Unbearable stress comes in many forms: usually it has something to do with the person's humanity being disregarded in some way. This could be emotional, physical, spiritual.

I have an article I call the Number One reason for developing an eating disorder. It's about disregarding boundaries, i.e. disregarding where one person begins and another ends. However, please remember, not all people in such situations develop eating disorders. Such coping mechanisms as alcoholism, drug use, compulsive exercising, compulsive work, addiction to drama, control, sex, etc. are all ways of coping with the unbearable. And sometimes they overlap with each other.

David: Joanna's "Cyberguide to Stop Overeating and Recover From Eating Disorders" can be found on her site at HealthyPlace.com. You'll definitely want to take the time to read it because it helps you understand why you may be overeating and then, there are exercises to help you stop.

Here's an audience question, Joanna:

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Mandy79: I'm not fat or anything, but I do admit that I am an overeater, and this is the cause that led me to be bulimic. I wanted to be in control of my body. My boyfriend is trying to help me with my eating disorder, but I don't know where to start. I feel so alone and reserved. How can he help me?

Joanna: Hello, Mandy. Thank you for speaking up. You are helping yourself and others with your question.

First things first. Before your boyfriend can help you, you might start thinking about the best way for you to help you. Then, he can follow your lead.

Sometimes friends and family think they can help by not eating sweets in front of someone. Or they can suggest that a person eat or not eat. This is getting into the behavior and not the dynamics of the person.

Actually, the best way, I think, to help a person with an eating disorder, is to treat them normally with the expectations they would have of any healthy person. That can help the person with the eating disorder see where their behavior and feelings are part of their illness. It can help a person be more aware of their own situation and show them where they need to get help for themselves. If you get on your own healing path, you'll know how to have him help you.

Good luck to you both, Mandy. He sounds like a nice guy. And you sound great yourself.

dr2b: How do you know when you are actually "overeating"?

Joanna: Actually, your stomach is about the size of your fist. Not very large, is it? Of course, it stretches. We can feel our stomach stretching when we eat. People unbuckle their belts and loosen a button or two at Thanksgiving.

When you eat because you are hungry, you could stop when you are no longer hungry. The problem is that we, in this affluent country, often do not eat because our bodies are hungry for nourishment. We eat for entertainment, for soothing, for social reasons, for family reasons. So we need to learn how to recognize our body sensations. Then we can know when it's time to stop eating.

A big problem for compulsive overeaters is that eating is the process used to create numbness. When you are numb, you are not sensitive to your feelings and so you can go on eating long past the time your body wants and needs you to stop.

I recommend yoga classes for my patients because a sensitive yoga teacher can help a person become more in touch with the sensations of their own body, and learn to respect their body, and learn to recognize body signals. Then, you can begin to treat your body more kindly, including that little stomach that really does not want so much food in it.

David: Here's a question related to what you were just talking about, Joanna:

Jill: I realize that I rely on food when I'm depressed. I eat when I'm not hungry. Is there anything I can do to stop this habit?

Joanna: Hi, Jill. You are raising the inner dynamic issues that are crucial in understanding and healing from eating disorders. Learning how to sit with yourself while you are feeling depressed, or feeling anything else that is difficult to bear, is the key to recovery.

So, how can you sit with yourself? First, how can you be with yourself while you are feeling depressed without doing something to numb yourself? I suggest that you make a list, when you are not very depressed, of all the things you enjoy. Give yourself a different kind of menu. Give yourself an assortment of activity selections that are kind to you, soothing and comforting to you and special to you.

• You might like walking in a garden.
• You might like taking a bath.
• You might like painting a picture or writing in your journal.
• You might like petting your cat or dog.
• You might like visiting an antique shop, a museum or art gallery.
• You might like listening to Sting or Mozart.

Make a list of what's delightful and loving for you. Post it somewhere that is obvious. When depression comes on, look at your list. Then, use your strength to pick one and try it. You can tell yourself that you are postponing eating. After all, you can always eat, so you'll eat later. First, you'll nourish yourself in one of these other ways. Sometimes people postpone a binge for the rest of their lives. This is how it starts.

David: Joanna, are there emotional or physical cues that trigger the compulsive overeater to eat? For example, smokers often have a cigarette when they have a cup of coffee.

Joanna: Well, there are probably cues for everyone, or most everyone. Movies and popcorn leaps to mind. Halloween and particular candies. Most holidays probably have a food association that, for an eating disordered person, can trigger a binge.

But most likely, a situation that feels like an old situation that was painful, stressful, frightening, despairing, could trigger a binge. The situation doesn't have to be terrible itself. It just has to remind the person of a terrible experience. They often don't even know consciously that it's happening. Family visits, especially to the home of childhood, often trigger binges. There is so much there to remind the person of childhood hurts. And, often the original binge food is still in the fridge and the cupboard.

Sometimes a look or expression from someone brings up feelings that are unbearable. And that's the key. When something starts to come up that is unbearable, the binge eating begins.

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Blue: How can I feel my feelings, when I don't even know what feelings I'm hiding from? When I binge, I don't necessarily know why I'm doing it. I mean, it's easy to understand if you have a fight with your spouse, or a bad day at work, or any other obvious reason.

Joanna: You can't know in advance, and you don't have to know.

Your feelings and your associations are being remembered and expressed through your body. So first we get in touch with the body and bear what the experience is. Often we (and I say we, because this is a human experience not exclusive to people with eating disorders) feel something, and then use our clever minds to try to come up with a reason, a local external reason for our experience. It makes us feel in control. It also makes us feel hopeful. If we know that it's 'his" or 'her' or 'it's' fault, we can do something to make the problem stop. Often this kind of thinking doesn't work and just creates more problems.

So again and again, the healing effort goes into postponing, waiting, being still, staying with whatever we feel until eventually it passes or we get a helpful association to bring to our therapist to work on.

dr2b: Do you feel that there are truly "trigger" foods, and that you (like an alcoholic) must totally abstain from them?

Joanna: Healing from eating disorders proceeds in stages. Not systematic, planned, controlled stages. Not stages where anyone could criticize themselves for skipping stages or going out of order, but stages nonetheless. Someone in early eating disorder recovery is often quite terrified. She or he can feel that the eating disorder is just waiting to jump out at any time and take over. So certain foods that have been classic binge foods are emotionally loaded.

Also, going back to a previous question, the physicality of the binge food, the way it feels in the mouth going down, the taste, the consistency, are all familiar physical sensations that can invite a person back into old habits. So early on it's probably a very good idea to avoid binge foods. But, at some later time, we want to revisit those foods. Not because you have to eat them. You could probably live your life without ever eating those particular foods again. But, wouldn't it be nice to get the fear out of the association, so you eat or don't eat something out of choice and not out of fear?

So when you are ready to experiment, to tiptoe back to those old scary places, like a child grown older who is looking in what used to be a scary closet, you do. You take the fear out.

Healing is freeing. It's very nice to discover that you can live as a free person. It's nice to know that you can choose based on your own deep authentic feelings and desires.

debpop: Sometimes I eat and the food tastes so good. I could be stressed or not, but I end up eating more than I need to. I know when I am full but I feel I can't stop. How can I stop?

Joanna: You are saying that you are experiencing a rich experience of pleasure while eating. I wonder where else you experience pleasure? The good feeling from eating is comforting, good company, fun, entertaining. Where else in your life can you have those experiences?

If your choices are limited, it's only natural that you would want to get as much as you can from what you do have available, i.e. delicious food.

I invite you to think about putting more pleasure in your life that takes other forms. Then we would find out if you would choose food over these other ways of enriching your experience

David: I'm assuming that recovery takes a lot of hard work. What are the benefits someone will derive being able to stop overeating?

Joanna: A new and amazing world opens up and you can run and play and work and love in it. When you stop overeating you start feeling what you could not feel. At first you feel some pretty difficult emotions. But... once you are able to feel those, you also start to feel other kinds of feelings, wonderful feelings that were buried and numbed along with the pain.

These feelings, all of them, help you choose people, places, things, ideas, activities, that are directly related to what you genuinely care about, now that you are capable of genuinely caring. Can you imagine the difference this means to someone's life?

• What if the people in your life were people you really wanted to be with?
• What if you were eager to go to work?
• What if you were eager to be at home?
• What if you experienced joy at being with yourself?

And, of course, there are health benefits. You'll live longer and healthier. In my personal opinion, there is no beauty treatment that compares to health and joy. And that comes with healing.

David: So many times Joanna, well-meaning people will say to the overeater: "all you have to do is not eat all the time." But we know it's not that simple. What makes it so difficult to stop overeating?

Joanna: When we are babies we are pretty helpless. We have two abilities that are essential to survive. We can cry, and let our caretakers know we are in distress. We can suck, to take in nourishment. So eating, taking in nourishment, hooks into the very basic feelings of survival.

There is a powerful biological imperative to continue the individual life and the species that goes far beyond any emotional or intellectual decision of our adult lives. When we eat to numb ourselves we are eating to protect ourselves from feelings we cannot bear. That means that we believe in an unconscious and primitive way that we will die if we feel those feelings. So we are back in that early stage where we are taking in nourishment so we will stay alive.

This is extremely powerful. It's why recovery takes time. It's why trust and developing trust in stages, as it is earned, is so crucial in recovery. A person will feel (even though their mind says differently) that they will die if they stop overeating. This is why people in recovery develop courage. It truly does take courage to heal.

David: Thank you Joanna for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. 

Joanna: Good-bye all. It was a pleasure for me to speak with you tonight. Thank you for your wonderful participation.

David: Good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Dr. Sacker joined us to discuss the medical risks of eating disorders (anorexia and bulimia), which range from hair loss, kidney failure, electrolyte imbalance, esophageal rupture, loss of menstrual period, to heart failure. He also commented on the problems that the audience shared, including how eating disorders affect fertility and pregnant women and problems with diet pills. What if you abused ipecac syrup, or abuse diuretics, or have been abusing laxatives?

To find out what these behaviors can result in, read the transcript below.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "The Medical and Psychological Risks of Eating Disorders." Our guest is Dr. Ira Sacker, director of the Eating Disorders Program at Brookdale Medical Center and co-author of the book, Dying To Be Thin.

Dr. Sacker is also the founder of HEED, "Helping To End Eating Disorders," a support and information organization based in New York. Just so everyone knows, Dr. Sacker is a medical doctor and so he's well-qualified to speak to the medical complications involved in eating disorders.

Good evening, Dr. Sacker, and welcome to HealthyPlace.com. Thank you for joining us tonight. Am I right in assuming that most people do NOT die from an eating disorder, but are more likely to suffer from different medical complications as a result of having anorexia or bulimia?

Dr. Sacker: Yes and no. Up to 20% still die from the complications. Usually a death certificate won't read "death from anorexia." It will read something like "death from heart failure."

David: From emails I receive, I think many people are under the mistaken impression that the only real medical problem that results from anorexia or bulimia is malnutrition. But that's not true, is it?

Dr. Sacker: No, it is definitely not true.

David: Maybe you can talk a bit about the medical complications of anorexia.

Dr. Sacker: Okay. Some of the medical complications of anorexia include hair loss, kidney failure, electrolyte imbalance, esophageal rupture secondary to vomiting, and loss of menstrual period, resulting in possibilities of osteoporosis and infertility. There are also cardiac complications which can result in sudden death.

David: And what about medical complications of bulimia? (risks of bulimia)

Dr. Sacker: Additional complications include ruptured blood vessels in eyes, all of the cardiac and renal complications, as well as multiple ulcers of the esophagus and stomach.

David: If one starts engaging in disordered eating behaviors, how long does it take for medical complications to arise?

Dr. Sacker: That really depends on the individual.

David: On the average though, are we talking about a few weeks or a few months, or many months, even years before any serious medical complications arise?

Dr. Sacker: Certain complications, like hair loss and loss of menstrual period, may occur rather soon, but other complications such as osteoporosis or heart and kidney disease, may not been seen at first, therefore giving the person a false sense of health.

David: The reason I asked that question is that there are many people suffering from eating disorders who think "this will never happen to me."

Dr. Sacker: That is where they are mistaken. This is a very seductive and unforgiving illness. You think that you are in control initially, but then realize that you actually have no control at all.

David: We have a lot of audience questions, Dr. Sacker. Let's get to a few of those right now, and then I want to address some of the psychological complications resulting from eating disorders. Here's the first question:

ChristineCC: What causes the ruptured blood vessels in the eyes, Dr. Sacker? I have those.

Dr. Sacker: Purging causes increased pressure which can be transmitted to the chambers of the eye.

BurnhamBuggirl: How long can you go without a period before you are infertile?

Dr. Sacker: The earlier the diagnosis is made, and the earlier the malnutrition is corrected, the greater the chance of full recovery of fertility.

David: Can one become permanently infertile as a result of prolonged anorexia or bulimia?

Dr. Sacker: Yes, you certainly can.

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rleehunter: Can you help me understand why, after a 15 year battle with anorexia, and at 86 lbs., 64" tall, I am still bleeding so heavily each month, even ovulating (as surmised from lab tests)? It is baffling to me that my body would sacrifice the protein each month.

Dr. Sacker: You are one of the fortunate few. Take this as a sign from your body that it wants you to get the help you so desperately need.

Jus: You've talked a lot about the medical complications of anorexia , but what about if you are a bulimic who is restricting instead of bingeing and purging? Are there the same risks?

Dr. Sacker: If you are restricting, rather than bingeing and purging, then you are engaging in anorexic behavior.

David: Some of the medical problems we are discussing tonight are explained in some detail on the Peace, Love and Hope Eating Disorders site here at HealthyPlace.com

Jus: If you are not underweight, are there the same medical concerns?

Dr. Sacker: Absolutely the same medical risks.

David: What about the psychological problems that can result from having an eating disorder?

Dr. Sacker: Some of the psychological problems include depression, isolation, mood swings, suicidal ideation, social withdrawal, feelings of rejection, unworthiness, loneliness, and obsessive compulsive behavior.

David: Are some of these disorders, like depression or mood swings, a result of possibly a situation the person finds themselves in or is it because of an imbalance in the brain chemicals?

Dr. Sacker: Both. In most cases, it is a combination of the two.

David: So how does a person deal with that?

Dr. Sacker: The first step is admitting that there is a problem, then you must realize that eating disorders are not all about food. Once this is accomplished, you can slowly begin to process the emotions behind the behaviors.

David: A few site notes, then we'll continue.

Here's the link to the HealthyPlace.com Eating Disorders Community.

Also, some of you are asking about whether you have anorexia or bulimia. Here are the definitions of those two eating disorders:

• Anorexia information
• Bulimia information

Here's the next audience question:

JBee: I struggled with bulimia / bulimarexia for about 2 years. It's been about 5 months since I purged, but when I did, I heavily abused ipecac syrup - so much so that, eventually, it had no effect and would not always come up. Could this still be a problem?

Dr. Sacker: Ipecac syrup can KILL you! It contains emetine, which gets lodged in your heart and brain, and has led to numerous deaths. Please, please do not take ipecac syrup.

David: No one has mentioned this yet, but some people abuse diuretics, pills that cause fluid loss in the body. What impact can that have?

Dr. Sacker: Death... kidney failure, dialysis, and a total false sense of weight loss leading to severe dehydration.

David: And what is the impact of abusing laxatives on the body?

Dr. Sacker: Abusing laxatives can cause all of the above complications, as well as chronic constipation, obstruction of the colon, and ultimate rupture of the rectum.

wayout: Is it true that for people who have low metabolism rates, they have to eat more in order for them to lose weight? I mean, my doctor told me that I have to eat more in order to lose weight, because I screwed up my metabolism so much.

Dr. Sacker: When you decrease your caloric intake, your metabolism will slow down. You need to eat more not to LOSE more, you need to eat more to stay alive.

David: Dr. Sacker's website is here: http://www.sackermd.com

Here's the next audience question:

krissyl: Hi, my name is Krissy. I have an eating disorder. I eat nothing but lettuce. If I eat anything else, I throw it up. I see a therapist for depression and am going tomorrow with my mom. Neither one of them knows of my disorder. I'm scared if I tell them, they will make me eat. Help!

David: Krissy is 21 years old, by the way.

Dr. Sacker: I know it may be frightening, but you are putting yourself in a lot of danger. You need to find a therapist who you trust, and, in turn, tell them what you are doing to yourself. You cannot survive on lettuce alone. Please reach out for the help you need.

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David: I think this may be a good point in time to ask what happens when you initially see a doctor about an eating disorder. What is an exam likely to entail?

Dr. Sacker: A history of the illness, previous eating habits, your family structure, recent behavioral changes, and a complete physical exam including laboratory tests.

David: And here's some information on the basics of eating disorders psychotherapy. Now, we have a few audience comments regarding medical complications people suffered as a result of their eating disorder:

stormie: I had trouble carrying my babies to full-term because I allowed my body to gain weight.

Jus: I was restricting and blacked out while going up some stairs. I went face first into the concrete steps and lost half of my 2 front teeth. I also have some liver damage as a result.

Havenly: I have had a cardiac arrest due to an electrolyte imbalance--hypokalemia (a potassium level of 1.4). That resulted in severe edema and kidney failure. I still have my kidneys, but I still suffer from problems of edema. I want to get well, but I now have chronic tachycardia.

krissyl: I'm not sure if it is from my eating disorder but I am ALWAYS freezing, tired, bruised all the time, and lost my periods for 6 months.

babygumm: My stomach ruptured. I had to have emergency surgery.

SugarSpunSadness: I recently went into renal failure as a result of a chronic laxative addiction.

Dr. Sacker: Very often, people with eating disorders have a difficult time realizing the devastating effects it can have (eating disorder complications). These complications are not something to be proud of, but rather something to indicate that you desperately need to get help immediately.

David: What medical issues would require someone to be hospitalized?

Dr. Sacker: Unstable vital signs including irregular pulse rate, blood pressure problems, electrolyte imbalance, or severe malnutrition of over 15%.

Havenly: My sphincter muscle, at the bottom of my esophagus, is not working correctly. I have chronic heartburn and food automatically comes back up into my mouth. I have a 17-year history of purging behavior. I no longer purge so much. What can help the sphincter muscle to heal?

Dr. Sacker: First, you must stop the purging completely. This will alleviate some of your pain. You may need a GI evaluation and there are some new medications that have been proven effective.

David: Here are some more audience comments on the medical effects of eating disorders:

Sueszy: I have been abusing laxatives for years and purging. This caused severe dehydration! I now have edema and kidney failure. God if only I ate properly! That's all it would have taken!!!

David: Here's an audience comment on the earlier question about an initial exam for an eating disorder:

ktmcroo: They will take blood, weigh you, ask you a bunch of questions very bluntly and you will want to lie, but you have to fight the fear and shame and tell the truth. This is the first step to not being as ashamed and understanding your disease.

David: Thanks for that comment, ktmcroo. Here's a question on the psychological aspect of an eating disorder:

scarlet47: I'm one that believes nothing will become of my 82 lb. weight loss. I am 51 and have had anorexia for 4 years. I am seeking help weekly with a psychiatrist. I live on 500 calories a day and wonder if this will catch up with complications. I now weigh about 100 lbs., still have periods and energy. I seem to starve for self punishment. I can't relate to the young that starve for thinness; that's not me. I can't seem to believe that I could ever die from this painful illness.

Dr. Sacker: Unfortunately, you can die from this illness - anyone can. Self punishment is a major aspect of the disease. You need to ask yourself why you feel you need to be punished.

fawnberry: My sister was like me when she was younger. She used to starve herself to the same extent that I'm doing now... And now, years and years later, she's perfectly healthy. I think I'm healthy now and I don't think I'm going to get sick. Is it possible to have an eating disorder and never get any medical effects from it?

Dr. Sacker: It is possible, but I would not take this as a sign to continue your eating disorder behaviors.

SugarSpunSadness: How bad does anemia have to get before it can be life threatening? What are the threats to life?

Dr. Sacker: Anemia is also a major complication, and is the beginning of total bone marrow failure. This can result in death.

SugarSpunSadness: What is bone marrow failure? How long does it take?

Dr. Sacker: When your bone marrow stops making blood cells, it is known as bone marrow failure. No one knows when or if this will occur.

sarahwhite: What's the best way to build bones back up?

Dr. Sacker: You need to increase your caloric intake, and under a physician's care, the addition of vitamin D, calcium, and other hormonal supplements may be helpful.

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florencia: Which are the signs of lack of potassium?

Dr. Sacker: This is known as hypokalemia, and is one of the main reasons for cardiac irregularity and sudden death.

David: And what are the signs of a potassium problem?

Dr. Sacker: The signs are lightheadedness, dizziness, vertigo.

WM: Hello Dr Sacker. Your book, Dying to Be Thin, was very sensitive to the needs of both patient and parent. What are some of the most common misconceptions you see parents showing regarding their ill children?

Dr. Sacker: Blaming themselves, thinking that they can make everything all better, or blaming the individual for hurting them, or just trying to make them eat.

sandy6: How does one deal with strong denial?

Dr. Sacker: Generally, when you are in denial, a loved one will notice that there is a problem and intervene. This helps the sufferer to become aware that a problem really does exist.

cv terra: I am on paxil (Paroxetine) for eating disorders and I just went off it because I hate it, and I keep falling and passing out, and I don't know what to do.

Dr. Sacker: Please seek medical attention immediately.

David: cv terra, if you are falling and passing out, that is a signal that something is seriously wrong. I hope you contact your doctor right away.

tatuma: Sometimes after eating a normal meal, my stomach will be in pain, and it seems like the food is not digesting at all. So it becomes easier to purge or not eat. Why is normal eating hard?

Dr. Sacker: It is not easier to purge, it makes you feel better. When you begin to re-feed your body, you are going to experience some discomfort initially. This is not permanent, the complications from purging are.

vancek: I have used diet pills for a few years. I'm concerned that combined with my coffee intake, this will cause problems.

Dr. Sacker: You are right to be concerned. My advice to you is to discontinue the use of diet pills immediately.

David: What is the effect of long-term use of diet pills on the body?

Dr. Sacker: Diet pills can cause permanent emotional dependence, all the complications of malnutrition, and the cardiac effects that can result in sudden death.

tinkrbell: I have been struggling with anorexia for over 3 years now and my doctor says that I have been losing a lot of muscle mass, while reminding me that the heart is also a muscle. How much muscle would you have to lose before your heart would really be in danger? I mean, would the body start losing some of the heart muscle even with other muscle still available?

Dr. Sacker: Yes it would. If you are concerning yourself with your heart muscle, I would advise you to seek professional anorexia help immediately.

David: Here's an audience comment on how laxative abuse affected her:

ktmcroo: I have abused laxatives, and aside from the initial effect that it had on the loss of intake, I felt much more fatigued and sickly. I always felt like that anyway, but being dehydrated was really hard to fight at the same time. I slept a lot and couldn't move. I just wanted to slip away.

kellkell: I'm no longer bulimic and anorexic like I was in my 20s. Now that I'm 40, should I be concerned about any damage that I might have done?

Dr. Sacker: Why not have a physical evaluation just to make sure that everything checks out.

babygumm: Hi. I'm 23. I recently was in the hospital and had surgery for a ruptured, perforated ulcer. I have anorexia and bulimia. I am eating now, but my metabolism has slowed down a lot. My insulin levels are low too. How can I speed up my metabolism? I am afraid to gain weight.

Dr. Sacker: You need a team, including a medical specialist in eating disorders, nutritionist, and possibly an endocrinologist, to evaluate you at this time.

ladyblacksheep28906: I'm bulimic and I can't stop getting up all night to eat. Then I am sick in the morning and after I eat each meal I vomit. Doctor, how can one that is bulimic and purges and still is overweight be helped?

Dr. Sacker: It sounds like you are stuck in a chronic cycle of restricting after you have binged and purged, then the behavior continues. You need to start to explore the underlying issues that are causing these behaviors to occur.

flute: I've had problems my whole life with weight. I was a compulsive overeater and now I am bulimic. I've lost 130 pounds by purging sometimes up to 6 or 7 times a day for a year-and-a-half now. I want to stop but I have this fear of food now and I don't even enjoy binges. How can I stop this terrible illness? I also abuse laxatives and faint constantly. Is my fainting from the laxatives or starvation?

Dr. Sacker: Fainting is a combination of all the abuse you are doing to your body. You need immediate professional intervention now to help you stop these destructive behaviors.

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David: A few minutes ago, we talked about the effects of long-term use of diet pills. Here's an audience comment on that:

Sueszy: I can answer that! If you could see me now, you would see all the effects of diet pills right before you're very eyes! Swollen everything and severe kidney failure!!! Don't take diet pills!!!!! DON'T!

Ryle: After 24 years of being bulimic, have you ever had anyone get better? Also, is this more of a brain disorder at this stage than an emotional one? Any suggestions on drug therapy (I've tried all anti-depressants)?

Dr. Sacker: Yes, recovery is still possible. At this point, however, you have to really want to get better to see positive changes occur. Oftentimes, you have had this disorder for so long that you believe that it is your only identity, but that is not true. You need to find a specialist who treats chronic eating disorders and have them recommend medication for you.

dancr122: Hello. I am in recovery from bulimia and anorexia. About a year ago, I tore my esophagus. I am trying very hard not to purge and now do it extremely infrequently (still trying not to at all). My question is, does the esophagus ever heal completely, or will I always have to worry about it tearing further or again?

Dr. Sacker: If you do not completely refrain from purging, you will always have to worry.

David: If you stop purging, will the esophagus heal completely?

Dr. Sacker: It depends on the individual case.

David: Here are some notes before we continue.

I received some questions tonight on overeating...and yes, that is considered an eating disorder. You can visit the Triumphant Journey site inside the HealthyPlace.com Eating Disorders Community for information on that.

LexiLuvs2Cheer: I'm 7 months pregnant and none of my doctors will tell me anything that I might have done to the babies (twins). Could you tell me what the eating disorder is/was doing to my babies?

Dr. Sacker: I need to know more about the disordered eating behaviors you were engaging in prior to and throughout your pregnancy. Let your obstetrician know your eating disorder history.

LexiLuvs2Cheer: Before I was pregnant, I was severely underweight. I'm still underweight for my height, and during the pregnancy everything was pretty good, except for now I have serious pains all over the body. I'm kind of weak and I have not gone to school for the past 3 days. My doctor knows I have an eating disorder, yet she won't tell me anything that is happening with that.

Dr. Sacker: If your sonograms are normal, and all other tests have been within normal limits, then right now, everything seems ok. If you are still concerned and you've shared these concerns with your present OB and not received an appropriate response, why not go to another obstetrician for a second opinion.

David: Here's the next question:

mickey19mouse28: When someone says they are "in recovery," what is considered "recovery," if one is anorexic?

Dr. Sacker: Recovery is when you have reached a healthy weight, you have been able to work through the issues that have caused your disordered eating, and when you are able to resume doing the things that you used to enjoy doing.

starandcrew: Is it possible for an eating disorder to be the cause of leukemia?

Dr. Sacker: Eating disorders lower one's immunity. We are unsure if there is a direct connection.

Di: Does having nosebleeds have any reflection on a person's being anorexic? I've had these nosebleeds for about a year and they are frequent.

Dr. Sacker: One cannot rule anything out. Please have this checked by your physician.

Keatherwood: I've been anorexic and bulimic most of my 45 years. I don't purge as much (only about 3 times/week) as I used to, but I am throwing up blood. Could this just be from irritation? I am too scared to see the doctor as I can't stand anything being put down my throat.

Dr. Sacker: You need to seek immediate medical attention. Throwing up blood is very dangerous.

David: I know it's getting very late on the east coast. Thank you so much, Dr. Sacker, for staying late this evening and answering audience questions. We appreciate you sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people in the chatrooms and interacting with various sites.

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Thank you, again, Dr. Sacker for being our guest tonight.

Dr. Sacker: It was my pleasure.

David: Good night, everyone. And I hope that if you are suffering from medical complications of anorexia or bulimia, that you get help immediately. As we've found out from many audience members and Dr. Sacker tonight, an eating disorder can cause serious medical problems.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Alexandra of the Peace, Love and Hope eating disorders site is our guest tonight. Find out what it's like living with an eating disorder and trying to get through the healing process.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts, the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Life with an Eating Disorder". Our guest is Alexandra, from the Peace, Love and Hope Eating Disorders Site here at HealthyPlace.com. Alexandra is 15 years old and will be a junior in high school this coming August.

Good evening, Alexandra, and thank you for being our guest tonight. On your site, you say signs of having an eating disorder began to appear when you were 8 years old. What were those signs of having an eating disorder and what was going on in your life at that time?

Alexandra: Hello everyone! I hope you're all doing well tonight. :) At that time, there was a lot of family stress and I resorted to eating to make what I was feeling inside of me go away. Purging (eating and throwing up) quickly followed, and looking back on it now, I realize that was the beginning of the battle.

David: When you say family stress, without going into too much detail, can you please describe it so we can better understand what drove you to disordered eating?

Alexandra: Sure. My parents never had a good relationship with one another, and it's a well-known fact in this house that they would have divorced by now had neither of my parents experienced financial troubles. There was constant fighting and bickering. There wasn't a night that went by that I didn't hear someone yelling at someone, or find my mother talking to me about how awful things were. Even being so young, I took it upon myself to relieve both of my parents of stress. I believed that their fighting was my fault, and that it was my job to "fix" them. My parents never expected that of me, though -- I just took it upon myself. The stress from that and constantly feeling "not good enough" is what, I believe, caused me to turn to food for comfort, and when I started purging, that added onto wanting to feel better.

David: That is a lot for an 8 year old to deal with. When you began the purging behavior, (eating and throwing up), how did that come about? Did you read about this, did a friend tell you about it?

Alexandra: Honestly, I still cannot figure that part out! I'm almost positive that I did not read about it or see it on TV, as the only books I read back then involved fairy tales and I almost never watched TV unless The Teenage Mutant Ninja Turtles were on. :) I think, now, that I always knew that if food went in, it had to come out, and went after ways to get it out. When I discovered what to do for purging, it never stopped.

David: Then, by the age of 11, you had a full-blown case of anorexia (anorexia information) and bulimia (bulimia information). What did that involve for you?

Alexandra: Progressively, over time, the bulimia did become worse, and so did the depression that I also experienced. Around the age of 11, I was in my first year of homeschooling, I believe, so I was more isolated than I was about a year before that. This gave me more time than ever to eat and purge, and then to go days "fasting." I would eat and purge anything that I could find, and that became worse. By the age of 13, I was staying up until 4 a.m. cooking and eating whatever I could. At that time, I was purging almost 15 times a day, and was constantly upset with my moods flying off the handle all the time. I was also always extremely tired and always felt run-down.

David: Did you understand what you were doing? Had it become clear to you that you had an eating disorder at that point?

Alexandra: Amazingly, I did not believe that my disordered eating behaviors were an actual medical problem. I always knew in the back of my head that what I was doing was not natural, even "wrong", but I had never heard of anorexia and bulimia or known of any specific facts about them. It wasn't until about age 12, that while sifting around in my mother's old nursing books (she went back to college to become a nurse), that I came about a chapter on eating disorders in a psychology book. I read over the whole thing and almost fell out of my chair when I saw that what the writers were describing was almost exactly what I was doing. It was then that I knew there was definitely a problem and that it had a name.

David: A lot of times we hear that eating disorders start with an individual's desire to have the "perfect body". But it doesn't sound like that's what was going through your mind at the time.

Alexandra: At age eight, I wasn't all that concerned with my body. I was naturally a little chubby due to genetics and my age, but when I reached elementary school I did want to lose weight. I was teased a lot, and by middle school the teasing was pretty horrendous. That's when I went into home-schooling and fell right into the dark world of an eating disorder. At that point, I remembered every mean comment that was made, weight-related or not, and believed that apart from not even deserving food because I was a failure, that if I just lost some weight and became thinner, I would have no problems and that I would never be teased again. Everything would be "perfect."

David: What has living with an eating disorder (anorexia and bulimia) been like for you?

Alexandra: A living hell. People on the "outside" that have not experienced an addiction like this, or those that have just started their battle, tend to not understand how much life an eating disorder, like anorexia and bulimia, can rip from you. I have lost friends because of this addiction; because instead of returning phone calls or going out with them, I am too worried about food being around or that I need to devote more time to exercising.

Because you go through chemical imbalances from purging and starving, I also have gone through long periods of dark depression, where it can be sometimes hard just to get out of bed. Living with an eating disorder stresses you out and breaks you down mentally and physically. And during those small periods of time, where you aren't being degraded by your own mind, you end up too tired and exhausted and stressed out to do much of anything. I've said it so many times to friends and I'll say it here: This is something that I would never wish upon my greatest enemy.

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David: Here are some audience questions, Alexandra. Then, we'll talk about your recovery efforts:

Alexandra: Sure :)

gmck: Did your parents know about your problem? If so, what did they have to say about it?

Alexandra: Hmmm. My father, although still living in this house, has never really been a big part of my life, so he never caught on. My mother, on the other hand, she caught me coming out of a bathroom one evening after I had just eaten and she caught on. Another time, shortly after that, I went to her for help, but due to stress and her not understanding about eating disorders like anorexia and bulimia, she responded back with yelling and fighting, and I have not spoken to her since about it. Since that time, she has always thought that the purging was just something I was toying with and that I'm "too smart" to still have problems with it.

David: How do you feel about the way your mother has responded?

Alexandra: Well, I became bitter and even more resentful towards her for how she responded. I just felt even more hopeless and unworthy, and naturally the eating disorder became worse because of that. I have grown, I think, and I have let go of a lot of anger and resentment towards my mother. I know now that one day I'll be able to talk to her about this, when she is less stressed out and more capable of just talking about this and understanding.

David: I want to mention here that Alexandra is 15 years old. She'll be a high school junior this coming school year. Her Peace, Love and Hope eating disorders site is here in the HealthyPlace.com Eating Disorders Community. Here's another question:

redrover: Did you maintain the same weight? Did anyone suspect you had an eating disorder? Don't you feel like if you get help for the disorder then you are a failure at the disorder also? I know that's how I feel each time I think about getting help.

Alexandra: In the beginning I lost about ten pounds, but after that, bulimia only caused me to gain a few pounds of water weight, but I never lost anymore actual weight after that. That's when I started "fasting" and I lost some more weight from that. Unfortunately, with eating disorders, especially with bulimia, since those that suffer just from bulimia do not reach a dangerously low weight, it is almost easy to hide the disordered eating behaviors (eating disorder symptoms), so no one suspected there was a problem.

Before starting towards recovery, I definitely did feel that I would be failing my eating disorder and also that I did not deserve help. I had to give it a shot, though, because I knew that I would not survive much longer otherwise.You eventually realize that you have nothing to prove, hon. There is nothing good about being successful at dying. I know how competitive the world of eating disorders is, but you have to learn that nothing good comes from being competitive over something that will wreck your body and mind.

David: Some of the audience questions center around medical advice. And Alexandra really isn't qualified to dispense medical advice.

Alexandra, have you made any efforts towards recovery from bulimia and anorexia?

Alexandra: I can only give my opinion on medical related questions. I am not certified to give actual advice, however. No matter what, and I know this is hard to do for sufferers, see your doctor when in doubt.

About me making any efforts towards recovery, definitely. Every day, I work harder to break free from purging and starving. I think the root of that is learning to accept yourself for you, not a sick person or a "broken" one or one that suffers from an Eating Disorder, but you as yourself as a person. You have to learn over time to accept yourself no matter what, instead of constantly finding flaws and believing that there is one true "perfect" person out there that you must attain.

David: Are you getting professional help...working with a therapist?

Alexandra: Because I am only 15 and still unable to drive, I am not seeing a therapist. I have brought the issue up with my mother, about seeing someone just to "talk," and she was none-too-pleased with the idea. So, currently I am fighting on my own and with the support of friends. I want to make a note here that you really cannot fully recover on your own or just from support from your family and friends. You eventually will need professional help at some point or another, as you are battling against your own mind and are unable to distinguish between what is too much, too little, etc. I realize this myself, and that's why as soon as I turn 16 and get my license, I will attend group therapy meetings regularly and look into meeting with a therapist that goes on a sliding-scale basis (you pay the therapist a set amount depending on how much you earn).

David: We have some more audience questions.

desides: Hi, Alexandra. I 'm a recovered anorexic/bulimic. What was the main thing that helped you accept life and enjoy it, rather than giving in to the eating disorder?

Alexandra: Congratulations on your recovery hon! I think that when I started to come out of the extreme purging and fasting behaviors I started to feel more energized, and then, I was able to see life in a different light. I began ever so slowly to see that I did not need to blame myself for everything under the sun, and that if I tried to get rid of my pain by purging and starving, that I was not solving anything and instead just adding onto my problems. It was really a combination of things that helped me to start recovering. I also started to see that doing just daily activities like cleaning, cooking, or doing the laundry, were more enjoyable because I wasn't counting calories in my head as much. When I did eat, it was nice to not immediately think "Dear God, how am I going to get rid of this? Where? When?"

Jennie55: How long did you have an eating disorder before trying to get better?

Alexandra: I began to try and recover about a year and a half ago, when I was 14.=) As you see, it took a long time before I even began to accept the possibility of recovery from anorexia and bulimia. It has to be something the person wants, and at that time I finally started wanting to end this battle.

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David: Was there something that happened in your life or thinking that triggered a change in your attitude - making you want to recover? (eating disorders recovery)

Alexandra: Honestly, I think I just became sick of being sick. My throat hurt constantly and I was breaking down crying everyday in my room from what was going on in my head. I always knew deep down that I could not continue on like this. Before I started to recover, I was cutting myself and contemplating suicide, and I knew that I had to do SOMETHING, anything, to help this situation. I had been told always almost the same thing by other people who I had met, that also had suffered or had recovered -- "do whatever you can to try and get better. You are missing out on so much." In the end, it came down to whether I thought I deserved to live and whether I deserved to get better. Although I was unsure of either of those things at the time, I decided to give this recovery gig a shot.

redrover: I think this is one the most embarrassing problems to admit to. You'll be looked at completely different from here on out. I heard you never really recover, that you can always relapse. I don't think I could have my parents look at me each time with fear and concern.

Alexandra: Sweetie, I know that there is a lot of stigma attached to mental health issues from society, but there will always be people that don't understand or are not willing to understand. You have to take your own health as first priority and realize that people will always react as they want to. Personally, I really do believe that you can fully recover. One of my good friends is in her early forties and recently fully recovered from a lifelong addiction to bulimia and alcohol. It took her a long, long time, but she has not relapsed in over a year and has no relapse-related thoughts.

I know it's hard to have people worry about you, because you feel that you do not deserve their attention, but the best thing you can do is try to have your parents understand what is going on in your head. One of the books that I always strongly recommend sufferers and family and friends to read is The Secret Language of Eating Disorders by Peggy Claude-Pierre. That book does a wonderful job of bridging the gap of understanding between sufferers and those that are on the "outside." Recovery is always hard in the beginning, but it DOES get easier eventually. You have to keep thinking about what life will be like if you never get help, though. It's definitely not a life that anyone should have to lead.

sandgirl01: Since it was not your parents, whom did you find the most support from? Was there anyone such as a school counselor that you went to?

Alexandra: I received most of my support from my best friend, Karen, who when I first met her was living with an alcoholic father and step-mother. She experienced almost the same things that I went through, and I found that she was the person that I could most relate to. She's still the first person that I call when I feel that I am relapsing and I have always received unconditional love from her.

David: Here are a couple of audience comments:

emaleigh: I want to recommend a book to the audience if that is possible. It's called Surviving an Eating Disorder: Strategies for Family and Friends by Siegel, Brisman, and Weinshel. I recommend it for everyone who has a friend or parent that just does not understand what they are going through or what eating disorders are really about! The book's only about ten dollars. It's an awesome book to be read by anybody that has a loved one going through an eating disorder problem. It was recommended to my mother by my therapist.

Alexandra: Thank you, emaleigh - I will look into that book myself! :)

Nerak: Alexandra, I do not think I have met a 15 year old with your insight. If you have not chosen a career for you future think about counseling. You have a compassion to help that will take you far in life. Keep up the great work in helping yourself and others.

Alexandra: nerak - Wow, thank you so much for your comments. I have looked into a life-long career as a therapist, but I'm still knocking around the idea of becoming a dentist instead. Who knows! :)

desides: Well, congrats to you too for recognizing that you are not the one to blame for everything under the sun. Continue your positive attitude and it'll get you where you want to go.

Alexandra: desides - Thank you for your support. I hope that you, too, will recover. I know that you can do it.

jesse1: I have suffered from anorexia/bulimia, on and off, now for six years. At one time, I was so close to being recovered. I was happy and actually started to like myself, but then I slipped back into the mirror. I was wondering what I can do to get back out? How do I say I deserve it?

Alexandra: Jesse - Look back towards the beginning of your relapse -- what was going on in your life during that time? Was there a lot of stress involved with your parents, friends, school, etc? If you can find out what triggered the relapse, you can start working towards fighting the battle. Along with finding your true self, you also have to learn to deal with any stress or problems in your life through other things that don't involve self-destruction. Instead of purging and starving to regain control and to feel better, you have to develop better coping mechanisms for life. That's a part of breaking free from an eating disorder and a relapse. Jesse, please talk to someone about what you are going through with your recent relapse. You do deserve to recover and so does anyone in here that is still suffering. Everyone deserves to LIVE, no matter what.

David: Were you ever involved with diet pills, laxatives, alcohol or illegal substances?

Alexandra: Yes, I was. I did use diet pills, laxatives, and diuretics during the worst times of my battle with an eating disorder. It was incredibly hard to stop all of those things, and when I did finally stop, I went towards alcohol to feel better. Last year, I started using speed as well, but I realized soon after that, even though I had stopped the diet pills and other abuses, I was not getting any better because I had just reached for something else to cure the pain. It took a lot of willpower to stop the alcohol and drug abuse, but I did thankfully. I think a big part of stopping all the abuses was always knowing inside that I was not helping any kind of pain that I was feeling. I was merely masking it for a short time. When the chemicals would wear off, I'd go back to feeling crappy again, plus I'd be going through withdrawals. I had to finally say, "No!" to any kind of chemical and I've been clean since.

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Alexandra: I want to make a quick note here. Drug abuse is very similar to purging and starving in that it helps to mask the pain you are feeling, but only for a certain amount of time. Then, you don't feel so great anymore and you end up doing the behaviors more-and-more to keep feeling just okay with yourself. Even though many in society still don't think it is, an eating disorder is an addiction and anyone can become addicted to the disordered eating behaviors, no matter how little they purge or abuse diet pills.

David: What about feelings of just giving up, saying "I'm already suffering so much. What's the point in trying to recover?" Have you experienced those and how did you deal with that?

Alexandra: I definitely have, and many times! When I would go through relapses, I, so many times, just wanted to throw my hands up in the air and say, "Argh, this is too hard and frustrating! Why even bother?!" It's very common to just want to give up when you are battling such a hard addiction. Depression is also common in almost every single person that suffers, so you also have that to contend with. I think you have to look at life as it is now, and then look at life as it will be in the future if you were to not change anything that you were doing. I'm sure that the outlook wouldn't be the greatest in the world, and that's what I saw with myself. I looked ahead towards the future, and I couldn't even imagine what life would be like if I did not stop what I was doing. I figured I'd be in a hospital for the rest of my life, or dead. I dealt with it mainly by learning to forgive myself. I had to learn that mistakes will happen and that it does me no good to become angry or frustrated with myself.

I, as well, had to learn the great virtue of patience and not expect recovery to come within a couple of weeks or months. I also learned to talk. It's strange to hear that, but when you are in recovery, it is like you're learning to talk all over again. You learn how to talk to others and talk about your feelings, which is something that so many of us find we are unable to do. So, from all of these things, I have always just kept at it with recovery. I've seen good results from breaking free from these demons, and I've also heard many stories of experience from those who have fully recovered, and this is not something that I want to give up on, even during my darker moments.

David: Here are some more audience comments:

jesse1: I know what was triggering me, a lot of family secrets coming out, but I don't want to hurt them by bringing them up.

redrover: We are playing with our destiny. But, this is kind of like what you see on TV extreme sports. They take great risks. For what? A sense of accomplishment, right? Sometimes, we feel we have to follow through.

Alexandra: Jesse - I know how you feel because I have always felt a fear of hurting my parents. You have to understand, though, that they will be even more hurt if you don't tell them and your problem gets worse, until one day you end up hospitalized. Maybe you don't have to tell them everything right away, but you can start by saying something like, "Mom/Dad, I haven't been feeling too great lately and I was wondering if I could talk to a therapist."

David: Here's a question, Alexandra:

Monica Mier y teran: I have a compulsive overeating disorder which I have had for years now. I am 38, and I know it is all emotional, but I can't seem to stop eating every time no one is looking. I've tried to be a bulimic even, and it didn't work. I just don't like throwing up. What I'm doing now is eating once a day, but every time I see food, I just want to dive into it. It is really frustrating and seems like no one understands. Everyone just says to me, just keep your mouth closed, as simple as that.

Although I've lost weight, I look at the mirror and I really hate myself. I don't like myself at all. How do you finally stop this addiction that makes you suffer? I just want to live a normal life and to be able to see food and not want to dive into it.

Alexandra: Are you receiving therapy, Monica? Just like with purging and starving, those that suffer from compulsive overeating overeat to cover up and try to deal with what they are feeling. Part of recovery is learning to talk and actually deal and learn from what you are feeling instead of trying to run away from it. Take it from me, adding one disorder onto another (like starting with overeating and then becoming bulimic) does not help anything. It may make you feel better for a short period of time, but then you have two battles to fight and things are twice as hard. You also want to stay away from fasting. That never works because you always end up going back to eating and then beating yourself up. Instead, you have to learn to eat "normally," and not fly from one extreme to another. I strongly recommend that you talk about how you are feeling to someone hon! Try overeaters anonymous support groups and, definitely, individual therapy. You deserve to get better and to live sweetie. Please believe that.

Monica Mier y teran: No, I'm not in therapy. I should be though. I know it's emotional. Thanks.

David: Monica, in the HealthyPlace Eating Disorders Community, there's a new site called "Triumphant Journey: A Guide to Stop Overeating" that is focusing on compulsive overeating. I hope you'll stop by there and visit that site. We are receiving a lot of positive comments about it and I think you'll find it helpful.

Alexandra: Monica - Please take that step and go into therapy. You can't go on living in pain like this forever. I hope that you do take a step to get help. I know that you CAN recover, no matter what.

David: How is it that you can be so open about your eating disorder, when so many want to keep it a secret?

Alexandra: I wasn't like this always:) I was very secretive and didn't want to open up, even to those that I knew suffered from the same thing. I think that it's a part of the healing process. You learn to open up or else you never get out how you are feeling, and then you never get any help as a result. Most of my friends that are in public school still do not know about my eating disorder, but I still have a support system that I can talk to, regardless. I think another big part about learning to open up also goes along with recovering -- you learn to throw society to the side and say, "Ok, I'm not going to let you make me feel bad about what I'm suffering from, or about my body."

David: I know it's getting late. Thank you Alexandra for coming by tonight and sharing your story and experiences with us. Judging from the audience comments I've received, it's been helpful to many. I also want to thank everyone in the audience for coming and participating tonight.

Alexandra: Thank you for having me as a guest! I hope that all of you in the room are able to one day be at peace with yourself if you aren't already. Hang in there guys, I'm with you in this battle for recovery!

David: Good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Our guest, Debbie Danokwsi has battled with an eating disorder for most of her life. She is addicted to food. Debbie tried many different ways to lose weight. She hid food, tried diet pills and diets, but couldn't stick to a diet. Finally, Debbie faced her food addiction and the feelings of being ashamed and lonely. At one point in her life, she says: "I hated myself. I had no self -esteem. I was ashamed of myself for having no willpower." To ease the pain, Debbie says "I even thought about killing myself."

Today, she weighs 150 pounds, down from over 300, and has maintained that weight for over ten years. Read about her addiction to sugar and flour (her trigger foods), and how her attraction to food, coupled with low self-esteem and depression, led to her life as a food addict. Then Debbie outlines the steps that brought her to overcoming food addiction and recovery from food addiction.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Food Addiction, Food Cravings." Our guest is Debbie Danowski, a recovering food addict and author of Why Can't I Stop Eating? Recognizing, Understanding and Overcoming Food Addiction. She has maintained a weight loss of 150 pounds for more than ten years. A nationally renowned speaker, she is an instructor of media studies at Sacred Heart University in Fairfield, CT.

Good evening, Debbie and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Can you describe for us your life as a food addict?

Debbie Danowski: Hello everyone it's great to be here. Being a food addict is similar to being an alcoholic: everything revolves around the substance and life is miserable. Nothing matters except getting food.

David: What were the reasons behind your food addiction?

Debbie Danowski: The reasons are a physical and emotional addiction to sugar and flour that is passed down in families. For instance, both of my grandfathers were alcoholics but I turned to food instead.

David: At what age did you begin to develop an addiction / attraction to food?

Debbie Danowski: I believe that I was born a food addict. Food was always so important to me. I really began to eat after I turned five. I weighed over 300 pounds when I was in my late teens.

David: And you are how old now?

Debbie Danowski: I am 35.

David: Did you suffer from depression or some other psychological disorder that lead to the food addiction?

Debbie Danowski: I believe that the depression was a result of the food addiction. Sugar and flour are depressants in the same way that alcohol is. Once I got these substances out of my body, I did not have the awful depression that I lived with for years. It was a depression that made it almost impossible to get out of bed each day.

David: Could you be specific about the impact that food had in your life before you started recovery?

Debbie Danowski: Food was my life. I spent each and every minute thinking about how I could get food (look under binge eating disorder, compulsive overeating). To get food, I did things I normally wouldn't have. I stole. I lied. I hid food. It was as if I couldn't help myself no matter how hard I tried. At my weight, it was difficult to move and my whole body ached. I isolated and had no life. It was me, my food and television. At the time, I didn't realize just how ashamed and lonely I really was.

David: I'm assuming that having these food cravings affected your self-esteem.

Debbie Danowski: Yes, so very much. I hated myself for being weak and having no willpower. I spent a lot of time being ashamed of myself.

David: Did you try various diets, diet pills, etc.? (dangers of dieting)

Debbie Danowski: Yes, I tried just about everything and each time that I did I hated myself even more for being unable to do anything. I couldn't even stick to a diet for a few hours in the end. I did try over-the-counter diet pills but luckily Phen-Fen and Redux were not available at the time or I could have been one of the people harmed before they were recalled.

I would have done anything, including risking my life to lose weight. I often wished that I would get sick so that I would have a way to lose weight because nothing else worked. What I didn't know is that these diets were setting me up to fail because many of the products had sugar and/or flour in them which just made me want more and more.

David: Besides the food, did you ever turn to alcohol or other substances to ease the pain?

Debbie Danowski: I did drink a little but I only liked the drinks with lots of whipped cream. I also used shopping as a way to ease the pain. I thought that if I could buy the prettiest clothes no one would notice my size 52 body or make fun of me.

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David: What developed that made you want to change and actually follow through?

Debbie Danowski: I was at the point that I was either going to get better or I was going to die. It was an incredible amount of pain that made me want to change. I couldn't bring myself to end my life but I couldn't continue the way that I was. It was the misery that made me work so hard at my recovery because I never want to be that miserable again. There were many times when I thought about killing myself and even more that I wished I would die. Today, I am grateful that I am alive.

David: We have a couple of audience questions I want to get to, then we'll continue with our conversation:

Joden: So in general, any specific foods may be addictive to an individual and act as a trigger to overeat? (compulsive overeating)

Debbie Danowski: Yes. For me, it's sugar and flour but some people have problems with wheat, fat, etc. Whatever your trigger foods are once you eat them you want more and more.

David: Let's talk about the move to recovery from food addiction that you mentioned. Was the idea something that took awhile to brew inside your head, or just one day you decided, "This is it. I'm going to do it."

Debbie Danowski: It took awhile to brew inside. First, I had to take the step to admit to someone that I did have a problem. I went to a counselor who asked me straight out what I did to deal with my feelings. I looked her in the eyes and said that I write over them. Then, she asked me if I ever ate over them. I was shocked that someone actually put it into words, and I couldn't lie to her. It made everything real for someone to actually confront me about it.

David: So, one thing you did was go to therapy. What were the next steps in recovering from food addiction?

Debbie Danowski: I went to an overeaters support group and eventually to an in-patient food addiction treatment center where I got the structure I was lacking.

David: Regarding the support group, so we can be helpful to people here tonight, are you referring to something like Overeaters Anonymous?

Debbie Danowski: Yes, Overeaters Anonymous is a valuable support system. It allows people who are suffering in the same way to come together. The first real step in recovering is to admit that there is a problem and OA helps people to do that.

David: Why did you have to go to a food addiction treatment center?

Debbie Danowski: I tried to simply go to the overeaters support group but I couldn't even bring myself to keep on going. I was so sick and hopeless that everything was overwhelming, so I needed extra help. Not everyone needs that to recover.

David: Do you completely abstain from your food triggers, even today?

Debbie Danowski: Yes, it's been almost 12 years since I've had my trigger foods which are sugar and flour. And my life has changed so much! I no longer have that hung-over feeling that I once had, and I can remember things and think clearly. It truly is a miracle.

David: What eating techniques did you learn that might be helpful to others here tonight?

Debbie Danowski: I learned to eat three balanced meals and a snack at night. I learned to eat these meals four to five hours apart and not to switch off foods because that sets me up for playing with the portions I eat. I also weigh and measure what I eat to be sure that I eat the proper amounts. Not everyone has to do that, but I do.

David: Here's the link to the HealthyPlace.com Eating Disorders Community.

Is it tough still everyday, Debbie, to stay away from those trigger foods?

Debbie Danowski: No, amazingly once those substances were out of my body it wasn't difficult to stay away from them because the physical cravings are gone. Sometimes when I smell something, I may think that it would be good to eat it, but then I think about what I would be giving up and it just doesn't seem worth it. One taste doesn't seem worth giving up all of the good things I now have in my life. I did not even know what sanity was until I began doing this. No taste is worth that.

Dalton: My family wants everything so perfect and I'm a perfectionist myself. I eat because it's the only part of my life that I can control. Did you have that experience?

Debbie Danowski: I did have that. I come from a family that is very controlling, and I used to want to show them by eating what I wanted when they didn't want me to. The ironic part of it is that my life with food was so out of control that I was causing even more pain for myself. What I needed to do was learn some communication skills, such as saying "no" or telling people how I feel. It's amazing how one little sentence about my feelings helps me to deal with them.

Hannah Cohen: I have clothes in my closet, size 3 to size 18. I was one of those yo-yo dieters. I wanted to find out what my food triggers were, and the next thing I did was join a gym. I was scared because most of the people there were slim and there to stay healthy and build tone. I thought for sure everyone was laughing behind my back. One really nice instructor told me to go at my own pace, eat in moderation, and cut out the goodies. I listened to him and after a 9 month period I went from a size 14 to a size 7. The main thing is that I am still maintaining those principles, although some cold days are really a struggle to get to that gym. Holiday times were awful with all that baking.

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David: One of the things that strikes me, Debbie, and I think you mentioned that you experienced this earlier, is that people are afraid to try because they've experienced so many failures in the past. How do you deal the fear of failing?

Debbie Danowski: Yes, that's true. I was afraid, too. I wondered why I should even bother. I, too, had a variety of clothes sizes in my closet. I had lost 100 pounds once and put it back on quickly. It broke my heart to see those clothes. I deal with the fear of failing by focusing on what could happen if I did succeed. As soon as those substances were out of my body, I knew that this was very different than anything else I had ever tried so that made it much easier for me to deal with all of the fears I had. For once, I was thinking clearly and that made all of the difference in the world.

David: How long did it take you to get a grasp on your binge eating, compulsive overeating?

Debbie Danowski: Right from the beginning, this was different. I didn't crave food, so it didn't take as long. It was almost instant that I stopped physically craving some foods. For others, it took a few weeks. There were still emotional cravings but they were much easier to deal with. However, I always need to remember that I am never cured. I will have to continue doing what I'm doing if I want to keep getting what I'm getting. The big difference here is that it was not the struggle that it had once been. Without the cravings, I had a chance.

David: And maybe that's something we should address. What is the difference between food cravings and food addiction? Is it just a matter of degree?

Debbie Danowski: Yes, food cravings in a food addict are so overwhelming that as soon as the thought comes up, the food addict has no choice but to get the food. It's important to mention that not everyone has to hit bottom. What are smaller cravings now may turn into overwhelming cravings later.

lalee: If you are morbidly obese, does it mean you have an eating disorder?

Debbie Danowski: My guess would be yes.

David: Do you have any children?

Debbie Danowski: No, not yet. I have a niece who I am very close to and she sometimes asks me why I weigh and measure my food or why I can't have birthday cake. I simply tell her that cake makes me sick and that I need to eat certain amounts to be healthy. It really is not the big deal that I can make it out to be. That's a big part of addiction - making things out to be more than they really are.

David: Are you concerned that you might genetically pass along your food addiction?

Debbie Danowski: Yes, I am. It has been a concern of mine but I have read that children are most influenced by the eating habits of their parents. If that's the case, ours will eat very healthy!

Troubled1: Can't genetics play a part in one's size and build? i.e. the rate of metabolism?

Debbie Danowski: Yes, it can, but I used it as an excuse to keep eating. My thinking went something like this - since I come from a family genetically predisposed to being overweight, I may as well eat whatever I want. I know that I will never be a size 2. That's not in my genes, but being a size 52 doesn't have to be my reality, either.

David: That's a good point, Debbie.

Debbie Danowski: Thanks.

David: How do you come to the realization that you will never be "Barbie-like?" and what's it like for you, self-esteem wise, when that finally sinks in?

Debbie Danowski: Considering that I used to weigh over 300 pounds, what I have now is amazing. Sure there are times when I wish I could be Barbie-like, but I know from being a media studies professor that the images we see on television and in magazines are not as realistic as they are made out to be. I also know that these things come with a price. Many times, the Barbie-like people are throwing up or using laxatives to maintain an unrealistic weight (take the eating attitudes test). I am making a choice not to do that today and the reward is sanity and a peace of mind that I've never known. These are the things that truly matter.

David: So are you saying you haven't experienced much pain from that realization. It wasn't something that was really hurtful or disappointing to you?

Debbie Danowski: I guess I would have to say that most times it doesn't disappoint me but there are times, usually in the summer, when I will feel it and then what I have to do is talk about it and get it out.

David: Here's an audience comment, then a question:

kessab: My children got eating disorders because I did it for 13 yrs of their life. I am living proof that eating disorders can pass down based on a mother's behavior.

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Joden: Once you started to lose the weight, were you tempted to over-restrict your intake?

Debbie Danowski: Yes, I was. It's funny how I can go to either extreme. That's why it was so important for me to have a food plan with outlined amounts so that I didn't begin skipping meals. For an addict, more is better but that's not usually the case. I thought that if I could lose a little weight, why not lose more? That's where the structure comes in.

David: Kessab, and others in the audience, I want you to know that it's not unusual to go from one extreme to the other, i.e., overeating to anorexia or bulimia. You can read some of the transcripts from previous conferences to find out more.

Debbie Danowski: Yes, that's true. I went into an anorexic period.

adawn1717: If I ate whatever I wanted, I'd be 800 lbs. I struggled not to throw up and take laxatives to try and get thin, but that didn't work for me. It just made me feel like crap and then I continued the process over-and-over-and-over until I finally broke down and told myself and others that I couldn't take being the way I was any longer, but everyday is a struggle!!!! I struggle everyday not to binge eat!! I hate it!! I just want to be able to eat until I'm full and stop! What's the key?

Debbie Danowski: Yes, I used to watch the world's fattest man on television (he weighed over 1,000 pounds) and think that I would be there soon. The key for me is to first let someone else know what I will be eating each day and to work out a food plan that supports a non-addictive way of eating. Once the addictive substances are out of the body, the physical cravings leave and the struggle isn't as bad as it once was. Outside support is necessary in this situation.

David: As you were continuing to gain weight, how did you rationalize it in your mind?

Debbie Danowski: I told myself that 328 wasn't that bad; that I really didn't look as if I weighed that much; and that I could lose the weight anytime I wanted to. I also told myself that I needed food to eat; that I couldn't live without the things I was eating. Today, I know this isn't true but then I truly believed it.

David: We have many excellent sites that dealing with all aspects of Eating Disorders, including overeating, anorexia and bulimia. One of the sites, Triumphant Journey, specifically deals with overeating.

Thank you, Debbie, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people in the chatrooms and interacting with various sites.

If you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Debbie Danowski: Thank you everyone for stopping by.

David: Thank you, Debbie and good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Noelle Kerr-Price, Psy.D. is an eating disorders treatment specialist and staff psychologist at Remuda Ranch Programs for Anorexia and Bulimia.

We cover what an eating disorder treatment center is, what goes on there, the eating disorder warning signs that indicate you need inpatient treatment, how much it costs, and whether treating the physical symptoms of an eating disorder is enough or are the psychological issues just as important.

David Roberts is the HealthyPlace.com moderator

The people in blue are audience members.

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David Roberts: Welcome to HealthyPlace.com and our chat conference on "Eating Disorder Treatment Centers." I'm David Roberts, the moderator for tonight's chat. Our guest is Noelle Kerr-Price, Psy.D. Dr. Kerr-Price is a Staff Psychologist at Remuda Ranch Programs for Anorexia and Bulimia, a specialized treatment center exclusively dedicated to women and adolescent girls suffering from anorexia, bulimia, and related issues. Her primary fields of expertise are eating disorders coupled with psychological assessment. Good Evening Dr. Kerr-Price and welcome to HealthyPlace.com. Just so we are all clear on the subject, what is an eating disorders treatment center?

Dr. Kerr-Price: An eating disorder treatment center is a place where girls and women go in order to receive intensive help for their eating disorders.

David Roberts: There's regular counseling, where you see a therapist in his/her office. There's outpatient treatment centers. And inpatient treatment centers. How does one know which is best for their particular situation?

Dr. Kerr-Price: You have just described different levels of treatment. Eating disorders vary in their severity and so require different levels of help depending on the individual. The greater the problem with the disorder, the more likely an intensive program is needed to help manage it. Less severe disorders may only need the help of an outpatient therapist once or twice a week. Again, it depends on the needs of the individual.

David Roberts: When you say "greater the problem" -- how is that measured?

Dr. Kerr-Price: In the mental health field, one means of determining the level of treatment needed is found in established "practice guidelines" in treating eating disorder patients. For instance, if a person has lost a substantial amount of weight and is struggling to function in many areas of life, like work, relationships, etc., then this would be a clue that the problem is intense and so needs intense help.

David Roberts: What other signs would be an indication that one needs inpatient treatment?

Dr. Kerr-Price: Certainly other physical symptoms such as poor vital signs, heart and/or kidney problems. Psychologically, depression and strong anxiety tend to occur.

David Roberts: We have a very large eating disorders community here at HealthyPlace.com and, of course, we hear all sorts of stories about what goes on inside a treatment center. What is it like to be inside an eating disorders treatment center?

Dr. Kerr-Price: Centers vary of course, so I can best speak about the one where I work, Remuda Ranch. We have a setting that is designed to be different than the traditional sterile hospital setting so as to provide a comfortable environment. Many different types of groups occur as does individual and group therapy. A lot of assistance is offered at meal times also, as we anticipate those to be hard times in the day.

David Roberts: What's the average stay?

Dr. Kerr-Price: For our adolescent patients, it is generally 60 days. For our adults, it ranges between 45-60 days.

David Roberts: We have a few audience questions, Dr., that I'd like you answer, then we'll continue with our discussion. Here's the first question:

riverrat0515: Why do most inpatient hospitals have you stay only 28 to 30 days?

Dr. Kerr-Price: Sometimes it's a matter of what insurance may cover in terms of cost. Other times, it is the design of the program itself.

David Roberts: What is the cost of being an inpatient at Remuda Ranch?

Dr. Kerr-Price: Frankly, I would be hard pressed to give a set figure simply because I know Remuda Ranch tries hard to work with families on the costs along with what their insurance will cover.

David Roberts: I understand, but just to give our audience some idea...for 30-days is it about $10,000 or is it $30,000 or more?

Dr. Kerr-Price: Given that our length of stay is longer than thirty days, it would be greater than $30,000. We are probably comparable to a hospital stay. But we work individually with each family and with the insurance companies to get the most benefits.

becgra: Is it true that Remuda is biblically oriented

David Roberts: and what does "biblically-based" mean in terms of treatment?

Dr. Kerr-Price: Yes, that is true. We are a Christian treatment center in which we maintain as a focus a Christ-centered approach. We include components of the Christian faith into each facet of the treatment as we believe that Christ offers healing.

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julesaldrich: What if I have learned the basics of recovery, but haven't been able to put it all together? Could Remuda Ranch still be a benefit to me?

Dr. Kerr-Price: It really could because sometimes people need assistance doing just that, putting it into practice rather than continuing to try by oneself.

David Roberts: I think several of our audience members are wondering if recovery is possible, even if you've been a long-time sufferer -- let's say 10+ years or more.

Dr. Kerr-Price: It is possible. Motivation is very important. The duration of the disorder does bring disadvantages, like causing a woman to feel it has become her identity and so she may wonder what she may do without it. But, it is possible.

David Roberts: We've also heard stories of people going to a treatment center and coming out and starting right back into the eating disorder behaviors. What should one expect when their stay is over?

Dr. Kerr-Price: When one finishes treatment and is preparing for the next phase of recovery, I anticipate that the person would be afraid of relapse. However, this can be a healthy fear if it is not extreme because some anxiety can help us to make good decisions and be safe.

David Roberts: I'm going to post a few audience comments relating to what we've been talking about so far, then we'll continue with more questions:

regmeg: Recovery is possible. I have had my eating disorder since I was 12 and I am 42. There is always hope.

DoriLyn: I am an alumni from Remuda. 6 months recovered.

David Roberts: One thing I'd like your reaction to -- since we've had other specialists on our chat and they've always focused on the psychological aspect of recovery. There's new research out that says treating the physical symptoms vs. the psychological problems is the most effective way to treat someone with an eating disorder. When treating the physical symptoms, the researchers found that remission rates were about 75% for patients with either anorexia or bulimia nervosa. What do you think of that?

Dr. Kerr-Price: I know the research you're referring to and that does sound impressive. However, a flaw in that study, which was the same thing they acknowledged needing to do, was that they didn't actually compare their treatment of the physical symptoms to standard treatment of eating disorders. Therefore, it is difficult to interpret that form of treatment as being superior to what is standard practice.

David Roberts: Do you think then that it's important to get to the psychological root of one's eating disorder in order to have a sustained recovery?

Dr. Kerr-Price: Absolutely! Eating disorders are not just about the food. In fact, there is usually much more going on needing psychological attention than just treating the physical symptoms.

David Roberts: Here's the next audience question:

angelface_dee1: I have been to a treatment center and I have been out for a year now and still I struggle with it every day. Is it possible to ever be fully recovered without any eating disorder behavior? Is it possible to have a full recovery without any eating disorder behavior in your life?

Dr. Kerr-Price: I realize professionals in the field of eating disorder treatment may differ in opinion, but I believe it is possible to have complete recovery.

Mark_and_Christine: Any thoughts on programs for younger patients? Most programs are for 14 and over, but unfortunately 9 and 10 year olds with eating disorders are out there?

Dr. Kerr-Price: We do work with some girls as young as 11 or 12, depending on the circumstances. However, I am not very familiar with eating disorders treatment centers that serve girls as young as 9 or 10.

Mark_and_Christine: What would be the circumstances that would have you consider an 11-year-old? Additionally, with younger patients, I think the family will have to be more involved which may be hard with sleep-away programs.

Dr. Kerr-Price: Our medical director and the program directors help to assess when it is appropriate to have an 11-year-old come here. You're right about the difficulties with younger kids being away. That may be why programs for them are so hard to find.

David Roberts: Here's a specific question about what goes on inside a treatment center like Remuda:

CindyD: Is it true that patients aren't allowed to go to the restroom without the door open or someone standing there to see that they don't purge? And does that rule apply to those that are anorexic and don't purge anyway?

Dr. Kerr-Price: We do have some rules like that but, typically, such a rule as that is not imposed throughout the length of the patient's stay. For instance, just during her first few days and following meals, for example. We apply the same rules to girls with anorexia because of the risk they may try to exercise.

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David Roberts: Out of curiosity, are most people who go inpatient "forced" into that type of treatment because of their medical condition? Or do they realize things have gotten out of hand and they elect to come in?

Dr. Kerr-Price: Either may occur. Often in the case of adolescents, they might not choose this for themselves but their parents recognize the need. Others, including some adolescents, do see their need for help and desire recovery desperately.

Lost_Count: Is it common to jump from one eating disorder to another. I was bulimic for 12 years and then began seeing a therapist. Though I no longer purge, I still have episodes of binging. How do you break through the cycle?

Dr. Kerr-Price: Switching from one form of the eating disorder to another does happen. Breaking the cycle requires seeking the help needed to understand the issues behind the behaviors and receiving help in making the behavioral changes.

David Roberts: Recovering from an eating disorder on your own -- is that possible or next to impossible?

Dr. Kerr-Price: It is possible but much less likely than receiving help through a team of professionals who can address the different components of the disorder.

David Roberts: Here's an audience comment:

tinyowl: It's possible, moderator, to recover on your own. I was bulimic for 10 years and recovered from it without help

David Roberts: In reference to tinyowl's comment above, I think that's wonderful. But just from my experience here at HealthyPlace.com and doing these conferences, most cannot recover on their own.

David Roberts: Earlier, you were talking about patients needing assistance during meals. Here's a question on that:

becgra: What type of assistance during meals?

Dr. Kerr-Price: Sometimes people become very distressed when trying to eat a meal because of the fears they have around food. So, assistance can include talking them through it, encouragement, distraction, etc. Also, it may entail helping the person recognize what she does with her food, like cutting it into small pieces ( a food ritual), or eating her meal at too quick a pace.

tator: What about the medical aspects of treatment? I have a jejunostomy tube and am wondering about medical support that is needed?

Dr. Kerr-Price: Our treatment includes the help of a primary care physician who can assess everything from heart functioning to vital signs, to liver functions, kidneys... The list goes on. Since I am not an M.D., I am unable to answer the second portion of your question.

David Roberts: Do you have people who come to Remuda and are treated for medical problems, as well as psychological issues, or are the medical issues handled at a medical hospital?

Dr. Kerr-Price: Definitely. Often eating disorders create physical problems that need to be addressed. In the instance of someone who is severely medically compromised, say to the point of not being cleared to travel here, then she would go to a medical facility first for stabilization.

Galiena: What about the families of these girls/women? Are there support for them while their loved ones are in your facility? Places to stay, etc?

Dr. Kerr-Price: For our adolescent and adult patients, they and their families get to experience a "family week" which is an important piece of treatment so that family is included in the process. Also, adolescents have weekly teleconferences with their families and therapist to deal with issues.

Lost_Count: Is there a waiting list to enter your program?

Dr. Kerr-Price: Often yes, but the length does vary so sometimes, the wait may be less. For instance, currently, we have some space available.

dancer81: The doctor said that they currently have space available. I was wondering how lengthy the process is to be accepted into their program and if that takes a long time to do?

Dr. Kerr-Price: The process may vary for different families but I do know that, sometimes, people come very soon after the initial call is made to us.

David Roberts: Dr. Kerr-Price, does one need to be referred by a therapist or medical doctor to get into an eating disorders treatment center or can one self-refer?

Dr. Kerr-Price: One can self-refer.

angelface_dee1: Have you ever seen anyone actually recover?

Dr. Kerr-Price: Yes, I have known many individuals who once had eating disorders and are now symptom-free.

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David Roberts: And can you define "recovery" for us? What does that mean exactly in terms of someone with anorexia or bulimia? Does that have to mean symptom-free?

Dr. Kerr-Price: "Recovery" is a continuum. Someone may not exhibit enough eating disorder symptoms to meet criteria for an eating disorder diagnosis but may still struggle with the desires for instance. Hopefully, one can reach a place of being absolutely free of the disorder but purging half as much as one did at one time is progress on the recovery continuum. 

dancerchic: I've had an eating disorder that has taken over my life yet I'm not underweight. I've done an intensive outpatient program and now my therapists are suggesting inpatient. Would you suggest inpatient even if the person's weight isn't below normal?

Dr. Kerr-Price: At times, that is very appropriate despite not being underweight. If the disorder has taken over your life, then help is definitely needed.

julesaldrich: I have been in and out of recovery several times, do not really have fear foods, but just seem to fall back especially when my life is stressed. Often, when I begin to feel healthy, I get scared of being "too healthy." I am wondering if Remuda would be right, or if maybe I just need to find a great therapist at this point?

Dr. Kerr-Price: Although it is difficult for me to say with any certainty because I don't know you, perhaps connecting with a therapist who knows eating disorders well would be a place to start now. That person could help assess if a more intensive program is necessary.

David Roberts: Dr. Kerr-Price, thank you for being our guest this evening and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active eating disorders community here at HealthyPlace.com. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Thank you, again, Dr. Kerr-Price for coming tonight and staying late to answer everyone's questions. 

Dr. Kerr-Price: Thank you very much and thanks to the audience for joining us.

David Roberts: Good night, everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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The decision by Diana, Princess of Wales, to publicise her harrowing battle with the eating disorder bulimia resulted in double the number of sufferers coming forward for treatment. A study by the Institute of Psychiatry in London shows that reported cases of the illness rose to 60,000 during the 1990s after the Princess's revelation.

Since she first spoke of it in 1994, the number has almost halved — a trend attributed by researchers to the "Diana effect" that persuaded them to acknowledge and seek treatment for their eating disorder.

The number of cases of anorexia, where an individual often starves himself or herself for fear of fatness, remained steady at about 10,000 cases between 1988 and 2000, the study showed.

However, researchers found that cases of bulimia, when sufferers binge-eat and then force themselves to vomit or fast to avoid weight gain, rose dramatically in the early 1990s and then suddenly declined.

The Princess first revealed her own battle with bulimia in 1992, when it was described in Andrew Morton's controversial book Diana: Her True Story. In later interviews she spoke of the "secret disease" that had preyed on her for many years.

"You inflict it upon yourself because your self-esteem is at a low ebb, and you don't think you're worthy or valuable," the Princess told the BBC One programme Panorama.

"You fill your stomach up four or five times a day and it gives you a feeling of comfort. Then you're disgusted at the bloatedness of your stomach, and then you bring it all up again. It's a repetitive pattern which is very destructive to yourself."

The Princess revealed that she first began struggling with the condition shortly before her marriage in 1981 and she was still suffering from its effects in the late 1980s when she sought treatment.

Figures in the study, published in the British Journal of Psychiatry, showed that in 1990 there were more than 25 cases of bulimia per 100,000 of the population among females aged 10 to 39. But that reached a peak of about 60 cases per 100,000 by 1996. Since then cases have been falling steadily, dropping by almost 40 per cent.

"Identification with a public figure's struggle with bulimia might have encouraged women to seek help for the first time," the researchers wrote.

"This would suggest that some of the 1990s peak might have been caused by the identification of long-standing cases rather than a true increase in community incidence."

The team added that it was notable that the Princess's death in 1997 coincided with the beginning of the decline in bulimia incidence.

They said that while her influence when alive may have encouraged some more vulnerable people to adopt a similar pattern of behaviour, the decline was more likely the result of the impact of successful treatment.

The researchers also suggested that rising rates of bulimia may have been due to increased recognition and detection efforts given to a new and fashionable diagnosis.

Steve Bloomfield, of the Eating Disorder Association, said that the organisation had a debt of gratitude to the Princess for her bravery in speaking publicly about her illness.

"Her willingness for people to know that she had a problem seems to have helped hundreds of others," he said.

"At the time (of her death) she seemed to have been cured of this terrible illness and her bulimia recovery acted as an example to the many women who had difficulty seeking help.

"Bulimia is often a very secretive disease and women don't come forward easily and Diana clearly had enormous influence on people."

Complaints of being cold even when room temperature is normal.

Don't refer to foods as either good or bad. That only reinforces the all-or-nothing thinking an anorexic.

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What is it like to have anorexia or bulimia and be inside an eating disorders treatment center? Who needs to go to one? How much does it cost? Read this.

Dr. Deborah Gross , our guest speaker, is a board-certified psychiatrist and also the president of a company that helps people with compulsive overeating (emotional overeating, binge eating).

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I hope your day has gone well. Our conference tonight is on "Compulsive Overeating: Dealing with the Feelings and How to Treat It". Our guest is Dr. Deborah Gross. Dr. Gross is a board-certified psychiatrist in private practice. She is also the president and co-founder of Sea Star, a company that produces programs to help people deal with compulsive overeating (emotional overeating, binge eating).

Good evening, Dr. Gross and welcome to HealthyPlace.com. We appreciate you being here tonight. Can you give us your definition of what "overeating" is?

Dr Gross: Overeating is eating more than you meant to, or more than what is healthy for you. Compulsive overeating is a different thing. A compulsion is anything we feel driven to do in spite of knowing that it is harmful

David: What causes someone to compulsively overeat? Is it brain chemically oriented or is it more of a psychological thing?

Dr Gross: The head bone is connected to the rest of the body, therefore, usually both elements are involved. Compulsive overeating, in one sense is an addiction, like alcoholism or drug addiction. It's not a weakness or a moral issue.

David: So, are you saying that some people have a propensity to compulsively overeat?

Dr Gross: Yes. Newer research is showing that the rate of compulsive overeating is much higher with blood relatives who have other compulsive or addictive disorders.

David: With many addictions, like drugs or alcohol, the addict finds it almost impossible to help himself stop using the substance and therefore self-help is really ineffective. Does that hold true for compulsive overeating?

Dr Gross: Good questions. Relapse happens in all compulsive disorders and it is important to have help, like a coach or a whole team of helpers. Many of the same tools used in AA, for example, can be used to help yourself with compulsive overeating. (Overeaters Anonymous)

David: What about the emotional tie-in to compulsive overeating? I'd like you to address that, and then we'll have some questions from the audience.

Dr Gross: Feelings influence food behavior. It starts in the cradle. Baby gets hungry, baby cries, mama feeds and cuddles, so the connections is really strong. You must learn to emotionally nourish yourself well in all ways, because not all hunger is for food. Ask yourself "is it my stomach that is hungry or my heart"?

David: How would you suggest one do that-- nourish yourself in other ways?

Dr Gross: The first thing you have to do is, learn what your triggers are for emotional overeating. For example, if you are extremely stressed out at the end of the day, before you go to the fridge and eat everything in there, try doing things that are relaxing for you, like take a walk, a bath, call a friend. I tell my patients to move the body, feed the mind and lavishly indulge the sprit.

David: Here are some audience questions:

DrkEyes2 A: What is behind the addiction to compulsively overeat?

Dr Gross: All of the research indicates that the biological part of the problem lives in a place in the brain called the mesolimbic system. This place is very deep inside our brain, and it's very primitive, so it doesn't listen to reason. There are also some brain chemicals, like serotonin, which maybe involved, although there is a lot we don't know. Depressive disorders and anxiety disorders are problems for some people as well.

mazey: I want to get control over my food intake but it saddens me as I continue to eat foods that make me real sick. I have the intellect but my emotions take control. Having Borderline Personality Disorder, will I ever be able to get a grip?

Dr Gross: Where there is breath there is hope. Most people with Borderline Personality Disorder, have had lots of losses, and so it is tempting to try to fill the empty place with food. Working on making your relationships more healthy will probably be very key to you.

David: Is there any medication out there that can help block the "feeling of wanting to eat" or is it all on the emotional level?

Dr Gross: Numerous medications have been studied for this purpose. Meridia has helped some people.

kateviennaoh: I have been fighting my overeating and bingeing for most of my life, with only temporary success. At this point, I can't see any way of being successful long term. I don't see or feel any hope. I don't know what to do except give up and eat. Thanks, Kate

Dr Gross: Don't give up. You're worth more than that. A person worth is not measured in pounds. I have a chapter in my upcoming book about this and I call it "Priced by the Pound". Society does that to you, but don't do it to yourself, please.

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David: And I think Kate brings up a great point here, doctor. Right now, society frowns on people being overweight. Some people are downright rude about it. How, as a compulsive overeater, can you deal with that emotionally, and not let your self-esteem hit rock bottom?

Dr Gross: Here's what I tell my patient's my motto is: "Always remember that it is perfectly possible to be perfectly wonderful without being anywhere near perfect".

David: I want to address one thing about Meridia, there are some questions as to its safety. Are you still recommending that to your patients?

Dr Gross: It depends on the specific situation. Medically and psychologically, no medications should be used without careful discussion with your doctor of the risks and side-effects, versus the potential benefits.

David: One other question I wanted to ask, since you compared compulsive overeating with an addiction. With an addiction, the doctors say you are never really "cured," you just manage it better. Is that the same with compulsive overeating?

Dr Gross: Absolutely! That is an important though unpleasant reality. The difference between alcoholism and compulsive overeating is that while the alcoholic can stay out of bars, the compulsive overeater can never get away from food. I think that accounts for a lot of the relapse problems.

kateviennaoh: Are there programs like detox for compulsive overeating? If so, what, and where are they?

Dr Gross: I consider all highly structured diet programs to be similar to a detox. The research shows that sometimes it is helpful for people to take a break from making decisions about food, that is why many commercial diet programs have highly structured eating plans at the beginning, and allow more choices as time goes on.

jat: I'm tired of trying different medications. I was on Paxil for awhile. Then it wasn't working anymore. As I tried to taper off, I experienced withdrawal. I've tried Prozac, and they didn't work. I tried Zyprexa, Effexor and had bad reactions. How can I be expected to even be willing to try another drug? And then, there's the insomnia I experience. When I do take a medication, I then need something else to help me sleep. Presently, I'm just taking St. Johns Wort and that isn't working at all. Where should I go from here? Or do I even bother with medications anymore?

Dr Gross: I can't give medical advice of that kind in this format, but I know it is frustrating to try and try, and have so many problems. I assume you are trying these medications for depression. Nowadays people have so many options that sometimes it's important to be sure that the psychological factors are being addressed. The research shows that a combo of medications and psychotherapy is best for complicated situations.

David: I'd like some feedback from the audience. Maybe you could share some of the emotional issues you are dealing with as a result of compulsive overeating. A lot of times, people feel they are the only ones who feel this way and by sharing this you might be helping someone else here tonight.

Dr. Gross, you have a program to help compulsive overeaters. Can you describe it and tell us a little more about it? And how effective is it?

Dr Gross: My program is called "The food and feelings system for weight loss wellness". It can be an additive to any program for the diet math "the calories and exercise part". It starts with having your food and feelings profile done. This self-test identifies the 12 food and feeling or compulsive overeating issues that I've found to be most important. Then you get a teaching module for each one of these.

David: Here are some audience responses regarding emotional issues:

jat: I am dealing with overeating and Obsessive Compulsive Disorder. I was doing so well with food, then I had a hysterectomy about 2 years ago and have gained so much weight. Now body image is a major issue as well as depression.

mazey: I have fatty liver disease. My trigs. were over 1400. My liver stuck out of my stomach even when I was at my heaviest. Real sad. I have a lot of self-hatred and embarrassment. I try to not eat in front of people because I'm fat, and when I eat at home I hate myself.

susie: When I am deep in depression, I feed the need for more and more food, even though I know that I have just eaten.

caglel: At times, my desire to eat is greater than my desire to lose weight. Do you have any tips on motivation?

Dr Gross: I define motivation as "you, plus all available help". Think hard about what has worked for you in the past and what has not. Having a trainer or a doctor or a nutritionist to give you professional help is a big advantage. But motivation is mostly all about You. Write down your goals, and why you want to lose weight, and read it everyday. It has to be for You.

David: Here's another audience response:

kateviennaoh: I'm doing the therapy etc., but when I'm alone I want to eat. I know what I need to do, but I don't!

DrkEyes2 A: So what is the NEED that is served by overeating?

Dr Gross: There is a reflex between your stomach and your brain. Think about puppies you have known. When you feed the puppy until it's belly is stuffed, it goes to sleep. Food is a very effective tranquilizer. Momma nature wanted us to survive, so she made us with a very strong connection to food.

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zeesant: I have tried many so called diets in my time, however, in time, different issues come up in my life that stop me in my tracks. Do you know of anything available that would help me know what my issues are concerning how my feelings control my diet?

Dr Gross: The food and feelings profile I mentioned, was designed to do that, to help you figure out what your triggers are for overeating. Ask yourself this question: what sends me to the fridge? If the answer isn't food or hunger, then you could eat everything in your house and still not feel any better.

hpcharles: The speed with which I substituted food stuff for cigarettes was incredible. Five months and 35 pounds later, and no sense of guilt - only justification...now what!!??

Dr Gross: That's a common problem. I'm glad you don't feel guilty, because feeling guilty makes people want to overeat more. Create a tool box of other things you can do besides overeating, surround yourself with little things you love, reward yourself with non-food items, figure out what builds you up and nourishes you emotionally. Also be sure that you know how to say the "N" word....NO.

David: If food is your "comforter" and helps you through the emotional issues, what do you replace it with?

Dr Gross: That depends on what the emotional issues are. If you have self-esteem problems you must learn to think more positively about yourself. Most of us are much better at doing this for other people, than we are for ourselves. I tell people to work on being a good momma to themselves.

David: One final question, do the antidepressants, like Paxil, Wellbutrin, Prozac, help with controlling compulsive overeating?

Dr Gross: Sometimes, but also these medications are associated with weight in long use.

David: I know it's getting late. I appreciate you coming tonight Dr. Gross, and sharing your knowledge with us. I also want to thank everyone in the audience for coming and participating. I hope you found it helpful. Good night everyone.

Dr Gross: Thank you very much for inviting me.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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