Cris Haltom, PhD., who has treated many adolescents and adults with eating disorders, is the guest speaker.

David 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 conference tonight is entitled: "A Survival Guide for Parents with Eating Disordered Children". This will cover children will suffer from anorexia nervosa and bulimia nervosa.

Our guest is Dr. Cris Haltom, PhD. Dr. Haltom has treated many adolescents and adults with eating disorders (anorexia and bulimia), has trained mental health clinic staff in eating disorders treatment and is a guest lecturer on the topic of eating disorders at Cornell University. She also works with parents to help them cope with the emotional stresses of having eating disordered children.

Good evening Dr. Haltom and welcome to the HealthyPlace.com site. I received about 20 emails today from parents who are not only concerned about their eating disordered children, but also explaining the impact that this has had on their lives and other members of their families. In your experience, what is the toughest part of surviving this ordeal for the parents?

Dr Haltom: Coping with the frustration of an eating disordered child who is resistant to treatment and the long-term nature of treatment.

David: And that's part of the disease. Many times, the sufferer doesn't realize or doesn't want to acknowledge that anything is wrong. How is a parent to deal with that?

Dr Haltom: Parents need to recognize, first, that they have a right to express their worries and concerns to their children. An open and honest approach to gently confronting a child is important. Parents need to use "I" statements when they confront a resistant child and to site some of the behaviors and signs that they have observed which suggest there is a problem.

Parents should approach an eating disorder like any other illness. It is a serious matter and they can communicate that to their children. They can also point out that there are professionals who will be gentle and supportive with them in proposed treatment.

David: I know that's easy to say. But many parents are faced with children who are openly combative and insist that nothing is wrong. Parents tell the child she/he needs help and the child says "no way." Then what?

Dr Haltom: Great question. Parents can expect resistance and anger. As you said, it is often part of the disorder. Taking a child to a physician can often be helpful. Because eating disorders also have a medical component, there are often telltale signs that will be picked up in a doctor's office. It is difficult for a child to refute medical evidence. In the case of a child's safety being jeopardized, a child may need to be escorted to the emergency room of a hospital where both a mental health and medical professional can assess the situation for safety.

Also, I would like to point out that there is nothing wrong with anger. Underneath a child's anger is some important communication about why they are having problems. And underneath anger is usually hurt and/or fear.

David: Dr. Haltom, here are a few audience questions:

PattyJo: Since a lot of eating disorder sufferers have a 'guilt complex' anyway, how can a parent express concern without triggering the eating disorder? I found that the eating disorder 'spoke' for my daughter about 80% of the time at her lowest weight. I found that even at 62 lbs., we had to "Force" our daughter into an inpatient treatment facility.

Dr Haltom: Since the eating disorder is often the primary way a child copes, it is often difficult to avoid triggering eating disorder symptoms. In general, it is best not to walk on eggshells with your child even if you are concerned about causing guilt.

Emerald Angel: What if you (the child or the parent) cannot afford to get help?

Dr Haltom: One important step for parents is to educate yourself about eating disorders. There is now excellent on-line information on a number of websites (including this one) about eating disorders. There are also a number of national organizations (e.g. National Association of Anorexia and Related Eating Disorders or ANAD) which act as referral sources to low cost treatment. These organizations all have websites.

Also, your local mental health clinic and pediatrician will most likely be able to help you. Recent studies have shown that primary care physicians, when educated about eating disorders, are key treatment team members.

David: If you haven't been on the main HealthyPlace.com site yet, I invite you to take a look. There's over 9000 pages of content. Check out the Eating Disorders Community.

Here's a question I've received from several parents: Is there really any such thing as "true recovery". Or is it like alcoholism, where, in a sense, you are always in recovery?

Dr Haltom: It depends on which school of treatment specialists you are talking to. The addiction camp suggests that once you have an eating disorder, you remain recovering. However, there are many who believe that people with eating disorders can and do recover from eating disorders. About 50% of people with eating disorders, after recovering, report being "cured."

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David: Many, though, go on to have relapses. That, too, can be very stressful and also wearing, I'm sure.

Dr Haltom: Yes, many people do relapse. Many times that is because of incomplete treatment. After intensive treatment, people who have reached normal weight and/or are free of debilitating symptoms leave treatment in what I call "hover mode." They are hovering between still having disordered eating and being healthy with eating and body image issues.

Treatment for eating disorders may last from six months or so to two years. Sometimes, as with chronic anorexia, the treatment may go on long-term. During recovery, there may be a period of good health only to be followed by temporary relapse. This uneven progress is to be expected in treatment. And the uneven recovery process can be frustrating to expectant and hopeful parents who desperately want to see their child recover.

David: So, for parents, one important thing to keep in mind is, even after being in extended treatment, whether in- or out-patient, it's important to receive follow-up treatment and monitoring. Just because your child says she/he is better, it doesn't mean that's so.

Here are some audience questions:

camkai: I have a 10 year old that is 8 months into her eating disorder. Are you seeing younger children with this problem?

Dr Haltom: Yes. About 10% of young people diagnosed with an eating disorder report the onset of their illness at age ten or younger.

JEN 1: My daughter is in treatment now. When she comes home, how much of a role should I play to insure she stays on the right track? Should I be involved in monitoring? She is 19 and living at home.

Dr Haltom: It sounds as if your child is in an day or inpatient eating disorder treatment program away from home. My guess is that the staff that are working with her are experts in the treatment of eating disorders. They will direct you with regard to monitoring.

David: One of the questions I received was that, of course, eating disorders are a "physical thing", but can a person ever recover from the "mental aspects" that led to it?

Dr Haltom: Yes. People can recover from the behaviors, emotional issues, poor body image, distorted beliefs and attitudes that led to and maintained the eating disorder.

lyn: Can you give any advice concerning prevention for those of us who still have younger children ?

Dr Haltom: A top piece of advice is the following: Teach children to "listen to their bodies" when it comes to eating habits, hunger, etc. In general, we want to teach children to pay attention to internal cues about eating and hunger.

chloe: Do you believe that hospitalization is necessary? Can an adolescent be treated successfully at home?

Dr Haltom: In this era of minimal insurance benefits available for expensive treatments (often about $1000 per day for good inpatient treatment), there are increasing numbers of people who are using intensive outpatient services to treat eating disorders. Of course, when there is a medical emergency, such as heart arrhythmia, esophageal tears, and other medical problems, hospitalization may be absolutely necessary.

Luvem: Why do therapists & nutritionists recommend that parents not discuss food issues?

Dr Haltom: Many young people in recovery need to learn to listen to internal cues and make autonomous decisions about food choices. It is part of the recovery process in many cases. Also, focusing on food is often not focusing on the most important issues - those underlying issues such as identity confusion and a myriad of other concerns are more important to focus on.

On the other hand, most of them are interested in promoting healthy eating habits in a child's home. That may require some talk about food. For example, a common recommendation is to make sure their is a family habit of eating three times a day and eating at least one meal together. Also, a common recommendation is to have a healthy variety of foods available in the home. There may be some "food talk" about what food choices different family members want in the home.

David: You have a program which you call an "anorexia survival guide for parents". Can you explain that in more detail?

Dr Haltom: This is a program which utilizes virtual modalities - computer, phone and fax - to connect parents for psychological and educational learning about their children's eating disorder. I have a free monthly newsletter which can be subscribed to at my website. And I have started offering teleclasses for parents which run for 4 to 6 weeks, one hour per week. Parents are connected by a telephone bridge line and I teach the class. Parents can both learn and support each other.

The idea is to support parents while their child is in treatment. The classes and newsletter are a supplement, not a substitute for treatment by a team of professionals.

Jackie: What is identity confusion?

Dr Haltom: Young people are often in the throes of developing their identities. That is, they are in the process of figuring out what their personal values are, what their chosen peer group is (who they identify with, e.g., athletes), what their sexual orientation is, what their career aspirations are, etc.

Children are picking their values, career aspirations, chosen interest areas, and educational goals. All this can be very overwhelming. As a result, there is sometimes a need to feel special or in control of their lives when everything around them seems to be one large question and difficult set of decisions. One way to be in control is to control one's body and eating. Or one way to feel special is to be the thinnest at school.

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Luvem: How can a parent show their concern and support for their child without sounding "controlling"?

Dr Haltom: Be a good listener. Be available to talk. Don't be too probing or judgmental. Many young people with eating disorders want to be "understood" by their families. Showing empathy is also a good way to draw out a child and show support. A parent can use reflective listening and they can ask about how a child might be feeling. They might say, for example, "That must have hurt your feelings."

David: An audience comment on point:

lyn: Not too easy to not be probing these days with young people.

PattyJo: What about medications, what is effective for anorexia? And should a parent be receptive to medication treatment for their child? (medications for eating disorders)

Dr Haltom: Because absorption of medications is sometimes affected by eating disorder behaviors, e.g., starvation and poor nutrition or vomiting near the time medication is taken, a physician will determine when the appropriate time to give medication occurs. And the physician prescribing, often listen to the mental health professional (unless it is a psychiatrist who is both prescribing and treating) about what mental health conditions may be underlying an eating disorder.

chloe: My daughter was put on the antidepressant, Zoloft, and we have seen tremendous progress in the depression that accompanied her eating disorder.

Dr Haltom: For example, it is very common for young people with eating disorders to suffer from depression. Also, social anxiety and obsessive-compulsive disorder (OCD) are often part of the clinical picture. And substance abuse is a consideration. The medication chosen will address the clinical psychiatric problems. There is some evidence that certain anti-depressant medications will curb appetite for those who binge. Also, sometimes medicine is given for gastrointestinal problems that arise with eating disorders.

In short, parents should be prepared to deal with the question of medication when their child is in treatment for an eating disorder.

David: It's getting late. I want to thank Dr. Haltom for being here tonight. There was a lot of good information and I appreciate the audience participation. Our homepage is www.healthyplace.com. I invite everyone to take a look around. Thank you again Dr. Haltom for coming tonight. 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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Online Conference Transcript

Judith Asner, MSW is a bulimia treatment specialist and founded one of the first outpatient eating disorders treatment programs on the east coast.

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 entitled "Beat Bulimia, Bulimia Treatment". Our guest is eating disorders treatment specialist, Judith Asner, MSW.

In 1979, Judith Asner opened one of the first outpatient eating disorders treatment programs on the east coast. Ms. Asner has been trained in psychodynamic psychotherapy, cognitive-behavioral therapy, and group psychotherapy.

She has presented papers on eating disorders at the American Group Psychotherapy Association and the International Association of Eating Disorders Professionals. In addition to primarily treating bulimics, Ms. Asner also publishes an eating disorders newsletter.

Good Evening, Ms. Asner and welcome to HealthyPlace.com. We appreciate you being here tonight. Because each person in the audience may have a different level of understanding, can you please define bulimia, bulimia nervosa for us (bulimia definition). Then we'll quickly get into the details.

Judith: Bulimia (bulimia nervosa) is defined as periods of uncontrolled eating. The person eats anywhere up to 10,000 calories in a sitting. Binge eating is followed by purging behaviors, i.e. vomiting, laxatives, exercise or sleep.

David: I think it's also important for everyone here tonight to know that you suffered from bulimia and it started over 30 years ago when you were 21. How did you develop it?

Judith: I developed "sudden onset bulimia", after the sudden death of a parent--a real trauma. But I certainly had some eating and body image issues all along.

David: This is back in the 1970s when no one was really talking about eating disorders. Did you know what you had, and what was it like for you?

Judith: I thought I was awful, that I discovered the best and the worst behavior in the world. I had no idea what disease it would become. Thank heavens for Jane Fonda because she spoke up about her experience with bulimia nervosa in 1980.

I lived in great anguish that someone would find out about me. Yet, I got so much positive reinforcement for being thin that it was all so confusing. There was so much praise for being thin from society, and men especially, that I wished I had discovered it sooner. I thought it would end all of my problems. Right!

David: You mentioned that you lived in great anguish that someone would find out about your having bulimia. Tell us how the disease progressed in you.

Judith: I began to get so into being thin, that I threw up several times a day. And I would binge on anything my heart desired, even on things I had deprived myself of before. It seemed like an answer to being just slightly overweight. And attention and beauty were a high! It is so sad to see the values that some people have about beauty.

David: Today though, it's still very difficult for someone with an eating disorder to talk about it. In fact, from what I've read, and from talking with bulimia sufferers, having bulimia nervosa is a real stigma; even worse than having anorexia.

Judith: I am sure it was a way to blunt emotion. Don't forget, I was dealing with parental loss. Bulimia is not a pretty disease. It does not bring admiration, as starving does. Starving is called "the moral superiority of anorexia nervosa." Being able to starve is an art. One feels so morally superior! Society admires starving women.

Not so with purging out of control women! There is no moral superiority in throwing up your food after stuffing yourself. But all in all, it is a way of avoiding feelings by focusing on food and thinness.

David: Here are a few audience questions, Judith:

dano: What is different between bulimia, and say, for instance, a person that eats and then 20 minutes later is really hungry and feels the need to eat again?

Judith: That person is responding to true hunger cues, I hope. With bulimia, one is unaware of one's true bodily needs and hungers. The satiety, or satisfaction signal, becomes disturbed during the course of the disease. The person who eats when hungry is responding to a real bodily cue, and the person who eats again is responding to hunger, not emotions. People with bulimia are not in tune with real hunger cues. The signals are disturbed by, or even before the disease.

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girlguide: Judith, did you have to deal with your bulimia while going through school?

Judith: Yes, I was a grad student in social work, if you can possibly believe that. Can you imagine the amount of shame I felt, saying I was someone who could help others when I could not even tell anyone about my secret? But of course, today, as a grown up and experienced therapist, I understand that the wounded healer is the most capable of feeling empathy.

It is so important for one to understand that no one is perfect. We all eventually get a disease. How can we be who we really are, or be authentic, if we do not allow ourselves to be human? So much of the illness is about a "false presentational self" of being perfect.

No one is perfect. Every personality has its glitches. Every single person has some problem.

David: What did you do to cope with the shame? And then, what made you get past the shame and decide to get help?

Judith: Many years of anguish and reading about the subject led me to finally realize that I might not be alive if I kept up such destructive behavior. I had to face that part of myself. It was very, very hard work and many years of therapy trying to understand why I did not love and accept myself as I was; why I thought my value was in being thin, not in my work or my being.

Don't forget, this was the 70's and 80's. Thinness was everywhere. The media made it into life's most important accomplishment. You could not get away from the message that nothing else mattered. The TV, magazines, and movies showed one thin woman after another. If one was susceptible to the media, the message was clear.

Do you know a woman's self-esteem goes down after watching 30 minutes of thin women on TV? Madison Avenue depends on this. It sells!

David: Just so everyone in the audience knows where you are coming from, have you completely recovered from your bulimia? (bulimia recovery)

Judith: I said I was not perfect! But always improving. One is always susceptible to a comforting but maladaptive behavior and has to be ever on guard.

There are many trigger foods that I do not have in my home today. Why? Because they are trouble for me. I still do not keep sweets in my home because I know enough to avoid these troubling foods.

When coupled with stress, any trigger can set off a binge. Is this recovery? There are many theories about that. Some say that one should debunk all food myths and eat any food in a proper proportion. That is good, theoretically, but it just doesn't seem to work for many women with bulimia.

I think, at least initially, it is best to deal with what one can manage. Perhaps in time, in a calm, safe environment, trigger foods can be managed in small amounts. Every person if different, but most have problems with foods that combine fat and sugar.

David: The audience has a lot of questions, Judith. Here we go:

wauf5: I understand that there is no "quick fix" for bulimia. I've suffered for over half my life. So what, if you had to put it in one short paragraph, is your answer?

Judith: First, I can really empathize with you. It is so tough.

If I were to say 2 things they would be: You really have to monitor yourself one MINUTE at a time, not just one day at a time. You need constant positive self-talk. "I can, I can."

Then, it is the capacity to continually say NO to one's desire to give in, and to get busy with something other than food. It really is a constant effort.

I wish I could give you a simple easy answer to cure it, presto. But you know, the more accepting you are of yourself, the more you can be honest about who you are with others, and you can ask them to help you in any way you need to be helped. The support of people who are there for you is essential.

Lex:My eating disorder resurfaced about 8 months ago and it has gotten so bad even though I see someone, it keeps getting more out of control. I feel so anxious when I think of eating, and if I eat (rarely), I can't keep it down. Any suggestions?

Also, I am worried it is going to get so bad. Is it that I need hospitalization? Any suggestions on what I can do to try and avoid that and help myself?

Judith: Have you spoken to a psychopharmacologist psychiatrist who can suggest a medication to help you with the compulsive behavior? Have you seen a nutritionist so you know exactly what you can eat without gaining a lot of weight? Are you going to daily 12-step Overeaters Anonymous groups?

David: Here are a few audience comments on what's being said so far. Then we'll continue with the questions.

mazey: I wasn't thin, about 190 lb., going into eating disorder treatment at 21. I got into a life-threatening emergency situation. Was in a medical hospital because I could no longer keep anything down, including water. Even if I wanted to eat or drink, my body rejected everything. I was closet binge/purger.

I haven't purged in at least 5 years. I have irreversible damage in my stomach and esophagus and don't have many teeth left. I have learned that for me, the purging was a control issue. When things were most out of control, I had this secret and was in full control. Losing weight, eating big time, and living with my face in the toilet. That was control, so I thought.

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Haven: I've been in a terrible bulimic "phase," bingeing and throwing up for a few years now, although I've had this for 12 years. I have 3 kids and want to change but am SO stuck now. It is an addiction now? I really feel powerless, it controls me. And I hate saying that, but it is true. Everything I eat makes me feel guilty and it leads to bingeing--I'm a true blue mess, Judith.

Judith: You must love your kids so much. Go to Overeaters Anonymous for you and for them.

Lori Varecka: That is what they tell us in the hospital "all foods are good". "Get busy" with the computer and isolation from my family. My husband isn't so keen on that. I have to do something after dinner though.

Same here, Lex, about the anxiety and things getting more out of control now.

Judith: Lori, can you talk to your husband and can he help you?

wauf5: I hear ya, Haven!!!!

David: Here's an audience question:

diane74: I've been struggling with bulimia for 4 years. I'm trying so hard to beat it for the sake of my husband, my two little girls, and me. How do I overcome the overwhelming fear that if I quit this behavior, I'll become fat?

Judith: A fear is not a reality. Work with a nutritionist or a therapist who can give you support and reassurance and who can help you modify your meal plan if you gain weight.

Is being here for your family more important than a few pounds? Think about how important you are to your loved ones and yourself. Your life is no small life--it is a big and important one. You deserve health. It is your birthright. Remember, balance.

David: For those who have asked, here's the link to the HealthyPlace.com Eating Disorders Community.

Here are some more audience questions:

Amy4: What advice do you have for someone who has been bulimic for 15 years?

Judith: Happiness is our natural state. We are meant to live that way. Often, women with bulimia feel they don't deserve happiness and they hurt themselves and deprive themselves of it by the bulimic behavior. Seek help. It is never too late to get well. Most people seek treatment well into the illness but not right away. I see many women who do recover after 15 or even 25 years. Five to six years is the mean years for most to seek treatment.

David: I want to post some audience comments here because I think it's important to realize that if you suffer from an eating disorder you are not alone, your feelings about what you are going through aren't abnormal or weird. There are others in the same position.

larissa: I also have anorexia along with being bulimic.

Marion: Not a question, but a 'thank you" to Judith for the last few comments. I work (with enormous success), on a private basis with eating disorder sufferers, yet I continue to struggle with alcohol issues myself...of course, in my "private world".

Judith: Thank you, Marion, for bringing that up. They seem to go together.

leslie2: I'm just really scared.

Kiki: I was anorexic then bulimic. Started out at 120 lb. and went down to 75 lb. I went into the mental health profession because I knew this was wrong and I thought I could "cure" myself. I have been going to a therapist for a year and while things are better (no more binge/purge) I still have the same ideas about food and control. I have used laxatives in the past few months, which I am really ashamed of.

Lex: I am 800 miles from my family. My best friend is here, but even though she knows, she doesn't understand when I ask for help like not going somewhere to eat where I feel uncomfortable, where we end up eating hoagies. I feel so alone and discouraged at times.

Lori Varecka: I do see a therapist and a nutritionist (who used to work at the eating disorders' section of the hospital). Even with the meal plan, which I can't seem to stay on, it isn't helping. I find outpatient not as helpful as partial or inpatient - but I don't want that again (after 3 hospitalizations in 3 1/2 years).

Judith: Do not be ashamed. In the grand scheme of things, bulimia is not a CRIME. It is just an illness and needs to be treated, like any other illness. Please give yourselves a break.

leslie2: I am almost 26 and was diagnosed last year and I'm just starting treatment now. Everyone seems concerned, but me. Why is that?

Judith: That can be Denial.

sillyme: My biggest problem is that I binge but don't purge, and I am up to 250 pounds and still going up. I am concerned about my health, but I just don't know how to stop.

Judith: Ladies, you are not alone. We can be a virtual community and can support each other. Try Overeaters Anonymous, It can help you find a saner way of life. Sane, as insane eating that is, sillyme. We are silly to hide ourselves. We are all beautiful human beings.

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David: You are right Judith--about being a virtual community. And I don't mean to be self-serving here, but that's what HealthyPlace.com is all about; people helping people. It is not a site built around experts, although we do have experts here and they are important, but it's also important to get support and knowledge from others who are going through similar experiences.

So, I do invite everyone to participate, come to the eating disorders chat rooms, join the support groups, visit the sites and participate.

Judith: This is why HealthyPlace is so important for issues like bulimia. The shame component can be overcome via the chat and then one can finally go out and get help. OUT OF THE CLOSET AND INTO THE VIRTUAL WORLD. HealthyPlace is doing a wonderful thing for us. Thank you, David.

David: How would you suggest sharing the news of your bulimia with someone close to you, so you can start on the road to recovery?

Judith: Just say: I want to enlist your support because I know how much you care for me and that you will be there for me no matter what. What I am about to say is difficult, so please hear me without judgment as I would you. Then say: this is what I most need from you to help me on my journey to recovery. And then enumerate the ways in which they can help; be positive, specific and ask for exactly what you need. It is a gift to honor someone with such an important job and they will be happy to be able to do a good deed. "The Interpersonal Bridge" is the most important bridge we can ever walk across.

David: Here's the flip side of that question, Judith, from a parent:

sarahsmom: What is the most important thing I can do to help a 7 year bulimic, age 21, daughter...other than love and support her. HELP! (bulimia support)

Judith: Just be there in an accepting way; no shame or blame; help her get the treatment she needs; ask her what she wants you to do. And don't forget to tell her how unconditionally you love her, bulimia or no bulimia. And tell her you have faith in her, that she will find the path and the belief in herself to do what she needs to do. And remember parents, bulimia is complicated and no one is to blame.

Marion: How often, in your practice, do you find a direct correlation between bulimia and drug and/or alcohol addiction?

Judith: Bulimia has many causes and no one is to blame. Alcoholism is the disease most closely associated with eating disorders. The behaviors are ways of not dealing with life's emotions and ups and downs. I recommend staying away from alcohol. It disinhibits a person and often leads to a food binge. Also, first degree relatives of bulimics have a higher percentage of alcoholism than the general population. They are all subsumed under "addictive disorders". Remember, these are bio-psycho-social illnesses. All 3 spheres play a part in their development. Biological vulnerabilities, social environment, and psychological makeup.

David: For those who didn't know this, Judith does coaching and teleclasses, helping sufferers and significant others deal with eating disorders. 

Now, I want to follow up on sarahsmom's question, Judith.

It must be difficult for a parent or significant other to also deal with what is going on with the sufferer. What do you do to cope when your child or spouse comes to you and says "enough! I'm not getting anymore treatment. I'll never get better." and then follows through on that attitude? How do you, as a parent or spouse, cope with that and what should you do?

Judith: You can do a few things. You can get support for yourself. Or you can tell the person that you cannot be in their life because it is too painful to see them destroy themselves. Please see "Intervention" on my archived newsletters on my site. It deals with a whole social system intervening to force a person into treatment for eating disorders.

David: Here are a few audience comments on what's being said here tonight:

Mocho: It's nice to see a parent looking for support too (sarahsmom) - mine have outright told me they no longer support anything I do to try and get better (I "failed them" the first time I went to the hospital 2 years ago by not getting better fast enough - well, I never did get better).

Judith: I say, as long as there is life, there is hope.

Lori Varecka: The hospital therapist made it seem like it was my mother's fault. This was at a family counseling session, the only one my mom went to. She doesn't want to know anything about eating disorders.

Judith: The role of the therapist is to instill hope into a person. Find one who does.

Is any one thing anyone's fault? That can't be. There are many factors that go into this complicated illness. I imagine with gene mapping, we will one day find the aberrant gene for eating disorders. I hope your mom is here to see that news flash!

Kiki: Thank you, Ms. Asner, for your candid comments about this disease and thank you to HealthyPlace for offering this chat. 

Janeperry2000: My daughter is 19, weighs 78 pounds now, and is 5'10". She still vomits a lot during each day! How do I help her to face the truth that this is what she has: bulimia! She doesn't want to go to the hospital! I don't want to wait until it's too late! I'm so concerned! Help!!!!

Judith: Jane: INTERVENTION - get a team mobilized. 

Lex: I am scared of getting better but I want to. Is that weird? It makes everything so hard. I tell myself when I weigh that I'll stop.

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David: Here's a question:

Jus: I have been diagnosed with anorexia and bulimia. Right now, I seem to binge every night at 3 a.m. Do you have any suggestions on how to stop?

Judith: Why are you waking up at 3 am? Are you depressed? Night waking can be a symptom of depression, a sleep disturbance, too much caffeine, not enough exercise, low blood sugar...I could go on and on. Have you consulted a professional?

Jus: Nightmares from PTSD.

Judith: PSTD must be treated by a trauma specialist. You know sexual trauma and eating disorders are related. Get help.

diane74: I've been hospitalized 3 times in the last three years because of dehydration. Once while I was pregnant with my 2 yr old daughter, almost losing her to pre-term labor. What is going to stop this insane behavior?

Judith: You are going to stop the behavior, with the help of a professional. YOU must be responsible for your behaviors ultimately. A force from without cannot replace the desire and determination from within. Pull out every plug to get the best treatment possible, and if you are a believer, ask for God to help you. No one from outside of you can make you stop a behavior. Only You can do that ultimately. The ultimate determination is within one's soul and it finally says: I am worth more than this. I deserve better. There is a big beautiful world out there and I deserve to enjoy it.

Chlo: Hi! I get your online newsletter and find it useful. Currently, I want to begin recovery for the bulimia again but I am doing some heavy duty therapy for past sexual abuse issues. Should I hold off on recovery until these issues are resolved? I am too afraid to ask my therapist. I don't want her to think I am defeating the purpose- even though I know I may be.

Judith: Sexual abuse issues are associated with eating disorders. I imagine you will have to get through the catharsis of the abuse first. Be very, very honest with your therapist. Discuss with her how the eating plays into other things you discuss. When you both feel you are ready, she can direct you to a person who can help you if she can't. Remember, above all, honesty to one's therapist and friends and most important, to Self.

But be kind to yourself. I am sure you are all suffering enough just having the eating disorder, so do not rank on yourselves day and night. Be kind. Shame and blame---there is no glory in them.

addy1: Hi, even though my daughter knows all that you have mentioned above, and has hit many rock bottoms with anorexia and bulimia, I wonder when she will find full recovery.

Judith: Maybe not full, but... every journey begins with a small step. Praise her every step of the way. Mirror her; be present for her and trust in the life force. We all want to be whole, and fully alive. I trust she is resourceful and will find her way out of the maze. God knows I and many others have. It feels real bad to be at rock bottom, but sometimes it is what it takes. Meanwhile, mom, my heart goes out to you. Talk to other moms who can support you.

AndreaD: Judith, I am in outpatient treatment for bulimia. How can I get help for my husband? He is always so worried about me and feels like I am sneaking around and almost like I'm cheating on him with food. Is there a support group or book for family members?

Judith: Have you ever heard of Imago Therapy based on the book "Keeping the Love You Find" by Harville Hendrix? I am an Imago therapist as well. It helps couples learn to dialogue honestly, to understand each other's childhood wounds and how they replay in the marriage. Most importantly, it deals with addictive disorders and eating disorders as EXITS to intimacy.

You know, when you are in the bulimic cycle, you are not truly available and present, so you are in an exit. The therapist will ask you to name your exits--everyone has them!- and will ask you when you will be ready to close that exit. Some work will be done on what the exit means to you and why you use it. At one time, it was probably an adoption to early wounding, but if you can be safe with each other and open about what you need from each other to heal childhood wounds, you can begin to close the exit, bring the vital energy back into the marriage and heal yourselves. Then you may not have to run away from your pain and fear by eating. It is quite an effective, hopeful means of working with the eating disorder and the restoration of the wholeness and goodness with which we are all born.

David: I know it's getting late. Before we leave, let me remind you to please make sure you sign up on the mail list at the top of the Eating Disorders Community homepage so you can keep up with events like this and informative news.

I want to thank Judith for being our guest tonight and sharing her life experiences and expertise with us. And thank you to everyone in the audience for coming and participating tonight.

Judith: Thank you all. Thank you all for giving me the opportunity to feel useful!

David: Thank you again Judith 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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Judith Asner, MSW is a bulimia treatment specialist and eating disorders coach. Ms. Asner founded one of the first outpatient eating disorders treatment programs on the east coast. She is also the sitemaster for Beat Bulimia inside the HealthyPlace.com Eating Disorders Community.

Ms. Asner discusses the importance of having a strategy for recovering from bulimia and other eating disorders. She maintains that trying to recover from bulimia without a plan is extremely difficult; next to impossible. She outlines the components of an eating disorders treatment plan. Audience members questioned Ms. Asner on how to stop the binge/purge cycle, episodic binging and purging, the fact that dieting, for recovered bulimics, triggers of a relapse, and more.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Morning. Welcome to HealthyPlace.com and our chat conference on "Recovering From Bulimia: What You Need To Know." I'm David Roberts, the moderator. Our guest is Judith Asner, MSW. Ms. Asner is a psychotherapist who specializes in treating bulimics and those who suffer from other eating disorders. She started one of the first outpatient programs for eating disorders in 1979 on the East Coast. She is also the owner of the Beat Bulimia website here at HealthyPlace.com and does life-coaching; helping people via telephone. Ms. Asner graduated from one of the top executive coaching schools in the U.S., The Hudson Institute. You can click here for a definition of bulimia. For comprehensive information on eating disorders, visit the HealthyPlace.com Eating Disorders Community.

I received an note from Ms. Asner, recently, saying that a lot of the email she received came from people who stated they had tried to recover from bulimia or other eating disorders and weren't doing very well. So they decided to give up. Like there was only one way to recover and if that didn't work, than that's that. And Judi mentioned to me that from her vantage point, as a psychotherapist, she could see that many didn't even understand the basics of eating disorders recovery, much less have a strategy for recovery. So that's what we're going to be talking about this morning.

Good Morning Ms. Asner and welcome to HealthyPlace.com.

Judith Asner: Hello, David and guests and welcome. It's always a pleasure to be here with you, David.

David: When you talk about a strategy for recovery from bulimia, what are you saying exactly?

Judith Asner: Well, I am talking about a plan, David. Nothing proceeds without a strategy; long term and short-term goals. A plan goes this way: First, one has to have health professionals on a team. There is no way around that because bulimia nervosa is a disease. This team has to begin with an internist to cover one's physical condition and follow it. Next, a psychiatrist is needed to evaluate wheteher or not the person is suffering from a biological depression or other condition.

David: Before we get deeper into that, I want to ask this question: Is is POSSIBLE for everyone or anyone to recover from their eating disorder? Or are there some people who, no matter what they try or how hard they try, will never recover?

Judith Asner: I believe where there is a will there is a way. But statistically, there is a percentage that does not recover and remains chronic. However, I never give up on ANYONE. With bulimia, about 20 percent remain chronically bulimic.

Let us define recovery, David. A person may feel much better about themselves and still have some eating problems but have a much better sense of self and function well, but have episodic binges and purges. This is not full recovery, but it is a far sight better than being in the throws of full-blown bulimia, daily. I consider this a victory. I don't look for perfection in life. I look for some balance in a person's life. If a person falls back into bulimic patterns, I try to help them out of the downslide as fast as possible and help them get back on their feet, understand the stressors and make the next time easier. This, to me, is pretty good progress. If a person never purges again, hooray. I just hope a person can feel valuable, have a good sense of self, be kind to themselves and others, and if they slip, so be it. It's over and let's get back to living as fully as possible. If the person can go for success every day, God bless them. Hooray for them--what a victory.

David:Earlier, you mentioned that recovery begins with having a team of professionals to help you and that there was no way to effectively recover without that team. I'm assuming you are talking about needing an internist, a psychiatrist and maybe even a nutritionist. Am I right?

Judith Asner: Yes, David. Now I am not saying a person can NEVER do it alone. Let me modify that. Certainly self-help books on eating disorders, family and peer support, faith and faith-based groups, and overeaters anonymous are enormously helpful. But when there is a serious case of bulimia with underlying depression, anxiety or bipolar illness, which we call a comorbid condition or dual diagnosis, medication is necessary, monitoring of the physical condition by an internist is essential and a sound nutritional plan and exercise in the appropriate amount are important elements in the eating disorders treatment plan.

David: Judi, we have a couple of audience questions I want to get to that pertain to what we've talked about already, then we'll continue with our discussion on a "Recovery Plan for Bulimia." Here's the first question:

rcl:How do you know if you are in that 20% that are chronic and may not recover significantly and, if you are, what should you do?

Judith Asner: If you have had bulimia for say 5-10 or more years and you throw up for 3 or more times a week, go to the drawing board again. Look at what has and has not worked in the treatment before. Have you been to an inpatient facility? Have you been reevaluated for psychotrophic medications? There are many, many new medications on the market in the past years. Have you seen a psychotherapist who has worked extensively with the disorder or, in fact, had it? Have you gone to OA meetings daily? Have you hired a coach? Have you stuck to a firm nutritional plan?

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David: We have some questions regarding limited financial resources:

maren:And if your financial resources are limited, then what? Are there many self-help groups at universities?

teetime: I have had a eating disorder for 4 years and do not know how to get help. Money is a big problem.

Judith Asner: Yes, Overeaters Anonymous has a meeting every day in every city. You could also apply any 12-step program's principals to eating disorders. Also on my website beatbulimia.com, you can find some free resources. Colleges have groups and you can start your own groups . The local hospitals also have self-help groups that are free.

David: So to recount what we've said about having a strategy to recover from bulimia or any eating disorder: First you need an overall strategy, a plan that you can use to guide you in your recovery, rather than just haphazardly trying things. Part of that plan is starting with a team of professionals working with you: an internist, a psychiatrist, a nutritionist and others. Or if you are limited in your financial resources, participating in self-help support groups like OA can help. What about a meal plan of some sort?

Judith Asner: Yes. That is true. And the drop-in groups at hospitals. You could also go to www.clinicaltrials.com and see if you could qualify for a clinical trial of some type. A meal plan is so essential. It is a road map for a trip. We just don't drive to a mountain resort without a map, do we? No business can proceed without a business plan. Well, we are organizations, just like a business or institution.

David:What is meant by a "meal plan"?

Judith Asner: A plan for breakfast, lunch, dinner and in-between snacks that is planned the day before, with the day's acitivites in mind. There can be substitutions but the person basically has to know that they can eat X amount of calories per day without gaining weight and that if they stick to this plan they will not have to binge and purge to maintain normal weight. Most people with bulimia do not believe they can eat 3 normal means and be a normal weight. This just isn't true. That is the reason that working with a registered diatecian is so important. A meal plan usually follows the guidelines of the American Dietetic Assn. plan and is balanced and healthy.

David, sometimes people don't stick to a meal plan. Well, that is okay. Use the slip as feedback information to understand what went wrong and go back and revision that scenario again and again in your mind. Then do scenario planning again. Keep using slips as feedback information to continue to learn about yourself and keep going until you get it right. It's like tennis. I think people have to try their backhand about 3,000 times until they get it right. But they never give up.

coolwaters: If you throw up after every meal you eat, does that make it impossible for recovery?

Judith Asner: If you stop throwing up, it will be possible to recover. You have to figure out how you are going to stop throwing up after every meal. That is very serious. You are not keeping any nutrition in your body and can be very seriously harming yourself.

fairydust:But how do you fight the urge to binge? If I eat 3 meals a day and binge/purge too, I'm sure I'll put on weight

Judith Asner: If you work with a nutritionist and have 3 healthy meals a day, you will not want to binge because your body will be full on what it needs and you will not crave the binge foods. If you have an emotional need to binge or you are controlling your mood by bingeing or you have a compulsion to binge, you can get help . Medications help control compulsions and emotions can be discussed with a therapist. This is what I mean by a team. Also, by going to a self-help meeting everyday, such as OA, you will get help with your assumptions, which are false, that you can;t eat normally.

AnnetteK99: For the last 8-9 yrs., I've bounced back and forth between bulimia and anorexia. Everytime I try to get better, it lasts for like a week or two. Then I plummet again. Any suggestions?

Judith Asner: Yes. Get continual help, both group and individual, to find out how you can break through this pattern of self-defeat. Also, do you have a mood disorder that is a cycle, called bipolar? If you think you might, I encourage you to see a psychologist or psychiatrist for an evaluation.

David: Some audience members have questions regarding medical issues associated with eating disorders.

Bobski:I am just as you describe. I'm not a daily bulimic anymore. I'm getting much better. I have had the eating disorder for 9 years. I used to binge and purge many times a day. I am now down to a couple of times a week. I have seen multiple therapists and I have been put on antidepressant medication. I do not know what else to do. How can I take my recovery to the next level.

Judith Asner: I happen to think that coaching is a great way to take the eating disorder to the next level, if you are highly functional in every other way. How about mood stabilizers? Have they been tried with antidepressants? Has group therapy been tried? It is great that you are down to a few times a week. I would have to know more about you. It is complicated but you have come far. I would say reevaluate the medications and rethink the strategy. You can go farther. Don't stop now.

For people who are almost recovered, like you, I have some additional thoughts. Let's suppose you are writing a business plan or a strategy about yourself. How would you take yourself to the next level? How about an overall strategy. Get a team of people around you. Have them fulfill different functions. Divide the difficult times into units and ask someone to monitor each unit with you. Assign yourself tasks around the 3 times a week to help you through them. Have a person with you at that time. In other words, you young women who have had the advantage of being out in the business world can apply some of your extraordinary common sense and business training to your own situations!!!!!

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David:As I mentioned earlier, Ms. Asner is not only a licensed psychotherapist, but she also graduated from one of the top coaching schools in the U.S. - The Hudson Institute.

Having a support system is another important part of the overall recovery strategy, isn't it Judi? And when you talk about that, what exactly do you mean when you say "support team"?

Judith Asner: Actually, your support team is anyone who cares about you. For me, being in the field I was where colleagues are so open and loving, I had permission to be whoever I was and still be loved for myself. So if I had bulimia 20 years ago, as a psychotherapist, it didn't matter. I don't know if you all can ask colleagues in the business world to watch out for you at a business lunch or ask an office buddy to help you with the donuts. It is a question of the culture you are in. But any friend, relative, pal, associate or lover who cares about you can be part of your team. I have my coaching clients email me about how the day has gone, and believe me, I look for those emails and look forward to them. Your team consists of anyone who sincerely cares about the well-being of another and is willing to lend a hand. My experience is that for every person who says "Ugh," thirty say, "I'm on board." Thank you, Oprah!!

David:Excellent point, Judith. Earlier you mentioned support groups. So maybe a person could find a support buddy there and not have the personal risk that one might face sharing the news of your eating disorder with a business associate, teacher, etc.

Judith Asner: Well, certain people are really links in the chain when it comes to helping us. Teachers usually know therapists and counselors and psychologists as do personal trainers and school guidance counselors and nurses. I wouldn't tell your CEO, if that is what you mean. Corporate America is not touchy feely and law firms are certainly not cuddly places. A buddy is a good idea. However, there are Employee Assistance Programs in most corportations and government agencies and the EAP counselors are bound legally to maintain privacy and send you to an appropriate treatment specialist.

David:One last thing I want to address, which you brought up to me in your email and then we'll go to more audience questions. "Practice" - the idea of trial and error. Can you elaborate on that, please?

Judith Asner: Yes. Just because one therapist has not been the right one for you, dont give up.You will eventually click. Ask your therapist if she has recovered from bulimia. If you keep failing on the food plan, keep trying. Go to OA meetings and get a sponsor. Use feedback to analyze what doesn't work. Figure out what were the triggers to "losing it" and try again and again.

David: Here's what Judith wrote me in the earlier email: There is no such thing as "it doesn't work" --you keep seeking, practicing, revising your plan until it works, changing this and that piece till the pieces fit.

Judith Asner: Also, do you belong to a spiritual community where you get sustenance or do you have a practice that is peaceful like yoga or do you spend some time helping others? This is part of a wholistic approach to life and recovery.

David: Let's get to some more audience questions. Earlier Judith, you said that recovery may mean a balance; not full-blown bulimia, but possibly sporadic episodes. Of course, if you had full-blown bulimia, that would be a great improvement. Here's a question on that:

tooey: What about people who consider episodic binging and purging to lead back to full-blown bulimia?

Judith Asner: Well, that is certainly a danger and that is why one must always let someone know immediately if the problem begins again and sort out the reason for the relapse---immediately!

Me5150:My husband is bulimic and refuses to believe he has a problem. I believe he is still binging and purging, but is hiding it more now than ever. How do I help him when he doesn't want to help himself?

Judith Asner: This is a tough question. Perhaps an intervention from those who love him would help. You can find that e-book on my web site beatbulimia.com. An intervention is a long process . I think men have a bigger problem admitting this than women.

liza5: Is it possible to "retrain" your body after you've had an eating disorder for a long period of time? I've been bulimic for 13 years, nothing "wants to stay" very long and it's very painful.

Judith Asner: Yes, you can retrain the body. We, and the body, are "miracles" and move toward wholeness and healing. First, get to a doctor to make sure everything in the gastrointestinal area is working well and then figure out what you can eat comfortable. There are meds that help with digestion and relaxation of your stomach and perhaps someone can stay with you and help you get used to that period that is so difficult after a meal.

jenniegator: Is there a physical withdrawal associated with recovery from bulimia?

Judith Asner: Oh, I would imagine there are lots of physical feelings that you would have to tolerate, real and imagined. That is what a professional can help you with, especially feeling fat when you are not.

pheobee:First, how do you get past that strong belief that you WILL gain weight no matter what?

Judith Asner: Well, in fact, you will rehydrate and gain some water weight because your cells have been dehydrated. But that is just 5 lbs. You will have to take that leap of faith and get lots of support from your team. And also, what will happen if you gain a few pounds? Is it perferable to the risk of dying?

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pheobee:My therapist and I are both very frustrated because I continue to purge and I don't get any better. She doesn't really understand because she has never had an eating disorder and has only been a therapist for 2 years. Is it more helpful to have a therapist with more experience and/or personal experience?

Judith Asner: Yes. Your therapist may be a wonderful person and a great therapist, but she should know how to manage your binge-purge cycle. What good is it doing you if you and she are in the same place? She is supposed to know what to do to help you. Let her help you find a specialist in this area.

Joy Joy:I am a recovering bulimic. A 15 year bulimic and now add 15 years in recovery with only an occasional, short relapse. Most of the past 15 years I have held off the beast. I am unable to find a way to safely lose the recent gain of twenty pounds. Dieting always brings on a feeling of deprevation and binge eating and triggers a relapse. What can I do?

Judith Asner: Probably exercise is the way with weight lifting, or acceptance of yourself. How about Weight watchers?

Be strong: I'm in self help and I'm starting to relapse -- six times in this past week. Is it time to seek medical help? And, if so, how do I ask my parents?

Judith Asner: Yes. Just ask. They are your parents, you know. I don't think they want you to be sick.

FlamingFireOf*Peace*: I am 16 and was in wrestling for my freshman year. I am pregnant, 14 weeks. The urge to purge, like I used to when I had to cut weight for wrestling always comes back to me. How much harm can this do to my health, being in this position?

Judith Asner: A great deal. Go see a nutritionsit. You need to eat when pregnant. It is normal. Don't deprive the fetus of the nutrition it needs. It can do damage. Go NOW and find out the accurate information you need.

David: When it comes to addressing problem areas, some parents have trouble communiticating with their children. With that in mind, here's the next question: (for parents, read: Survival Guide for Parents with Eating Disordered Children and Help for Parents of Children with Eating Disorders)

LaurenD:How can I help my daughter?

Judith Asner: Can you be more specific?

David: I think what she means is how does a parent approach their child about their concern and what if the teen continues to deny there's a problem?

Judith Asner: If you KNOW that there really is a problem, I recommend you get the ebook, Intervention, on my site and read it. It tells how to intervene to help a youngster. The longer you wait, the more entrenched this behavior becomes. So deal with it right away if you have the evidence of vomiting, food disappearing.

David: Here's a helpful comment from a teen who's been there:

FlamingFireOf*Peace*: I know, being a teen myself, when my parent approaches me that, yes, I will deny a lot. But if they continue to show love towards me to help, I will open up to them. It's just a love of loving, not pushing, persistence.

David: Thank you, Judith, for being our guest today 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

Thank you, again, Judith, for being here this morning.

Judith Asner: Thanks, David and friends.

David: Have a good day 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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Online Conference Transcript

Jane Latimer , our guest, author, and therapist, struggled with eating disorders and binge eating during twenty long years. What did she learn that helped her recover?

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 "Binge Eating and Self-Esteem". Our guest is Jane Latimer. Ms. Latimer holds a masters degree in psychology and is a therapist, coach and mentor. She is CEO of The Aliveness Project, a mentoring program for women with food and weight issues. And Ms. Latimer is author of several books including "Living Binge Free" and "Beyond the Food Game." For twenty years, she suffered with various eating disorders, including binge eating. She says it's been eighteen years since she broke free from the pain of those eating disorders.

Good evening, Jane, and welcome to HealthyPlace.com. Thank you for being our guest tonight. The first thing, I'm sure, that everyone would like to know is: How did you do it? What were the keys to your recovery from eating disorders?

Jane Latimer: A lot of things. I believed I could fully recover because I didn't believe that I was being my real self. Then, I got into a food plan, which enabled me to start feeling things. The food plan provided space for me to get in touch with myself.

The spiritual part of my recovery from eating disorders was so very important, because I knew that I was first and foremost, a beautiful being who was loved by my Higher Power. The eating disorder wasn't me. I learned that I wasn't really all those horrible feelings I had. And I learned to use the feelings to discover my truth, my authentic self which is in alignment with the FLOW, or with Higher Power. I also began to really trust myself. That took awhile, but I had to learn to trust ME, not be what I thought others wanted me to be.

David: What is the difference between binge eating, overeating, or being a compulsive overeater?

Jane Latimer: I like to think of binge-eating as a feeling of being out-of-control. While overeating is more eating when you are not hungry.

David: What causes someone to binge eat?

Jane Latimer: That's very complex. I like to follow 3-tracks.

• Track 1 is looking at the biochemistry.
• Track 2 is looking at the underlying emotional issues.
• Track 3 would be the relationship to food itself.

Usually, when I ask people not to binge-eat when they want to, they describe the feeling as being out-of-control. The word I use for that feeling is fragmented. A person feels panicky, scattered, disoriented and food helps them get grounded and numb out.

David: I'm assuming that since you were involved with eating disorders for twenty years, separating yourself from food issues is a very complicated process. Am I right about that?

Jane Latimer: It's very scary. There are so many scary feelings that a person doesn't know how to deal with. They can't make sense of it. It's very overwhelming. So, it's easier just to go back to the food. I always suggest that people work with safety. It is very important to build safety resources, both internal and external, so that giving up their reliance on food becomes easier. They, then, have other things they can rely on.

David: We have some audience questions, Jane, and then we'll continue:

Becky1154: Have you used other ways to cope with the stressors that used to make you binge?

Jane Latimer: Absolutely, I use many things. I've grown to rely on my ability to process my feelings, if not with another person, then in my journal. I journal daily and I also meditate daily. I exercise quite a bit, because that keeps me feeling good. I also have really worked on shifting my "negative mind" so that I don't let it ramble on for days on end anymore. I think that everything that is happening is always for my best. That's what has gotten me through.

David: Going through your site, you talk a lot about what I like to call "alternative" healing methods vs. strict therapy for eating disorders. Can you expand on that for us here and tell us what role that played in your healing and continues to play today?

Jane Latimer: Actually, I recovered before there was therapy for eating disorders, so I used all alternative healing methods. As I mentioned, my recovery process was mainly through my spiritual practice. I learned how to work with my feelings spiritually. I used Overeaters Anonymous (OA) for the first three years, as I was recovering because I needed the support of the group and my food sponsor. But then, I broke away because I didn't believe, as they did, that I'd always be a compulsive overeater. I, then, began testing different foods and teaching myself how to eat them. I would say that the biggest help to me was learning how to love myself and that I got through my spiritual program. I literally learned to love myself through everything. I'd meditate and think of surrounding myself in loving light. I'd love myself when I binged. I practiced sending loving thoughts to my body (which I hated by the way.) Soon the love words, and the light, and the meditations just began having their effect.

I also would experience some spontaneous regressions during my meditations in which I felt myself very young in darkness and void, very empty, very despaired, but I always brought light into those dark spaces. It was the creation of the Sacred Healing Space that created a container for my healing. So while I was despairing, and feeling shame and stupid, I was also in a "Sacred Space" that I had created for myself through my spiritual teachings. I felt like I was actually transforming my past. I wasn't just venting or reliving the pain, I was transforming it.

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David: You touched on Overeaters Anonymous. Here's an audience question about that:

jat: I'd like to know what you think of the twelve-step model of recovery, applying it to food. Does what works for alcoholics, work for compulsive overeating?

Jane Latimer: It works for some people, not everyone. Track 1 is the track that deals with biochemistry. And some people absolutely cannot tolerate sugar or flour. They do well with a strict OA food plan. And the twelve steps can be very, very helpful. But not everyone needs to do this. In fact, it just doesn't work at all for some people.

ms-scarlett: What, exactly, was your food plan?

Jane Latimer: I was on a very strict weighed and measured plan with no starches at all. It was called Grey Sheet and I believe they don't have it anymore because it's not considered too healthy.

David: What did it consist of?

Jane Latimer: I would prefer not to go into details about it, because I don't think I'd want people copying it. Instead, I would prefer you talk to a dietician or go to OA or HOW, or FA and get a food plan that they're using today.

dnlpnrn: I can't quit eating, partly because I don't want to look good. When I looked good, too many times it only brought more abuse, more trauma. I don't love myself. I don't want anyone to see me. I don't even look in a mirror at myself.

David: What would you suggest in this instance, Jane? I think a lot of people involved in binge eating or compulsive overeating feel this way.

Jane Latimer: That goes back to the safety I was talking about before. We have to learn strong boundaries. We have to learn to say "no." We have to learn that who we are is loveable, even though people abused us. It's about learning that the abuse was about them, not about us. It's about learning how to strengthen ourselves from the inside out, learning to become strong. Sometimes, it means feeling the rage for a very long time, maybe even years. The anger has to be directed outward, so it's not going inward to the self.

As children, we can be hurt, because we are small and vulnerable. And when we're hurt like this, we don't learn how to fight back. So, one of our biggest jobs is to learn to fight back and to say "no." That is a skill that we can learn. Then, when we have that skill, we begin to feel safer to be in our bodies.

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

tereeart: I totally agree with Jane that, self talk that is positive, really changes my behavior.

dnlpnrn: I am a victim of child abuse and I know now, that is a large part of the reason I binge eat. I do it to relieve my anxiety and it seems like I just have to eat like that when I am upset. You are right about the out-of-control part. I do panic and it is like the food is a source of comfort to me.

Jane Latimer: The panic underneath the binge-eating is the biggest thing to learn to deal with. That is what all of my work is about with people. I help people take the mystery out of the out-of-control place and help people understand it.

David: How long did it take you to come to grips with your eating disorders and go through the healing, therapeutic process?

Jane Latimer: I was working on myself from the age of twenty-four. When I was twenty-eight, I really got it, that my food was a bigproblem. Then I worked very hard for the next few years. So by the time I was about thirty-three years old, I was pretty much okay.

David: What about relapses? Have you had any? Or any urge to go back to the old ways?

Jane Latimer: Not since that time. No, not at all. Although before that, all during my recovery period, from age twenty-eight to thirty-three, I was relapsing off and on. I'd do well for awhile and then I'd just have a bad episode. This happened over-and-over again. The most important thing is to pick yourself up and keep going forward.

David: One of the things that struck me, Jane, was the use of the phrase "out of control" eating. What produces that feeling? And how, specifically, would you suggest one cope with that?

Jane Latimer: That is a real big topic and the subject of my book, "Beyond the Food Game." But to briefly describe it, it is an experience of being back in the original wound. So, for example, since we were talking about child abuse, when we are feeling out-of-control, something has usually triggered that feeling. Maybe a person looked at us in a mean way and that triggers the memory of the old abuse (or an old wound, whatever it is). That old wound is felt in the body (all wounds are in the body). Then the disoriented feelings starts to happen, like we can't tell if we are in the present or in the past. And in fact, the experience is a memory. If we can understand that the out-of-control feeling is a memory we are experiencing in our bodies, and we know what to do at that point, then we have the incredible opportunity to heal it. If we don't understand that, we reach for food, and we never get the healing. We perpetuate the cycle and it never stops.

David: What about those who haven't been abused. Why do they get involved in binge eating?

Jane Latimer: There are two types of wounding: abandonment and invasion wounding. I was never abused. I was "abandoned." My parents were not present for me and I just didn't learn how to be present for myself. So, it doesn't matter what the wound is; however, it does matter that we understand the wound, for then, we can heal it. Because for every wound, there is a corresponding healing that is very specific.

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David: Are you talking about emotional detachment?

Jane Latimer: Yes.

David: So, to clarify, there are some who were physically or sexually abused, and binge eating is one way of dealing with those issues. Others, are coping with strong emotional issues.

Jane Latimer: Yes, underneath most emotional eating, is a wound. We're all wounded. It's wounding just to be born. But some of us are wounded more than others.

David: You can purchase Jane Latimer's book "Beyond the Food Game" online.

And now, we have another question:

ms-scarlett: Do you agree with the Geneen Roth method of eating only when hungry or do you agree more with the three square meals a day strategy. I need to know what to eat if I'm going to be thin.

Jane Latimer: Again, it depends on a lot of complex issues. If you're very sensitive to sugar or flour, then you might not be able to handle those foods. So Geneen Roth's natural eating method doesn't work. On the other hand, the three squares don't work for some because it's too rigid. I like to think of Full Recovery from eating disorders as a process in which we learn to eat in a way that supports our unique biochemistry and that is different for different people.

David: One of the things Ms. Scarlett said was her goal is to be thin. Should that be the goal?

Jane Latimer: If the goal is to be thin, then we can be in trouble. I prefer to think of the goal as aliveness. When I was recovering, I remember I had to confront and get over my fear of fat. That was very important. Because if I didn't, then the scales would be my God. I'd be happy only when the number on the scale said what I wanted it to say.

However, if my goal is Aliveness, then I'm in charge of my own happiness. And the potential is always there. I can be happy no matter what I weigh, and no matter what life presents me with. With our priorities straight, we are free to lose weight if that is appropriate.

David: Can you define "Aliveness" for us?

Jane Latimer: Aliveness is about the body-felt experience of joy and that is felt in the heart. We love living. We are able to choose things that bring us joy. We can say no to things that don't bring us joy. And we can find "joy" in many things, even in those things that appear to be stressful. Aliveness is about being in control and surrendering at the same time. It is about living in alignment with the flow of life. To feel alive is to be full and fulfilled, even when things aren't going as planned. In fact, aliveness happens outside of the plan.

tereeart: I like that perspective of making your goal aliveness, not thinness. I also like the thought of using your abilities to meet your needs, not others.

Jane Latimer: I like to call that Extreme Self-Care. Meeting my needs is so important. It was learning how to really honor my needs, that enabled me to deal with life. Because before that, I couldn't deal at all. I was overwhelmed. So, I learned to meet my needs however I could. Little by little, I've inserted things into my life that truly meet my needs more-and-more.

David: I always like to give our audience something they can take home with them. If you are "out-of-control" with your eating, what is the first thing you would suggest that person do to regain control and move towards recovery from eating disorders, binge eating?

Jane Latimer: Not joking, read my book, "Beyond the Food Game." I don't know anyone who addresses these issues as succinctly as that. Because I list very specifically the steps to healing the out-of-control experience. After that, I'd say, journal. Journal about what triggered the feeling. Then, ask yourself, is there something about this situation or feeling that reminds me of my family? Then I'd ask myself, "What did I need as a child, that I didn't get?" Then it is your job to give yourself what you didn't get then. Its really quite simple, its just hard to do at the time.

David: Thank you, Jane for being our guest tonight. For those in the audience, thanks for coming and participating. I hope you found the conference helpful. We have a large eating disorders community here at HealthyPlace.com. So please feel free to come by anytime and also to share our URL with others you may know. It's www.healthyplace.com 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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online conference transcript

Kathleen Young Psy.D. , our guest, has fifteen years of experience treating eating disorders. She has studied and helped many with eating disorders such as anorexia nervosa, bulimia nervosa, and compulsive eating. Here, Dr. Young discuss recovery from anorexia, treatment of eating disorders, eating disorder relapses and shifting between being anorexic and bulimic.

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 "Treating Anorexia: The Recovery Process."

Before I introduce our guest, here is some basic information on Anorexia. You can also visit the Peace, Love and Hope Eating Disorders site in the HealthyPlace.com Eating Disorders Community.

Our guest is Kathleen Young, Psy.D., who has fifteen years of experience treating those with with anorexia, bulimia, and compulsive eating. She is located in Chicago, Ill. Besides obtaining her Doctorate in psychology, Dr. Young received additional training in the treatment of eating disorders at Northwestern Memorial Hospital and the University of Arizona's Medical Center.

Good evening, Dr. Young and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Many people talk about wanting to stop being anorexic, yet they find it extremely difficult to accomplish that. Why is that?

Dr. Young: Hi everyone! It's great to be here. That's a good question. I think its important to remember that anorexia is a complex disorder and that it begins as an attempt to cope with, or manage, some circumstances and feelings in the individual's life.

David: Just so we are all on the same page here, when you use the word "recovery," what do you mean by that?

Dr. Young: I think of it as having two components, the surface or behavioral level of working towards a healthy relationship with food, and the underlying issues such as feelings, personal issues, and self-esteem for example. We can't just focus on the food or eating behavior.

David: Are there cases that you can think of, where it would be impossible that a person could recover?

Dr. Young: I would never want to think that in advance! I believe that recovery from anorexia nervosa is possible, even if only to some extent. It is ultimately up to the individual.

David: What does it take, inside the person, to bring about a significant recovery?

Dr. Young: It often takes first getting to the point of being sick and miserable with how things are. It often takes the motivation of pain to make us want to change! It also takes perseverance and patience with what can be a long process, as well as, the willingness to let go of rigid ideas about weight or food. However, the last happens gradually with a lot of support.

David: We have some audience questions, Dr. Young, and then we'll continue with our conversation:

Lexievalle: How do we acquire a support system for recovery?

Dr. Young:That is very important, Lexievalle. Without support from others, it can be harder to give up the comfort of the old behaviors. The first step is getting an experienced therapist. There are also many free support groups in most areas, such as ANAD (National Association of Anorexia Nervosa and Associated Disorders). The internet can also be a source, as we see here :)

brewnetty:Recovery is being able to eat without fear, right?

Dr. Young: Brewnetty, that's a great way to put it! Often anorexics become very afraid of food. It can seem like the enemy, rather than a part of healthy self care. I would also add the ability to value yourself for aspects beyond weight and appearance.

David: One of the things I would like you to clarify, because we get emails that go something like this: "I'm hardly eating or eating very light meals. I'm always concerned about food, but I don't weigh 78 pounds. Am I still anorexic?" Could you answer that question, please?

Dr. Young: Yes, I hear that a lot too. "I'm not thin enough to have a problem." Anorexia does not require any specific weight. It is diagnosed by:

• the drive for thinness
• pattern of restricting
• weight loss
• loss of menstrual period

However, you still may have an eating problem even if you do not meet all the criteria. If it takes up a lot of your time, and energy, and makes you unhappy, it is a problem.

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David: Here are some more audience questions:

joycie_b: I understand that Anorexia is about emotions, not the actual food. If this is true, then what is the best way to help my friend to talk about what she ate that day and help her realize it was not "too much" or should I not bring it up at all?

Dr. Young: Joycie, it is great you want to help your friend! This is a common concern, because actually focusing too much on the food and eating can make things worse, since needing control may be a factor for the anorexic. It's helpful to honestly express your concerns and what you see one time and then ask how you can be of support. You should be there to listen, validate feelings, and tell your friend all the great things about her or him.

David: Joycie, here's a great resource for family and friends of those with eating disorders.

EHSchic: I am not eighteen yet. Is there anywhere that I can get help (as cheap as possible) without my parents finding out?

Dr. Young: EH, I know that's tough. You may need to consider whether its worth involving them to get financial help and whether they can be of any support. Sometimes anorexic's don't want to tell parents for fear of hurting or burdening them, but that is part of the problem because your needs are important. If it is really not an option, than please check at any local colleges or universities, because they usually offer counseling programs. You can even check any community health centers. ANAD is a group that runs free support groups in many areas.

David: Dr. Young's websites are here:

• Counseling Referrals located at: http://www.counselingreferrals.com
• and Affirming Alternatives located at: http://www.affirmingalternatives.freeservers.com

Dr. Young, how would you suggest that teenagers with eating disorders broach the subject with their parents? Many say they are afraid to because their parents would be disappointed in them or feel let down or they don't want to burden them?

Dr. Young: Right. I know it is tough and may go against a long family pattern. Sometimes it helps to share a book on eating disorders, or written information, like from a website. Basically, tell them whichever way you can, the behavior and how you feel about it. Let them know you love them and need their help and support. Family therapy is often important to change the old habits of all family members that contribute to the development of anorexia.

chatter:Doctor, do you find it difficult to deal with the families of anorexia sufferers in the way that they perceive the disease? For example, a family may think recovery is as simple as making the sufferer eat again and not recognize the emotional and psychological issues behind anorexia. (how to support someone with anorexia)

Dr. Young:Chatter, yes that is often the case. Families need to be educated about the eating disorder and they have to learn that telling someone to eat, will not fix the problem. It is not a "just pull yourself up by your boot straps" type of situation. If it were that easy, you would have done it already!

Krystie: I am twenty-eight years old and have taken on many anorexic tendencies just in the last year-and-a-half alone. Because of my age, I am regarded as childish and looking for attention; treated as though I am using this as a game, when I have spent so much time, effort, and money to overcome this. How does an adult sufferer begin recovery with this societal attitude?

Dr. Young: Krystie, I am sorry you are encountering that bias! How unfortunate. Women and men of all ages can suffer from anorexia. Because it does often begin in adolescence, there may be that confusion. Try to find a good therapist with experience with anorexics at different ages, and a group (or treatment program) with an age range as well.

David: Here's another question from an adult, Dr. Young:

scarlet47: I am fifty-one years old and have had anorexia for four years. I also have PTSD (Post Traumatic Stress Disorder) and self-harm. All stem from abuse and a frightening fear of abandonment. Is this becoming more common with middle age women? Mine never started with the thoughts of wanting to be thin. I had high blood pressure and they said I needed to lose weight, as opposed to taking medications. I guess I went to the extreme. I have been with a private therapist and have lost twenty-five pounds since. I feel so alone because most eating disorders seem to be associated with teenagers. Thank you.

Dr. Young: Scarlet, thanks for sharing. You also raise important points. One is that anorexia may be part of a more complex picture. It may be one reaction to trauma in the past, like another type of self-harm. Or weight loss can be a symptom of depression. It is important to have a skilled clinician to help you differentiate.

David: I did not realize how many people develop an eating disorder in adulthood. Here's another audience member with a comment:

rcl: Mine started at age 40 !!!!

Dr. Young: I think women of all ages are susceptible. This is a frequent choice for coping, given society's focus on thinness and appearance in women. Getting thin and not eating, can feel like succeeding in the world's eyes. On the other end, girls as young as five, are now talking about being fat and needing to diet!

David: I'm wondering, in these circumstances, were these people predisposed to anorexia and just never developed it until something "kicked in"?

Dr. Young: We don't really know if people are biologically predisposed, set up by their family dynamics and society, or even some combination. It may be that a person used other coping mechanisms earlier, or may have had alcohol or drug problems, so the eating issues did not surface until later. Any time of life transition or stress can be a kind of trigger for developing issues that were lurking beneath the surface.

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lanie: Which methods of treatment of eating disorders are most successful when dealing with an anorexic teenager?

Dr. Young: Family therapy is usually crucial, since the adolescent is often still at home. Individual therapy is necessary, as well. Many individuals, may also work with a nutritionist, to help make food plans.

hopedragon:Dr. Young, thank you for chatting with us tonight. How big is the chance of anorexia coming back after beating it twice? I recovered from anorexia about a year ago and I'm afraid it's coming back.

Dr. Young: Thank you, Hope and everyone. Sometimes there remains a vulnerability to these issues. With stress or loss, that may be the way you turn to cope without even meaning too. It is important not to get discouraged. You have accomplished a lot and can put it into practice again. You may just need a refresher :)

David: So are you saying, if you feel an eating disorder relapse coming on, get back into therapy a.s.a.p.?

Dr. Young: Definitely! The tendency may be to ignore it, but that never works. The sooner the better, before the behavior gets very entrenched again.

Clubby8346: Dr. Young, I am in so much confusion about anorexia right now. About four years ago, I dealt with anorexia for about two years. I was strong, and thank God it was so bad that I overcame it on my own. About one year ago, two of my family members were murdered. It seems like, since then, I have turned to food more and more. I eat all the time and now I find myself wanting to be anorexic again because of all the weight I have gained. I also eat to feel comfort. What should I do?

Dr. Young:Oh clubby, I am so sorry to hear about your loss. Anyone would be rocked by that kind of trauma. Often, women who have anorexia may develop another type of eating disorder at some point such as bulimia or bingeing (binge eating). It's all part of the same spectrum. Of course, anorexia is the culturally preferred disorder. Have you ever heard anyone say "I wish I could be anorexic for awhile?" You need support and help through this trauma and the way it is being expressed is through your eating and not eating. I hope you seek help.

LucyDean: Is it possible to control your problem eating patterns when you are having to deal with relationship and family problems and other anxieties?

Dr. Young: Sure, it just takes planning ahead! Identifying triggers and difficult situations is part of the therapy process. Then you can plan for alternative behaviors. If your family is making you nuts, can you call a friend, go for a walk, yell in the car, etc.? You get the idea?

David: A moment ago, you mentioned a spectrum of eating disorders, where a person may cross between one disorder like anorexia to another, like compulsive eating. Here's a question on that subject:

caraaddison: What advice would you give to someone who is no longer anorexic, and now allows herself to indulge to the point where it is very, very hard to stop? When I am eating cookies, let's say, I can't stop and tell myself it's okay. Then I eat a large amount and later I feel so bad about it. What can I do to find the happy medium of emotions?

Dr. Young:That's a question I bet many share! Remember, starving yourself sets everyone up for the likelihood of bingeing or compulsive overeating, eating later in ways that feel out of control. The best prevention is to make sure you are eating enough, as well as, well balanced meals throughout the day. You may not be the best judge of that. I suggest a few visits with a nutritionist to help develop a meal plan. I believe that foods like cookies need to be worked into the plan so you don't feel deprived.

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

Sonja: Yes, I have had people say they are so envious of my thinness. They have no idea what it feels like to be wiped out physically by a simple cold turning into pneumonia! I think I don't eat because it means taking up space. It is like, by being as small as I can, no one will see me. It is never been about being fat or thin for me.

earthangelgrl: A lot of people say they want to be.

Clubby8346: What can I do? I am so alone and long to be anorexic again.

rcl: I am anorexic and bulimic. I fight the bulimia with the anorexic behaviors and the anorexia with bulimic behaviors. I seem to do it by days. So I have three days right now when I am "bulimic" and four days when I do not binge and purge, but eat only a salad. To be free of the bulimia and anorexia, I think I have to win the fight against one or the other of the eating behaviors first. Is that right? Second, which one do I try to get rid of first?

Dr. Young: Thank you all for your honest sharing. You really demonstrate the pain that is part of this disorder. It is a vicious cycle and often bingeing and purging follow some period of restricting. It is that physical and emotional deprivation. It all starts with re-learning to eat in a healthy way. Sometimes you have to commit to not purge no matter what first. You also need to get help from a therapist to identify what you are using this to cope with, and how to cope instead. Who of us could give up a means of coping without anything else to put in its place?

David: Here's another audience comment:

abumonkeywolfe: Some days, I get so overwhelmed and don't think I will ever overcome the vicious cycle of my eating disorders.

Dr. Young:I can understand, abu! Many people feel that. It helps to have someone else who can hold onto hope for you and help you through those points.

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abumonkeywolfe: Speaking of cost, for those of us with limited funds, what options are available? I've struggled with my eating disorders for nearly thirteen years now. I've asked for help several times through free counseling services available to me, and was turned away. Now that I've joined the work force, time and money are serious concerns in finding help.

Dr. Young: Yes, finances are always an issue. There are referral services to help people find sliding scale or low fee therapy. You need to research your area, do an internet search, or ask someone to help you find resources if you are too overwhelmed. Then there are free support groups and twelve step groups like Overeaters Anonymous. Some anorexics and bulimics find OA meetings helpful and think about restricting, bingeing and purging as their "addiction. I wish there were a simpler answer! You can contact me through my sites by email and I can share the resources I know about.

jode101: I've been anorexic for five years and I have severe health problems now. I was wondering if there was an average time it takes for someone to get over this disease?

Dr. Young: That is a good question. I don't know of any figures off the top of my head. I expect that the longer it has gone on, the longer it may take to heal. Another factor is how willing you are to gain weight if need be to get well.

halle: I am twenty-three and have had anorexia subtype purging for what seems like forever (since I was thirteen). Is there any way to change something so long standing? I'm in medical school and I think that this is my coping mechanism. The stress isn't going away and I am kind of lost at the moment. I feel like it is not going to change.

Dr. Young: I understand why you feel that way and medical school is stressful, but it is never too late. The sooner you seek help, the sooner you can get better. You really can find other ways to cope and feel good about yourself. However, it can be scary. Some say the eating behavior can feel like a best friend, but what a destructive one. We haven't talked about this aspect, but anorexia is life threatening and can have long term health consequences. It is so worth getting help.

jode101: Dr. Young, how do you educate a spouse about an eating disorder, if they don't believe or understand it is a real disease?

Dr. Young: Jode, that's tough, and furthermore, not being validated like that, may be part of the problem. Sometimes an outside party can help, or even a book or an article. The bottom line though, is to do it for you, no matter what other people believe. You all deserve it!

David: We touched on eating disorder relapses earlier, but apparently it's a real concern among many in the audience tonight. Here's another question on that:

vancek: I am twenty-one and have been anorexic for about two years now. I have never been anywhere close to recovery, but for a while I was doing better (though my nutritionist questions even that). Anyway, I'm really relapsing again, and now I am scared. It seems that I get worse when stressed. I have a really hard time even admitting most of the time that it's getting bad and I need suggestions on pulling out of a relapse?

Dr. Young: Sharing, like you are here, is a great step. You need to admit to those you work with, that it feels like a relapse. Try to trust their recommendations on what will help you manage stress differently. Some suggestions are relaxation techniques like breathing and yoga. These can be great. Good luck! And remember, progress is often up and down like this.

David:Thank you, Dr. Young, 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 large eating disorders community here at HealthyPlace.com. You will always find people in the eating disorders community, 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. Young.

Dr. Young: Thank you all for this opportunity. I wish you the best in your healing journey.

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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back to:   Eating Disorders Conference Transcripts
~ Other Conferences Index
~ all eating disorders articles

Anorexia, Bulimia, and Compulsive Overeating Chat Transcripts

1. Anorexia Story: Getting on the Road to Anorexia Recovery
   Guests: Stacy Evrard, Dr. Harry Brandt
2. Beat Bulimia - Bulimia Treatment with Judith Asner, MSW
   Guest: Judith Asner MSW
3. Binge Eating / Compulsive Overeating with Joanna Poppink
   Guest: Joanna Poppink, M.F.C.C.
4. Binge Eating and Self-Esteem
   Guest: Jane Latimer, author and therapist
5. 'Body Image' Conference with Carolyn Costin
   Guest: Carolyn Costin
6. Dr. Steven Crawford on Compulsive Overeating
   Guest: Dr. Steven Crawford
7. Compulsive Overeating and Binge Eating with Glinda West
   Guest: Glinda West
8. Compulsive Overeating: Dealing With The Feelings and How To Treat It
   Guest: Dr. Deborah Gross
9. Compulsive Overeating with Dr. Matthew Keene
   Guest: Dr. Matthew Keene
10. Defeating Your Eating Disorder
    Guest: Dr. Ira Sacker
11. Eating Disorders Diagnosis and Treatment
12. Guest: Dr. David Garner
13. Eating Disorders with Dr. Brandt
    Guest: Dr. Brandt
14. Eating Disorders Hospitalization
    Guest: Rick and Donna Huddleston
15. Eating Disorders Recovery with Dr. David Garner
    Guest: Dr. David Garner
16. Eating Disorders Treatment Centers
    Guest: Noelle Kerr-Price, Psy.D.
17. Eating Disorders - Getting the Help You Need
    Guest: Jonathan Rader
18. For Parents, Spouses, Friends & Relatives of those with eating disorders
19. Guest: Mary Fleming Callaghan
20. Help For Parents Of Children With Eating Disorders
21. Guest: Dr. Ted Weltzin
22. How to Tell Others About Your Eating Disorder
    Guest: Monika Ostroff
23. I Recovered From My Eating Disorder, You Can Too
    Guests: Linda, Debbie
24. Is Self-Esteem Healthy? What Kind of Self-Esteem Is Unhealthy?
    Guest: Dr. Robert F. Sarmiento
25. Life With An Eating Disorder
    Guest: Alexandra - Peace, Love and Hope Eating Disorder Site
26. Overcoming Overeating
    Guest: Jacki Barineau
27. Positive Body Image
    Guest: Dr. Debra Brusard
28. Identifying and Preventing Eating Disorders
    Guests: Holly Hoff, Dr. Barton Blinder
29. Recovery from Food Addiction, Food Cravings
    Guest: Debbie Danowski, food addict and author
30. Recovery from Overeating with Joanna Poppink, MFT
    Guest: Joanna Poppink, MFT
31. My Struggle With Anorexia: Something's Fishy with Amy Medina
    Guest: Amy Medina
32. Strategies for Recovering From Bulimia and Other Eating Disorders
    Guest: Judith Asner, MSW
33. Survival Guide for Parents with Eating Disordered Children
    Guest: Dr. Cris Haltom
34. Surviving Bulimia
    Guest: Judith Asner, MSW
35. The Meaning of Eating Disorders Recovery and Help for Family and Friends
    Guest: Dr. Steven Crawford
36. The Psychological and Medical Risks of Eating Disorders
    Guest: Dr. Ira Sacker
37. The Relationship Between Eating Disorders and Self-Injury
    Guest: Dr. Sharon Farber
38. The Truth About Life After Eating Disorders
    Guest: Aimee Liu

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Dr. Luann Linquist, discusses what you can do about a persistent irrational fear of social situations. When it comes to social phobia, social anxiety (some refer to it as extreme shyness), the outcome is generally good with treatment.

David: 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 guest is psychologist Luann Linquist and our topic tonight is "Social Phobia, Social Anxiety".

People who experience "Social Phobia, Social Anxiety" become very anxious when facing certain social situations. They desperately fear becoming humiliated in social situations, specifically of embarrassing themselves in front of other people. In case some of you were wondering if you're the only ones suffering from this debilitating disorder, about 8% suffer from some form of social anxiety at any given time.

Our guest, Dr. Luann Linquist, has been in practice for over 20 years and works with Anxiety and Phobia patients. She uses various "brief therapy" techniques, including one called the "Delete Technique," which we'll talk about later.

Good evening Dr. Linquist and welcome to HealthyPlace.com. What is it that causes someone to have a fear of social situations; to be a social phobic?

Dr. Linquist: There are several causes. There is usually a family of origin connection or a major incident of abuse embarrassment. The usual onset is mid-teens to early childhood.

David: I read somewhere that people who suffer from social anxiety usually have another disorder along with that. In many cases, either depression or an addiction, like alcoholism. Is that your experience with your clients?

Dr. Linquist: No, that is not my experience with my clients. Anxiety and panic are usually very prominent.

David: Individuals who suffer from social anxiety, are they afraid of only certain situations or is it most social situations that cause severe anxiety?

Dr. Linquist: There is a range of suffering, from one type of situation like public speaking to a generalized suffering under any social situation. For instance, many men and women suffer from the inability to use public bathrooms.

David: What types of treatment for social phobia are available and which are most effective?

Dr. Linquist: The traditional treatment is desensitization, a newer one is EMDR (Eye Movement Desensitization and Reprocessing), and my specialty is DELETE Techniques.

David: Can you briefly describe each, their purpose and how they work?

Dr. Linquist: Sure. The first one, desensitization, exposes people to the situation that is producing the anxiety and panic. This is usually a graduated process over a period of time.

The second is Eye Movement Desensitization and Reprocessing (EMDR), which I'm certified to do. It is based on the healing response from REM sleep.

The third is a process that is teaching people how to use their own 'delete' button to get rid of unwanted thoughts, feelings, and beliefs, quickly.

Many people have found relief and freedom from all three of the methods. DELETE is my favorite and gives the best results quickly.

David: Before we start taking audience questions, I want to mention a site note:

Here's the link to the HealthyPlace.com Anxiety-Panic Community. You can click on this link and sign up for the anxiety mail list at the top of the page so you can keep up with events like this.

And now, here are some audience questions Dr. Linquist:

bigmac: I have been suffering from social anxiety for over 10 years and have tried practically all antidepressants. However, none of them seem to do any good. Any suggestions?

Dr. Linquist: Medications, without addressing your thoughts, feelings and beliefs is obviously not doing the job. Find a good therapist.

I help people every day who are caught up in the 'swirl' of their thoughts. There is an ongoing battle and habit of going over-and-over the same limited thinking. It's like a knot with no beginning and no ending. What is needed is a way to break through that thinking and get rid of it...NOW!

Tray: I have just recently read a book by a physician and he believes anxiety and panic are actually diseases of the brain we are born with. Do you have an opinion on this?

Dr. Linquist: There is research to indicate this is true. In addition, researchers have also found that some causes of anxiety and panic are situational in nature--the result of being exposed to possibly a traumatic incident.

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David: One of the questions I received, Dr. Linquist, is: how does one find a good therapist experienced in treating social anxiety?

Dr. Linquist: Traditional ways are to ask your medical doctor, look in the phone book, and make some calls. Now, you can look on the Internet.

KayCee: I'm having marital problems, I've had social anxiety all my life, I don't have any really close friends or family, no support system, I'm thinking of leaving my husband but am so scared of being alone, and having no one in my life. Do you have any advice for me? I come to the anxiety chat room here often, but I just don't think that's enough."

Dr. Linquist: Well, if you think coming to the anxiety chatroom is not enough, it probably isn't. It's certainly not the same as talking one-on-one and hearing the interaction voice responses. Really, you may consider going to a marital therapist and also learn how to form a small support system. One of the signs of good mental health is having a support system of at least 3 people. I'd like to see you grow strong enough to tolerate being alone before you jump out into a non-support situation.

Lillylou: What is meant by delete techniques?

David: And can you go into a bit more detail about how that works?

Dr. Linquist: It's an experiential process that helps you get rid of unwanted thoughts, feelings, and beliefs....quickly. You've heard that we only use a small portion of our brain power. Well, DELETE teaches you how to use a method you use all the time unconsciously, and use it consciously.

Chris B: Can an embarrassing, frightening moment happen when a person is very young, disappear and then surface again years later?

Dr. Linquist: YES! Happens all the time. One executive I'm working with on the phone is now able to speak in front of groups. When I first started working with him, it was difficult for him to talk to anyone who didn't work in the company.

Michelle6: Why would one bad experience in a social situation cause a lifetime of social panic?

Dr. Linquist: Because when this happens to a small child, that child makes a decision as best they can about life. Then, they learn all sorts of ways to compensate, hide, overcome (seemingly) all situations. And then, the original situation bubbles up --seemingly out of nowhere. It's a matter of undoing the original thoughts by dealing with the ones that are coming to mind presently.

jamesjr1962: I have a learning disability and have been told I have a mild depression. I now stay at home for days at a time and never leave (for example: I haven't left home since Sunday) plus I have trouble with long-term relationships. Is this a social problem or do you think there is another problem?

Dr. Linquist: Sounds like you have several things going on here. One of the best antidotes for depression is to get out and help --volunteer someplace-- any place. I'm so proud of my 40 year old mentally retarded niece who attends gathering, meetings, helping in minor ways, but giving whatever help she can.

Sharon1: What is the difference between panic disorder and social anxiety?

Dr. Linquist: They can both be present in the same person. Not everyone who has panic is social phobic. However, most people who have social anxiety avoid panic by not getting into situations that trigger them.

David: Have you seen people make a complete recovery? And secondly, do you feel anti-anxiety medications are helpful to those who suffer from social phobia?

Dr. Linquist: Some people choose to use medication. I'm not a medical doctor, so I don't advise to either way.

And yes, I've completed hundreds of DELETEs with a 95% success rate. Most of my clients have panic, anxiety and one of the phobias.

David: And do people make a complete recovery, or is it really something that's managed, in the sense of recovering from an addiction, lets say?

Dr. Linquist: People can and do find relief and freedom from anxiety, panic, and phobias. Certainly, if they re-connect with the same situation, there may seem to be a relapse. However, if they follow a good program, they can have the freedom again.

psilocybe: Is cognitive-behavioral therapy the best treatment for social phobia? Also, is group therapy better than individual therapy?

Dr. Linquist: Cognitive therapy is a part of my work, and it depends on the therapist. However, a phobia (social anxiety) is irrational by definition. Have you ever tried to be rational with an irrational person? What happens is they will out-irrationalize you every time.

People with anxiety, panic, phobias are fighting within themselves all the time ---part one is the rational side and part 2 is the irrational side. You already know who is going to win. That's why undoing the 'Gordian Knot ' of unwanted thoughts, feelings, and beliefs is so important. The Gordian Knot has no beginning and no end. Just one continuous same old tape, over-and-over.

TarynUpAlbertane: My parents think I'm just shy (I'm 15) and should get over social anxiety. How can I convince them that it's more than that?

Dr. Linquist: Don't you just love it when someone says "get over it"! when you are bleeding inside?

Taryn--talk to a school counselor or another adult you trust, reach out to someone else who may be able to help you with the problem and with your parents.

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David: Dr. Linquist's website is: http://www.deletestress.com for those of you who want more info on the Delete method. Dr. Linquist can help you with that over the phone.

I'm also wondering if from social phobia one can develop agoraphobia?

Dr. Linquist: Absolutely! Phobias grow unless they are pulled out...stomped on...blown up...or DELETED!

Agoraphobia is usually a combination of several phobias.

David: Here are two similar questions about EMDR (Eye Movement Desensitization and Reprocessing):

nadineSeattle: Can you explain in more detail what EMDR is?

Amber13: Can this EMDR help other phobias, as it does with social phobia? How does it work and where can one go for it?

Dr. Linquist: Eye Movement Desensitization and Reprocessing, EMDR, has a web site. In there, you will find an additional explanation of EMDR. Also you will be referred to a clinician (you might be referred to me, because I'm certified to do EMDR).

There are also various EMDR books (like this, but you can search for more) available.

Depends on the therapist and client, as to whether EMDR works for phobias.

WhatsUp 75766858http: I'm visually challenged and I'm self-conscious about my social skills and to some people I'm different. How do I improve my social skills?

Dr. Linquist: Get a mentor or femtor to teach you about social skills. This person would go with you to social places and practice with you. A good friend might be just the support for that.

lbzorro80: I am a pianist and suffer from performance anxiety. My heart races, my legs go weak, and my hands tremble. This severely hinders my performance. I have tried breathing techniques and positive thinking and nothing helps. I can't afford therapy. Any help?

Dr. Linquist: Yes, the breathing and positive thinking are great ---and you are right--- not enough. It's like having a bunch of wonderful new red apples, then you put them in a barrel with a bunch of old rotting apples, and you know what's going to happen. The stinking thinking will come up and spoil your affirmations.

You can't afford therapy? Can you afford not to afford therapy? Play the piano more and earn some bucks. There are many resources that have a sliding scale; for instance, your county mental health center, or try a local medical school where they psychiatric residents work at a significantly reduced fee.

sordid_goddess: I have had Separation Anxiety Disorder (S.A.D.) for over two years now, but was only recently diagnosed. After being put first on Paxil, then trying Effexor, I gave up on both and decided to try mind over matter. Do you suggest this? Because ironically, I am doing 100x better now than when I was taking anything. I am pretty much recovering from S.A.D. solely from talking to mentors and using mind over matter, but I am still very dependant on others to go places with me. Is there anything I can try that will ease me away from being so reliant? (I'm 17, by the way).

Dr. Linquist: Hey---you're doing great. You are using your very powerful mind successfully. Congratulations! Give yourself some time to become very solid in your new recovery, then think about taking the next step.

TIPCrys: Are there certain other disorders that seem to have a high correlation with social phobia? If so, what major complications usually have to be dealt with?

Dr. Liuistnq: WOW, that's an 'open the book and let all the disorders fall out' question. The physical symptoms and conditions of stress are the major complications.

Catrina: Do you think Gestalt Therapy could be a good challenge for someone with social phobia?

Dr. Linquist: Sure. Again, it depends on you and the therapist.

David: I want to thank Dr. Linquist for being our guest tonight and answering everyone's questions. For more information on Dr. Linquist and the Delete technique, you can visit her website at: http://www.delete.com.

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

Thanks again Dr. Linquist.

Dr. Linquist: You are welcome.

David: Good night everyone.

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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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Online Conference Transcript

Dr. Darien Fenn, our guest, is an expert in trauma psychology. The discussion focused on the causes, symptoms, and treatment of PTSD (Posttraumatic Stress Disorder).

David Roberts: 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 "Posttraumatic Stress Disorder, (PTSD)." Before I introduce our guest, here is some basic information on PTSD. You can also visit the HealthyPlace.com Abuse Issues Community.

Our guest is Dr. Darien Fenn, who is a clinical psychologist in private practice in Wilsonville, Oregon. He is also an assistant professor of psychiatry and a research psychologist with the Department of Psychiatry at the Oregon Health Sciences University in Portland. Dr. Fenn has written many articles on depression and suicide and is an expert in the field of trauma psychology.

Good evening, Dr. Fenn and welcome to HealthyPlace.com. We appreciate you being our guest tonight. I have read that many times PTSD is misunderstood or misdiagnosed. So, I'd like to start with you giving us a general overview of what PTSD is and is not?

Dr. Fenn: Hi, and thanks for the introduction. PTSD is one of a spectrum of anxiety disorders. Unlike most psychiatric diagnoses, PTSD is tied to a specific event. Although we usually think of the event as traumatic, it is not always that way. PTSD has been seen after assaults, disasters, witnessing a trauma, chronic stress, chronic illness, and even sometimes after learning of a severe illness. PTSD is closely related to Acute Stress Disorder (ASD). The main difference being that ASD is what you get if the trauma is recent (30 days or less), and PTSD is what you get if it goes longer. The disorder is characterized by four types of symptoms:

1. Re-experiencing - which can include the classic flashback symptom.
2. Avoidance - usually of places or reminders of the trauma, but sometimes also avoidance of the memories of the trauma.
3. Emotional numbing - when people's emotions seem to shut down.
4. Arousal - including jumpiness, difficulty concentrating, anger, and sleep problems.

David: What is it in the individual that leads to PTSD? To clarify, two people can suffer from a similar traumatic event, let's say sexual abuse, but one will develop PTSD, the other will not. Why is that?

Dr. Fenn: That's one of the most interesting things about the disorder, is that some people "don't" get it, even after terrible traumas, and sometimes side-by-side with someone that does get it. There are a number of factors that seem to matter.

1. First, there does seem to be "some" genetic predisposition, but this is not a big part of it.
2. More important seems to be psychological factors, such as whether the victim thinks they are going to die.
3. Also, people who have a past history of psychological problems are more vulnerable.
4. Depression also adds an increment of risk.
5. Post-Traumatic Stress Disorder seems to stem primarily from a hormonal response to the trauma. Hormones released into the brain can create a long-lasting chemical imbalance that is responsible for many of the symptoms. People who have more of this surge of stress hormones seem to be at more risk.
6. Also, trauma experiences are cumulative. If you have more than one, you are more and more sensitive, so they seem to be additive.

Then, there is a separate set of factors that relate to how the person reacts to the initial symptoms.

1. People who dissociate (space out the emotional reaction) are at risk for lingering PTSD,
2. people who ruminate over the incident (why me), are chronically angry about the experience,
3. or people that have some chronic reminder of the trauma, such as a lingering physical disability, or sometimes even involvement in the legal system itself.

David: So, what may be extremely stressful for one person experiencing an event, may be better psychologically handled by another. Is that what you are saying?

Dr. Fenn: Yes, and in truth, for the most part, we don't know why.

David: We have a lot of audience questions, Dr. Fenn. Let's get to a few, then we'll continue with the conversation:

angel905d: How long does PTSD last?

Dr. Fenn: Post-Traumatic Stress Disorder seems to have a natural course for healing on its own. Some studies done with auto accident victims show that about 60% of people who initially have PTSD get over it within the first six months. After that, however, things pretty much level off. There appear to be something upwards of 20% that go into a chronic course. In chronic PTSD, symptoms have been found to persist in concentration camp survivors (more than 50 years!). So, without treatment, the condition can become pretty persistent.

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rick1: Dr. Fenn, do you agree that PTSD is nothing more than old memories that are worked up?

Dr. Fenn: Old memories are what is most visible, but there is physiological alterations that result too. Changes have been documented in neurological structures in the brain, the neuroendocrine system, brain structures (there is sometimes atrophy of the amygdala for example), peripheral receptors (individual cell structures), immune systems function less well (perhaps due to sleep disturbance), and there are problems with attention and memory. The problem is that most symptoms are subjective, so it is harder to diagnose.

punklil: Thank you for coming tonight! My question is, can you have PTSD for more than one event?

Dr. Fenn: Yes, as I said before, it is additive. Sometimes, a new event can bring up PTSD from an old event that had gotten better.

Jennifer_K: Dr. Fenn, you mentioned flashbacks; however, can you expound on night terrors, please?

Dr. Fenn: Be careful asking me to "expound" because I feel like I'm rambling as it is. But yes, nightmares are very common. Sometimes the dreams are about the trauma, sometimes they are just bad dreams about death, other accidents, or fearful situations. There are some theories of PTSD that suggest the dreams are part of the healing process. Your unconscious memories coming up so that they can be processed, made sense out of in some way.

David: Dr. Fenn, what about the treatment of PTSD?

Dr. Fenn: There are a number of treatment options. Some of the new SSRI antidepressant medications help control some symptoms. There are many that seem to help, but that differ from individual to individual, but the primary treatments are still psychological (therapy). Of those, many people have heard of EMDR (Eye Movement Desensitization and Reprocessing), which has some good supporting evidence, but also some detractors, as some studies have shown the eye movements don't appear to be necessary and there are several cognitive-behavioral approaches that have shown good success. Almost all approaches involve two things:

1. Control of the arousal symptoms.
2. Systematic re-exposure to the traumatic memories, most frequently done gradually and in a safe setting (don't try this at home).

In some cases, people's sense of the safety of the world, or of their basic worth, or competence, is damaged in the experience and those issues become an important part of the treatment focus.

David: The treatment phase sounds like it could take a long time, at least a year or more. Is that true?

Dr. Fenn: Yes. The shortest case I have had was about twelve weeks. Sometimes, especially if there are multiple traumas, if the traumas occurred a long time ago, or if people have developed an avoidance (or dissociative strategy for coping), the treatment may take several years.

David: Here are some more audience questions:

hope: Will CBT (Cognitive Behavioral Therapy) work with someone who has been diagnosed PTSD and bipolar, or is it a waste of time?

Dr. Fenn: Actually, almost all cases of PTSD involve some sort of companion problem (a co-morbid disorder, in the lingo). The treatment rule is that these issues need to be treated simultaneously. Certainly, it is possible for the stresses associated with Bipolar Disorder to produce PTSD, so that is likely to be a common presentation and a manageable one.

saharagirl: Sometimes, it seems that I am drawn to things that remind me of the trauma as opposed to avoiding it. What is going on here? It seems like intentional triggering.

Dr. Fenn: The leading theory of PTSD contends that there is a natural healing mechanism built into us for trauma. Since we know from treatment studies that the most important part of the treatment is frequently the exposure to the memories of the trauma, it would make perfect sense to find that people are unconsciously drawn to do exactly what you mention. The idea is that this exposure to the traumatic memories is necessary for sorting it all out.

Medic229thAHB: If a Vietnam Vet goes into a flashback, is that person in Vietnam or in the U.S.?

Dr. Fenn: I like the question. To an outside observer, the person is here. From the person's point of view, they are in Viet Nam. It really is re-experiencing, from the point of view of the person affected.

scarlet47: I developed PTSD after going through childhood abuse and abandonment. I am currently in therapy and want to know, when one is recovered, does PTSD return? I can't seem to ever get rid of the flashbacks. I can't ever imagine having a clear mind. I also suffer with anorexia and self-harming behavior. These disorders certainly seem to be very complex to understand and heal. Thank you.

Dr. Fenn: Not an easy question to answer, but I'll give it a shot. The reactions that characterize PTSD are a form of conditioned response, just like the conditioning that Pavlov described with his famous dogs.

What this means is that some of the reactions are recorded in the body at the level of the neurons. When a conditioned response "goes away," what is actually happening is that a new response is learned. That new response suppresses the old one. So the old response is still under there somewhere. What people experience, is that the PTSD can go away, but sometimes, things can trigger a return.

The good news is that the recurrence of the symptoms is usually very short-lived and not very strong. If the triggers are repeated, the responses also diminish each time. So it's not quite like getting over a cold, where the virus disappears. It's more like getting over a case of tennis elbow, where there may be lingering, if low-level, symptoms that gradually get better over a long time.

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Mucky: Can you talk about delayed onset?

Dr. Fenn: That is a really good question. Some people have PTSD that appears after the trauma, by many months or even up to a year, or eighteen months. However, it's not like it suddenly pops up out of nowhere. In all cases of delayed onset that I have seen studied, the person who later developed PTSD had some symptoms to start with. Just not enough of them to qualify under the official diagnosis.

There also seems to be an important characteristic common in these cases, and that is that delayed onset appears most often in people who dissociate a lot or who try to suppress their reactions, or who are extremely avoidant. It seems that these efforts at avoiding the traumatic memories or reactions are doomed to failure, but that people can keep it up for a good while.

The other important part of this is, that it points out a problem with the diagnostic system itself. There is now a lot of evidence that many people can have what is known as a sub-syndromal form of PTSD. That is they have some symptoms, but not enough to get diagnosed. It is clear that this form of the disorder is extremely debilitating for people. So even if you don't have the full disorder, you may have a problem that needs attention. I expect the diagnostic criteria to be revised on the next cycle of the code.

David: If a person experiences delayed onset of PTSD, is it that another smaller trauma, or stress, comes along to push them over the edge?

Dr. Fenn: It could be that way, but I think that the delayed onset really reflects a breakdown of a coping mechanism that tries to avoid the problem.

Medic229thAHB: What would the differences be in posttraumatic stress disorder from a war or a rape case? Would they have the same symptoms?

Dr. Fenn: Yes, they mostly would have the same symptoms. However, there is a difference, but it is probably due to the fact that most war-related cases of PTSD involve multiple and ongoing traumas, where rape is typically a more limited exposure.

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

scarlet47: David, that is what happened to me. At age seventeen I was sexually abused, and at age forty-seven I was stripped by a doctor. That experience brought on flashbacks and PTSD thirty years later!

cbdimyon: But actually it's a collection of responses, that's why syndrome seems a more useful term than disorder.

A_BURDEN: I know all this stuff about PTSD. What I need to know is, how to overcome it. I have tried everything it seems.

Medic229thAHB: I have had PTSD for twenty-seven years. How come it hasn't healed yet?

David: Do some never recover?

Dr. Fenn: PTSD can get very difficult to treat if it has been around for a long time. It is hard to say whether or not there are cases that don't recover, because especially as people adapt to the problems, they entrench their behaviors and attitude. There are multiple issues to treat. So, it is hard to know what all the relevant factors are. I do not know exact statistics, but I recall that all the treatment studies I have seen have a success rate less than 100%.

Now, with that said, I would be very reluctant to say that there might be untreatable cases. It would depend on the nature of the original trauma, the other existing problems, current stressors, and importantly, the skill of the therapist. Most of what I have seen has been very optimistic with regard to treatment success. If people feel like they are not progressing in treatment, they should always consider changing treatments or providers or both. This would be true for any problem.

However, it is also important to note that there are some chemical and structural alterations inside the brain and body. It may be that for some people, there will be some lingering problems, just like when you hurt a knee, for example, it can continue to bother you some, even after it has mostly healed.

David: Here's the link to the HealthyPlace.com Abuse Issues Community. You can click on this link, sign up for the mail list at the top of the page so you can keep up with events like this. The Anxiety Community is here.

JeanneSoCal: Does the "size" of the trauma have anything to do with how long it lasts? For instance, Viet Nam vets seem to deal with this for many years afterward.

Dr. Fenn: The "size" doesn't seem to matter as much as you would think. Some Viet Nam vets have no symptoms. However, with Viet Nam, for many, it was a very prolonged stress. As I said before, whether you think you are going to die seems to be important, so I would also think that this might have been the case for many vets. So for those reasons, PTSD might be worse. However, PTSD can also occur in relatively minor traumas like being in a fender-bender.

NOWAYOUT: Can having PTSD make you hostile?

Dr. Fenn: Yes, absolutely. Anger is one of the seventeen symptoms that constitute the syndrome. It appears to be connected both, to the heightened arousal of the body and to psychological factors.

dekam20: How do you deal with reoccurring systems of PTSD?

Dr. Fenn: Depending on the particular symptom, people can learn specific containment strategies. The overall treatment of PTSD would probably be the same for long-term resolution of the disorder. Although a good therapist will tailor the treatment to your issues.

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efe: How does one differentiate this from other anxiety disorders? They seem so closely linked.

Dr. Fenn: They are related. Differentiation depends on chronicity, the specific symptom profile, and on how people react to the anxiety. OCD, for example, is an anxiety disorder where the compulsive symptoms are attempts to control the anxiety. So the reaction defines the problem in that sense. The short answer to your question is, it depends on how the symptoms fit the diagnostic profiles that have been defined.

David: By the way, PTSD is classified as an anxiety disorder, isn't it?

Dr. Fenn: Yes.

PatriciaO: My husband is taking shock treatments for his Posttraumatic Stress Disorder. On this past Sunday, he told me he didn't want to live in my home anymore, and today he called and blamed it on the shock treatments and PTSD. Should I believe this?

David: I want to clarify here that shock treatments (ECT) are used to treat treatment-resistant depression, which may be one of the results of the trauma. But it's not a specific treatment for PTSD.

Dr. Fenn: I really couldn't say without knowing a lot more. Many times relationships fail due to PTSD because the symptoms can be hard for spouses to take. But I'm sorry, I really couldn't answer in your specific case.

kaj: I am getting married in fourteen days, and I am many miles away from my provider. I am afraid I will flashback to fifteen years ago to a very abusive marriage. I have kicked depression (although I am still on lithium). I am a bit scared of having flashbacks with a very kind, gentle, and understanding man. How do I shake the fear and avoid the flashback?

Dr. Fenn: Again, I can't offer advice specific to your case for ethical reasons. However, flashbacks are always a possibility after PTSD, especially if the issues have not been resolved completely. Some problems are better managed than solved. If you know you are likely to experience flashbacks or anxiety symptoms, it is a good idea to prepare for them. Especially if the people around you know where the symptoms come from, they can best be prepared to understand and offer support.

bukey38: How would one go about helping someone who has been sexually assaulted, and they refuse therapy, but exhibit classic symptoms of PTSD?

Dr. Fenn: Always a tough question. My recommendation is that we can offer concern but we can't insist. If we continue to be concerned, eventually, if there is trust, people begin to consider the possibility of getting help, and perhaps eventually get it. It may also help to provide information that help is available and effective. Sometimes, people can hear the message better from someone less involved, or someone with a similar experience in their past. So, arranging a meeting can sometimes help. Mostly, I think, just caring and worrying in a gentle way is the best way to get people out of resistance.

Lucybeary: To what extent might an ADD child, living in a very dysfunctional environment, develop PTSD?

Dr. Fenn: It could happen to non ADD children too. A possibility, but not in every case.

mothervictoria: My partner has PTSD, and is involved in a lengthy court case over the issue of assault and the splitting of their combined assets. Is it true that healing for her will not begin to take place until after the final hearing?

Dr. Fenn: Healing can begin, but it is unlikely to be completed until it is all over. The trauma is, in a way, still going on.

LBH: My therapist says I need to avoid triggers, however, your thoughts seem to go against that idea.

Dr. Fenn: My reading of the research evidence is that exposure to the trauma is essential and that avoidance is often harmful. However, in any particular case, there might be exceptions. For example, if someone completely dissociates when driving on the freeway (after an accident there), that is dangerous and that trigger should be avoided until the response can be brought under control.

David: Here are some more audience comments on what's been said tonight:

Lucybeary: When I'm a passenger in a car, it feels like I get triggered all the time and startle so easily. I've been doing EMDR therapy for a couple of years now.

cbdimyon: I am chronically angry, not about the incident, but the complete and chronic failure of fundamentally male legal and medical systems to respond appropriately to rape and sexual violence. My anger is just like being propelled by an explosion, just imploded with no control at all.

Dr. Fenn: The legal system frequently traumatizes rape victims as much as the rape.

Medic554: Shock treatments should be outlawed! They do more bad than good.

debmyster: I am a forty-two-year-old woman and have been diagnosed with PTSD for about fifteen years and it's still lingering.

shariohio: Hello, I have suffered from anxiety attacks for ten years and still have no relief. I am so tired of this. I can't go anywhere by myself and its frustrating.

Dr. Fenn: If you are not progressing, consider changing providers. The same goes for EMDR, the therapist is probably much more important than the technique.

David: Here are a few kind words for Dr. Fenn:

Mucky: This is the most useful conference I have been to. Dr. Fenn is a very good speaker. Thank you for having him, and thank you, Dr. Fenn for coming.

Dr. Fenn: Thanks to all.

David: 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, Dr. Fenn, 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 large Abuse Issues and Anxiety Disorders communities here at HealthyPlace.com.

Thanks again, Dr. Fenn and good night everyone.

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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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Bronwyn Fox, a leading authority on Panic and Anxiety Disorders in Australia, and author of the book and video series Power Over Panic.

David: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 and I want to welcome everyone to HealthyPlace.com. Our topic tonight is "POWER OVER PANIC". Our guest is Bronwyn Fox, the founder of Panic Anxiety Education Management Services.

Bronwyn is based in Australia. She is very well-known in that country for her work with panic and anxiety sufferers. For a long time, Bronwyn suffered from panic disorder and agoraphobia herself. She eventually made a significant recovery and from her experiences, she developed the "Power Over Panic" series of books, videos, and seminars. She also co-founded a consumer group and lobbied the state and federal governments in Australia to fund research and treatment programs for the approximately 2 million Australians who suffer from anxiety and panic disorders.

Good Evening Bronwyn and welcome to HealthyPlace.com. We appreciate you being here tonight. So our audience members get to know a bit more about you, can you tell us about your struggle with panic disorder and agoraphobia? How it started, how old you were at the time, and what it was like for you?

Bronwyn Fox: Thank you for inviting me. I was 30 years old when I had a life-threatening illness and panic attacks started at the same time. Once they got the illness under control, I was left with panic disorder and agoraphobia. I couldn't leave my bedroom for almost 2 years. Then I learned to control my thinking through meditation and I recovered. That was 15 years ago.

David: What was it that got you into the recovery mode?

Bronwyn Fox: Learning to be aware of my thinking and learning to control this thinking.

David: Did you ever take any types of anti-anxiety medications or enter into long-term therapy to cope with your panic disorder and agoraphobia?

Bronwyn Fox: Initially, I did take tranquilizers and I did see a psychiatrist for 12 months. Then my doctor left psychiatry and I didn't see anyone for 3 years.

As part of my recovery, I had to then go through withdrawl from the tranquilizers. It became very difficult so I went back to see the same psychiatrist. He helped me with the withdrawls and I eventually recovered. I've been medication-free for 15 years. Sometimes, I still have panic attacks when I'm tired or stressed, but they last only about 30 seconds.

David: And just so everyone knows Bronwyn, have you made a "complete" symptomless recovery, or do you still experience some symptoms today?

Bronwyn Fox: I have no anxiety, but occasionally once every 9 to 12 months I may have a panic attack when I'm tired or stressed. But now I don't care if I have one or not.

David: Here are some audience questions before we get into how you made the recovery and sustained it all this time.

DottieCom1: Did you have depression along with panic and phobias?

Bronwyn Fox: Yes I did. Many people will develop major depression in reaction to their anxiety disorder. Part of the reason is because we feel powerless and our lives become so restricted as a result of the disorder. Recovery means learning to take back our own power from the disorder.

vero: How do you change your thinking?

Bronwyn Fox: We do things a bit different than normal cognitive behavioral therapy. We use meditation to help us relax and then use a mindfulness technique. This technique teaches us to become aware of the intimate relationship between our thoughts and the body's response, which are our anxiety symptoms. Once we are aware and can see the relationship very clearly, we can then begin to lose the fear and begin to realize we have a choice in our thinking.

Redrav: Did the panic ever turn into a fear of fear? If so, how did you overcome that?

Bronwyn Fox: The fear of fear is what it is for all of us. I overcame it by learning to change the way of thinking that was causing the fear of the fear.

friend: How did you get strong enough to leave the house?

Bronwyn Fox: By learning to relax through meditation and learning to take back the power from my thoughts. Not having the power, or control, over my thoughts is what were causing it all.

Suz on LI: Will I ever be able to have a normal life again?

Bronwyn Fox: If you are prepared to really work at it, do the hard yards work with your thinking, and challenge your fear, you can have a normal life again. I have and so have thousands of us.

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MaryJ: Do you feel anti-anxiety medications are the way to go or can a person take the natural approach?

Bronwyn Fox: There is a time and place for medications, especially if depression exists. But you can learn the techniques while on medications, and then slowly under medical supervision, withdraw from them. Then, you can control your panic and anxiety to the point that you become free.

David: I want to address your recovery from panic disorder and your Power Over Panic method of dealing with panic attacks and anxiety. Before we get into that though, earlier you mentioned that you were stuck inside your house because you were depressed. Did you do something internally to change, to say "I need help" or did it come from an outside source?

Bronwyn Fox: No, it happened within me through meditation. When I had panic disorder, agoraphobia was barely understood, so I used to think I was the only one in the world who had it. And so, it came down to the fact that it was up to me and I needed to do something for me.

David: You briefly touched on the meditation aspect of your healing. Can you please go into more detail about your "Power Over Panic" method of recovery and what it entails?

Bronwyn Fox: It means learning to meditate. The meditation we use is not a spiritual technique. Its a basic meditation technique that we use in five different ways:

1. as a relaxation technique

2. to become aware or mindful

3. to learn how to manage our thinking

4. to learn how to stop fighting the panic and anxiety

5. and to learn, for some people, not to be frightened of any derealization or depersonalization symptoms

David: Is this something you practice day in and day out even today, or are you past that point now?

Bronwyn Fox: Every day I meditate and I also have now an automatic awareness of my thoughts so I can choose moment-to-moment what I want to think about.

David: How long did it take you, using this method, to achieve substantial results?

Bronwyn Fox: It took, from the beginning to the end, 18 months. Six of those months involved withdrawing from tranquilizers. At the 12 month mark, I went back to work and, then, at 18 months I was free.

David: Here are some audience questions Bronwyn:

Italiana: Where do you find the strength after having this for years-and-years, like me?

Bronwyn Fox: It comes back to our own self. The fact that you are in the anxiety chatroom now, means you are still looking for answers. That tells me your motivation to recover is still there and behind your motivation will be the strength.

vio_71: My counselor had said that meditation doesn't always help everyone. That everyone is different.

Bronwyn Fox: Meditation is a natural technique, and in some areas it's considered the opposite response to the fight and flight response because it is controlled by the same part of the brain. People have trouble meditating or relaxing because they are frightened of either letting go of control, or of the sensations of their body relaxing. Some people have not relaxed for many years, and when their body does begin to relax, they think their worst fears are coming true!

tracy_32: How did you get over the initial fear of facing what you were afraid of?

Bronwyn Fox: By seeing that my fear was being created by the way I was thinking. Those of us with panic disorder, we are not so much frightened of a situation and/or places, but are frightened of having a panic attack. Once we lose the fear of the attack and control our thinking, there is no anxiety and life becomes easier and easier.

blusky: Did you use daily visualization to overcome this? And how long did it take?

Bronwyn Fox: No, I did not use it.

David: Here are a few audience comments on what's been said tonight and then we'll get to some more questions:

ebonie_woman: I am also agoraphobic and I hate it.

dhill: My son is 8, and has been diagnosed with anxiety disorder. He was diagnosed borderline adhd 2 years ago.

Sharon1: How about biofeedback in learning to control our mind and body.

Bronwyn Fox: It can be of assistance, but it's not used much in Australia and the most effective technique is cognitive behavioral therapy.

Kali27: Do you think that distraction (distraction technique) helps temporarily (like counting things in the room) when you feel a panic attack beginning?

Bronwyn Fox: It may, and I say this with caution. You'll not get permanent recovery using a distraction technique because you are not confronting the thoughts and the fear.

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David: If you are enjoying this conference, I want to let everyone know we have a fairly large panic and anxiety community. There are many sites there, and we almost always have people in the anxiety chatrooms, so I encourage you to come by and participate. Here's the link to the HealthyPlace.com Anxiety-Panic Community.

tlugow: Did you have problems with shame or embarrassment?

Bronwyn Fox: Yes, I did. The shame and the embarrassment coexisted with my disorder. I felt weak and helpless and powerless. But then, as I recovered, I realized that the power within me had always been there; and I also understood that we are not weak people, nor are we helpless. I realized that once shown the way, we can tap into our own strength and use it for recovery, instead of trying to get through day-after-day.

David: Bronwyn, would you say there are cases where recovery from panic disorder is impossible?

Bronwyn Fox: If panic disorder is the primary diagnosis, we can recover. But there may be past and/or current life issues that we may not recognize, or deny, and these can keep us stuck.

David: Earlier, Bronwyn mentioned that she felt "alone" with her panic and agoraphobia. That she thought no one else suffered like she did. Many people who experience panic and anxiety feel the same way.

MISSTERIOUS1: How do you find that power within yourself?

Bronwyn Fox: It's being masked by the panic and anxiety. I know this sounds simple but, again, the fact that you are in the anxiety chatroom, looking for answers, tells me that your motivation to recover is there. Otherwise you wouldn't be here. How much do you feel and how strong do you have the feeling of "I WANT TO RECOVER!?" That's your power.

JEAN3: Is there any way to calm down a racing heart during a panic attack?

Bronwyn Fox: As long as you know that it is your anxiety panic, we teach people to simply let the heart race and not fight it. Don't buy into the thinking about it, as this just keeps the heart racing.

Bonnie112: I have a problem returning to places where I have had a panic attack. Any ideas on how to overcome this? I had a medical test and had a panic attack there. I need another test at the same place and don't want to return.

Bronwyn Fox: Again, this is just based on thought. The thought is "if I have another panic attack in the same situation..."

It's OK to be anxious when you are having medical tests. That's normal for many people. You need to separate the thought, "what if I have a panic attack," away from the actual situation.

Rusty: What are some of the things a support person can do to help a loved one recover from agoraphobia?

Bronwyn Fox: The most important thing is to take care of themselves first, because support people's lives can also be destroyed through anxiety disorders.

It would be of benefit for support people to challenge the person with anxiety disorder. Ask them what they are thinking about and if they could begin to see the relationship between their thoughts and their symptoms. This is something that the person needs to learn to do, but just saying "think positive" is totally useless. It's learning to see the connection between thoughts and symptoms.

David: This is for the audience, if you have found a technique or something else that helped you in dealing with, or recovery from panic disorder, please briefly write it down. Include how effective it was for you and send it to me, and I'll post it as we go along here.

Jen6: Is it dangerous to take anti-anxiety medications and to meditate? I have heard that meditation can affect medications.

Bronwyn Fox: I have never heard of that. I have taught over 30,000 people to meditate, and I've never seen research that suggests that this happens.

POWSTOCK: What else can you do, other than meditation?

Bronwyn Fox: The most important thing is to learn to control your thinking.

Rocky1: Hi Bronwyn, I had a severe panic disorder 10 years ago, for 3 years. I then recovered totally asymptomatic for 7 years. Then the disorder came back full blown, but recovered twice as fast this time! Your thoughts?

Bronwyn Fox: We can go into remission, or we can work at it to the point of making it disappear. But if we have not lost our fear of it, we can roll over back to Panic Disorder. I know this from experience.

Sometimes, when I do have a panic attack, it can feel so violent that it would be easy to be scared of it again, but I refuse to be frightened and it disappears. Not being frightened has helped me not to roll back over Panic Diosrder. And this is why I always say, recovery is the loss of fear. That's the only way you don't develop Panic Disorder again.

David: So what you are saying is, Bronwyn, that the power of the mind is a great instrument in the healing process. And it's important to train it to work for you.

Bronwyn Fox: Definitely!!! The energy we use in getting caught up in our fears, our panic and anxiety, is the same energy that we can use to control our mind. It's exactly the same energy. We can give our anxiety disorder the power, or we can take it back.

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David: Here are a few things that have helped members of our audience deal with their panic and anxiety. Maybe they'll help you too:

Nerak: I try to remember a time when I started to have a panic attack and remind myself that I made it through. Seems to help me some.

Redrav: When I am out and feel one coming on, I get very quiet and think to myself this is only a feeling and it will pass. It will pass quicker if I let go of the thought that these feelings are dangerous.

Bonnie112: In my own therapy, I have learned that facing my fears helps some. And sometimes, if I can Not think about the situation I am entering and just DO it, I am ok.

charlie: I use thought records and really look at the facts not the feeling. Then explore why the feelings are present.

Italiana: It is so difficult for me to have good thoughts for more than one day at a time. The setbacks are killer! They diminish my spirit.

David: How do you learn to control your thinking, your fears?

Bronwyn Fox: You need to be taught how to become aware of your thinking and how it is creating your fears.

Redrav: I have heard hypnotism can be helpful. Is this true?

Bronwyn Fox: We have only seen the people where it hasn't worked in the long-term. It may work for some people, but what we have seen is that the disorder can start again after 12 months or so, and it can be worse the second time around. The reason I think this happens is because the person has never been taught to work with their thinking themselves.

Moni: Do you have any religious beliefs??

Bronwyn Fox: Not at that point. I was an atheist during my recovery, but not now.

David: Did praying or not praying have any impact in your recovery?

Bronwyn Fox: After I recovered, I became interested in Buddhism because it teaches so much about the relationship between our thoughts and our responses. I lived with a Tibetan Lama and studied with him for 3 years.

David: Do you think nutrition plays any role in the development of, or recovery from, panic disorder?

Bronwyn Fox: Definitely, in so far as many of us don't eat properly. Part of recovery does mean learning to eat in more healthier ways.

Martha: What about graded exposure therapy versus flooding?

Bronwyn Fox: Many people find flooding too severe. And graded exposure, so long as a cognitive is used, can be more effective for some people.

David: Bronwyn, thank you for joining us from Australia tonight. I'm glad you came. We get many emails from visitors to your site asking for a chance to talk with you. So I hope you'll come by again.

I also want to thank everyone in the audience for participating.

Bronwyn Fox: Thank you very much. I appreciate the opportunity.

David: As I said, we have a large panic-anxiety community and we invite you to come by anytime. You can click on this link, sign up for the mail list at the top of the page so you can keep up with events like this. There's a lot of information about panic and anxiety disorders here at HealthyPlace.com.

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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,Dr. Michael Gallo says a combination of Cognitive-Behavioral Therapy (CBT) and medications is the best treatment for OCD (Obsessive-Compulsive Disorder). Cognitive Behavioral Therapy is a type of therapy where you identify and challenge your irrational thoughts and modify your behavior accordingly.

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 "OCD and Cognitive-Behavioral Therapy". Our guest is Michael Gallo, PSY.D. Dr. Gallo has trained and served as a psychotherapist and researcher at several major OCD treatment centers, including Harvard Medical School/Massachusetts General Hospital and The Emory Clinic. Dr. Gallo practices in Atlanta, Georgia.

Good evening Dr. Gallo and welcome to HealthyPlace.com. Thank you for being our guest tonight. So everyone knows, can you please define Cognitive-Behavioral Therapy (CBT)?

Dr. Gallo: Cognitive Behavioral Therapy is a very concrete, goal-oriented type of therapy. It focuses on helping people learn to identify, analyze and challenge irrational thoughts (i.e., the "cognitive" portion).

The behavioral portion of the therapy teaches people to change counter-productive behaviors which may be instigating or contributing to their problems.

David: Can you give us an example of CBT and how it would be used in relation to Obsessive-Compulsive Disorder?

Dr. Gallo: Well, that is a big question, but let me take a crack at it.

A person with OCD may feel compelled to engage in a less than rational, compulsive behavior. For example, excessive checking of door and window locks. CBT would help the person understand that by resisting the compulsive urge to check the locks, over-and-over again, they can eventually "wait out" their anxiety until the anxiety level dissipates over time. This is a technique known in CBT as Exposure and Response Prevention.

Cognitive therapy would work by helping the person rationally challenge the practical necessity for checking the locks multiple times.

David: What would you consider the optimum treatment for OCD (Obsessive-Compulsive Disorder)?

Dr. Gallo: Clinical research has clearly demonstrated that most people with moderate to severe OCD will respond best to a combination of OCD medications and Cognitive Behavioral Therapy. However, if one had to choose either OCD medications or CBT, I think the clear choice should be CBT. This is because CBT gives a person the tools to effectively manage their OCD for their entire life.

David: I realize that every person is different, but is there any general statistic you can give us, regarding the effectiveness of CBT alone. Can a person expect, let's say, a 50% relief of their OCD symptoms using CBT?

Dr. Gallo: In general, research has suggested that approximately 75-80% of people who diligently participate in CBT will achieve substantial relief from their OCD symptoms. I have personally had patients who, after suffering for years with severe OCD, have experienced as much as 80-90% reduction in symptoms and anxiety.

David: That's amazing. Is this a significant problem -- people with OCD become frustrated and give up before completing the therapy, getting all the tools they need to deal with the OCD symptoms?

Dr. Gallo: Yes, unfortunately one of the biggest problems encountered in CBT for OCD is resistance to full-fledged engagement in the therapy process. CBT is first and foremost...hard work! It requires persistence and high motivation on the part of the patient. In fact, ultimate success is highly correlated with the patient's level of motivation.

You see, engaging in CBT for OCD will require that a person "face their fears" (however, in a highly structured and supportive environment.

In CBT for OCD, a person can expect to "feel worse" before they ultimately feel better.

Cognitive Behavioral Therapy is akin to a highly effective, but bitter tasting medicine. However, if a person diligently participates in CBT for OCD it is virtually impossible for them NOT to experience at least some substantial improvement.

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

teddygirl: Do OCD and depression always go together?

Dr. Gallo: Not necessarily. However, having a severe problem with Obsessive-Compulsive Disorder often causes a person to become depressed in a "reactive", secondary way. It is only normal to feel depressed when you have such a problem with disturbing thoughts and compulsive rituals. Sometimes, however, OCD and depression are mutually exclusive and truly unrelated per se.

Hope20: Will that type of CBT ( Exposure and Response Prevention) also work for Trichotillomania sufferers?

Dr. Gallo: Trichotillmania is a special subtype of OCD that has many complex components. There is a specialized type of Behavioral Therapy called Habit Reversal which can be helpful in remediating problems with hair pulling. In short, this involves switching the hair pulling behavior to another more benign type habit (e.g., rubbing a touch-stone) which is incompatible with pulling one's hair.

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jmass: What if a person does not respond to exposure therapy? Are drugs the only other alterative?

Dr. Gallo: It's important to remember that Exposure Therapy must work if it is conducted diligently and persistently. The human nervous system simply must desensitize eventually to any anxiety provoking stimuli. However, if the anxiety is too severe, then medication can help the person to begin learning to use exposure and response prevention.

Often times, a person can eventually taper off the medication after they become skilled at (and confident in) the ERP.

mrhappychap: I have OCD as well as other stuff, and I was wondering if homicidal thoughts are part of Obsessive-Compulsive Disorder?

Dr. Gallo: Sometimes, a person with OCD will have what we call "ego dystonic" thoughts. These are thoughts which the person recognizes are foreign to your true self, your true desires, but which none-the-less intrude into one's mind seemingly out of nowhere and with little instigation.

Often, a person will find these thoughts abhorrent, but find that they continue to pop into their minds. Homicidal thoughts and sexual thoughts are common forms of these ego dystonic thoughts, essentially "nonsense" thoughts.

David: Does a person with OCD ever have to worry about "acting" on those types of intrusive thoughts?

Dr. Gallo: A person who has true OCD (and not another type of disorder, such as an impulse control disorder or schizophrenia) in all likelihood, does not need to worry about acting upon ego dystonic thoughts. I have never heard of a case of a person with OCD acting upon their obsessive thoughts. Most people who have these thoughts know, deep down, that they truly have no desire to do such things. However, they "fear" that they "might" become capable. In essence, the true impulse to do these bad things is not really there...only the fear and doubt that one might become capable of doing so.

maggie29: Is CBT something that must be done with a therapist, or can it be done on our own?

Dr. Gallo: Generally, it's best to learn the ropes from an experienced therapist. Once one has had practice, you can, in essence, eventually become your own therapist. Actually, the majority of your therapy takes place when you leave your therapist's office and go out in the real world to practice what you have learned. The more practice in real life, the quicker you will improve.

David: Here's the link to the HealthyPlace.com OCD Community. You can sign up for the mail list at the top of the page, so you can keep up with events like this.

Here are some more audience questions:

mkl: I have Obsessive-Compulsive Disorder and take prozac. Is it okay to have a beer or 2 or marijuana (if legal-I know) once in a while or does it screw up all medications?

Dr. Gallo: As a psychologist who does not have a license to prescribe medication, I am afraid I can not comment on this question. I suggest you speak with the doctor who is prescribing your Prozac.

David: This person, Dr. Gallo, is using the beer or marijuana to occasionally relieve anxiety. What's your opinion about that?

Dr. Gallo: Well, this is a common occurrence. We refer to this use of substances as "self-medication". While alcohol and marijuana are both somewhat "effective" at temporarily reducing anxiety, they are indeed, not very good medicines. In fact, both of these substances tend to leave you with an increased overall level of anxiety, once their effect wears off.

Moreover, each of these drugs, comes with a host of other problems which make them poor substitutes for prescription medication.

paulbythebay: Is CBT preferable to a potent SSRI, such as Luvox?

Dr. Gallo: Not necessarily. Many people obtain significant relief from the SSRIs. However, SSRIs can usually work well only on the obsessions. A person must still teach themselves to resist the compulsive rituals.

Moreover, SSRIs and CBT complement each other and work very well together. In fact, most of my patients use both Cognitive Behavioral Thearpy and an anti-obsessional drug like Luvox, Anafranil, Prozac, Zoloft or Paxil.

Matt249: Is CBT equally effective in treating both obsessions and compulsions?

Dr. Gallo: It is indeed. In fact there is a special type of CBT designed for people who have only "pure obsessions" and/or mental compulsions.

stan.shura: Is behavior therapy an effective option for someone who has many different "smaller" rituals as opposed to one big one like hand-washing? My waking and "going to bed" routines -among others - are a frustrating series of rituals that take about 45 minutes in the A.M. and over an hour in the P.M. Some of these are repeated throughout the day - but I have "substituted" smaller rituals that seem to satisfy the need/anxiety.

Dr. Gallo: Behavior therapy is ideal for dealing with all rituals, large or small. The same techniques, when applied creatively, can be used on an ongoing basis throughout the day to help you combat a variety of rituals.

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Dan3: Are there any foods, for example fruits, that help treat OCD?

Dr. Gallo: While it is very important to pay attention to what I call the basics of good health" (e.g., proper nutrition, sleep, exercise and recreation) there is no substantive evidence that any particular foods have a therapeutic effect on OCD. I cannot, though, over-emphasize attention to the important basics.

pinky444: I was wondering if I have OCD. I think I show signs of it, but I'm not sure. I obsess over people I know, and I, in a sense "stalk them". Could I have Obsessive Compulsive Disorder?

Dr. Gallo: While it is not possible, or ethical, for me to attempt to make a diagnosis over the internet (without a thorough personal evaluation) this does not, at first glance, seem like classic OCD. This type of "obsessive" thinking and "compulsive" behavior falls into a different category of problems.

David: I'm sure Dr. Gallo would agree, if you believe you have a problem or psychological issue, it would be important to see a psychologist to be evaluated.

Dr. Gallo: Absolutely. All of my answers are meant to inform. If you are experiencing significant problems or distress in your life, please do consult with a professional psychologist or psychiatrist.

annie1973: I am in CBT, as well as on OCD medications. They are both working well for me. Skin picking, I am told, is part of my OCD. This, I cannot seem to control, even though my other symptoms are getting better. My therapist says it will get easier when I start applying my tools more often, but I try to and they are of no help. Any suggestion?

Dr. Gallo: You might ask you therapist to research the technique called habit reversal. It also works for skin picking.

obiwan27: Could helping somebody out with their OCD, actually make my OCD worse?

Dr. Gallo: By trying to "help" a person engage in their rituals, you can actually reinforce the obsessive-compulsive problem. The best way to help someone with OCD is to remind them that what they are experiencing is truly OCD and that they should practice the CBT techniques that their therapist has taught them. Above all, resist enabling the person or you will only make things worse (despite your pure intentions).

4mylyfe: Dr. Gallo, I am wondering how the patient and doctor can best identify the irrational thoughts and fears which come into play in Obsessive-Compulsive Disorder? Also, how long does CBT generally need to last?

Dr. Gallo: It is essential that a person see a doctor who is VERY experienced in OCD, otherwise they will miss many of the more subtle obsessive cues. Many people are misdiagnosed for years.

Cognitive-Behavioral Therapy essentially lasts a life time, but the actual time with the therapist can be relatively brief. Ten to fifteen sessions can work wonders, if the person diligently practices the techniques in their everyday life. However, the patient in essence becomes his/her own therapist and continues to utilize CBT throughout their lives. OCD is an illness which can be effectively managed if a person practices what they learn in therapy throughout their life.

pstet55: Is working with obsessive thoughts tougher than say, just having compulsions. I'm talking about disturbing, tormenting thoughts.

Dr. Gallo: Yes, I am afraid it does tend to be harder. However, a skilled cognitive therapist can help you learn how to rationally challenge and restructure these thoughts.

samantha3245: Do they try this treatment on young children? I'm 11 years old.

Dr. Gallo: Oh yes, Samantha! Young children are capable of a lot more than we give them credit for. However, the child must be motivated to work with the therapist. Sometimes parents can get involved also, and help the child with his/her therapy exercises. As an 11 year old, you can definitely benefit from CBT! Go for it and start living a happier life!

We B 100: I feel so frustrated because I have to color code everything and alphabetize everything. Just to do my homework I have to use 4 different colors of ink (pink, purple, blue, green). I feel like such a weirdo and hate this feeling of craziness. Is there anything that I can do at home to stop this without uprooting my whole life?

Dr. Gallo: First and foremost, a person with OCD is not crazy or weird. The very fact that you recognize the irrationality of your actions shows how lucid and sane you actually are. I would suggest seeking a skilled CBT therapist in your area. There are two very fine organizations which can help you locate someone. Anxiety Disorders Association of America and the Obsessive Compulsive Foundation.

MeKaren: I used to be a checker, but over the years my compulsions have changed. I'd have to resist this ridiculous thing I do of always taking 3 steps before doing anything. It is quite time consuming and frustrating. What can I do?

Dr. Gallo: While it is hard for me to give specific individual therapeutic advice, you can try resisting the impulse to do so, tolerate the anxiety until it hits a peak, starts to plateau and then eventually declines. Also, there is an excellent guide by Dr Edna Foa on CBT for OCD that you can read to get you started if you cannot find a good therapist.

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bruin:What kind of an approach to CBT would you use for someone whose anxiety-reducing "rituals" are almost exclusively based on religious beliefs and religious rituals? (i.e. saying a certain amount of prayers before bedtime or before I go to church on Sunday).

Dr. Gallo: Cognitive therapy combined with good spiritual counseling from a clergy member who you respect can help with these types of obsessions and compulsions.

tiger007: I fear something bad may happen to me by other people. Is it Obsessive Compulsive Disorder or paranoia? What is the best way to cure this?

Dr. Gallo: From the info provided, it is hard to make an definitive diagnosis. It could be OCD or another type of anxiety disorder called Generalized Anxiety Disorder. Unless you really believe that other people are trying to hurt you, you most likely are not suffering from paranoia.

Brenda1: What about the type of OCD where you constantly fidget or count things. My doctor says this is a way of distraction, but I do it without thinking. How can I stop this?

Dr. Gallo: If you feel you need to count in order to reduce anxiety, or because you fear that something "bad" will happen if you don't count, then this may be OCD. However, it could also simply be a plain old habit behavior, which many of us possess.

neuro11111: Dr. Gallo, I have done a little reading on CBT (Jeff Schwartz). I can understand how actively refraining from certain compulsions can eventually lead to creating less of an importance in carrying them out. I can sort of relate to that, as throughout the years, I have established at least some kind of control over excessive washing (hands & arms). Since acts like washing and checking are tangible, they are somewhat easier in some cases. However, when it comes to controlling those darn thoughts! What can I do?

Dr. Gallo: One technique for banishing thoughts is to use something we call "mental-exposure therapy". I suggest you do this with the help of a skilled therapist, because it involves exposing yourself mentally to the anxiety-provoking thoughts in a systematic and gradual way. It is important that you have professional therapeutic help and support while doing this. Mental exposure does eventually lead to desensitization to the anxiety.

Also, a good cognitive therapist can help you learn to do what we call cognitive restructuring, whereby you identify, analyze, challenge, and restructure your obsessive, irrational thoughts.

paulbythebay: I am 38 now, but have endured parental abuse, verbal badgering and serious losses (employment, relationships), due to OCD. What is being done to promote understanding of this, as a treatable disorder?

Dr. Gallo: The two organizations I mentioned, as well as the National Institute of Mental Health are actively and aggressively involved in promoting rational understanding of this rather common disorder. You might consider becoming an active member of one of these organizations.

stan.shura: Is it appropriate and/or beneficial for a person to disclose something like Obsessive-Compulsive Disorder to his/her supervisor or company? Are there any specific accommodations that can be made - or is OCD fundamentally different in that any such accommodations would be enabling instead of helpful?

Dr. Gallo: This is a good question. While opinions may differ, I believe that it would be better not to disclose or ask for accommodations for one's OCD. Accommodations, in essence, feed into, and reinforce the ritualistic behavior. Compulsions must be aggressively challenged, if they are to be beaten. They are like a monkey on one's back, that must be tossed off. Ultimately, the person who produces the cure is the patient him or herself.

espee: How is the category of "obsessive thoughts" and "compulsive behavior" different from classical OCD?

Dr. Gallo: Classical OCD consists of two primary symptoms. Intrusive, Disturbing, Anxiety-Provoking, Obsessive thoughts, coupled with compulsive rituals which are physical or mental actions intended to neutralize the anxiety caused by obsessions.

David: I know it's getting late. I want to thank Dr. Gallo for being our guest and staying to answer many of the audience questions. We appreciate that. I also want to thank everyone in the audience for coming and participating. I hope you found it helpful. Please feel free to continue chatting in our OCD chatroom or any other chatroom here. Thank you again, Dr. Gallo.

Dr. Gallo: Thank you, and good night for having me here tonight. I hope I've answered your questions well.

David: You did, and we appreciate it. Good night everyone.

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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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