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It’s Enough to Make You Crazy

posted by Julie O'Toole on October 2, 2015 at 11:25am

Let’s start with the impetus for my morning study focus: requirements by the American Board of Pediatrics (ABP) for what they call “Maintenance of Certification”.  Those of you reading this who are American physicians know what I mean: we are required to take Board Examinations every ten years, something I have just finished doing (again).  Some of you reading this may be lawyers or therapists—imagine if you had to retake your professional exams every ten years.  I am not talking…

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Wishing Tom Insel Well

posted by Julie O'Toole on September 16, 2015 at 4:35pm

This morning it was announced that Dr. Tom Insel, executive director of the National Institutes of Mental Health (NIMH) since 2002, will be leaving that august institution to join Google (aka Alphabet) in their quest to change the world of health. We have followed Dr. Insel’s blogs and presentations closely for many years on our own Kartini newsletter.

Now that he's leaving I say more power to him (after a moment of panic at the prospect of losing his strong and biology-focused…

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Why We Ban Cell Phones at Kartini Clinic

posted by Julie O'Toole on September 9, 2015 at 4:36pm

All our kids know it: at Kartini Clinic there are no cell phones allowed on the unit.

But why not?

Well, treatment takes focus and it takes interaction with the therapists, doctors and other patients.  Today I walked in on a group therapist talking with the high school-aged kids about the difficulties one of them was experiencing with concentration.  The supportive comments and suggestions given from one patient to another were nothing short of amazing.  The kids are amazing, but…

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Helping Parents, Together

posted by Julie O'Toole on August 26, 2015 at 6:04pm

Mother nature built us to protect our offspring and, where necessary, the offspring of other members of our “tribe”.  Elephants and non-human primates have been reported to foster or adopt motherless infants and raise them as their own.  Few adults can bear to see the suffering of a child.

Life can throw some of us a lot of pain.  But perhaps the worst kind of pain we endure is the kind we experience when our own small children are suffering.  We are supposed to be able to protect…

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Can Measuring Leptin Lead to Happiness?

posted by Julie O'Toole on August 19, 2015 at 2:27pm

In our clinic we spend a lot of time thinking and talking to our patients about the hormone leptin.

In another instance of the concordance of important findings to obesity science and eating disorder science, the study of leptin and body weight, leptin and menstrual function and now leptin and mood, has revealed relevance to both of these groups.   According to an article titled Leptin Predicts Decreased Depressive Symptoms, from the Neuroendocrine Unit of the Department of…

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Where Are The Grown-Ups?

posted by Julie O'Toole on August 5, 2015 at 2:00pm

I read an article on Medpage the other day - “Docs have Role in Preventing Childhood Obesity” - about recent recommendations by the American Academy of Pediatrics (AAP), which I found both annoying and discouraging in equal amounts.

First the annoying part: a prominent, almost certainly staged picture of two overweight children with their mouths open, watching TV, a huge spread of take-out food on the coffee table before them.  Who allows their children to be photographed like that?…

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What Real Mental Health Parity Looks Like

posted by Julie O'Toole on July 30, 2015 at 1:21pm

According to a June 29th article by Sam PK Collins for, “last week, Missouri Gov. Jay Nixon (D) signed a bill that explicitly states the types of eating disorder treatments insurance providers must cover. The new law builds on the mental health parity law by expanding the definition of “medically necessary” to include mental health treatment. It will also ensure that weight no longer serves as the sole determinant for whether someone may continues treatment.…

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The Trouble With Accurate Eating Disorder Diagnoses

posted by Julie O'Toole on July 15, 2015 at 4:20pm

Almost anyone who works in a specialized field (such as pediatric eating disorders) spends a great deal of time thinking about diagnostic criteria for diseases and conditions.  This is true throughout medicine and psychiatry, of course:  is it type 1 or type 2 diabetes?  Is it autism or pervasive developmental disorder?  Is it bulimia nervosa or binge purge anorexia nervosa? Is it eating disorder not otherwise specified (EDNOS, a term no longer included in DSM-5) or anorexia nervosa?Read More

Traveling with ED

posted by Julie O'Toole on May 28, 2015 at 1:48pm

I am writing to you from Berlin tonight and thinking about a recent article written by Dr. Bulik on the challenges of international travel for those with an eating disorder, in particular anorexia nervosa. In the article Dr. Bulik talked about time changes and irregular meals, of long distance transportation being a danger to those whose brain chemistry is less anxious when they don’t eat and more anxious when they do. It's how a person’s weight may slide down inadvertently, because…

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Telling your kid apart from “Ed”

posted by Julie O'Toole on May 15, 2015 at 5:01pm

I can’t tell you how many parents report their child with anorexia nervosa (or bulimia nervosa, binge eating disorder, fill in the blank…) becoming very irritated, not to say ANGRY, at them for something we call “externalizing the illness”.

What does this term mean?  It actually refers to a very positive attitude adjustment undergone by both parents and patients whereby they are able to separate the sufferer from the illness and blame the illness, not the sufferer, for how hard life…

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