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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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The Suffering of Others

posted by Julie O'Toole on May 8, 2015 at 10:04am

“With what incredible courage we are able to endure the suffering of others” -- My favorite quote from English garden writer Christopher Lloyd.  And nowhere does it apply more than in medicine.  And within the world of medicine, nowhere more than in the world of mental health.

When my neighbor is poor, he deserves it for his sloth and lack of thrift.  When I am poor, I am the victim of unfairness and persecution.  When a young man medicates his abdominal pain with narcotics, he just…

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Obesity: Something You Have, Not Something You Are

posted by Julie O'Toole on April 29, 2015 at 3:32pm

The other day I sent around to our staff at Kartini Clinic an article on the gut microbiome (our intestinal bacteria) which is now thought to have some effect on the increasing rates of obesity worldwide.  This article/video is a discussion between Dr Eric Topol (editor-in-chief of Medscape, and a cardiologist by training) and Dr Martin Blaser, of the Human Microbiome Center.  The article covered new discoveries between increasing rates of human obesity and antibiotics as they affect…

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Kartini Clinic’s New Food Phobia Program

posted by Julie O'Toole on April 22, 2015 at 6:04pm

Kartini Clinic has a new home, and we are excited for a number of reasons. For starters, this time around we were able to design our units especially for our kids; they’re full of light and air and space to do art, a new classroom, a roof deck, not to mention our very own commercial kitchen - designed to provide space for parent cooking class as well - from which we serve all of our meals. Our food is sourced from the neighborhood’s New Season’s Market, conveniently located across…

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The Biological Similarities Between Anorexia and Obesity

posted by Morgan O'Toole-Smith on April 15, 2015 at 5:42pm

One thing I believe to have learned over the years is that those readers who are interested in anorexia nervosa seem to have little interest in obesity, which they regard as an lifestyle choice irrelevant to them, while those who study obesity often ask themselves what this rare condition (AN) has to do with their vastly more prevalent (read: important) condition of obesity (OB)? Well, as it turns out, quite a lot.

And by the way, it’s worth repeating at the outset, neither…

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Very Early Onset Anorexia Nervosa

posted by Julie O'Toole on April 3, 2015 at 3:20pm

For the purposes of this discussion I am somewhat arbitrarily defining “very early onset” as 12 years and younger.  Despite what you might think, this is not synonymous with “pre-pubertal onset” as Caucasian girls on average begin breast development - and the hormonal changes associated with this - at about 10 ½ years of age. Boys on average begin to go through pubertal changes about two years later.  And for girls and boys of African and Hispanic heritage average ages for these…

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Avoiding negative energy balance

posted by Julie O'Toole on February 26, 2015 at 5:01pm

Last week I was pleased to discuss a paper by Walt Kaye and colleagues that I felt strongly supported ordered eating for people with anorexia nervosa.  Ordered eating on our Kartini meal plan has always been the cornerstone of our weight restoration strategy for children and young adults who suffer from this condition. It works and Dr Kaye’s research tells us why.

This week I would like to refer you to a blog written by Cindy Bulik of the University of North Carolina. Cindy is a…

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Connecting the Dots

posted by Julie O'Toole on February 6, 2015 at 4:33pm

Two current Kartini parents handed me an excellent article the other day whose lead author, Walter Kaye, is likely well known to our readers.  The article, Temperament-based Treatment for Anorexia Nervosa, appeared in the European Eating Disorders Review.

I was especially pleased to see this article, although many of us have heard Walt speak about meal planning and the latest neuro-biological and neuro-radiological evidence before.  Neuro-biological and neuro-psychological evidence…

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