There seems to be a discussion that simply will not die in the world of eating disorders (particularly when it comes to anorexia nervosa) around whether the “desire for thinness” is culturally bound and whether AN is a “modern phenomenon”.

A few years ago I was fortunate enough to acquire a copy of Pthsiologia, a book written in 1689 by Richard Morton, an astute observer and physician of his day.  Morton’s description of two cases—one in a boy and one in a girl-- of what we now call…

I am often surprised and pleased at the way we—pediatric providers who believe in the biological basis for eating disorders and parents who are caring for their children-- stumble our way forward trying to make things work and find ourselves on the same track.

I was given this lovely plate after the FEAST conference, by a mom, with the following kind words:

Dr. O'Toole,

Thank You for believing in parents and for all your hard work and dedication in the treatment of EDs, and…

If your child or adolescent is admitted to a hospital for the medical complications of an eating disorder, you need to carefully assess adequacy of care at that hospital.  

Common sense would dictate that we not become aggressive, belittling or demanding of professionals on whom our child is temporarily dependent for medical intervention, however you should not hesitate to inform yourself, rely on your intuition and experience and ask questions.  The days of “because I said so and I…

I have a lot to give thanks for, great and small, and I bet you do too: for the soft, cold rain instead of icy roads, for the warm cup of coffee at the start of a hard day, for a season where oranges are fresh, for good books and seed catalogues…..

I give thanks this week for the continued good health of my children and grandchildren.
And while I cannot (yet) give thanks for the health of my husband, I give thanks for the physicians he has encountered who care enough to transplant him.…

Friends:  at the F.E.A.S.T. conference in Washington DC, I was approached by a mother (we’ll call her Kathy) who thanked me for helping her out from a distance with my blog titled “Determining Ideal Body Weight”.  She told me how she struggled to come to grips with the weight gain her daughter truly needed to get well.  I was very impressed by her eloquence, humility and dedication to her daughter.  I asked her if she would consider writing a guest blog so that other parents…

This is a difficult time of the year for our patients and, I imagine, for eating disordered patients everywhere.  All over the country people are making plans for family to gather and to frequently do what can only be described as “binge” together.  Why do I say binge?  Well, because on Thanksgiving day people frequently eat more, sometimes much more, than they ordinarily do, which triggers a lot of “regret” style talk, which triggers a lot of discussion of everyone’s diets, weight…

I made this dialogue up, pieced it together from things that have been said to mothers and fathers seeking our care for their eating disordered children many times over the years.  

“Doctor, I am really worried about Simon.  He seems thin to me and recently all he does is study and exercise, he rarely goes out with his friends any more and he used to be such a social kid.”

“Don’t worry, Mom.  Kids go through all kinds of stages.  They have to experience who they are and often try on…

Life for most pediatricians used to be pretty well defined: you got up early and made hospital rounds on all your patients—mostly newborn babies and an occasional hospitalized child—before you went to see patients in the office.  Day in and day out, rounds were the rhythm of a doctor’s life. For many of us “making rounds” meant driving to more than one hospital to see everyone, so the day started early and was highly predictable, if a lot of work.  Most physicians trained in the era…

Readers of this blog know that Kartini Clinic offers inpatient medical stabilization, partial hospitalization and outpatient care, all entirely family based.  We do not offer residential care.  However, we find ourselves occasionally forced to refer a patient for residential treatment despite the fact that residential care is by its very nature not family based and despite the fact that the patient will ultimately have to return to their community and family and try to stay in…

The great thing about having your own blog is that you get to decide what you think is appropriate reading for your patients and their families.  Book reviews are always subjective, and never more so than on a blog, but I am pleased to have some books (besides my own Give Food A Chance) to recommend to families and other providers which are compatible with our Kartini approach to eating disorders.

I am often told that if I recommend books with a scientific approach “parents won’t be…