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The Ten Percent

posted by Julie O'Toole on August 25, 2016 at 12:56pm

The literature on lifetime mortality (the death rate) from anorexia nervosa has been cited as 20%, 10% and 5%, but I think whichever turns out to be the real number, we can all agree that it is too high.

When a young person dies, for any reason, we feel a terrible sense of loss if we are close to them, and a terrible sense of waste if we are not. To die because your brain commands you to refuse food, to fear your own body, to resist your family’s attempts to feed you is sad indeed.…

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Animal Assisted Therapy

posted by Julie O'Toole on August 18, 2016 at 11:34am

Kids and animals, it’s magical. Although some researchers have tried to figure out why, exactly, really - who cares? Many a little kid, or even older kid, who refuses to talk to grown ups will happily spend time with an animal. Some find courage through the presence of one.

I remember a little boy who was sent to us from a distant hospital. They’d told us he was “the sickest kid they had ever seen” and that he “refused to talk to anyone.” Indeed, he was curled up into a ball in the…

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Self Punishing

posted by Julie O'Toole on August 4, 2016 at 10:31am

One of the lesser known symptoms of early onset anorexia nervosa is “self abnegation” or even “self punishment.” Although these symptoms can be seen in older patients (adolescents) too, our experience has shown it to be most common in the younger patients. And most heartbreaking too.

What does it look like? Well, let me tell you, it is torture, both for the child as well as for the parents. It looks like this:

The 12 year old boy of very engaged and devoted parents who calls…

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When to Jump Ship

posted by Julie O'Toole on July 28, 2016 at 9:59am

Part of any successful voyage, especially one that involves reaching a critical destination for you and your loved ones, involves deciding when to keep rowing and when it would be wiser to jump ship.

Rowing, especially when it sometimes seems that people are not pulling together in the same direction (and at least one entity - the eating disorder - is actively punching holes in the hull) is exhausting. Never underestimate the role of exhaustion in decision making.

It occurs to me…

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Eating Flexibly

posted by Julie O'Toole on July 21, 2016 at 11:38am

One of the most common comments and questions we get about our ordered-eating family-style meals is about whether or not such eating is “normal” and whether it doesn’t represent some rigid food plan flying in the face of “real” recovery. Isn’t intuitive eating, well, intuitively better?

This is an area where I feel the perfect is the enemy of the very, very good. It's a bit like saying that the goal of recovery from childhood polio is to walk without a limp or crutch, in a way that…

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First Do No Harm, Then Innovate

posted by Julie O'Toole on July 14, 2016 at 12:32pm

Whichever genius came up with the pithy “first do no harm” knew what they were talking about, or at least had a profound understanding what evil could be committed in the cause of “we need to do something!”

From the journal of Clinical Pharmacology 2005 (Apr; 45(4):371-7). Regarding the Origin and uses of primum non nocere--above all, do no harm! The abstract by CM Smith:

“The so-called Hippocratic injunction to do no harm has been an axiom central to clinical pharmacology and to…

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On Individualized Treatment

posted by Julie O'Toole on July 8, 2016 at 10:11am

I was reading an online opinion piece by one of my colleagues, Dr Ovidio Bermudez, who like me is an adolescent medicine physician and eating disorder doctor.  This one sentence jumped out at me since it reflects what I have said in many ways before, only Ovidio said it better and more succinctly: “Families like to hear that care is tailored to their loved one’s unique recovery need, but core principles of treatment, including symptom interruption and weight restoration, should not…

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Practical re-feeding hints for parents: Benecalorie®

posted by Julie O'Toole on June 30, 2016 at 12:37pm

This blog post is about a useful, if prosaic, product we use in the initial phases of re-feeding at Kartini Clinic. I hope this post is helpfull to parents looking for feeding alternatives for their child with an eating disorder. And I would prefer to report on a generic product, but I have not found one: Benecalorie® is made by Nestlé and sold as a nutritional supplement. We have found it extremely useful when we need to add calories but do not want to use sugary additions such as…

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Binge / purge anorexia vs. bulimia: a DSM 5 update

posted by Julie O'Toole on June 23, 2016 at 10:20am

It has now been three years since the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published and it’s time for an update to previous blogs on this topic (which have been replaced by this update).

Many people say: “I used to have anorexia and then I developed bulimia,” or “She has anorexia and bulimia.” These statements are not accurate, and stem from a common misperception that any purging (vomiting) means a patient “is bulimic” or “has bulimia.” More…

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Is Anorexia Nervosa a Chronic Illness?

posted by Julie O'Toole on June 16, 2016 at 12:30pm

Recently, while responding to a struggling parent who had posed a specific concern on the F.E.A.S.T. website, I used the word "remission." Another mother on the forum responded that she did not like my use of the word "remission" since she preferred to think her daughter's illness was not chronic. Until that moment it had not occurred to me that this question of chronicity was a controversial one for some parents.

Ken Nunn, neuro-anatomist, eating disorder specialist and great…

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