Thanksgiving with your child

posted by Julie O'Toole on November 21, 2017 at 10:56am

Here we go into our season of Thanksgiving again. And we, at Kartini Clinic, give thanks for a lot of things: for the healing of our patients, for the continued evolution of  (more) affordable healthcare for families, for enough food to put on the table, for the health and safety of our loved ones. 

That’s the good side of Thanksgiving for us, but there is a challenging side as well.  Thanksgiving is not just about gratitude in this country.  Traditionally it has also been about…

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Meet Ryla

posted by Julie O'Toole on November 9, 2017 at 12:25pm

We had a therapy dog at Kartini Clinic for many years, and when the honorable Cleo, a black standard poodle, died it left a hole in our hearts.

I’ll never forget the day a small boy arrived in our office from another Children’s Hospital. His mother had removed him from the locked psychiatric ward where he had been placed for anorexia nervosa and terrible social anxiety. His transfer records labeled him as, “the worst case they had seen.” His mother was terrified we would say we…

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Building Trust in Food One Sandwich at a Time: Introducing Annastacia Weiss

posted by Julie O'Toole on October 26, 2017 at 1:49pm

It’s lunchtime at Kartini Clinic, and patients in our partial hospitalization program are settling in for their midday meal. Joining them at the table is Nutrition Counselor Annastacia Weiss. Annastacia came to Kartini Clinic with decades of culinary experience. She studied at Western Culinary Institute and the Institute for Integrative Nutrition in New York City, interned at farms, founded the much loved North Portland cafe SweeDeeDee, and incorporated her knowledge of food as…

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posted by Julie O'Toole on October 12, 2017 at 12:32pm

In the treatment of children and adolescents with eating disorders, depression is a not uncommon finding. Sometimes we identify it on admission to Kartini Clinic, sometimes it has already been identified before the patient ever saw us, and sometimes it is a residual of otherwise successful treatment. The latter is especially frustrating.

There is a saying in medicine, “when you leave the appointment feeling depressed, you know the patient's diagnosis.” Which might be why many…

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Back To School And The Risk Of Relapse

posted by Julie O'Toole on September 28, 2017 at 10:51am

When you practice as long as I have in the field of childhood eating disorders, one thing becomes abundantly clear: there are cycles to the frequency with which patients appear on our doorstep for treatment -- and on the doorsteps of all the other treatment centers as well. The trouble is, it has proven difficult to understand the peaks and troughs of these cycles and correlate them to much of anything. But there do seem to be a few tentatively recognizable patterns. And these…

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Mood and Treatment

posted by Julie O'Toole on September 13, 2017 at 1:45pm

Mood is a hard thing to measure, a chimera at times, hard to grasp, hard to define. Good mood, while often eluding exact definition, is obvious to the observer: the step is light, the smile is on, the shoulders are straight, the energy level is high. Low mood is just that: the shoulders are held low, the facial features droop, the light goes out of the eyes and energy is… low.

Depression seems to be expressed as consistently low mood. It is hard to experience and it is hard to be…

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posted by Julie O'Toole on August 31, 2017 at 10:00am

Is anorexia nervosa (AN) a chronic illness? What do we mean when we say that AN, or any other eating disorder, is a chronic illness?

Wikipedia says: “The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include arthritis, asthma, cancer, COPD, diabetes and viral diseases such as hepatitis C and HIV/AIDS. In medicine, the opposite of chronic is acute.”

Lasts for more than three months? Oh yes. By that metric AN is…

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The Importance of Parent Groups

posted by Julie O'Toole on August 17, 2017 at 9:06am

At Kartini Clinic, we have had a parent support group from the beginning. At first my husband Steve and I led parent group. After a few years it was taken over by a much more competent leader, Kartini family therapist Leslie Weisner LMFT, in whose hands it remains today. As our program grew and developed we added more groups, all free of charge, for our patients’ parents. Jean Malnati, our parent advocate and herself a parent of a child with an eating disorder, leads the parenting…

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Selective Eating Disorder: Call For Participants

posted by Julie O'Toole on August 10, 2017 at 3:42pm

For many years I have been saddened by our inability to help families with a child with selective eating. This condition is described here and here

And since, for the most part, such children remain on their growth curve, there has been no medical urgency to this—which completely ignores the psychological urgency that many parents (and some patients) feel.

Now, however, we are exploring a new biological option, which, if we are successful, may offer hope of change for people…

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How to Recognize Eating Disorders in Boys

posted by Morgan O'Toole-Smith on August 3, 2017 at 2:31pm

This video shows an 11 year old boy who has struggled with classic anorexia nervosa, including fear of fat, self-denial, increased and compulsive exercise,weight loss and intrusive thoughts of worthlessness and shaming. He is also an excellent student, excels at sports and is personally very tidy. He comes from an intact, highly functional and supportive family and there is a family history of OCD and perfectionism. He is able to talk about “voices” telling him not to eat and…

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