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Viewing blog posts categorized under "Anorexia Nervosa"

Why Weight Restoration in Eating Disorder Treatment Must Come First

posted by Julie O'Toole on December 29, 2016 at 8:46am

This post was originally published on February 13, 2012.

I (among others) have recently been challenged by Laura Collins to get the message out that weight restoration is critical to psychological recovery in anorexia nervosa. Some authority, Laura says, must declare definitively that psychological recovery is tied to weight restoration.

Some authority… okay… but who?

Since the late 1990’s the AAP (American Academy of Pediatrics) has issued guidelines for hospitalization (after…

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Tolerating our own children’s distress

posted by Julie O'Toole on October 20, 2016 at 8:32am

This post was originally published on November 13, 2013.

Until I lived in the world of therapists and mental health professionals as part of the Kartini multidisciplinary team treating children with eating disorders, I had never actually heard the phrase “tolerating distress”, particularly as it pertained to parents.  Like most parents, I have a very difficult time tolerating pain in my own children, either physical or emotional and, when put in that situation, I immediately get…

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Family-based Treatment: why is it so wretchedly hard?

posted by Julie O'Toole on October 13, 2016 at 10:19am

This post was originally published on June 12, 2013. 

We’ve all heard from parents whose child had (or has) an eating disorder and who re-feed them at home, single-handedly and successfully. The Around the Dinner Table forum is full of such stories from parents who help other parents trying to do the same. But not all children’s illnesses can be so managed. At Kartini Clinic we practice a day treatment model of family-based care (as well as inpatient medical stabilization and…

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Why We Limit Hyper-Palatable Foods for One Year

posted by Julie O'Toole on September 22, 2016 at 9:50am

When I was first introduced to the Minnesota Semi-Starvation Study (MSSS), published in 1950 by Ancel Keys and his team, I was overwhelmed by the sheer volume of data they were able to accumulate about the physical and psychological ramifications of semi-starvation in humans.

It was mind-blowing. Then I came across the graph on page 106 of the hardbound edition called “Over-all Changes in Body Weight in the Minnesota Experiment” with the subtitle: “Expressed as a percentage of the…

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Building a Web of Safety

posted by Julie O'Toole on September 15, 2016 at 11:17am

One of the challenges of swimming against the stream -- as when, for example, one insists that parents don’t cause eating disorders when many providers learn and believe otherwise -- is that you become a bit of a pariah. At a minimum, people will prefer to talk to those of their colleagues who think as they do.

So building a web of safety around our patients once they leave the immediacy of Kartini Clinic has been a challenge. What are the needs of our young patients once they leave…

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Back To School And The Risk Of Relapse

posted by Julie O'Toole on September 9, 2016 at 12:51pm

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 peaks…

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Setting Goal Weights

posted by Julie O'Toole on September 1, 2016 at 10:43am

Setting a goal weight is not simple. And it is never harder than in a growing child, where it is a moving target.

I have written some rather lengthy guidelines for determining ideal body weight in the pediatric patient and about what we at Kartini Clinic call “state not weight.” Today, we use the term “goal weight” rather than “ideal body weight” as “ideal” has so much baggage.

Professor Bryan Lask once asked me to participate in a debate in an international journal about whether…

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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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Why Wait For Treatment?

posted by Julie O'Toole on January 20, 2016 at 3:35pm

It still happens all the time.  I go to see a family in the hospital (and they can be from anywhere) and as I take their history, the parents begin their recitation of what brought their son or daughter to this juncture in the first place.

It often starts subtly: increased alone time as a result of less interest in social activities, more time spent on homework and “fitness” or sport.  Eating “healthy”.  Who can argue with eating healthy and homework?  Then the vegetarianism.…

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Our First Teaching Webinar

posted by Julie O'Toole on January 7, 2016 at 2:36pm

Today we did our first webinar on a site called ReelDX, specifically created as a teaching tool for providers and students, offering lifelong learning for a variety of other specialists and, eventually, for parents as well.  When we signed on to do teaching thorough ReelDX, we were especially thrilled at the prospect that parents could also access actionable medical information on health conditions that affected them personally.

To participate in these teaching vignettes, “case…

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