Viewing blog posts categorized under "Recovery"

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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The Secret Language of Eating Disorders

posted by Julie O'Toole on September 29, 2016 at 10:30am

The canny ability of eating disorders to twist even the most kindly meant words is something that is experienced by almost all our patients. We originally published this post back in the summer of 2011 and have decided to share it again because an awareness of of this facet of ED is so valuable to patients, families and care providers at every stage of recovery.


I find myself explaining this many times to parents and friends of our patients: there is a secret language to eating…

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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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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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Christmas and a New Year

posted by Julie O'Toole on December 23, 2015 at 4:47pm

Everyone in our field knows that the Holiday season provides special challenges to those with eating disorders, be those restricting, bingeing and purging or predominantly bingeing eating disorders.  Add to this the fact that this is typically a very important time of year to children and you have, well, a mess. It’s over in January though, and that’s the good news!

What makes it a mess? Holidays raise expectations in everyone, expectations that even for adults are often not met and…

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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

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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Taking A Moment To Vent

posted by Julie O'Toole on November 19, 2014 at 9:27am
My good friend and colleague Therese Waterhous, a PhD, RD eating disorder specialist and board member of the parent organization F.E.A.S.T., called me the other day.  She needed to vent, and now, apparently, I do too. It’s not that her annoying experience was rare or new, it’s just the fact that such ignorance persists and that at this point -- given the avalanche of new information about pediatric eating disorders --  such ignorance seems willful. You can update your database.… Read More

What To Do With An Affected Parent?

posted by Julie O'Toole on November 5, 2014 at 9:15am
This blog is asking for help from those of you who have a child with anorexia nervosa but who may have experienced an eating disorder yourself. Any clinic or provider who treats pediatric eating disorders will sooner or later see children whose families have more than one affected (or partially affected) family member. This is the fancy way of saying that when you do a careful history you are likely to find other family members who have eating disorders in addition to the child.… Read More
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