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Viewing blog posts categorized under "Anorexia Nervosa"

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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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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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 Role of Parents in Treatment

posted by Julie O'Toole on December 16, 2015 at 4:30pm

Possibly nothing has changed so much over the last ten years as the acceptance of parents’ role in the treatment of children and adolescents with eating disorders.

When I founded Kartini Clinic in 1998, “dysfunctional” parents were widely considered to cause eating disorders in general and anorexia nervosa in particular.  Toxic and enmeshed mothers were commonly cited by therapists, doctors and lay people as the common denominator in these illnesses.  In fact, eating disorders were…

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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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