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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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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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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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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Can Measuring Leptin Lead to Happiness?

posted by Julie O'Toole on August 19, 2015 at 2:27pm

In our clinic we spend a lot of time thinking and talking to our patients about the hormone leptin.

In another instance of the concordance of important findings to obesity science and eating disorder science, the study of leptin and body weight, leptin and menstrual function and now leptin and mood, has revealed relevance to both of these groups.   According to an article titled Leptin Predicts Decreased Depressive Symptoms, from the Neuroendocrine Unit of the Department of…

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What Real Mental Health Parity Looks Like

posted by Julie O'Toole on July 30, 2015 at 1:21pm

According to a June 29th article by Sam PK Collins for Thinkprogress.org., “last week, Missouri Gov. Jay Nixon (D) signed a bill that explicitly states the types of eating disorder treatments insurance providers must cover. The new law builds on the mental health parity law by expanding the definition of “medically necessary” to include mental health treatment. It will also ensure that weight no longer serves as the sole determinant for whether someone may continues treatment.…

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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

Traveling with ED

posted by Julie O'Toole on May 28, 2015 at 1:48pm

I am writing to you from Berlin tonight and thinking about a recent article written by Dr. Bulik on the challenges of international travel for those with an eating disorder, in particular anorexia nervosa. In the article Dr. Bulik talked about time changes and irregular meals, of long distance transportation being a danger to those whose brain chemistry is less anxious when they don’t eat and more anxious when they do. It's how a person’s weight may slide down inadvertently, because…

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