Viewing blog posts categorized under "Recovery"

The Evidence Is There, Now Make It Work

posted by Julie O'Toole on April 13, 2012 at 8:29pm

Jacques, a friend and parent advocate, sent me an online summary of an article discussing the current evidence base for the use of Olanzapine in anorexia nervosa.  Keep in mind as you read the summary that, regardless of the evidence base for efficacy and safety of Olanzapine in general and with anorexia nervosa in particular, this is still an off label use of this drug.  Off label means it is a drug approved for one condition which is used by physicians to treat a different…

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Re-training the brain and modifying behavior in eating disorder treatment

posted by Julie O'Toole on March 18, 2012 at 1:11am

Ah the brain, it's so complex; we are so complex!  What of our behavior is under our control?  What is amenable to cajoling, influence and even coercion? Does this change with age?  How is general willingness and ability to learn affected by a specific brain disorder, or can we generalize?

These issues quite frequently come to the fore during the treatment of food phobia, and even infrequently in the treatment of early onset anorexia nervosa.

Some percentage of our young food phobia…

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Exercise and the Severely Anorexic Patient

posted by Julie O'Toole on March 2, 2012 at 11:15pm

On February 18 I attended the annual conference of the Columbia River Eating Disorder Network (CREDN) and heard Dr Ken Weiner of ERC speak there.  Ken spoke about the uselessness, hopelessness and mirage of dieting, but he also spoke about some of the issues pertinent to managing the patient with anorexia nervosa.

In Dr. Weiner’s experience, and the experience of his colleague Dr Craig Johnson (founding editor of the International Journal of Eating Disorders and founding member of…

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A wolf in sheep’s clothing

posted by Julie O'Toole on January 20, 2012 at 2:00pm

Every researcher in the field of eating disorders tries their best to reduce the burden of suffering for patients.  They try to contribute to the meaningful scientific discussion.  Having said that, however, I am going to proceed to critique an article by Natalie Godart, Sylvie Berthoz, Florence Curt and colleagues at the Institut Mutualiste Montsouris in Paris, France; the French National Institute for Health and Medical Research; King’s College, London Institute of Psychiatry; the…

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Richard Morton’s Description of Anorexia Nervosa in a Young Man

posted by Julie O'Toole on January 6, 2012 at 2:00pm

This is the second and final case presentation Dr. Morton makes of two illustrative examples of anorexia nervosa.  This time it is a young man.  He mentions that the patient is the son of a friend—so imagine how motivated he was to establish the correct diagnosis and find a successful treatment! First Morton discusses the differential diagnosis, establishes the correct diagnosis, discusses failed treatments and finally discusses his successful treatment of what, to him, is a chronic…

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Anorexia Nervosa Case Report, Circa 1684

posted by Julie O'Toole on December 23, 2011 at 11:50pm

As promised, here is the first patient case report by Richard Morton in his 1689 book, Pthisiologia. My comments are in regular italics and his original text in bold (with original, Stuart England grammar and spelling!).

History 1

Mr. Duke’s Daughter in S Mary Axe (a medieval parish in London memorialized by a modern London street of that name) in the year 1684. and the Eighteenth Year of her Age, in the month of July fell into a total Supression of her monthly Courses from a…

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Anorexia Nervosa in the 17th century

posted by Julie O'Toole on December 17, 2011 at 12:38am

There seems to be a discussion that simply will not die in the world of eating disorders (particularly when it comes to anorexia nervosa) around whether the “desire for thinness” is culturally bound and whether AN is a “modern phenomenon”.

A few years ago I was fortunate enough to acquire a copy of Pthsiologia, a book written in 1689 by Richard Morton, an astute observer and physician of his day.  Morton’s description of two cases—one in a boy and one in a girl-- of what we now call…

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Inpatient Eating Disorder Treatment Checklist for Parents

posted by Julie O'Toole on December 2, 2011 at 2:00pm

If your child or adolescent is admitted to a hospital for the medical complications of an eating disorder, you need to carefully assess adequacy of care at that hospital.  

Common sense would dictate that we not become aggressive, belittling or demanding of professionals on whom our child is temporarily dependent for medical intervention, however you should not hesitate to inform yourself, rely on your intuition and experience and ask questions.  The days of “because I said so and I…

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Coming to Terms with My Daughter’s Genetically Programmed Body Size

posted by Julie O'Toole on November 18, 2011 at 1:59pm

Friends:  at the F.E.A.S.T. conference in Washington DC, I was approached by a mother (we’ll call her Kathy) who thanked me for helping her out from a distance with my blog titled “Determining Ideal Body Weight”.  She told me how she struggled to come to grips with the weight gain her daughter truly needed to get well.  I was very impressed by her eloquence, humility and dedication to her daughter.  I asked her if she would consider writing a guest blog so that other parents…

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Making Thanksgiving plans

posted by Julie O'Toole on November 11, 2011 at 2:00pm


This is a difficult time of the year for our patients and, I imagine, for eating disordered patients everywhere.  All over the country people are making plans for family to gather and to frequently do what can only be described as “binge” together.  Why do I say binge?  Well, because on Thanksgiving day people frequently eat more, sometimes much more, than they ordinarily do, which triggers a lot of “regret” style talk, which triggers a lot of discussion of everyone’s diets, weight…

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