Is Anorexia a Lifelong Illness? — (The New York Times)

SSRI Ed note: Woman and her GP blame antidepressant for causing her eating disorder. Such disorders are difficult to fully resolve.

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The New York Times

July 21, 2009, 12:41 pm

By The New York Times

Jeremy M. Lange for The New York Times Margie Hodgin, featured in the Times story “ When Eating Disorders Strike in Midlife,” is among many people who struggle with anorexia and related problems well beyond the teenage years.

Dr. Kathryn Zerbe, professor of psychiatry at Oregon Health and Science University and a longtime expert on eating disorders, recently took readers’ questions on anorexia, bulimia, binge eating and related problems. Here, she responds to various questions on treatment of eating disorders, how to pay for therapy, and whether conditions like anorexia and bulimia can be cured.

Q:  Dear Dr. Zerbe,

I am in my late 40s, have BED, Bulimia and anorectic tendencies. I haven’t heard of this much, but in my case the binge-eating was triggered by an anti-depressant (long ago), which started my disordered eating. This is the opinion of my current doctor, who has referred to my eating disorder as “iatrogenic.”

I literally can not keep any food in my house, including fruit, plain yogurt, etc, because I will binge on ANYTHING. Though my first choice would be sweets. I alternate between periods of binge-eating of MASSIVE quantities of sweets … for weeks or months or longer, and at some point I seem to be able to stop the binge cycle but can wind up on the overly restrictive end of the spectrum

I am a member of overeaters anonymous, which has provided me with incredible support, but has at the same time filled me with fear as in  “One never knows which cookie will be the 150 lb cookie-” ; The all-or-none sugar as alcohol approach.

I have been in and out of treatment programs, inpatient, outpatient, etc. Often, the treatment has been aborted when the insurance company has seen fit to “pull the plug” despite the best attempts of the treatment teams. The Psychiatrists and Psychologists who specialize in the treatment of eating disorders rarely accept insurance of any form.

If you have any suggestions, please let me know. Do you advocate any particular type of therapy for eating disorders, i.e Cognitive Behavioral, etc.?

BTW- if there are any Doctors reading this, please take complaints of binge-eating seriously. I tried so hard to communicate to my internist that the urge to overeat was overwhelming and that I had no control over it ­ and he did not acknowledge or understand this. I believe that this was a major component in my having become bulimic. Bulimia ­ now that is a “Real” Illness, while Binge Eating ­ well, that is apparently to some, or many, just the example of another lazy, fat American.

I am not saying this with malice. If one doctor reads this and decides to take a complaint of out of control eating seriously in the future and helps that person before he/she becomes bulimic ­ I would be very grateful.

and for anyone who may be reading this who thinks bulimia could be any kind of possible solution- PLEASE, PLEASE DO NOT ATTEMPT TO INDUCE Vomiting.

Try to imagine how awful you will feel when your teeth become transparent and discolored and you know you will need $30,000 + of dental work ­ I didn’t listen to my bulimic friends in OA ­ and now ironically, in an effort to avoid obesity and to be attractive, I have ruined my appearance further. It is easier to lose weight than to grow new teeth! not to mention the possibilites of esophageal cancer, burst esophagus, electrolyte imbalance, death, etc.

A:  Dr. Zerbe responds:

I agree with my colleague G. Terence Wilson (see the Times story, “What to Ask Your Therapist About Eating Disorders”), who recommends finding a therapist who is flexible in approach and knows cognitive-behavioral techniques that can be so helpful in the treatment of full-blown anorexia, bulimia, binge eating disorder and the “subclinical” eating disorders.

You are right to remind health professionals and those who suffer from these problems about all of the physical and emotional tolls that they take and to be on the lookout for all of them. Because recovery tends to be slow for many, and relapse rates are high even after treatment, it may be important to look at therapy a bit like “weeding a garden.” Behavioral suggestions are like pulling out the weeds; they are an essential step, but after you are feeling better you may need to “dig deeper” to get to the root of the problem. Then the weeds have less of a chance of growing back because the roots have been pulled out.

More and more therapists who treat eating disorders are now blending cognitive-behavioral therapy and psychodynamic therapy to insure better outcomes. (See Heather Thompson-Brenner and Drew Westen’s important 2005 study on this in The Journal of Nervous and Mental Disease, “A Naturalistic Study of Psychotherapy for Bulimia Nervosa, Part 1: Comorbidity and Therapeutic Outcome,” and “Part 2: Therapeutic Interventions in the Community.“) I am fond of quoting to my own patients a statement by psychologist Lucy Daniels, who wrote about her recovery after suffering from a longstanding eating disorder like your own. She found that understanding herself in psychodynamic therapy was essential because, as she writes:

“It provides support during the process of working through conscious and deeply unconscious separations and for bearing the pain that such losses entail. It maintains a sense of being listened to intently by a thoughtful person who will not let you be self-destructive without at least asking a question, but who will also, unblamingly, let you accept the consequences for your mistakes….” She continues: “thoughts and feelings expressed freely allow reality to emerge.”

Good luck to you as you take the next steps on your own journey. It is clear to me that you are confronting yourself with some of the long-term effects of having an eating disorder and trying to help others by warning them about some of the less well known but life threatening consequences.