Wednesday, April 02, 2008

Can eating disorders be prevented?

Laura Eickman thinks so. She's a Psy.D. with a private practice in Kansas who makes presentations on what she calls the danger zone, which she defines as the area between eating disorders and "healthy" behaviors. (Which, by my reckoning, is everything else. But I digress.)

Eickman gave a talk recently at Pittsburg State University, a fact that caught my eye because of her emphasis on prevention. The question of whether prevention efforts are effective is a controversial one; some say that few to none show any tangible results, while others see value in certain kinds of interventions.

It's a question that weigh heavily on my mind. Could my daughter's anorexia have been prevented? Her younger sister is at greater risk of developing an eating disorder now; what, if anything, can be done to prevent it?

I don't think Eickman has any answers, at least not judging from the news articles about her presentations. (I haven't seen them myself.)

This quote, from Collegionline, the PSU student independent online paper, disturbed me greatly:

Eickman says people in the danger zone take only one to two years to treat, while those with fully developed disorders take five to six years.

As I have reason to know, at least the last half of that sentence is a lie. My daughter was weight restored from severe anorexia in 11 months; her mental recovery took another 6 months or so. Today, about 3 years after she developed anorexia, she is healthy and happy, with a positive relationship to eating, food, and her body, thanks to the fact that we used family-based treatment to help her recover.

Maybe it's PTSD on my part, but I don't trust "experts" who make statements like the one attributed to Eickman. And somehow I suspect her so-called prevention program is little more than words.

Which is too bad. Because God knows we need prevention that works.


Lady Epiphany said...

My sister is currently in-patient treatment for her eating disorder. I share your skepticism, Harriet. While I try to make an environment that doesn't include disordered behaviors for my daughters who are at risk, I think we still have to watch and wait. And pray.

I've seen similar statistics about treating eating disorders taking between 5-7 years. I'd say in the 5 or so years of treatment, my sister's ED has gotten far worse.

Anonymous said...

I didn't find Eickman's ideas of merit, either. For instance: "She also says we should increase opportunities for physical activity, the availability of healthy food..."

Exactly the kinds of obsessions that we do not need more of today! That's dieting, regardless of how it's disguised.

Anonymous said...

You scored a bullseye with 'family-based treatment'. More and more in and out patient treatment programs are realizing that the treatment of eating disorders, along with alcoholism, drug abuse and all the other addictions, is more successful when treated as a family disease rather than just one individual. From my experience, all addiction treatment is two phased, as you alluded to; elimination of the physical behaviors and working through the psychological trauma behind it. Great post.

Anonymous said...

This is just to say - one person's fast recovery doesn't change a larger body of research statistics. The "six year" factoid can be helpful to people who are tired of putting in recovery effort for such a long time. It takes a lot of effort to consistently fight against one's own head! Comfort as in, 'keep trucking, because you're super-close to when things will get easier.'

Harriet said...

True, anon, but my daughter's recovery wasn't super fast, at least not if you mean much faster than most people's. I think it was typical of a teenager whose e.d. was treated early and effectively. It sure didn't feel super fast to us.

epiphany, I'm sorry about your sister. That's rought.

Anonymous said...

My two cents here - I think it's really tough to take the position that ED can somehow be "prevented" when I don't think we have a really good grasp of the causes. My sister and I grew up in the same house - she's been(in my not-so-humble opinion)ED ever since she was about 12, I think. I was younger and witnessed it all. Why does she have this seemingly crushing fear of fat - of getting fat? Why does so much of her energy on a daily basis get channeled into "not eating" and making sure she gets huge amounts of exercise (the addition of a dog to her family was precisely so that she would have the need to go out running first thing in the morning and the last thing at night)? I do not have a clue and my parents (who were both health professionals) did not have a clue either but did all they could to prevent her from starving herself to death. Sometimes, all we can do as parents is to love them and show it and do our best. I have three kids, two of them girls. Why did those two girls NOT develop eating disorders when I saw a fair number of their friends who showed all the signs of it? I have no idea whatsoever. None. The only thing I can think of is that we lived in the country, worked in the barn every day(so physical strength was an asset), never said, "You can't eat that", and did not watch commercial TV.

Harriet said...

Spot on, Toby. Which is why researchers like Walt Kaye are looking so hard at genetics. Kaye believes up to 80% of eating disorders have a strong genetic component, which might explain why one child develops an e.d. and others in the family do not. Other factors can be triggers, for sure, but ultimately I think it's bad luck to have the genetic loading for an e.d. and to live in a culture that is about as triggering as you can get.

The Celtic Chimp said...

I don't really understand how something like an eating disorder could be prevented. Surely in the case of something like this, there must be some manner of symptoms observed. Is this not how you know there is a problem to begin with?

Undoubtedly though, the earlier the treatment begins the better.
Even if there is a genetic component, it is unlikely to be something that kids will be vaccinated against. A strong genetic factor would be encouraging from a treatment perspective though.

Trying to quantify recovery time seems like a futile effort. The recovery of an individual would be based on countless factors. I also think it could be a very detrimental thing for families and sufferers. It could lead to 'Shouldn't they be getting better by now?' type of thinking.

Very sorry to hear about your sister. I hope she gets better.

Anonymous said...

Every time I hear someone quote recovery times of 5-7yrs - usually in reference to traditional psycho-therapeutic models - it reminds me of this problem I had getting to a high-end mall near me.

It's a fairly straight-foward route: 128 to I95 to 495, and right off the exit. Except that there are two exits for the town it's in. The first time I went there, I got off on the wrong exit, had to "bang a U-ey" in Mass parlance, got back on the highway, and got off at the next exit. The next time, I went with my sister. We had the directions. Despite this, I got off on the first (wrong exit), realized that wasn't right, went back on the highway, etc. The next time I went - the same thing happened. It was then that I realized what was happening. I had "taught" myself that getting to the high-end mall involved using the wrong exit, turning around, getting back on the highway, THEN getting off the right exit.

This is what I think happens to many clinicians trying traditional approaches. They mistake *their* experience for *the best possible* experience. I had to undo some cerebellar learning in order to make it to that mall without the extra steps (finally mastered on the 2nd try after my epiphany :D). Many practitioners have to undo their previous experience and learning and accept that there is a better, faster way to treat EDs - namely by leaving the psycho-social issues for the end of treatment, and restoring healthy eating and nutrition first, rather than vice-versa.

As for prevention, I bet it would turn out to be hard and highly imperfect. But one could argue that using/modeling/teaching CBT-type techniques early on for an at-risk kid could certainly be helpful. Harm-reduction might be a more useful concept in this context than actual prevention, anyway.

Harriet said...

Great story, IrishUp. It made me laugh because we all do stuff like that. And I think it's a good analogy to. I like the concept of harm reduction rather than prevention, because, frankly, I don't think there is a way to prevent e.d.s. I've looked at a few studies that suggest that anything you do tends to trigger e.d.s, and of course you can't really measure prevention in this case.

To my mind harm reduction would mean getting kids weight restored asap if they're anorexic, and stopping binging/purging asap if they're bulimic. The rest becomes much easier to handle once physical health and balance is restored.

Brwneyedgrl08 said...

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