DSM-5 Finally Fixes Anorexia Criteria!

This is long over due! The criteria for diagnosing anorexia has finally been broadened to include any weight - instead of the precious under weight "symptom". This help clear up the misconception that anorexia is a weight disease instead of purely a psychological one. With Weight Stigma Awareness Week in full swing I'd say this is a great time for the news! 

More than 55% of teen girls and more than 30% of teen boys report some kind of “disordered eating”. This means they exhibit symptoms like purging by way of self-induced vomiting, laxative and/or diuretic abuse, excessive exercising, restricting food consumption, binging, using diet pills, and even diabetics using insulin to regulate and manipulate their weight. 

“Before, patients were very sick before meeting criteria, and the evidence is pretty clear that if you interfere in anorexia before there’s been significant weight loss, the outcomes are much better and the illness is easier to treat in an outpatient setting,” says Kimberli McCallum, founder and medical director of eating disorder clinic McCallum Place in Saint Louis, in an article by Tara Haelle with Scientific America[1]. 

Before, many people fell into the EDNOS category[2]. EDNOS is the diagnosis given to any person exhibiting disordered eating but didn't fit exclusively into either the anorexia or bulimia category. 

So what was the problem with EDNOS? Usually the EDNOS diagnosis was not taken seriously by insurers, family members, or even physicians. This tremendously complicates treatment for an extremely deadly disorder. In fact, it's the most deadly eating disorder. 

Aside from the change to the DSM-5 criteria regarding a weight requirement are other changes. Instead of the previous psychological markers of “intense fear of gaining weight or becoming fat,” it now reads “or persistent behavior that interferes with weight gain, even though at a significantly low weight.” And the criterion "at least three missed periods" has been completely removed. It has also added that while using BMI to help establish severity, “the level of severity may be increased to reflect clinical symptoms, the degree of functional disability and the need for supervision.” Additions of “partial remission” or “full remission” have also been added to prevent recovering anorexics from being rebranded with EDNOS. I know that, for myself, there have been several partial remissions. These remissions I experienced always had some other element that wasn't there the first time around. I suspect it's the same for many others. 

The real challenge is going to be physicians and families seeing an over weight child/adolescence lose weight and actually investigating the weight loss methods instead of just congratulating them. Being complimented and praised is so addictive, not only to children and adolescents, but to anybody. The truth is that there can be serious health complications going on such as dehydration, digestive issues, cardiac issues, kidney and liver issues, and difficulty concentrating.  

These changes will hopefully help health insurance claims as well. Many insurance companies automatically refused any patients for overnight treatment if they were more than 85% of their ideal weight. 

This should also help obtaining more reliable research statistics as well. Yay!

This is a win, guys!!!  

[1] http://www.scientificamerican.com/article.cfm?id=expanded-clinical-definition-of-anorexia-may-help-more-teens&WT.mc_id=SA_sharetool_Twitter

[2] http://www.something-fishy.org/whatarethey/ednos.php 

Lost Down The Rabbit Hole

There seems to be a new fad going around in full force: clean eating

The root cause of this lifestyles is admirable and important. I love that more people are becoming aware of what they're consuming and really beginning to examining their food... 

That being said, I desperately want to caution those who have adopted this lifestyle change. So here is my cautionary tale:

{source}

http://www.michellechant.com/2011/08/

curiouser-and-curiouser-down-the-rabbit-

hole-and-back/

I wanted to be a lean, mean, clean eating machine. I did everything right. I did my research. I balanced my meals. I was informed, and level-headed. I workef put everyday and had six pack abs. Despite all of that, my obsession turned lethal. The scary truth is that being "healthy" nearly killed me. Now anytime I see someone being/striving to be uber-healthy I feel an urge to warn them, to show them the otherside of the looking glass. 

 

 *Let me clearify, by "healthy" I mean: Cutting out processed foods, trans fats, unnatural sugars, added sodium and chemicals, preservatives, refined flours, dairy, and meat. I ate a very balanced vegetarian diet (I did eat fish and egg whites). 

At about the same time that I had mastered clean eating, I also began experiencing terrible GI issues (including extreme nausua, severe cramps, and stabbing pains). I don't believe my new lifestyle had much to do with it. I felt physically better whilst adhering to it,and  drastically worse when I veered off-course. I had bouts of milder symptoms before (off and on for several years, actually) so I believe the severe physical illnesses I was experiencing were most likely the same thing. I do belive that my compromised health exasperated my underlying medical issues (I just recently got my answer as to what this mystery ailment that has plagued me for over 10 years is - Dysautonomia). Coincidentaly, the deepest part of my struggle with ED occured just when my Dysautonomia really started to get revved up. As that gained strength, the physical pain of my body was in became too much. The pain from just ingesting food was great enough to cause a fear so intense that I would develop a full-fledged phobia. 

I should also mention that I experience (and sometimes still do) a strange compulsion to move after ingesting something. This started several years before my epic battle with ED began. It was as if being idle turned the food into lead, which would painfully weigh down on my stomach. That "full" feeling was physically painful. Excruciating. 

Soon after the clean eating and fitness obsession hit its pinnacle, the delusions began. If I worked out, the calories I ingested would turn to muscle and it would fuel my body more efficiently. If I didn't, then said calories would turn to fat and would be wasted. The health and fitness fanatic in me just screamed "Muscle is good, fat is bad!"

I will always remember one particular day in the fall of 2002. It was then that I realized I was completely at the mercy of my eating disorder. This was the day that I knew I was sick. I knew I was too thin. I knew I was dying. Even more startling - and important to convey- is the fact that I didn't want to be that thin. Not in a million years. I wanted to gain weight. I wanted to be like I was before: Athletic, strong, fit, lean but not skinny. What happened that day and the revelation I had, shook me to my very core. I was terrified. That moment went something like this:

It was morning and I was sitting on the couch, watching TV while I ate breakfast which consisted of a regular sized bowl of cereal (some sort of Kashi), soy milk, and 1/2 a banana. Sensible and satisfying. 

Immediately after ingesting it, I panicked. That was the day I knew I was a prisoner on death row. The only reason I didn't reach out and seek help right then and there was because of the social stigma attached to eating disorders. I was too scared of what everyone else would think. The fear of being labeled a weak, entitled little white girl was too strong. This vivid memory is locked in my mind, forever etched into the walls of my psyche. I dig it up anytime I hear that voice - that dreaded siren call of ED- whenever I'm on the brink of relapse. This memory reminds me of the journey back home and how long, scary, and dangerous it was. Because of that, I don't dare jump back down that rabbit hole.

“In another moment down went Alice after it, never once considering how in the world she was to get out again.” 

― Lewis Carroll, Alice's Adventures in Wonderland

* Side note: I think it is important to be honest in order to truly grow awareness. However, to keep things as safe as possible I will NOT divulge information such as: weight, height, BMI, or clothing size.

The depth of my rabbit hole

*Upon Hospital Addmittance*
    Average body temperature: 95 degrees
    Average heart rate: 40bpm
    Hospitalized in critical condition
    Beginning stages of multipule organ failure
    NG (nasogastric) Feeding Tube (24hr/day feeds) 
    PICC line with 24 hr IV infusion nutrition (TPN - Total Parenteral Nutrition)
    Refeeding Syndrome after starting IV and NG tube nutrition.
    Gastroparesis

    Severe GERD

    Water intoxication 

How long did it take  me to make my way out of just that part of it?

    I was rid of the PICC line and NG tube after 6 months, but was still unable to attend school for another year. 

Ok, how about after that? 

    It's 11 years later and I still have issues with gastroparesis. 

    I have weak joints, osteoarthritis, gastritis (which causes my stomach lining to bleed periodically), neurological damage (though some of that is due to a medication reaction a year later), memory problems... That's all I can think of at the moment. 

Please, please, please be careful! Being healthy and fit is wonderful. No longer being able to enjoy (or even eat) something "unhealthy", or just a day to be "lazy" is not. 

No Makeup Monday

Yesterday, I learned about the No Make Up Monday movement. Every Monday Operation Beautiful celebrates the natural beauty we all have by going make up free. For the record, I love make up. I think it's so fun! - and Operation Beautiful agrees with me ;) But it is so important to remind everyone just how amazingly beautiful they are as their naked self. I actually really needed this reminder. After taking several pictures and analyzing which one was the best, (Proof of just how strong our sense of commercial "beauty" really is.) I nervously posted my picture to Facebook and Twitter. Here I am posting, once again, on the Internet. I must be getting better at this whole "body confidence" thing.

 

Some added inspiration, courtesy of Huff Post Women, helped quite a bit. In this article "Why I'm Wearing A Bikini On The Internet" Brittany Gibbons writes about her mountain she wants to climb: Wearing a bikini. *Note: I love bikinis but after having two kids I'm less than friendly towards them* She goes even farther and posts pics of this endeavor on the Internet! She's now my hero. Later this week she posted another article in response to the outpouring of commentary on the bikini one. This one was the reveal of her weight! I know, she's amazing! This article titled, Why I'm Revealing My Weight On The Internet she writes about how she had to defend her body and how she is, in fact, plus-size. In the end she writes: " People carry weight in all different ways. you can't draw a line in the sand and toss assumptions on either side. I do this, all of this, to show you what a real person looks like at this weight. And what a real person looks like in those cloths." 

Love it! Maybe one day I'll be that brave... Until then I will continue to raise awareness and try to help others in their recovery. Another awesome act of bold, natural beauty in the media is The Nu Project. The Nu Project is a 100% volunteer gallery of nude women in all shapes and sizes.The goal is to inspire women to feel better about their bodies. Huff Post Women also did a story about this project (how I heard about it) and has a slide show of 7 pictures from the gallery that are stunning. The creator of The Nu Project, Matt Blum, says that he tries to photograph women where they feel most comfortable - in their own homes- respectfully, with out a lot of sexual over/undertones.

Simply beautiful
        

Letter to my 16 Year Old Self

Dear Me,

Yeah, this is me...Er, you... In the future... I know what you're thinking - but this isn't a dumb prank your friends are pulling. You're quirky and aren't one to dismiss strange things, so I'm going to assume that about half way through this you're going to just take my word for it. I also know that you're crazy busy but please just listen and give me the benefit of the doubt. So, yeah, this is you in the future... I'll let that sink in a minute. Ok. Now that we're on the same page (or at least the same book), I'll begin. You are 16, and unlike most 16 year olds you don't take yourself to seriously. That's good. Hold onto that. The adults in your life really do respect you and what you have to say. You don't have to try so hard to impress them, or anyone for that matter. For some reason (believe me, you'll spend years trying to figure this out. You'll come up with some theories, but nothing earthshaking. No crazy revelations.), you feel that you must be the best. Quit chasing that coveted #1 spot. In everything. I know that working your ass off only to make it to the top 5 (in everything) is frustrating - and for once it would be amazing to actually be the best in something - but top 5 is actually really awesome.

After that speal I feel compelled to tell you that you don't even need to try for top 5. No matter what anyone says. You don't have to exhaust yourself trying to impress everyone because of some idealized notion society has placed on you. Everything is not a competition. That also goes for your love life. Let's face it, it's not even about the boy anymore. It's a competition. If you could just move on it would save a lot of heartache for several people. Teenage angst and melodrama aside, you really can stop competing with yourself. Stop pressuring yourself to be the "ideal" daughter/student/friend/etc. Let go of that incessant need to be "perfect". To have zero flaws. LET IT GO! It could help us tremendously in the future if you would just realize that you already are perfect. There is no need to keep chasing the mirage. That's all it is, a twisted little mirage. In two years someone will say these words to you: "you ARE perfect" and they will resonate with you more than any truth ever before. I know that 2 years seems really close, but it is actually light-years away. You're rolling your eyes right now and are thinking, "Yeah, yeah, yeah. Whatever. Everything is going great right now. I have awesome friends and everything is going according to my plan. I have a high GPA and am on track for a stellar transcript. I have scholarships lined up and it's all because of my hard work. That hard work that you're telling me to let up on. If I let up, I am never going to make it. I'll fail."

That takes me to my next message.
In a year your world is going to come crashing down around you. You will have no warning (other than this right now) and you'll panic. You'll panic like you've never panicked before. Yeah, I thought that would get you're attention. To be honest, I'm conflicted with whether or not to disclose certain details of this chapter. If you know before hand and somehow manage to side-step it, it would change everything about you... I know I would have liked some warning, so I'll tell you anyway. If for some reason, through some kind of divine intervention you do see it coming, just let it happen. If nothing else, let this be of some comfort and hopefully it will soften the blow of what is to come. In one year life is going to test you. Big time. You MUST survive. No, I'm not being dramatic. This is a real. It's life or death. Ok, don't panic. You're panicking, aren't you? Stop. Breath. 

It's nothing like what you are thinking, or could possibly think. You aren't going to be stalked by some crazy serial killer or anything. When your world is bleaker than anything you've ever been through, trust in your friends. They really are great friends. They will stand by you through everything. Don't cut them out. You won't want to talk to people, but try. They care more than you realize. Give your parents a break. They aren't trying to control you. They are scared. Terrified. Stick to your guns. Just because they are supposed to be "experts" doesn't mean they know what's best. Listen to your inner voice. Above all else, remember: This too shall pass When it does, wonderful things will happen because of it - but I can't say anymore about that ;) Be strong. Your life may not happen as you so carefully planned, but it will be perfect. *Thank you, Carrie at Just Mildly Medicated for this great blog idea. I loved it :)

The R Word

 Follow my blog with Bloglovin 

  It was late afternoon and my mom was cooking dinner. My sister was... well, I actually don't remember what she was doing, and I was in the living room watching TV. Suddenly I heard shouting outside and something hit the front of our house. Startled, I looked out the window. Standing outside my house was the girl who lived down the street from me, shouting and throwing rocks at the front of my house. we went to school together, and for some reason we just never really got along. We tolerated each other. I thought she was a show-off and she thought I was too. I had probably done something or said something at school that day that peeved her off, I don't know. I threw the door open and was shocked at what I heard her yelling. " Melinda's sister is a retard!", "Retard!", "Retard!" "Melinda's sister is retarded!" Each verbal assault was accompanied by rocks hitting my house. The shock quickly faded and anger took over. I ran across the yard and yelled for her to "Take that back!" She kept shouting it and shoved me. I broke her nose. Right there, in my front yard, for all the neighbors to see. I probably should have felt bad or at least a little scared because people saw it. I was, after all, a total goody-goody. But I didn't and I still don't. My dad was watching from the front door, half upset by my outburst and half proud of how I defended my sister. I don't remember anything else that happened that day. I didn't get in trouble aside from a lecture about how resorting violence isn't the right thing to do. 

  I learned how to deal with things like that better and by high school I calmly asked people to please not use that word. If they asked why not, I explained it to them. Everyone I spoke to respected my request and I never heard any of them intentionally use that word in my presence again. When the occasional slip-up happened they always sincerely apologized. Generally, people use this term in a completely benign way and have no idea what the power of that word actually holds. Once they find out, as with most other things that are shrouded in ignorance, they understand better and it changes their perception and behavior. It is for that reason that I am a firm believer in spreading awareness.

  March 6th was the annual "Spread The Word To End The Word" 
awareness day

What is Spread the Word to End the Word? Spread the Word to End the Word is an on-going effort to raise the consciousness of society about the dehumanizing and hurtful effects of the word "retard(ed)" and encourage people to pledge to stop using the R-word. The campaign is intended to get schools, communities and organizations to rally and pledge their support to help create communities of inclusion and acceptance for all people. Learn more about this campaign here 

  The R-word fosters LONELINESS 

“It hurts and scares me when I am the only person with intellectual disabilities on the bus and young people start making “retard” jokes or references. Please put yourself on that bus and fill the bus with people who are different from you. Imagine that they start making jokes using a term that describes you. It hurts and it is scary.” – Joseph Franklin Stephens, Special Olympics Virginia athlete and Global Messenger As evident with my childhood confrontation, there are times, situations and personalities sometimes involved that may not be best suited for an immediate intervention when you hear someone use the R-word.  It simply may be best at times to walk away from a situation, but that doesn't mean you can’t still do good after walking away. 

• Language affects attitudes. Attitudes impact actions. Make your pledge to choose respectful people first language at http://www.r-word.org/Default.aspx

It Starts With A Voice is an amazing facebook page chronicling the journey of a wonderful family in their quest to end the r-word. If nothing else, please watch this video. I just did and now I'm in tears, happy tears. Other resources to check out (please do!): The World Of Special Olympics NYT: A Word Gone Wrong Barrington Patch: Spread The Word To End The Word denverpost.com The Hurtful Effects Of The R-Word written by Eddie Barbanell from the hit movie “The Ringer"

A Dangerous Blind Spot

As NEDAwareness week wraps up, I'd like to leave you with one last post. 

 *Note: I do plan to add other posts pertaining to this subject well after this week is over ;) 

There is a lot of attention on the current childhood obesity epidemic that seems to not only over shadow another epidemic, but fuel it altogether. 

In a CMAJ (Canadian Medical Association Journal) article from 2004, Dr. Joan M. Johnston addresses the push towards eliminating childhood obesity upon receiving a package as part of an obesity-awareness campaign for family physicians and pediatricians. 

She writes: "I am disgusted by the cavalier disregard for eating disorders exhibited in the medico-cultural war against obesity." 

This publication had ZERO mention of eating disorders. I don't know about you, but I'm pretty sure that BED (binge eating disorder) is infact an actual eating disorder. Am I wrong? Did this phenomenon occur purely out of poorly educated choices, or is this much more complex issue than the health industry would like us to think? It is beyond ignorant to think that anyone in America who is overweight (or has a child who is) doesn't already have a plethora of information regarding the issue or, even worse, doesn't already know they are over weight. Johnston later sums up this eating disorder blind spot by stating that "For such individuals, launching a frontal assault on the symptom (obesity) instead of dealing with the underlying cause (the eating disorder) may simply catalyze the transformation of their disorder into anorexia or bulimia nervosa." 

The quick fix of caloric intake vs expenditure will have devastating results. With out addressing the person as a whole and just focusing on the numbers we set up for poorer health. It doesn't take very long before you are so far down the rabbit hole that you realize the "control" you thought you had was just a mirage (remember: most EDs are not about the food or the weight,they are much more complex than that). 

Up to 20% of those lost in wonderland will die from their eating disorder. That is a number far HIGHER than the risk of death from diabetes or heart disease related to obesity. Johnston sums up with "By adding the official voice of family physicians and pediatricians to the consumerist messages already bombarding them about diet and exercise, we will be endorsing the exploitative purveyors of these messages. We will be telling our kids that they are not okay, and we will drive many of them into the waiting arms of anorexia and bulimia." Combine that knowledge with the fact that this was in 2004 and both the health-care industry and our government's attention to this issue has increased exponentially while still having this blind spot is terrifying.

In today's Huff Post Parents an article spot lights a school who sent home "fat letters" to all students with an elevated BMI. 

Seriously, I can't even go into detail about this article because it is so maddening. PLEASE follow the link and see for yourself. BMI and I have been long-time enemies. It is purely height in relation to weight and does NOT account for muscle mas or bone structure. In another insightful article, Time Magazine's website (Time Ideas) that was published last Thursday focuses on this issue and adds some great points: "promoting healthy eating, regardless of one’s weight or age, seems like a positive thing on the surface. But here’s the potential downside: We know kids and teens react differently than adults to external pressures like persistent messaging. Sometimes these pressures can translate into incredible waves of anxiety and fear. At the extreme, a healthy-weight youth could be pushed to monitor his weight more frequently or even begin an unsupervised diet — behaviors that might represent an impending eating disorder." As someone who started out trying be healthy and wound up almost dead, I can't stress the truth in this statement enough. There is no doubt that the current level of obesity in this country is alarming and needs to be addressed, I just feel that there MUST be a better way than how we're doing it now.