Walking in Lock Step - The Parent Trap

I'm reading Bitter Pills: Inside the Hazardous World of Legal Drugs by Stephen Fried.  Fried turned to this subject because his wife, Diane, was prescribed and took one pill of a new [at that time] quinolone called Floxin.  I repeat, one pill.  Quinolones can get past the blood brain barrier, and it did.  Diane's response included the development of bipolar disorder.  Her brain was biologically primed through genetics.  Others who took this drug experienced terrible side effects, as well.  Those who were affected created the expression that they had been "floxed."

Fried went on to investigate just how the FDA worked (and still does) to screen drugs coming to market.  He also delves into the workings of the drug industry and its relationship with the medical professionals who prescribe the drugs as well as the process by which the drug makers do an end run to potential patients and therefore users (something that has continued at much higher levels these days, especially with medications for brain disorders) using, for example, advertisements in newspapers and magazines.

I bring this up because Stephen walked the walk (lived the walk) that so many of us do who care for loved ones with an eating disorder.  I know this following passage will sound familiar and perhaps it will help loved ones understand the process in which they've become entwined.  More importantly, I think this passage illustrates why it's critically important for a family to work with a therapist not only to learn how to deal with the illness but also to learn how to get out of the way of their loved one's efforts to get and stay on the path to recovery as fully functioning as possible.

From page 106:

"I realized it was very easy for me to shift into "emergency mode," but terribly difficult to shift out.  How did you treat a chronic illness if not by declaring a permanent emergency?  I didn't know.  In my family [many of his family members were struggling with illnesses or death of a family member at this time] we just left the siren running and adjusted to the noise.  We're basically loud people: we never really liked the quiet much anyway....

"It seemed that Diane and I were experiencing what my friend Barry Jacobs - a clinical psychologist specializing in medical family therapy with people dealing with traumatic or chronic illnesses - has called the 'locked embrace.'  He describes it as 'a rigid pattern of interaction in which the patient is stuck in an underfunctioning role as other family members overfunction in an effort to protect [her].  It allows the family as a whole to avoid difficult feelings such as anger or overwhelming sadness, but can prevent the patient from recovering to the maximum extent possible.'  I understood that Barry was describing a sort of loving dysfunction, born more of fear than hope, that should be treated with psychotherapy...."

This is a shocking, not easy to read book that is well written and chock full of information.  I am hoping to find a more recent book that will continue this conversation.  The book includes a  chapter titled "Psychopharm" because of the brain disorder his wife developed and what he learned about this aspect of pharmacology while working with folks from NAMI, for example.

As I said in my last post, I am finding myself inadvertently drawn into literature I never dreamed I'd be reading six years ago.  I've always been interested in the medical field and now more so in the workings of the brain and medications.   Fascinating.

Addictions

No, I'm not going to write about ED, although I believe that once those behaviors identified as eating disorders, whatever they are, become entrenched, the person is addicted to them.  Which is why an eating disorder truly is, for a host of reasons, a medical emergency needing immediate attention and treatment.

Instead, I continue to be intrigued by the path I am taking in my reading.  Having read the Immortal Life of Henrietta Lacks by Rebecca Skloot and then a book I posted about here earlier, The Emperor of All Maladies, by Siddhartha Mukhurjee,  I've just become acquainted with the writing of  Dr. Abraham Verghese, who is the author of the acclaimed book, Cutting for Stone.  Dr. Verghese took time out from his life as a professor of medicine to study and then be graduated from the Iowa Writers' Workshop.  We readers are all very lucky, I think.  Having finished Cutting for Stone this week, I looked him up and learned that he has written two other books -- My Own Country and The Tennis Partner.  So I ordered the books and they arrived today.

Not one to allow a book to pass unexamined even if I'm still reading another one, I picked up The Tennis Partner and read the prologue.  And, there it was again:  another viewpoint from another person in medicine who believes that alcoholism and drug addictions truly are diseases that are biologically based disorders of the forebrain.  In addition, the medical doctor speaking to David Smith, an intern addicted to cocaine and the subject of the book, notes on page 5 of the prologue that, "....you have a disease, like diabetes.  And just like a diabetic taking insulin and monitoring blood sugars, every day for the rest of your life, you will need to monitor and treat your disease."  Add eating disorders to this list.

[And here's an article from the New York Times on the subject of addictions, looking at what goes on in the brain.  This article is particularly important, I think, because the author also notes the prevalence of these behaviors in connection with other brain disorders.]

If only this philosophy would make it into federal and state laws and on into the regulations governing insurance companies so that all brain disorders would be treated equitably, without regard to cost and with knowledge of the time it will take to help the person develop new behaviors and the means to avoid old behaviors.  For many, it'll take several attempts before the demon is brought under control and then, as noted, the person will indeed "....need to monitor and treat your disease"...."every day for the rest of your life."

Now back to the book I'm currently reading, which is Bitter Pills - Inside the Hazardous World of Legal Drugs by Stephen Fried.

"Addictive Personality? You Might be a Leader"

I love titles like this one which enticed me to read a New York Times opinion piece this past Sunday morning (July 24, 2011, "Sunday Review", p. 4) at breakfast.  Written by David J. Linden, a professor of neuroscience at Johns Hopkins University School of Medicine as well as author of a book with the startling title, The Compass of Pleasure: How Our Brains Make Fatty Foods, Orgasm, Exercise, Marijuana, Generosity, Vodka, Learning and Gambling Feel So Good.

[I have now (7/28) received the book and the chapter "Feed Me" is one of the best easily understood descriptions of why we get hungry or the reverse that I have read.  As usual, I flipped through the book and looked at the index when I opened the package.] 

One of the sentences highlighted in the New York Times article is, "Traits that make us crave pleasure also contribute to creativity and risk-taking."

Traits and States was a topic at the National Eating Disorder Association's meeting last Fall.   I wrote a piece reflecting on this topic.   Traits are those pieces of us that can be maligned and at the same time raved about, depending on the behavior that comes along with them.  While working at the University of Arizona, I participated in a fascinating job evaluation in which I was asked to look at my traits and qualities and write about the positives and negatives and how these affected my performance.  I learned so much about myself.  I also learned to be grateful for traits that I used to believe were detrimental.  I came to value my behavior better, too.  The affirmations course I took about this time underscored my ability to get ahead.

David Linden takes this positive outlook when he notes that ...."the psychological profile of a compelling leader - think of tech pioneers like Jeff Bezos, Larry Ellison, and Steven P. Jobs - is also that of the compulsive risk-taker, someone with a high degree of novelty-seeking behavior.  In short , what we seek in leaders is often the same kind of personality type that is found in addicts, whether they are dependent on gambling, alcohol, sex or drugs."

Wow!  novel approach here.  Then he delves into the functions of the brain related to pleasure and reward.  Timely, for sure.

He also looks at the medial forebrain pleasure circuit and the role of dopamine in the seeking of rewards.  What could be classified, after all, as a reward?  Well, for starters food.  If one is hungry, one eats.  One gets pleasure from taste and the responses of the body to food.  As a runner-turned-hiker, I can tell you that water is right up there when I'm out in the desert and getting low in the fluids I'm carrying.  He also touches on the point that Dr. Ryan in her lecture noted (in an earlier post here) that one can get pleasure even thinking about things like gambling. 

Dr. Linden, however, proposes that those who have an addictive personality crave things and at the same time actually like them less.  Sounds counter-intuitive.  He also provides a clear (current) explanation about why some become addicts and others do not.  Genes "....account", he says, "for 40 to 60 percent of the variation in the risk for addiction" and that there is "...no one 'addiction gene'."  Their dopamine response is attenuated.  In other words they need higher and then higher levels of stimulation to obtain the same level of pleasure that others gain in moderation. 

Linden goes on to list a few famous addicts; it'd be interesting to learn how many others there are with an "addictive personality" who channel their risk-taking solely into "legal" pursuits.  Must be quite a few, actually.  He counsels search committees to "...look for someone with an attenuated dopamine function:  someone who is never satisfied with the status quo, someone who wants the feeling of success more than others - but likes it less."

Having read this piece, I will read his book.  Surely there are some who get quite a good "high" out of this kind of achievement and who have learned to moderate their behavior so they can continue feeling good about what they are doing..... Or who love the high, continue to go after it, and like what they are doing? ....  or not?

Nicotine and the Brain

Provocative title!  I've known for years thanks to anecdotal comments that nicotine is helpful not only to those who want to avoid weight gain and so worry about quitting smoking but also to some with brain disorders such as schizophrenia.  There seems to be a moderating effect for the latter folks.  There's been quite a bit of research about this, too.  Those with binge eating disorder may be served by this research, as well.

There's a blurb in today's Wall Street Journal (Tuesday, July 26, 2011) on page D2 in the "Health and Wellness" section (actually, there are four articles that captivated me - seriously - today).

Here's the blurb:

"Nicotine-based drugs may be useful in controlling obesity and other metabolic disorders, and also help people stop smoking, according to a study in Science.  Smokers often cite depressed appetite and weight control as reasons for not quitting, but the anorexic effects of nicotine aren't well understood.  Researchers at Yale University found that low doses of nicotine or cytisine, a drug that binds to nicotine receptors, reduced body fat in mice by 15% to 20% and food intake by up to 50% but had no effect on water consumption.

"Research showed the nicotine drugs acted on a brain pathway involved in the regulation of appetite called the hypothalamic melanocortin system.  The drugs activated receptors located on pro-opiomelanocortin or POMC cells, a subset of neurons in the hypothalamus.

"When mice with the POMC pathway were given nicotine or cytisine, they lost weight whereas mice without the pathway were unchanged.  The study found that POMC receptors aren't the same as those that trigger tobacco cravings.  Drugs that target the POMC pathway could limit the weight gain that follows smoking cessation, researchers noted. 

"Caveat: Nicotine's effects on the POMC pathway have only been demonstrated in mice."

There's more to this research too, apparently, regarding reward.  I am reminded of this link and continue to believe that eventually everything will lead back to this intriguingly complicated area of the brain  - especially the Medial Forebrain Bundle - as well as the areas of the brain through which pathways pass.

It's All in Your Head......actually, your brain, which by the way is an integral physical part of the body

Following on the research I first highlighted in my post about ameliorating reward seeking behaviors, if one reviews each of these studies, there seems to be a common denominator here about reward-seeking behavior or at the very least a strong link to neurocircuits and these disorders.

First, there's the recent study by Dr. James Lock looking at bulimia and reward-seeking behavior.

Then, thanks to Carrie Arnold and her Ed Bites Facebook site, there's this study titled:  

Sex differences precipitating anorexia nervosa in females: the estrogen paradox and a novem framework for targeting sex-specific neurocircuits and behavior.

And then there's this study on clinical utility of personality subtypes - perhaps if one's reward seeking behaviors go undampened, then one is undercontrolled?

The more this kind of data is documented and presented to  insurance companies as well as to legislators looking at the FREED Act, perhaps this Act will be passed quickly.  It's comprehensive and so critical on behalf of those who are fighting eating disorders as well as their families.

Write your legislator(s)! 

Guest Post by Marjie Ruth - Today is a New Day

[Note from Jen:  Perfectionism was an underlying current in my life.  Thanks to a lot of introspection and life experience, I've realized that I missed out on many opportunities or shied away from them because I was afraid I would fail.  As I got older, fortunately, I became more daring.  This post by Marjie Ruth is a reminder that failure and learning is an important part of life as is getting up again and continuing on.......]

 

Today is a new day. You will get out of it just what you put into it...

If you have made mistakes, even serious mistakes, there is always another chance for you. 

And supposing you have tried and failed again and again, you may have a fresh start any moment you choose, 

for this thing that we call "failure" is not the falling down, but the staying down.

~ Mary Pickford

This week's quote is, I think, a very special one for a number of reasons. Before getting into the content of it, did you notice the author's name? I recognized it from the early days of Hollywood, and after doing a little research via our friend Google I was able to find out more about Ms Pickford. Somehow, I find it a bit ironic that such hard hitting words are associated with a "silent movie" star. But while the celluloid world for most of her career did not encompass sound, Mary was a woman who could definitely speak for herself. She started very young (age 5) in an industry controlled by patriarchal males. But eventually through her own determination and effort, she became the highest paid actor of her era and was the founder of United Artists. She maintained ownership of every movie she acted in, which numbered in the hundreds. Today the Mary Pickford Foundation, which she established in her later years, is still actively involved in the preservation and chronicling of early film work. Mary found her voice and was not afraid to use it.

Mary's words are ones that offer encouragement, inspiration, and hope. "Today is a new day..." This is a quote that's perfect for the bathroom mirror as it's one that should be spoken aloud each morning as we embark on another of life's 24 hour journeys. Her words are ones that we long to share with our loved ones, especially those struggling with an eating disorder. But like all inspirational words, they're only so much ink on paper if we don't take them to heart and work to apply them in our own lives.

Mary is so very right. Each day is a clean canvas, a fresh start, a new opportunity to try again. Mistakes in and of themselves are not bad. On the contrary, mistakes are necessary and even vital to growth and change. Mistakes are a form of life's feedback; they are learning experiences. (Hence, the importance of letting our children own their own failures as well as their successes.) The only bad mistakes are the ones we don't bother to learn from. But there are times when we find ourselves feeling discouraged and depressed because life doesn't go the way we planned or hoped for or because we've made bad decisions or because accidents happen.  And when it seems that bad things are happening to those we hold dear, and we feel powerless to help--we can indeed begin to feel like failures.

And here's where it gets really tricky, because--when we're concerned about our loved one, maybe even feeling consumed with worry--words can seem so trite and easy to ignore. What we really want is power...the power to step in, the power to do something to make things get better. We want the ability to make them see that hurting themselves through starvation doesn't make anything better, and instead makes everything worse, much worse. We want the power to make them see beyond the disorder, to know that the high from the binging or purging is hollow and false and extremely dangerous. We want the power to make the eating disorder go away so that rational reasoning can return. We want the power to heal. We want them to feel our love and to love themselves. But...and it's a big one...we don't have that power. We only have that desire. We can't do the healing for another. And we cannot make them choose to do that healing.

Then, what are we left with? Frustration and worry, to be sure. If we stay in the frustration and worry, we stay in the failure. Instead, we need to refuse to enable the addictive behavior and work to understand how we must change in order to meet that goal. We can make therapy available as an option. We can be loving without being smothering--another challenge for some of us. We can continue on with our own lives and turn to our higher power as we recognize our own powerlessness. We can work at accepting all the things we can't change and letting go of all the expectations that lead us to become resentful. We cannot change others, but are we willing to make changes in ourselves?? Are we brave enough to accept the truth that we can't do the healing for another, and wise enough to embark on self growth?

Mary Pickford's quote didn't originate from a wellspring of Pollyanna-like optimism. No, I think it came from a depth of struggle that was the result of her own long battle with alcoholism, an addiction which claimed the lives of her father and brother. Mary lived to the age of 87, and I would venture to guess that it was her strong sense of personal determination not to succumb to failure that kept her going for so long. Each day she started anew.  We can choose to do the same.  A very wise Chinese philosopher said it ever so succinctly:

"Fall down seven times, stand up eight."

And that's another good statement for the bathroom mirror.

Marjie
727-244-9011 (cell)
sruth1@tampabay.rr.com (or marjieruth1@gmail.com)

Note: As always, please feel free to share this email with anyone who might be interested. Just be sure to include my name & email address. Secrecy is the domain of demons. Through sharing we let in the light.

So..... what about anorexia then?

Updated March 31 2019

After reading and writing a lot about reward seeking behavior, I want to return to the topic of anorexia but want to review my experience as a starting point.

My experience with what I believe was anorexia but which was never formally diagnosed because I never sought treatment came along in the late 1950's long before much was known about it. I started with bulimia in ninth grade and then went through a phase (late high school/early college) where I became dreadfully thin.  I did not like how I looked in that phase.

By my senior year in college, I had regained enough weight through eating more than I was purging and I conscientiously would make a point of eating breakfast and lunch while resorting to binging in the evening or on weekends.  I remember trying very hard to quit in my freshman year and that lasted for about two weeks followed by infrequent episodes until the end of that first semester.  Then all hell broke loose in my life and bulimia became entrenched.  I've talked about this in another post. 

From that point on, I maintained a fairly steady weight although too low according to my PCP and went through periods of fluctuation -- heavier binging/purging followed by more controlled episodes, meaning less frequent episodes.   I shared this information with no one.  My BMI was constant until I began long distance running and volunteering and changed my life.  I slowly gained weight and held it for about twenty years and then gained more over the past fifteen years.  With the weight came stamina, fewer bouts with bronchitis until that totally disappeared, and a marvelously strong body.

So although I did lose a lot of weight, I cannot really identify with the concept of anorexia but I've watched my family member wrestle with it and bulimia since she, too, was fifteen. Only anorexia is much more of a factor for her.  In fact, I often wonder what might have happened to me had I not had the habit of bulimia first.  Would I have starved to death?  Was it inevitable?  Why was my path different from my daughter's?  Does it have something to do with the area of the brain involved in reward-seeking behaviors?  

Both of us have a very strong will and both of us have a strong will to live.  The will to live has brought my daughter back from the brink each time.  It has been her choice to get into treatment admittedly with thanks to the existence of Title 36 here and the creation of an incredible team that worked (and still works) on her behalf.  But lately she has given up.

I believe that the AN piece of her brain disorder is significant.  I know that she can make the choice to stop her bulimia and has several times.  But the AN is still there, no matter how well nourished she has become - twice about 10 pounds over a suggested set point.  I don't often write about her so directly but I do so now to illustrate the point that something else is involved in AN.  Going across the line, so to speak, into starvation is not, I believe, a choice.  As I said in an earlier post, something goes haywire.

Nutrition must come first to get the person back across that line and to help them hold that line until the brain rewires itself somewhat.  It is then that therapy has a real role in helping the person develop a solid sense of self as well as total awareness of this underlying syndrome and more importantly how to prevent its recurrence.  Whether or not that syndrome remains lurking there is yet to be determined. 

The answer is somewhere in the brain as well as, of course, in the individual's genome.  As I've said before, we're all like snowflakes.  Not one of us is totally alike.  But something is in there that those who develop anorexia have in common.  

I'm looking forward to further research in this area and hoping that Dr. Walter Kaye and his colleagues will obtain funding to further understanding of this dreadful disease.  Here's a link again to recently published research.

"Cells that Fire Together, Wire Together" - book review of Brain Over Binge

The title of this post, Cells that Fire Together, Wire Together, is the basis (to me) of a remarkable book titled Brain Over Binge: Why I was Bulimic, Why Conventional Therapy Didn't Work, and How I Recovered for Good by Kathryn Hansen.  This expression, found on page 140 of her book, and drawn from page 107 of The Mind and the Brain: Neuroplasticity and the Power of Mental Force by Jeffrey M. Schwartz, M.D. and Sharon Begley (New York: HarperCollins, 2002), sums up what happens when we humans carry out an action enough times that it becomes a habit.

I've attempted to write this review at least three times and because there's so much in her book, I found it difficult to summarize.   So here's my brief synopsis.  I strongly believe buying her book is a good step for those who haven't found an answer to their bulimia.   Her book contains material that I've studied as well as heard from researchers in the field of neuropsychology here at the University of Arizona.  The material dovetails so very well with my own experience, too.  

[update comment July 2, 2015 - I noticed that people are selecting this link.  I've placed a link to this post in my "Of Note" section.]

A good habit obviously is a good thing.  But those with the tendency towards (genetics?) strong reward-seeking behavior that is not tempered by the temporal lobes can run into trouble.  So, what is the solution?  And, can stopping binging and purging be a choice?  I happen to think so but I reached that conclusion long after (in terms of the length of time I battled bulimia) Kathryn did and I reached it because I was sick and tired of being sick and tired. 

Kathryn reached this decision because she encountered a program - Rational Recovery - that worked to steer her into a different perspective and she then spent a lot of time learning about her brain and how it's currently understood to work.  I also know people who've managed to use Alcoholics Anonymous with the same results.  I believe that there is an underlying biological reason for all of these disorders. 

Interestingly enough, I've also learned recently that people during the 1800's used sugar/sweets to get high.  Stop and think about that for a moment.  

The beauty of our brain, as Ms. Hansen eloquently and with considerable research puts it, is that the neurons and other material in our brains can continue to develop new pathways throughout our lives.  The neuroplasticity of the brain -- something I learned about in my class here at the University of Arizona last spring -- is our saving grace in so many ways.  We can learn new habits, we can learn to use a hand or walk  again after a stroke or injury, we can learn to speak new languages, soldiers returning from battle can overcome PTSD, and some can continue to function seemingly normally even with Alzheimer's Disease (as revealed by autopsy following death).  We can quit binging and purging.   Neuroplasticity is a remarkable thing.  Basically, to quote Ms. Hansen, "neuroplasticity refers to the brain's ability to rewire itself."

And she worked hard to rewire her brain.  She decided that she needed to do this.  I agree with her that others can, too.  She takes the reader through her disease and then recovery using knowledge of the workings of the brain as well as her discovery of what was driving her and why. 

She also thoroughly looked at herself through the lens of much of today's focus in eating disorders therapy and she concluded that the therapy doesn't really get at what started her disease in the first place.  She realized that getting to know herself and understanding her behaviors certainly helped in her development/her growing maturity but to her it was not a cure or a means of stopping the binge eating/bulimia.  I, too, turned to therapy after I quit binging and purging and found therapy to be instrumental in my personal development.  But, to repeat, by then I no longer binged and purged, either.  And she also believes, and so do I, that bulimia is triggered by something much deeper and at the same time simpler.

She has taken complicated information and presented it in a way that most should be able to understand.  The brain is complex.  Our anatomy is complex.  The media is also examining the workings of the brain thanks to the efforts I've outlined previously here on my blog in response to the needs of our returning military, of those who have suffered strokes, of those with brain disorders like schizophrenia, depression, and eating disorders, and more recently and quite tragically for us here in Arizona, of Representative Gabrielle Gifford's recovery from a point blank gunshot wound to her brain.

Ms.Hansen speaks an underlying truth that  her eating disorder was indeed about the food!  Or in her case, as with so many, with the results of the lack of it.

My own thinking has gradually come around to her thesis, too, which is that dieting in the sense of purposefully restricting one's caloric intake, sets off a chain of events in the brain that leads to the development of a potentially fatal disease:  an eating disorder.  She focuses on binge eating disorder (BED) and bulima.  

The word diet has been defined in our society not as what one eats daily  but rather the purposeful  change of eating patterns to lose or gain weight but that for some something goes haywire (interesting that the word "wire" is in this expression and the word haywire was used long before the workings of the brain became better understood) and leads to excessive restriction of food or to excessive eating and for some, death.  What is that something?  An imbalance?  An endocrine disorder?  An  immature portion of the brain?  Dr. Cynthia Bulik terms it a "negative energy balance."  Here is a link to Dr. Bulik's paper.

Once food is restricted, she proposes that the rudimentary part of our brain (she calls it the animal brain) recognizes that there is a threat to our organism's survival and the animal brain takes over.  One binges because one is starving.  One goes on to develop the habit of binging because it helps to feel better.  Sure it does!  You're no longer starving!  Remember, cells that fire together, wire together.

One purges because one who develops either BED or bulimia also either develops the habit to purge, in whatever way works, or continues to gain weight because they are caught in the habit of overeating.  The goal is to stop binging by eating rationally in response to the body's needs and therefore to stop purging (by vomiting, exercising, etc.) because one comes to understand -- to "get it" -- that they don't need to any longer.  Again, this can be hard work.  And, it can be done!

It would seem to me that for those who have the urge to binge eat without purging and who have developed the habit of binging, an underlying endocrine disorder in combination with, for some reason an uncontrollable urge to eat, must be addressed at multiple levels.

Some readers (and parents) will question how this process can work for a younger person.  I believe the parent needs to step in and learn about the brain, habits, and nutrition.  This book would be an excellent start.  The parent needs to serve their child as the light along the path and if the parent cannot or is not available, then the person with BED or bulimia needs to enter a residential program or live with a competent, knowledgeable and determined foster parent where s/he is monitored to eat well as well as not to purge until the new behavior becomes not only a habit but also believable.

This is not an overnight thing.  It's absolutely not easy.  But it sure does feel good to no longer be doing something that is so harmful and that interferes with a normal life.  I highly recommend this book as a valuable different perspective on overcoming bulimia and as a means of getting a handle on binge eating.

An important P.S. - this thesis does not address the difficulties encountered by those who are fighting other co-existing diagnoses such as Borderline Personality Disorder, Bipolar Disorder, Anxiety Disorder, or Obsessive-Compulsive Disorder.  I think this is where Dr. James Lock's recently published research will add much to the discussion.
P.P.S. - Kathryn has self-published this book.  It is available on Amazon.

 

Reward Seeking Behaviors: Part II

Shortly after I blogged about reward seeking behaviors, Dr. James Lock published a study linking bulimia to impulse control.  He also is beginning a study of bulimia in adolescents and is recruiting patients to participate:

I think this published study is hugely important because one of the symptoms of a person diagnosed with what's [incorrectly, in my opinion] called Borderline Personality Disorder is also faulty impulse control and emotional disregulation.  Twenty-five to 28 percent of those diagnosed with BPD are also battling eating disorders.  Faulty brain function appears to be involved.

So back to my earlier post re Ameliorating Reward Seeking Behavior.

Hopefully more research will uncover ways for a person to overcome this behavior that so undermines one's ability to live well.  

You Don't Know What You Don't Know

Let me repeat that:  You don't know what you don't know.

The first time I heard someone say this, I was attending a class offered by the National Alliance on Mental Illness, otherwise known as NAMI.  The local Tucson chapter is NAMISA.   The class, Family to Family, is still offered and I will be forever grateful to a friend of mine who not only told me about NAMI but also about this class.  I gained a tremendous amount of knowledge and also insight not only about the workings of the brain but also an inkling of what it must be like to have illnesses like OCD and Schizophrenia (through intensive class exercises) and more importantly resources in Tucson.

The point is, we aren't omniscient.  I know many of us whose children/loved ones are embroiled in an eating disorder or addiction or have been diagnosed with another brain disorder wish we had seen this coming, or understood what the early signs were, or somehow wish we could turn back the clock with the knowledge we have now.  But, we can't.

My goal and the goal I encourage others to have is to move forward from now, become the best advocate you can be for your loved one by learning as much as you can to change his/her ship's direction, and help your loved one get onto the path to recovery.  Spinning your wheels about could have's and should have's is a tremendous waste of energy.

You don't know what you don't know.