Traits...... introversion and extroversion and how this information meshes with family-based therapy

Yesterday one of my favorite bloggers connected her readers with another TED talk session.  After watching a remarkable presentation by Elyn Saks (Yale Law School Graduate; Professor, USC College of Law; and MacArthur Fellow among other accomplishments) and about her life's journey with schizophrenia, I decided to browse around and see what else I could find before dinnertime.

I noticed that Susan Cain had been a presenter (more than 2 million views at this point) - The Power of Introverts - and I remembered that I had not yet finished reading her book, Quiet - The Power of Introverts in a World that Can't Stop Talking (Crown Publishers, 2012).  In fact, I'd barely started a few weeks ago.  After watching her talk, I vowed I'd pick up her book again.  So, this afternoon, I did.

I'm not finished yet, actually.  But I am quite grateful to Charlotte for leading me to the TED site and for a few minutes of my own yesterday afternoon, because I've learned more not only about myself, but have come to understand a lot more about introverts, developmental psychology, and perhaps even about my family member.

I don't think I would have picked up the book this afternoon if I hadn't also attended my usual Saturday morning meeting and realized how far I'd come in the program (and how much more work I needed to do).  I know myself far better than I did eight years ago.  I've also come to understand at a much deeper level how different my family member and I are.

She's an extrovert.  In fact, she confirmed this yesterday when we talked.  I'm an introvert.  And, Susan Cain has helped me to understand better what these two words mean developmentally and how we differ.

I've also just realized how this knowledge fits so aptly into the concepts of family therapy and communication, topics that I've written about on my blog (links provided earlier in this sentence) - e.g. "All in the Family and Elsewhere."  Susan Cain provides terrific examples of how both children and adults respond to experiences, depending on this part of who they are.   For example, I rarely have either the television or the radio on.  Sometimes I'll listen to music while doing something.  My husband, also an introvert, often remarks about the peacefulness of our home and how much he looks forward to coming home after a long, busy, interactive day.  When my family member comes to visit, however, her first comment is something along the lines of "it's too quiet here!"

She likes to be with people a lot; I need time-outs and relish days at home after spending other days with groups of people in meetings.  One might ask, how does this translate into what you daughter or son needs as part of their recovery?  their experiences at home following a stint in a residential treatment center?  These are important questions for the family to address before their loved one returns home.

Backtracking a bit, I wrote a piece on States and Traits after hearing Dr. Kate Tchanturia's talk on Cognitive Remediation Therapy at the NEDA Conference in New York City a couple of years ago.  I hadn't thought much about traits lately until I listened to Susan Cain's talk.  I'm thinking a lot more about traits now that I've read her book and about the research of scientists like Dr. Jerome Kagan.

Dr. Kagan's studies have revealed that one can pretty much forecast whether one will become an introvert or an extrovert from infancy and that fMRI's and the work of one of his colleagues, Dr. Carl Schwartz, have shown that the processing of the adult brain really hasn't changed that much  - in other words the traits are fairly intact in spite of a lot of other things we call environment.

I'm still reading (Chapter 6 and sensitivity as well as empathy) and will probably come back here with more to say.  In the meantime, I've found reading Cain's book to be very helpful as I unravel the puzzle of my family member's journey.

Our Body's Microbial Garden

I took the title of this post from the title of an article written by Carl Zimmer that appears in today's New York Times (Tuesday, June 19, 2012, pp. D1-6) titled Tending the Body's Microbial Garden.   We can either nurture or interfere with the balance of our microbiome, a collection of apparently "....100 trillion microbes that call us home."

Just last week, the mail brought me the most recent issue of Scientific American Mind (July/August 2012).  The cover advertises that inside I'll find information about Gut Microbes Influence Moods.  Moheb Costandi, author of the article "Microbes on Your Mind"writes about, among other topics, the existence of the enteric nervous system found in the intestines that communicates - actually the neurons in the intestines communicate - with the neurons in the brain through the vagus nerve.  He notes that "by the age of three the gut contains a full complement of approximately 100 trillion microbes...."  (p. 34).

Fascinating.  Think about the presence of receptors for the neurotransmitter serotonin in the gut.  Serotonin manufacture in the brain.  Does the human body in partnership with these microbes create neurotransmitters?  Help the body maintain a healthy balance of these neurotransmitters?

Recently I bought but have not yet completed Sebastian Seung's book Connectome - How the Brain's Wiring Makes Us Who We are (Houghton Mifflin Harcourt, 2012).  Just the brain's wiring?  Something else?

Whoa!  What's going on here?  As I've learned recently at a NEDA conference from those who are doing research into eating disorders, outcomes often take 20 years to reach the public press let alone those who treat us.    Science fiction?  Fact?  Possibility? Ridiculous?

Can we shape our biome?

Our children's biome?  The answer is, in fact, "yes".  Mothers do help shape their children's biome.

Want to learn more about this?  Listen to the recent TED lecture by Jonathan Eisen titled Meet Your Microbes.

Thinking about Dr. Eisen's lecture, Will we someday be able to buy a probiotic drink like those now found in the supermarket or take a pill from a bottle bought off the shelf at the pharmacy and change what's going on biochemically or neurologically in our bodies?  I know we already can but this takes this process to another level.  Perhaps we are doing that already based on recent small clinical trials in France and Ireland that examined the antianxiety effects of probiotics.

All of this sure is interesting and with the availability of online data, shared data, grant-making bodies like the NIH that publish the data, and so forth, hopefully larger and larger strides will be made to uncover and treat illnesses like diabetes, eating disorders, autism, anxiety disorders, schizophrenia, bi-polar disorder and even the common cold, something I picked up on my recent trip.

Using the brain to treat the brain

I still remember the first time I saw the movie "Carrie"  For years, I have been skeptical about a human's ability to direct her/his brain power to accomplish telekinesis.  However, recently more and more articles have been appearing about the brain's ability to do something similar as research delves into finding ways for those severely wounded to use their artificial limbs more productively.

What if a person could turn that brain power into a healing energy source for themselves?  What if, indeed, a person could be taught to use their brain power to treat their eating disorder behaviors or better yet what lies behind that behavior?

Imagine if  a servicewoman or man, who returns from combat with PTSD, could use this technology to eventually retrain their brain to heal.

I don't think this is so far-fetched since for at least five years I've been reading reports and studies that illustrate how a person can train themselves to go to thought B rather than thought A in order to interrupt a harmful behavior.  I began to pay more attention to this idea while taking NAMI's free 12-week Family to Family Course back in 2007 when I learned about work done in addiction studies that was being applied to brain disorders.

So now comes news of companies in San Jose - NeuroSky - and San Francisco - Emotiv Systems, Inc. - which offer headsets and software designed to "empower" users to do things like control a computer with their thoughts or play a game called "Mind Labyrinth" "....which grants players access to 52 different levels of an ancient temple as their relaxation grows deeper."

You can find more information in an article that appears in today's (Tuesday, May 29, 2012) Wall Street Journal in Section B, pp. 1-5.

This news is very exciting.  There are, according to the article, "1,700 developers working with NeuroSky's technology, .... making mindcontrolled computer games for the company's $129 MindWave Mobile headset."  Others believe that these games will further the efforts to improve mental health.

This will take time, of course, and one needs to be wary of a silver bullet approach.  But what a possibility!!!!

Two weeks of H#!$ and Modeling/ Mirroring

I've attended several Family Weeks at this point while my daughter has continued her journey with the evil ED.

Each time, as I've written before, I've learned valuable tools as well as lessons on how to continue on the journey with my daughter without collapsing in the process.  There are times, like last night, when I've been an emotional wreck after witnessing what can only be described as a complete meltdown -- adult version -- comparable to (for those of you who are parents) a two and a half year old's temper tantrum.  By saying this, I am not in any way attempting to belittle the meaning of the adult's version; rather, trying to illustrate what happened.

One of the lessons I learned and need to remind myself at this point is that when I visit I need to put on a suit of armour that permits me to give all the love and support I can without melting in the process in front of her.  An underlying technique is called "modeling" or providing an example of behavior in the direst of circumstances so that she will hopefully adopt or "mirror"  that behavior.  Our children, from birth, look to us to see how we handle circumstances, both easy and terribly difficult.  They learn to behave as we do.  Many parents can recognize themselves in some of the behaviors and statements their children make on down the road.  Or children can withdraw, because they cannot fathom themselves being able to behave in a way that does not make sense to them.

I am certain that we three kids, while traveling to India back in the 1950's for example, would have panicked if my mother hadn't kept cool, calm and collected (she years later said perhaps she was just in shock and just hung on) when we disembarked from our plane in the Middle East and had to walk through a gauntlet of soldiers pointing their weapons at us.  I do remember this.  Our passports were taken from us and all the passengers were held in a room until our plane was refueled and we were finally on our way again.

Last week I did break down following a hearing and wish I hadn't but I was frustrated more than anything else by the conclusion that a "danger to self" was not included in the description.  Last night, I was able to remain calm until I had left the building and was held by another of the mothers who was visiting that evening.

We do set an example with every one of our behaviors.  The old saying, "do as I say and not as I do" needs to be thrown out the window because walking one's talk makes a difference.  This is why family therapy can be so darned valuable.  Families learn how to behave in the face of the monster eating disorder.  Families learn when they need to take time outs and how to do that.  Families need to learn how to decline (what to say and how to say it) to visit if they simply cannot handle the emotions at that time while present with their loved ones.  I do not mean one needs to be cold.  Far from it.  I got down on the floor, too, and stroked her back.  When I saw that wasn't working, I knew I needed to leave and told her I loved her and would report what was going on to her team.

Being a parent of a person with an eating disorder is really, really difficult.  My heart goes out to all parents who might read this note.  Hang in there.  Research is opening doors and journals like the International Journal of Eating Disorders and the European Eating Disorders Review are making some of  their publications and/or articles available to download and pass along to therapists and other team members to bring them up to date.

Three Excellent Articles from the European Eating Disorders Review, Volume 20, Issue 1

These papers would make a good start for anyone wanting to get an up-to-date report about eating disorders and the treatment of eating disorders as well as related diagnoses.

I am specifically referring to the paper by Janet Treasure et al (Eating in Eating Disorders) ; by Bryony Bamford and Victoria Mountford  (Cognitive Behavioral Therapy for Individuals with Long-Standing Anorexia Nervosa); and Tom Hildebrandt et al, (Anxiety in Anorexia Nervosa and its Management Using Family Based Treatment) .

Or you can simply download the whole issue!!!!!!!!!!!!!!  How wonderful for this journal to make this up to date information available to everyone.

"Brain in Your Guts"

Thanks to poster Charlotte on the F.E.A.S.T. site for highlighting this Stanford University Researcher's thoughts about the gastrointestinal system, the presence of serotonin and dopamine (for example) in the gut, and the possible linkages to hormone changes, among other facts.  Jam-packed video.  Harriet Brown examined some of this information in a 2005 NY Times article  and I postulated about what serotonin in the gut might do in an earlier post but this is all a leap beyond what I learned a year ago from Martha Fankhauser.

Thanks to the wonderful world wide web, I also found this amazing website that focuses on autoimmunity lists studies having to do with serotonin.  Striving Chef's posts house a wealth of information.  What a great resource!

This research is very promising, for sure!

Too much dopamine? not enough oxytocin? SSRI's? Autism Spectrum?

In earlier posts, after a detailed discussion with Martha Fankhauser, a pharmacologist whose interest extends to working with local behavioral health providers, I wrote about the balance of SSRI's and dopamine, and mentioned the problems that occur when dopamine is in excess.  A simple explanation along with symptoms can be found at this site, too.     I  also thought out loud about the significance of oxytocin.

These neurotransmitters and this hormone are on my mind again today because I just read a fascinating article in today's New York Times (December 26, 2011) titled "Navigating Love and Autism" in which the young man mentioned, who has been diagnosed with a form of autism (others describe the symptoms as being along the autism spectrum) known as Asperger syndrome, is also thinking about these things.

The article is an insightful piece, looking at the problems that people -- children, young adults, and adults -- must deal with.  The article is also illuminating for those who do not understand the syndrome or haven't needed to not only because it reviews articulately the behaviors that many find rude or hard to understand but also opens doors of possibility for those reading it to recognize behaviors of a family member or client (as in the case of a psychologist or psychiatrist).

I am among many who believe that many of the behaviors we see connected with the autism syndrome, eating disorders, "personality disorders"  such as borderline personality disorder (which research is showing is also a disorder of the brain rather than of the personality) and other brain disorders such as schizophrenia  are all linked in the sense that they rise from imbalances in neurochemicals or in the endocrine system.  Until the cause is found that might be treated, the current approach is to treat with meds.  Finding the right one, or multiples, and the balancing of those is critical.  So is teaching those with these disorders to learn how to cope and therefore develop new and improved ways of interacting with  and responding to their environment.  

A significant interest of the young man written about -- Jack Robison -- is on the biochemical/neurological issues that are in the background of his syndrome and he has been investigating those.  I hope he and others continue the investigation.

Will.....Willpower

[It's raining with some lightning here so rather than going for a hike this morning, I pulled out this article because the subject has intrigued me for a very long time.  I have wondered what was behind my decision to quit my eating disorder - sick and tired of being sick and tired? change in mind-set? deeper understanding of my "self"?  will power?  And, if willpower, am I genetically blessed with the whatever it is to have a strong will?....]

The Sunday, November 27, 2011, New York Times published an article titled "Willpower: It's in Your Head" written by Greg Walton, an assistant professor of psychology at Stanford and Carol Dweck, professor of psychology, also at Stanford [colleagues of Dr. James Lock?] in which they conclude that attributing our failures of will to our biology -- to our "fixed biological limits" -- is wrong.

They state, 

"In research that we conducted with the psychologist Veronika Job, we confirmed that willpower can indeed be quite limited -- but only if you believe it is.  When people believe that willpower is fixed and limited, their willpower is easily depleted.  But when people believe that willpower is self-renewing -- that when you work hard, you're energized to work more; that when you've resisted one temptation, you can better resist the next one -- then people successfully exert more willpower.  It turns out that willpower is in your head."

[The mind/brain is an amazing thing, isn't it?]

The authors provide studies and the results to support this thesis.  They emphasize that of course a person needs to eat and to rest/sleep but they do not, as posited by Roy F. Baumeister and John Tierney in their book Willpower: Rediscovering the Greatest Human Strength, need to ingest straight glucose to keep that willpower going.

The authors of the New York Times article conclude by writing,

"At stake in this debate is not just a question about the nature of willpower.  It's also a question of what kind of people we want to be.  Do we want to be a people who dismiss our weaknesses as unchangeable?  When a student struggles in math, should we tell that student, "Don't worry, you're just not a math person"?  Do we want him [or her] to give up in the name of biology?  Or do we want him to work harder in the spirit of what he wants to become."

Yes, this essay does not mention those who have disabilities and I do believe, no matter what they write, that some people have difficult with advanced mathematics (I do; my daughter doesn't at all).  Neither does it touch on genetics.  However, this essay and the book have me curious enough that I'll probably read the recently published book -- for I know that the brain does need 500 calories a day of glucose preferably (my opinion) available from complex carbohydrates and not straight sugar as the authors apparently suggested on NPR -- and I'm happy to see that researchers are continuing to take a look at this aspect of our behavior/decision making.

A Map of the Brain

Thanks to the "magic" of Facebook and social networking, I was alerted to the existence of a lecture titled "A Map of the Brain" by Allan Jones on TED.

Great way to launch one's knowledge about the brain.

Go to this link.   You will, I hope, enjoy a fascinating 15 minutes or so lecture.

Report - Day One -The First Annual F.E.A.S.T. Symposium: The Map Ahead - November 3-4, 2011

Earlier this year I received a notice that the F.E.A.S.T. community would be hosting a 2-day conference in Alexandria, Virginia.  I also knew, because I'd received several emails, that the National Eating Disorder Association would be hosting a conference in Los Angeles the month before.  What to do?  I could not attend both; I had other plans for October but not that weekend; and I had been a staunch supporter of Laura Collins since I first encountered her book Eating with Your Anorexic - How My Child Recovered Through Family-Based Treatment and Yours Can Too published in 2005, the year my daughter, slowly declining since 2002 after she relapsed, careened towards death and needed intensive treatment.

My thought was that once she was released from treatment, she could live with us and I would try to use the principles of the book and the other references.  My daughter was in her early thirties by then, an adult, and determined to do things on her own.  The "parentectomy" encouraged by the treatment center was successful and my hopes of transitioning her for a few months went by the wayside.

I decided to go to Alexandria, Virginia since I had attended the NEDA Convention just a year ago,  to meet, hopefully, many of the parents who I'd met on Something Fishy/Around the Dinner Table and especially, Laura, with whom I had been corresponding off and on for awhile.

I was intrigued by the purpose of the Symposium, too:

Moving forward from a history of being blamed and marginalized, families will collaborate with the scientific community to re-write the map of options and actions for families.  A new era of science-based, family inclusive, and truly optimistic eating disorder treatment begins now.

I've decided to take the agenda that we were given and use it to describe my personal journey and my "take-aways" through the next few days, starting with Wednesday night at dinner.

The dinners at the end of the day deserve a special mention.  As my son rightly has noted, I'm more of an introvert than an extrovert - perhaps somewhere in the middle.  So, I have have found it difficult to plop myself down in the middle of an event and easily connect with people.  I've been working on this all my life but it's still not easy for me.  As well, my sensitivity level is such that after awhile too many people and too much noise leads me to escape for awhile to regroup.  Last year at the NEDA Conference I often found myself adrift and still very much overwhelmed by my daughter's severe illness.  Attempting to connect was hard and there weren't to my way of thinking opportunities to do that after a long day.  And, besides, truthfully,  I was really tired even before I got there but eager to learn as much as I could.  As my blog after that event illustrates, I did learn a lot and became a major supporter of NEDA.

This year, just knowing that there would be an organized dinner at which I could just show up and sit next to someone, helped me a lot.  I joined a large group the first night at a "George Washington ate here" place - Gadsby's Tavern and walked there with a couple - parents - from Michigan and a pediatrician from N. California.  A great way to get the evening started.  Then I sat with them at the table, too.  We had a good time!

So back to the beginning.......

The conference was at the Holiday Inn in Old Town Alexandria, Virginia.  I obtained lodging there.  A grocery store was across the street where I purchased a few things I like to have that I don't want to haul in my suitcase.  The facilities worked well - the large dining room (where we enjoyed lunch each day) was separate from the large main meeting room.  There were break-out rooms along the corridor with the corridor and side corridor being wide enough to provide room for participants as well as snack tables, beverages, the daily morning buffet breakfast, and the information/registration table.  My room was large and comfortable and was on an upper floor, something I appreciate when traveling by myself.  The entire hotel is non-smoking, another plus.  A USA Today appeared at the door each weekday morning and  The Financial Times was available in the lobby on Saturday morning when I left early for the airport.  Incidentally, the latter is new to me and I loved the variety of articles.  I finally got around to reading USA Today in the evening right before bed.

Thursday morning breakfast was served beginning at 7 a.m. and Laura Collins, F.E.A.S.T. Executive Director, was introduced by her daughter to start the program at 8:30 a.m.  I felt that Laura's opening remarks drew us all together and laid out the plan for the conference and our collaboration.  I noticed early on that Dr. Doug Bunnell, past President of  NEDA and a charter member of the Academy for Eating Disorders was there - a plus for the idea of collaboration, too.

A highlight of any conference (to me) is the coordination of the introduction of speakers and transition from one speaker to another.  So well done!  Having been a member of Toastmasters for awhile, I learned that this aspect and skill are very important to set the professional tone.  Carrie Arnold and Stephanie Milstein, PhD, served as the Masters of Ceremony team, coordinating the hand-off of speakers for two days.  Carrie is a writer, author - Running on Empty and Next to Nothing,   and blogger (ED-Bites.com) in recovery from anorexia.  Stephanie is a doctoral level clinical psychologist licensed in the state of Michigan.

I certainly cannot report everything stated; however, I will provide some of the takeaways that stuck with me. It's my understanding that information presented at the conference will be posted on the website at a later time.

I gathered from the two-day schedule that we would first be reminded of where we are in terms of what's come before and what is happening now.  We'd also be alerted to what to look for and what to set aside.  From there, thanks to Ruth Sullivan, we'd get a look into another activist's method for gaining traction and learn about current efforts.

The second day we'd move quickly into experiences and what has worked, build on the conversations that had been going on for more than twenty-four hours at the conference as well as those outside involving all the organizations having to do with eating disorders, and also start to look forward using the questions provided including "where are the new parent activists going to come from?"  From there we'd get some guidelines, and then hear from Dr. Thomas Insel, director of NIMH, who would summarize and give us a heads up on where research is headed.  The question and answer period to follow was designed to provide the panelists here represented by the acronyms of their organizations (NIMH, EDC, BEAT, AED, and the AAP) with our concerns as parents and to obtain their feedback.

Finally, we were to be given the opportunity to hear from four people in recovery from the United States, the UK, and Australia.  A rather wonderful way to wrap it up.

The first speaker was Dr. James Lock, a professor of Child Psychiatry and Pediatrics in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine where he also serves as Director of the Eating Disorder Program for Children and Adolescents.  He is co-author with Daniel Le Grange of the important book, Help Your Teenager Beat an Eating Disorder.  Their work has changed how eating disorders are treated. His research includes 4 current NIH funded projects and his recent research focuses on integrating treatment research with neurosciences in eating disorders.

His presentation, titled Rocky Terrain: Challenging Ideas About How Professionals Look at Families began with a photo of a pile of rocks.  He steered the direction of the conference towards better understanding of why many in the Eating Disorder Treatment Field use outdated methods (they were taught that way and find it difficult if not even terrifying to change what they are so invested in) and then on towards how to encourage change.  He reminded the audience of the original opinions about autism and schizophrenia and eating disorders, citing several well-known names whose theories are no longer mainstream.  He also reminded us that medicine is a "practical art" and used Greek mythology imagery to discuss the old way love affair with etiology that eventually crashed on the shores.  He reminded us, too, that not everyone responds to the same kind of therapy and expressed concern about the insular quality of treatment centers.

This reminder was an underlying theme that was repeated throughout the conference.

I connected with his list of characteristics of a good parent in a crisis situation:  enmeshed, rigid, anxious, over-involved.  As he stated, when a child is ill, why not?  He also referred to a study that looked at parents of children who were cancer survivors and found many suffered from PTSD even ten years later!

Becky Henry, author, speaker and coach and member of the F.E.A.S.T. Board of Directors moderated a question and answer period involving those present with Dr. Locke.  Some of the highlights I grasped  included:

His suggestion that parents remember a therapist may have been taught in the "old way" and need to be approached with the initial question, "Do you know about Family-Based Therapy?"  If amenable to hearing about the technique, share information and get a sense of what might be next.  If not, move on.

To the question of when to start therapy after diagnosis, Dr. Lock referred to the responses of the patients themselves:  1/3 wanted to work; the other 2/3 were not ready yet.  The conceptualization has a lot to do with the reaction of the 1/3 who said they were ready to work, he said, and when healthy behaviors are disrupted for a long time, the individuals take longer to shift back to healthy behaviors.  He said art therapy was okay but otherwise to follow the suggestions in their book and manual at the beginning.

Re underlying traits, acknowledging that some do not fit the profile, he said there is a continuum and that anorexia can exacerbate these such as anxiety but for others, not at all.

Re boys with eating disorders - he remarked in his experience that although the frequency of illness may be less, the personality and behaviors are similar to those of girls.  He said his studies were the first to include boys and noted that the content of an assessment for boys and men needs to improve; a thorough and in-depth study is needed.

Following the break, Cynthia M. Bulik, PhD, author of the book Crave (see my review elsewhere on this blog), and Director of the University of North Carolina Eating Disorder Center, concentrated on the avoidance of pseudoscience and misinformation.

She underscored the complexity of eating disorders and reminded us that a cure will not be simple; genetic and environmental information blend in unforeseeable ways. She advised us to avoid blame and sensationalism, recommended Carrie Arnold's blog (ED-bites.com), and emphasized again that "no one shoe fits all".  This attitude is important, especially for those fighting an ED for whom treatment did not work (including FBT).  She said the emphasis on only one way can lead to what she called evidence-based guilt on the part of the patient.  In other words patients can be overwhelmed by guilt when they are repeatedly told that x treatment works and yet can see for themselves in their own experience that it does not.  The no one shoe fits all information can also help parents help their children look for something else rather than just give up.  Bulik also reminded all of us that we mustn't let desperation interfere with our critical thinking as we examine information presented to us.

Next up was Dr. Walter Kaye, Director of the University of California, San Diego Medical Center Eating Disorder Treatment and Research Program.  Building on what Dr. Bulik had said, he noted that to date our evidence base is limited; a lot of research involving more participants needs to be done.  In other words, currently there is little long-term outcome data.  This will change as more funding for such research becomes available and our work is to agitate for that funding.

Dr. Kaye briefly summarized what is known in the fields of genetics, biology and traits.  He noted that 50 to 70 percent of those who develop eating disorders recover by their mid-twenties.  Why?  He repeated that we do not have enough data on the course of the illness to answer that question.  We do know that some people fit a profile; others do not and that traits continue after the eating disorder is gone that need to be addressed.

Dr. Kaye drew attention to the state of programs for the treatment of eating disorders.  He suggested that programs need to provide more data to illustrate that their approach can work (if the materials say so) rather than just publish blanket statements about their success.  He said in our search for a program we need to know who is involved in the direct care of patients and especially the time they've spent in training, their expertise, their skills and direct experience with those with eating disorders.  As an aside, he observed many sites will mention they have a staff but will not provide a list of who's currently on the staff, whether they are full time or part time, and what their credentials and background are.  He emphasized the importance of staff training in the facility's environment. We, he said, should be able to contact the program and evaluate the owner's expertise in the field, as well.

We, he said, should look for constructive skill training with real life applications and preparation for the patients.

Dr. Kaye summarized the need for data, better knowledge of genetics and of behavioral wiring, improved treatments, outcome studies and Centers of Excellence which provide intensive internships in those improved and evidence-based treatment programs.  We all should call for the intensive re-training of all those involved in the treatment of eating disorders.  He repeated that currently we have what he termed terrible longitudinal data and expressed the hope that with funding such as he has now received, he will be able to add to that data.

In closing, Dr. Kaye announced that he had received funding to conduct brain imaging studies on a cohort of those in recovery between the ages of 18 and 45, who are not on any medication, and for women those who have menstrual cycles.  The funds will pay for travel to his research center and expenses while there.  Here is a link for more information about the study and eligibility.

After a welcomed break for lunch following an intensive morning, we returned to hear from Dr. Ruth Sullivan and her summary of the history of the organization that she helped found - the Autism Society of America - and what we, as parent activists, might take away to implement in order to gain traction.  This link to an interview provides a lot of the information we gained yet for those present her personal spin and sense of humor brought the history of the Autism movement to life.

Dr. Sullivan then joined Darcy Gruttadaro, Director of the NAMI Child and Adolescent Action Center, in a discussion moderated by Kitty Westin of the Emily Program.  Some of the points that were highlighted in the discussion included:

• work to avoid infighting
• define common ground
• take a stand
• obtain training through, e.g., the Eating Disorder Coalition on how to influence Congress and other federal agencies
• contact state and national legislators
• ask for what you want and work with other ED organizations to say it in the same way
• involve celebrities (Dustin Hoffman, Rainman (autism) and Glenn Close, Bring Change to Mind
• develop a forceful and attention getting PSA
• continue to research the data and the science
• demand better quality of care
• invite legislators to meetings, to breakfast
• work to agree to disagree and still talk
• respect the dignity of others

Re the PSA, I was quite taken with the suggestion to develop a poster/an ad/a PSA using the photo of a young person apparently in terrific health coupled with the words, "this is the face of anorexia".  As we learned during day two, there is a theory that eating disorders like other developmental disorders first begin below the surface, so to speak, and that the actual behaviors of the disease itself indicate a late stage in this disease.  This poster would speak to that fact and experts might want to work on what the poster might say.

Wonderful activists Jeanine Cogan, PhD, and Kathleen MacDonald, of the Eating Disorder Coalition came to the microphone and continued the discussion, specifically geared towards working with legislators.  They highlighted the F.R.E.E.D. Act and its potential far-reaching effects on policy and practice in this country including, for example, the establishment of Centers of Excellence.  They both emphasized the importance of the stories of those affected by eating disorders and gave examples of the EDC's effectiveness to date.  They encouraged those attending to participate in lobbying at the Capitol.

We closed out the day with the opportunity to attend one of four offerings in Activist Training:  Government/Policy Change; Traditional Media and Public Speaking; Virtual Media; and Online Social Networking.  I chose to attend Carrie Arnold's group to discuss Virtual Media since I've been enjoying working on my blog and am wondering how I might improve it.  Carrie focused first on on-line news-sites and the need for new information all the time that is presented in an exciting, edgy and sometimes but not always negative (sensationalistic) way.  She encouraged those of us who visit such sites to click on "like" if we do because the number of hits influence the direction of future articles (as well as bring in advertising income) and to not share a story if we disagree with it.  Carrie then outlined some poinst to know about blogging, using the history of her site as an example.  She reminded those present that the information becomes archived forever on the internet.  She advised using pseudonyms if one is concerned about privacy and she gave us tips about how to gain more information about a subject in the blogging and twitter world.

After resting up, I joined quite a crowd at the Bilbo Baggins restaurant where we commandeered a large room and had a raucous but very good time.  I sat with a new group of folks and was fortunate to meet several moms whose names were familiar to me on Around the Dinner Table and to sit next to a woman in her twenties who, after battling anorexia for quite some time, established recovery by researching the Around the Dinner Table Forum and extracting menu and food options to give herself the structure she needed until she re-nourished herself and moved on.

I was glad to get to bed shortly after that and enjoyed another good night's rest in preparation for the day ahead.

"Mental Illness Defined as Disruption in Neural Circuits" - Dr. Thomas Insel

Dr. Thomas Insel, director of the National Institutes of Mental Health, keeps a blog.  

On August 12, 2011 he wrote an article with the above title and I've linked it here.  I've also linked his blog on my blog site and now intend to review his previous posts.  I'm so excited to have found another important source thanks to one of the F.E.A.S.T. folks!!!

What is ADHD?  What is schizophrenia? What is depression?  OCD?  BPD?  Bipolar Disorder?  Can these be prevented?  can these brain disorders be treated before symptoms arise?  Can the brain's cortex be kept on track or put back on track to develop normally?  Other questions lurk excitedly in the background.

Dr. Insel closes by writing, "While the neuroscience discoveries are coming fast and furious, one thing we can say already is that earlier notions of mental disorders as chemical imbalances or as social constructs are beginning to look antiquated.  Much of what we are learning about the neural basis of mental illness is not yet ready for the clinic, but there can be little doubt that clinical neuroscience will soon be helping people with mental disorders to recover."

More on Responsibility

I have spent a lot of time this week thinking about responsibility, particularly in terms of what's mine and what's not.  Consequently, when Marjie Ruth's post arrived in my email box earlier this week, the timing was perfect.  Not only that, but this topic rose again during a conversation among a group of women on Thursday and yet again this morning at my meeting.

While reading Marjie's post, which is here on my blog,  I especially focused on the sentence I highlighted, which was: 

" ....For us, we may want success so badly for our loved one that we usurp their responsibilities."

I realized through a lot of work with my therapist these last two years and by listening to others dear to me and by listening to the experience, strength and hope of still others, that I usurped my daughter's responsibilities in many areas of her life.  I also know that others usurped her responsibilities, too.  I did not want her to be hurt.  I did not want her to continue to be ill and to decline.  I did not want her to die.  Of course not.  But I extended my reach into her world so much these past several years that she didn't have to face reality on several fronts to figure out what to do to fix things herself. 

Marjie wrote:

While parents readily desire to provide an environment for their children that will foster their success, they sometimes can't seem to bear having their offspring deal with failure. It's with good intentions that they'll jump in to avert an impending negative outcome from a misguided sense of helping. When they step in to rescue their child from the consequences of his or her own inappropriate actions, they're often teaching them that they can get away with it...that they're not subject to society's rules. Such actions engender a moral lack of personal responsibility, hardly the intended outcome but a very real one nonetheless. 

Wow, the above paragraph strikes home for me, too.  There were times when I was able to step back and see the bigger picture and draw everyone who interacted into that picture to understand what was going on.  But more recently, I took myself over my own edge by somehow believing that I could change what was going on.  In fact, I certainly could contribute to the possibility of that change, but not actually change the situation.  That's what I had to learn.   That is truly up to her.

I continue to need to be reminded that I, as Marjie wrote,

.... all too often jump in to do it for our loved ones with the hope of getting them to a happy place more easily. And this, folks, is called enabling--doing something for someone else that they can and should be doing for themselves. When we help someone else circumvent accepting personal responsibility--when we make excuses for them, lie for them, do their work for them--we may actually be doing more harm than good by derailing that person's emotional growth. 

I did this, too.  I thought I was helping.  In fact, I was enabling.  Sure did take me a long time to finally "get" this:

Helping occurs when we do something for someone that they are incapable of doing for themselves. We feed and cloth a baby. We guide the blind person through traffic. We assist the elderly with housekeeping. The problem occurs when we are unable or unwilling to discern the difference between enabling and helping. And it is a problem because, ultimately, recovery is about accepting personal responsibility. 

No doctor, no therapist, no hospital, no residential treatment program can make an eating disordered individual well. They can support a person in their striving. They can offer training and tools that can be used by the person to recover. They can even point out they way. But in the end...or should I say, the beginning, because real recovery only begins and happens when the ED sufferer accepts the reality of their addiction and accepts personal responsibility for the tough road that is recovery. Successful recovery only comes with a price that entails many failures along the way. That is learning. That is growth. You may walk beside someone, but you can't walk for someone on the recovery road.

The most difficult step for me now is to simply walk beside her.  Yesterday I handed over a very important (to me) article that was published in Scientific American  (June/July 2008, pp. 60-67) by Trisha Gura titled, "Addicted to Starvation."

Many parents, including myself, have been to Family Week at residential facilities where we've been reminded that it's one thing to be able to recover from an addiction to substances like drugs and alcohol by abstaining and working, for example, a 12-Step Program but quite another to recover from an eating disorder when one needs to eat to live.  

The piece that must be reflected upon by many people is, I believe, that these illnesses are addictions that are evidenced by extreme disordered eating.  In the case of anorexia, the addiction is to the sensation of starvation.  How else can one starve oneself if not for some kind of reward, if only the reduction in anxiety that comes from eating?  How else does self-preservation fall by the wayside?  To put it simply, the person's brain sends a message that starvation is "feels good or at least better" and eating is "bad."  There are complicated explanations for this and more research is continuing in hopes of figuring out how and why.

Meanwhile, it seems to me, that the goal of the person who has chosen to live and fight (once they have been re-nourished enough to understand where they are and/or have reached a spot in their decline where their alarm bells are still going off) is to learn to immediately switch thoughts when they start to eat from "this is bad for me or feels terrible" (whatever form that thought takes) to "this is good for me.  I love myself.  I need to eat to show my love for myself.  I am worth it."

Getting to this internal language is hard.  It involves practice and practice and practice and repetition until the thought totally replaces the thoughts that are so harmful.  The voice of one so many of us call  ED.    Yet it can be done.  Although we read the alarming statistic (that may no longer be true and rather a myth because of lacking up-to-date information and better treatment modalities), the known statement is 80 percent survive these illnesses and 20 percent die.  The more we all know the more we can all work together in some role to increase that success rate.

My responsibility is to continue to shine the light and to love her, which I do.  So much.

Borderline Personality Disorder - another biologically based brain disorder?

For those of you whose loved ones with eating disorders have been diagnosed with the accompanying mental illness Borderline Personality Disorder (BPD), TARA is an organization that offers information and assistance to families.   TARA - Treatment and Research Advancements/National Association for Personality Disorder.

As readers of this blog know,  I firmly believe but of course do not know (yet) that BPD will someday (hopefully soon) be recognized as a brain disorder of biological origin, especially given this article published May 26, 2011 in the New England Journal of Medicine by John Gunderson, M.D. 

This research by Stanley Siever is hugely important, too, and hopefully will lead those who are knowledgeable about BPD away from the early emotional experiences blaming (the mom/family thing again) and more into understanding that the basis of this disorder may instead have to do with neuropeptides like oxytocin and vasopressin.

I had not been familiar with TARA, but noticed a link provided by the Cleveland Center for Eating Disorders.  I now intend to learn more about this organization. 

Meanwhile, here's TARA's link to some other helpful publications including the one mentioned above by Dr. Gunderson.
 

Research Update: Genetics and Eating Disorders

With thanks to Carrie and her weekly blog post specifically about news/research on eating disorders, here's a news release on work led by Cinnamon Bloss, Ph.D. of  University of California, San Diego’s Eating Disorder Treatment and Research Program.  

The conclusion from the study published in the journal Neuropsychopharmcology points to the probability that ....

"An international team of scientists has identified possible genetic variations that could influence a patient’s recovery from the diseases.

Their findings may provide new insights into development of effective interventions for the most treatment-resistant patients with these disorders."

     

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)! 

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.