What about the "contributing to" part?

[edited an hour later after thinking about this even more]

I spent several days thinking about the title of this post because I wanted to catch attention and at the same time not totally alienate those who firmly believe that "contributing to" in terms of the family is not a factor in the development of an eating disorder.  Note, I did not write the word "cause."

I think "contributing to" can be a  factor.  My daughter thinks so.  I agree with her. Environment is a factor.  Family is part of the environment.  Sometimes the family needs to engage in therapy if only because the family's son's or daughter's brain works differently and so the person needs a different communication or sensory  environment. We are all different.  Not even twins are the same.  Remember that I fought bulimia for more than 15 years and slipped into anorexia at least twice, judging by photos and family recollections.  I know my thoughts in this paragraph are true, at least for me and for my daughter.  I imagine they are true for others.

What has prompted me to write about this again?  I have written about this because the subject keeps cropping up and even dividing groups that all have the same goal - recovery.

 I have written about this issue before in two of my essays:  "Reflections on Communication - Family Week" and "All in the Family and Elsewhere". 

Here's the current thinking about what might cause an eating disorder.  This is taken from an NIMH publication titled "Understanding Eating Disorders" .  I could have used a variety of sources but I think many would agree with these basic points that continue to be referenced:

"There have been a number of studies showing that people who develop anorexia nervosa have certain traits in childhood that put them at risk, such as anxiety and perfectionism. If people do not have those traits, they are probably less likely to develop an eating disorder," says Walter Kaye, M.D. He directs the eating disorders program at the University of California, San Diego and also receives NIH funding for his research.

Studies also show eating disorders run in families. But is it nature or nurture, inherited or learned behavior? Studies of twins suggest that genes play a role. To help further research into the genetics of eating disorders, Drs. Kaye, Bulik, and other researchers are collecting DNA and blood samples from people in families where more than one person has anorexia nervosa. NIMH is supporting the research and will maintain a bank of the DNA and cell lines collected, so they can be used by researchers trying to identify variations in genes that affect the risk for anorexia and bulimia nervosa."

I then turn to, as an example and there are others listed here on my blog, all of Dr. Janet Treasure's research and work, too, noting her and her colleague's book - Skills-based Learning for Caring for a Loved One with an Eating Disorder - the New Maudsley Method - family dynamics are hugely important in the recovery of a loved one.

Again, in this context my statement about contributing to is a positive step/thought towards examining the home environment so it will be as supportive as possible.  At the time of the onset of my illness, this did not happen.  Heck, my parents didn't even know about it.  Early on they knew something wasn't right and even hospitalized me but neither they nor the hospital staff knew that I was binging and purging and there was no way I was going to tell them.  Things were going on in my household that were troubling and upsetting.  B/P worked for me. I hated that I was suddenly gaining weight.  Purging soon became a habit and I was vulnerable to that development.   At the time of the onset of my daughter's illness, this examination and change did not happen, either, although I did arrange therapy and then a month's hospitalization for her.  I did not know any better because my own environment growing up was similar.  I did not know the science behind eating disorders.  I figured if I could get well (eventually), so could she because she did have access to therapy and I didn't.  What an error in thinking that was!!!

 I did learn to change.  It involved hard work.   I truly regret my lack of understanding and knowledge and have made it my life's purpose since to learn more and therefore to support and advocate for my daughter for years now.

So, on the thought of contributing to -
The family environment may be wonderful; but the school environment may be awful, either for example due to bullying or due to scholarly expectations that are beyond the person's ability to handle. The family needs to know and/or to find out about this and respond to it as well as to the following examples.  The family may be wonderful; but a person's peer or relative sexually assaulted or raped her and she is hiding the emotional triggering fall-out from that event.  The family's environment may be wonderful but another event - even an activity - in the vulnerable person's life has opened the door to disordered eating that leads to an ED.  Think about hormonal changes, too.  Think about the adolescent developing brain and impulsive behavior.  The family dynamics may be tense because the breadwinner's (or plural) environment may be brought into the house at night.  The family dynamics may be tense because a caregiver is starting to chafe about wanting to make her or his mark in the world and feels trapped.  The family dynamics may be awful because one member (or more) is abusive.  The family dynamics may be disrupted because of divorce and perhaps the continuing bitterness that just might be affecting the vulnerability to an ED.  Divorce itself can be a triggering factor.  The family dynamics may be disrupted because another family member may be seriously ill so less attention is being paid to one - the vulnerable one - who needs it during adolescence.  The family environment may be wonderful but the person is mentally ill and is frightened and confused by what is going on in his/her mind.... and is genetically vulnerable to an ED.  I could continue this list.

Then there's the whole issue of societal norms, changing values, peer pressure, substances abuse and advertising......

My point is that something probably contributed to the appearance and continuation of the eating disorder beyond the genetic component.  Something triggered that genetic component.


So, how to address all of this?

A solution would include helping a person to  manage change.  This link offers some thoughts on this.
If your child is an adolescent or younger, I'd recommend the book Help Your Teenager Beat an Eating Disorder.  The authors, James Lock and Daniel Le Grange have written an excellent resource.  Again, Janet Treasure, Grainne Smith and Anna Crane's book, Skills-based Learning for Caring for a Loved One with an Eating Disorder offers insight to change.  A supportive environment is hugely important, whether it be a home or a residential treatment center or a hospital.  Love is important.  So is the immensely important recognition of the fear that underlies so much of the behavior of a person who has become trapped in an eating disorder.  The knowledge and understanding obtained by attending a conference put on by NEDA or Maudsley Parents or NAMI might help.  A trip to San Diego and a week at Dr. Walter Kaye's clinic might help.  If the family has support and structure and training to endure the hard work involved in treating the child at home using the Maudsley Method, recovery may be possible.  I say "may" because this method does work but not for every family nor can every family manage the complex arrangements that are involved, including, of course, financial support.  Here's the latest on the efficacy of this approach.

Therapy and medications certainly can be a factor but nutrition - meaning food as well as a balanced meal plan behind it to provide things like calories and electrolytes and fatty acids (think omega-3's) and necessary enzymes and vitamins is the first step.  Sometimes it's important to provide supplements but the bottom line is food. 

The  magic bullet, if one can call it that,  is "food is medicine."  The how to get them to eat is the frightening hurdle.  Creating an environment where this can happen is paramount to - using that phrase again - contributing to their recovery.  The environment must not be punitive.  Everything must be done with caring and love for this person, and sometimes that can be very difficult to pull off when the person is fighting every step of the way.     It's very, very hard work.

Time for a Hike

For a change of pace until the next step in my daughter's care is firmed up (more later on this subject when things settle out including why this path for her recovery was recommended), my husband and I decided to go for a hike on a recently finished section of trail out here where we live on what is called the "far east side of Tucson."

The complex starts at the Loma Alta Trailhead.  We planned to hike the Hope Camp Trail to the Coyote Wash Trail to the Ruiz Trail and back the Hope Camp Trail for about 5.6 miles total.

The Loma Alta Trailhead can be reached by driving east/southeast on Old Spanish Trail (a pretty drive, actually, that ultimately takes one to Colossal Cave).  To get to Old Spanish Trail, we often direct people to drive east on 22nd Street until it intersects with Old Spanish Trail just beyond Harrison Road (Harrison runs North/South).  From there, Old Spanish Trail (which is just a name, by the way, and not a historical road at all) travels past homes on large lots, wide stretches of our desert, and beautiful views of the Rincons to the east, the Catalinas to the North, and the Santa Ritas to the South.  Among the features we enjoy out here are the peace and quiet, the slightly cooler temperatures (we're at 3000 feet and at the same elevation of those who escape to the foothills of the Catalinas but with much less congestion and noise than where they are), and the beautiful views.

We arrived at the trailhead shortly before 11 a.m. --rather late by Tucson hiking standards given that the temperature was already at 70 degrees and the route we had chosen was shadeless.  

Here's Enrique at the start of the hike:

Further along here I am with a rather large Saguaro and of Enrique with Rincon Peak in the background.

And here's the temporary trail map:

We walked up the Hope Camp Trail until the intersection with the Coyote Wash Trail, off and back to the right.  Immediately we saw we would indeed be hiking in a sandy and rocky wash for quite a ways, something neither of us particularly enjoys.

We became increasingly frustrated with the terrain and our slowed pace while hoping we'd see the Ruiz trailhead around the next bend.  However, about a third of a mile from the trailhead by our calculation we encountered bees swarming near a hole in the ground of the wash and decided it would be healthier and safer to turn around, which we did while realizing, of course, that we'd need to retrace our path through the wash again.  [I called the Park Service and reported the bees, which were undoubtedly Africanized.]

Once we got back on the Hope Camp Trail, we headed northeast and eventually passed the other end of the Ruiz Trail.  We noticed the trail came _down_ the slope and figured we would have needed to climb rather steeply, probably, once we'd come to the more south-west Ruiz trailhead off of the Coyote Wash Trail.

Along the Hope Camp Trail we passed a rickety old water collection spot and windmill.

We continued our hike to about a half mile before the intersection with the Quilter Trail before turning back.  We had run low on water, having spent so much time slogging in the sand of the Coyote Wash Trail (I think you can tell we didn't enjoy that part), and decided to call it a day.

I want to hike on up the Quilter Trail towards Manning Camp and hope to keep extending that hike in training for hikes I hope to do later this year, including the Grand Canyon for a friend's Medicare Eligibility birthday hike.  Having watched the wonderful film, The Way, last night, I also am intent on hiking the entire Camino de Santiago sometime in the next year, as well.  Five years ago I thought there might be the possibility of doing this walk with my daughter.  However, her recovery did not happen and now my time to do something like this - meaning the whole thing - is running short, since I'm approaching 70 in less than three years.

We did notice, much to our surprise, that biking is not allowed along this part of the trail.  Neither are pets.

We were surprised because about 18 years ago we rode with a group of mountain bikers up a dirt road on the Rocking K Ranch that merged with what is now the Hope Camp Trail and emerged onto Loma Alta Road.  We remembered this, and the windmill actually, because a few of the guys decided to catapult a dirt mound right before the pavement on Loma Alta and one succeeded in falling and breaking his collarbone.  Quite memorable, that ride.

I'm looking forward to more hikes on this trail with Enrique,  friends Kathy and Nancy...... and others who will be at the Canyon and perhaps in Europe......

Is Food Medicine?

I've often been told and then tell my daughter that "food is medicine."

Is food medicine?

Would it be possible to persuade the Powers That Be that for someone with an eating disorder, FOOD IS MEDICINE?

And, if that is true, then would that mean a medical doctor could prescribe food?

And, if a medical doctor could write a prescription for food, would this prescription be permissible for someone on government benefits (SSDI or SSI) - to go beyond the SSI allocation re the portion for food or to replace food stamps (which are permissible) with delivered food, ready to eat?

And, if permissible, could an adult with an eating disorder obtain a prescription for a local Meals on Wheels or some kind of  daily (so one would not binge on the delivery of e.g. a week's worth of food) food delivery service that provided the calories needed for recovery?

Could this food that is prescribed and delivered be tax deductible as a medical expense?

Could this be a possible solution for someone who needs this kind of service to get on the road to recovery?

So many people with eating disorders literally panic when going into a grocery store let alone buying groceries, bringing them home, putting them in the pantry, and then selecting items to prepare food.

What a great solution this might be as a first step solo!

What do you think?

NBC News segments - Boys and Men Get Eating Disorders, too

These links will introduce the idea that boys and men get eating disorders, too.

http://video.msnbc.msn.com/nightly-news/46480643/#46480643

http://video.msnbc.msn.com/nightly-news/46480643/#46495231

http://video.msnbc.msn.com/nightly-news/46480643/#46489113
 

Eating disorders do not discriminate.  The eating disorder is like a deadly virus, intent on overwhelming and killing anyone it infects.  An eating disorder, however, is a serious mental illness - a biological brain disorder -  and is, in fact, the deadliest of all mental illnesses.

If you suspect that your son or daughter has an eating disorder, run - do not walk - to your family doctor.  Take this booklet published by the Academy of Eating Disorders with you. You can download it and print it.  Insist that the examination of your child include what is written here.

If the tentative diagnosis is an eating disorder, know that this is a medical emergency requiring emergency attention.  If your family doctor does not know how to treat it, then find one who does.