online conference transcript
Dr. Brandt is our guest, and he will be talking about eating disorders.
Bob M is the moderator.
Bob M: Evening everyone. I'm Bob McMillan, the conference moderator. I want to welcome everyone to the Concerned Counseling website for our first Wednesday Night Online Conference of the new year. Our topic tonight is EATING DISORDERS. Our guest is Dr. Harry Brandt. He is the Director of the Center for Eating Disorders at St. Joseph's Medical Center in Towson, Maryland. St. Joseph's is one of the few Eating Disorders specialty centers in the country. Dr. Brandt is a psychiatrist. He's also a professor at the University of Maryland Medical School. Prior to his present job at St. Joseph's...he was, I believe, head of the Eating Disorders Unit at NIH (the National Institute of Health. So he has quite a bit of knowledge on this subject. Good Evening Dr. Brandt. Welcome to the Concerned Counseling website and thank you for being our guest tonight. Besides my brief introduction, could you please tell us a bit more about your expertise before we get into the questions.
Dr. Brandt: Sure....I've been involved in the treatment of persons with severe eating disorders since 1985. I have been both a researcher and clinician on a full time basis. My current position involves the direction of one of the largest eating disorder programs in our region. I want to say good evening to everyone in the audience and thank you for inviting me onto your site this evening, Bob.
Bob M: To start off, because there is such a wide variety of people in the audience, what are eating disorders and how do you know if you have one?
Dr. Brandt: The eating disorders are a group of psychiatric illnesses that have, as primary features, severe alterations in eating behavior. The three most common disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. Anorexia nervosa is an illness characterized by starvation and marked weight loss. Persons suffering from this illness feel grossly obese despite being extremely thin. They fear eating to the point that they avoid caloric intake at all costs. Further, they often have a range of physical problems as a result of their illness and behaviors. Bulimia nervosa is characterized by episodes of significant binge eating, perhaps thousands of calories in an episode. Then, to counteract the binge episodes, persons with this illness will use various behaviors in an attempt to reverse the caloric intake. Self induced vomiting is common, but many people will use laxatives or fluid pills or compulsive exercise or fasting. Anorexic patients are at low weight., while bulimia nervosa can exist at any weight. Complicating the diagnosis is the fact that many anorexic patients will also pursue bulimic behaviors (approx. 50%). And many persons with bulimia nervosa will have wide fluctuations in weight as well. Both illness are highly dangerous with significant morbidity and mortality. The third major eating disorder is the most recently defined....binge eating disorder. This is similar to bulimia nervosa, but without the compensatory purging behavior. Many of these individuals are at an above normal weight because of their eating pattern. In addition to the basics that I have outlined thus far...there are many associated features of each illness.
Bob M: Why does someone develop an eating disorder and is there anything new that's been uncovered in recent research as to the "why" question?
Dr. Brandt: There are many factors that are involved and I will highlight three major areas. The first is our culture. We are obsessed with thinness as a culture to the point where there is a tremendous emphasis on weight, shape, and appearance. This has increased through the decades, to the point now where just about everybody is worried about their weight. This even includes people who are at a perfectly normal or appropriate weight. As people attempt to manipulate their weight with dieting, they are at greater risk of developing one of these illnesses. The second factor that must be considered is a person's life history and underlying psychological issues from development. We see many common psychological themes in our patients with severe eating disorders. The final area I would highlight from the perspective of etiology or "why" is the biological arena. There has been an explosion in research about the control of hunger and fullness and weight regulation, and there are many important new developments in our understanding of these highly complex problems. Perhaps we can explore some of these in more detail this evening.
Bob M: What are the treatments for an eating disorder? And is there such a thing as a "cure" for an eating disorder? If not, is there a possibility of a cure in the future?
Dr. Brandt: The treatment of eating disorders begins with a diagnostic evaluation, and is guided by the nature and degree of symptoms and difficulties. A first step is to rule out any immediate medical danger in persons dealing with any of the eating disorders. Then, one needs to assess whether the individual can be treated on an outpatient basis, or whether a more structured, hospital-based setting is necessary. Often, persons with less severe eating disorders can be treated on an outpatient basis with some combination of psychotherapy, nutritional counseling, perhaps medication if indicated. If a person is unable to block the dangerous behaviors of the disorder on an outpatient basis, then we encourage the patient to consider inpatient or day treatment or intensive outpatient programs.
Bob M: Is there a cure though for an eating disorder, or one coming in the near future, or is it something that an individual deals with forever?
Dr. Brandt: Some patients do extremely well with appropriate treatment and may be considered "recovered." However, many will struggle with these illnesses for long periods of time. It is our hope that the treatment of these illnesses will continue to improve as we learn more about the causes and new therapeutic strategies emerge. I have seen tremendous strides in the past decade!! Also, there are a number of new pharmacological strategies. And psychotherapies are becoming increasingly refined.
Bob M: Here are some audience questions Dr. Brandt.
- Next >>