Our guest, Debbie Danokwsi has battled with an eating disorder for most of her life. She is addicted to food. Debbie tried many different ways to lose weight. She hid food, tried diet pills and diets, but couldn't stick to a diet. Finally, Debbie faced her food addiction and the feelings of being ashamed and lonely. At one point in her life, she says: "I hated myself. I had no self -esteem. I was ashamed of myself for having no willpower." To ease the pain, Debbie says "I even thought about killing myself."

Today, she weighs 150 pounds, down from over 300, and has maintained that weight for over ten years. Read about her addiction to sugar and flour (her trigger foods), and how her attraction to food, coupled with low self-esteem and depression, led to her life as a food addict. Then Debbie outlines the steps that brought her to overcoming food addiction and recovery from food addiction.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Food Addiction, Food Cravings." Our guest is Debbie Danowski, a recovering food addict and author of Why Can't I Stop Eating? Recognizing, Understanding and Overcoming Food Addiction. She has maintained a weight loss of 150 pounds for more than ten years. A nationally renowned speaker, she is an instructor of media studies at Sacred Heart University in Fairfield, CT.

Good evening, Debbie and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Can you describe for us your life as a food addict?

Debbie Danowski: Hello everyone it's great to be here. Being a food addict is similar to being an alcoholic: everything revolves around the substance and life is miserable. Nothing matters except getting food.

David: What were the reasons behind your food addiction?

Debbie Danowski: The reasons are a physical and emotional addiction to sugar and flour that is passed down in families. For instance, both of my grandfathers were alcoholics but I turned to food instead.

David: At what age did you begin to develop an addiction / attraction to food?

Debbie Danowski: I believe that I was born a food addict. Food was always so important to me. I really began to eat after I turned five. I weighed over 300 pounds when I was in my late teens.

David: And you are how old now?

Debbie Danowski: I am 35.

David: Did you suffer from depression or some other psychological disorder that lead to the food addiction?

Debbie Danowski: I believe that the depression was a result of the food addiction. Sugar and flour are depressants in the same way that alcohol is. Once I got these substances out of my body, I did not have the awful depression that I lived with for years. It was a depression that made it almost impossible to get out of bed each day.

David: Could you be specific about the impact that food had in your life before you started recovery?

Debbie Danowski: Food was my life. I spent each and every minute thinking about how I could get food (look under binge eating disorder, compulsive overeating). To get food, I did things I normally wouldn't have. I stole. I lied. I hid food. It was as if I couldn't help myself no matter how hard I tried. At my weight, it was difficult to move and my whole body ached. I isolated and had no life. It was me, my food and television. At the time, I didn't realize just how ashamed and lonely I really was.

David: I'm assuming that having these food cravings affected your self-esteem.

Debbie Danowski: Yes, so very much. I hated myself for being weak and having no willpower. I spent a lot of time being ashamed of myself.

David: Did you try various diets, diet pills, etc.? (dangers of dieting)

Debbie Danowski: Yes, I tried just about everything and each time that I did I hated myself even more for being unable to do anything. I couldn't even stick to a diet for a few hours in the end. I did try over-the-counter diet pills but luckily Phen-Fen and Redux were not available at the time or I could have been one of the people harmed before they were recalled.

I would have done anything, including risking my life to lose weight. I often wished that I would get sick so that I would have a way to lose weight because nothing else worked. What I didn't know is that these diets were setting me up to fail because many of the products had sugar and/or flour in them which just made me want more and more.

David: Besides the food, did you ever turn to alcohol or other substances to ease the pain?

Debbie Danowski: I did drink a little but I only liked the drinks with lots of whipped cream. I also used shopping as a way to ease the pain. I thought that if I could buy the prettiest clothes no one would notice my size 52 body or make fun of me.

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David: What developed that made you want to change and actually follow through?

Debbie Danowski: I was at the point that I was either going to get better or I was going to die. It was an incredible amount of pain that made me want to change. I couldn't bring myself to end my life but I couldn't continue the way that I was. It was the misery that made me work so hard at my recovery because I never want to be that miserable again. There were many times when I thought about killing myself and even more that I wished I would die. Today, I am grateful that I am alive.

David: We have a couple of audience questions I want to get to, then we'll continue with our conversation:

Joden: So in general, any specific foods may be addictive to an individual and act as a trigger to overeat? (compulsive overeating)

Debbie Danowski: Yes. For me, it's sugar and flour but some people have problems with wheat, fat, etc. Whatever your trigger foods are once you eat them you want more and more.

David: Let's talk about the move to recovery from food addiction that you mentioned. Was the idea something that took awhile to brew inside your head, or just one day you decided, "This is it. I'm going to do it."

Debbie Danowski: It took awhile to brew inside. First, I had to take the step to admit to someone that I did have a problem. I went to a counselor who asked me straight out what I did to deal with my feelings. I looked her in the eyes and said that I write over them. Then, she asked me if I ever ate over them. I was shocked that someone actually put it into words, and I couldn't lie to her. It made everything real for someone to actually confront me about it.

David: So, one thing you did was go to therapy. What were the next steps in recovering from food addiction?

Debbie Danowski: I went to an overeaters support group and eventually to an in-patient food addiction treatment center where I got the structure I was lacking.

David: Regarding the support group, so we can be helpful to people here tonight, are you referring to something like Overeaters Anonymous?

Debbie Danowski: Yes, Overeaters Anonymous is a valuable support system. It allows people who are suffering in the same way to come together. The first real step in recovering is to admit that there is a problem and OA helps people to do that.

David: Why did you have to go to a food addiction treatment center?

Debbie Danowski: I tried to simply go to the overeaters support group but I couldn't even bring myself to keep on going. I was so sick and hopeless that everything was overwhelming, so I needed extra help. Not everyone needs that to recover.

David: Do you completely abstain from your food triggers, even today?

Debbie Danowski: Yes, it's been almost 12 years since I've had my trigger foods which are sugar and flour. And my life has changed so much! I no longer have that hung-over feeling that I once had, and I can remember things and think clearly. It truly is a miracle.

David: What eating techniques did you learn that might be helpful to others here tonight?

Debbie Danowski: I learned to eat three balanced meals and a snack at night. I learned to eat these meals four to five hours apart and not to switch off foods because that sets me up for playing with the portions I eat. I also weigh and measure what I eat to be sure that I eat the proper amounts. Not everyone has to do that, but I do.

David: Here's the link to the HealthyPlace.com Eating Disorders Community.

Is it tough still everyday, Debbie, to stay away from those trigger foods?

Debbie Danowski: No, amazingly once those substances were out of my body it wasn't difficult to stay away from them because the physical cravings are gone. Sometimes when I smell something, I may think that it would be good to eat it, but then I think about what I would be giving up and it just doesn't seem worth it. One taste doesn't seem worth giving up all of the good things I now have in my life. I did not even know what sanity was until I began doing this. No taste is worth that.

Dalton: My family wants everything so perfect and I'm a perfectionist myself. I eat because it's the only part of my life that I can control. Did you have that experience?

Debbie Danowski: I did have that. I come from a family that is very controlling, and I used to want to show them by eating what I wanted when they didn't want me to. The ironic part of it is that my life with food was so out of control that I was causing even more pain for myself. What I needed to do was learn some communication skills, such as saying "no" or telling people how I feel. It's amazing how one little sentence about my feelings helps me to deal with them.

Hannah Cohen: I have clothes in my closet, size 3 to size 18. I was one of those yo-yo dieters. I wanted to find out what my food triggers were, and the next thing I did was join a gym. I was scared because most of the people there were slim and there to stay healthy and build tone. I thought for sure everyone was laughing behind my back. One really nice instructor told me to go at my own pace, eat in moderation, and cut out the goodies. I listened to him and after a 9 month period I went from a size 14 to a size 7. The main thing is that I am still maintaining those principles, although some cold days are really a struggle to get to that gym. Holiday times were awful with all that baking.

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David: One of the things that strikes me, Debbie, and I think you mentioned that you experienced this earlier, is that people are afraid to try because they've experienced so many failures in the past. How do you deal the fear of failing?

Debbie Danowski: Yes, that's true. I was afraid, too. I wondered why I should even bother. I, too, had a variety of clothes sizes in my closet. I had lost 100 pounds once and put it back on quickly. It broke my heart to see those clothes. I deal with the fear of failing by focusing on what could happen if I did succeed. As soon as those substances were out of my body, I knew that this was very different than anything else I had ever tried so that made it much easier for me to deal with all of the fears I had. For once, I was thinking clearly and that made all of the difference in the world.

David: How long did it take you to get a grasp on your binge eating, compulsive overeating?

Debbie Danowski: Right from the beginning, this was different. I didn't crave food, so it didn't take as long. It was almost instant that I stopped physically craving some foods. For others, it took a few weeks. There were still emotional cravings but they were much easier to deal with. However, I always need to remember that I am never cured. I will have to continue doing what I'm doing if I want to keep getting what I'm getting. The big difference here is that it was not the struggle that it had once been. Without the cravings, I had a chance.

David: And maybe that's something we should address. What is the difference between food cravings and food addiction? Is it just a matter of degree?

Debbie Danowski: Yes, food cravings in a food addict are so overwhelming that as soon as the thought comes up, the food addict has no choice but to get the food. It's important to mention that not everyone has to hit bottom. What are smaller cravings now may turn into overwhelming cravings later.

lalee: If you are morbidly obese, does it mean you have an eating disorder?

Debbie Danowski: My guess would be yes.

David: Do you have any children?

Debbie Danowski: No, not yet. I have a niece who I am very close to and she sometimes asks me why I weigh and measure my food or why I can't have birthday cake. I simply tell her that cake makes me sick and that I need to eat certain amounts to be healthy. It really is not the big deal that I can make it out to be. That's a big part of addiction - making things out to be more than they really are.

David: Are you concerned that you might genetically pass along your food addiction?

Debbie Danowski: Yes, I am. It has been a concern of mine but I have read that children are most influenced by the eating habits of their parents. If that's the case, ours will eat very healthy!

Troubled1: Can't genetics play a part in one's size and build? i.e. the rate of metabolism?

Debbie Danowski: Yes, it can, but I used it as an excuse to keep eating. My thinking went something like this - since I come from a family genetically predisposed to being overweight, I may as well eat whatever I want. I know that I will never be a size 2. That's not in my genes, but being a size 52 doesn't have to be my reality, either.

David: That's a good point, Debbie.

Debbie Danowski: Thanks.

David: How do you come to the realization that you will never be "Barbie-like?" and what's it like for you, self-esteem wise, when that finally sinks in?

Debbie Danowski: Considering that I used to weigh over 300 pounds, what I have now is amazing. Sure there are times when I wish I could be Barbie-like, but I know from being a media studies professor that the images we see on television and in magazines are not as realistic as they are made out to be. I also know that these things come with a price. Many times, the Barbie-like people are throwing up or using laxatives to maintain an unrealistic weight (take the eating attitudes test). I am making a choice not to do that today and the reward is sanity and a peace of mind that I've never known. These are the things that truly matter.

David: So are you saying you haven't experienced much pain from that realization. It wasn't something that was really hurtful or disappointing to you?

Debbie Danowski: I guess I would have to say that most times it doesn't disappoint me but there are times, usually in the summer, when I will feel it and then what I have to do is talk about it and get it out.

David: Here's an audience comment, then a question:

kessab: My children got eating disorders because I did it for 13 yrs of their life. I am living proof that eating disorders can pass down based on a mother's behavior.

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Joden: Once you started to lose the weight, were you tempted to over-restrict your intake?

Debbie Danowski: Yes, I was. It's funny how I can go to either extreme. That's why it was so important for me to have a food plan with outlined amounts so that I didn't begin skipping meals. For an addict, more is better but that's not usually the case. I thought that if I could lose a little weight, why not lose more? That's where the structure comes in.

David: Kessab, and others in the audience, I want you to know that it's not unusual to go from one extreme to the other, i.e., overeating to anorexia or bulimia. You can read some of the transcripts from previous conferences to find out more.

Debbie Danowski: Yes, that's true. I went into an anorexic period.

adawn1717: If I ate whatever I wanted, I'd be 800 lbs. I struggled not to throw up and take laxatives to try and get thin, but that didn't work for me. It just made me feel like crap and then I continued the process over-and-over-and-over until I finally broke down and told myself and others that I couldn't take being the way I was any longer, but everyday is a struggle!!!! I struggle everyday not to binge eat!! I hate it!! I just want to be able to eat until I'm full and stop! What's the key?

Debbie Danowski: Yes, I used to watch the world's fattest man on television (he weighed over 1,000 pounds) and think that I would be there soon. The key for me is to first let someone else know what I will be eating each day and to work out a food plan that supports a non-addictive way of eating. Once the addictive substances are out of the body, the physical cravings leave and the struggle isn't as bad as it once was. Outside support is necessary in this situation.

David: As you were continuing to gain weight, how did you rationalize it in your mind?

Debbie Danowski: I told myself that 328 wasn't that bad; that I really didn't look as if I weighed that much; and that I could lose the weight anytime I wanted to. I also told myself that I needed food to eat; that I couldn't live without the things I was eating. Today, I know this isn't true but then I truly believed it.

David: We have many excellent sites that dealing with all aspects of Eating Disorders, including overeating, anorexia and bulimia. One of the sites, Triumphant Journey, specifically deals with overeating.

Thank you, Debbie, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people in the chatrooms and interacting with various sites.

If you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Debbie Danowski: Thank you everyone for stopping by.

David: Thank you, Debbie and good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Noelle Kerr-Price, Psy.D. is an eating disorders treatment specialist and staff psychologist at Remuda Ranch Programs for Anorexia and Bulimia.

We cover what an eating disorder treatment center is, what goes on there, the eating disorder warning signs that indicate you need inpatient treatment, how much it costs, and whether treating the physical symptoms of an eating disorder is enough or are the psychological issues just as important.

David Roberts is the HealthyPlace.com moderator

The people in blue are audience members.

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David Roberts: Welcome to HealthyPlace.com and our chat conference on "Eating Disorder Treatment Centers." I'm David Roberts, the moderator for tonight's chat. Our guest is Noelle Kerr-Price, Psy.D. Dr. Kerr-Price is a Staff Psychologist at Remuda Ranch Programs for Anorexia and Bulimia, a specialized treatment center exclusively dedicated to women and adolescent girls suffering from anorexia, bulimia, and related issues. Her primary fields of expertise are eating disorders coupled with psychological assessment. Good Evening Dr. Kerr-Price and welcome to HealthyPlace.com. Just so we are all clear on the subject, what is an eating disorders treatment center?

Dr. Kerr-Price: An eating disorder treatment center is a place where girls and women go in order to receive intensive help for their eating disorders.

David Roberts: There's regular counseling, where you see a therapist in his/her office. There's outpatient treatment centers. And inpatient treatment centers. How does one know which is best for their particular situation?

Dr. Kerr-Price: You have just described different levels of treatment. Eating disorders vary in their severity and so require different levels of help depending on the individual. The greater the problem with the disorder, the more likely an intensive program is needed to help manage it. Less severe disorders may only need the help of an outpatient therapist once or twice a week. Again, it depends on the needs of the individual.

David Roberts: When you say "greater the problem" -- how is that measured?

Dr. Kerr-Price: In the mental health field, one means of determining the level of treatment needed is found in established "practice guidelines" in treating eating disorder patients. For instance, if a person has lost a substantial amount of weight and is struggling to function in many areas of life, like work, relationships, etc., then this would be a clue that the problem is intense and so needs intense help.

David Roberts: What other signs would be an indication that one needs inpatient treatment?

Dr. Kerr-Price: Certainly other physical symptoms such as poor vital signs, heart and/or kidney problems. Psychologically, depression and strong anxiety tend to occur.

David Roberts: We have a very large eating disorders community here at HealthyPlace.com and, of course, we hear all sorts of stories about what goes on inside a treatment center. What is it like to be inside an eating disorders treatment center?

Dr. Kerr-Price: Centers vary of course, so I can best speak about the one where I work, Remuda Ranch. We have a setting that is designed to be different than the traditional sterile hospital setting so as to provide a comfortable environment. Many different types of groups occur as does individual and group therapy. A lot of assistance is offered at meal times also, as we anticipate those to be hard times in the day.

David Roberts: What's the average stay?

Dr. Kerr-Price: For our adolescent patients, it is generally 60 days. For our adults, it ranges between 45-60 days.

David Roberts: We have a few audience questions, Dr., that I'd like you answer, then we'll continue with our discussion. Here's the first question:

riverrat0515: Why do most inpatient hospitals have you stay only 28 to 30 days?

Dr. Kerr-Price: Sometimes it's a matter of what insurance may cover in terms of cost. Other times, it is the design of the program itself.

David Roberts: What is the cost of being an inpatient at Remuda Ranch?

Dr. Kerr-Price: Frankly, I would be hard pressed to give a set figure simply because I know Remuda Ranch tries hard to work with families on the costs along with what their insurance will cover.

David Roberts: I understand, but just to give our audience some idea...for 30-days is it about $10,000 or is it $30,000 or more?

Dr. Kerr-Price: Given that our length of stay is longer than thirty days, it would be greater than $30,000. We are probably comparable to a hospital stay. But we work individually with each family and with the insurance companies to get the most benefits.

becgra: Is it true that Remuda is biblically oriented

David Roberts: and what does "biblically-based" mean in terms of treatment?

Dr. Kerr-Price: Yes, that is true. We are a Christian treatment center in which we maintain as a focus a Christ-centered approach. We include components of the Christian faith into each facet of the treatment as we believe that Christ offers healing.

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julesaldrich: What if I have learned the basics of recovery, but haven't been able to put it all together? Could Remuda Ranch still be a benefit to me?

Dr. Kerr-Price: It really could because sometimes people need assistance doing just that, putting it into practice rather than continuing to try by oneself.

David Roberts: I think several of our audience members are wondering if recovery is possible, even if you've been a long-time sufferer -- let's say 10+ years or more.

Dr. Kerr-Price: It is possible. Motivation is very important. The duration of the disorder does bring disadvantages, like causing a woman to feel it has become her identity and so she may wonder what she may do without it. But, it is possible.

David Roberts: We've also heard stories of people going to a treatment center and coming out and starting right back into the eating disorder behaviors. What should one expect when their stay is over?

Dr. Kerr-Price: When one finishes treatment and is preparing for the next phase of recovery, I anticipate that the person would be afraid of relapse. However, this can be a healthy fear if it is not extreme because some anxiety can help us to make good decisions and be safe.

David Roberts: I'm going to post a few audience comments relating to what we've been talking about so far, then we'll continue with more questions:

regmeg: Recovery is possible. I have had my eating disorder since I was 12 and I am 42. There is always hope.

DoriLyn: I am an alumni from Remuda. 6 months recovered.

David Roberts: One thing I'd like your reaction to -- since we've had other specialists on our chat and they've always focused on the psychological aspect of recovery. There's new research out that says treating the physical symptoms vs. the psychological problems is the most effective way to treat someone with an eating disorder. When treating the physical symptoms, the researchers found that remission rates were about 75% for patients with either anorexia or bulimia nervosa. What do you think of that?

Dr. Kerr-Price: I know the research you're referring to and that does sound impressive. However, a flaw in that study, which was the same thing they acknowledged needing to do, was that they didn't actually compare their treatment of the physical symptoms to standard treatment of eating disorders. Therefore, it is difficult to interpret that form of treatment as being superior to what is standard practice.

David Roberts: Do you think then that it's important to get to the psychological root of one's eating disorder in order to have a sustained recovery?

Dr. Kerr-Price: Absolutely! Eating disorders are not just about the food. In fact, there is usually much more going on needing psychological attention than just treating the physical symptoms.

David Roberts: Here's the next audience question:

angelface_dee1: I have been to a treatment center and I have been out for a year now and still I struggle with it every day. Is it possible to ever be fully recovered without any eating disorder behavior? Is it possible to have a full recovery without any eating disorder behavior in your life?

Dr. Kerr-Price: I realize professionals in the field of eating disorder treatment may differ in opinion, but I believe it is possible to have complete recovery.

Mark_and_Christine: Any thoughts on programs for younger patients? Most programs are for 14 and over, but unfortunately 9 and 10 year olds with eating disorders are out there?

Dr. Kerr-Price: We do work with some girls as young as 11 or 12, depending on the circumstances. However, I am not very familiar with eating disorders treatment centers that serve girls as young as 9 or 10.

Mark_and_Christine: What would be the circumstances that would have you consider an 11-year-old? Additionally, with younger patients, I think the family will have to be more involved which may be hard with sleep-away programs.

Dr. Kerr-Price: Our medical director and the program directors help to assess when it is appropriate to have an 11-year-old come here. You're right about the difficulties with younger kids being away. That may be why programs for them are so hard to find.

David Roberts: Here's a specific question about what goes on inside a treatment center like Remuda:

CindyD: Is it true that patients aren't allowed to go to the restroom without the door open or someone standing there to see that they don't purge? And does that rule apply to those that are anorexic and don't purge anyway?

Dr. Kerr-Price: We do have some rules like that but, typically, such a rule as that is not imposed throughout the length of the patient's stay. For instance, just during her first few days and following meals, for example. We apply the same rules to girls with anorexia because of the risk they may try to exercise.

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David Roberts: Out of curiosity, are most people who go inpatient "forced" into that type of treatment because of their medical condition? Or do they realize things have gotten out of hand and they elect to come in?

Dr. Kerr-Price: Either may occur. Often in the case of adolescents, they might not choose this for themselves but their parents recognize the need. Others, including some adolescents, do see their need for help and desire recovery desperately.

Lost_Count: Is it common to jump from one eating disorder to another. I was bulimic for 12 years and then began seeing a therapist. Though I no longer purge, I still have episodes of binging. How do you break through the cycle?

Dr. Kerr-Price: Switching from one form of the eating disorder to another does happen. Breaking the cycle requires seeking the help needed to understand the issues behind the behaviors and receiving help in making the behavioral changes.

David Roberts: Recovering from an eating disorder on your own -- is that possible or next to impossible?

Dr. Kerr-Price: It is possible but much less likely than receiving help through a team of professionals who can address the different components of the disorder.

David Roberts: Here's an audience comment:

tinyowl: It's possible, moderator, to recover on your own. I was bulimic for 10 years and recovered from it without help

David Roberts: In reference to tinyowl's comment above, I think that's wonderful. But just from my experience here at HealthyPlace.com and doing these conferences, most cannot recover on their own.

David Roberts: Earlier, you were talking about patients needing assistance during meals. Here's a question on that:

becgra: What type of assistance during meals?

Dr. Kerr-Price: Sometimes people become very distressed when trying to eat a meal because of the fears they have around food. So, assistance can include talking them through it, encouragement, distraction, etc. Also, it may entail helping the person recognize what she does with her food, like cutting it into small pieces ( a food ritual), or eating her meal at too quick a pace.

tator: What about the medical aspects of treatment? I have a jejunostomy tube and am wondering about medical support that is needed?

Dr. Kerr-Price: Our treatment includes the help of a primary care physician who can assess everything from heart functioning to vital signs, to liver functions, kidneys... The list goes on. Since I am not an M.D., I am unable to answer the second portion of your question.

David Roberts: Do you have people who come to Remuda and are treated for medical problems, as well as psychological issues, or are the medical issues handled at a medical hospital?

Dr. Kerr-Price: Definitely. Often eating disorders create physical problems that need to be addressed. In the instance of someone who is severely medically compromised, say to the point of not being cleared to travel here, then she would go to a medical facility first for stabilization.

Galiena: What about the families of these girls/women? Are there support for them while their loved ones are in your facility? Places to stay, etc?

Dr. Kerr-Price: For our adolescent and adult patients, they and their families get to experience a "family week" which is an important piece of treatment so that family is included in the process. Also, adolescents have weekly teleconferences with their families and therapist to deal with issues.

Lost_Count: Is there a waiting list to enter your program?

Dr. Kerr-Price: Often yes, but the length does vary so sometimes, the wait may be less. For instance, currently, we have some space available.

dancer81: The doctor said that they currently have space available. I was wondering how lengthy the process is to be accepted into their program and if that takes a long time to do?

Dr. Kerr-Price: The process may vary for different families but I do know that, sometimes, people come very soon after the initial call is made to us.

David Roberts: Dr. Kerr-Price, does one need to be referred by a therapist or medical doctor to get into an eating disorders treatment center or can one self-refer?

Dr. Kerr-Price: One can self-refer.

angelface_dee1: Have you ever seen anyone actually recover?

Dr. Kerr-Price: Yes, I have known many individuals who once had eating disorders and are now symptom-free.

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David Roberts: And can you define "recovery" for us? What does that mean exactly in terms of someone with anorexia or bulimia? Does that have to mean symptom-free?

Dr. Kerr-Price: "Recovery" is a continuum. Someone may not exhibit enough eating disorder symptoms to meet criteria for an eating disorder diagnosis but may still struggle with the desires for instance. Hopefully, one can reach a place of being absolutely free of the disorder but purging half as much as one did at one time is progress on the recovery continuum. 

dancerchic: I've had an eating disorder that has taken over my life yet I'm not underweight. I've done an intensive outpatient program and now my therapists are suggesting inpatient. Would you suggest inpatient even if the person's weight isn't below normal?

Dr. Kerr-Price: At times, that is very appropriate despite not being underweight. If the disorder has taken over your life, then help is definitely needed.

julesaldrich: I have been in and out of recovery several times, do not really have fear foods, but just seem to fall back especially when my life is stressed. Often, when I begin to feel healthy, I get scared of being "too healthy." I am wondering if Remuda would be right, or if maybe I just need to find a great therapist at this point?

Dr. Kerr-Price: Although it is difficult for me to say with any certainty because I don't know you, perhaps connecting with a therapist who knows eating disorders well would be a place to start now. That person could help assess if a more intensive program is necessary.

David Roberts: Dr. Kerr-Price, thank you for being our guest this evening and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active eating disorders community here at HealthyPlace.com. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Thank you, again, Dr. Kerr-Price for coming tonight and staying late to answer everyone's questions. 

Dr. Kerr-Price: Thank you very much and thanks to the audience for joining us.

David Roberts: Good night, everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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The decision by Diana, Princess of Wales, to publicise her harrowing battle with the eating disorder bulimia resulted in double the number of sufferers coming forward for treatment. A study by the Institute of Psychiatry in London shows that reported cases of the illness rose to 60,000 during the 1990s after the Princess's revelation.

Since she first spoke of it in 1994, the number has almost halved — a trend attributed by researchers to the "Diana effect" that persuaded them to acknowledge and seek treatment for their eating disorder.

The number of cases of anorexia, where an individual often starves himself or herself for fear of fatness, remained steady at about 10,000 cases between 1988 and 2000, the study showed.

However, researchers found that cases of bulimia, when sufferers binge-eat and then force themselves to vomit or fast to avoid weight gain, rose dramatically in the early 1990s and then suddenly declined.

The Princess first revealed her own battle with bulimia in 1992, when it was described in Andrew Morton's controversial book Diana: Her True Story. In later interviews she spoke of the "secret disease" that had preyed on her for many years.

"You inflict it upon yourself because your self-esteem is at a low ebb, and you don't think you're worthy or valuable," the Princess told the BBC One programme Panorama.

"You fill your stomach up four or five times a day and it gives you a feeling of comfort. Then you're disgusted at the bloatedness of your stomach, and then you bring it all up again. It's a repetitive pattern which is very destructive to yourself."

The Princess revealed that she first began struggling with the condition shortly before her marriage in 1981 and she was still suffering from its effects in the late 1980s when she sought treatment.

Figures in the study, published in the British Journal of Psychiatry, showed that in 1990 there were more than 25 cases of bulimia per 100,000 of the population among females aged 10 to 39. But that reached a peak of about 60 cases per 100,000 by 1996. Since then cases have been falling steadily, dropping by almost 40 per cent.

"Identification with a public figure's struggle with bulimia might have encouraged women to seek help for the first time," the researchers wrote.

"This would suggest that some of the 1990s peak might have been caused by the identification of long-standing cases rather than a true increase in community incidence."

The team added that it was notable that the Princess's death in 1997 coincided with the beginning of the decline in bulimia incidence.

They said that while her influence when alive may have encouraged some more vulnerable people to adopt a similar pattern of behaviour, the decline was more likely the result of the impact of successful treatment.

The researchers also suggested that rising rates of bulimia may have been due to increased recognition and detection efforts given to a new and fashionable diagnosis.

Steve Bloomfield, of the Eating Disorder Association, said that the organisation had a debt of gratitude to the Princess for her bravery in speaking publicly about her illness.

"Her willingness for people to know that she had a problem seems to have helped hundreds of others," he said.

"At the time (of her death) she seemed to have been cured of this terrible illness and her bulimia recovery acted as an example to the many women who had difficulty seeking help.

"Bulimia is often a very secretive disease and women don't come forward easily and Diana clearly had enormous influence on people."

Complaints of being cold even when room temperature is normal.

Don't refer to foods as either good or bad. That only reinforces the all-or-nothing thinking an anorexic.

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What is it like to have anorexia or bulimia and be inside an eating disorders treatment center? Who needs to go to one? How much does it cost? Read this.

Dr. Deborah Gross , our guest speaker, is a board-certified psychiatrist and also the president of a company that helps people with compulsive overeating (emotional overeating, binge eating).

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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BEGINNING:

David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I hope your day has gone well. Our conference tonight is on "Compulsive Overeating: Dealing with the Feelings and How to Treat It". Our guest is Dr. Deborah Gross. Dr. Gross is a board-certified psychiatrist in private practice. She is also the president and co-founder of Sea Star, a company that produces programs to help people deal with compulsive overeating (emotional overeating, binge eating).

Good evening, Dr. Gross and welcome to HealthyPlace.com. We appreciate you being here tonight. Can you give us your definition of what "overeating" is?

Dr Gross: Overeating is eating more than you meant to, or more than what is healthy for you. Compulsive overeating is a different thing. A compulsion is anything we feel driven to do in spite of knowing that it is harmful

David: What causes someone to compulsively overeat? Is it brain chemically oriented or is it more of a psychological thing?

Dr Gross: The head bone is connected to the rest of the body, therefore, usually both elements are involved. Compulsive overeating, in one sense is an addiction, like alcoholism or drug addiction. It's not a weakness or a moral issue.

David: So, are you saying that some people have a propensity to compulsively overeat?

Dr Gross: Yes. Newer research is showing that the rate of compulsive overeating is much higher with blood relatives who have other compulsive or addictive disorders.

David: With many addictions, like drugs or alcohol, the addict finds it almost impossible to help himself stop using the substance and therefore self-help is really ineffective. Does that hold true for compulsive overeating?

Dr Gross: Good questions. Relapse happens in all compulsive disorders and it is important to have help, like a coach or a whole team of helpers. Many of the same tools used in AA, for example, can be used to help yourself with compulsive overeating. (Overeaters Anonymous)

David: What about the emotional tie-in to compulsive overeating? I'd like you to address that, and then we'll have some questions from the audience.

Dr Gross: Feelings influence food behavior. It starts in the cradle. Baby gets hungry, baby cries, mama feeds and cuddles, so the connections is really strong. You must learn to emotionally nourish yourself well in all ways, because not all hunger is for food. Ask yourself "is it my stomach that is hungry or my heart"?

David: How would you suggest one do that-- nourish yourself in other ways?

Dr Gross: The first thing you have to do is, learn what your triggers are for emotional overeating. For example, if you are extremely stressed out at the end of the day, before you go to the fridge and eat everything in there, try doing things that are relaxing for you, like take a walk, a bath, call a friend. I tell my patients to move the body, feed the mind and lavishly indulge the sprit.

David: Here are some audience questions:

DrkEyes2 A: What is behind the addiction to compulsively overeat?

Dr Gross: All of the research indicates that the biological part of the problem lives in a place in the brain called the mesolimbic system. This place is very deep inside our brain, and it's very primitive, so it doesn't listen to reason. There are also some brain chemicals, like serotonin, which maybe involved, although there is a lot we don't know. Depressive disorders and anxiety disorders are problems for some people as well.

mazey: I want to get control over my food intake but it saddens me as I continue to eat foods that make me real sick. I have the intellect but my emotions take control. Having Borderline Personality Disorder, will I ever be able to get a grip?

Dr Gross: Where there is breath there is hope. Most people with Borderline Personality Disorder, have had lots of losses, and so it is tempting to try to fill the empty place with food. Working on making your relationships more healthy will probably be very key to you.

David: Is there any medication out there that can help block the "feeling of wanting to eat" or is it all on the emotional level?

Dr Gross: Numerous medications have been studied for this purpose. Meridia has helped some people.

kateviennaoh: I have been fighting my overeating and bingeing for most of my life, with only temporary success. At this point, I can't see any way of being successful long term. I don't see or feel any hope. I don't know what to do except give up and eat. Thanks, Kate

Dr Gross: Don't give up. You're worth more than that. A person worth is not measured in pounds. I have a chapter in my upcoming book about this and I call it "Priced by the Pound". Society does that to you, but don't do it to yourself, please.

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David: And I think Kate brings up a great point here, doctor. Right now, society frowns on people being overweight. Some people are downright rude about it. How, as a compulsive overeater, can you deal with that emotionally, and not let your self-esteem hit rock bottom?

Dr Gross: Here's what I tell my patient's my motto is: "Always remember that it is perfectly possible to be perfectly wonderful without being anywhere near perfect".

David: I want to address one thing about Meridia, there are some questions as to its safety. Are you still recommending that to your patients?

Dr Gross: It depends on the specific situation. Medically and psychologically, no medications should be used without careful discussion with your doctor of the risks and side-effects, versus the potential benefits.

David: One other question I wanted to ask, since you compared compulsive overeating with an addiction. With an addiction, the doctors say you are never really "cured," you just manage it better. Is that the same with compulsive overeating?

Dr Gross: Absolutely! That is an important though unpleasant reality. The difference between alcoholism and compulsive overeating is that while the alcoholic can stay out of bars, the compulsive overeater can never get away from food. I think that accounts for a lot of the relapse problems.

kateviennaoh: Are there programs like detox for compulsive overeating? If so, what, and where are they?

Dr Gross: I consider all highly structured diet programs to be similar to a detox. The research shows that sometimes it is helpful for people to take a break from making decisions about food, that is why many commercial diet programs have highly structured eating plans at the beginning, and allow more choices as time goes on.

jat: I'm tired of trying different medications. I was on Paxil for awhile. Then it wasn't working anymore. As I tried to taper off, I experienced withdrawal. I've tried Prozac, and they didn't work. I tried Zyprexa, Effexor and had bad reactions. How can I be expected to even be willing to try another drug? And then, there's the insomnia I experience. When I do take a medication, I then need something else to help me sleep. Presently, I'm just taking St. Johns Wort and that isn't working at all. Where should I go from here? Or do I even bother with medications anymore?

Dr Gross: I can't give medical advice of that kind in this format, but I know it is frustrating to try and try, and have so many problems. I assume you are trying these medications for depression. Nowadays people have so many options that sometimes it's important to be sure that the psychological factors are being addressed. The research shows that a combo of medications and psychotherapy is best for complicated situations.

David: I'd like some feedback from the audience. Maybe you could share some of the emotional issues you are dealing with as a result of compulsive overeating. A lot of times, people feel they are the only ones who feel this way and by sharing this you might be helping someone else here tonight.

Dr. Gross, you have a program to help compulsive overeaters. Can you describe it and tell us a little more about it? And how effective is it?

Dr Gross: My program is called "The food and feelings system for weight loss wellness". It can be an additive to any program for the diet math "the calories and exercise part". It starts with having your food and feelings profile done. This self-test identifies the 12 food and feeling or compulsive overeating issues that I've found to be most important. Then you get a teaching module for each one of these.

David: Here are some audience responses regarding emotional issues:

jat: I am dealing with overeating and Obsessive Compulsive Disorder. I was doing so well with food, then I had a hysterectomy about 2 years ago and have gained so much weight. Now body image is a major issue as well as depression.

mazey: I have fatty liver disease. My trigs. were over 1400. My liver stuck out of my stomach even when I was at my heaviest. Real sad. I have a lot of self-hatred and embarrassment. I try to not eat in front of people because I'm fat, and when I eat at home I hate myself.

susie: When I am deep in depression, I feed the need for more and more food, even though I know that I have just eaten.

caglel: At times, my desire to eat is greater than my desire to lose weight. Do you have any tips on motivation?

Dr Gross: I define motivation as "you, plus all available help". Think hard about what has worked for you in the past and what has not. Having a trainer or a doctor or a nutritionist to give you professional help is a big advantage. But motivation is mostly all about You. Write down your goals, and why you want to lose weight, and read it everyday. It has to be for You.

David: Here's another audience response:

kateviennaoh: I'm doing the therapy etc., but when I'm alone I want to eat. I know what I need to do, but I don't!

DrkEyes2 A: So what is the NEED that is served by overeating?

Dr Gross: There is a reflex between your stomach and your brain. Think about puppies you have known. When you feed the puppy until it's belly is stuffed, it goes to sleep. Food is a very effective tranquilizer. Momma nature wanted us to survive, so she made us with a very strong connection to food.

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zeesant: I have tried many so called diets in my time, however, in time, different issues come up in my life that stop me in my tracks. Do you know of anything available that would help me know what my issues are concerning how my feelings control my diet?

Dr Gross: The food and feelings profile I mentioned, was designed to do that, to help you figure out what your triggers are for overeating. Ask yourself this question: what sends me to the fridge? If the answer isn't food or hunger, then you could eat everything in your house and still not feel any better.

hpcharles: The speed with which I substituted food stuff for cigarettes was incredible. Five months and 35 pounds later, and no sense of guilt - only justification...now what!!??

Dr Gross: That's a common problem. I'm glad you don't feel guilty, because feeling guilty makes people want to overeat more. Create a tool box of other things you can do besides overeating, surround yourself with little things you love, reward yourself with non-food items, figure out what builds you up and nourishes you emotionally. Also be sure that you know how to say the "N" word....NO.

David: If food is your "comforter" and helps you through the emotional issues, what do you replace it with?

Dr Gross: That depends on what the emotional issues are. If you have self-esteem problems you must learn to think more positively about yourself. Most of us are much better at doing this for other people, than we are for ourselves. I tell people to work on being a good momma to themselves.

David: One final question, do the antidepressants, like Paxil, Wellbutrin, Prozac, help with controlling compulsive overeating?

Dr Gross: Sometimes, but also these medications are associated with weight in long use.

David: I know it's getting late. I appreciate you coming tonight Dr. Gross, and sharing your knowledge with us. I also want to thank everyone in the audience for coming and participating. I hope you found it helpful. Good night everyone.

Dr Gross: Thank you very much for inviting me.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Cris Haltom, PhD., who has treated many adolescents and adults with eating disorders, is the guest speaker.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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BEGINNING:

David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our conference tonight is entitled: "A Survival Guide for Parents with Eating Disordered Children". This will cover children will suffer from anorexia nervosa and bulimia nervosa.

Our guest is Dr. Cris Haltom, PhD. Dr. Haltom has treated many adolescents and adults with eating disorders (anorexia and bulimia), has trained mental health clinic staff in eating disorders treatment and is a guest lecturer on the topic of eating disorders at Cornell University. She also works with parents to help them cope with the emotional stresses of having eating disordered children.

Good evening Dr. Haltom and welcome to the HealthyPlace.com site. I received about 20 emails today from parents who are not only concerned about their eating disordered children, but also explaining the impact that this has had on their lives and other members of their families. In your experience, what is the toughest part of surviving this ordeal for the parents?

Dr Haltom: Coping with the frustration of an eating disordered child who is resistant to treatment and the long-term nature of treatment.

David: And that's part of the disease. Many times, the sufferer doesn't realize or doesn't want to acknowledge that anything is wrong. How is a parent to deal with that?

Dr Haltom: Parents need to recognize, first, that they have a right to express their worries and concerns to their children. An open and honest approach to gently confronting a child is important. Parents need to use "I" statements when they confront a resistant child and to site some of the behaviors and signs that they have observed which suggest there is a problem.

Parents should approach an eating disorder like any other illness. It is a serious matter and they can communicate that to their children. They can also point out that there are professionals who will be gentle and supportive with them in proposed treatment.

David: I know that's easy to say. But many parents are faced with children who are openly combative and insist that nothing is wrong. Parents tell the child she/he needs help and the child says "no way." Then what?

Dr Haltom: Great question. Parents can expect resistance and anger. As you said, it is often part of the disorder. Taking a child to a physician can often be helpful. Because eating disorders also have a medical component, there are often telltale signs that will be picked up in a doctor's office. It is difficult for a child to refute medical evidence. In the case of a child's safety being jeopardized, a child may need to be escorted to the emergency room of a hospital where both a mental health and medical professional can assess the situation for safety.

Also, I would like to point out that there is nothing wrong with anger. Underneath a child's anger is some important communication about why they are having problems. And underneath anger is usually hurt and/or fear.

David: Dr. Haltom, here are a few audience questions:

PattyJo: Since a lot of eating disorder sufferers have a 'guilt complex' anyway, how can a parent express concern without triggering the eating disorder? I found that the eating disorder 'spoke' for my daughter about 80% of the time at her lowest weight. I found that even at 62 lbs., we had to "Force" our daughter into an inpatient treatment facility.

Dr Haltom: Since the eating disorder is often the primary way a child copes, it is often difficult to avoid triggering eating disorder symptoms. In general, it is best not to walk on eggshells with your child even if you are concerned about causing guilt.

Emerald Angel: What if you (the child or the parent) cannot afford to get help?

Dr Haltom: One important step for parents is to educate yourself about eating disorders. There is now excellent on-line information on a number of websites (including this one) about eating disorders. There are also a number of national organizations (e.g. National Association of Anorexia and Related Eating Disorders or ANAD) which act as referral sources to low cost treatment. These organizations all have websites.

Also, your local mental health clinic and pediatrician will most likely be able to help you. Recent studies have shown that primary care physicians, when educated about eating disorders, are key treatment team members.

David: If you haven't been on the main HealthyPlace.com site yet, I invite you to take a look. There's over 9000 pages of content. Check out the Eating Disorders Community.

Here's a question I've received from several parents: Is there really any such thing as "true recovery". Or is it like alcoholism, where, in a sense, you are always in recovery?

Dr Haltom: It depends on which school of treatment specialists you are talking to. The addiction camp suggests that once you have an eating disorder, you remain recovering. However, there are many who believe that people with eating disorders can and do recover from eating disorders. About 50% of people with eating disorders, after recovering, report being "cured."

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David: Many, though, go on to have relapses. That, too, can be very stressful and also wearing, I'm sure.

Dr Haltom: Yes, many people do relapse. Many times that is because of incomplete treatment. After intensive treatment, people who have reached normal weight and/or are free of debilitating symptoms leave treatment in what I call "hover mode." They are hovering between still having disordered eating and being healthy with eating and body image issues.

Treatment for eating disorders may last from six months or so to two years. Sometimes, as with chronic anorexia, the treatment may go on long-term. During recovery, there may be a period of good health only to be followed by temporary relapse. This uneven progress is to be expected in treatment. And the uneven recovery process can be frustrating to expectant and hopeful parents who desperately want to see their child recover.

David: So, for parents, one important thing to keep in mind is, even after being in extended treatment, whether in- or out-patient, it's important to receive follow-up treatment and monitoring. Just because your child says she/he is better, it doesn't mean that's so.

Here are some audience questions:

camkai: I have a 10 year old that is 8 months into her eating disorder. Are you seeing younger children with this problem?

Dr Haltom: Yes. About 10% of young people diagnosed with an eating disorder report the onset of their illness at age ten or younger.

JEN 1: My daughter is in treatment now. When she comes home, how much of a role should I play to insure she stays on the right track? Should I be involved in monitoring? She is 19 and living at home.

Dr Haltom: It sounds as if your child is in an day or inpatient eating disorder treatment program away from home. My guess is that the staff that are working with her are experts in the treatment of eating disorders. They will direct you with regard to monitoring.

David: One of the questions I received was that, of course, eating disorders are a "physical thing", but can a person ever recover from the "mental aspects" that led to it?

Dr Haltom: Yes. People can recover from the behaviors, emotional issues, poor body image, distorted beliefs and attitudes that led to and maintained the eating disorder.

lyn: Can you give any advice concerning prevention for those of us who still have younger children ?

Dr Haltom: A top piece of advice is the following: Teach children to "listen to their bodies" when it comes to eating habits, hunger, etc. In general, we want to teach children to pay attention to internal cues about eating and hunger.

chloe: Do you believe that hospitalization is necessary? Can an adolescent be treated successfully at home?

Dr Haltom: In this era of minimal insurance benefits available for expensive treatments (often about $1000 per day for good inpatient treatment), there are increasing numbers of people who are using intensive outpatient services to treat eating disorders. Of course, when there is a medical emergency, such as heart arrhythmia, esophageal tears, and other medical problems, hospitalization may be absolutely necessary.

Luvem: Why do therapists & nutritionists recommend that parents not discuss food issues?

Dr Haltom: Many young people in recovery need to learn to listen to internal cues and make autonomous decisions about food choices. It is part of the recovery process in many cases. Also, focusing on food is often not focusing on the most important issues - those underlying issues such as identity confusion and a myriad of other concerns are more important to focus on.

On the other hand, most of them are interested in promoting healthy eating habits in a child's home. That may require some talk about food. For example, a common recommendation is to make sure their is a family habit of eating three times a day and eating at least one meal together. Also, a common recommendation is to have a healthy variety of foods available in the home. There may be some "food talk" about what food choices different family members want in the home.

David: You have a program which you call an "anorexia survival guide for parents". Can you explain that in more detail?

Dr Haltom: This is a program which utilizes virtual modalities - computer, phone and fax - to connect parents for psychological and educational learning about their children's eating disorder. I have a free monthly newsletter which can be subscribed to at my website. And I have started offering teleclasses for parents which run for 4 to 6 weeks, one hour per week. Parents are connected by a telephone bridge line and I teach the class. Parents can both learn and support each other.

The idea is to support parents while their child is in treatment. The classes and newsletter are a supplement, not a substitute for treatment by a team of professionals.

Jackie: What is identity confusion?

Dr Haltom: Young people are often in the throes of developing their identities. That is, they are in the process of figuring out what their personal values are, what their chosen peer group is (who they identify with, e.g., athletes), what their sexual orientation is, what their career aspirations are, etc.

Children are picking their values, career aspirations, chosen interest areas, and educational goals. All this can be very overwhelming. As a result, there is sometimes a need to feel special or in control of their lives when everything around them seems to be one large question and difficult set of decisions. One way to be in control is to control one's body and eating. Or one way to feel special is to be the thinnest at school.

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Luvem: How can a parent show their concern and support for their child without sounding "controlling"?

Dr Haltom: Be a good listener. Be available to talk. Don't be too probing or judgmental. Many young people with eating disorders want to be "understood" by their families. Showing empathy is also a good way to draw out a child and show support. A parent can use reflective listening and they can ask about how a child might be feeling. They might say, for example, "That must have hurt your feelings."

David: An audience comment on point:

lyn: Not too easy to not be probing these days with young people.

PattyJo: What about medications, what is effective for anorexia? And should a parent be receptive to medication treatment for their child? (medications for eating disorders)

Dr Haltom: Because absorption of medications is sometimes affected by eating disorder behaviors, e.g., starvation and poor nutrition or vomiting near the time medication is taken, a physician will determine when the appropriate time to give medication occurs. And the physician prescribing, often listen to the mental health professional (unless it is a psychiatrist who is both prescribing and treating) about what mental health conditions may be underlying an eating disorder.

chloe: My daughter was put on the antidepressant, Zoloft, and we have seen tremendous progress in the depression that accompanied her eating disorder.

Dr Haltom: For example, it is very common for young people with eating disorders to suffer from depression. Also, social anxiety and obsessive-compulsive disorder (OCD) are often part of the clinical picture. And substance abuse is a consideration. The medication chosen will address the clinical psychiatric problems. There is some evidence that certain anti-depressant medications will curb appetite for those who binge. Also, sometimes medicine is given for gastrointestinal problems that arise with eating disorders.

In short, parents should be prepared to deal with the question of medication when their child is in treatment for an eating disorder.

David: It's getting late. I want to thank Dr. Haltom for being here tonight. There was a lot of good information and I appreciate the audience participation. Our homepage is www.healthyplace.com. I invite everyone to take a look around. Thank you again Dr. Haltom for coming tonight. Good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Online Conference Transcript

Judith Asner, MSW is a bulimia treatment specialist and founded one of the first outpatient eating disorders treatment programs on the east coast.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good evening everyone. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. I hope your day has gone well. Our conference tonight is entitled "Beat Bulimia, Bulimia Treatment". Our guest is eating disorders treatment specialist, Judith Asner, MSW.

In 1979, Judith Asner opened one of the first outpatient eating disorders treatment programs on the east coast. Ms. Asner has been trained in psychodynamic psychotherapy, cognitive-behavioral therapy, and group psychotherapy.

She has presented papers on eating disorders at the American Group Psychotherapy Association and the International Association of Eating Disorders Professionals. In addition to primarily treating bulimics, Ms. Asner also publishes an eating disorders newsletter.

Good Evening, Ms. Asner and welcome to HealthyPlace.com. We appreciate you being here tonight. Because each person in the audience may have a different level of understanding, can you please define bulimia, bulimia nervosa for us (bulimia definition). Then we'll quickly get into the details.

Judith: Bulimia (bulimia nervosa) is defined as periods of uncontrolled eating. The person eats anywhere up to 10,000 calories in a sitting. Binge eating is followed by purging behaviors, i.e. vomiting, laxatives, exercise or sleep.

David: I think it's also important for everyone here tonight to know that you suffered from bulimia and it started over 30 years ago when you were 21. How did you develop it?

Judith: I developed "sudden onset bulimia", after the sudden death of a parent--a real trauma. But I certainly had some eating and body image issues all along.

David: This is back in the 1970s when no one was really talking about eating disorders. Did you know what you had, and what was it like for you?

Judith: I thought I was awful, that I discovered the best and the worst behavior in the world. I had no idea what disease it would become. Thank heavens for Jane Fonda because she spoke up about her experience with bulimia nervosa in 1980.

I lived in great anguish that someone would find out about me. Yet, I got so much positive reinforcement for being thin that it was all so confusing. There was so much praise for being thin from society, and men especially, that I wished I had discovered it sooner. I thought it would end all of my problems. Right!

David: You mentioned that you lived in great anguish that someone would find out about your having bulimia. Tell us how the disease progressed in you.

Judith: I began to get so into being thin, that I threw up several times a day. And I would binge on anything my heart desired, even on things I had deprived myself of before. It seemed like an answer to being just slightly overweight. And attention and beauty were a high! It is so sad to see the values that some people have about beauty.

David: Today though, it's still very difficult for someone with an eating disorder to talk about it. In fact, from what I've read, and from talking with bulimia sufferers, having bulimia nervosa is a real stigma; even worse than having anorexia.

Judith: I am sure it was a way to blunt emotion. Don't forget, I was dealing with parental loss. Bulimia is not a pretty disease. It does not bring admiration, as starving does. Starving is called "the moral superiority of anorexia nervosa." Being able to starve is an art. One feels so morally superior! Society admires starving women.

Not so with purging out of control women! There is no moral superiority in throwing up your food after stuffing yourself. But all in all, it is a way of avoiding feelings by focusing on food and thinness.

David: Here are a few audience questions, Judith:

dano: What is different between bulimia, and say, for instance, a person that eats and then 20 minutes later is really hungry and feels the need to eat again?

Judith: That person is responding to true hunger cues, I hope. With bulimia, one is unaware of one's true bodily needs and hungers. The satiety, or satisfaction signal, becomes disturbed during the course of the disease. The person who eats when hungry is responding to a real bodily cue, and the person who eats again is responding to hunger, not emotions. People with bulimia are not in tune with real hunger cues. The signals are disturbed by, or even before the disease.

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girlguide: Judith, did you have to deal with your bulimia while going through school?

Judith: Yes, I was a grad student in social work, if you can possibly believe that. Can you imagine the amount of shame I felt, saying I was someone who could help others when I could not even tell anyone about my secret? But of course, today, as a grown up and experienced therapist, I understand that the wounded healer is the most capable of feeling empathy.

It is so important for one to understand that no one is perfect. We all eventually get a disease. How can we be who we really are, or be authentic, if we do not allow ourselves to be human? So much of the illness is about a "false presentational self" of being perfect.

No one is perfect. Every personality has its glitches. Every single person has some problem.

David: What did you do to cope with the shame? And then, what made you get past the shame and decide to get help?

Judith: Many years of anguish and reading about the subject led me to finally realize that I might not be alive if I kept up such destructive behavior. I had to face that part of myself. It was very, very hard work and many years of therapy trying to understand why I did not love and accept myself as I was; why I thought my value was in being thin, not in my work or my being.

Don't forget, this was the 70's and 80's. Thinness was everywhere. The media made it into life's most important accomplishment. You could not get away from the message that nothing else mattered. The TV, magazines, and movies showed one thin woman after another. If one was susceptible to the media, the message was clear.

Do you know a woman's self-esteem goes down after watching 30 minutes of thin women on TV? Madison Avenue depends on this. It sells!

David: Just so everyone in the audience knows where you are coming from, have you completely recovered from your bulimia? (bulimia recovery)

Judith: I said I was not perfect! But always improving. One is always susceptible to a comforting but maladaptive behavior and has to be ever on guard.

There are many trigger foods that I do not have in my home today. Why? Because they are trouble for me. I still do not keep sweets in my home because I know enough to avoid these troubling foods.

When coupled with stress, any trigger can set off a binge. Is this recovery? There are many theories about that. Some say that one should debunk all food myths and eat any food in a proper proportion. That is good, theoretically, but it just doesn't seem to work for many women with bulimia.

I think, at least initially, it is best to deal with what one can manage. Perhaps in time, in a calm, safe environment, trigger foods can be managed in small amounts. Every person if different, but most have problems with foods that combine fat and sugar.

David: The audience has a lot of questions, Judith. Here we go:

wauf5: I understand that there is no "quick fix" for bulimia. I've suffered for over half my life. So what, if you had to put it in one short paragraph, is your answer?

Judith: First, I can really empathize with you. It is so tough.

If I were to say 2 things they would be: You really have to monitor yourself one MINUTE at a time, not just one day at a time. You need constant positive self-talk. "I can, I can."

Then, it is the capacity to continually say NO to one's desire to give in, and to get busy with something other than food. It really is a constant effort.

I wish I could give you a simple easy answer to cure it, presto. But you know, the more accepting you are of yourself, the more you can be honest about who you are with others, and you can ask them to help you in any way you need to be helped. The support of people who are there for you is essential.

Lex:My eating disorder resurfaced about 8 months ago and it has gotten so bad even though I see someone, it keeps getting more out of control. I feel so anxious when I think of eating, and if I eat (rarely), I can't keep it down. Any suggestions?

Also, I am worried it is going to get so bad. Is it that I need hospitalization? Any suggestions on what I can do to try and avoid that and help myself?

Judith: Have you spoken to a psychopharmacologist psychiatrist who can suggest a medication to help you with the compulsive behavior? Have you seen a nutritionist so you know exactly what you can eat without gaining a lot of weight? Are you going to daily 12-step Overeaters Anonymous groups?

David: Here are a few audience comments on what's being said so far. Then we'll continue with the questions.

mazey: I wasn't thin, about 190 lb., going into eating disorder treatment at 21. I got into a life-threatening emergency situation. Was in a medical hospital because I could no longer keep anything down, including water. Even if I wanted to eat or drink, my body rejected everything. I was closet binge/purger.

I haven't purged in at least 5 years. I have irreversible damage in my stomach and esophagus and don't have many teeth left. I have learned that for me, the purging was a control issue. When things were most out of control, I had this secret and was in full control. Losing weight, eating big time, and living with my face in the toilet. That was control, so I thought.

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Haven: I've been in a terrible bulimic "phase," bingeing and throwing up for a few years now, although I've had this for 12 years. I have 3 kids and want to change but am SO stuck now. It is an addiction now? I really feel powerless, it controls me. And I hate saying that, but it is true. Everything I eat makes me feel guilty and it leads to bingeing--I'm a true blue mess, Judith.

Judith: You must love your kids so much. Go to Overeaters Anonymous for you and for them.

Lori Varecka: That is what they tell us in the hospital "all foods are good". "Get busy" with the computer and isolation from my family. My husband isn't so keen on that. I have to do something after dinner though.

Same here, Lex, about the anxiety and things getting more out of control now.

Judith: Lori, can you talk to your husband and can he help you?

wauf5: I hear ya, Haven!!!!

David: Here's an audience question:

diane74: I've been struggling with bulimia for 4 years. I'm trying so hard to beat it for the sake of my husband, my two little girls, and me. How do I overcome the overwhelming fear that if I quit this behavior, I'll become fat?

Judith: A fear is not a reality. Work with a nutritionist or a therapist who can give you support and reassurance and who can help you modify your meal plan if you gain weight.

Is being here for your family more important than a few pounds? Think about how important you are to your loved ones and yourself. Your life is no small life--it is a big and important one. You deserve health. It is your birthright. Remember, balance.

David: For those who have asked, here's the link to the HealthyPlace.com Eating Disorders Community.

Here are some more audience questions:

Amy4: What advice do you have for someone who has been bulimic for 15 years?

Judith: Happiness is our natural state. We are meant to live that way. Often, women with bulimia feel they don't deserve happiness and they hurt themselves and deprive themselves of it by the bulimic behavior. Seek help. It is never too late to get well. Most people seek treatment well into the illness but not right away. I see many women who do recover after 15 or even 25 years. Five to six years is the mean years for most to seek treatment.

David: I want to post some audience comments here because I think it's important to realize that if you suffer from an eating disorder you are not alone, your feelings about what you are going through aren't abnormal or weird. There are others in the same position.

larissa: I also have anorexia along with being bulimic.

Marion: Not a question, but a 'thank you" to Judith for the last few comments. I work (with enormous success), on a private basis with eating disorder sufferers, yet I continue to struggle with alcohol issues myself...of course, in my "private world".

Judith: Thank you, Marion, for bringing that up. They seem to go together.

leslie2: I'm just really scared.

Kiki: I was anorexic then bulimic. Started out at 120 lb. and went down to 75 lb. I went into the mental health profession because I knew this was wrong and I thought I could "cure" myself. I have been going to a therapist for a year and while things are better (no more binge/purge) I still have the same ideas about food and control. I have used laxatives in the past few months, which I am really ashamed of.

Lex: I am 800 miles from my family. My best friend is here, but even though she knows, she doesn't understand when I ask for help like not going somewhere to eat where I feel uncomfortable, where we end up eating hoagies. I feel so alone and discouraged at times.

Lori Varecka: I do see a therapist and a nutritionist (who used to work at the eating disorders' section of the hospital). Even with the meal plan, which I can't seem to stay on, it isn't helping. I find outpatient not as helpful as partial or inpatient - but I don't want that again (after 3 hospitalizations in 3 1/2 years).

Judith: Do not be ashamed. In the grand scheme of things, bulimia is not a CRIME. It is just an illness and needs to be treated, like any other illness. Please give yourselves a break.

leslie2: I am almost 26 and was diagnosed last year and I'm just starting treatment now. Everyone seems concerned, but me. Why is that?

Judith: That can be Denial.

sillyme: My biggest problem is that I binge but don't purge, and I am up to 250 pounds and still going up. I am concerned about my health, but I just don't know how to stop.

Judith: Ladies, you are not alone. We can be a virtual community and can support each other. Try Overeaters Anonymous, It can help you find a saner way of life. Sane, as insane eating that is, sillyme. We are silly to hide ourselves. We are all beautiful human beings.

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David: You are right Judith--about being a virtual community. And I don't mean to be self-serving here, but that's what HealthyPlace.com is all about; people helping people. It is not a site built around experts, although we do have experts here and they are important, but it's also important to get support and knowledge from others who are going through similar experiences.

So, I do invite everyone to participate, come to the eating disorders chat rooms, join the support groups, visit the sites and participate.

Judith: This is why HealthyPlace is so important for issues like bulimia. The shame component can be overcome via the chat and then one can finally go out and get help. OUT OF THE CLOSET AND INTO THE VIRTUAL WORLD. HealthyPlace is doing a wonderful thing for us. Thank you, David.

David: How would you suggest sharing the news of your bulimia with someone close to you, so you can start on the road to recovery?

Judith: Just say: I want to enlist your support because I know how much you care for me and that you will be there for me no matter what. What I am about to say is difficult, so please hear me without judgment as I would you. Then say: this is what I most need from you to help me on my journey to recovery. And then enumerate the ways in which they can help; be positive, specific and ask for exactly what you need. It is a gift to honor someone with such an important job and they will be happy to be able to do a good deed. "The Interpersonal Bridge" is the most important bridge we can ever walk across.

David: Here's the flip side of that question, Judith, from a parent:

sarahsmom: What is the most important thing I can do to help a 7 year bulimic, age 21, daughter...other than love and support her. HELP! (bulimia support)

Judith: Just be there in an accepting way; no shame or blame; help her get the treatment she needs; ask her what she wants you to do. And don't forget to tell her how unconditionally you love her, bulimia or no bulimia. And tell her you have faith in her, that she will find the path and the belief in herself to do what she needs to do. And remember parents, bulimia is complicated and no one is to blame.

Marion: How often, in your practice, do you find a direct correlation between bulimia and drug and/or alcohol addiction?

Judith: Bulimia has many causes and no one is to blame. Alcoholism is the disease most closely associated with eating disorders. The behaviors are ways of not dealing with life's emotions and ups and downs. I recommend staying away from alcohol. It disinhibits a person and often leads to a food binge. Also, first degree relatives of bulimics have a higher percentage of alcoholism than the general population. They are all subsumed under "addictive disorders". Remember, these are bio-psycho-social illnesses. All 3 spheres play a part in their development. Biological vulnerabilities, social environment, and psychological makeup.

David: For those who didn't know this, Judith does coaching and teleclasses, helping sufferers and significant others deal with eating disorders. 

Now, I want to follow up on sarahsmom's question, Judith.

It must be difficult for a parent or significant other to also deal with what is going on with the sufferer. What do you do to cope when your child or spouse comes to you and says "enough! I'm not getting anymore treatment. I'll never get better." and then follows through on that attitude? How do you, as a parent or spouse, cope with that and what should you do?

Judith: You can do a few things. You can get support for yourself. Or you can tell the person that you cannot be in their life because it is too painful to see them destroy themselves. Please see "Intervention" on my archived newsletters on my site. It deals with a whole social system intervening to force a person into treatment for eating disorders.

David: Here are a few audience comments on what's being said here tonight:

Mocho: It's nice to see a parent looking for support too (sarahsmom) - mine have outright told me they no longer support anything I do to try and get better (I "failed them" the first time I went to the hospital 2 years ago by not getting better fast enough - well, I never did get better).

Judith: I say, as long as there is life, there is hope.

Lori Varecka: The hospital therapist made it seem like it was my mother's fault. This was at a family counseling session, the only one my mom went to. She doesn't want to know anything about eating disorders.

Judith: The role of the therapist is to instill hope into a person. Find one who does.

Is any one thing anyone's fault? That can't be. There are many factors that go into this complicated illness. I imagine with gene mapping, we will one day find the aberrant gene for eating disorders. I hope your mom is here to see that news flash!

Kiki: Thank you, Ms. Asner, for your candid comments about this disease and thank you to HealthyPlace for offering this chat. 

Janeperry2000: My daughter is 19, weighs 78 pounds now, and is 5'10". She still vomits a lot during each day! How do I help her to face the truth that this is what she has: bulimia! She doesn't want to go to the hospital! I don't want to wait until it's too late! I'm so concerned! Help!!!!

Judith: Jane: INTERVENTION - get a team mobilized. 

Lex: I am scared of getting better but I want to. Is that weird? It makes everything so hard. I tell myself when I weigh that I'll stop.

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David: Here's a question:

Jus: I have been diagnosed with anorexia and bulimia. Right now, I seem to binge every night at 3 a.m. Do you have any suggestions on how to stop?

Judith: Why are you waking up at 3 am? Are you depressed? Night waking can be a symptom of depression, a sleep disturbance, too much caffeine, not enough exercise, low blood sugar...I could go on and on. Have you consulted a professional?

Jus: Nightmares from PTSD.

Judith: PSTD must be treated by a trauma specialist. You know sexual trauma and eating disorders are related. Get help.

diane74: I've been hospitalized 3 times in the last three years because of dehydration. Once while I was pregnant with my 2 yr old daughter, almost losing her to pre-term labor. What is going to stop this insane behavior?

Judith: You are going to stop the behavior, with the help of a professional. YOU must be responsible for your behaviors ultimately. A force from without cannot replace the desire and determination from within. Pull out every plug to get the best treatment possible, and if you are a believer, ask for God to help you. No one from outside of you can make you stop a behavior. Only You can do that ultimately. The ultimate determination is within one's soul and it finally says: I am worth more than this. I deserve better. There is a big beautiful world out there and I deserve to enjoy it.

Chlo: Hi! I get your online newsletter and find it useful. Currently, I want to begin recovery for the bulimia again but I am doing some heavy duty therapy for past sexual abuse issues. Should I hold off on recovery until these issues are resolved? I am too afraid to ask my therapist. I don't want her to think I am defeating the purpose- even though I know I may be.

Judith: Sexual abuse issues are associated with eating disorders. I imagine you will have to get through the catharsis of the abuse first. Be very, very honest with your therapist. Discuss with her how the eating plays into other things you discuss. When you both feel you are ready, she can direct you to a person who can help you if she can't. Remember, above all, honesty to one's therapist and friends and most important, to Self.

But be kind to yourself. I am sure you are all suffering enough just having the eating disorder, so do not rank on yourselves day and night. Be kind. Shame and blame---there is no glory in them.

addy1: Hi, even though my daughter knows all that you have mentioned above, and has hit many rock bottoms with anorexia and bulimia, I wonder when she will find full recovery.

Judith: Maybe not full, but... every journey begins with a small step. Praise her every step of the way. Mirror her; be present for her and trust in the life force. We all want to be whole, and fully alive. I trust she is resourceful and will find her way out of the maze. God knows I and many others have. It feels real bad to be at rock bottom, but sometimes it is what it takes. Meanwhile, mom, my heart goes out to you. Talk to other moms who can support you.

AndreaD: Judith, I am in outpatient treatment for bulimia. How can I get help for my husband? He is always so worried about me and feels like I am sneaking around and almost like I'm cheating on him with food. Is there a support group or book for family members?

Judith: Have you ever heard of Imago Therapy based on the book "Keeping the Love You Find" by Harville Hendrix? I am an Imago therapist as well. It helps couples learn to dialogue honestly, to understand each other's childhood wounds and how they replay in the marriage. Most importantly, it deals with addictive disorders and eating disorders as EXITS to intimacy.

You know, when you are in the bulimic cycle, you are not truly available and present, so you are in an exit. The therapist will ask you to name your exits--everyone has them!- and will ask you when you will be ready to close that exit. Some work will be done on what the exit means to you and why you use it. At one time, it was probably an adoption to early wounding, but if you can be safe with each other and open about what you need from each other to heal childhood wounds, you can begin to close the exit, bring the vital energy back into the marriage and heal yourselves. Then you may not have to run away from your pain and fear by eating. It is quite an effective, hopeful means of working with the eating disorder and the restoration of the wholeness and goodness with which we are all born.

David: I know it's getting late. Before we leave, let me remind you to please make sure you sign up on the mail list at the top of the Eating Disorders Community homepage so you can keep up with events like this and informative news.

I want to thank Judith for being our guest tonight and sharing her life experiences and expertise with us. And thank you to everyone in the audience for coming and participating tonight.

Judith: Thank you all. Thank you all for giving me the opportunity to feel useful!

David: Thank you again Judith and good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Judith Asner, MSW is a bulimia treatment specialist and eating disorders coach. Ms. Asner founded one of the first outpatient eating disorders treatment programs on the east coast. She is also the sitemaster for Beat Bulimia inside the HealthyPlace.com Eating Disorders Community.

Ms. Asner discusses the importance of having a strategy for recovering from bulimia and other eating disorders. She maintains that trying to recover from bulimia without a plan is extremely difficult; next to impossible. She outlines the components of an eating disorders treatment plan. Audience members questioned Ms. Asner on how to stop the binge/purge cycle, episodic binging and purging, the fact that dieting, for recovered bulimics, triggers of a relapse, and more.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Morning. Welcome to HealthyPlace.com and our chat conference on "Recovering From Bulimia: What You Need To Know." I'm David Roberts, the moderator. Our guest is Judith Asner, MSW. Ms. Asner is a psychotherapist who specializes in treating bulimics and those who suffer from other eating disorders. She started one of the first outpatient programs for eating disorders in 1979 on the East Coast. She is also the owner of the Beat Bulimia website here at HealthyPlace.com and does life-coaching; helping people via telephone. Ms. Asner graduated from one of the top executive coaching schools in the U.S., The Hudson Institute. You can click here for a definition of bulimia. For comprehensive information on eating disorders, visit the HealthyPlace.com Eating Disorders Community.

I received an note from Ms. Asner, recently, saying that a lot of the email she received came from people who stated they had tried to recover from bulimia or other eating disorders and weren't doing very well. So they decided to give up. Like there was only one way to recover and if that didn't work, than that's that. And Judi mentioned to me that from her vantage point, as a psychotherapist, she could see that many didn't even understand the basics of eating disorders recovery, much less have a strategy for recovery. So that's what we're going to be talking about this morning.

Good Morning Ms. Asner and welcome to HealthyPlace.com.

Judith Asner: Hello, David and guests and welcome. It's always a pleasure to be here with you, David.

David: When you talk about a strategy for recovery from bulimia, what are you saying exactly?

Judith Asner: Well, I am talking about a plan, David. Nothing proceeds without a strategy; long term and short-term goals. A plan goes this way: First, one has to have health professionals on a team. There is no way around that because bulimia nervosa is a disease. This team has to begin with an internist to cover one's physical condition and follow it. Next, a psychiatrist is needed to evaluate wheteher or not the person is suffering from a biological depression or other condition.

David: Before we get deeper into that, I want to ask this question: Is is POSSIBLE for everyone or anyone to recover from their eating disorder? Or are there some people who, no matter what they try or how hard they try, will never recover?

Judith Asner: I believe where there is a will there is a way. But statistically, there is a percentage that does not recover and remains chronic. However, I never give up on ANYONE. With bulimia, about 20 percent remain chronically bulimic.

Let us define recovery, David. A person may feel much better about themselves and still have some eating problems but have a much better sense of self and function well, but have episodic binges and purges. This is not full recovery, but it is a far sight better than being in the throws of full-blown bulimia, daily. I consider this a victory. I don't look for perfection in life. I look for some balance in a person's life. If a person falls back into bulimic patterns, I try to help them out of the downslide as fast as possible and help them get back on their feet, understand the stressors and make the next time easier. This, to me, is pretty good progress. If a person never purges again, hooray. I just hope a person can feel valuable, have a good sense of self, be kind to themselves and others, and if they slip, so be it. It's over and let's get back to living as fully as possible. If the person can go for success every day, God bless them. Hooray for them--what a victory.

David:Earlier, you mentioned that recovery begins with having a team of professionals to help you and that there was no way to effectively recover without that team. I'm assuming you are talking about needing an internist, a psychiatrist and maybe even a nutritionist. Am I right?

Judith Asner: Yes, David. Now I am not saying a person can NEVER do it alone. Let me modify that. Certainly self-help books on eating disorders, family and peer support, faith and faith-based groups, and overeaters anonymous are enormously helpful. But when there is a serious case of bulimia with underlying depression, anxiety or bipolar illness, which we call a comorbid condition or dual diagnosis, medication is necessary, monitoring of the physical condition by an internist is essential and a sound nutritional plan and exercise in the appropriate amount are important elements in the eating disorders treatment plan.

David: Judi, we have a couple of audience questions I want to get to that pertain to what we've talked about already, then we'll continue with our discussion on a "Recovery Plan for Bulimia." Here's the first question:

rcl:How do you know if you are in that 20% that are chronic and may not recover significantly and, if you are, what should you do?

Judith Asner: If you have had bulimia for say 5-10 or more years and you throw up for 3 or more times a week, go to the drawing board again. Look at what has and has not worked in the treatment before. Have you been to an inpatient facility? Have you been reevaluated for psychotrophic medications? There are many, many new medications on the market in the past years. Have you seen a psychotherapist who has worked extensively with the disorder or, in fact, had it? Have you gone to OA meetings daily? Have you hired a coach? Have you stuck to a firm nutritional plan?

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David: We have some questions regarding limited financial resources:

maren:And if your financial resources are limited, then what? Are there many self-help groups at universities?

teetime: I have had a eating disorder for 4 years and do not know how to get help. Money is a big problem.

Judith Asner: Yes, Overeaters Anonymous has a meeting every day in every city. You could also apply any 12-step program's principals to eating disorders. Also on my website beatbulimia.com, you can find some free resources. Colleges have groups and you can start your own groups . The local hospitals also have self-help groups that are free.

David: So to recount what we've said about having a strategy to recover from bulimia or any eating disorder: First you need an overall strategy, a plan that you can use to guide you in your recovery, rather than just haphazardly trying things. Part of that plan is starting with a team of professionals working with you: an internist, a psychiatrist, a nutritionist and others. Or if you are limited in your financial resources, participating in self-help support groups like OA can help. What about a meal plan of some sort?

Judith Asner: Yes. That is true. And the drop-in groups at hospitals. You could also go to www.clinicaltrials.com and see if you could qualify for a clinical trial of some type. A meal plan is so essential. It is a road map for a trip. We just don't drive to a mountain resort without a map, do we? No business can proceed without a business plan. Well, we are organizations, just like a business or institution.

David:What is meant by a "meal plan"?

Judith Asner: A plan for breakfast, lunch, dinner and in-between snacks that is planned the day before, with the day's acitivites in mind. There can be substitutions but the person basically has to know that they can eat X amount of calories per day without gaining weight and that if they stick to this plan they will not have to binge and purge to maintain normal weight. Most people with bulimia do not believe they can eat 3 normal means and be a normal weight. This just isn't true. That is the reason that working with a registered diatecian is so important. A meal plan usually follows the guidelines of the American Dietetic Assn. plan and is balanced and healthy.

David, sometimes people don't stick to a meal plan. Well, that is okay. Use the slip as feedback information to understand what went wrong and go back and revision that scenario again and again in your mind. Then do scenario planning again. Keep using slips as feedback information to continue to learn about yourself and keep going until you get it right. It's like tennis. I think people have to try their backhand about 3,000 times until they get it right. But they never give up.

coolwaters: If you throw up after every meal you eat, does that make it impossible for recovery?

Judith Asner: If you stop throwing up, it will be possible to recover. You have to figure out how you are going to stop throwing up after every meal. That is very serious. You are not keeping any nutrition in your body and can be very seriously harming yourself.

fairydust:But how do you fight the urge to binge? If I eat 3 meals a day and binge/purge too, I'm sure I'll put on weight

Judith Asner: If you work with a nutritionist and have 3 healthy meals a day, you will not want to binge because your body will be full on what it needs and you will not crave the binge foods. If you have an emotional need to binge or you are controlling your mood by bingeing or you have a compulsion to binge, you can get help . Medications help control compulsions and emotions can be discussed with a therapist. This is what I mean by a team. Also, by going to a self-help meeting everyday, such as OA, you will get help with your assumptions, which are false, that you can;t eat normally.

AnnetteK99: For the last 8-9 yrs., I've bounced back and forth between bulimia and anorexia. Everytime I try to get better, it lasts for like a week or two. Then I plummet again. Any suggestions?

Judith Asner: Yes. Get continual help, both group and individual, to find out how you can break through this pattern of self-defeat. Also, do you have a mood disorder that is a cycle, called bipolar? If you think you might, I encourage you to see a psychologist or psychiatrist for an evaluation.

David: Some audience members have questions regarding medical issues associated with eating disorders.

Bobski:I am just as you describe. I'm not a daily bulimic anymore. I'm getting much better. I have had the eating disorder for 9 years. I used to binge and purge many times a day. I am now down to a couple of times a week. I have seen multiple therapists and I have been put on antidepressant medication. I do not know what else to do. How can I take my recovery to the next level.

Judith Asner: I happen to think that coaching is a great way to take the eating disorder to the next level, if you are highly functional in every other way. How about mood stabilizers? Have they been tried with antidepressants? Has group therapy been tried? It is great that you are down to a few times a week. I would have to know more about you. It is complicated but you have come far. I would say reevaluate the medications and rethink the strategy. You can go farther. Don't stop now.

For people who are almost recovered, like you, I have some additional thoughts. Let's suppose you are writing a business plan or a strategy about yourself. How would you take yourself to the next level? How about an overall strategy. Get a team of people around you. Have them fulfill different functions. Divide the difficult times into units and ask someone to monitor each unit with you. Assign yourself tasks around the 3 times a week to help you through them. Have a person with you at that time. In other words, you young women who have had the advantage of being out in the business world can apply some of your extraordinary common sense and business training to your own situations!!!!!

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David:As I mentioned earlier, Ms. Asner is not only a licensed psychotherapist, but she also graduated from one of the top coaching schools in the U.S. - The Hudson Institute.

Having a support system is another important part of the overall recovery strategy, isn't it Judi? And when you talk about that, what exactly do you mean when you say "support team"?

Judith Asner: Actually, your support team is anyone who cares about you. For me, being in the field I was where colleagues are so open and loving, I had permission to be whoever I was and still be loved for myself. So if I had bulimia 20 years ago, as a psychotherapist, it didn't matter. I don't know if you all can ask colleagues in the business world to watch out for you at a business lunch or ask an office buddy to help you with the donuts. It is a question of the culture you are in. But any friend, relative, pal, associate or lover who cares about you can be part of your team. I have my coaching clients email me about how the day has gone, and believe me, I look for those emails and look forward to them. Your team consists of anyone who sincerely cares about the well-being of another and is willing to lend a hand. My experience is that for every person who says "Ugh," thirty say, "I'm on board." Thank you, Oprah!!

David:Excellent point, Judith. Earlier you mentioned support groups. So maybe a person could find a support buddy there and not have the personal risk that one might face sharing the news of your eating disorder with a business associate, teacher, etc.

Judith Asner: Well, certain people are really links in the chain when it comes to helping us. Teachers usually know therapists and counselors and psychologists as do personal trainers and school guidance counselors and nurses. I wouldn't tell your CEO, if that is what you mean. Corporate America is not touchy feely and law firms are certainly not cuddly places. A buddy is a good idea. However, there are Employee Assistance Programs in most corportations and government agencies and the EAP counselors are bound legally to maintain privacy and send you to an appropriate treatment specialist.

David:One last thing I want to address, which you brought up to me in your email and then we'll go to more audience questions. "Practice" - the idea of trial and error. Can you elaborate on that, please?

Judith Asner: Yes. Just because one therapist has not been the right one for you, dont give up.You will eventually click. Ask your therapist if she has recovered from bulimia. If you keep failing on the food plan, keep trying. Go to OA meetings and get a sponsor. Use feedback to analyze what doesn't work. Figure out what were the triggers to "losing it" and try again and again.

David: Here's what Judith wrote me in the earlier email: There is no such thing as "it doesn't work" --you keep seeking, practicing, revising your plan until it works, changing this and that piece till the pieces fit.

Judith Asner: Also, do you belong to a spiritual community where you get sustenance or do you have a practice that is peaceful like yoga or do you spend some time helping others? This is part of a wholistic approach to life and recovery.

David: Let's get to some more audience questions. Earlier Judith, you said that recovery may mean a balance; not full-blown bulimia, but possibly sporadic episodes. Of course, if you had full-blown bulimia, that would be a great improvement. Here's a question on that:

tooey: What about people who consider episodic binging and purging to lead back to full-blown bulimia?

Judith Asner: Well, that is certainly a danger and that is why one must always let someone know immediately if the problem begins again and sort out the reason for the relapse---immediately!

Me5150:My husband is bulimic and refuses to believe he has a problem. I believe he is still binging and purging, but is hiding it more now than ever. How do I help him when he doesn't want to help himself?

Judith Asner: This is a tough question. Perhaps an intervention from those who love him would help. You can find that e-book on my web site beatbulimia.com. An intervention is a long process . I think men have a bigger problem admitting this than women.

liza5: Is it possible to "retrain" your body after you've had an eating disorder for a long period of time? I've been bulimic for 13 years, nothing "wants to stay" very long and it's very painful.

Judith Asner: Yes, you can retrain the body. We, and the body, are "miracles" and move toward wholeness and healing. First, get to a doctor to make sure everything in the gastrointestinal area is working well and then figure out what you can eat comfortable. There are meds that help with digestion and relaxation of your stomach and perhaps someone can stay with you and help you get used to that period that is so difficult after a meal.

jenniegator: Is there a physical withdrawal associated with recovery from bulimia?

Judith Asner: Oh, I would imagine there are lots of physical feelings that you would have to tolerate, real and imagined. That is what a professional can help you with, especially feeling fat when you are not.

pheobee:First, how do you get past that strong belief that you WILL gain weight no matter what?

Judith Asner: Well, in fact, you will rehydrate and gain some water weight because your cells have been dehydrated. But that is just 5 lbs. You will have to take that leap of faith and get lots of support from your team. And also, what will happen if you gain a few pounds? Is it perferable to the risk of dying?

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pheobee:My therapist and I are both very frustrated because I continue to purge and I don't get any better. She doesn't really understand because she has never had an eating disorder and has only been a therapist for 2 years. Is it more helpful to have a therapist with more experience and/or personal experience?

Judith Asner: Yes. Your therapist may be a wonderful person and a great therapist, but she should know how to manage your binge-purge cycle. What good is it doing you if you and she are in the same place? She is supposed to know what to do to help you. Let her help you find a specialist in this area.

Joy Joy:I am a recovering bulimic. A 15 year bulimic and now add 15 years in recovery with only an occasional, short relapse. Most of the past 15 years I have held off the beast. I am unable to find a way to safely lose the recent gain of twenty pounds. Dieting always brings on a feeling of deprevation and binge eating and triggers a relapse. What can I do?

Judith Asner: Probably exercise is the way with weight lifting, or acceptance of yourself. How about Weight watchers?

Be strong: I'm in self help and I'm starting to relapse -- six times in this past week. Is it time to seek medical help? And, if so, how do I ask my parents?

Judith Asner: Yes. Just ask. They are your parents, you know. I don't think they want you to be sick.

FlamingFireOf*Peace*: I am 16 and was in wrestling for my freshman year. I am pregnant, 14 weeks. The urge to purge, like I used to when I had to cut weight for wrestling always comes back to me. How much harm can this do to my health, being in this position?

Judith Asner: A great deal. Go see a nutritionsit. You need to eat when pregnant. It is normal. Don't deprive the fetus of the nutrition it needs. It can do damage. Go NOW and find out the accurate information you need.

David: When it comes to addressing problem areas, some parents have trouble communiticating with their children. With that in mind, here's the next question: (for parents, read: Survival Guide for Parents with Eating Disordered Children and Help for Parents of Children with Eating Disorders)

LaurenD:How can I help my daughter?

Judith Asner: Can you be more specific?

David: I think what she means is how does a parent approach their child about their concern and what if the teen continues to deny there's a problem?

Judith Asner: If you KNOW that there really is a problem, I recommend you get the ebook, Intervention, on my site and read it. It tells how to intervene to help a youngster. The longer you wait, the more entrenched this behavior becomes. So deal with it right away if you have the evidence of vomiting, food disappearing.

David: Here's a helpful comment from a teen who's been there:

FlamingFireOf*Peace*: I know, being a teen myself, when my parent approaches me that, yes, I will deny a lot. But if they continue to show love towards me to help, I will open up to them. It's just a love of loving, not pushing, persistence.

David: Thank you, Judith, for being our guest today and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a very large and active community here at HealthyPlace.com. You will always find people interacting with various sites. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com

Thank you, again, Judith, for being here this morning.

Judith Asner: Thanks, David and friends.

David: Have a good day everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Online Conference Transcript

Jane Latimer , our guest, author, and therapist, struggled with eating disorders and binge eating during twenty long years. What did she learn that helped her recover?

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts, the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our topic tonight is "Binge Eating and Self-Esteem". Our guest is Jane Latimer. Ms. Latimer holds a masters degree in psychology and is a therapist, coach and mentor. She is CEO of The Aliveness Project, a mentoring program for women with food and weight issues. And Ms. Latimer is author of several books including "Living Binge Free" and "Beyond the Food Game." For twenty years, she suffered with various eating disorders, including binge eating. She says it's been eighteen years since she broke free from the pain of those eating disorders.

Good evening, Jane, and welcome to HealthyPlace.com. Thank you for being our guest tonight. The first thing, I'm sure, that everyone would like to know is: How did you do it? What were the keys to your recovery from eating disorders?

Jane Latimer: A lot of things. I believed I could fully recover because I didn't believe that I was being my real self. Then, I got into a food plan, which enabled me to start feeling things. The food plan provided space for me to get in touch with myself.

The spiritual part of my recovery from eating disorders was so very important, because I knew that I was first and foremost, a beautiful being who was loved by my Higher Power. The eating disorder wasn't me. I learned that I wasn't really all those horrible feelings I had. And I learned to use the feelings to discover my truth, my authentic self which is in alignment with the FLOW, or with Higher Power. I also began to really trust myself. That took awhile, but I had to learn to trust ME, not be what I thought others wanted me to be.

David: What is the difference between binge eating, overeating, or being a compulsive overeater?

Jane Latimer: I like to think of binge-eating as a feeling of being out-of-control. While overeating is more eating when you are not hungry.

David: What causes someone to binge eat?

Jane Latimer: That's very complex. I like to follow 3-tracks.

• Track 1 is looking at the biochemistry.
• Track 2 is looking at the underlying emotional issues.
• Track 3 would be the relationship to food itself.

Usually, when I ask people not to binge-eat when they want to, they describe the feeling as being out-of-control. The word I use for that feeling is fragmented. A person feels panicky, scattered, disoriented and food helps them get grounded and numb out.

David: I'm assuming that since you were involved with eating disorders for twenty years, separating yourself from food issues is a very complicated process. Am I right about that?

Jane Latimer: It's very scary. There are so many scary feelings that a person doesn't know how to deal with. They can't make sense of it. It's very overwhelming. So, it's easier just to go back to the food. I always suggest that people work with safety. It is very important to build safety resources, both internal and external, so that giving up their reliance on food becomes easier. They, then, have other things they can rely on.

David: We have some audience questions, Jane, and then we'll continue:

Becky1154: Have you used other ways to cope with the stressors that used to make you binge?

Jane Latimer: Absolutely, I use many things. I've grown to rely on my ability to process my feelings, if not with another person, then in my journal. I journal daily and I also meditate daily. I exercise quite a bit, because that keeps me feeling good. I also have really worked on shifting my "negative mind" so that I don't let it ramble on for days on end anymore. I think that everything that is happening is always for my best. That's what has gotten me through.

David: Going through your site, you talk a lot about what I like to call "alternative" healing methods vs. strict therapy for eating disorders. Can you expand on that for us here and tell us what role that played in your healing and continues to play today?

Jane Latimer: Actually, I recovered before there was therapy for eating disorders, so I used all alternative healing methods. As I mentioned, my recovery process was mainly through my spiritual practice. I learned how to work with my feelings spiritually. I used Overeaters Anonymous (OA) for the first three years, as I was recovering because I needed the support of the group and my food sponsor. But then, I broke away because I didn't believe, as they did, that I'd always be a compulsive overeater. I, then, began testing different foods and teaching myself how to eat them. I would say that the biggest help to me was learning how to love myself and that I got through my spiritual program. I literally learned to love myself through everything. I'd meditate and think of surrounding myself in loving light. I'd love myself when I binged. I practiced sending loving thoughts to my body (which I hated by the way.) Soon the love words, and the light, and the meditations just began having their effect.

I also would experience some spontaneous regressions during my meditations in which I felt myself very young in darkness and void, very empty, very despaired, but I always brought light into those dark spaces. It was the creation of the Sacred Healing Space that created a container for my healing. So while I was despairing, and feeling shame and stupid, I was also in a "Sacred Space" that I had created for myself through my spiritual teachings. I felt like I was actually transforming my past. I wasn't just venting or reliving the pain, I was transforming it.

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David: You touched on Overeaters Anonymous. Here's an audience question about that:

jat: I'd like to know what you think of the twelve-step model of recovery, applying it to food. Does what works for alcoholics, work for compulsive overeating?

Jane Latimer: It works for some people, not everyone. Track 1 is the track that deals with biochemistry. And some people absolutely cannot tolerate sugar or flour. They do well with a strict OA food plan. And the twelve steps can be very, very helpful. But not everyone needs to do this. In fact, it just doesn't work at all for some people.

ms-scarlett: What, exactly, was your food plan?

Jane Latimer: I was on a very strict weighed and measured plan with no starches at all. It was called Grey Sheet and I believe they don't have it anymore because it's not considered too healthy.

David: What did it consist of?

Jane Latimer: I would prefer not to go into details about it, because I don't think I'd want people copying it. Instead, I would prefer you talk to a dietician or go to OA or HOW, or FA and get a food plan that they're using today.

dnlpnrn: I can't quit eating, partly because I don't want to look good. When I looked good, too many times it only brought more abuse, more trauma. I don't love myself. I don't want anyone to see me. I don't even look in a mirror at myself.

David: What would you suggest in this instance, Jane? I think a lot of people involved in binge eating or compulsive overeating feel this way.

Jane Latimer: That goes back to the safety I was talking about before. We have to learn strong boundaries. We have to learn to say "no." We have to learn that who we are is loveable, even though people abused us. It's about learning that the abuse was about them, not about us. It's about learning how to strengthen ourselves from the inside out, learning to become strong. Sometimes, it means feeling the rage for a very long time, maybe even years. The anger has to be directed outward, so it's not going inward to the self.

As children, we can be hurt, because we are small and vulnerable. And when we're hurt like this, we don't learn how to fight back. So, one of our biggest jobs is to learn to fight back and to say "no." That is a skill that we can learn. Then, when we have that skill, we begin to feel safer to be in our bodies.

David: Here are a few audience comments about what's been said so far, then we'll continue:

tereeart: I totally agree with Jane that, self talk that is positive, really changes my behavior.

dnlpnrn: I am a victim of child abuse and I know now, that is a large part of the reason I binge eat. I do it to relieve my anxiety and it seems like I just have to eat like that when I am upset. You are right about the out-of-control part. I do panic and it is like the food is a source of comfort to me.

Jane Latimer: The panic underneath the binge-eating is the biggest thing to learn to deal with. That is what all of my work is about with people. I help people take the mystery out of the out-of-control place and help people understand it.

David: How long did it take you to come to grips with your eating disorders and go through the healing, therapeutic process?

Jane Latimer: I was working on myself from the age of twenty-four. When I was twenty-eight, I really got it, that my food was a bigproblem. Then I worked very hard for the next few years. So by the time I was about thirty-three years old, I was pretty much okay.

David: What about relapses? Have you had any? Or any urge to go back to the old ways?

Jane Latimer: Not since that time. No, not at all. Although before that, all during my recovery period, from age twenty-eight to thirty-three, I was relapsing off and on. I'd do well for awhile and then I'd just have a bad episode. This happened over-and-over again. The most important thing is to pick yourself up and keep going forward.

David: One of the things that struck me, Jane, was the use of the phrase "out of control" eating. What produces that feeling? And how, specifically, would you suggest one cope with that?

Jane Latimer: That is a real big topic and the subject of my book, "Beyond the Food Game." But to briefly describe it, it is an experience of being back in the original wound. So, for example, since we were talking about child abuse, when we are feeling out-of-control, something has usually triggered that feeling. Maybe a person looked at us in a mean way and that triggers the memory of the old abuse (or an old wound, whatever it is). That old wound is felt in the body (all wounds are in the body). Then the disoriented feelings starts to happen, like we can't tell if we are in the present or in the past. And in fact, the experience is a memory. If we can understand that the out-of-control feeling is a memory we are experiencing in our bodies, and we know what to do at that point, then we have the incredible opportunity to heal it. If we don't understand that, we reach for food, and we never get the healing. We perpetuate the cycle and it never stops.

David: What about those who haven't been abused. Why do they get involved in binge eating?

Jane Latimer: There are two types of wounding: abandonment and invasion wounding. I was never abused. I was "abandoned." My parents were not present for me and I just didn't learn how to be present for myself. So, it doesn't matter what the wound is; however, it does matter that we understand the wound, for then, we can heal it. Because for every wound, there is a corresponding healing that is very specific.

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David: Are you talking about emotional detachment?

Jane Latimer: Yes.

David: So, to clarify, there are some who were physically or sexually abused, and binge eating is one way of dealing with those issues. Others, are coping with strong emotional issues.

Jane Latimer: Yes, underneath most emotional eating, is a wound. We're all wounded. It's wounding just to be born. But some of us are wounded more than others.

David: You can purchase Jane Latimer's book "Beyond the Food Game" online.

And now, we have another question:

ms-scarlett: Do you agree with the Geneen Roth method of eating only when hungry or do you agree more with the three square meals a day strategy. I need to know what to eat if I'm going to be thin.

Jane Latimer: Again, it depends on a lot of complex issues. If you're very sensitive to sugar or flour, then you might not be able to handle those foods. So Geneen Roth's natural eating method doesn't work. On the other hand, the three squares don't work for some because it's too rigid. I like to think of Full Recovery from eating disorders as a process in which we learn to eat in a way that supports our unique biochemistry and that is different for different people.

David: One of the things Ms. Scarlett said was her goal is to be thin. Should that be the goal?

Jane Latimer: If the goal is to be thin, then we can be in trouble. I prefer to think of the goal as aliveness. When I was recovering, I remember I had to confront and get over my fear of fat. That was very important. Because if I didn't, then the scales would be my God. I'd be happy only when the number on the scale said what I wanted it to say.

However, if my goal is Aliveness, then I'm in charge of my own happiness. And the potential is always there. I can be happy no matter what I weigh, and no matter what life presents me with. With our priorities straight, we are free to lose weight if that is appropriate.

David: Can you define "Aliveness" for us?

Jane Latimer: Aliveness is about the body-felt experience of joy and that is felt in the heart. We love living. We are able to choose things that bring us joy. We can say no to things that don't bring us joy. And we can find "joy" in many things, even in those things that appear to be stressful. Aliveness is about being in control and surrendering at the same time. It is about living in alignment with the flow of life. To feel alive is to be full and fulfilled, even when things aren't going as planned. In fact, aliveness happens outside of the plan.

tereeart: I like that perspective of making your goal aliveness, not thinness. I also like the thought of using your abilities to meet your needs, not others.

Jane Latimer: I like to call that Extreme Self-Care. Meeting my needs is so important. It was learning how to really honor my needs, that enabled me to deal with life. Because before that, I couldn't deal at all. I was overwhelmed. So, I learned to meet my needs however I could. Little by little, I've inserted things into my life that truly meet my needs more-and-more.

David: I always like to give our audience something they can take home with them. If you are "out-of-control" with your eating, what is the first thing you would suggest that person do to regain control and move towards recovery from eating disorders, binge eating?

Jane Latimer: Not joking, read my book, "Beyond the Food Game." I don't know anyone who addresses these issues as succinctly as that. Because I list very specifically the steps to healing the out-of-control experience. After that, I'd say, journal. Journal about what triggered the feeling. Then, ask yourself, is there something about this situation or feeling that reminds me of my family? Then I'd ask myself, "What did I need as a child, that I didn't get?" Then it is your job to give yourself what you didn't get then. Its really quite simple, its just hard to do at the time.

David: Thank you, Jane for being our guest tonight. For those in the audience, thanks for coming and participating. I hope you found the conference helpful. We have a large eating disorders community here at HealthyPlace.com. So please feel free to come by anytime and also to share our URL with others you may know. It's www.healthyplace.com Good night everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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online conference transcript

Kathleen Young Psy.D. , our guest, has fifteen years of experience treating eating disorders. She has studied and helped many with eating disorders such as anorexia nervosa, bulimia nervosa, and compulsive eating. Here, Dr. Young discuss recovery from anorexia, treatment of eating disorders, eating disorder relapses and shifting between being anorexic and bulimic.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts, the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Treating Anorexia: The Recovery Process."

Before I introduce our guest, here is some basic information on Anorexia. You can also visit the Peace, Love and Hope Eating Disorders site in the HealthyPlace.com Eating Disorders Community.

Our guest is Kathleen Young, Psy.D., who has fifteen years of experience treating those with with anorexia, bulimia, and compulsive eating. She is located in Chicago, Ill. Besides obtaining her Doctorate in psychology, Dr. Young received additional training in the treatment of eating disorders at Northwestern Memorial Hospital and the University of Arizona's Medical Center.

Good evening, Dr. Young and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Many people talk about wanting to stop being anorexic, yet they find it extremely difficult to accomplish that. Why is that?

Dr. Young: Hi everyone! It's great to be here. That's a good question. I think its important to remember that anorexia is a complex disorder and that it begins as an attempt to cope with, or manage, some circumstances and feelings in the individual's life.

David: Just so we are all on the same page here, when you use the word "recovery," what do you mean by that?

Dr. Young: I think of it as having two components, the surface or behavioral level of working towards a healthy relationship with food, and the underlying issues such as feelings, personal issues, and self-esteem for example. We can't just focus on the food or eating behavior.

David: Are there cases that you can think of, where it would be impossible that a person could recover?

Dr. Young: I would never want to think that in advance! I believe that recovery from anorexia nervosa is possible, even if only to some extent. It is ultimately up to the individual.

David: What does it take, inside the person, to bring about a significant recovery?

Dr. Young: It often takes first getting to the point of being sick and miserable with how things are. It often takes the motivation of pain to make us want to change! It also takes perseverance and patience with what can be a long process, as well as, the willingness to let go of rigid ideas about weight or food. However, the last happens gradually with a lot of support.

David: We have some audience questions, Dr. Young, and then we'll continue with our conversation:

Lexievalle: How do we acquire a support system for recovery?

Dr. Young:That is very important, Lexievalle. Without support from others, it can be harder to give up the comfort of the old behaviors. The first step is getting an experienced therapist. There are also many free support groups in most areas, such as ANAD (National Association of Anorexia Nervosa and Associated Disorders). The internet can also be a source, as we see here :)

brewnetty:Recovery is being able to eat without fear, right?

Dr. Young: Brewnetty, that's a great way to put it! Often anorexics become very afraid of food. It can seem like the enemy, rather than a part of healthy self care. I would also add the ability to value yourself for aspects beyond weight and appearance.

David: One of the things I would like you to clarify, because we get emails that go something like this: "I'm hardly eating or eating very light meals. I'm always concerned about food, but I don't weigh 78 pounds. Am I still anorexic?" Could you answer that question, please?

Dr. Young: Yes, I hear that a lot too. "I'm not thin enough to have a problem." Anorexia does not require any specific weight. It is diagnosed by:

• the drive for thinness
• pattern of restricting
• weight loss
• loss of menstrual period

However, you still may have an eating problem even if you do not meet all the criteria. If it takes up a lot of your time, and energy, and makes you unhappy, it is a problem.

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David: Here are some more audience questions:

joycie_b: I understand that Anorexia is about emotions, not the actual food. If this is true, then what is the best way to help my friend to talk about what she ate that day and help her realize it was not "too much" or should I not bring it up at all?

Dr. Young: Joycie, it is great you want to help your friend! This is a common concern, because actually focusing too much on the food and eating can make things worse, since needing control may be a factor for the anorexic. It's helpful to honestly express your concerns and what you see one time and then ask how you can be of support. You should be there to listen, validate feelings, and tell your friend all the great things about her or him.

David: Joycie, here's a great resource for family and friends of those with eating disorders.

EHSchic: I am not eighteen yet. Is there anywhere that I can get help (as cheap as possible) without my parents finding out?

Dr. Young: EH, I know that's tough. You may need to consider whether its worth involving them to get financial help and whether they can be of any support. Sometimes anorexic's don't want to tell parents for fear of hurting or burdening them, but that is part of the problem because your needs are important. If it is really not an option, than please check at any local colleges or universities, because they usually offer counseling programs. You can even check any community health centers. ANAD is a group that runs free support groups in many areas.

David: Dr. Young's websites are here:

• Counseling Referrals located at: http://www.counselingreferrals.com
• and Affirming Alternatives located at: http://www.affirmingalternatives.freeservers.com

Dr. Young, how would you suggest that teenagers with eating disorders broach the subject with their parents? Many say they are afraid to because their parents would be disappointed in them or feel let down or they don't want to burden them?

Dr. Young: Right. I know it is tough and may go against a long family pattern. Sometimes it helps to share a book on eating disorders, or written information, like from a website. Basically, tell them whichever way you can, the behavior and how you feel about it. Let them know you love them and need their help and support. Family therapy is often important to change the old habits of all family members that contribute to the development of anorexia.

chatter:Doctor, do you find it difficult to deal with the families of anorexia sufferers in the way that they perceive the disease? For example, a family may think recovery is as simple as making the sufferer eat again and not recognize the emotional and psychological issues behind anorexia. (how to support someone with anorexia)

Dr. Young:Chatter, yes that is often the case. Families need to be educated about the eating disorder and they have to learn that telling someone to eat, will not fix the problem. It is not a "just pull yourself up by your boot straps" type of situation. If it were that easy, you would have done it already!

Krystie: I am twenty-eight years old and have taken on many anorexic tendencies just in the last year-and-a-half alone. Because of my age, I am regarded as childish and looking for attention; treated as though I am using this as a game, when I have spent so much time, effort, and money to overcome this. How does an adult sufferer begin recovery with this societal attitude?

Dr. Young: Krystie, I am sorry you are encountering that bias! How unfortunate. Women and men of all ages can suffer from anorexia. Because it does often begin in adolescence, there may be that confusion. Try to find a good therapist with experience with anorexics at different ages, and a group (or treatment program) with an age range as well.

David: Here's another question from an adult, Dr. Young:

scarlet47: I am fifty-one years old and have had anorexia for four years. I also have PTSD (Post Traumatic Stress Disorder) and self-harm. All stem from abuse and a frightening fear of abandonment. Is this becoming more common with middle age women? Mine never started with the thoughts of wanting to be thin. I had high blood pressure and they said I needed to lose weight, as opposed to taking medications. I guess I went to the extreme. I have been with a private therapist and have lost twenty-five pounds since. I feel so alone because most eating disorders seem to be associated with teenagers. Thank you.

Dr. Young: Scarlet, thanks for sharing. You also raise important points. One is that anorexia may be part of a more complex picture. It may be one reaction to trauma in the past, like another type of self-harm. Or weight loss can be a symptom of depression. It is important to have a skilled clinician to help you differentiate.

David: I did not realize how many people develop an eating disorder in adulthood. Here's another audience member with a comment:

rcl: Mine started at age 40 !!!!

Dr. Young: I think women of all ages are susceptible. This is a frequent choice for coping, given society's focus on thinness and appearance in women. Getting thin and not eating, can feel like succeeding in the world's eyes. On the other end, girls as young as five, are now talking about being fat and needing to diet!

David: I'm wondering, in these circumstances, were these people predisposed to anorexia and just never developed it until something "kicked in"?

Dr. Young: We don't really know if people are biologically predisposed, set up by their family dynamics and society, or even some combination. It may be that a person used other coping mechanisms earlier, or may have had alcohol or drug problems, so the eating issues did not surface until later. Any time of life transition or stress can be a kind of trigger for developing issues that were lurking beneath the surface.

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lanie: Which methods of treatment of eating disorders are most successful when dealing with an anorexic teenager?

Dr. Young: Family therapy is usually crucial, since the adolescent is often still at home. Individual therapy is necessary, as well. Many individuals, may also work with a nutritionist, to help make food plans.

hopedragon:Dr. Young, thank you for chatting with us tonight. How big is the chance of anorexia coming back after beating it twice? I recovered from anorexia about a year ago and I'm afraid it's coming back.

Dr. Young: Thank you, Hope and everyone. Sometimes there remains a vulnerability to these issues. With stress or loss, that may be the way you turn to cope without even meaning too. It is important not to get discouraged. You have accomplished a lot and can put it into practice again. You may just need a refresher :)

David: So are you saying, if you feel an eating disorder relapse coming on, get back into therapy a.s.a.p.?

Dr. Young: Definitely! The tendency may be to ignore it, but that never works. The sooner the better, before the behavior gets very entrenched again.

Clubby8346: Dr. Young, I am in so much confusion about anorexia right now. About four years ago, I dealt with anorexia for about two years. I was strong, and thank God it was so bad that I overcame it on my own. About one year ago, two of my family members were murdered. It seems like, since then, I have turned to food more and more. I eat all the time and now I find myself wanting to be anorexic again because of all the weight I have gained. I also eat to feel comfort. What should I do?

Dr. Young:Oh clubby, I am so sorry to hear about your loss. Anyone would be rocked by that kind of trauma. Often, women who have anorexia may develop another type of eating disorder at some point such as bulimia or bingeing (binge eating). It's all part of the same spectrum. Of course, anorexia is the culturally preferred disorder. Have you ever heard anyone say "I wish I could be anorexic for awhile?" You need support and help through this trauma and the way it is being expressed is through your eating and not eating. I hope you seek help.

LucyDean: Is it possible to control your problem eating patterns when you are having to deal with relationship and family problems and other anxieties?

Dr. Young: Sure, it just takes planning ahead! Identifying triggers and difficult situations is part of the therapy process. Then you can plan for alternative behaviors. If your family is making you nuts, can you call a friend, go for a walk, yell in the car, etc.? You get the idea?

David: A moment ago, you mentioned a spectrum of eating disorders, where a person may cross between one disorder like anorexia to another, like compulsive eating. Here's a question on that subject:

caraaddison: What advice would you give to someone who is no longer anorexic, and now allows herself to indulge to the point where it is very, very hard to stop? When I am eating cookies, let's say, I can't stop and tell myself it's okay. Then I eat a large amount and later I feel so bad about it. What can I do to find the happy medium of emotions?

Dr. Young:That's a question I bet many share! Remember, starving yourself sets everyone up for the likelihood of bingeing or compulsive overeating, eating later in ways that feel out of control. The best prevention is to make sure you are eating enough, as well as, well balanced meals throughout the day. You may not be the best judge of that. I suggest a few visits with a nutritionist to help develop a meal plan. I believe that foods like cookies need to be worked into the plan so you don't feel deprived.

David: Here are a few audience comments on what's been said tonight, then we'll continue with more questions:

Sonja: Yes, I have had people say they are so envious of my thinness. They have no idea what it feels like to be wiped out physically by a simple cold turning into pneumonia! I think I don't eat because it means taking up space. It is like, by being as small as I can, no one will see me. It is never been about being fat or thin for me.

earthangelgrl: A lot of people say they want to be.

Clubby8346: What can I do? I am so alone and long to be anorexic again.

rcl: I am anorexic and bulimic. I fight the bulimia with the anorexic behaviors and the anorexia with bulimic behaviors. I seem to do it by days. So I have three days right now when I am "bulimic" and four days when I do not binge and purge, but eat only a salad. To be free of the bulimia and anorexia, I think I have to win the fight against one or the other of the eating behaviors first. Is that right? Second, which one do I try to get rid of first?

Dr. Young: Thank you all for your honest sharing. You really demonstrate the pain that is part of this disorder. It is a vicious cycle and often bingeing and purging follow some period of restricting. It is that physical and emotional deprivation. It all starts with re-learning to eat in a healthy way. Sometimes you have to commit to not purge no matter what first. You also need to get help from a therapist to identify what you are using this to cope with, and how to cope instead. Who of us could give up a means of coping without anything else to put in its place?

David: Here's another audience comment:

abumonkeywolfe: Some days, I get so overwhelmed and don't think I will ever overcome the vicious cycle of my eating disorders.

Dr. Young:I can understand, abu! Many people feel that. It helps to have someone else who can hold onto hope for you and help you through those points.

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abumonkeywolfe: Speaking of cost, for those of us with limited funds, what options are available? I've struggled with my eating disorders for nearly thirteen years now. I've asked for help several times through free counseling services available to me, and was turned away. Now that I've joined the work force, time and money are serious concerns in finding help.

Dr. Young: Yes, finances are always an issue. There are referral services to help people find sliding scale or low fee therapy. You need to research your area, do an internet search, or ask someone to help you find resources if you are too overwhelmed. Then there are free support groups and twelve step groups like Overeaters Anonymous. Some anorexics and bulimics find OA meetings helpful and think about restricting, bingeing and purging as their "addiction. I wish there were a simpler answer! You can contact me through my sites by email and I can share the resources I know about.

jode101: I've been anorexic for five years and I have severe health problems now. I was wondering if there was an average time it takes for someone to get over this disease?

Dr. Young: That is a good question. I don't know of any figures off the top of my head. I expect that the longer it has gone on, the longer it may take to heal. Another factor is how willing you are to gain weight if need be to get well.

halle: I am twenty-three and have had anorexia subtype purging for what seems like forever (since I was thirteen). Is there any way to change something so long standing? I'm in medical school and I think that this is my coping mechanism. The stress isn't going away and I am kind of lost at the moment. I feel like it is not going to change.

Dr. Young: I understand why you feel that way and medical school is stressful, but it is never too late. The sooner you seek help, the sooner you can get better. You really can find other ways to cope and feel good about yourself. However, it can be scary. Some say the eating behavior can feel like a best friend, but what a destructive one. We haven't talked about this aspect, but anorexia is life threatening and can have long term health consequences. It is so worth getting help.

jode101: Dr. Young, how do you educate a spouse about an eating disorder, if they don't believe or understand it is a real disease?

Dr. Young: Jode, that's tough, and furthermore, not being validated like that, may be part of the problem. Sometimes an outside party can help, or even a book or an article. The bottom line though, is to do it for you, no matter what other people believe. You all deserve it!

David: We touched on eating disorder relapses earlier, but apparently it's a real concern among many in the audience tonight. Here's another question on that:

vancek: I am twenty-one and have been anorexic for about two years now. I have never been anywhere close to recovery, but for a while I was doing better (though my nutritionist questions even that). Anyway, I'm really relapsing again, and now I am scared. It seems that I get worse when stressed. I have a really hard time even admitting most of the time that it's getting bad and I need suggestions on pulling out of a relapse?

Dr. Young: Sharing, like you are here, is a great step. You need to admit to those you work with, that it feels like a relapse. Try to trust their recommendations on what will help you manage stress differently. Some suggestions are relaxation techniques like breathing and yoga. These can be great. Good luck! And remember, progress is often up and down like this.

David:Thank you, Dr. Young, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. I hope you found it helpful. We have a large eating disorders community here at HealthyPlace.com. You will always find people in the eating disorders community, interacting with various sites.

Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com.

Thank you again, Dr. Young.

Dr. Young: Thank you all for this opportunity. I wish you the best in your healing journey.

David:Good night, everyone.

Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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back to:   Eating Disorders Conference Transcripts
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Anorexia, Bulimia, and Compulsive Overeating Chat Transcripts

1. Anorexia Story: Getting on the Road to Anorexia Recovery
   Guests: Stacy Evrard, Dr. Harry Brandt
2. Beat Bulimia - Bulimia Treatment with Judith Asner, MSW
   Guest: Judith Asner MSW
3. Binge Eating / Compulsive Overeating with Joanna Poppink
   Guest: Joanna Poppink, M.F.C.C.
4. Binge Eating and Self-Esteem
   Guest: Jane Latimer, author and therapist
5. 'Body Image' Conference with Carolyn Costin
   Guest: Carolyn Costin
6. Dr. Steven Crawford on Compulsive Overeating
   Guest: Dr. Steven Crawford
7. Compulsive Overeating and Binge Eating with Glinda West
   Guest: Glinda West
8. Compulsive Overeating: Dealing With The Feelings and How To Treat It
   Guest: Dr. Deborah Gross
9. Compulsive Overeating with Dr. Matthew Keene
   Guest: Dr. Matthew Keene
10. Defeating Your Eating Disorder
    Guest: Dr. Ira Sacker
11. Eating Disorders Diagnosis and Treatment
12. Guest: Dr. David Garner
13. Eating Disorders with Dr. Brandt
    Guest: Dr. Brandt
14. Eating Disorders Hospitalization
    Guest: Rick and Donna Huddleston
15. Eating Disorders Recovery with Dr. David Garner
    Guest: Dr. David Garner
16. Eating Disorders Treatment Centers
    Guest: Noelle Kerr-Price, Psy.D.
17. Eating Disorders - Getting the Help You Need
    Guest: Jonathan Rader
18. For Parents, Spouses, Friends & Relatives of those with eating disorders
19. Guest: Mary Fleming Callaghan
20. Help For Parents Of Children With Eating Disorders
21. Guest: Dr. Ted Weltzin
22. How to Tell Others About Your Eating Disorder
    Guest: Monika Ostroff
23. I Recovered From My Eating Disorder, You Can Too
    Guests: Linda, Debbie
24. Is Self-Esteem Healthy? What Kind of Self-Esteem Is Unhealthy?
    Guest: Dr. Robert F. Sarmiento
25. Life With An Eating Disorder
    Guest: Alexandra - Peace, Love and Hope Eating Disorder Site
26. Overcoming Overeating
    Guest: Jacki Barineau
27. Positive Body Image
    Guest: Dr. Debra Brusard
28. Identifying and Preventing Eating Disorders
    Guests: Holly Hoff, Dr. Barton Blinder
29. Recovery from Food Addiction, Food Cravings
    Guest: Debbie Danowski, food addict and author
30. Recovery from Overeating with Joanna Poppink, MFT
    Guest: Joanna Poppink, MFT
31. My Struggle With Anorexia: Something's Fishy with Amy Medina
    Guest: Amy Medina
32. Strategies for Recovering From Bulimia and Other Eating Disorders
    Guest: Judith Asner, MSW
33. Survival Guide for Parents with Eating Disordered Children
    Guest: Dr. Cris Haltom
34. Surviving Bulimia
    Guest: Judith Asner, MSW
35. The Meaning of Eating Disorders Recovery and Help for Family and Friends
    Guest: Dr. Steven Crawford
36. The Psychological and Medical Risks of Eating Disorders
    Guest: Dr. Ira Sacker
37. The Relationship Between Eating Disorders and Self-Injury
    Guest: Dr. Sharon Farber
38. The Truth About Life After Eating Disorders
    Guest: Aimee Liu

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