Saturday, May 23, 2015

A Daughter’s Anorexia And Her Mother’s Fight To Save Her

About 24 million Americans suffer from eating disorders. They are among the most difficult psychiatric conditions to treat and have higher mortality rates than most other forms of mental illness. Clare and Elena Dunkle know these statistics well. This mother and daughter pair has just released companion memoirs, documenting Elena’s struggle with anorexia nervosa. Written for young adults, “Elena Vanishing” traces the story as Elena moves in and out of treatment, her disease threatening her life. “Hope and Other Luxuries” recounts the same events from the perspective of a mother, desperately battling for the health of her child. We hear their stories and more about the disease from an expert.

Guests

  • Clare Dunkle former librarian and award-winning children’s novelist. She is the co-author of “Elena Vanishing: A Memoir” and author of “Hope and Other Luxuries: A Mother’s Life with a Daughter’s Anorexia.”
  • Dr. Angela Guarda associate professor of psychiatry and the director of the Eating Disorders Program at The Johns Hopkins Hospital
  • Elena Dunkle co-author of “Elena Vanishing: A Memoir”

Featured Excerpts

Elena and Clare Dunkle have both written about Elena’s battle with anorexia. Here are parts of their stories.

Elena and Clare Dunkle

Sunday, May 17, 2015

The Hunger: A True Story of Anorexia by Maura Kelly


woman in bikini on beach


It was in the eighth grade — four years after my mother died — that I first remember becoming unhappy with my body. Every night, after brushing my teeth and squeezing some blackheads, I'd look in the mirror and pound on my abdomen with my fists. Although I know now that it was just an early sign of puberty, I was disgusted by the way my belly had begun to protrude under the band of my underwear. So I got the idea to make it disappear by losing five pounds, then 10, and then 15. Pretty soon I was addicted to losing.

It's a control thing, doctors say, and in my case that was all too true: I needed to organize a world that had been thrown into chaos after my mother died. Her death had come as a complete shock to me; she'd never told me she had cancer, or that she was dying. And with her sudden disappearance, all the things that I'd trusted as absolutes — all the other foundations of my life — began to crumble.

I couldn't believe in God anymore, not when I'd been such an incredibly dedicated little Catholic and all I got in return was a vicious punishment. What kind of system was that? I couldn't believe in my earthly father, a construction-working Irish immigrant who'd become angry, depressed, and dysfunctional — a sad version of the charismatic and fun-loving dad I once knew. I couldn't believe in my own worth anymore, either. Catholicism had set some deep grooves in my soul, and even if I'd rationally given up on God, it was impossible to free myself from the magical thinking that goes along with religious zealotry: Deep down, I thought I must be damned if my mother had been taken away from me. Flawed, cursed, worthless. That was me.

Dieting became a way of imposing an external value system on my flesh: If I could control myself enough to lose another pound, I was that much closer to good. I hoped I could redeem myself.

That Fall, I started my freshman year at an all-girls Catholic high school, and kept chiseling away at myself, trying to purify my soul through the transformation of my body. By October, I was subsisting on almost nothing — about 250 calories a day. I'm amazed I had the energy to get up and go to school every day, let alone keep up with varsity soccer practice. But despite how uncomfortable my body was — I was exhausted and freezing because I had no body fat — my mind felt better than ever. If dieting was my new religion, I was on my way to becoming a saint.

The skinnier I got, the harder it was to keep the adults around me from noticing, although I did everything I could to hide my body. I'd spend lunch hour in the library. I'd change for soccer practice in the bathroom, instead of in the locker room with everyone else. I'd wear extra layers under my school uniform and baggy clothes at home — not that they did much to quell my father's growing suspicions.

He and I seemed to do nothing but scream at each other. Our fights almost always reduced me to sobs — which just induced him to get louder. "Why are you crying? I wish I could cry," he'd taunt. "But what would happen to us if I lay down and cried? This family would fall apart!" I'd despise myself for being a baby, but the more I hated myself, the harder it was to stop my tears.

Our fights often began over the news headlines, like abortion and capital punishment. On the surface, those clashes were political: I was a budding liberal and he was a Reagan-loving Republican. But I think I was also arguing that I deserved to have control over my body, and by extension, my mind. I wanted to be free of that miserable house, and the deadly gloom that had descended on it, and my own depression.

As I continued to wither, my father kept on shouting, but he also began to cajole. "Please eat," he'd say. "For me? A little food's not going to hurt you." As satisfying as it was to hear him plead, the better pleasure was knowing that I finally had the power I wanted — over my body, and over him.

So I stopped caring about what he thought, focusing instead on living up to my own standards of starvation. As long as I concentrated on them, I didn't have time to dwell on anything else — not when my head was so full of caloric calculations, and my body so empty.

By November, things started happening that I couldn't cover up with clothes or lies. My feet had gotten so thin that my soccer cleats had cut holes into the skin around my ankles; after several weeks, the resulting sores got so bad that I started to hobble. One day, when I could barely walk, my coach called me over. "You look terrible out there — like a drunk with two broken feet," she said, forcing a laugh. "What's going on?"

I made some excuse, but she had me sit out the rest of practice.

When I got home that afternoon, my coach had left a message for my father on our answering machine. "Could you please call me as soon as you can?" her recorded voice said. I erased it.

The next morning, when I tried to get up from my desk after Spanish class, I collapsed. The nun who was my teacher peeled me off the floor, and with her help, I was able to stand, then limp, but it seemed clear my left leg was paralyzed from the knee down. My father took me to my pediatrician, who told me I was so bony that I'd pinched an important nerve simply by crossing my right leg over the left. I'd probably be able to regain feeling — eventually — but only if I gained weight, he said.

As we drove home in my father's red pickup truck, he cried in front of me for the first time since my mother's funeral. He recounted a story about watching his 6-year-old brother die of lockjaw on Christmas Day, less than a week after stepping on a rusty nail. My father's parents were so devastated, his mother barely got out of bed for a year. He'd worried his father would drown himself in the tide off the coast of western Ireland, where they lived. "I'm not sure I'd be able to live with it if I lost you too," my father told me.

I felt sorry for him for going through all that as a little boy, and I knew he was only trying to get me to eat, but the way he put it annoyed me. He made it sound like my suffering was significant not because I was in pain, but because it made his life more miserable.

A couple of weeks later, my father took me to see a New York City eating-disorders specialist, Joseph Silverman. He was a bald man with a maroon silk bow tie that bloomed at the top of his lab coat. Sitting across from him in his fancy office, I felt underdressed in my school uniform, and embarrassed by my father in his jeans and work boots.

"You're in terrible shape," Silverman said after examining me. "I've seen a lot of bad patients, but never anyone whose leg has gone out like yours." I nodded, hoping he wouldn't notice how pleased I was. Being the worst patient meant I was the best at losing. It meant I was tough and in control.

"I'm sure you're happy to hear you're one of the worst cases," he continued, like a mind reader. "But keep it up and more important parts of your body will give out. Your kidneys. Your heart. And I don't have to tell you what happens to people whose hearts stop."

"What — they have heart attacks?"

He nodded. "And some of them die." Only when he said that did I realize death was what I'd been gunning for all along. Of course, the idea of not being alive was terrifying — but at the same time, I wasn't sure I deserved to live.

Fat tears tripped down my face.

Silverman pushed a box of tissues toward me. "Your father is here today because he thinks I can save you," he said. Out of the corner of my eye, I could see my father pull himself forward toward the desk. "I'd give up my life for her, doctor. Whatever it takes."

Silverman looked at me. "Do you want to get better?"

I paused. "I used to like what was happening to me," I began shakily. "But now I'm scared I'll never be able to stop until . . ." I couldn't say it. "I do want to get better."

After four months I was discharged from the children's ward of Columbia Presbyterian. I weighed 100 pounds, and my leg had improved so much that you wouldn't notice my limp unless you were looking for it.

But it was another 10 years before I got all the feeling back in my foot, and even today, I'm still waiting to emerge from the emotional numbness. Now I realize that, more than anything, losing weight was an attempt to starve certain feelings — of depression and abandonment and worthlessness — before they could destroy me. It was a way to train myself not to care much about anyone else — like my father, whose anger I didn't have any power over, and my mother, who disappeared without giving me a chance to say good-bye — and to focus entirely on the one thing I could control: the size of my body. I became my own parent.

I'm grateful that my real parent, my father, came to my rescue. I wouldn't have made it through without him. But our relationship still isn't easy for me — no close relationship ever has been. Since I left home, I've never truly depended on anyone. I have a hard time staying with any boyfriend for more than three months: I refuse to get intimate with people I might end up losing. And although I don't hide what I eat anymore, I do hide my emotional needs from the men I date.

It seems like there's still so far to go before I'll feel "normal." I'm always worried that I'm not attractive enough, smart enough, young enough, successful enough for someone to love me.

Friday, May 15, 2015

Young trans are favourite victims of anorexia and bulimia by Paola Battista


It is transgender people who are most at risk of developing an eating disorder. This is the conclusion of the research conducted by Washington University, St. Louis, which has investigated the link between sexual orientation, gender identity and eating disorders involving college students -heterosexual, “uncertain” and LGBT – in 223 American colleges. The result is clear: the use of diet pills and compensatory behaviour to prevent weight gain (self-induced vomiting and laxatives) is twice as high among young transsexuals as that recorded among heterosexual peers. Published in the Journal of Adolescent Health, the study also found that these disorders were common among young people, but levels were lower compared to transgender people, even among young people insecure about their sexual orientation and gay people whose gender identity coincides with the their biological sex. The figures are probably related to the emotional distress of being discriminated against and researchers warn that development of specific appropriate interventions is urgently required.

Thursday, May 7, 2015

Could this mean a cure for anorexia? Scientists claim they have discovered the gene responsible for eating disorders

Scientists claim they have located the gene responsible for anorexia.


The discovery, led by Dr Michael Lutterat at the University of Iowa’s Carver College of Medicine, could be the breakthrough needed for the development of new treatments.

http://www.dailymail.co.uk/femail/article-3066166/Scientists-claim-discovered-anorexia-gene.html#v-3690590495001

Scientists believe that 50 to 70 per cent of the risk of developing an eating disorder is genetic, and that the western obsession with thinness still has a significant part to play in the condition.

According to the new research, which was published in the Cell Report, a specific genetic mutation has been found to cause several behavioural abnormalities in mice which are similar to those seen in people with anorexia nervosa.

Neuroscientist Dr Michael Lutterat said: 'It’s been known for a long time that about 50 per cent to 70 per cent of the risk of getting an eating disorder was inherited, but the identity of the genes that mediate this risk is unknown.'

In earlier studies, the research team sequenced the genomes of two large families with multiple members affected by eating disorders.

They found members with eating disorders often had rare mutations in the oestrogen-related receptor alpha gene (ESRRA) or another gene that influences ESRRA.

Both mutations decreased the activity of the protein expressed by ESRRA.

Although the protein is known to be expressed in the brain, relatively little is known about its function in neurons.


Following experiments on mice, the team has now been able to show that levels of ESRRA protein in the brain are regulated by energy reserves.

Mice genetically bred with lower levels of the protein showed obsessive compulsive-like behaviours and social impairments.

They also showed a decreased willingness to work for high-fat food when hungry.

Dr Lutter said: 'This work identifies oestrogen-related receptor alpha as one of the genes that is likely to contribute to the risk of getting anorexia nervosa or bulimia nervosa.

'Clearly social factors - particularly the western ideal of thinness - contribute to the remaining non-genetic risk.

'We know that the rate of eating disorders has been increasing over the past several decades and this is likely due to social factors, not genetics.'

The research team is planning to examine the mechanisms involved in oestrogen-related receptor alpha’s effects on the brain and to test whether novel treatments can reverse the behavioural problems seen in their mouse model. 

Wednesday, May 6, 2015

Too Few People Know What “Diabulimia” Is, But It Is A Deadly Eating Disorder Every Diabetic Should Know About by the ADA

Eating disorders are a terrible affliction, especially in young women. While anorexia and bulimia are immediately recognized, diabulimia is seldom mentioned or thought of. Emilee Wilson, a Type 1 diabetic, restricted her food intake, exercised to extremes, and stopped using insulin to help her lose weight. This powerful and gut-wrenching video documents Emilee’s deeply personal struggles. Thankfully, she is leading a healthy and productive life, and even began her own non-profit, Die Or Beat This to help others who are suffering from diabulimia.


http://youtu.be/1lAX-pNs0po


Saturday, May 2, 2015

I’m a 35-Year-Old Man With Bulimia. Here’s Why I’m Speaking Up.

I’m sitting in a fast-food restaurant with enough food to feed a family. I’m going to eat the lot. My heart is pounding. I’m excited. In fact, I’m very excited.


I’ve been in a state of frenzy since I walked through the doors and the smell of oil and fat hit my nostrils. I know what I’m doing is going to hurt me, but I don’t care. I want to hurt. I want to eat until I’m stuffed. It’s a compulsion. I’m an addict scoring a fix.

I eat quickly, table manners forgotten. I wash it down with huge gulps of soda which helps it all come back up when I purge. For now, though, I just want to eat and eat until my body can take no more.


Like many men, I refused to accept I had an eating disorder for a long time. I have always enjoyed food, and my weight has yo-yoed over the years. I’m 35 now and have only really been comfortable using the word “bulimia” for a year or two. 

I’m not alone — According to the National Association of Anorexia Nervosa and Associated Conditions, up to 24 million people of all ages and genders suffer from an eating disorder (anorexia, bulimia and binge eating disorder) in the U.S. — and an estimated 10 to 15 percent of people with anorexia or bulimia are male. Among gay men, nearly 14% appeared to suffer from bulimia and over 20% appeared to be anorexic.

But men are less likely to seek treatment for eating disorders because of the perception that they are “woman’s diseases.

And it's not just in the States — I'm British, and an estimated 180,000 men in the UK suffer from eating disorders. The full extent of the problem could be even higher because denial and stigma lead the statistics to understate the situation, although in 2011, the British Health Service reported a 66 percent increase in hospital admissions for men with eating disorders in England over the last decade.


I began purging what I ate when I was 16 as a useful means of keeping my weight down after a large meal. Since then it’s become an uncontrollable monster. When I get the urge to binge, nothing can satisfy me until I feel the walls of my stomach stretched almost to breaking point.

Purging is a necessary evil, almost a luxury that enables the binge to take place without affecting my waistline. In the moment of the purge, I feel a rush of satisfaction. I’ve beaten the system and gotten away with it — well done, me! Then I’m overcome by emptiness, regret and shame. Later, I get tired and crave sugary food. Sometimes I’ll have a smaller secondary binge and purge on chocolate.

It’s been my little secret for a long time, but I think it’s time men started talking about eating disorders. We need to fight macho stigmas that can ruin lives. Men like me need to be brave enough to speak out on the subject.

If you think you may have binge eating disorder, break the silence and get help. Call Ramey Nutrition at (206) 909-8022 to be connected to treatment options. 

www.RameyNutrition.com

By Antony Harvey for The Mighty