Are YOU Keeping a Secret?

This past week was National Eating Disorders Association Awareness Week. The National Eating Disorders Association (NEDA) supports those affected by eating disorders and educates the public about various types of eating disorders.  These disorders are more common than most people think. That’s because people who have eating disorders are so secretive. Often even close family members, including spouses, don’t realize that their loved one is suffering from an eating disorder.

When most people think of eating disorders, they think of anorexia nervosa. This is probably the most well-known of the eating disorders. However, it’s not the only one. Bulimia and binge eating disorder are the other types.   The most sensational cases get publicity. Most of us remember Karen Carpenter of the singing group, The Carpenters, who died of anorexia.  However, there are many people suffering silently, perhaps not even aware that they actually suffer from a diagnosable eating disorder.

These are the most common types of eating disorders.

  • Anorexia Nervosa is characterized by extreme fear of gaining weight. These women are severely underweight, and amazingly enough, they don’t recognize it. They completely lack insight into the fact that they are starving themselves. They may look like a concentration camp survivor to everyone else, but that isn’t what they see when they look into the mirror. According to NEDA, up to 1% of women in the US suffer from anorexia.   Although there are men who suffer from anorexia, 95% of those with anorexia are women.  Some people with anorexia will binge and then purge (purging behaviors cause the person to eliminate food already eaten, for example self-induced vomiting or using laxatives).  About 5-20% of people with anorexia will die of the disorder.
  • Bulimia Nervosa is characterized by binging and purging behaviors. In other words, large amounts of food are consumed, larger than what most people would consider normal. This is followed by purging, self-induced vomiting or use of laxatives. The hallmark of bulimia is a feeling of loss of control while eating. People with bulimia are very focused on appearance as a source of self-esteem, as are those with anorexia. Usually, however, the sense of loss of control and the amount of food consumed during a binge are what distinguishes bulimia from anorexia. People with bulimia usually do recognize that their eating behaviors are abnormal. They may not be extremely under or over weight. There are more males with bulimia than anorexia, though 80% of bulimic patients are still women.
  • Binge Eating Disorder (BED) was recently recognized formally as an eating disorder. It is characterized by episodes of consuming large quantities of food, larger than what most people would consider normal, to the point of discomfort. The food is consumed rapidly, generally within 2 hours, and the binges occur at least weekly. People with BED do not usually compensate by purging. They do experience a sense of loss of control when binging. They usually feel terrible afterwards, and they may experience depression, anxiety, and other mental health issues. BED is the most common eating disorder affecting 3.5% of women and 2% of men. BED is more evenly spread between the sexes with 60% being women and 40% men.

 

Eating disorders are treatable.  Medication in addition to psychotherapy may be helpful. Recently a report from the Agency for Healthcare Research and Quality found several medications, including some antidepressants, Topamax (a seizure medication), and the stimulant vyvanse (used for attention-deficit disorder) particularly helpful for BED.  In extreme cases, particularly in people with anorexia who are at dangerously low body weight, inpatient programs may be necessary. If you aren’t certain whether you have an eating disorder, go to mybodyscreening.org for an online screening tool. If you believe that you may have an eating disorder, check out the NEDA website at nationaleatingdisorders.org.  They have great information about diagnostic criteria, treatment resources, and support.

Eating disorders, besides being potentially lethal, can cause many medical issues including heart and metabolic abnormalities.  There is no shame in having an eating disorder.  Remember almost 3 women and 2 men out of 10 suffer from an eating disorder. Get treatment today.

Mother Angst

I am a new grandmother.  I just returned from spending a few days with my daughter, her husband, and their new baby, my grandson Liam.  I’m already missing him. There is nothing quite so intoxicating as a newborn baby. I can feel his little head on my shoulder and smell his newborn aroma. I must have picture updates at least daily if not more – otherwise I’ll have withdrawal symptoms!

Spending time with Jamee and Hunter this week reminded me of some of the stresses of new parenting. It brought back a flood of memories from my days as a new Mom with Jamee. I was terrified.  I was sure that there was a right way to do things.  If the baby cried, I must not be doing the right thing.  Breast feeding did not always go smoothly. I constantly worried about my milk supply, whether Jamee was getting enough milk, whether she was sleeping the right number of hours, whether she pooped enough, and whether it was the right kind of poop.  I was a little less anxious with Mackenzie, but not much. Unfortunately, sometimes women (and even doctors) unwittingly perpetuate the idea that there is one way to do things when it comes to child rearing. I’ve often said that I’ve known women who were perfectly rational in their work lives, but totally irrational with regard to raising children.  They were quick to criticize any deviation from what they thought was the best way of doing things.  I suspect that’s a way of dealing with their own insecurities, but it keeps alive a myth that there is a right and wrong way to be a Mom. It feeds into the vulnerabilities of new Mothers. The universal fear of all Mothers, not just new ones, is that we aren’t adequate, we aren’t good Moms.

I found this to be particularly true of the issue of breast-feeding.  Don’t get me wrong – I absolutely believe in breast-feeding. However, I remember hearing so many “rules” such as never supplementing, never using formula, never using a bottle even if it contained pumped breast milk.  Some of the breastfeeding support groups were very rigid and fostered the idea that women who did not breast feed were somehow not doing the best for their child.

When Jamee was a newborn, my pediatrician was a sleep expert. He advised that children should be put down at exactly the same time every day for naps, and that they should not be picked up at night when they were crying between feeding times. I could not manage to get my babies down at exactly the same time each day. It always seemed like something came up. I also could not bring myself to let them cry. I would leave his office in tears. I felt like a failure. My husband, much more realistic than I was, grumbled that we should call his wife and find out whether she actually followed her husband’s rules about sleep.  You get the idea. So many “never” and “always” edicts.

Jamee was struggling, looking for the right way. Breast feeding wasn’t going as planned. She began to question herself. She actually said to me “Am I a bad Mom? What if I don’t breastfeed? What if the baby doesn’t bond to me?”    I know that this comes from all of the information out there about how it “should” be.  Why do we women guilt trip each other by insisting that there is only one way to do things? Why do we play on the fear that all women have that they are “bad “ Moms if they don’t do things the “right” way. What is the right way anyway?

In my view, these are the basic requirements for being a good Mom.

  • Is the baby eating, pooping, peeing? If not have you sought a medical evaluation?
  • Have you provided a warm home?
  • Do you love the little critter with all of your heart? Do you kiss him and cuddle him? Do you tell her how much you love her?

If these things are happening, then the rest will fall in place. We don’t all breast-feed, we don’t all put the baby down at exactly the same time every day. Some women supplement with formula, some pump. Some women work full-time or part-time outside the home while some women don’t.  Believe me, I think being a stay-at-home Mom is harder. I felt confident at work, but there were no set answers at home when things didn’t go as planned.  However, I think that Jamee and Mackenzie survived and thrived in spite of my shortcomings.

I hope Moms (and doctors, lawyers, and politicians)  embrace the idea that there is not one way to do things. This is not a competition. It’s a collaboration.  Let’s support each other in this wonderful job of mothering and grandmothering.

William Marques Alexander Rogers

William Marques Alexander Rogers

 

 

The Horatio Alger Myth

There is so much controversy about making health care accessible to everyone in our country.   Why? We are the wealthiest country in the world, yet we quibble about the cost of basic health care for our citizens. I believe that underneath this controversy are some cultural assumptions that we Americans make. We still believe in the Horatio Alger story – the idea that anyone, no matter what their origins, can be successful. The corollary, though, is that if you aren’t successful, it’s your fault.

Are we honest with ourselves about our beliefs regarding people who are poor?   Do we believe that people who are below the poverty line are lazy? That they chose to be where they are? That they are less than the rest of us because they are poor? That because they are poor, they are not contributing to society? That they don’t need to be heard? Though most people would not readily own such assumptions, I suspect that they are unspoken but commonly held.  If we believe that poor people have chosen their lot, then it relieves us of the need to be concerned about them. It’s a convenient excuse.

First of all, think of life as a race. What are your chances of winning if you start the race ten feet behind everyone else? Many people who are not functioning well in society, especially financially, started out far behind the rest of us in the race of life.  I was lucky to grow up in a healthy, supportive family. As a psychiatrist, I’ve seen how devastating it is when that doesn’t happen. Growing up in a family where there is constant emotional or physical abuse makes it impossible to develop the kind of self esteem that we all need in today’s world. Children living in a dysfunctional, perhaps abusive, family are simply in survival mode. They are focused on here and now, getting through today. They aren’t focused on learning, another important life skill.  Can some people over come this? Sure, there are stories of people who are amazingly successful in spite of terrible odds against them. But in general, these people had someone supportive in their lives, maybe a teacher or a friend’s family. They could see what life should be like. They had a vision.

Of course, not everyone who is poor grew up in a dysfunctional family. Sometimes illness or addiction intervened. Sometimes people who come from solid families do make bad choices that contribute to their lack of success. But what are we accomplishing by the “you made your bed, now lie in it” approach?  Does it really help society as a whole when a segment of the population doesn’t have access to health care?  In the long run, that affects us all. For the first time, under the Affordable Care Act, people who had never had health insurance before, could get it.  Is it possible that allowing poor people better access to health care is a first step in helping them move up the ladder?   Learning to take better care of their health gives people a sense that they are important, a sense of some control over their lives. It increase their self esteem. Preventing illness is one of the keys to lower costs for healthcare.  Now if the Affordable Care Act is repealed, we will again have a large segment of the population without access to health care, using emergency rooms as their primary care. That means preventive care goes down the drain.  How does that help us as a society?

I also find the argument that we can’t afford health care for everyone rather puzzling. It’s a matter of priorities. If your child is very sick, you find a way to afford the medicine that he needs. You make it a priority because the health of your children is so important. You do what you have to do. Why don’t we care for the health of all of our citizens the way we care for our own family members?

Frequently poverty comes from multigenerational dysfunction. It will take generations to turn it around. But I don’t see a healthy prognosis for a society with a wide gap between haves and have-nots.   I also don’t think poverty will end itself. It will take financial and emotional investment on the part of each person, not just the government. I believe that adequate access to health care is a basic right along with food, clean water and education. It’s a key to a society that functions well and to me that means giving people the basic tools to make the most of their lives. After that, it is up to them.

strive

 

Colleen Ryan, MD