Progress in diagnosis and treatment in psychiatry historically relies on the experience and knowledge of clinicians who use their time with patients, educate themselves about new treatment ideas and collaborate with colleagues to further the field and hopefully improve overall clinical care. Social media opens a new door to how the field progresses. Patients themselves express original ideas based on their lived experience and communicate with each other to find ways to assess and even consider new treatment for their condition. And this new path is starting to affect progress in psychiatry. O ..read more

Typically eating disorders are treated as psychological illnesses. A doctor manages any medical symptoms, lab abnormalities and medications, but the primary work in recovery is mental and emotional in nature. The root cause of an eating disorder is almost always seen as a mental health issue. For many people with eating disorders, this paradigm is accurate. Separation and individuation from an enmeshed parent relationship, numbing of emotions from traumatic experiences and the strong desire to avoid adulthood are still common initial events that lead to an eating disorder. Treatment still need ..read more

The assessment, diagnosis and treatment plan for people with eating disorders has changed dramatically in recent years. Historically, the initial appointment comprised of a standard psychological intake followed by medical, therapeutic and nutritional follow-up. These components are still essential to any treatment plan. Eating disorder symptoms clinically appear to be connected to other biological systems as well, predominantly metabolic, endocrine and immune (autoimmune disorder and Mast Cell Activation Syndrome). In addition, there has been more data connecting other psychiatric disorders s ..read more

Most chronic illnesses, medical or psychiatric, have a significant impact on a person’s quality of life. Coming to terms with an illness not easily managed or cured changes how someone sees their life trajectory and future. Although an illness can become a part of the lens through which one sees the world, eating disorders are unusual in how they become tightly woven into one’s sense of self. No matter how the eating disorder starts, the symptoms, self-image and behaviors around food become paramount. All decisions center around the convenience or difficulty of eating or around what the eating ..read more

Eating disorder treatment and recovery isn’t just about mind over matter. Access to so many types of clinical care, in person and online, doesn’t change the intractability of an eating disorder—illnesses that are physiological as well as emotional. The psychological draw of an eating disorder can be powerful in many ways, for example the emotional numbing through the release from overeating/binging or the protection from traumatic symptoms via restriction. Over time, the repeated disordered eating behaviors can engender a physiological response in the body’s gastrointestinal system which adapt ..read more

Telehealth in therapy is here to stay. The abrupt transition to remote treatment in eating disorder work during the pandemic was noteworthy. There won’t be a return to mostly in person appointments. That ship has sailed. We all—clinicians and patients—have agreed to this new method of treatment. It’s clear what has been gained from telehealth: increased access, convenience and new programs for in home treatment. The practical considerations of treatment work well remotely. Monitoring food, cognitive tools to combat eating disorder thoughts and even group sessions for people with similar recove ..read more

Social media has changed eating disorder diagnosis and recovery greatly in recent years. Long before seeking help, most people these days are aware of their eating disorder, have read, listened to or watched media that explained not only the disorders but various symptoms and the path of recovery. Thus, education about eating disorders is now largely delegated to online platforms so therapists can both clarify what people learn online and individualize treatment for each person. Patients used to start treatment often more confused about the diagnosis and without much knowledge of treatment. No ..read more

The recent posts in this blog hypothesize about changes in our relationship with food and our bodies after the advent and proliferation of GLP-1 agonists like Ozempic and Mounjaro. To be clear, many beneficial purposes for these drugs exist: diabetes and metabolic issues, to name two important ones. But this new class of drugs also lands squarely in the camp of life enhancers, not just medications to treat illness. What I mean by this term is drugs with benefits people deem attractive but not necessarily therapeutic. Stimulants like Adderall are a good example of a drug people use for extended ..read more

Hunger is one the most powerful and essential ways our bodies communicate with us. Put simply, hunger prioritizes the need for food as sustenance and for survival. The meaning of hunger has changed greatly due to a transformed food supply for many countries in recent decades. After centuries of food scarcity as the obstacle to survival, humans created societies with bountiful food, more than can be eaten and often with a huge amount of waste. We aren’t designed to know how to handle excess food. Hunger is an acute feeling intended to focus all senses and thoughts on procuring food. Subtle hung ..read more

The recent article about Anorexia Nervosa in the New York Times informed its readers about the severe medical consequences of this illness. In fact, the article made the case that some people with Anorexia might do best with palliative care, perhaps even assisted suicide. For a clinician who treats people with eating disorders, the article did not talk about anything new in the field but focused largely on the most extreme cases. The two doctors the article highlighted work on the medical floor which treats the most acutely sick patients in the country, aptly names ACUTE. Doctors know ..read more