Are you the parent of an adult child with an eating disorder? Run, don't walk to this blog post by one of my favorite blogs, F*ck Feelings.

Actually, I'll save you the bother of clicking and just post the whole thing in its entirety below (the question from the parent is in italics. Everything else is from the blogger/psychiatrist):

People like to turn to an authority when they’re helpless, and if that helplessness only applied to 911-like situations, there would be no problem. For problems that don’t involve theft or fire but sadness and family, however, authority is useless; sure, doctors like me can give advice, but until medical schools start borrowing from Hogwarts’ curriculum, the best resources you have are your own. The sooner you realize that, the sooner you’ll learn to draw on your own authority to come up with the best possible management plan and execute it with confidence. You are your own best first responder.


I need to find a doctor who will tell my daughter she needs to take her medication. She’s always had a problem with depression, and she did well in high school when she took antidepressants. Now, however, she’s 24 and very reactive to however she’s feeling, whether it’s not getting out of bed, or not working, or feeling dizzy and deciding it’s the medication and stopping it. My husband and I can’t get her to stick with anything, and she won’t listen to us in any case, so our goal is to get you, or some professional, to tell her what she needs to do.



Whenever parents want a doctor to tell their kid what to do, you can be pretty sure they’ve lost faith in themselves and overestimated the power of communication/a medical degree.

And no, it doesn’t matter how old the kid is or how many Harvard degrees the doctor has; the doctor doesn’t have more power than the parents, no matter how powerless the parents feel.

In your case, I don’t know whether your daughter can be induced to take her medication, but I do know that she’s not going to be persuaded by the authority of a doctor at the age of 24 if her own experience and your words haven’t done it by now.

The probable reason for her unresponsiveness, by the way, isn’t stubbornness or a lack of respect, but a lack of control over her own impulsivity (probably enhanced by depression). In other words, it’s not clear she can make herself take medication regularly, even if she sincerely believes she needs it. At some point, other impulses take over, like the impulse to stay in bed indefinitely.

Fortunately, even though persuasion is probably useless, you have other tools that a mere doctor can’t touch. You can access them if you believe you know what your daughter needs, regardless of what she has to say about it.

For instance, if you believe that she needs to get up early and follow a daily activity regimen, then let her know that’s what you’ll pay for. If she says she’s too blah, tell her you know it’s hard, but she needs to try, and that she might be able to do it if she puts together a schedule and asks friends to help her keep it.

If she argues that she can’t do it until she feels better, tell her that you don’t know when she’ll feel better, so she’d better start trying to keep busy now, and maybe that will help her feel better later. Your tone should say that you believe what you believe, and there’s no point in arguing.

If she tells you that you don’t know what she needs, tell her that you’re the mother and you have a good idea what she needs. Don’t ask a doctor to be the authority– get whatever information you need from the doctor, and then assume you’re the authority. At 4 or 24, your kid needs to hear the same thing; you’re the mommy, that’s why. End of discussion.

If your incentives don’t work, don’t blame her or yourself, because, again, you don’t know whether she’s too sick to have the control she needs. By putting a priority on self-control, however, you provide her with a blueprint for moving forward that is not reactive to negative feelings or thoughts or painful side-effects.

You’re urging her to embrace goals that arise from her values and that she can stick with, regardless of how she feels or how much she accomplishes. Knowing medicine isn’t as important as knowing your daughter and what’s best for her. If she won’t listen to me, you can, and I’m telling you you’re the most qualified professional for the task.

STATEMENT:
“I’d like to think my daughter could respond to persuasion from someone she respects, but I suspect it’s not true. I’ll push her towards doing as much as she can, regardless of how she feels, and hope that incentives for good habits will take over where persuasion has failed.”

Excuse me while I go clone this guy millions of times over so that a) he can be all of our doctor and b) so that we can have him as our very own Psychiatrist Pocket Pal^TM.

I am currently in Miami, attending the 2011 International Conference on Eating Disorders. Several deadlines and spending most of today traveling meant that I haven't had much time to blog until just now.

I have a new post on Body of Evidence called Rethinking Recovery. Yes, PJ, this is the post I promised you. A little delayed, but better late than never, right? I get paid based on page views, so visit early and visit often! LOL

In other news, I got to meet the wonderful Julie O'Toole in person for the first time, and was totally flattered to hear her and her husband say that they hoped I would be attending because they really wanted to meet me. That's almost like having George Clooney say he was looking forward to meeting me. Swoon!

Tomorrow is a full day of talks, interviewing, and schmoozing, so it's bedtime for me. I will be live Tweeting the conference, and you can follow my ED Bites Twitter feed or just search for the hashtag #aed11

Last week, I received a wonderfully unexpected email in my inbox from my editor at Psychology Today. I had been working with her on a piece about eating disorders (it will appear in the July/August issue), when she asked me to join the Psychology Today blogging team.  My focus? The science of eating disorders.

And so it is without any further adieu that I introduce you to:

Body of Evidence: Dispatches from the Forefront of Eating Disorder Science.

I won't stop blogging here at ED Bites. This blog will remain my place for personal insights and such.  The PT blog will cover more of the latest research and other issues related to eating disorders.

I hope you like my new blog, and be sure to come on over and view my first post.  {{I get paid based on page views, so be sure to visit regularly!}}

I don't know whether this means I'm definitely in the right career, or just a glutton for punishment.

I started another blog.  A science writing blog.

"Somewhere, something incredible is waiting to be known." --Carl Sagan

I know that the only way to get better at writing is to actually do it.  And there are so many cool things to write about, things that I won't get the chance to cover for, you know, money.  That's where this blog comes in.  It's my chance to write about all of the cool things that I normally wouldn't write about.

I probably won't be blogging all that much at first.  I'm trying to pack and move, and deadlines for paying work will always take prescedence.  So, too, will ED Bites.  It's my baby.  It's not going anywhere.  I've put way too much effort into this blog to let it wither away.

But I also need to start putting more effort and time and energy into non-ED things.  I don't think this blog is holding me back--far from it.  Yet I also don't want to be known just for my ED work.  It doesn't bother me that most of the world knows me for ED-related and recovery things.  At the same time, that's not all I want the world to know me for.  It's been a big part of my life, but I hope to make it a much smaller part of my life.

Hence this blog. 

It's a recovery step, in a way, even though it really has nothing much to do with the eating disorder at all.

On my way to see TNT and go to group, I was listening to a podcast from last year's DarwinFest at Arizona State University (2009 was the 200th anniversary of Darwin's birth and the 150th anniversary of the publication of "On the Origin of Species").  The next talk on my playlist was by Nina Jablonski on the evolution of skin pigmentation.

Dr. Jablonski spent a portion of the talk discussing how UV radiation damages the skin, and the different responses animals have evolved.  She said that certain types of UV radiation were pretty much universally bad; they had no real positive effects on life.

And yet, Dr. Jablonski said, UV radiation was an "enormously creative force" in the evolution of life on Earth.  UV radiation created DNA mutations, which are the raw material of natural selection and evolution.  Without mutations, we'd all still be pond scum.

And all I could think was: this is such a great description and metaphor for eating disorders.  EDs are tremendously destructive.  I know some people say that they are grateful to their eating disorder, that it helped them cope with life when nothing else did. Although I understand and sympathize with the sentiment, it's not something in my own personal experience. 

That being said, here I am.  The destructiveness of my eating disorder has been a creative force.  It's resulted in two books and this blog.  More indirectly, it's led to my career as a writer.  It's brought me to where I am today.  As much as I whine about my life, as much as I hate it at times, I am where I am, and it's really not all that bad.  Okay, true, my current life is nowhere near the one that I thought I would be living.  At the same time, I'm working to accept that where I am is just freaking fine.

UV radiation is tremendously destructive, and yet from this destruction has sprung an amazing array of plants, animals, fungi, protists, and microbes. And so it goes with the eating disorder and my life.  Enormous destruction has led to enormous creativity.

I left my laptop on my bed, only to come back and find my cat, Aria, trying to edit my blog.

It's true that I go to the NEDA conferences every year to stay on top of the latest research and findings, but after so many years of going, the main draw for me is to see all of my friends.  Many of them, I've met before, but this year was especially nice because I got to meet so many new people.

It's odd, meeting people you've only known over the internet, people who know more about you than 90% of your "real life" friends.  Yet I couldn't pick some of these people out of a police lineup.  It was just lovely to be able to put names and faces together after (sometimes) years of online correspondence.  I'm sitting in the lobby of my hotel next to the lovely Melissa of Finding Melissa.  I spent a lot of time with Laura and the other moms of Around the Dinner Table--you know who you are!  My mom and I got to meet Marcella, who first met my mom back in 2001, shortly after I was first diagnosed.  They had been friends for years but never got to meet.

I also got to be with the ED recovery Twitteratti, which included Kendra, Rachel, Jenn, Claire, and Julie (among others).  I had more than a few laughs with Susan Ringwood of B-EAT and her charming husband and Becky Henry of the Hope Network.  I also saw David again, and finally met Sarah Ravin in person.

It was a lovely time, being with everyone.  I truly felt at ease and comfortable in my own skin, even in some overwhelming and demanding social situations which doesn't happen very often!  It was nice to have my blog and all of the work I've done here over the years to really get some good recognition.  I didn't need it, and I would have been fine without it, but it's always gratifying to know that my work has impacted others.

I fly back to Virginia tomorrow, and this will be the last time I see a lot of these people until the AED conference in Miami next April (if my proposal is accepted) or next year's NEDA conference in Los Angeles.

(Sorry if I forgot to mention anyone- my brain is pretty much frazzled right now!)

So a little article in Marie Claire magazine called The Hunger Diaries about online food and health bloggers has raised quite a stir.  The premise of the article is whether these health bloggers might be promoting an unhealthy and obsessive lifestyle.  The health bloggers say that their quotes were taken out of context and the dangers of such health blogs were horrifically overblown.

Generally, I don't read these blogs and really am not interested in these types of blogs, where food and exercise routines are documented in almost pornographic detail.  I think about food and weight quite enough, thank you.  Unless it's specifically helping me with my recovery, I'll pass, thank you very much.  Also, these blogs tend to make my competitive and judgemental side get twitchy.  She exercised more than me, I will think, which then takes me down the path of "She's stronger/better than me" => "I must exercise more and eat less." => RELAPSE.  So yeah--for any number of reasons, these blogs aren't for me.

So I can't really say anything about the accuracy of the article and whether some health bloggers might have disordered eating or an actual eating disorder.  That's not my place, I don't know, so I'm not going there.  But I do have several points to make that have gotten lost in the dust of the kerfuffle.

1) Don't believe everything you read on the internet.  Maybe I've watched a few too many House reruns, but the fact is: everybody lies.  And it's very easy to do so online.  Just because someone says they ran X miles doesn't mean they actually did.  Maybe they ran less.  Or more.  Who knows.  I'm not anti-blogger; after all, I am a blogger.  Yet the fact remains, people are complicated.  Things might get left out inadvertently.  You might have misinterpreted.  And just because someone calls themselves a "health blogger" doesn't mean that they are healthy or that doing what they are doing will automatically make YOU healthy.

2) "Health" is not an extreme.  In a lot of the comments on the Marie Claire website, people talked about these bloggers as being something the rest of us Big Mac chowing Americans would do well to emulate.  Um, hello.  Did you not realize there is a ginormous freaking gap between a steady diet of french fries and marathons fueled by kale brownies?  To me, health is not health without joy, and joy comes from real brownies, not kale ones.  I exercise regularly, eat a very healthful diet most of the time, and I humor my sweet tooth when I can.  You can take steps to improve your life without following the dictates of a health blogger.  Are they healthy?  I don't know- that's between the bloggers and their doctors.  Which leads me to my next point:

3) "Health" is an individual definition.  People have tried to define health for centuries and have really come up with vague descriptions.  What someone else defines as health (such as kale brownies and marathons) might not be healthy for someone like me in recovery from an eating disorder.  I have to take steps to moderate my impulses to exercise.  Ultimately, you have to define health in your life.  That definition needn't be static--it can change with age, circumstance, you name it.

4) Bloggers have an obligation to their readers.  These obligations will be different based on different types of blogs, but, like it or not, bloggers have an obligation to their readers.  I see my obligations as being honest about my own recovery (the struggles and the victories), and not passing along information I believe to be unhealthy or uninformed.  I can't vouch that everything I write about is 100% accurate--no one can.  But I can (and do) refuse to write on subjects that will be obviously misconstrued, not in line with my own authenticity, and not anything I wouldn't tell someone to do.  I try to be careful and say how something (such as a meal plan) has been helpful to me, but a meal plan isn't universally helpful.

5) Your readers are listening.  This goes along with the point above.  If people are reading your blog, then they are listening to what you have to say.  They are absorbing this information.  Remember this.  Unless your blog is completely private, you are writing to an audience.  When you talk about how great your workout routine is (and then describe it in detail), people are going to copy you.  No, you aren't responsible for the fact that they do copy you and that people can be idiots (sorry, too many House reruns again), but you are responsible for being cognizant of what you say.

6) Obsession can masquerade as health.  I'm not saying anything about these bloggers in particular.  Like I said, I don't really read them and so I'm making no judgements.  But I do have to applaud the writer for bringing up the thorny cultural issue of health being used as a smokescreen for any number of obsessive behaviors.  Part of the problem is that most of the obsessed really think they're just being healthy.  They see nothing wrong, and the unending kudos from adoring blog readers probably doesn't make it any more likely that people will see the light.  Many eating disorders have started by a simple effort to be more healthy.  Soon, it becomes a life-threatening obsession, but how can you be sick if you're just trying really hard to be healthy?  It's a fine line and it's hard to find out where to draw it.

So those are my thoughts.  What do you think of health blogs?  Do you read them?  Why or why not?  Share in the comments.

There are many reasons why I blog, but an email from a family friend really captured much of why I have found blogging so rewarding. We connected via LinkedIn and he found my blog website on my profile. He kindly sent me the following email:

Keep giving and you will benefit from the giver's gain in all ways, as you are surely already aware. Speaking loudly and clearly in testimony reinforces your own behaviors and self expectations. Notice how the Mormons send all their youth out into the world clad in white-shirt-tie mounted on bike back? I suspect it’s not so much a function of “convert the word”, as it that aforementioned reinforcement of self expectations.


This blog has helped me self-identify as a person in recovery, as an actual writer, as someone who has something to give to this world. It's very different than thinking of myself as Carrie the Weight Loss Wonder Goddess. It's something that means something to me and to others. It's not unimportant for me to be able to use my writings and my experiences to help people, but that alone doesn't keep me blogging. Knowing that I can't help people if I relapse is very helpful, however.

Nonetheless, this blog has been a tremendous reinforcement of my own recovery.

My history of OCD and current experience of Generalized Anxiety Disorder have made me very, very familiar with obsessing and worrying. It is, quite possibly, the world's most pointless activity--especially since I don't have any control over the things I'm freaking out about!

So when I saw a PsychCentral post on how obsessions can be productive, I had to read it. Because I was convinced the authors were well and truly full of shit. Obsessions make me so anxious I puke. Obsessions make me wash my hands in Clorox, make me run on the treadmill for hours, make me starve myself for days in preparation for a meal out with friends. How could obsessing be productive?

I'm still not convinced that the obsessions themselves are productive, but it's a matter of channeling that productivity into something worthwhile. My friend Jeff Bell calls it The Greater Good. In the PsychCentral post, which reviewed the book Brainstorm, blogger Susan Perry had this to say:

Writers and other artists are often desperate for fresh inspiration and renewed motivation. By learning concrete ways to tap into the brain’s potential, Maisel’s readers can better move forward in whatever realm they care most passionately about. What the Maisels are talking about here is another way to look at flow, or focus, or deep engagement, or mindfulness. Even if they’re not all defined as precisely the same experience, there’s no particular need to pull apart the threads of difference. They’re all extremely positive states of mind, ones that creative people often crave and benefit from.

PRODUCTIVE OBSESSIONS (paraphrasing Maisel):

1. Are not always easy or fun; but ease, fun, and joy may be part of the process.
2. Are fueled by good reasons, not only love and passion.
3. Need to be strategized. To be continuously effective, you need to plan what you’ll do when you feel anxious or at a dead end.
4. Require stretching. “Expect the emotional equivalent of aches and pains,” writes Maisel.
5. Necessitate switching gears between your normal life and your obsessive life. Learn to do so with the least time wasted and “no internal drama.”
6. Need to be monitored. Learn to pay attention to your state of mind, taking breaks when needed, or devoting a full week to your obsession when that is what’s called for.
7. Are risky. “Take the risk that your project may not prove as important as you had hoped,” notes Maisel. “Take the risk that it will prove exactly as important as you had hoped, taxing you with its difficulty and troubling you by its felt significance.”

As I read through this list of seven things, I thought about how true it was, especially for my blog. It is exhausting and frustrating at times--the writer's block or, at other times, the flooding of ideas--and I think about my blog a lot. It's also true of my life as a science writer and my work as an advocate in the field of eating disorders. I think about these things all the time anyway- I may as well make some good come out of them.

The other reason I was glad to read this was that it showed me that my propensity to obsess about basically everything could actually be a useful skill. It can allow me to immerse myself in my work, focus on one subject and become and expert. Things like this blog and my writing career let me use my skills for good instead of evil.

How do you turn your obsessions into something productive? Share your thoughts in the comments!

When I first started blogging three and a half years ago, I didn't really foresee much of a future for my blog. It was really just me, sitting at my keyboard, needing a place to vent. I've passed several milestones along my way (100 posts, 100,000 unique site visits, 200,000 unique site visits), and it still seems totally surreal. I feared that blogging would get old- or that my readers would find my posts boring and dull. I had stopped writing in my journal a year ago because I got so bored of always writing how much I hated myself, how fat I was, how much my life sucked. I was wallowing in my own misery, and I feared, more than anything, that my blog would become filled with the same tedium that my journals would.

But it didn't.

Some of that is due to the fact that I am further along in recovery than I was and have far more interesting things to write about than How Unfair It Is and How Fat I Am. But a lot of it has to do with my readers, and my desire for my blog to be a source of information and hope rather than misery and despair. I enjoyed your presence in my life so much that I began to challenge the eating disorder. I don't see my blog as just an online journal- I see it more of as a community that is part of the larger ED recovery community. I love writing for writing's sake (I am, after all, a writer by trade), but that's not why I blog.

I blog because for the first time in my life, I feel I have something important to say. I blog because I find so much support from others and enjoy being able to give some support back. I blog because it keeps me real.

I never would have gotten to 1000 posts or any of my other milestones without my readers. You have made this blog one of the most worthwhile things I have ever done in my life.

So here's to another 1000 posts!

...like a little baby stoat!



Thanks to all of you wonderful readers out there, I am currently #7 in the People's HealthBlogger Award 2009. This is just a little reminder to keep those votes coming! Every last one is appreciated. Click on the "vote now" link below to work your magic. You do have to join Wellsphere, but they don't spam and it's super-easy.

Carrie A. http://www.wellsphere.com/linkOut.s?link=http%3a%2f%2fwww.edbites.com

Regardless of the outcome, I would totally vote for you all in the Best Readers contest. You rock!

There's a new eating disorder blog on the scene, this one by a real, live trained professional (Barnum and Bailey probably would have charged you a quarter for a peek sometime last century- alas how copays have changed). I am thrilled beyond words that Dr. Sarah Ravin is joining the wonderful, wacky world of ED blogs.

I love Dr. Ravin's bio:

A major component of my professional identity is staying informed about recent developments in the field so that I may provide my clients with scientifically sound information and evidence-based treatment. There is a plethora of information on the internet about eating disorders, depression, anxiety, and psychotherapy. Unfortunately, much of this information is unsubstantiated and some of it is patently false. It is my hope that by sharing my thoughts and opinions on psychological issues, with scientific research and clinical experience sprinkled in for good measure, I can help to bridge the gap between research and treatment.

Her first post, Top 10 Mistakes in Eating Disorder Treatment, is so spectacular I had to link to it here, and it's going in my permalink section to the right. It is a must read for anyone who even attempts to treat an eating disorder and is filled with wisdom and truth.

I can't wait to see what else she has to say!

(An extra gold star for those who caught the Flannery O'Connor allusion in the post title. Dr. Ravin is in Florida, so I thought the Southern reference would be marginally appropriate.)

As I read others' blogs (of which there are many, though surprisingly it hasn't eaten into my book reading, as I manage about 3 week still, thanks to living at the end of the DC Metro lines), people refer to their blogs in one of two ways:

• this is MY blog- usually if trolls arrive, and is meant in the don't-you-think-a-public-blog-gives-you-permission-to-be-an-ass way. Or in the choice of subjects, etc.
• this is YOUR blog- tell me what you want me to write about, give me your input, I'm writing for others to read.

And, like so many things in life, I fall somewhere in between. I am painfully aware that my blog is public--very public. My writing style is much more linear, much less Faulkner stream of consciousness (sans the Nobel Prize literary merit) than in my personal journals. It also contains less swearing and less open self-loathing. I'm not navel gazing here.

I write about research that I think sufferers and caregivers and friends and family need to know. I write about stuff that gets twisted in mainstream media because I want people to be aware. In that sense, ED Bites is a bit of a literary soapbox.

On the other hand, a lot of what I write, I write for me. I write about how to be okay with your body because I need to learn that, too. I need those reminders. When I write recovery-oriented stuff, it helps place me in that frame of mind, helps me see the upside of leaving anorexia behind.
In the end, I'm not sure whose blog this is, nor if it really matters. What I write ceases to become entirely mine the second I put it out there, and I think that's a good thing. Change comes from dialogues, not monologues.

When I was first diagnosed with OCD, almost 9 years ago now, I remember finding someone else who also had fears of AIDS contamination. I gasped, and then giggled a bit, in relief. I wasn't alone. For the seven years between the onset of my symptoms and my diagnosis, I thought I was living in a delusional world, Population: One.

I wasn't. And it felt pretty good.

Many people diagnosed with a mental illness (or other condition) find great solace in virtual gathering places where they feel less alone, where their daily trials and tribulations are understood and honored. These places--websites, blogs, bulletin boards, chat rooms--can be incredibly healing.

They can also keep an individual stuck in their illness.

An article in this week's New York Times discussed a disturbing trend of websites that support the idea of mind control. In this case, sufferers of paranoia or schizophrenia who believe they are being stalked or that their minds are being controlled gather together on websites, where they swap stories and provide evidence of how they are all being stalked or controlled.

In the article, Dr. Ralph Hoffman, a psychiatry professor at Yale is quoted as saying:

“The views of these belief systems are like a shark that has to be constantly fed,” Dr. Hoffman said. “If you don’t feed the delusion, sooner or later it will die out or diminish on its own accord. The key thing is that it needs to be repetitively reinforced.”

You could easily argue, as was mentioned in the paragraph after this quote, that the pro-eating disorder websites are exactly the same thing.

A person with an eating disorder isn't generally delusional, except on the subject of food and weight. Then, all bets are off. And this gathering of people only feeds and reinforces the "shark" of the eating disorder. The solace of knowing you aren't the only person afraid of potential calories in Chap Stick is lost to the swapping of weight loss tips and out-and-out competition to lose the most weight.

Some have argued that these websites can be the only support these sufferers get, and so leave them up. But these websites aren't supporting sufferers. They're supporting the illness.

And that is the difference. It's why I participate in this blogging community, and not other message boards, including those deemed "pro-recovery." There, I often feel I am shouting into the wind, and that those sites only reinforce the illness. Why is this community different? Perhaps its people in recovery or actively pursuing it. Maybe it's because we don't just talk about the eating disorder.

Speaking of people believing they are being stalked or controlled: "These people lead quietly desperate lives,” said Dr. Jeffrey A. Lieberman, chairman of the Department of Psychiatry at Columbia University. “And if they are reinforcing each other and pulling people toward something, if they are using the Internet and getting reinforcement, that’s good."

And in this little corner of the blogosphere, I think, we are are really reinforcing recovery.

Newsweek has an article that just tells us bloggers what we already know:

My Shrink Says...Blog?

Psychiatrists are starting to tout the therapeutic power of blogging, and many have begun incorporating it into patient treatment...

...Mental-health experts say blogs are a step up from plain old diaries, chiefly because of the built-in audience. As kids, we learn that if we air our problems, we get help. We associate communication with consolation, particularly when the going gets tough. Blogging fulfills that primal need for sympathy.

And I think blogging also forces me (us) to think through our problems more slowly and rationally, as well as solicit feedback on what is going wrong and what we can possibly do about it.