https://www.youtube.com/watch?v=c0rVwulxZ8k

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog https://standingabovethecrowd.com/?p=16634

And how does it affect children and teenagers?

Writer: Caroline Miller

https://www.youtube.com/watch?v=cgIPkigb8dI

What You'll Learn

- How does binge eating develop in children and teenagers?

- What is loss of control eating?

- How can we help kids with binge eating or loss of control eating?

- Quick Read

- Full Article

- Kids and binge eating disorder

- Diagnosing binge eating disorder

- How are kids different from adults with BED?

- Who is at risk for binge eating disorder?

- Treatment for binge eating disorder

- CBT for binge eating in teenagers

- IPT for binge eating in teenagers

- Scalable treatments

Binge eating — consuming an unusually large amount of food in a short period of time — was classified as an eating disorder in 2013. It is usually diagnosed in teenagers and young adults, but children can also develop binge eating.

One of the characteristics of binge eating is that the person feels they have lost control of their eating. They feel they can’t stop eating. And this loss of control (LOC) eating sometimes develops in children (as young as eight years old) who will later develop full-blown binge eating disorder (BED). So identifying and treating children with LOC eating could be an important way to prevent adult BED and weight gain.

Adults with BED usually report that their eating binges are triggered by negative feelings, but kids generally don’t. Instead they describe feeling zoned out. And rather than intending or planning to binge, they tend to do it when an opportunity arises, such as after school when parents aren’t home or are otherwise occupied. BED is often diagnosed in teenagers who are looking for weight loss treatment, who may not even realize they have an eating disorder.

Most of the research on BED has been done in adults with the disorder, but experts are adapting adult treatments for adolescents and children. Two kinds of therapy are being used to help kids with binge eating.

In cognitive behavioral therapy (CBT) kids learn to change their eating habits to prioritize regular meals and healthy foods. They also work on self-regulation and impulse-control skills.

In interpersonal therapy (IPT), kids get help improving relationships that may be troubling them, triggering binge eating episodes.

Binge eating, which involves consuming an unusually large amount of food in a short time, has long been associated with weight problems and psychological distress.  But it’s only since 2013 that repeatedbinge eating has been classified as an eating disorder. Binge eating disorder is usually first diagnosed in teenagers or young adults, but it can also occur in children.

It’s not just the unusual amount of food eaten that defines binge eating. People with the disorder also report feeling a loss of control while eating. And when it comes to children and adolescents who struggle with binge eating, experts say it’s more useful to focus on the “loss of control” experience than the amount of food consumed in an eating binge.

That’s in part because when you’re talking about kids, it’s hard to be clear what “large amount” means — it varies for different ages, genders anddevelopmental stages, explains Marian Tanofsky-Kraff, PhD, a researcher of binge eating in youth and a professor at the Uniformed Services University School of Medicine. “If you have a 14-year-old boy going through a burst of puberty, he could easily eat a whole pizza. Is that large?” asks Dr. Tanofsky-Kraff. “What about an eight-year-old girl who’s eating four slices of pizza? Is that too much?”

But it’s also important to focus on the loss of control (LOC) experience because it’s a behavior that often appears in kids before they have developed full-blown binge eating disorder (BED). Kids who have episodes of LOC eating — regardless of the amount eaten — have been shown to be at higher risk for developing BED and adult obesity. So interventions that treat LOC eating in kids may be an important way to prevent BED.

Kids and binge eating disorder

Most young people who are diagnosed with BED are identified because they are seeking treatment for obesity, explains Andrea Goldschmidt, PhD, an associate professor of psychiatry at the University of Pittsburgh School of Medicine whose research focuses on LOC. They often don’t know they have an eating disorder.

“When I ask kids and their families where they want to start, often times it will be weight loss,” Dr. Goldschmidt says. “And we have to help them understand that the thing they need to work on before they can lose the weight is managing their binge eating.”

Binge eating disorder is rarely flagged by pediatricians and other doctors. That is in part because doctors don’t think of eating disorders when they see a patient at an above average or higher weight, notes Dr. Tanofsky-Kraff. But more broadly, doctors often avoid talking to kids about their weight, for fear of undermining their self-esteem.

Drs. Goldschmidt and Tanofsky-Kraff report seeing LOC eating in kids as young as eight years old. And they’ve seen kids with the full-blown BED as young as 12 or 13.

Diagnosing binge eating disorder

The primary symptoms of BED are recurring episodes of binge eating. Those episodes are defined by eating more food than most people would consume in a discrete period of time — for instance, within a 2-hour period — and a sense of lack of control over eating during the episode. A person with BED feels unable to stop.

The episodes may also be characterized by:

- Eating much more rapidly than normal

- Eating until feeling uncomfortably full

- Eating large amounts of food when not feeling physically hungry

- Eating alone because of feeling embarrassed by how much one is eating

- Feeling disgusted with oneself, depressed or very guilty afterward

For a BED diagnosis, these episodes must occur at least once a week, have continued for 3 months, and be causing serious distress. Individuals with the disorder are typically ashamed of their eating problems and often eat in secret to hide their symptoms.

How are kids different from adults with BED?

While adults who have BED tend to say their episodes are triggered by negative feelings, younger kids generally don’t connect them to feeling bad. That may be because they’re not able to articulate their feelings, Dr. Tanofsky-Kraff notes. “A lot of children talk about feeling like they’re zoning out or paralyzed. They describe a sort of numbing out when they’re eating. We’re not 100 percent sure why, but we think part of it is because they’re using food to cope, to deal with aversive feelings.”

Unlike adults with the disorder, kids don’t tend to plan for binges. Instead, the episodes happen when there is an opportunity.

Often kids report that they don’t eat regularly during the school day. “I will often hear that they don’t want to bring a packed lunch and say the food at school is gross, so they’re coming home from school very hungry,” explains Dr. Tanofsky-Kraff. “Maybe nobody else is home, or their parents are busy doing something else. Those after-school hours can be the prime risk period for loss-of-control eating.”

Who is at risk for binge eating disorder?

Like other eating disorders, girls are more likely to develop BED than boys. And the disorder is highly heritable.

Young people who have been engaging in unhealthy dieting to lose weight are also at higher risk for BED. They restrict their eating so much that they become famished, and they feel deprived. Then they end up overeating and feeling out of control later.

Research led by Dr. Tanofsky-Kraff published in American Psychologist proposes that there are several factors that, combined, may increase the development of BED and high weight among youth who report LOC eating behaviors. They are:

- Negative mood: experiencing depression, anxiety, stress or interpersonal difficulties

- Responsiveness to foods: being particularly sensitive to food as rewarding

- Executive functioning issues: poor impulse control and self-regulation skills

Research has also found that a greater percentage of kids with ADHD have recurring LOC incidents than kids without ADHD.

Treatment for binge eating disorder

Treatment for BED has been studied more in adults than teenagers.  For adults, several forms of therapy have been shown to be effective.

- Cognitive behavior therapy (CBT): CBT is the most studied and well-established form of therapy for BED. CBT works with patients to normalize eating patterns, develop self-control and modify negative views of themselves in order to reduce binge eating.

- Interpersonal psychotherapy (IPT): IPT focuses on improving interpersonal skills to foster healthy relationships and a positive self-image, and helps individuals manage negative feelings without turning to food.

- Dialectical behavior therapy (DBT): DBT focuses on improving emotional regulation skills to avoid using binge eating as a way of responding to painful emotional experience.

There are three kinds of medicine that have been found to help reduce BED in adults, sometimes in conjunction with therapy:

- Stimulant medications developed for ADHD, which may reduce impulsiveness (Vyvanse is FDA-approved for BED in adults).

- Antidepressants, including SSRIs, which may reduce binges by boosting mood.

- Anti-seizure drugs like Topamax, which help stabilize mood and reduce impulse control problems.

Drs. Goldschmidt and Tanofsky-Kraff are both involved in adapting adult treatments for use with teenagers. They emphasize that there is not yet enough research to establish a gold standard treatment for kids with the disorder.

CBT for binge eating in teenagers

Dr. Goldschmidt uses CBT to help young people reset their eating habits to reduce extreme dieting and prioritize regular eating and flexibility with respect to food choices. There is also a big focus on helping kids improve their self-regulation around eating, and strengthening self-regulation skills in general.

Dr. Goldschmidt sees promise in web-based interventions for teenagers, given how much they are online already, and because issues like access and stigma might limit their willingness to engage in face-to-face therapy. In her work, she uses smartphones to collect data on how kids are feeling and what they’re doing, including eating. It’s called “ecological momentary assessment.”

“We ping them throughout the day, or they respond to surveys at the time that they have an eating episode,” Dr. Goldschmidt explains, “and they’re answering a series of questions about where they are, who they are with, how they are feeling, and what they are doing.”

This allows clinicians to offer guidance in real time. “We can identify the momentary factors, as they’re occurring, that are going to trigger a binge eating episode, and we can intervene in the moment to tell them, ‘It looks like you’re heading into a party with your friends. Let’s think about the ways that you’re going to avoid overeating at the buffet table,’” Dr. Goldschmidt adds.

Once patterns are established, Dr. Goldschmidt says, teens can be sent periodic reminders for high-risk situations, or when they’re likely to be experiencing a trigger, to remind them to practice skills they have learned. Dr. Goldschmidt calls this technology-based treatment “CBT augmented by self-regulation interventions.”

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

IPT for binge eating in teenagers

Dr. Tanofsky-Kraff advocates using IPT, which is focused on helping the child to understand relationship issues that may make them turn to overeating.  

Kids who are binge eating are usually struggling with relationships, she says. You might assume that their biggest concerns would be friendships and acceptance by peers, she adds, but it’s usually stressors with their parents. “We did a study where we looked at all the problem areas to see what was it that was prompting their loss of control episodes, and it was most frequently difficulties with their parents.”

IPT helps kids focus on interpersonal issues that are related to their eating. “For instance,” she notes, “if every day when you come home from school you’re having a battle with your mom, you feel badly, and you use food to cope.”

Dr. Tanofsky-Kraff stresses that IPT improves not only kids’ eating habits but also their lives. “It goes deeper, to what is promoting the loss of control. It also improves relationships and mood symptoms, and loss of control is highly comorbid with things like anxiety and depression.”

Scalable treatments

Dr. Goldschmidt notes the importance of developing scalable interventions that could be used to get care to kids who may have poor access to mental health professionals. “We know that binge eating affects kids who are under-resourced, maybe come from minority populations, like racial and ethnic minority youth, and don’t have adequate insurance coverage.”  

She sees hope in the use of technology like smartphones that could enable short-term treatment that targets the eating behaviors and starts to address the mechanisms, though she recognizes that this kind of treatment “is not going to cover all of the bases in terms of what’s underlying the eating disorder.”

Frequently Asked Questions

What is binge eating disorder (BED)?

Binge eating disorder (BED) involves eating unusually large amounts of food in a short time and a feeling of loss of control. A person with BED feels they can’t stop eating. Loss of control (LOC) eating sometimes develops in children as young as eight years old who can later develop binge eating disorder.

What are binges usually triggered by?

What is the treatment for binge eating disorder? https://standingabovethecrowd.com/?p=16630

A person sitting and feeling depressed on bed with city view in dusk moment. Stay home, depression and loneliness concept.

Christopher Brown, Staff Writer

Content warning: mentions of sexual assault and suicide.

Suicide is one of the leading causes of death among Americans, including college students. Conversations about mental health often center on those visibly struggling, but visibility and risk are not the same. Stigma and misconceptions around men’s mental health, in particular, prevent many from receiving help.   

“Mental health normal,” senior and president of the Men’s Mental Health Club (MMHC) at Villanova, Zander DeLuca, said. “It’s something that everyone—male and female—goes through, and it is a shame that it’s so stigmatized, specifically in the male community, just based on how men were grown and raised.”  

Men account for roughly 75 to 80% of suicide deaths per year. CDC data reports 38,925 male lives lost in 2024 alone. SAMHSA data further indicate that adults aged 18 to 25 report the highest prevalence of suicidal thoughts, with similar rates among men and women.  

In 2019, a study of children and young adults (ages 12 to 29) in the Journal of Adolescent Health focusing on LGBT youth also shed light on suicide among non-LGBT youth. It emphasized the need for inclusive prevention strategies. DeLuca cautions against generalizing experiences, noting that people cope, behave and grow up differently. 

  Non-LGBT youth accounted for roughly 90% of the cases in the study, and four of every five of those were male. In addition, the data confirmed disquieting truths about suicide in young men.  

First, most non-LGBT male suicide cases had no history of mental illness. Relationship issues were commonly reported. Seven out of ten (1,100) of the men and boys in the study had no mental illness before death. 62% of them faced intimate partner problems, ranging from bad breakups and cheating to ongoing conflicts. It even included experiences of physical or emotional abuse. 

Recent national survey data from the CDC/NISVS corroborate these findings. They indicate that nearly one in three men experience intimate partner violence. Most of it occurs before turning 25. About 1-in-4 report experiencing sexual violence, and 1-in-14 report being made to penetrate. These experiences are often underreported, stigmatized or subject to differing legal classifications.  

Villanova University survey data show that male students who experience relationship or sexual violence often describe similar experiences to female survivors. Given how frequently relationship issues appear, small shifts in how peers respond may be critical. DeLuca suggested asking “Are you okay?” or “How can I help?” to start conversations that a casual “How are you?” cannot. 

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Male survivors often report difficulty recognizing or disclosing abuse. Social expectations around masculinity can discourage vulnerability. Public narratives frequently emphasize men as perpetrators of violence while stories of male victims and female-perpetrated violence receive less attention in comparison, making it harder for male survivors and anyone harmed by a female perpetrator to seek help or recognize their abuse. 

Perhaps the most unsettling truth from the study is that some men already sought help before taking suicidal action. One in six of the men and boys were in treatment for mental illness at the time of death, and about half had a history of suicide attempts or suicidal thoughts as well. Despite this tragedy, that does not mean men talking about their feelings never works, as sophomore and MMHC co-president Luke Brocius can attest. 

“What I learned, especially from talking to some of these presenters and these mental health kinds of people, is that when men do speak out, when men actually do decide to identify and figure out their problems, there is a huge success rate,” Brocius said.

Brocius’ words suggest that outcomes improve significantly when men can identify and address their tribulations early. 

So, the question is: How can modern mental health resources improve success, especially in an academic institution? Anthony Ciliberto, assistant director for Fraternity and Sorority Life, shared his answer. 

“What works is not telling men to be vulnerable, but creating conditions where vulnerability is normalized and rewarded,” Ciliberto said.  

Effective strategies include peer mentorship mixed with small-group dialogue, storytelling from respected male role models and skill-building around emotional literacy. Help-seeking must be framed as a strength rather than a weakness. People must offer multiple entry points to support men, such as conversation, movement, service and creativity. 

Men interested in the MMHC can find more information about them on Instagram @mensmentalhealthvu. The University offers multiple resources for students suffering from mental illness, suicidal ideation, sexual misconduct and more, such as the University Counseling Center and Title IX. Off campus, there are hotlines dedicated to suicide prevention, domestic violence and sexual violence, such as the 988 Suicide and Crisis Lifeline. 

Check in on the men you care about. A simple “Are you OK?” or “How can I help?” can potentially save a person’s life.

A person sitting and feeling depressed on bed with city view in dusk moment. Stay home, depression and loneliness concept. https://standingabovethecrowd.com/?p=16625

Katherine ShortDead at 42

Martin Short's daughter, Katherine, has taken her own life ... TMZ has learned.

The 42-year-old died from a self-inflicted gunshot wound ... law enforcement sources tell TMZ.

LAPD and the fire department responded to her Hollywood Hills home Monday, shortly after 6:40 PM PT, where she was found deceased.

A representative tells TMZ ... "It is with profound grief that we confirm the passing of Katherine Hartley Short. The Short family is devastated by this loss, and asks for privacy at this time. Katherine was beloved by all and will be remembered for the light and joy she brought into the world."

Katherine -- the daughter of Short and Nancy Dolman, Martin's wife of 30 years who passed away in 2010 of ovarian cancer -- worked as a social worker in Los Angeles after receiving her bachelor's degree from NYU and her master's in social work from USC several years later.

Katherine was involved with a nonprofit organization called Bring Change To Mind, which works to break down stigmas connected to mental health issues.

While her father is obviously very famous, Katherine mostly stayed out of the public eye ... attending a few events with her father throughout the years. She was the eldest of Short's three children.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

We last saw Katherine in January 2020 outside Craig's ... a world-famous restaurant in West Hollywood.

This is the second personal tragedy Short has felt in the last several weeks ... having recently paid tribute to his longtime friend Catherine O'Hara after she passed away last month.

Short has comedy shows with Steve Martin scheduled for Friday in Milwaukee and Saturday in Minneapolis. Staff members for the theaters told us it's unclear whether the shows will take place.

Katherine was 42.

RIP

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org. https://standingabovethecrowd.com/?p=16621

How bulimia, the bingeing-and-purging disorder, affects adolescents, and how it is best treated

Writer: Caroline Miller

Clinical Expert: Daniel Le Grange, PhD

What You'll Learn

- How is bulimia different from anorexia?

- Why do fewer kids with bulimia get treatment than those with anorexia?

- What is the best treatment for bulimia?

- Quick Read

- Full Article

- Symptoms of bulimia nervosa

- Warning signs of bulimia

- Bulimia and shame

- Health consequences of bulimia

- Treatment for bulimia

- Challenges in treating bulimia

- Positive factors in treating bulimia

Bulimia nervosa is a serious eating disorder that usually starts in adolescence. It is characterized by frequent episodes of binge eating followed by purging to avoid weight gain. Unlike anorexia, kids with bulimia often maintain a healthy weight, making it harder to detect. Binge eating involves consuming large amounts of food in a short time, accompanied by a loss of control, followed by purging through vomiting, laxatives, or excessive exercise.

Bulimia can have severe health consequences, including electrolyte imbalances, irregular heartbeats, heart failure, esophageal tears, dental problems, bone weakness, digestive issues, and more. Despite these risks, while it’s twice as common as anorexia, it’s treated much less frequently, in part because of the shame associated with it.

Parents and caregivers play a crucial role in helping their child recover from bulimia. Family-based treatment (FBT) is the most effective approach, focusing on eliminating bingeing and purging behaviors and promoting healthy eating habits. Parents closely supervise their child, monitor bathroom trips, and even flush the toilet to prevent purging. They externalize the disorder, recognizing it as separate from their child, and offering support without criticism.

One challenge in treating bulimia is that tracking progress is more difficult than with anorexia. Rather than monitoring weight gain, it relies on self-reports from the patient and their parents. Sometimes kids with bulimia don’t disclose the full extent of their behaviors due to embarrassment. Therapists work with parents to communicate truthfully about their kids behavior without criticism.

A positive aspect of treating bulimia is that individuals with the disorder are often more willing to seek help compared to those with anorexia. While kids with anorexia often don’t think there’s anything wrong with them, and resist treatment, kids with bulimia may welcome help in overcoming distressing behaviors.

Bulimia nervosa is an eating disorder that involves a pattern of frequent binge eating and then purging to avoid gaining weight. Binge eating is when a person consumes an unusually large amount of food in a short period of time, often feeling out of control or unable to stop while doing so. They will then purge, which is usually done by throwing up, but can also include misuse of laxatives, diuretics, or extreme exercise.  

Bulimia nervosa generally starts in adolescence, and in this age group it’s actually thought to be more common — by one estimate more than twice as common — than anorexia nervosa. And like anorexia, it’s treated most effectively with family-based treatment (FBT).

But bulimia is harder to spot than anorexia. Kids with bulimia usually are not underweight and they may appear to eat a healthy amount at family meals. Bingeing and purging are most often done in secret. When kids go into treatment, many parents are shocked to find out how often they’ve been vomiting after meals, notes Daniel Le Grange, PhD, director of the Eating Disorders Program at the University of California, San Francisco.

Despite its prevalence, far fewer teenagers get treatment for bulimia than anorexia. That may be because bulimia is easier to hide from parents, Dr. Le Grange explains, and because kids are often embarrassed to admit that they have it.

But bulimia is just as life-threatening as anorexia, though the causes of death are perhaps different in the two disorders.

Symptoms of bulimia nervosa

The key symptoms of bulimia are recurring episodes of binge eating, followed by purging, at least once a week for no less than three months at a time. As is the case in anorexia, young people with bulimia also have an intense focus on body weight as the basis for self-esteem.

Binge eating is defined as eating an amount of food that’s larger than what most individuals would eat in a similar period of time under similar circumstances. Dr. Le Grange notes that what’s considered an unusually large amount is relative to the person’s culture. The eating episode is accompanied by a feeling of loss of control over eating. It’s common for teens with bulimia to binge on calorie-rich foods they would otherwise avoid and consume only low-calorie foods between episodes.

Purging involves the use of compensatory behaviors to prevent weight gain, such as self-induced vomiting, fasting, excessive exercise, or the misuse of laxatives or diuretics.

Accompanying the bingeing and purging is an intense focus on weight and body shape as the basis for the teenager’s self-esteem. Like those with anorexia, kids with bulimia are obsessed with their appearance and very worried about gaining weight. Bulimia is 10 times more prevalent in girls than it is in boys.

Warning signs of bulimia

While kids often hide symptoms of this disorder, there are behaviors that can be signs of bulimia that parents might notice, especially if they occur frequently. These behaviors include:

- Worrying or complaining about being fat

- Having a distorted, negative body image

- Eating large quantities of food in one sitting, including foods they usually avoid

- Strict dieting or fasting

- Being secretive about eating

- Going to the bathroom right after eating

- Disappearance of large amounts of food

- Drinking excessive amounts of water or beverages  

- Using excessive amounts of mouthwash, mints, and gum  

- Exercising too much

- Having sores, scars, or calluses on their knuckles or hands

- Having damaged teeth and gums

Bulimia and shame

One important difference between anorexia and bulimia is how kids feel about what they are doing to avoid weight. Anorexia is what Dr. Le Grange calls “ego syntonic,” meaning that it is aligned with the person’s values and self-image. As a result, kids with anorexia don’t think there’s anything wrong with them, and they often resist treatment.

Bulimia, by contrast, is by and large “ego dystonic,” meaning that behaviors such as bingeing and purging conflict with the person’s values and sense of self. “Most young people with bulimia nervosa, ” Dr. Le Grange notes, “do not like the fact that they have bingeing episodes and then compensatory behaviors like self-induced vomiting that are unpleasant ways of getting rid of excess calories. Such episodes are often followed by guilt, disgust, and/or self-loathing.”

While kids with anorexia may be proud of their ability to resist eating and even be admired by other kids, those who binge and purge often see it as a sign of weakness and feel ashamed of these behaviors. It’s common for kids in treatment for bulimia to say they started out meeting criteria for anorexia and then resorted to binge eating because they found restricting calories too difficult. Some of these young people, Dr. Le Grange adds, even describe themselves as “having failed at anorexia.”

Health consequences of bulimia

Due to the many dangerous health risks associated with this disorder, bulimia is associated with an increased likelihood of an early death. Unfortunately, these medical risks are often underestimated because they’re not visible, and at least half of the young people with the disorder are at a healthy-looking weight.

But frequent purging, whether by vomiting, laxatives, or enemas, can damage multiple organs in the body and cause electrolyte imbalances and other health risks. This can lead to irregular heartbeats and possibly heart failure, which is one of the main causes of death in people with bulimia. Repeated vomiting can cause a sore throat and chest pain from esophagus burns, and in some instances even esophageal tears. It can also lead to tooth decay, gum disease, and damage to the salivary glands. A weakened gut lining can make it hard for the body to absorb nutrients, causing one’s bones to become brittle and weak, resulting in higher risk for osteoporosis. Digestive disruption can cause stomach pressure and nausea. Abuse of laxatives can irritate the bowels and lead to constipation and diarrhea. Additionally, dehydration from purging can result in kidney stones and infections.

To prevent or reduce long-term damage from this disorder, it’s important to seek treatment as soon as possible.

Treatment for bulimia

Family-based treatment (FBT) has been shown in studies to be the most effective treatment for adolescents with bulimia, and is recommended by the American Psychiatric Association. In the case of bulimia, the main goal is usually not gaining weight but helping the patient eliminate the bingeing and purging episodes and maintain healthy eating habits.

The parents’ role is to supervise the child carefully enough to inhibit bingeing and purging behaviors. That might mean, for instance, sitting with the child after meals to prevent purging, monitoring trips to the bathroom, and being the one to flush the toilet.

“These are all very intrusive steps,” Dr. Le Grange admits. “But without that level of vigilance, there’s no way you’re going to get a handle on the behaviors. So, we say to the parents, ‘This is what would happen if Amanda was in an inpatient unit. Do you think that you could adopt some of those levels of supervision? This may be what’s necessary to help her overcome these urges and these behaviors that are not just unpleasant, but life-threatening.’ And so parents will usually agree.”

Parents also support their child by what experts call “externalizing the disorder”— identifying the bulimia as separate from the child. “Young people do not choose to develop these illnesses, and illness-related behaviors are not willfully engaged in, even if it seems so at times,” notes Dr. Le Grange.

To avoid being critical or angry, parents are encouraged to keep in mind that the child is in the grip of a powerful disorder that is influencing their thoughts, feelings, and behaviors. They are coached on how best to support their child through this ordeal. “The parents’ task is to battle the bulimia,“ notes Dr. Le Grange, “not their healthy child, who is still there but may be overshadowed by the disorder.”

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Challenges in treating bulimia

One challenge in FBT for bulimia is that progress is more difficult to track than with anorexia, because it depends on reports from the patient regarding binge eating and purging episodes, corroborated by their parents, rather than a scale that reports weight gain. The therapist depends on the patient accurately reporting the weekly count of bingeing and purging.

Sometimes the young person feels so embarrassed that they won’t acknowledge the true extent of their bingeing and purging. “When that happens, the clinician needs to help parents share the real frequency of these behaviors without being critical,” notes Dr. Le Grange. “They need language that they can use to express sympathy that the illness has gotten the hold of the young person in this way, rather than saying, ‘Oh, no, that is just blatantly untrue. She vomited at least six times,’ and you can just hear the criticism rolling from the parents’ tongue.”

Positive factors in treating bulimia

What works in the favor of FBT for bulimia is that kids with the disorder tend to be less resistant to participation in treatment than those with anorexia. In part, Dr. Le Grange says, that’s because kids may actually want help to stop these behaviors that they find embarrassing and distressing. This can give parents some leverage in the treatment process, and the child can help articulate how they think parents can best support their changing these behaviors.

But Dr. Le Grange also notes that, for the most part, kids with bulimia tend not to be as emotionally impacted as those with anorexia. For instance, “You don’t typically see someone with bulimia nervosa declining time with their friends or not wanting to go out anymore, isolating themselves. They would still find a way to really be out there in the world with their friends.”

“At least eighty plus percent of young people with bulimia can and should be treated as outpatients,” notes Dr. Le Grange. “If they really have to be admitted to a hospital, then it’s because the degree of engagement in bingeing and purging is such that parental effort has not made any impact on these behaviors.”

Frequently Asked Questions

What is bulimia?

Bulimia nervosa is a serious eating disorder that usually starts in adolescence. It is characterized by frequent episodes of binge eating followed by purging to avoid weight gain.

Why is bulimia harder to detect than anorexia?

How is bulimia treated? https://standingabovethecrowd.com/?p=16618

Photo by Matthias Zomer on Pexels.com

Caring for a loved one with dementia is an act of love that can be overwhelming at times. As dementia progresses, your loved one becomes increasingly dependent on you for their daily needs. 

Our dementia caregiver tips include practical advice on how to help someone with dementia daily, such as keeping your loved one safe, managing behavior, minimizing agitation, reducing sundowning, caring for hygiene needs, managing meals, and more. We also provide tips for caring for yourself and finding resources so you do not have to do it alone.

Keeping Your Loved One Safe

Dementia can cause disorientation, unusual behaviors, and physical limitations that increase your loved one’s risk of injury. An effective safety plan should include the following actions:

- Provide 24-hour supervision. Never leave your loved one alone in the home or the car, and do not allow them to leave the house alone.

- Block access to hazards within the home. Remove stove knobs and add child-proof plastic covers to doorknobs. Install alarms on exterior doors and windows to signal when they are opened.

- Prepare for emergencies. Provide an ID bracelet or necklace for your loved one to wear at all times in case your loved one wanders. Create a fire plan and plan for natural disasters common to your area.

- Remove fall hazards. Avoid using throw rugs, keep clutter to a minimum, and provide nightlights throughout the home.

- Do not let your loved one drive. Disable the car, hide the keys, or sell the vehicle and say it is in the shop. Keep your keys hidden or out of your loved one’s reach. 

Although it may feel dishonest, therapeutic lying is not dishonesty. It is a method of participating in your loved one’s reality and minimizing unnecessary distress.

Managing Dementia-Related Behaviors

People with dementia respond to caregivers and their environment in ways that may be hard to understand. Their bathroom habits may change. They may resist your help and make statements that do not make sense to you. The following tips can help you cope with common dementia-related behaviors:

- Maintain a structured, predictable routine. Establish regular times for sleep, wake-up, meals, and activities.

- Develop a toilet schedule. Once every two hours is common. As dementia progresses, the gastrocolic reflex, which signals the need for a bowel movement, may be reduced. The bladder may also fail to signal the brain with an urge to urinate. A regular toilet schedule can help your loved one maintain continence.

- Accommodate rather than control. If your loved one becomes restless, provide meaningful tasks or activities, and use redirection and distraction rather than force.

- Participate in your loved one’s reality. Avoid arguing or correcting your loved one if they insist something happened or do not remember a conversation. Find natural ways to redirect the conversation or initiate an activity as a distraction.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

Minimizing Agitation and Anxiety

Agitation, anxiety, and aggression in a loved one with dementia may stem from pain, hunger, thirst, infections, medications, and difficulty expressing themselves. Confusion and loss of control can contribute to these responses. You may be able to minimize negative emotions and aggression by doing the following:

- Avoid overstimulation. Keep noise, clutter, and visitors to a minimum.

- Maintain a routine. Do everything at the same time of day and avoid rearranging furniture or other items.

- Avoid substances that increase agitation. Do not give alcohol or stimulants to someone with dementia, and avoid using them yourself when you are or will be with them.

- Maintain a soothing environment. Use aromatherapy, such as lavender or lemon essential oils. Play relaxing music at a low volume, such as wholetones, classical music, or your loved one’s preferred music.

- Provide gentle massages. Massage your loved one’s hands or feet.

- Provide exercise opportunities. Go for a daily walk with your loved one or provide other physical activities.

- Avoid forceful solutions. Do not physically restrain your loved one unless necessary for their safety.

- Avoid arguing. Acknowledge your loved one’s thoughts and feelings. Distract, redirect, and perhaps offer a snack to overcome difficult moments.

Handling Duplicate Conversations and Questions

Your loved one may forget conversations within moments and either bring up something they just told you or ask a question you had already answered. It is important to note that there is usually nothing you can say to jog their memory, and it could create embarrassment, agitation, and anxiety in your loved one. The following dementia caregiver tips describe the best ways to handle duplicate conversations and questions:

- Answer questions simply without elaborating.

- Redirect your loved one to an activity or start singing a familiar song.

- Wait to discuss plans until just before the event.

- Create signs that answer frequently asked questions and hang them in relevant areas throughout the house.

Identify behaviors that indicate needs, such as pulling on clothing when they need to use the restroom.

Coping with Delusions, Suspicion, and Paranoia

Brain changes and memory loss alter your loved one’s information-processing abilities and perceptions of others. If your loved one becomes suspicious of you, the following tips can help you cope and may ease your loved one’s concerns:

- Do not take it personally. Your loved one’s suspicions are a reflection of cognitive decline, not failure on your part.

- Avoid giving them money. Your loved one may forget when they bought something and accuse you of stealing the money. Instead, give them play money or an expired credit card.

- Be aware of their hiding places. Your loved one may hide important items out of fear of theft, but they may not remember hiding them. Being able to find the items for them can reassure your loved one and de-escalate the situation.

- Avoid arguing. Trying to prove your innocence will not change your loved one’s perception. Arguing escalates the suspicions, leading to agitation and increasing mistrust.

- Warn other caregivers and loved ones. Let other family members and caregivers know if your loved one tends to accuse people of stealing. Educate them on appropriate responses.

Use verbal and non-verbal reassurances. Use gentle touch and kind words to reinforce your love and affection.

Minimizing Sundowning

Sundowning occurs when someone with dementia experiences an increase in confusion and agitation late in the day. They may become aggressive, ignore directions, or attempt to wander away. The following tips may minimize sundowning:

- Increase daytime activities. Provide activities that involve exercise and physical exertion.

- Expose your loved one to sunlight frequently. Take your loved one outside during the day when they can see the sun.

- Minimize daytime napping. Restrict your loved one from taking naps lasting longer than 15 minutes.

- Provide proper late-day nutrition. Prepare a light meal high in protein and fat and low in sugar in the evening.

- Establish a calming bedtime routine. Provide quiet, structured activities in the late afternoon and evening. Be consistent.

- Prevent shadows. Strange shadows can frighten sundowners and trigger hallucinations. Turn on the lights before the sun goes down and close blinds at night.

Managing Meals

As dementia progresses, eating can become increasingly challenging for your loved one. The following tips will help you make the most of every opportunity:

- Establish a routine. Prepare meals at the same times every day, with breakfast or lunch being the biggest meal. Most people with dementia eat less at night.

- Feed your loved one when they are hungry. If they are constantly hungry, they may be confusing hunger with thirst. Try providing half a meal so they can still eat at their regular time.

- Provide peaceful, quiet meals. Reduce distractions at mealtimes.

- Encourage independence. Allow your loved one to do as much for themselves as possible during mealtimes. Providing a sippy cup and finger foods can make it easier for them to feed themselves without assistance.

- Supervise. Eat with your loved one or at least sit at the table and supervise. Cognitive decline can lead to difficulty swallowing and increase the risk of choking.

- Note decreased food consumption. Track how much your loved one eats and notify their physician if you notice reduced consumption.

- Serve nutritious foods. Avoid empty-calorie foods and foods high in sugar.

Caring for Your Loved One’s Hygiene Needs

Your loved one may lose the ability to perceive when they need to use the restroom and may not remember how to wash their hair or body. The following tips can help you keep your loved one clean and protect their dignity:

- Maintain a routine. Have your loved one use the restroom on a regular schedule, such as every two hours. Establish set days and times for bathing, which may only be necessary twice a week. Try to match their preferred routines from before dementia started.

- Provide towels and clothing for bathing. Your loved one may be uncomfortable naked. Provide clothing or a towel they can wear while bathing.

- Provide safety features. These include proper lighting, a non-slip mat in the bathtub or shower, grab bars near the toilet and bathtub, a shower seat, and a hand-held shower head.

- Provide supervision. Never leave your loved one unattended while bathing or showering.

- Wash hair separately. If your loved one cannot wash their hair, wash it at a separate time in a sink or with dry shampoo.

- Consider a sponge bath. If conventional bathing or showering is difficult or the risk of falling is too high, provide sponge baths instead.

Choosing the Best Clothing for Your Loved One

The wrong clothing could cause your loved one to feel trapped or constricted, and some clothing may be too difficult for them to put on. You can ensure your loved one’s clothing is safe, appropriate, and comfortable by doing the following:

- Provide accommodating clothing. Choose loose-fitting clothing free of zippers or snaps. If they must have clothing with zippers or snaps, ensure they are large and easy to use.

- Establish a clothing selection routine. Set out a change of clothes for your loved one to wear and promptly remove the dirty clothing.

- Reduce conflicts about the same outfit. If your loved one wants to wear the same outfit every day, buy several of that outfit.

- Make it hard to undress if necessary. If your loved one tends to undress themselves at inappropriate times, choose clothing that closes in the back.

Taking Care of Yourself While Caring for Your Loved One

Caring for a loved one with dementia is a 24-hour job. Without appropriate self-care, you can become burned out or malnourished. You cannot provide the quality of care you desire if your mental and physical health suffers. You can take care of yourself and your loved one by doing the following:

- Put your needs first. The most important way to be there for your loved one is to stay strong yourself.

- Get help. Ask friends and family members to help. If they are uncomfortable staying with your loved one, they can help buy groceries or run other errands. Many agencies provide respite care to give caregivers a break.

- Join support groups. Nearly every community offers in-person support groups where you can share experiences and ideas for elderly dementia care. Your loved one’s doctor or your Area Agency on Aging should be able to direct you to local support groups.

- Take time to care for your physical needs. Eat healthy meals, get enough sleep, and exercise regularly.

- Get some alone time. Alone time provides an opportunity to recharge.

- Maintain a sense of humor. Laughter is an important way to relieve stress and feel less overwhelmed.

Managing Your Loved One’s Legal Affairs

If your loved one is newly diagnosed with dementia, take care of legal matters while they can still understand legal documents. Once their dementia progresses and they lose that capacity, your loved one cannot legally sign documents. You will need to do the following:

- Prepare and Execute a Durable Power of Attorney and Advance Directives. The Durable Power of Attorney will allow the person your loved one designates to sign on their behalf in medical, financial, or other matters requiring their signature. Advance Directives inform the family of your loved one’s wishes regarding end-of-life care. An estate planning attorney or elder law attorney can help with these documents.

- Designate a spokesperson. The family spokesperson is often the power of attorney. The spokesperson communicates about your loved one’s condition with health care providers, family members, and friends. If there are disputes within the family, the spokesperson can serve as a buffer.

- Copy documents. Make multiple copies of the Advance Directives and Durable Power of Attorney. Keep a few copies in a safe place and be prepared to provide copies to hospitals and other health care providers. 

Additional Resources for Caregivers of People with Dementia

You do not have to go through this alone. Most communities offer multiple resources for caregivers of people with dementia. We recommend the following:

- The 36-Hour Day by Mace & Rabins

- Area Agency on Aging for your area

- The local chapter of the Alzheimer’s Association

- California Caregiver Resource Center

- Family Care Navigator

- Lanzone Morgan, LLP

Placing Your Loved One in a Nursing Home

Many families must make the difficult decision of entrusting their loved one’s care to a nursing home. Nursing homes must provide quality care in safe, home-like environments. However, if you notice unexplained injuries, rapid cognitive decline, weight loss, wandering incidents, or a gut feeling that something is wrong, your loved one may be experiencing abuse or neglect. 

Negligent nursing homes sometimes impose chemical restraints, such as antipsychotic medications, on high-need residents, particularly those with dementia. These medications can be fatal for dementia patients. Some nursing homes provide inadequate supervision, allowing residents with dementia to wander away unnoticed. Nursing home residents with dementia are also vulnerable to verbal, physical, and sexual abuse.

The following tips can help you choose a safe nursing home for your loved one:

- Visit each facility you are considering. Show up at unannounced times during the day and night. Observe the smells and the care the residents receive. Interview staff and try to determine whether staff like working there.

- Check each nursing home’s ratings. Read Google reviews and look up each nursing home on Medicare.gov. You will be able to view inspection reports and ratings. You can also determine whether a nursing home is understaffed.

Photo by Matthias Zomer on Pexels.com https://standingabovethecrowd.com/?p=16613

The parents’ role in helping children recover

Writer: Hannah Sheldon-Dean

Clinical Expert: Daniel Le Grange, PhD

What You'll Learn

- What is family-based treatment for eating disorders?

- What do parents do in family-based treatment?

- Why does family-based treatment work?

- Quick Read

- Full Article

- What is family-based treatment?

- How does family-based treatment work?

- Time commitment for parents

- Why is family-based treatment effective?

- How is family-based treatment structured?

- How do you know if family-based treatment is right for your child?

For most young people with anorexia or bulimia, the treatment that experts recommend lets kids get better at home with their families. Research shows that family-based treatment helps kids gain weight faster than any other eating disorder treatment.

In family-based treatment, parents take the lead in helping kids recover. A mental health clinician guides parents in showing their child empathy while also enforcing strict rules about eating. Parents choose, prepare and serve all of the child’s foods. They require the child to eat and offer lots of support. The child and their parents meet with a clinician every week for coaching on this process.

Family-based treatment is a big commitment. It’s helpful to think of the treatment like any other emergency medical treatment. It changes everyone’s routines, but the changes are necessary to save the child’s life. In later phases of treatment, the child slowly takes charge of their own eating again.

The idea behind family-based treatment is that getting the child nourished is the most important thing. That’s because it’s hard for kids to think clearly when they are starving. Once they start eating more, they can get perspective on their eating disorder and start to behave in a healthier way.

As long as your child does not need emergency medical or psychiatric treatment, recovering from an eating disorder at home is usually the best option. A clinician can help you manage the changes in routine and find ways to balance your other responsibilities.

Traditional approaches to treating eating disorders in children and young adults often involve removing kids from their homes — and their parents — for in-patient psychiatric treatment.

In cases where a young person with an eating disorder needs immediate medical or psychiatric care, in-patient treatment is still recommended. But the treatment experts prefer for most kids with anorexia or bulimia lets kids remain at home, with parents taking the lead in helping them recover. Family-based treatment (or FBT) gives parents the job of strictly supervising the patient’s eating, and evidence shows that it is the quickest way for an underweight child to return to a healthy weight. And in the case of bulimia, parents also learn to monitor the child’s opportunities for binging and purging.

What is family-based treatment?

The core of family-based treatment is the assumption that parents are capable of helping a child recover from an eating disorder. “FBT relies on that core parental capacity to feed your child,” says Daniel Le Grange, PhD, one of the founders of FBT and director of the Eating Disorders Program at the University of California, San Francisco. “In practice, it coaches parents to do the same job that nurses in an in-patient program would do.”

Because eating disorders are complex and confusing illnesses that severely disrupt family life, parents of a child with anorexia have often come to doubt themselves, and they may have given up asserting parental authority over the child’s eating. In FBT they take back that role. “Clinicians in FBT reinforce the idea that parents can do this,” Dr. Le Grange says. “We slowly but surely coach them to begin to trust their gut once more.”

How does family-based treatment work?

In FBT, a clinician guides parents or caregivers in replicating the two major components of in-patient eating disorder treatment: empathy for the child and, in Dr. Le Grange’s words, “an environment in which not eating is not an option.” Just as a parent would insist on treatment for an illness like cancer, even if it is unpleasant, the parent insists that the child comply with FBT guidance. A child with an eating disorder will almost certainly fight eating food that will enable them to gain weight. “But parents need to understand that the disorder is like a malignant tumor,” Dr. Le Grange explains. “They’re not fighting their kid, they’re not trying to make their child’s life miserable. They’re fighting the illness.”

Right at the start of FBT, parents manage their child’s eating, from choosing foods to preparing and serving them. “Essentially, you say to the child: ‘I know this is tough for you, but I’m going to sit here with you until you eat this,’” Dr. Le Grange says. Repeating that process without any exceptions is the core of the initial phase of FBT.

“It can take time,” says Melissa Gerson, LCSW, the founder and clinical director of Columbus Park, a New York City eating disorder treatment clinic. “We may have a parent sitting at the table with the child for an extended period of time, and just waiting for the child to finish.” The idea, she says, is that there’s no room for negotiation. By calmly and confidently directing their child’s eating under a clinician’s guidance, parents are empowered to enforce the boundaries that kids need in order to recover.

Time commitment for parents

Participating in FBT usually means big changes in the family’s routine. For instance, in a two-parent family, the parents might take turns staying home from work to supervise the child’s eating. In single-parent families, it may be necessary to enlist help from extended family or trusted friends. “The first phase of FBT really requires parents to put their lives on hold,” says Dr. Le Grange. Because the treatment can be so disruptive, he emphasizes to parents that eating disorders are an urgent medical threat. “It’s like having a child who’s in renal failure and needs dialysis three times a week,” he says. The change in routine can be hard to manage, but it’s medically necessary.

Ideally, siblings are involved in FBT as well. “Parents are responsible for weight restoration, and siblings are supposed to be supportive of their ill sibling outside of mealtimes,” Dr. Le Grange says. Because the treatment can be stressful and upsetting for the child with the eating disorder, siblings can give the child space to relax and be a kid, away from the structures that the parents impose at mealtimes. Depending on the family circumstances, it may not be plausible to involve siblings without creating more stress, but when possible, they can be an important support system.

In later phases of FBT, the goal is to return decision-making over food intake back to the child or adolescent, once they’ve regained sufficient nutrition and stabilized their weight and behaviors.

Why is family-based treatment effective?

FBT has been shown to be efficacious for underweight kids (with anorexia nervosa) and kids with binge eating and purging behavior (bulimia nervosa). FBT has also been used for kids with other eating disorders such as a typical anorexia or ARFID, but the evidence is not quite as robust as it is for anorexia and bulimia.

The thinking behind FBT is that focusing on improving nutrition is more helpful than analyzing the underlying causes of the disorder. That’s because, Gerson explains, “with anorexia in particular, much of the distress around food — and the low mood, and the isolation, and the compulsivity — is caused by starvation. The child is behaving this way mainly because the brain is starved.” Once the child is no longer starving, they’re better able to think through what’s happening and maintain healthier behaviors going forward.

Dr. Le Grange notes that it’s crucial for families to avoid getting trapped in what clinicians call “anorexic debate.” When your child is trying to convince you that it’s fine to eat only salad, he says, “you’re not reasoning with your rational, smart adolescent. You’re having a discussion with a psychiatric illness.” FBT gives parents a structure in which they can avoid those dead-end debates and focus instead on getting their kids nourished.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Click here to follow James Donaldson's Blog

How is family-based treatment structured?

FBT generally involves roughly 20 weekly sessions, divided into three phases. Throughout all three phases, the clinician works primarily with the parents or caregivers, while being supportive of the adolescent who is in distress. At the start of each session, the child has a short check-in with the FBT clinician to check their weight and get basic mental health support. Then, parents or caregivers, along with the child and sometimes their siblings, meet with the clinician for coaching and support around their work to nourish their child.

The first phase usually lasts for 10 to 12 sessions, and it’s where the bulk of the work takes place. “Phase one is all about re-nourishing the adolescent,” Dr. Le Grange says. During phase one, parents focus on all aspects of the child’s eating.

The child usually does not attend school for the first week or two, in part because they need to conserve energy while they gain weight. Then, if the treatment is going well, the parents might supervise the child a bit less as phase one goes on. “For instance,” says Dr. Le Grange, “by week three the child might go back to school after lunch. And if they keep gaining weight, then maybe by week five the child eats lunch at school, but with a parent or school counselor there to supervise.”

In phase two, which lasts for five or six sessions, the child begins to make some limited decisions about their eating again, and to participate in age-appropriate activities outside of the home. It’s important to move slowly and look out for backsliding in phase two. “These are all very tentative moves, because just a month or two earlier they were still pretty unwell,” Dr. Le Grange notes. “We had a case where the adolescent was doing really well, and they were a very good athlete, but the parents reintroduced physical activity too quickly, and too vigorously, and everything came tumbling down.” If problems do arise in phase two, then the family has to largely return to phase one.

Phase three, the final three or four sessions of FBT, focuses on launching the child back into their normal daily life. It also helps parents learn how to interact with their child again now that their relationship is much less focused on the eating disorder.

How do you know if family-based treatment is right for your child?

If a child or young adult is in a life-threatening medical or psychiatric situation, then hospitalization is necessary. In most other cases of anorexia and bulimia — including those where the young person is very underweight but otherwise medically stable — experts recommend FBT.

Dr. Le Grange emphasizes while FBT might sound daunting, most parents do have the capacity to manage it. “All parents come to us with strengths and weaknesses,” he says. FBT involves coping with each family’s unique challenges and building on their strengths. “And the major strength is that families love their kids,” Dr. Le Grange adds. There are other eating disorder treatments (including enhanced cognitive behavioral therapy, called CBT-E, and adolescent-focused therapy, called AFT) available if FBT doesn’t work or isn’t feasible, but they generally don’t help kids regain weight as fast as FBT does.

Accordingly, Dr. Le Grange urges parents not to rule out FBT, even if their circumstances are challenging. “We have to be creative as clinicians,” he says. That might mean helping parents juggle work responsibilities or financial difficulties, bringing in extended family for support, or helping parents navigate disagreements with each other. “Some situations are much tougher than others, without a doubt,” says Dr. Le Grange. “But that just means that we as clinicians have to work harder and be more supportive.”

Frequently Asked Questions

What is family-based-treatment (FBT) for eating disorders?

In family-based treatment (FBT) for eating disorders, a mental health clinician guides parents in showing their child empathy while also enforcing strict rules about eating. Parents choose, prepare, and serve all the child’s foods. The child and their parents meet with a clinician every week for coaching. https://standingabovethecrowd.com/?p=16607