Managing Eating Disorders: A Family Affair

When eighth-grade boys repeatedly bullied Pam Kimmel’s 14-year-old daughter, making fun of her muscular, gymnast legs, the teenager’s mother advised her to brush off the unkind remarks because, well, boys can be mean at that age. But her daughter took the abuse to heart and started a diet. Her parents noticed she was not eating the foods she used to and consuming more fruits and vegetables.

"We thought she was just eating healthy and losing weight normally," Kimmel says. "We had no idea she was purging." In a period of about two months, however, their daughter had dropped from a well-proportioned 130 pounds to a slight 103. Her baggy clothes hid the heartbreaking truth that finally came to light after her friends confided in her parents, expressing their concerns. Indeed, their daughter had developed a life-threatening eating disorder, anorexia nervosa. Unbeknownst to her parents, she was learning anorexia "tips" from websites and was slowly starving herself. Her blood pressure and heart rate were dangerously impacted by the dramatic weight loss, often causing her to pass out suddenly. 

The Kimmels immediately found treatment for their daughter, seeking the help of a couple of local therapists. But she continued to deteriorate and she required hospitalization. Desperately worried, the Kimmels contacted Lindner Center of HOPE in Mason where they worked closely with Scott K. Bullock, MSW, LISW-S, CEDS, clinical director and family therapist, Child/Adolescent Services, with the Harold C. Schott Foundation Eating Disorders Program. The eating disorders program serves adolescents and adults. 

The Lindner Center of HOPE’s multi-disciplinary approach to  eating disorders treatment, for female and male adolescents, combines psychiatric management, psychotherapy and nutritional services, all focused around Family-Based Treatment (FBT) involving all members of a family. The goal is to allow the developing adolescent to avoid hospitalization or residential treatment because the family learns to provide the necessary care in the child’s home environment.

When it became evident that weekly therapy sessions were not enough, the Kimmels considered sending their daughter to an out-of-state residential treatment program. But Bullock advised otherwise. He pointed out that no matter how initially successful a long-distance treatment program might seem, their daughter would eventually return to live at home with the family – the people who are closest to her – and the treatment would be for naught unless the family also learned how to deal with the dynamics of her eating disorder.

"Scott, without a doubt, saved our daughter’s life," says Kimmel, noting that her daughter is now a healthy, thriving, 19-year-old college freshman. "It wasn’t easy. There were so many tumultuous times and issues we had to work through during the past five years. But Scott stuck with us.

"She had to learn how to develop a whole new idea of self and how to be happy with that. She now recognizes that certain stressful situations can trigger a return of her eating disorder." 

Bullock’s work with the Kimmels and their daughter helped to create Lindner Center of HOPE’s Proximi Recovery Eating Disorder Program (PREP). The program will make its debut this spring. 

Parents struggling to understand their loved one’s anorexia nervosa or bulimia nervosa begin to question their own parenting skills and their ability to successfully help their loved one, Bullock says. Proximi – which means the closest ones – is uniquely designed to meet the daily needs of struggling families through home, school and community assistance from trained therapists. With proper education and training, Bullock and his associates maintain, families learn to work together to prevent hospital re-admissions and successfully manage the eating disorder in the home.

"It’s running away from the stressors that cause the continuing pain of an eating disorder," Bullock says. "If you stand up to the stressors, they lose their power and energy and no longer control you."

Proximi will provide committed families access to a therapist every day of the week to provide consultation, education, training and support through a combination of office visits, phone calls and in-home and family meal sessions. Bullock adheres to the philosophy that the therapist is the consultant in the battle against an adolescent’s eating disorder, assisting the parents – the experts on their loved ones – in managing daily family life situations. 

"Parents are still in charge of their child," Bullock emphasizes. "I just help them out."

The intensive 24-week Proximi program includes:

• Initial two-hour evaluation

• Initial one-hour nutrition assessment and meal planning with registered dietitian

• One 50-minute office session per week with the therapist

• One in-home mealtime session per week

• One 50-minute in-school or in-community mealtime session per week

• One daily phone consultation with parents (5 to 10 minutes a day, up to 60 minutes weekly)

• One 30-minute follow-up registered dietitian session per month (five sessions total)

• As warranted, consultation/collaboration with all pertinent patient care providers (primary care physician, psychiatrist, school personnel, dietitian or other specialists)

• A protocol pamphlet and other education materials and assignments

• Pre- and post-testing to measure change

• Post-program follow-up sessions, three 30-minute sessions at 6, 12 and 18 months post-program

• Assistance in obtaining follow-up services in traditional outpatient therapy, if needed

In addition to anorexia nervosa and bulimia nervosa, Lindner Center of HOPE also treats binge eating, overeating and obesity, compulsive exercise and avoidant/restrictive food intake disorder. A common denominator across the board? All patients need help distinguishing themselves from their eating disorder, explains Dr. Paul Houser, MD, staff psychiatrist and medical director at Lindner Center of HOPE’s Harold C. Schott Foundation Eating Disorders Program. 

"Often times, they do not know who they are apart from the disorder," Dr. Houser says. "We have to get them to separate from it as if it is an actual person. Their eating disorder (ED) has been their friend. Their means of control. We encourage them to see all the negative things that have come out of their friendship with ED, and help them realize what their life is about outside of ED."

The first phase of eating disorder treatment is most critical, Dr. Houser says, because it focuses on the refeeding process. "It’s a tough time for patients because their brains are so starved yet eating becomes the scariest thing in the world. Patients are absolutely petrified of taking nourishment, of getting proper nutrition, which really is the most important medicine for getting your body to heal, especially in that first week."

Avoidant Restrictive Food Intake Disorder catches an entirely different spectrum of patients, according to Dr. Houser. "They don’t have the same core struggle with body image like someone suffering from anorexia and bulimia, but they have restricted their food intake so much they have become ill."

Binge eating, however, is the most common eating disorder of all. "A patient can have this for many years but not recognize it," says Anna I. Guerdjikova, PhD, LISW, CCRC, director of administrative services for the Harold C. Schott Foundation Eating Disorders Program. "Overall, eating disorders can start as early as age 5."

One of the main things Lindner Center of HOPE has to offer that sets them apart from other facilities is that they are a mental health center that specializes in multiple areas, including eating disorders, so they can treat the co-morbidities that often come along with these illnesses, says Sarah Arszman Lavanier, PsyD, CEDS, a staff psychologist at the Lindner Center of HOPE and clinical director of the adult eating disorder services. "We treat all the co-morbidities, not just the eating disorders. A patient may come here after being diagnosed with Obsessive Compulsive Disorder, PTSD and an eating disorder, for example, and we treat all of those."

Support groups are an integral part of the healing process. The center offers education, support and feedback for families, as well as a caring, safe environment for families to express concerns. All groups are facilitated by an experienced professional member of the Harold C. Schott Foundation Eating Disorders Program, offering discussion on a variety of topics that include general education on eating disorders, how to communicate with eating disorder patients, in-patient treatment routine and protocol, how to provide proper meal support, relapse prevention and strategies and how other family members, particularly parents, can – and should – take care of themselves as valuable members of the treatment team.

Changing society’s conversation regarding body image, dieting and the role food plays in our lives is necessary in the ongoing, long-term battle against eating disorders, Lavanier says. She is an enthusiastic proponent of the Body Positive Movement, a nationally recognized crusade, if you will, that recognizes the importance of body diversity by encouraging people to be more accepting of who they are, to use positive language regarding their and others’ bodies, and to prioritize health before beauty.

"We implemented the the Body Project here at the center two years ago," Lavanier says, adding that she would like to see the basic tenets of the movement incorporated into high school health programs. 

The Body Positive Movement says no to:

• Society and advertisers preying on women’s insecurities

• Excessive Photoshopping of body images in the media

• Being programmed into accepting unrealistic body images

• The notion that being a certain weight determines whether you’re healthy

• Women being treated as sexual objects and the objectification of women

A resounding yes, however, is given to:

• Embracing all body types, shapes, sizes, colors and reveling in the human form

• Celebrating the journey our bodies have been on

• Growing old, and acknowledging the privilege to do so

• Focusing on things that are important in our lives, rather than comparing ourselves to others

• Being healthy at every weight

Lavanier hopes to host a screening of "Embrace" – the acclaimed social impact documentary exploring the issue of body image – at Lindner Center of HOPE during National Eating Disorders Week in February. "Embrace" is directed by and told from the vantage point of Taryn Brumfitt as she travels the world talking to experts, women on the street and well-known personalities about the alarming number of body image issues affecting women. The film explores the factors contributing to the problem and seeks solutions. Its world premier took place at the 2016 Sydney Film Festival, making it into the festival director’s Top Five picks, and was nominated for the Documentary Australia Foundation Award for best documentary. 

Lindner Center of HOPE is located at 4075 Old Western Row Road, Mason, OH 45040. For more information, call 513.536.HOPE (4673) or visit  www.lindnercenterofhope.org.