Helping your patient "come out"
Patients may take the first step towards ED recovery
by talking with a health care provider. Most of the time
family members have a sense that "something" is going
on, but it is not being addressed yet in a helpful way.

Encourage your patient to "come out" rather than being
"found out". It allows the patient to take charge over
who will be involved, how it will be presented and to
anticipate possible reactions.

Prior to coming out, ask your patient to consider:
What do I hope to accomplish by coming out now and
in the long run? Who do I want involved with me in
this process? Where and when will I actually come out?
What will I say and how will I say it?
Offer these ideas for beginning a dialogue, from Nancy
Kolodny's book,  The Beginner's Guide to Eating
Disorder Recovery.

"I'm ready to discuss some things about myself that
might make you uncomfortable. I need to know whether
you think we can talk without you lecturing or yelling at
me."
"I have a problem with food and eating. I think you are
probably aware of this. I don't know what to do about it
and I'd like to hear your thoughts. Here's what's going
on…"
"I can't guarantee how I'll react when we talk, but I'm
tired of all the tension around here. I'm
anorexic/bulimic/binge eating and I need to know  how
you feel about that."
Eating disorders at midlife
Although ED's have the stigma of being a young
persons disease, the media has suggested that more
women are developing midlife eating disorders, dubbing
it "the desperate housewife syndrome". Is this true?
Ultimately no, according to findings from the 2006
National Eating Disorders Association conference. It is
true that more mid life women are seeking treatment,
but not with initial onset disorders.

Women who present for treatment at mid-life tend to
fall into one of three categories: (1) The ED has had a
chronic lifetime course, with earlier years perhaps at
the sub-threshold level,  (2) The ED has had periods of
remission  over the years, perhaps re-triggered by a
major midlife transition, (3) The ED is an evolution of a
critical medical ill
ness, such as cancer, that induces a weight loss - if a
person has genetic predisposition, this weight loss can
trigger full expression of an ED (this group represents
the small population of initial onset disorders).

Women at midlife have similar tempermant and
character qualities as younger patients, so treatment
strategies are similar, just adjusted for appropriate
developmental levels.
Suggestions for providers:
  • Be confrontive, in a respectful way, no matter
    how high functioning a person appears.
  • Ask that the spouse be involved
  • Connect the dots--if there are bone, fertility
    and immune issues and it looks like an ED it
    probably is.
"….more
midlife women
are seeking
treatment, but
not with initial
onset disorders".
Is it Bipolar or Unipolar depression?
Dr. Ken Weiner, from the Denver Medical Center,
spoke at the 2006 National Eating Disorders
Association conference regarding co-morbid Bipolar
Disorder as an impediment to ED recovery.
He recommends 5 questions that doctors can use to
differentiate bipolar from unipolar depression:
  • Age of onset of first depression? Bipolar comes
    earlier, in childhood/early adolescence.
  • Psychotic features? Happens with both but
    more common with bipolar.
  • Any post-partum depression? Happens with
both, but more common with bipolar.
  • History of response to antidepressants? If
    antidepressants induced racing thoughts,
    suicidality, sleeplessness--think bipolar
  • Family history? Bipolar families tend to have
    very profound, chaotic histories with
    hospitalizations, suicidality, "eccentric"
    characters.

Of course no one question is diagnostic, but these
questions can help you look for trends differentiating
unipolar and bipolar depression.