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  1. #1

    Eating disorder clinic raises local experts' ire

    Eating disorder clinic raises local experts' ire
    March 25, 2006
    By Melissa Fyfe

    It is dismissed as "bullsh*t" and an expensive placebo. But Sweden's Karolinska Institute is so convinced its treatment can cure eating disorders that it has set up a clinic in Melbourne, Australia.

    The institute, which does not believe that anorexia nervosa stems from a mental health problem, is at odds with most of the world's anorexia experts. Instead, its doctors believe that the disorder, which claims the life of one in five sufferers, develops as a girl diets and then gets pleasure from losing weight and exercising too much. The starvation then triggers the psychological problems such as obsessive-compulsive disorder and depression.

    The doctors say that if they teach the girls how to eat again, the mental symptoms will disappear. The standard care is to treat anorexia as a psychiatric disorder, and this usually includes antidepressants.

    Desperately trying to save the lives of their daughters, 19 Australian families have paid hundreds of thousands of dollars to have them treated at the institute in Stockholm in the past few years. Their daughters were treated there at a cost of $1000 a day as an outpatient, or $2000 as an inpatient.

    Of these Australian patients, 10 have recovered, two have not and the rest are continuing treatment. The institute has a 75 per cent success rate after 14 months with all its patients, according to the results of a small trial published in scientific literature.

    As part of its treatment, a Mandometer, a disc-like weighing scale with a small computer attached to it, tells each patient how much they should eat and at what speed. After eating, the patients are put into a warm room. Doctors say this lowers patients' anxiety. Patients receive counselling but do not take antidepressants. The institute says these suppress appetite.

    The Melbourne clinic, in Brighton, will initially provide support for the Australian girls treated in Sweden. But the institute aims within three years to set up an inpatient and outpatient clinic and a research centre.

    One of the treatment's pioneers, Cecilia Bergh, said yesterday that the institute was talking to several private health insurance funds.

    Dr Bergh said the institute would like Medicare support, but knew hard lobbying would be required.

    Treatment for outpatient care at the clinic, over six to 12 months, will cost between $50,000 and $60,000.

    Ineke Clark, now 21, who was treated in Sweden for seven months, said the institute saved her life. She was quite underweight when her anorexia was at its worst. "I had been told that I had depression before I got sick. That never made sense to me. All I remember was being a normal, happy, healthy girl, getting too obsessed with diet and exercise and then suddenly falling into this hole," she said.

    Ms Clark... went off antidepressants at the clinic. "It is so incredibly important to get some sort of (public) funding," she said. "In Sweden it is just standard treatment."

    Last year, a State Government inquiry recommended that the Department of Human Services and the federal Health Department look at a trial of a Karolinska-type clinic in Victoria. This week, the state department said this was a Federal Government job.

    Claire Vickery, founder and chief executive officer of the Butterfly Foundation, a support and education group, said yesterday that Karolinska was another private clinic that most people could not afford. "I think it is absolutely outrageous that there is so much fuss about this clinic. The craziest thing is that we have fantastic therapies right here in Australia, but people can't afford them."

    Eating disorder expert Susan Sawyer, at the Royal Children's Hospital Centre for Adolescent Health, said yesterday that the institute's theory on the disorder was "just bullshit". Dr Sawyer said the public health system needed more money to deal with the ever-increasing demand for eating disorder treatment, from ever-younger patients.

    "We want to provide a quality service to those who can afford to pay and those who can't."

  2. #2

    Re: Eating disorder clinic raises local experts' ire

    Please note:

    As with many of the articles I post, I want to remind forum members that I am not the author and I do not necessarily agree with the opinions or comments in the article. Indeed, there are some aspects of the treatment program, at least as described in this article, which seem somewhat misguided and potentially counterproductive to me. On the other hand, part of what I suspect is going on in this program, regardless of their philosophy about the nature and origin of eating disorders, is a probably congitive restucturing and reframing (CBT) regarding self-talk and beliefs about eating and body image as well as reinforcement of and practice with healthier habits.

    I am posting this because I think it might stimulate discussion and additional analysis of our views about eating disorders.

  3. #3

    Re: Eating disorder clinic raises local experts' ire

    a disc-like weighing scale with a small computer attached to it, tells each patient how much they should eat and at what speed. After eating, the patients are put into a warm room. Doctors say this lowers patients' anxiety. Patients receive counselling but do not take antidepressants. The institute says these suppress appetite
    I'm sorry, but if someone were to tell me, this is how you should eat, how much, and at what speed and then you will be "cured" I think I would start screaming at them. I understand that many programs include teaching patients how to eat and that this includes having to eat certain foods, amounts, and within a given time, but that sounds much more empathetic than the computer scale in this program... also, the upright refusal to include antidepressants is also somewhat controversial, after research has shown that eating disorders are often comorbid w/ other disorders, such as depression, and some, such as bulimics, have high rates of depression. I don't think medication should be a standard form of treatment by any means but it should at least be considered on a case to case basis. Also, as far as I know, not all medication suppress appetite. also, what about all of the people who do learn to eat again, but that still have cognitive distortions about their body image and food, and still have very restrictive eating habits? if they can eat, then according to this approach they should be cured, which is a point I would argue... what about the programs where the main focus is on having people gain weight to bring them back up to a healthy weight and then leave it at that (at least many programs used to be like this in the past): many of those people relapse. they too learned- or were forced to- to eat again- but you can't just focus on teaching someone to eat again and then think that the "mental symptoms will disappear".

    this reminds me a lot of Peggy Claude-Pierre's eating disorder approach & clinic. Her idea about the confirmed negative condition and her approach in treating young children and very severe anorexics without the necessary (medical) staff etc. was very controversial... then again, many people found "hope" in her understanding on how to "cure" eating disorders. I've read her book The Secret Language of Eating Disorders, as well as a book criticizing Peggy Claude-Pierre: Anorexia's Fallen Angel: The Untold Story of Peggy Claude-Pierre and the Controversial Montreux Clinic by Barbara McLintock. I think there will always be some cure that works for some people, just like one diet will work for some people and not others, or how one medication will have side effects for one person but not someone else- but what is important to remember is that the majority of the people could not afford these expensive private programs, and I wonder, if there is so much controversy about them, then why should people pay so much $ for them? I think a lot of it comes down to pure desperation- desperate to find anything that works.

  4. #4

    Re: Eating disorder clinic raises local experts' ire

    David, I forgot to mention this in my original reply.... I know it's an article and I know people can find these #'s ALL over the place but I think that is the more reason to keep this forum "safe" in terms of posting weights & heights.... can we get rid of those maybe? it's okay if you don't want to but I think it would help to get a break from that at least on here...

  5. #5

    Re: Eating disorder clinic raises local experts' ire

    i can't comment reallly on the above... i know nothing about ed's...
    where the cost that this clinic charges... it could be they know they may not last... and are charging these rates for the quick buck... Maybe. that's just me being cynical?? is that the right word. oh another word i keep coming accoss . comorbid..what does it mean?? (sorry i left sch many yrs ago.. and at that way too early. ) *s*

  6. #6

    Re: Eating disorder clinic raises local experts' ire

    comorbid means the presence of one disorder in association with another... so on top of a primary disorder you could have related disorders, that are "comorbid" so to say... hope that makes sense.

    also, as far as I know, the reason why they charge so much is b/c they're privately funded so they have to charge so much in order to sustain themselves, ie. there's no gov't backing etc.. it's all privately funded. it's like private universities and their ridiculously high tuition fees- they depend on each student's tuition to sustain the entire institution.

  7. #7

    Re: Eating disorder clinic raises local experts' ire

    Eunoia's right in that every person is different. Perhaps for some people, this treatment is enough. Maybe some people who suffer with anorexia only need to be forced to start eating properly again and as they gain back their strength and natural satisfaction for food they think Why on earth did I do that to myself? Probably with some therapy about body image, etc along the way. But, I don't see how this could work for a lot of people. Even for myself - I'm not sick anymore, but thoughts about weight and body image linger all the time.
    Wow, that cost is incredible! Anyway, interesting article. It was interesting how that girl said that she can never remember being depressed before the eating disorder. This is a tough debate, because does the eating disorder cause depression? Yes, i believe so. But, can depression help to cause eating disorders. Yes, I believe this too. So it's like the chicken and egg question. I really don't think they should be so fast to dismiss the idea that eating disorders have nothing to do with other phychological problems or with genetics. I think some of their ideas are valid, but they seem to be too extreme by segregating anorexia as something on it's own. The human brain is very complex. Even happy, healthy girls can have self-conscious emotions on some level.
    Just my opinion.

  8. #8

    Re: Eating disorder clinic raises local experts' ire

    I liked this article a lot. I've been able to relate to this ED article more than any other that I've ever read.

    the disorder, which claims the life of one in five sufferers, develops as a girl diets and then gets pleasure from losing weight and exercising too much
    I swear that is exactly what happened to me. And then the other part...
    The starvation then triggers the psychological problems such as obsessive-compulsive disorder and depression
    Perhaps this could also apply to me because I did have OCD and still do have some residual elements of it.
    if they teach the girls how to eat again, the mental symptoms will disappear
    I think this could work with me because I taught myself not to eat. It was hard at first, but eventually I learned. So maybe it could go the other way too.

    I don't know, I mean, it sounds like I like this article a lot more than other people but I feel like it makes sense, whereas some of the other information that I've read just kind of 'misses' and it's all the same.. Over and over again on these boards we talk about how everybody is different, EDs are different...so why can't this be a successful approach too? Do we have to pick one or the other? I don't know why one approach has to call the other one bullshit and whatnot. It seems petty...I mean, the point is to get well here, right? Whatever works, works period. This article states that this program is in fact working so why should anyone be putting it down?

    I am posting this because I think it might stimulate discussion and additional analysis of our views about eating disorders.
    I would like to hear more about what you think about eating disorders, including their origin, what consititutes a problem that needs to be dealt with, etc? It seems like you remain more quiet than usual on this subject and I am interested to hear you elaborate on your thoughts regarding this matter.

  9. #9

    Re: Eating disorder clinic raises local experts' ire

    Hey, definitely. If something works, it works. It's great for the people it worked for. I guess I just kind of got the impression that the approach was ignoring other variables. Of course, this is only one article about it, so I really don't know what they include in their therapy, etc. The same also happened to me about just simply dieting a bit and losing some weight and then becoming obsessed about it.

  10. #10

    Re: Eating disorder clinic raises local experts' ire

    I don't think anyone is "putting down" this particular approach or any other one per say, Diana & I even specifically said that some approaches work for some people and not for others- which is to be expected- the reason why someone develops an eating disorder varies from one person to the next so it'd be narrow-minded to think that there is one approach to fix it all. what these people are saying is that anorexia (or any other ED for that matter) develops as a "girl's diet" in ALL cases, has nothing to do w/ any other mental ilness in ALL cases, and can be cured by reteaching someone how to eat in ALL cases. that's what bugs me personally. it's like the chicken and egg that Diana referred to. In some patients a mental ilness precipitated the ED or at least a vulnerabiltiy, and in others it is a consequence of the ED. it can be a successful approach and no, we don't need to pick one over the other, but it's interesting to note why a treatment works and for whom.

    the claim that the symptoms associated with anorexia and bulimia (such as obessions w/ food, binge eating, purging etc) are a consequence of starvation in itself is not necessarily a new concept. There was a study done where men were severly restricted in their food intake (in the 1940's) and results showed that their behaviour and personality completely changed as a result of being starved- they became very obsessive & preoccupied w/ their food and depressed as well. so yes, not getting enough nutrients makes people become more obsessed w/ food. psychological problems can result from starvation, such as OCD, anxiety, depression... some have even argued that ED's are a form of anxiety disorders or some form of obessive-compulsive construct.

    The institute has a 75 per cent success rate after 14 months with all its patients, according to the results of a small trial published in scientific literature.
    note the words "small trial".
    "Sixteen patients, randomly selected out of a group composed of 19 patients with anorexia nervosa and 13 with bulimia nervosa, were trained to eat and recognize satiety by using computer support. 14 patients went into remission after a median of 14.4 months." They then reported relapse results on 168 patients who entered their program between Oct. 28, 1993 and Oct. 31, 2000, but these people were not part of the randomized control trial. They used a control group that was receiving no treatment at all at the time.

    anyways, this is the study (pdf) if anyone's interested: http://www.mando.se/ATTACHMENTS/PNAS-Bergh_et_al.pdf
    and the clinic's website, wich describes the treatment in more detail: http://www.mando.se/ours-en.htm

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