• Quote of the Day
    "The only normal people are the ones you don't know very well."
    Alfred Adler, posted by David Baxter

David Baxter

Administrator
Joined
Mar 26, 2004
Messages
37,569
Points
83
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."
 

David Baxter

Administrator
Joined
Mar 26, 2004
Messages
37,569
Points
83
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.
 

Eunoia

Member
Joined
Feb 14, 2005
Messages
785
Points
16
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.
 

Eunoia

Member
Joined
Feb 14, 2005
Messages
785
Points
16
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...
 

foghlaim

Member
Joined
Feb 18, 2006
Messages
1,549
Points
36
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*
 

Eunoia

Member
Joined
Feb 14, 2005
Messages
785
Points
16
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.
 

Diana

Member
Joined
May 26, 2005
Messages
297
Points
16
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.
 

Peanut

Member
Joined
Aug 1, 2005
Messages
1,084
Points
36
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.
 

Diana

Member
Joined
May 26, 2005
Messages
297
Points
16
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.
 

Eunoia

Member
Joined
Feb 14, 2005
Messages
785
Points
16
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
 

foghlaim

Member
Joined
Feb 18, 2006
Messages
1,549
Points
36
I am posting this because I think it might stimulate discussion and additional analysis of our views about eating disorders
? it did!! and i am facinated.. i'm learning here..? thank you.
 

Peanut

Member
Joined
Aug 1, 2005
Messages
1,084
Points
36
I don't think anyone is "putting down" this particular approach or any other one per say
When I said that I was referring to the people in the article, where it states:
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".

To me that sounds unprofessional, for one thing, and, I don't see why the focus is on what is wrong with this approach.? I think the focus should be on the possible benifits and perhaps why we think that these aspects could be benificial..and who knows, maybe there could eventually be a hybrid program that takes the strengths of different approaches and mixes them up and makes that approach stronger.? Maybe it could also lead to more individualized treatment.

I did not go look at the study because I don't think that looking at the details is really relevant to what I am saying here.? I mean, even if the new approach worked for only ONE person, I think it should be written up and reviewed and looked at for ideas or as a possible alternative or improvement on the current approach..?

I am not saying that that approach is perfect...but what is perfect?? I think I'm correct in saying that anorexia is one of the deadliest psychological disorders to have (meaning high fatality rate) so obviously we don't have all the answers yet....and why should we stop looking??

Plus, I also forgot to add that I love this part:
After eating, the patients are put into a warm room. Doctors say this lowers patients' anxiety.
This works so well for me--I can see exactly how it work to calm people after they eat.? When I get extremely anxious I always go turn on my hair dryer and blow warm air all over myself and it is the most physically calming thing that I have to do.? It works, and sometimes after I eat I blow warm air on myself to relax.?

I am also coming from the perspective of having tried about seven different types of anxiety meds that have been heavily hyped, and are generally looked at as the correct way to handle anxiety.? Well, none of them ever worked for me, so naturally, I can relate to the aspect of
Patients receive counselling but do not take antidepressants
.? Sure some people want medicine, but a lot of people don't for various reasons.?
.
If this program looks good to someone, why not let them try it?? While experts are trying to decide whether the chicken or the egg came first, these people are apparently teaching people how to eat the chicken and the egg again, and I have to say that seems like a good idea to me.?

Does this sound a like a bit more of a behavioral approach??? It kind sounded like that to me.
 

Peanut

Member
Joined
Aug 1, 2005
Messages
1,084
Points
36
Ineke Clark, now 21, who was treated in Sweden for seven months, said the institute saved her life

Here is one example of this program really working. If it works for one, there are likely others who would benefit from the same type of thing. I just think that we should not be so fast to criticize, when maybe we could learn from parts of it.
 

foghlaim

Member
Joined
Feb 18, 2006
Messages
1,549
Points
36
maybe there could eventually be a hybrid program that takes the strengths of different approaches and mixes them up and makes that approach stronger.? Maybe it could also lead to more individualized treatment.

while i agree with what u have written here Toeless:? (and again knowing zilch about ed's)
i'm thinking that this programme is a hybrid of those that are already out there.? ??That maybe this centre has taken One element and focused on that alone. and that this is what's causing the "conflict" with other professionals in the field.

maybe i'm wrong...it's just a thought.


and i also agree that what works for one doesn't mean it works for everybody with an ed.
 

Peanut

Member
Joined
Aug 1, 2005
Messages
1,084
Points
36
Yes, good point, maybe this is a hybrid program.? I guess I just saw this article and thought, if it were me, that sounds closer to what would work than some of the other types of things....the warm air, even that scale that reads out what your supposed to eat, etc....I think if I weighed myself on a scale and instead of seeing a number, I saw what I was supposed to eat, I think I would be more inclined to eat that amount!? I probably came off too strongly about it but I just didn't want to see it be ignored because of the faults because I thought it had a lot of really good techniques

As I said before it kind of sounds (and I could be wrong about this) like more like a behavioral approach and sometimes behavioral approaches seem more logical and practical to me, but maybe that it because that is what I am used to (since I work in a field where we use behaviorism a lot).? I like things that are regimented and concrete.? I thought maybe if the behavior was learned the cognitive aspect would follow.?

Eunoia is probably right though--maybe there is just not enough of a cohort to study the effectiveness...I just hate to see that though, because then it leaves all of the outliers, the few people that the usual treatment doesn't work for, without another alternative.? Of course, the expense of this particular treatment facility is probably very restrictive.
 

foghlaim

Member
Joined
Feb 18, 2006
Messages
1,549
Points
36
the expense of this particular treatment facility is probably very restrictive
it probably is for some... and for others they might be inclined to think.. if it's this expensive it MUST work. ???????

i'm only learning about cbt.. the stuff you are saying above,sounds like cbt.
so I will leave the others here to comment on that aspect ok. *s*
 

Diana

Member
Joined
May 26, 2005
Messages
297
Points
16
Toeless, that's a good point you made about the program being more regimented and concrete. People who are strictly anorexic tend to be extremely regimented and concrete. I find for myself, when I give myself a routine for eating, I eat much better and am not as inclined to skip meals.
 
Joined
Oct 14, 2004
Messages
8,518
Points
38
Diana said:
Toeless, that's a good point you made about the program being more regimented and concrete. People who are strictly anorexic tend to be extremely regimented and concrete. I find for myself, when I give myself a routine for eating, I eat much better and am not as inclined to skip meals.

me too. Lately I've really slipped back into anorexic behaviors (how easy it is to do that). :( So I am trying to sit down each morning and write out what I am planning to eat so that I can make sure I'm getting enough calories. I realize that it might not be a good idea for some people to do this, but it helps me make sure I'm doing ok.
 
Top Bottom