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INTERVIEW
WITH THE WASHINGTON POST 24/02/03
Newark, Del.: I
know someone who does not eat very much, except at restaurants. Does
that mean she has an eating disorder? She is slender, but not
underweight.
Dr. Patricia Fallon and Marya Hornbacher: Pat: No, that doesn't mean she
has a disorder. Eating Disorders are a complex group of symptoms. While
someone may have odd habits, doesn't mean they have an eating disorder.
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Milwaukee, Wis.: This question is for Marya. Do you ever think about the
"what-ifs?" Like, what if I hadn't began to throw up at age
nine? What if I'd stopped at bulimia and hadn't developed anorexia? I
mean, do you spend a lot of time thinking about any regrets you might
have?
Dr. Patricia Fallon and Marya Hornbacher: Marya: I can't really spend a
lot of time thinking about what if. Of course it crosses my mind, and
then I have to think about something else.
I wouldn't be who I am now if it hadn't happened and I wouldn't trade
who I am now.
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Columbia, Md.: I work with an organization that creates and utilized
educational curricula to teach children about sensitive topics. I am
currently researching information that will help me create a program
that focuses on Eating Disorders and Body Image. In your opinion, what
would be the most important piece of information you would want a child
to know about eating disorders?
Dr. Patricia Fallon and Marya Hornbacher: Dr. Fallon: As your
researching its important to remember not to recreate the wheel. THere
are a variety of good sites (many listed on the PBS site) that will
direct you to prevention programs. Any approach has to be untertaken
carefully and thoughtfully. We're not sure what happens as we try to
teach kids about eating disorders (ED). You need to not just teach kids
about ED -- that's been shown to sometimes get EDs started, but to focus
more on cultural norms of thinness, nutritional information, healthy
eating. But I'd encourage you to look at what's been done.
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Denver, Colo.: Marya, As a child and adolescent clinician and previous
sufferer of an eating disorder I have witnessed your memoir having a
significant impact on many with eating disorders. Unfortunately a
majority of the time it is questionable if the impact is helpful. Often
patients report that they read and reread your book as a way to escape
into the ED with significant concentration on numbers, methods, and
hospitalization. I myself felt truly on my path to recovery when I threw
your book out.
Do you feel your book is helpful for someone with an ED to read? Who is
the intended audience, and why did you include all the numbers and
methods which research has proven is much more harmful than helpful in
the prevention of ED's?
Dr. Patricia Fallon and Marya Hornbacher: Marya: That's several
questions. In answer to the the one that always comes as a challenge --
is it damaging. Obviously you think it is and I respect your opinion on
that. I get a 50/50 split on what clinicians tell me. Some think it
helpful, others not. I will honestly say I did not write this for people
with eating disorders. I knew it would be read, though, that's why
there's nothing in there that a person with ED does not know. The
inclusion of numbers is a good point. If I had to do it again I would
keep those out. I underestimated how fixated people could be on numbers.
Did I write it to help others? Yes. I wrote it so their mothers,
husbands would put them in the hospital. I wrote it so people would
admit their problem. I have thousands of letters from people who have
read it and said it helped.
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Albany, N.Y.: I have heard horrible things about eating disorder
treament in hospitals -- that patients are not taught about proper
nutrition or healthy ways to exercise, that patients are punished for
standing up, that patients are made to feel worthless because they
somehow "brought the disease upon themselves."
Some patients go along with the "treatment" just to get out of
the hospital sooner. What is your opinion about this kind of
"treatment?"
Dr. Patricia Fallon and Marya Hornbacher: Dr. Fallon: Sounds awful. It's
hard when someone says they've heard horrible things to know what you're
really referring to. I think that the kind of things you're describing
are not at all typical of what you see in treatment programs in
hospitals. In the last several decades, outpatient treatment has grown
more sophisticated, thoughtful and focuses more on things people need to
do to discover.
Marya: Having been inside the mind of an ED. You sound like someone with
an ED who would be horrified at the idea that proper nutrition is not
taught -- that doesn't mean diet isn't taught. Proper dieting is not
taught. I have seen people having problems with people standing up
because they refuse to sit down -- for days.
What you're writing sounds like someone who is threatened by the idea
that catches some of those details -- like lack of exercise when you're
hopelessly in danger is not a big deal when you're running the risk of
cardiac arrest.
Dr. Fallon: I would agree.
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Harrisonburg, Va.: I have been treated for anorexia nervosa inpatient at
Remuda Ranch (1999), and now can not get insurance coverage anywhere. I
am paying Cobra and going to graduate school, but it's hard to pay the
high Cobra fee. Is there any hope for a person with a past eating
disorder to get coverage outside of employment?
Dr. Patricia Fallon and Marya Hornbacher: Marya: I have to pay for
private insurance and it is because of the eating disorder history.
Dr. Fallon: I think that the issue of insurance in the U.S. and to whom
its available is a very important one. I would suggest people go to the
PBS Web site, there is some info about insurance there.
Marya: Most states have some kind of back-up plans for people with
pre-existing conditions, which is often very good, just a little
costlier.
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Middleton, Wis.: Hello,
I have been struggling with adult onset anorexia as a result of lifelong
depression and OCD. I have had anorexia for 20 years (and still do to
some extent). I am wondering if anyone afflicted ever really
"recovers" and what does "recovery" really mean?
Also, I have had my potential and watched my life become destroyed as a
result of the disorder. How might I become involved in helping others --
as a spokesperson, writer, communicator, lobbyist etc. at the national
level? Finally, is anorexia considered a disease, disorder, illness,
mental illness, affliction and/or a "protest" of some kind? I
am uncertain as to what to call this "battle" and am ashamed
to admit that it is due to not eating food (a basic responsibility that
we all have). I appreciate your "listening" and look forward
to the discussion and program. ("Wasted" was very well written
and has a primary site on my "anorexia" bookcase). Thank you
so much!
Dr. Patricia Fallon and Marya Hornbacher: Dr. Fallon: Recovery -- the
definition is a very complicated one. In an essential way it means being
at a normal weight, not purging. But at a more complex level it means
not having your life overtaken by thoughts of food and hating your body,
being able to be in relationships with people. So there's interpersonal
piec and behavioral piece.
Absolutely people do recover. A large portion of people with ED do get
better. There are people who get better but don't really recover and
some who are stuck in their disorders and don't survive the disorder. As
we've learned more about the causes and good treatment, more people have
recovered.
Marya: I can attest to the fact that people recover. In the time that's
past since treatment became a part of my life, the help available has
improved so dramatically I have so much more hope for people now than I
did back then. When I went into treatment, recovery was considered
unlikely. Now I'm sitting here in my office thinking about eating lunch
soon. I eat very normally, my health is very good (within reason), but
especially that element of interpersonal relationships -- the ability to
function is not impeded by ED. That's what recovery means to me. I would
settle for some recovery, given how bad the disorder is.
Dr. Fallon: To help others, there are links on the Web site. And
continue to work on your own recovery because that will allow you to be
able to help others.
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Milwaukee, Wis.: What do you think of the rise in pro-anorexia sites?
Dr. Patricia Fallon and Marya Hornbacher: Dr. Fallon: Pro-anorexia Web
sites glorify anorexia or bulimia as a lifestyle choice. There have been
a number of statements out expressing strong concern about these sites.
Some of the servers have pulled those sites. One of the largest issues
is that -- in anorexia, one of the most central characteristics is how
serious it is. And Web sites that glorify it as a lifestyle choice play
directly to the psychology of people with anorexia. While it's clear
that there's always a balance between free speech and protecting
individuals, these sites target adolescents and they promote anorexia as
a lifestyle and provide encouragement in behaviors that will threaten
health.
Marya: I think that my take on them is colored by the fact that I've had
one. I don't have enough distance from the subject matter to assess
them, so everything I say here has to be taken with a grain of salt.
Recently I was looking through them and found them pathetic, they
saddened me. The encouragement they provide is as if all of the visitors
to the site got to get together and help each other self destruct.
They're not shocking -- I think -- just sad. WHat I found most striking
was how engaged they are with pop culture. The glorification striking.
That was interesting to me. IT was more what I've tried to get away from
and they're just a natural result of the web, the way pornography is.
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Nashville, Tenn.: My son has lost about 40 lbs in the past year. He was
a slightly plump kid through is freshman year of high school. Now I can
count his ribs from the back. It seemed to me that lately he has been
eating more although he spends a lot of time on the treadmill. I was not
too concerned because he is a boy and girls get anorexia and he had
begun frequently snacking on popcorn. I discovered this weekend a
trashcan in the basement that he had been vomiting up the popcorn. I
don’t know how to approach hem about this. He does not acknowledges
that his is too thin and I am afraid he will simply deny it if I tell
him that I know he has been purging.
My son is very intelligent honor student in his junior year of high
school. He plans on studying pre-med in collage and someday becoming a
psychiatrist. I can’t understand why he is doing this to himself.
Dr. Patricia Fallon and Marya Hornbacher: Dr. Fallon: It sounds like
from what you're describing that your son is very much involved in ED
behavior and it is important to get him some help. What if he was a girl
and if you can count his ribs from the back and doing all these anorexic
and bulemic behaviors, at this point it is important to sit down with
him and other family members to express concern and say its time for him
to get some treatment and that you'll be willing to go with him. Just
because he's a male, doesn't mean he can't have an ED. Five to 10
percent of people with ED are males. We don't have clear figures on
whether there is a rise in men, or whether with more information we're
just doing a better job of diagn osing.
Marya: I'm concerned about the line that you wrote that "girls get
anorexia." It saddens me that people are so still unaware. Even in
my personal experience I've noticed an enormous change in male body
image.
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Dallas, Texas: Ms. Hornbacher,
What are your eating habits like now? Do you avoid certain foods? Do you
follow the USDA pyramid guidelines, or do you do something different?
Dr. Patricia Fallon and Marya Hornbacher: Marya: I follow the guidelines
my body dictates. They're very specific. I eat in the morning, noon at
night. I eat when I'm hungry. I require quite a bit of food. I'm very
active and physical. I don't know if the pyramid is better than anything
else, because that's irrelevant to me. I find that most of my friends
and I are somewhat baffled by following an exterior resource to tell us
what we're hungry for, because it's obvious if you pay attention to your
own body. People say this will make you blow up like a balloon and just
want McDonalds -- this isn't true.
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New York, N.Y.: Hello Dr. Fallon and Marya,
I want to say to Marya that I love your book and I have read it many
times. It helps me cope when no one seems to understand. I have been
bulimic and anorexic since 1999.
Since then I have become more and more isolated from friends and family.
Ever day I find it harder and harder to leave my home. I feel that I
will leave once I lose the weight. Ever since I graduated from college I
have seen very little of my friends. I also have not sought treatment
because I don't have the money.
Question: Do you know of a place that offers free and private
counseling, treatment, or information in my area?
Thank you and bless you,
Jenna
Dr. Patricia Fallon and Marya Hornbacher: Dr. Fallon: I would encourage
you to go to the PBS WEb site and e-mail some of the centers on that
site and ask about referrals and resources in your area and see if ther
are some programs that might be available.
I'm concerned about your all or nothing thinking and that you're staying
at home and in many places there are free support groups that are an
essential first step.
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Boston, Mass.: What is the difference between someone who is careful
about what she eats, does not like to eat fatty foods, exercises, likes
to eat low calorie vegetables, and someone who is anorexic?
Dr. Patricia Fallon and Marya Hornbacher: Marya: Everything. IF she's
telling the whole story. Personally I think you're wasting time, but
that's fine. A person with an eating disorder has a lot wrong in their
head. It's not just a behavior. It's obsession, self-hatred,
self-destruction. IT gets triggered by stuff like that, but that's not
the whole story.
Dr. Fallon: The difference between careful food intake and anorexia is
profound. Behaviorally, there is loss of your mentrual period, an
intense need to be thin, an abnormally low body weight. And there is
also a difference in connections with others. Often the anorexic is
concerned about eating, hides the amount they eat from others. Someone
who eats carefully feels open about it.
I like the idea of being a thoughtful eater, not a careful eater.
"Careful" suggests some dangerousness. You make thoughtful
choices based on what you're body needs. "Careful" sounds like
you're standing on an edge and need to make a right choice.
It is possible for careful eaters to become anorexic.
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Springfield, Va.: How has fertility been affected in women with chronic
anorexia-nervosa?
Are there any new therapies for those who have been in and out of
therapy (sort of Therapied out or therapy-savvy), and are still in an
eating disorder?
Dr. Patricia Fallon and Marya Hornbacher: Marya: Research suggests
there's probably an impact on some sufferers. I have had issues with it
and I know other people who in recovery find conception somewhat
difficult. It's not impossible. I would direct you to medical Web sites
for details.
My only suggestion on the second thought, would be to find a therapist
who is smarter than you. If you feel you can outtalk yours, you will.
Even in recovery, it becomes so old hat.
Dr. Fallon: The second part of the question. Getting better involves
this complex relationship between the therapy being offered, who the
therapist is and the person who is coming to therapy and how much one
foot in the door and one out you have. Is there a new therapy now that
is going to cure you? You're adopting a passive role in therapy. But we
know a lot more now, so there are new strategies and information and how
to work with cognitive processes that are more helpful. So you need to
find someone you can connect with and be willin to make changes.
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Union City, Ga,: I believe I have an eating disorder that is never
talked about. I am an binge eater or B.E.D also known as an overeating
disorder O.E.D.
Thank you,
April
Dr. Patricia Fallon and Marya Hornbacher: Dr. Fallon: Binge eating is
when people eat an unusually large amount of food and if you're bulemic,
but binge eaters don't purge, but feel they've lost control and
stressed. So its something to be concerned about. There are very few
people who I've met who believed they have an eating disorder who
doesn't, so I'd want to encourage you to get help.
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Southern Maryland: One of the major causes of eating disorders is
wealth. I've never known or heard of an anorexic who was in the poverty
level income bracket. It's strictly a rich girl's disease, so stop
making it out like it's such an epidemic. It's only spoiled rich kids
looking for attention. Anybody in those programs with parents making
under $200,000 per year? I don't think so. The opposite is true of lower
incomes -- obesity. They stoke up on high calorie, high carb junk food.
Dr. Patricia Fallon and Marya Hornbacher: Marya: There is a correlation
between income level and type of eating disorder. It's not known how
close a connection that is. To make vast generalizations in any case is
dangerous. I was a kid in one of those centers with parents making under
$200K a year. Wealth is not a cause of eating disorders and the last
even 15 years have seen a huge rise in ED across economic, racial and
all demographic lines. Epidemic is a word with a specific definition. I
don't even know if eating disorders qualify.
Dr. Fallon: I would strongly disagree. There's no data that supports
this in any way. I"m not sure what you're personal experience is.
But I"ve seen families totally devastated by the burden of care for
someone with a disorder. If you listen to the stories -- they've
mortgaged their homes to provide help. I do think the more money one
has, the more access to care one has, so it is possible that if you
don't have any money -- like the earlier questioner -- that the more
money you have the more likely you are to have choices in treatment.
Eating disorders, contrary to what people thought 30 years ago, aren't
rich kids' disease. Those were just people that could get to treatment.
More recent studies show it cuts across demographic and economic strata.
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Beaver Dam, Wis.: After months of "outpatient" therapy, and
continual improvement, our 13-year-old daughter continues to be lying to
her therapist, purging sometimes twice daily, and verbally abusing her
family members. How and when is it the "right" time to have
her admitted to an adolescent female treatment center? Is there a
treatment center for 13 year olds you can recommend, or that you have
experience and feel comfortable with recommending?
Dr. Patricia Fallon and Marya Hornbacher: Dr. Fallon: Seems like the
most important piece is when is the right time to have more intensive
treatment than you've been receiving. If after months of outpatient
therapy, you're still having these troubles, it is certainly appropriate
to investigate other treatments. I would work with the outpatient
therapist, look at the Web site and there are additional intensive day
treatment programs as well as in-patient programs.
Marya: I think in-patient primarily is for breaking the cycle that a
client is unable to break herself. There's nothing on the outside that
will tell you when that time is. If it's been this long you're in a good
position to think now is the time. Thirteen is a good age to be with an
eating disorder. That points toward recovery, so there's a lot of hope.
Delaying help probably won't serve her, so personally I don't think any
harm is done by getting more help earlier whereas the opposite certainly
causes problems.
As far as a specific place, I can't say.
Dr. Fallon: I agree with Marya about breaking the cycle. If someone is a
danger to themself also or in a medically compromised state.
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Dr. Patricia Fallon and Marya Hornbacher: Marya: I think if anybody's
reading this discussion, there's probably a reason and this should not
be your last resource. Whatever your personal reasons are, educate
yourself with as much balanced information you can and get whatever help
you can.
Dr. Fallon: If you or someone you love has an eating disorder, know it
can get better, be painful and take a long time, but it is possible.
Hang in there.
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