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… where are we?
Objective: The present review addresses the outcome of bulimia nervosa, effect variables, and prognostic factors. Method: A total of 79 study series covering 5,653 patients suffering from bulimia nervosa were analyzed with regard to recovery, improvement, chronicity, crossover to another eating disorder, mortality, and comorbid psychiatric disorders at outcome. Forty-nine studies dealt with prognosis only. Final analyses on prognostic factors were based on 4,639 patients. Results: Joint analyses of data were hampered by a lack of standardized outcome criteria. There were large variations in the outcome parameters across studies. Based on 27 studies with three outcome criteria (recovery, improvement, chronicity), close to 45% of the patients on average showed full recovery of bulimia nervosa, whereas 27% on average improved considerably and nearly 23% on average had a chronic protracted course. Crossover to another eating disorder at the follow-up evaluation in 23 studies amounted to a mean of 22.5%. The crude mortality rate was 0.32%, and other psychiatric disorders at outcome were very common. Among various variables of effect, duration of follow-up had the largest effect size. The data suggest a curvilinear course, with highest recovery rates between 4 and 9 years of follow-up evaluation and reverse peaks for both improvement and chronicity, including rates of crossover to another eating disorder, before 4 years and after 10 years of follow-up evaluation. For most prognostic factors, there was only conflicting evidence. Conclusions: One-quarter of a century of specific research in bulimia nervosa shows that the disorder still has an unsatisfactory outcome in many patients. More refined interventions may contribute to more favorable outcomes in the future.
http://ajp.psychiatryonline.org/cgi/content/short/appi.ajp.2009.09040582v1?rss=1
Is this year’s theme during NEDA’s Awareness Week 2009- February 22-28 and there are so many ways to get involved within your community– let’s all work towards the continuation of creating greater access to quality ED care-treatment, prevention and awareness!
FAQ for potential NEDAwareness Week participants.Find events & Coordinators in your area. Research into eating disorders focuses on causes, prevention and cures.
Source: National Eating Disorders Association
Eating Disorders are illnesses, not choices! NEDA’s mission is to support those affected by eating disorders and be a catalyst for prevention, education and access to quality care.
NEDAwareness Week – February 22 – 28, 2009 – “Until Eating Disorders Are History” – throughout the US, Canada and other countries
-Erin Hael
Anyone involved with eating disorders knows all too well the commitment, expense, and time that treatment and recovery encompass. There are no quick fixes on this journey towards reclaiming ones’ Life back from a devastating illness that can lead to chronic health debility and even death if left untreated.
Just mention the word “insurance” to anyone acquainted with eating disorders and you will undoubtedly get a credible grunt of frustration or despair when it comes to what insurance companies “allow” for treatment and follow up care. And for those of us who have loved ones requiring the most intense level of care in either residential ED programs and/or partial-day programs for any length of time, insurance becomes yet another demon to lock horns with; and certainly not what caregivers, families and sufferers need tacked onto an already onerous battle to save someones Life.
We have had many a battle with insurance to get our daughter the care she deserves, and to push beyond the bullying that desperate parents face when told your child cannot get the medical services s/he needs until you’ve taken out a second mortgage, gone bankrupt, taken out exorbitant loans because extended coverage was denied, but by all Dr recommendations is absolutely necessary in continuing care and treatment.
The manner at which eating disorders are covered by insurance (and obtaining equal access to quality care is another needle-in-the-haystack!) is still quite crude that my blood boils when listening to parent after parent exhaustively stating the same heartrending scenario over and over. And speaking with parents and sufferers outside the US, you find some of the same- sometimes even worse.
Well, after stating all this rather negative reality, there is some hopeful news to share with the now infamous New Jersey Blue Cross/Blue Shield class action federal court case which restores my belief, coupled with the progression of Mental Health Parity, that 2009 will continue to move forward and keep chipping away towards change in improved coverage and treatment of eating disorders that is well overdue:
January 10, 2009 Horizon Blue Cross/Blue Shield of New Jersey has tentatively settled a class action pending in federal court in Newark, New Jersey involving reimbursements for medical expenses relating to the treatment of eating disorders. The terms of the settlement must still be approved by the court.
Although Horizon covered treatments related to eating disorders (primarily anorexia and bulimia), including hospitalization, outpatient treatment, psychotherapy and nutritional counseling, there were benefit limits on such treatments.
Under the settlement terms, Horizon has agreed to pay claims for eating disorders that were denied because they exceeded the plans’ maximum benefit for non-biologically based mental illness.
Horizon has also agreed to give parity treatment to eating disorder claims for Horizon insureds in the future and to enhance its appeals procedure by providing the right to select review by an eating disorder specialist of all claims denied on the basis of medical necessity.
With the passing of Mental Health Parity many who suffer from eating disorders will finally (albeit slowly-see how your state ranks) be able to begin receiving adequate insurance coverage and necessary treatment needed for long term recovery goals. Great progress without a doubt.
But there is a Judge by the honorable name Faith Hochberg who is rockin‘ the houses of Aetna, Horizon- Blue Cross/Blue Shield who has recently ruled:
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- approval Tuesday to a class action settlement that requires Aetna Insurance Co. to provide about $300,000 in back payments to 119 insureds whose benefits for eating disorders were limited.
The company also promised to treat future claims more liberally and make internal reforms to resolve disputes over benefits for eating disorders.
U.S. District Judge Faith Hochberg also approved a $350,000 payment to the plaintiffs’ class counsel, Nagel Rice in Roseland, N.J. All of the fee comes from Aetna, not out of a percentage of the class members’ recovery.
“It makes perfect sense to me,” Hochberg said after ruling that the settlement in De Vito v. Aetna, 07-418, was fair, reasonable and adequate.
The settlement requires the company to treat some claims for anorexia and bulimia as it does claims for biologically based mental illnesses, such as schizophrenia. That makes a class of eating-disorder patients eligible for eight months of treatment, compared with 20 outpatient visits per calendar year and 30 days of inpatient benefits.
The 119 insureds who will receive checks were those who had at least one claim limited by Aetna’s practices during the past seven years. And in the future, Aetna will treat anorexia and bulimia the same way it does BBMIs.
In addition, anyone Aetna determines to have no medical necessity for enhanced eating-disorder treatment during the next four years would have the right to elect binding review by an independent eating-disorder specialist selected with input from the plaintiffs’ lawyers.
At the same time, though, the settlement affects only patients in “fully insured” plans — those funded by employers. Enrollees in self-funded plans, such as employee welfare and state worker health benefits programs, are not covered by the settlement and would not automatically benefit from the more liberal process.
Nagel estimates that about 530,000 of Aetna’s 1.2 million insureds are eligible for the new claims procedures and that the process could be worth up to $2 million in recoveries by the insureds.
-Law.com
-NY Times
… and putting real faces and voices to the lives of those with Eating Disorders. The NYtimes Health Guide along with Well column/blog by Tara Parker has a wonderful piece documenting a variety of brave and courageous individuals who share their journey of Hope and Healing.
-shanti
President Signs Mental Health Parity Legislation!
Thanks to the thousands of Advocacy Network members who lent tireless support to our years-long effort to win enactment of legislation to end discrimination in mental health coverage. Today we won! After House passage of the Emergency Economic Stabilization Act today, 263-171, President Bush has at last signed mental health/addiction parity into law.
Click here to learn more about the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
-Fantastic news worth celebrating!
Journalist and author Trisha Gura will be hosting an online chat this evening at 8PM on The Center for Eating Disorder Sheppard Pratt forum and will be speaking at CED’s afternoon conference on October 5th in Baltimore, Maryland. Attendance is free and Ms Gura will have signed copies of her book Lying in Weight available as well.
With Dr Daniel leGrange taking his sabbatical in Australia there has been a hub of conference presentations and various skills-based workshops and training for implementing the Maudsley Method into eating disorder treatment and care as well as informing and assisting families and caregivers of utilizing this Family-Based approach to help their loved one.
The collaboration and gathering of these individuals, families and professionals probably could not have arrived at a better time since Australia has recently been highlighting an increase of younger children diagnosed with anorexia.
On a positive note, one Sydney mother describes their experience using the Maudsley Method for their adolescent daughter as valuable and further stated, “It’s not a quick fix. But we’re absolutely stronger as a family. We’ve always been strong.”
Go Maudsley!
The European Eating Disorder Review published two interesting case studies utilizing the NF therapuetic intervention which resulted in some differences (though it appeared both participants found the method beneficial from their personal feedback) which involve three distinct Sessions:
- Session 1 – Neuropsychological Assessment
- Session 2 – Feedback, Formulation & Target Setting
- Session 3 – Reflection
Researches Carolina Lopez, Marion Roberts, Kate Tchanturia and Janet Treasure make clear that these results are preliminary and indeed need further development and study, but that they show promise towards working individually with AN sufferers (I would also think this modality can be implemented and fine-tuned specifically within the other eating disorder spectrum/diagnosis’ as well) and their distinct cognitive processes that can be or become increasingly rigid, singly focused, and inflexible keeping one “stuck” (my words) in a repetitive cycle usually not helpful for an eating disorder sufferer. The “aim of the intervention is to help individuals transcend their information processing styles and develop a more balanced strategy in their relationship with food and shape/weight“.
What stood out positively within the study was pointing out that there is no “right or wrong” in terms of a sufferers cognitive style, and that the emphasis was not to constantly drill a negative personal message of something being “wrong” with an individual. But rather, using the modality to assist in being able to “step back” (where the reflection session comes in) and gain some personal perspective, more reflectively to “problem solve” and restrategize what may be perpetuating a cyclical unhealthy processing in terms of the eating disorder and cognitive-rigidity; and expand a broader scope to better assist and support the sufferer within continued recovery.
What also stood out to me personally in reviewing the case studies was a reflection upon how “acting quickly”, finding treatment, experienced and trained providers, and having a “plan of action” earlier vs later cannot be understated. And sometimes you have to really be a bug up someones arse to get things moving and changing, or finding better care if you’re not getting the services you or your loved one need– so don’t give up, keep plugging forward — everyday is a new beginning.
-shanti
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