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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
We know you always deal with your illness with such courage,
but we still wanted to send you a few hugs,
along with rays of sunshine, big smiles,
and a whole roomful of good thoughts!
So think of these words as a beautiful sunset all your own
and the sound of the ocean gently washing the shore…
Let our thoughts wrap you up in warmth and peace
and sit at your side.
So as you imagine yourself in the midst of these things,
remember how many people care about you and are
wishing you comfort and Love.
-Mary Miro
*Lots&Lots of LOVE to You Today and Everyday! — Mom*Dad*Sis*
When you begin to touch your heart or let your heart be touched, you begin to discover that it’s bottomless, that it doesn’t have any resolution, that this heart is huge, vast, and limitless. You begin to discover how much warmth and gentleness is there, as well as how much space.
-Pema Chodron
* A Very Blessed and Happy Mother’s Day! *
The world’s favorite season is the spring.
All things seem possible in May.
-Edwin Way Teale
__________________
Is it really May, already?
Life has been good… definitely busy, but equally good!
The frenzy of prepping for gallery openings along with late nights doing my own work at the studio, holding support groups combined with some Yoga&Massage on the side has been quite the balancing act to say the least.
The end of the school year countdown has begun by our daughter, who has been finding recovery balances, challenges, and triumphs, mingled in with the excitement and plans for what she’ll be wearing and planning for graduation along with pre-summer preparations– Life is good!
And daily I try to make time to reflect on how grateful and blessed I am for my family, dear friends and acquaintances on this journey of Life- merci!
By now everyone has read and seen the devastation caused by the earthquake measuring a magnitude of 7.9 in the Sichuan province of China. We have been holding our breath these past couple of days since dear friends of ours were living and working in China but were extremely fortunate and arrived saftely back home in India.
Many, many others are yet to be accounted for, and have not been left untouched by this horrific natural disaster– something of this extent not witnessed in over thirty years.
There are several relief organizations scrambling to help those who have been affected by this catastrophe, though what’s growing increasingly frustrating is how the local government is really making things difficult for aid-workers to get through and deliver assistance ASAP.
We continue to send our deepest sympathies and heartfelt condolences to all those affected by this tragic event.
-shanti
“This day is a special day, it is yours
Yesterday slipped away, it cannot be filled anymore with meaning
About tomorrow nothing is known.
But this day, today, is yours, make use of it.
Today you can make someone happy.
Today you can help another,
This day is a special day, it is yours.
-INDIAN POEM-
Most of us realize that we need “fat” not only in our diet, but within our bodies– I say most since when you have an eating disorder, know someone with an ED, or care for someone suffering with this illness, specifically anorexia nervosa, which is hallmarked by the intense fear of gaining weight, this is a very difficult truth to swallow as well as visually accept within ones’ physical body.
There are also some studies that suggest for some this ”fear” can be a precusor to eating disorders among the array of environmental, behavioral influences as well as genetic and/or biochemical predeterminers that scientists are still compiling and discovering that can leave some individuals much more susceptible than others to either severe eating disordered behavior, EDNOS, or a severe diagnosed eating disorder that requires serious and comprehensive treatment.
What’s also intriguing is the work by researchers continuing to unfold in evolutionary biology, genetic imprinting, and epigenetic inheritance which I’m certain there are correlations within these findings and eating disorders that have yet to be fully available and utilized, but may be able to provide us with a much more inclusive picture behind the illness and how to improve prevention and treatment.
There was a recent study highlighting the benefits (mostly catching everyone’s eye with the glorification of our ever evolving rump, or as writer Debra Dikerson slammed in Salon.com last year about mainstreaming “Gi-normous butts”) of subcutaneous fat, which produces hormones known as adipokines found to boost metabolism (of course, I’m assuming this study will also fuel the weight-loss industry and war-on-obesity too) found in the booty area as well as belly and showing to be protective against type2 diabetes, but also reaffirming the adage that “diets don’t work” and briefly explains why this is part of the reason it’s difficult to keep that weight off once lost; and that our fat cells are set during adolescence and don’t decrease, but do actually expand in size.
And while I don’t embrace the the good/bad dichotomous thinking and categorization of really anything when it comes to our daily living and Life– you tend to find things more in shades of gray or muted with other colors vs just a pigment of one– the study is looking at two types of fat: subcutaneous and visceral , and where they are found within the body. Subcutaneous tends to be in the booty and stomach area, and has more benefits vs visceral, which tends to be the gunk blocking arteries, causing damage to organs– sorry to say you’re bad visceral, or maybe scientists just haven’t fully found out what you’re doing and why you are getting such a bad wrap.
Another study that continues in similar dialogue and highlights the complications of metabolic syndrome and that this can be triggered by overeating, which is correlated with weight gain, especially if done consecutively over a sustained period of time, and makes me wonder about endocannabinoids and their role cause/effect in obesity and how this, if at all correlates. The study also points to our fat cells being set during adolescence, but Dr Stephen O’Rahilly of Cambridge remains unconvinced, and isn’t prescribing to this determination just yet.
Maybe another more basic message to keep at forefront is that it’s not nice to fool with Mother Nature– she rises up with a vengeance. Our bodies have evolved over time and there is inherit wisdom to what we carry around with us everyday.
-Love Thyself
T. Mere-
I awoke early before the rest of the family this morning to have some quiet time- make some chai, sit out on the deck in the bitter chill, layered in winter-wear. May 1st it is… our daughter will be turning a year older this month and is fully discharged from the eating disorder program she has had several months of treatment in, both inpatient, residential and finishing with their intensive outpatient program.
Thinking back to her initial admission in November seems eons away from where she is now. She’s come full-circle, rather similar to the cycle of the year and anticipated, sometimes even prominent, seasonal changes (this winter was one of the heaviest in terms of snowfall and duration!) that mark distinct, at times mundane or significantly important passages of time. For our family it was one of change, acceptance and movement forward- leaving what does not nurture or support us happily behind. And with great hope, looking towards the future, but staying as grounded and balanced as possible in the present.
I remember when our daughter’s were much younger and attended a Waldorf school where seasonal change, holidays and traditions were both honored and incorporated directly within the curriculum (such idealism we as parents carried– but so much fun!) and one of the highlights of the school’s year end was the annual May Faire that had Maypole dancing, farmer’s market, crafts… just all around energy, wonderful food, children running, giggling, singing with weaved flower-crowns or greenery in their hair (parents too!) and just an all-around connected sense of community, diversity and optimism– SPRING had sprung! It was a celebration to honor the changing of the seasons, from darkness into light. Back then our daughter was completely free from fears of food and worries of weight-gain, she couldn’t have been farther from such an ugly menace as ED.
Much time has passed since those pre-K days, and our children grow to find their own unique challenges and strengths– sometimes we are faced with circumstances in our lives that can send one afloat upon unchartered territory, navigating can be difficult, but you find a way back to dry land, solid ground and the comfort of those that love and welcome you; and are there for you “have your back” when you need them most.
Yesterday after our daughter had a brownie with “sprinkles” I realized she is really making huge steps towards facing the ED demon head-on, and while she won’t admit at this point “Wow! I just loved that brownie– Yum, yum!” she is taking what is presented to her each day, much more consciously than five months ago. Perhaps not always with her trademark dimpled smile and sparkly eyes, but she’s doing it, and we’re cheering her on!
As I see the small buds on the apple and cherry trees grow in size each day, and the striking presence of the yellow daffodils dot the yard along with the tulips beginning to take on their dark hues; I feel on this first day of May that we’re finally able to see some Light shine back into our own families’ healing and daily rhythm more akin to life before ED– and that feels so wonderful!
An optimist is the human personification of spring
- Susan J. Bissonette
This month is such a busy month… I’m very blessed and so very happy that I’ve sold two paintings (not current work, but nonetheless- yeah!) and it was a carefree act on my end, thinking nothing would move someone to be so compelled for work that honestly doesn’t resonate for me personally right now– but all good!
Easter was nice, we are a culturally diverse family (hubby from India) so we partake in other various festivals and events, Holi (see above) being one this month too– my birthday is coming up (not telling how many candles- tsk!) and having our daughter home from residential after nearly three months of treatment is no light lot.
I love spring! New green shoots pushing forth from the ground– and the snow is finally melting here- yippee! New life, new beginnings… change.
And while our daughter is definitely on her road to recovery, this is not a easy road for her to travel– she still needs lots of love, encouragement and support. She is also quite young, so the decision to “just do it” and fully connect both physically and intellectually to what has taken place over the past year is not all there for her to wade through and have immediate light-bulb moments and decide that today is the day she knows ED is behind her- for good. She herself has openly admitted she “is not ready” to say ado to her tango with ED– not yet.
She has however been slowly “emptying” and “letting go” of ED– one day at a time. A deep breath in and a very long exhale out…
“What will become of me if I let go of my eating disorder?”
“How many times have you tried to let go by hanging on?”
It doesn’t work… and it doesn’t happen all at once. One day, one step, one mouthful at a time.
Our daughter did something incredibly powerful a few weeks back. She wrote a “good-bye” letter to ED and she opened herself up to share this moving note:
ED,
I need to leave you. You have made me do some relapses and only made me think about shapes, sizes or weights. I feel really bad for leaving you but it’s the only way I can stay on the path of recovery and be able to achieve my goals in life. I will miss you a lot.
You have helped clear my feeling of stress out and do something that makes me feel comfortable (restrict). You have really hurt me. My friends and family have been here supporting me, and it seems that you want to shove my parents away. You also have not made me be able to hang out with my friends and then just isolate.
ED, I plan to take care of myself and to listen to myself more than YOU. I plan to become a ballet dancer and veterinarian, and enjoy my life and live my dreams. You may come back to me when I look into the mirror but I won’t let you take my passions away.
Good-bye ED-
Indeed. With the snow continuing to melt, the extended light of the days and the darkness of winter slowly turning more and more towards spring, I feel a renewed sense of Hope and Strength for our daughter’s continued striving forward towards full health, full Life. There will be days, as there already are, that will challenge and the proverbial two steps forward, three-five steps back… but she’ll get there and we’re all right there behind her cheering her on!
Happy Spring- Happy Holi-Hai!
“Heinasirkka-heinasirkka mene taalta hiiteen!”
(Grasshopper-grasshopper go away!)
Having Finnish ancestral blood-lines, we take this man-made legend with both some celebratory flare as well as good-natured humor. Though when I was growing up, St Urho was presented more as a fact– I actually believed there was a real St Urho chasing those grasshoppers out of the vineyards!
And I do remember drinking the grape juice (now we’ve switched to framboise) having bowls of fish soup (not too memorable taste-wise, but I’ve revised this recipe accordingly throughout the years) wearing something purple, and having a sense of pride in our family’s heritage (rarely did anyone I know growing up have any idea about Finnish culture, let alone being a fellow Finn) ; and how my great-grandparents came to the US, fleeing Soviet conflict to make a better life imbued with “Sisu“ strength. Imagine too, to my surprise and sense of fellow-kinship when I found out one of my teacher’s was also Finnish and knew this St Urho character, even going so far as to wear the green (representing the grape leaves) and purple and taking the time during chemistry class to shed a little cultural legend to the day!
So you may be wondering what I’m going on about… what does this have to do with eating disorders, has this woman lost her mind completely, gone off on a tangent of sorts? Well yes, and no…
Our daughter has been battling anorexia nervosa since last year, and as most families with young adolescents struggling with ED know- -it’s definitely a challenge, sometimes requiring every last reserve, every ounce of your sanity, energy, finances, etc. to help pull your child through the black hole of this life-threatening illness towards supporting, loving and helping them find their way back to Life, to Hope and Healing. And it is possible for your child to find their way back towards full recovery, in whatever form that may take that fully supports, treats and assists your child and family best to getting the best care possible.
Many times as parents when confronted with the diagnosis of an eating disorder, after we clear the fog of our own lack of knowledge having not experienced the illness first hand, and then educating ourselves, we may also feel conflicted by all the advice of those while well-meaning, or touting as “experts”cannot ultimately speak for our individual circumstances and personal family needs, preferences, values and choices. And as parents, we have the right to make those fully-informed decisions knowing our child best, and not feeling coerced, manipulated, brow-beaten or given endless heavy-handed black/white-right/wrong ways of fighting this illness and finding the best treatment options for our child– whatever it takes. You, as the parent, will know what is best for your child and should not have to feel guilty or at fault, or having failed , or less of a parent in any way for your choices towards making treatment possible and suiting your individual childs’ needs as well as that of your family.
However, not making a decision or acting towards taking a stand against your childs’ eating disorder/illness will only dig that black hole even deeper, and really no one suffering with this illness or their families should be alone in finding help and the care they deserve. There is help, support and resources available, but since eating disorders are still relatively incoherently and inconsistently treated, and in many instances not adequately covered by insurance for long-term outpatient treatment/services, let alone intensive residential treatment options when necessary, we as parents must take a stand, advocate for our children (and ultimately all those suffering from an eating disorder) and be the “squeaky wheel” in our child’s treatment plan.
Even when your child is at a “safe” stage within his/her recovery, as parents we know there is no looking back– our lives have profoundly changed, ED is not a welcome guest, yet at your childs’ most vulnerable moments, the disorder will work so damn hard at trying to stay and undermine progress– Health and Recovery. Recovery takes time, patience and perseverance. It requires us as parents to listen, be present, and support our children yet also allowing them to take ownership of this process without being left on their own, and with ED’s it’s a complex balancing act because we love our children and want to keep them safe, but at the same time cannot force the process on our terms, or by what we feel when they are feeling something completely other– recovery does have to be ultimately theirs, they will own it, and feel the triumph of success everytime ED rears it’s ugly head and they can face these challenges with courage, resilience and continued strength. Slowly dismantling this pernicious illness, as Lee Wolfe Blum pointedly states: “protect your recovery”…. like the patron St Urho, chasing after either the original mythical frogs or later the grasshoppers; I think there are a couple of translations that have the word “hell” added to the chant.
We Finns celebrate this day every year at this time in March, (some corners of the globe even have a dance ritual they gather together to enjoy– very interesting!) but this year something about St Urho’s Day brought an even more striking meaning to me personally with his image holding up the trident with a captured grasshopper, I was instantly struck by the power of this statue/image minus the grasshopper(s): “ED- ED, get the hell out!”
-May the spirit of this St Urho’s Day be with you all!
After weekend celebrations of ’The Night of Lord Shiva’ at this time of Year, I’m thankfully reminded just how amazing and beautiful Life truly is…
“Om tatpurushaya vidmahe
Mahadevaya dhimahi
Tanno rudran prachodayat”
With Peace & Prosperity-
May Siva Ratri bring Hope & Blessings to All!
Om Namah Shivaya-
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