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The Am Journal of Psych

… 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

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NEDA 2009

 

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

Umbrella 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.

Ophelia's Place

 

If you are in NYC December 4-5th you won’t want to miss this seminar along with a free showing of America The Beautiful followed by Q&A with Mr Roberts:

Beauty In Every Body …You’re looking in the dressing room mirror at your backside, wondering where the air brushers are when you really need them. But it’s not your body that needs air brushing, it’s your brain. We’ve all been brainwashed by messages that undermine our self-esteem and ability to make healthy choices. What will it take to look in the mirror and accept what you see–to cherish the physical form that embodies the true beauty of who you are? This seminar will address the media images and messages that diminish our self-esteem and will offer strategies to nurture body-acceptance and health.

Sol Stone, The Nutrition Clinic, and Ophelia’s Place present: The 9th Annual Erin Leah Robarge Memorial Seminar December 5th, 2008Radisson Hotel, Corning, NY
click here for registration form and brochure
for more information, please call The Nutrition Clinic at 607-732-5646

 

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:

                           __________________________________________________

– 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

 

As many of us already know recovering from an eating disorder takes time, patience, perseverance and an added sense of humor never hurts either. This journey of Hope, Change and Healing can be a long road, but well worth every step! And when a sufferer is not able to obtain the adequate and experienced care that is required for ED treatment this journey can seem like climbing the Himalayas.

Families and sufferers can have a voice and advocate for the care and support they deserve, but it takes some persistence and not taking “no” for an answer but digging deeper and rooting out the resources and connections one needs to help along this road.

One courageous and honorable teen diagnosed with anorexia has taken such a step in Northern Ireland, and is demanding change all the way to the courts to get the care she needs- bravo!

With fire-in-the-heart like that, the sky is the limit to what can be possible so that everyone suffering from this illness will eventually have access and covered care that they need to fight the battle and win their full and healthy lives back.

-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!

 

A wonderful non-profit organization created by Gail Schoenbach For Recovery and Elimination of Eating Disorders – F.R.E.E.D. will be holding a Mother-Daughter Workshop in conjunction with the Eating Disorders Association of New Jersey Saturday, October 18th from 9:30AM-2:30PM at Summit Medical Group.

The workshop’s aim is to “engage women and girls as they explore and challenge their beliefs about themselves, their bodies, and body image”. Freelance journalist, blogger and author, Courtney E. Martin who wrote Perfect Girls, Starving Daughters will be the keynote presenter along with therapist, Suzanne Rubinetti.

F.R.E.E.D.’s mission is to:

  • Provide financial support for treating eating disorder (a major hindrance for sufferers and their families in obtaining treatment/recovery resources as well as follow-up care — F.R.E.E.D.’s priority and focus on this issue is to be commended).
  • Increase public awareness and provide educational resources.
  • Advocate for the acknowledgement and acceptance of Eating Disorders as a serious and urgent disease.

Ms Schoenbach’s own battle with ED and body image issues took place in silence for years until she began the slow process of recovery, and it was during this healing time that she found a passion and drive to create F.R.E.E.D. and her additional adjunct G.R.Schoenbach Foundation which holds annual fund-raising events and campaigns to continue her committed work.

Organizations like these are inspiring, so if you live in the New Jersey area, are a mother with a daughter with/without an eating disorder, go partake in “day of empowerment”, sharing, support and learning– it will do the body&mind good!

shanti

… then shouldst have it for gingerbread*.   -William Shakespeare

      * Or in my case fresh carrot cupcakes

                                  _______________________________

Summer is winding down and it’s been a fantastic couple of months.  Gracious thanks to those of you who continued to email throughout the summer (for almost a month we were too deep in another world to even want access to the internet) with a wealth of supportive and heart-filled thoughts.  I was touched beyond words that can even begin to express my endless appreciation to you all.  And though I didn’t get a chance to respond to everyone in kind as of yet, I just wanted to share, once again how much this has meant to me and our family– merci!**

On another update-note, Drs Daniel le Grange and James Lock will be conducting a one and 1/2 day FBT-Maudsley training targeted towards adolescents with eating disorders in Portland, Maine: September 23-24th.  What a wonderful opportunity to continue to utilize family-based, supportive and evidence backed treatment practices that integrate all those involved within their loved ones’ care and recovery.  Mary Orear, executive director of Mainely Girls is sponsoring this event, for further information click on the highlighted link.

Hope all of you had a restful and recuperative Summer– and looking forward to reconnecting more regularly soon!

-shanti

 

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!

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