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Interview: Dr. Daniel Amen, Sondra Kronberg and Janet Whitney discuss seasonal eating disorder triggers

Q&A featuring Dr. Daniel Amen, M.D., Psy.D., a physician, double board-certified psychiatrist, 10-time New York Times bestselling author and founder and CEO of Amen Clinics; Sondra Kronberg, M.S., R.D., CDN, CEDRD, the Founder/Executive Director of the Eating Disorder Treatment Collaborative/FEED IOP programs in New York and former board member of National Eating Disorders Association; Janet Whitney, MFT, consultant on Sovereign Health’s Eating Disorders Program.

This time of year is known for Thanksgiving feasts and festive holiday treats. What many of us wait all year for can be repugnant and triggering for people with eating disorders. In the parade that is the holiday season, what is appropriate behavior for someone recovering from or in the throes of an eating disorder?

“In Your Right Mind” talk radio host Kristina Kuestner and Sovereign Health’s CEO Dr. Tonmoy Sharma sat down with three clinical experts to discuss holiday triggers for people with eating disorders. The guests now share some additional insights. 

Q: Do you feel that an eating disorder (ED) can truly touch any family or are there types/regions that are more susceptible? More than 30 million Americans experience ED annually. Are we all touched by the disease in some sort of 6 degrees of separation?

Janet Whitney: “Many [colleagues] in the past have approached me because someone in their family, or even themselves, struggle with an eating disorder. If someone is dying every 62 minutes form an ED and these are the current statistics, we have an epidemic on our hands. Some people choose to live in denial because it is such a frightening disease.”

Q: Some outsiders have a hard time comprehending the addiction of eating disorders. If ED were a drug, would it be an upper, downer or escapist dissociative drug?

Dr. Daniel Amen: “Bulimia would be an upper, anorexia more like [obsessive compulsive disorder] and binge eating like dissociation.”

Q: What is the punctuation to the radio program episode followers can take away from the discussion?

Sondra Kronberg: “Balance and flexibility and learning how to feel good about who you are, what you are and how you look. Eating disorder recovery is naught to do with shaming any food type. ED brains function on a rigidly perfectionist and obsessive compulsive plane. Any commentary perceived as criticism will reinforce ED, so, this season especially, is not the time to shame or attach punitive values to certain food groups like sugar or carbs.

“For the ED person this season, loved ones should enfold them in a focus more about the ambience and circumstance than food. It’s already a very stimulating and triggering time of year. Start your own traditions, it’s ED recovery practice to have a group activity after eating, so patients don’t isolate, purge or self-loathe after nourishment. I can’t say more emphatically it’s about progression over perfection.

“Restrictive eating doesn’t work long term for anyone, let alone people with ED. Patience, compassion and forgiveness around Thanksgiving and the rest of the holiday season is paramount. The individual and supporting loved one can set a realistic goal of just making two steps better than last year on thanksgiving, and celebrating that.”

Q:  Dr. Amen, you’ve talked at length about modern clinical treatments that do not address the person as a whole (to treat mood and soul; attention and relational problems). For individuals with and ED who either go without therapy or rely exclusively on treatment without personalizing recovery, why are they relapsing?

Dr. Amen: “Often because the diagnosis isn’t correct. This person often has a brain that works too hard, especially in the [frontal cortex]. Spiritual exercises and meditation can help balance the brain and make this person feel better.” 

Q: Ms. Kronberg, you’ve been deeply invested in promoting ED recovery wellness in your personal practice in addition to your NEDA affiliations. Groups like AA, NA and HA have social events galore only a click and an RSVP away online, to replace the milieu and social lives lost when a recovering individual separates from a previously toxic environment.

When an individual goes online to find ED social activities/events, why are they hard to find?

Is it just as important to have social reinforcements for recovering ED? If so, what is being done in the ED community to cultivate activities?

Kronberg: “I think there’s a risk because people with ED are still in various stages of recovery and you” can’t abstain from food as you can with other addictions “Eating disorder recovery by contrast is far more cyclical than the all-or-none road to recovery for drugs or alcohol.

“Though recovering ED people need support, it’s largely from loved ones; other overcomers can be a support, but that needs to be in a therapeutically supervised setting, unmonitored social groups would be difficult. There can be healthy groups but they’re hard to find because there are multifaceted triggers everywhere. It’s not more straightforward like an alcoholic staying away from bars or close proximity to the smell of alcohol. Substance abuse recovery groups can be motivated by sober social activities but any ED activity would have to be away from food and a nonphysical activity because there are ED types that have exercise phobia or exercise obsessed – and further split by each one’s stage of recovery.

“In my FEED IOP clinics, we’ve done movie outings, gone to the ballet and hosted belly dancers but that’s heavily supervised and with small groups at a stronger season of recovery. In my adolescent ED program we are piloting Struggle to Juggle: a six person small group of young people run by younger therapists. They are really moving and shaking socially; it’s a controlled provision for social development.”

Q: There’s the family disaster kit, the junk drawer, and perhaps a household religious book: these are all things that hold importance, are priceless and at your fingertips when most needed.

Sovereign Health has published a free online guidebook: “The Unbearable Weight” to add to each family arsenal. The toolkit features interactive insights and self-assessments as well as a printable one-stop-shop guidebook.

Is it helpful or harmful to have a sort of “first response” guidebook at home or should loved ones wait for a pattern to develop? 

Whitney: “It is never too early to begin a dialogue about a suspected problem. The approach must be that the behavior has been noticed but to never shame or blame the person for not eating or for purging or for binging. The important aspect is the feeling underneath the behavior.

“Reading the correct responses in the guidebook can be very helpful. Every parent should be aware of the symptoms provided in Sovereign’s guidebook. This disease is about hating or disliking the body – which is the self. These feelings need to be explored and talked about.

“Professional help is the best route to take and the earlier, the better for a positive outcome. The family members need to check there own fears because that can just escalate the problem. It becomes a family disease and it becomes an opportunity for every family member to improve their behaviors and their responses to one another.”