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Articles tagged with: Cleveland

Does Your Teenager Have An Eating Disorder?

May 06, 2014.
  • The Emily Program offers all levels of care for teenagers, from outpatient services to 24/7 residential treatment. Our compassionate staff understand the complexities that come with eating disorders and that no two teenagers are alike. Working with the teenager and their family, we establish a treatment plan that will fit each individual’s needs.

    In this brief, Ask the Expert video by Mpls-St. Paul Magazine, Dr. Jillian Lampert discusses the signs and symptoms to watch for and how to get started.

    We welcome concerned parents and guardians to call us at 1-888-EMILY-77 (364-5977) if you are worried about your teenager. We’ll help answer questions and guide you through how eating disorder treatment can look for your teen.

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Introducing Adult Binge Eating Disorder Intensive Outpatient Program (BED-IOP) in Cleveland

April 18, 2014.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    By Jean Doak

    Cleveland Center for Eating Disorders is excited to announce the opening of a new program – BINGE EATING DISORDER INTENSIVE OUTPATIENT PROGRAM (BED-IOP). An IOP for Binge Eating Disorder (BED) that is separate from the current IOP for individuals with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) has been developed to assist with the unique challenges one encounters with binge eating. By definition, individuals with BED engage in binge eating episodes and do not engage in food restriction or purging behaviors as do those with AN and/or BN.

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Eating Disorder Education in the Community

March 17, 2014.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    By Dr. Mark Warren

    I co-taught a day long conference at the Gestalt Institute a few weeks ago on eating disorders, the science behind them, when to refer, and when to treat. It's a topic that forms the core of the work we do and is very dear to my heart. The participants at the conference were a terrific group.

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A Review of Eating Disorders and The Brain

February 26, 2014.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    By Dr. Mark Warren

    One of the most exciting books to recently be published on eating disorders is the book Eating Disorders and the Brain by Drs Bryan Lask and Ian Frampton. A review of the book was recently published by Dr. Joel Yager, a prominent psychiatrist in the eating disorder field. Dr. Yager describes 2 parts of the book which I thought to be extraordinarily important. The first is an early chapter in the book by David Wood on why clinicians should love and appreciate neuroscience. This discussion, which focuses on free will, determinism, how the presentation of an eating disorder makes one think about philosophical, clinical, and medical issues is critically important. This chapter also discusses past assumptions and questions around the origins of eating disorders including genes, attachment theory, cultural theories, social adversity, family issues, maturation, issues of neural networks and how all of these issues can be seen not as etiologic factors but as factors that must be considered while treating these complex disorders. By moving beyond etiology into understanding complexity, he makes a tremendous contribution to the conceptualization of these illnesses.

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What makes FBT most effective?

November 04, 2013. Written by Mark Warren, M.D.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    By Dr. Mark Warren

    For several years it's been clear that Family Based Therapy (FBT) has the most evidence based support for its effectiveness with recovery rates in the 50-60% range for adolescents with anorexia who have been ill for less than three years. This number is two to three times better than other therapies for this patient population. Having said that, this still means there are a significant number of adolescents who are not recovering through traditional FBT. A recent study highlights behaviors during the family meal that appear to predict when FBT is most likely to be effective. As FBT is the core of how we treat adolescents at CCED, we are particularly interested in this research. This may be significant for adolescents and families for whom FBT may be quite effective but need greater support around parental empowerment, setting contingencies, managing meals and other mechanisms that may improve their rates of recovery. This article will hopefully be part of a new wave of interest in ways to make this evidence based therapy even more effective for more patients.

    Contributions by Sarah Emerman

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Diagnosing an Eating Disorder in an Overweight Teen

October 18, 2013. Written by Mark Warren, M.D.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    By Dr. Mark Warren

    The DSM V has brought formal recognition to a significant issue in those with eating disorders that have been previously excluded. The disorder "atypical anorexia" describes an individual who meet the criteria for anorexia, however despite significant weight loss the individual's weight is within or above the normal range. With the current focus on childhood obesity this awareness is particularly important as children and teens who are overweight may be directed to lose weight for their health. While weight loss may be good advice for some, for others who are biologically predisposed to developing an eating disorder weight loss may lead to the psychological and physical manifestations of this illness. A recent article in the Huffington Post summarized an article from the Journal of Pediatrics – It notes that overweight and obese children and teens who are at significant risk of developing an eating disorder may be ignored or overlooked due to our focus on obesity and weight loss. Pediatric eating disorders do not receive the same attention that pediatric obesity receives. It is estimated that at least 6% of children have an eating disorder and that close to half of high school females and a third of high school males engage in disordered eating behaviors including fasting, diet pills, and laxative abuse. As many as one third of children and adolescents with an eating disorder may be of normal or above normal weight and suffer the same medical consequences, psychological pain, obsessions, behaviors, and loss of quality of life that underweight individuals suffer from. Going forward it is crucial for all of us that we do not define anorexia and underweight as the same thing. Body mass index is not always a measure that can be used to determine if an eating disorder is present. Questions related to disordered eating and weight management behaviors should be asked and taken seriously regardless of weight.

    Contributions by Sarah Emerman

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Gratitude for Primary Care Physicians

September 20, 2013. Written by Mark Warren, M.D.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    By Dr. Mark Warren

    Over the past few weeks I have started rounding on a pediatric inpatient unit with Drs Gillespie and Rome, adolescent medicine specialists who we are privileged to work closely with. It has been a new experience for me to work with patients at the medical inpatient level of care. Upon admit, these clients and families often are in a state of extraordinary surprise, confusion, and fear. They may have gone to their physician thinking everything was alright, then learned their heart rate was low, EKG was abnormal, or electrolytes were off balance. Instead of going home with a prescription or reassurance, they find themselves in a hospital with fears about the things that might happen next. As I have sat with these patients and their families I have had an awareness of what it means to be a pediatrician or family medicine provider – to be the first person to see the eating disorder, its negative physical consequences and to give news to families and patients that is so new, painful, and frightening. Once a patient is at an eating disorder treatment center they are already halfway to knowing what is happening and what they need treatment. While our work here is often difficult it has been profound to stand as the line of first defense. I am so appreciative of the work these physicians do and their abilities to transition patients into life saving treatment.

    Contributions by Sarah Emerman

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The Need for Evidence Based Care

August 09, 2013. Written by Mark Warren, M.D.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partneredin 2014.

    By Dr. Mark Warren

    A recent article by Dr. Russell Marx, The National Eating Disorder Association's chief science officer, discussed evidence based treatment. The article noted Harriet Brown's New York Times piece, which we have discussed in previous blogs, concerning why surprisingly few patients get evidence based care. Dr. Marx discusses the NICE guidelines, which is the National Institute for Health and Care Excellence in the United Kingdom. What's particularly exciting about this article was that it noted the growing evidence for the efficacy of FBT and general family based interventions for clients with anorexia. The NICE guidelines are of significance specifically in the United Kingdom but are utilized worldwide in understanding evidence basis for eating disorder treatment. In the NICE guidelines Dialectical Behavioral Therapy is noted as a treatment well conducted with clinical studies for binge eating disorder, but is not included as a proven treatment for anorexia or bulimia. These guidelines were last completed in 2011 and will be reviewed again in 2014. It is our hope that recent studies on DBT will show the effectiveness of this treatment for other eating disorder diagnoses.

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Validation

August 02, 2013.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partneredin 2014.

    By Samantha Mishne, LISW, LICDC

    Recently a client kept telling me how invalidating I was. Instead of getting defensive and saying all the things I was thinking in my head which I knew were not validating, I took a validation course. Recently when I was taking an online training the facilitator and a colleague both commented on how validating I was. I share this because it just goes to show when you take in feedback you can teach an old dog new tricks. Given this feedback, I am going to stop invalidating myself and start validating myself by telling people, "I am validating." Remember you can validate others and yourself.

    Why did I need to take in this feedback and learn to become more validating? I wish I could tell you it was because I wanted to be more adherent to dialectical behavioral therapy which is about pushing for change and validation, however it was more self-serving. As I say to the young people I work with: "validation makes people want to do things for you." Yes, it also shows that you understand, are listening, and want to tend to the relationship. Once I realized that to validate someone does not mean you agree with them, it became easy to validate. Remember you can only validate the valid.

    How do you validate someone? You make eye contact, stay focused and show that you are actively listening which is hard, you may need to put down your electronic devices in order to do this. Next be mindful of your verbal and nonverbal reactions, which for me is my tone. Try and identify how the other person is feeling and name that feeling. Yes, you might be wrong, but at least they will know you are trying to help them express their feelings. Try and find the kernel of truth in what the other person is saying. Lastly respond in a way that shows you are taking them seriously. We validate ourselves the same way-observe how we are feeling, reflect those feelings back, and look for how those feelings make sense. Remember validation also increases people's willingness. Whenever a client validates me, I feel my motivation increasing; I am more attentive and in turn more validating.

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Parent Conversations and Adolescent Disordered Eating Behaviors

July 26, 2013. Read more

Radical Truth

June 14, 2013. Written by Mark Warren, M.D.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partneredin 2014.

    By Dr. Mark Warren

    One of the saddest and complicated components of an eating disorder is how it encourages secrets. Behaviors, negative thoughts, feelings of shame, and the pain one carries often happen in secret. By the time someone presents for treatment they are so familiar and so used to keeping secrets that it can be very difficult to tell the truth. Keeping secrets is not a failure, a betrayal, or an attempt by a patient to trick or fool a therapist or loved one. Keeping secrets is part of the illness. In treatment we need to work on revealing secrets, on becoming more honest and finding ways to speak truths, even though those truths may feel that they expose us. They may expose how ill we really are, the sadness we carry, the obsessions of our minds, our fears that we will never recover, or past events that we wish were not true. The pain of holding secrets is too great and holding them only make us sicker and less likely to receive the help we need. Like radical acceptance, treatment requires radical honesty for patients, therapists, and loved ones. Speaking our truths and being honest both in treatment and with oneself is truly a key to recovery.

    Contributions by Sarah Emerman

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Dr. Wisniewski Receives AED Outstanding Clinician Award!

May 17, 2013.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    CCED is very proud to announce our very own Lucene Wisniewski, PhD, received the 2013 Outstanding Clinician Award from the Academy for Eating Disorders "for her contributions to the clinical care and well-being of individuals with eating disorders through clinical contributions to the field."

    "I feel really lucky to be part of this community of experts in eating disorder treatment," Dr. Wisniewski said during her acceptance speech. "On a day-to-day basis, if I feel stuck with a patient, I can call people literally all over the world because of this group. I have learned so much from being a part of the AED, and it is just an honor to receive this award."

    Dr. Wisniewski was honored during an award's ceremony at this year's International Conference on Eating Disorders, Crossing Disciplinary Boundaries in Eating Disorders, held in Montreal, May 2 – 4. During her acceptance speech, she joked that the irony of this award is the fact that she never wanted to be a clinician. So, she offered the audience one piece of advice: Take the opportunities that come to you, even if you don't think they will lead you down what you think is your desired path.

    Watch Dr. Wisniewski receiving her award live at the AED's award ceremony below. Her acceptance speech begins at timestamp 5:45.

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Willfulness vs. Willingness

May 10, 2013.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    By Samantha Mishne, LISW-S, LICDC

    How do you move from a willful place to a willing place? I remind myself willingness is not a thing or a place; it is instead a view on life. Life is happening all around and I can either be willing to accept the change or feedback I receive, or I can be willful and in turn stay miserable, or say "yes, but". I think about this often with the clients I sit with who are asked or sometimes forced to make changes that are often times reinforced by the world we live in. The strength that they exhibit to move to a willing place is inspiring. I say to the young people who participate in family based treatment, your parents are going to reefed you, so you can either stay willful or move to a willing place. The nourishment that food provides often increased people's ability to a move to a willing place along with parents resolve to care for their children.

    When trying to increase willingness the first thing I do is really try and listen to what it is that someone thinks or wants me to do, then I pro and con making the changes vs. staying the same. Ultimately what moves me to a willingness place is being witness to the change my clients make daily and my acceptance that change is constant. Though I say often that I do not like change the older I get the more I am realizing it is constant. You can only push a way for so long before you need to be willing. It is important to note that there are no shades of gray when it comes to willingness. Currently I am pushing away the water stain on my ceiling because I know I have a leak which I need to become willing to have someone come out and fix. Yes this is not as big an issue (no pun intended) as gaining weight, increasing meal plan compliance, not exercising . . .but it is an example of how every day we are faced with a choice to be willing or willful and we must accept the consequences. I will let you know if my ceiling falls in because I have yet to move to a willing place.

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Dr. Mark Warren Voted “Best Doc” by Cleveland Magazine!

March 26, 2013.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    We are very proud to announce our very own Mark Warren MD was voted a "2013 Best Doctor" by Cleveland Magazine! He was named by a national board of his peers. Pick up a print version to see the full listing, or read about the featured physicians.

    "I'm so honored and thrilled to be acknowledged by my peers and community as a Best Doc," says Dr. Warren. "It's gratifying to know that all of our hard work at the Cleveland Center for Eating Disorders and our profound and unrelenting commitment to eating disorder treatment is getting noticed and making a difference in this field."

    With this monumental achievement, we sat down with Dr. Warren to reflect on his career and accomplishments, where his passion for eating disorder treatment comes from, and what's next for him. Read on to learn more about Dr. Warren and why he continues to inspire us every day.

    CCED: What is your area of expertise within the subject of eating disorders?

    Dr. Warren: There are several areas that I have gained expertise in. The three that are my greatest focus are men and eating disorders, professionals with a history of eating disorders, and evidence-based therapies.

    CCED: At what point in your training did you decide to specialize in the study of eating disorders, and why?

    Dr. Warren: I went into the treatment of eating disorders after about 12 years of practice. I have a history of anorexia, which started in my teenage years. I was lucky to fall in love with (and for her to have been equally smitten) with a woman who successfully re-fed me. As there was no eating disorder treatment at the time, my own recovery was haphazard and spread out over many years.

    Only after full recovery — not only being re-fed and stopping behaviors, but also feeling whole and having a good relationship with my body and with food — did I enter the field of eating disorder treatment. I then retrained in dialectical behavioral therapy, learned Maudsley Family Based Therapy, and began my full-time eating disorder work with Lucene Wisniewski, PhD — my partner here at CCED.

    CCED: What is the most interesting or surprising thing you have learned about eating disorders over your years of research and practice?

    Dr. Warren: I suppose it is how much sense they make when you are suffering from an eating disorder and how little sense they make to everyone else. Our new understanding of the biology of eating disorders and the brain has helped to make this separation so much clearer. I have great hopes that our further biological understanding will make eating disorders sensible to everyone and make clear how foolish and wrong it is to see eating disorders as a conscious choice.

    CCED: If money were no object, what aspect of eating disorders would you most like to explore in research, or what resource/treatment would you most like to develop?

    Dr. Warren: I would most like to explore in research how to develop treatments that help to stop the painful thoughts and feelings that accompany the disorder. We are getting better at re-feeding. We need to figure out how to help everyone with an eating disorder to experience a life worth living.

    CCED: When you reflect on how far CCED has come since opening in 2006, what are you most proud of?

    Dr. Warren: Before CCED, there was no way to get the most advanced, evidence-based care for eating disorders in Northeast Ohio. Patients either saw practitioners who were not using proven treatments or had to travel long distances to get the necessary care. We are still in a treatment environment where many providers either don't know what evidence-based care is or don't do the training needed to become an expert.

    Now, for many patients, they can get the care they need, while staying at home. Eating disorders are deadly illnesses. Patients deserve the best practice of care from providers who have done the work to learn what has the highest likelihood of success. I am proud that CCED continuously strives to provide the best practice for all our patients.

    CCED: What's next on your list?

    Dr. Warren: We have three main goals:

    Under the lead of Dr. Wisniewski, we have developed and implemented new therapies based on the best evidence and will continue to expand in this way.

    Second, we need to continue to research our outcomes so we know how well we are doing and what we can do to make ourselves better. This work is already ongoing and we are publishing and presenting our outcome data, which both improves the work we do and helps the eating disorder field as a whole.

    Third, we need to get the word out that there is real therapy, therapy based on a scientific model, for eating disorders. Pediatricians, therapists, family doctors, internists, Emergency Room doctors and, especially patients and their families, need to know that there is true help for those who suffer with eating disorders. When patients, providers and families work together, there is hope for recovery.

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Recovery for life is possible 888-364-5977

Recovery for life is possible

888-364-5977

The Emily Program