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Articles tagged with: Cleveland

Eating Disorder Awareness Week: What you may have missed at “Body Beautiful”

March 01, 2013.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    Our expert panel answers your questions about body image disorder and eating disorders.

    Thanks to those of you who joined us on Monday at "Body Beautiful," presented by Cleveland Center for Eating Disorders and John Carroll University. We had a great turnout! Students, professors, eating disorder professionals and families came out to increase awareness and promote hope around body image disorder and eating disorders.

    The event, which ran in conjunction with National Eating Disorders Awareness Week, featured a student interactive art show, "Mirror Images" and a screening of the popular documentary, "America the Beautiful." Immediately following, our expert panel was there to answer questions from the audience.

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What might Family Based Treatment suggest about treatment for adults with eating disorders?

February 19, 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

    In the field of eating disorders, multiple studies have shown that Family Based Treatment (FBT) is the most effective method available to achieve successful weight restoration and maintenance after treatment is completed. Unfortunately, specific treatments for adults have not been shown to have the same long term benefits as FBT. Clearly there are many variables involved in this data, however there are elements to FBT that may point us to a better understanding of what happens for adults.

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Recent Maudsley FBT Research

January 15, 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

    A recent article in the International Journal of Eating Disorders by Couturier, Kimber, and Szatmari (2013) adds to the literature on the effectiveness of Maudsley Family Based Therapy (FBT). Their conclusion is that while FBT does not show superiority to other therapies during treatment, there are significant benefits at the 6 -12 month follow up. These benefits reach a level of significance that would cause one to recommend FBT for the treatment of eating disorders in adolescents instead of individual therapy. As they discuss in their article, there are multiple limitations to this study, however research literature has long pointed to the superiority of FBT over individual therapy. This article therefore adds to a growing body of data.

    From a CCED perspective, we are particularly interested in what happens in those first 6 months and if there is a way to improve the outcome of FBT more rapidly for adolescents. Our clinical experience is that by adding higher levels of care, in particularly partial hospitalization in conjunction with FBT, that we can improve orientation, adherence, and effectiveness of FBT, while still staying in line with the FBT model. Our clinical experience does not meet the criteria of the research considered in this particular article, since it is not a randomized control trial or have a control group associated with it. However, given the data that we have, we hope to find that the utilization of FBT within a higher level of care may be a more rapid way to help our clients move from anorexia to recovery. We hope to publish in the next year on the results of our research into this question.

    Couturier, J., Kimber, M. and Szatmari, P. (2013), Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. Int. J. Eat. Disord., 46: 3–11. doi: 10.1002/eat.22042

    Contributions by Sarah Emerman

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To Tell or Not To Tell – By Dr. Sarah Ravin

December 14, 2012.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    We are happy to announce that today's post is written by psychologist Dr. Sarah Ravin. Dr. Ravin utilizes DBT, CBT and ACT to treat adolescents and young adults with eating disorders, body dissatisfaction, anxiety, depression, OCD, and self-injury. We have often linked to and are inspired by the posts on her blog. A big thank you to Dr. Ravin for her contribution to our blog!

    If you have an eating disorder, you have probably struggled with the question of whether to reveal your diagnosis to others.

    Teenagers and young adults with eating disorders run the gamut of self-disclosure: some of them never tell a single soul about their illness, while others write about it on Facebook or tweet about it daily to hundreds of followers. In my practice, I advise patients to think carefully before revealing their illness to anyone. In this age of tell-all books, tabloid magazines, and Jerry Springer, it is easy to forget that the concept of revealing deeply personal information to large numbers of people is relatively new and quite controversial. There are consequences – both positive and negative – to telling people about your eating disorder.

    In considering whom to tell, it is important to balance the desire for privacy with the need for social support. On the one hand, having an illness is a personal matter and is not typically something you would share with a large number of people. Think about whom you would tell if you had asthma or a learning disability. Most people would share this information with their close friends, relatives, and doctors. Most people would not share this information on a first date, or on a job interview, or on their Facebook page.

    On the other hand, someone going through an eating disorder needs a tremendous amount of support in order to get well. Friends and loved ones can only support you if they are aware that you are struggling and that you need their help. Suffering from an eating disorder can be a lonely and isolating experience, particularly if you keep your illness a secret from everyone.

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Updates on Men and Eating Disorders

December 10, 2012. 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.

    Males are historically underrepresented throughout the eating disorder field- as patients, treatment professionals, by diagnosis and prevalence, in research studies and in stories of recovery. 30 years ago men with eating disorders were virtually invisible and options for treatment were mostly non-existent. Fortunately, we are at a tipping point in our understanding of males and eating disorders. While major gaps still exist in our understanding, we are continuously learning more about males with ED.

    According to the National Comorbidity Study (Hudson, 2007), lifetime prevalence in ED in men is:

    Anorexia Nervosa- 0.3%

    Bulimia Nervosa- 0.5%

    Binge Eating Disorder- 2%

    In this study, over 50% of men also had co-morbidities.

    In a study by Striegel-Moore, et al in 2009, over 26% of men in the community had ED symptomatology.

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4 Reasons Why You May Not Be Getting Evidenced Based Care

August 31, 2012. 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

    Every year our understanding of the brain and eating disorders improves. However, there are still a limited number of truly evidence based treatment for our patients. The search for evidence based care may feel overwhelming and sometimes futile. Unfortunately, moving in the direction of care that is not evidence based reduces the likelihood that clients will achieve recovery. There are several reasons why providers may offer care not based on the literature or published data:

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Haiku

August 29, 2012.
  • Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

    This haiku was written by a client at CCED. He shares it in hopes that it will inspire others.

    A better hope

    gentle wind as a peace

    another sunrise

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What Do We Mean By Causation?

August 22, 2012. 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

    Often times while in treatment clients wonder how and why their eating disorder developed. The common question "What caused my eating disorder?" is very complicated because it pulls from so many ideas, understandings, conceptions, and misconceptions about the importance of causation, the implication of causation, and the definition of what causation means. Before we deal with the notion of causation itself, it is crucial to point out there is no evidence that knowing causation leads to cure, and no current evidence that knowing cause provides an avenue to change the treatment that we do. Having said that, virtually all clients and families want to know why they have an eating disorder. We believe, and research has indicated, that there are biological factors that predispose an individual to the illness and environmental factors then influence the manifestation of the disorder. This mirrors most psychological illnesses. When you have a treatment that is purely biological for an illness it moves someone towards recovery, but usually they do not feel better until they have re-established the quality of life they had before the illness. This often means a re-establishment of social contacts, work, school, and the ability to experience personal growth, change, pleasure and happiness. So we are careful not to say that the lack of these things are the causes of the illness, even though attaining them may be a core part of the recovery process. The experience of cure does not need to flow directly from the notion of causation. We know that nourishment and cessation of behaviors is a prerequisite to getting better, and we also know that after stabilization of symptoms there is still much work to do. Our current understanding is that the work left to do is not due to underlying things that caused the illness, but rather issues that may persist after refeeding, issues of body image, negative self talk and shame, and the ability to experience oneself as whole and healthy.

    Contributions by Sarah Emerman

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Biology and Eating Disorders

August 01, 2012. 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 Mark Warren, MD

    The book Eating Disorders and the Brain edited by Drs Lask and Frampton continues to be an extraordinarily important book to understanding the etiology of eating disorders. Given our current knowledge, we often say that eating disorders are biologically based. Yet, this is somewhat of a two-dimensional statement as eating disorders are experienced as complex and multi factorial. A large number of factors seem to be interacting when someone presents with an eating disorder. These include genes, early attachment, personality issues, cultural issues, cultural norms, peer relationships, sensitivity, and on and on. Current biological work is beginning to show us is that many of these factors may in fact be related to one and other. The complex development of the eating disorder can be understood as the product of a specific genetic profile that develops in a specific individual under specific circumstances. Rigidity, perfectionism, skillfulness, and skill deficits, that are often seen in individuals with the illness are often mislabeled as "causes" when they are in fact part and parcel of the same developmental picture that may ultimately result in an eating disorder. With continued research of the brain, we are closer to understanding this complexity in terms of a specific biology that causes multiple expressions and can ultimately understood and treated through development and improvement of structures within the brain.

    Contributions by Sarah Emerman

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Why Can't I Just Eat?

April 13, 2012. Written by Mark Warren, M.D.
  • By Dr. Mark Warren

    Anyone with an eating disorder has been asked at some point or another "Why don't you just eat?" Most likely if you have an eating disorder you have asked yourself the same question. You might wonder "Why is eating so hard for me when it seems to be so easy for everyone else?" On one level the answer to this is incredibly simple, and on another level incredibly complicated. The simple level is biology. Having an eating disorder means having neurological or neuroanatomical organization of your brain that creates enormous barriers to eating normally. These barriers include visual and sensory distortions, impacts on reward centers and executive organization of the brain, distortions of senses of fullness and hunger, and over evaluation of body size and shape, in addition to other issues that may be present. The combination of all of these things makes eating incredibly hard to do. The complex answer comes from the interaction of all the issues above in addition to the fact that eating itself is an activity that is way more complicated than people give it credit for. Eating is not just about seeing food, grabbing food and putting it in our mouths. Eating is about being aware of what's happening inside our bodies, understanding and appreciating our sensations, knowing what gives us pleasure and how to eat in a balanced way. Add social eating and societal influence and its clear that eating is a complex activity on many levels. So the answer to why can't I just eat is that you have an eating disorder and that in fact is what the disorder is. It's what makes it such a scary, painful, and life threatening disease. Having an eating disorder is confronting the question "Why can't I just do something that ultimately may save my life?" It's also what makes recovery from an eating disorder so rich, full, and rewarding. Because when you are able to "just eat", you are able to embrace life in a way that had never felt possible before.

    Should you have an questions or comments regarding this post please email This email address is being protected from spambots. You need JavaScript enabled to view it..

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The Importance of Early and Aggressive Treatment

February 06, 2012. 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.

    A recent study by Dr. Janet Treasure, one of the world's most prominent eating disorder researchers, has demonstrated the significant importance of early and aggressive treatment for anorexia nervosa. In her study, regardless of the treatment mechanism, patients who had been ill for longer than three years had significantly worse outcomes after treatment then those who had been ill for less time. Give the lack of evidence based treatment available until ten years ago, we do not know if current treatment mechanism may be more effective for those who have been ill longer. However, we can certainly say that based on this study, the faster someone gets into treatment and the more aggressive the treatment, clients are faster into recovery and less likely to relapse.

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New Research from the Journal of Adolescent Health

January 06, 2012. 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.

    An interesting article from the Journal of Adolescent Health was recently profiled in the New York Times. This article challenges traditional methodologies for in-patient re-feeding of teenagers with anorexia nervosa. Historically, the protocol for teens hospitalized for anorexia has been to "start low and go slow" with food. However, this often results in much slower weight gain or even lack of weight gain during the first week of hospitalization and may result in a teen being discharged from the hospital at a significantly lower weight than they would have been if they had been re-fed more aggressively. As we know from other literature, not reaching prior growth curves is thought to be the single greatest factor in relapse for anorexia and hospitalization is often utilized to jump start this vital and necessary weight gain.

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Updates at Cleveland Center for Eating Disorders (CCED)

January 03, 2012. 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 and Sarah Emerman

    We've had a very busy year in 2011 and want to thank all of our blog readers for your support and interest. As the year comes to a close we hope this post finds everyone in good health and moving to new places of healing.

    At CCED we know that as new research emerges we must constantly change and evolve to provide the most up to date evidence based care. In the spirit of constant improvement we have made several additions to our programming in the last few months.

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We’re The Emily Program

December 15, 2009.
  • The Emily Program is a warm and welcoming place, close to home and work, where individuals and their families can find comprehensive treatment for eating disorders and related issues.

    We offer comprehensive psychological, nutritional, medical and psychiatric care at multiple locations across the Minneapolis/St. Paul metro area and Duluth. Treatment options range from periodic outpatient appointments to residential/inpatient care at the Anna Westin House.

    We offer help with a variety of eating disorder, exercise and body image issues, including anorexia nervosa, bulimia nervosa, compulsive overeating, binge eating disorder and eating disorder not otherwise specified.

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Recovery for life is possible 888-364-5977

Recovery for life is possible

888-364-5977

The Emily Program