Identity Transformation at the Center of Eating Disorder Recovery
Dr. Lissak's Treatment Plan
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3d ago
Most chronic illnesses, medical or psychiatric, have a significant impact on a person’s quality of life. Coming to terms with an illness not easily managed or cured changes how someone sees their life trajectory and future. Although an illness can become a part of the lens through which one sees the world, eating disorders are unusual in how they become tightly woven into one’s sense of self. No matter how the eating disorder starts, the symptoms, self-image and behaviors around food become paramount. All decisions center around the convenience or difficulty of eating or around what the eating ..read more
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One Key Limitation to Expanded Eating Disorder Care
Dr. Lissak's Treatment Plan
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1w ago
Eating disorder treatment and recovery isn’t just about mind over matter. Access to so many types of clinical care, in person and online, doesn’t change the intractability of an eating disorder—illnesses that are physiological as well as emotional. The psychological draw of an eating disorder can be powerful in many ways, for example the emotional numbing through the release from overeating/binging or the protection from traumatic symptoms via restriction. Over time, the repeated disordered eating behaviors can engender a physiological response in the body’s gastrointestinal system which adapt ..read more
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What Treatment Loses with Telehealth
Dr. Lissak's Treatment Plan
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2w ago
Telehealth in therapy is here to stay. The abrupt transition to remote treatment in eating disorder work during the pandemic was noteworthy. There won’t be a return to mostly in person appointments. That ship has sailed. We all—clinicians and patients—have agreed to this new method of treatment. It’s clear what has been gained from telehealth: increased access, convenience and new programs for in home treatment. The practical considerations of treatment work well remotely. Monitoring food, cognitive tools to combat eating disorder thoughts and even group sessions for people with similar recove ..read more
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The Effect off Social Media Exposure in Eating Disorder Treatment
Dr. Lissak's Treatment Plan
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3w ago
Social media has changed eating disorder diagnosis and recovery greatly in recent years. Long before seeking help, most people these days are aware of their eating disorder, have read, listened to or watched media that explained not only the disorders but various symptoms and the path of recovery. Thus, education about eating disorders is now largely delegated to online platforms so therapists can both clarify what people learn online and individualize treatment for each person. Patients used to start treatment often more confused about the diagnosis and without much knowledge of treatment. No ..read more
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What will the Ozempic World Look Like? Part 2
Dr. Lissak's Treatment Plan
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1M ago
The recent posts in this blog hypothesize about changes in our relationship with food and our bodies after the advent and proliferation of GLP-1 agonists like Ozempic and Mounjaro. To be clear, many beneficial purposes for these drugs exist: diabetes and metabolic issues, to name two important ones. But this new class of drugs also lands squarely in the camp of life enhancers, not just medications to treat illness. What I mean by this term is drugs with benefits people deem attractive but not necessarily therapeutic. Stimulants like Adderall are a good example of a drug people use for extended ..read more
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What will the Ozempic World Look Like?
Dr. Lissak's Treatment Plan
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1M ago
Hunger is one the most powerful and essential ways our bodies communicate with us. Put simply, hunger prioritizes the need for food as sustenance and for survival. The meaning of hunger has changed greatly due to a transformed food supply for many countries in recent decades. After centuries of food scarcity as the obstacle to survival, humans created societies with bountiful food, more than can be eaten and often with a huge amount of waste. We aren’t designed to know how to handle excess food. Hunger is an acute feeling intended to focus all senses and thoughts on procuring food. Subtle hung ..read more
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Chronic Anorexia Vs. Terminal Anorexia
Dr. Lissak's Treatment Plan
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2M ago
The recent article about Anorexia Nervosa in the New York Times informed its readers about the severe medical consequences of this illness. In fact, the article made the case that some people with Anorexia might do best with palliative care, perhaps even assisted suicide. For a clinician who treats people with eating disorders, the article did not talk about anything new in the field but focused largely on the most extreme cases. The two doctors the article highlighted work on the medical floor which treats the most acutely sick patients in the country, aptly names ACUTE. Doctors know ..read more
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Standardizing Training for Eating Disorder Treatment
Dr. Lissak's Treatment Plan
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2M ago
Training for clinicians to treat people with eating disorders is limited, unregulated and often unsupervised. The result is very uneven clinical care and often treatment that can be as harmful as it is beneficial. Eating disorders are different from all other psychiatric disorders largely because there are frequent and severe medical consequences. Psychiatrists typically avoid treating these patients and often take a very limited role in care if they do. Even more problematically, medical doctors in other specialties who track the progress of these patients are also often limited in their kno ..read more
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The Role of Regular Weighing in Eating Disorder Treatment
Dr. Lissak's Treatment Plan
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2M ago
A standard focus of treatment since the beginning of the eating disorder field is weight. It’s easy to see why weight feels imperative to recovery and health, but the pitfalls of prioritizing weight are equally disruptive, if not counterproductive. Almost any time someone starts eating disorder treatment, weight is one of the first things to be discussed and monitored. Typically, a dietitian or primary care doctor will weigh the person once weekly, thus establishing a precedent that weight is indeed a—if not the—most important data point in recovery. People with eating disorders almost always ..read more
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Respect and Autonomy Help Avoid Treatment Trauma
Dr. Lissak's Treatment Plan
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2M ago
The evolution of eating disorder treatment began with adolescent girls with Anorexia Nervosa starting in the 70’s through the early 80’s. The field was new and the symptoms and course of illness confusing. Clinicians were not sure how to approach children in severe medical and psychiatric distress because they were unable to eat. However, the initial population needed to be treated as children because they were for the most part young, very ill and severely impaired by starvation. Treatment programs in hospitals and later residential programs designed clinical approaches with this population i ..read more
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