Spring 2015 LACPA Eating Disorder SIG events

Wednesday, February 11, 7:15 pm

Pia Guerrero

Pia Guerrero

Presenter:  Pia Guerrero

Title:  Adios Barbie: Body Image, Intersectionality, Healing and Advocacy

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Pia Guerrero  is a media literacy and youth development expert with a focus on body image, race, and representation in the media.  For the past 20 years she has led a number of youth development organizations and programs in the San Francisco Bay Area.  From Harlem to Hawaii, she’s  led presentations to thousands of teachers, youth workers, and youth on the impact the media has on young people, especially girls. Pia is also the founder and editor of Adios Barbie, the first body image website to expand the conversation beyond size to include race, age, ability, sexual orientation, and sexuality. As the first website of its kind, Adios Barbie has been mentioned in MSNBC, The New York Times, Forbes, Al-Jazeera, Glamour, among others. Pia has also appeared numerous times as an expert on CNN’s Headline News (HLN) and Huffington Post Live. Currently, Pia works as the Executive Director of SheHeroes, a non-profit that profiles exceptional career women for their accomplishments and character with the purpose of empowering girls to pursue rewarding careers.

Wednesday, March 4, 7:15 pm

Nikki DuBose

Nikki DuBose

Presenter:  Nikki DuBose

Title:  B.E.A.U.T.Y: Paint Me A Soul

The talk will reflect on my life struggles and will focus on the modeling and entertainment industries and how I believe they contributed to my eating disorders, addictions, and mental health issues.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Nikki is a former fashion model, host, and commercial actress who recovered from a 17 year battle with anorexia and bulimia.  Writing for recovery turned into a full-time career for Nikki. She is working on her first book, detailing her life’s challenges, in an attempt to help others overcome their hardships as well.  She is an advocate for  the National Eating Disorders Association (NEDA), and the Project HEAL.

April  – date TBD

Presenter:  Stephanie Knatz, Ph.D.

Tentative Title:  Temperament, neurobiology and implications for adult eating disorder treatment

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio: Stephanie Knatz is a postdoctoral fellow at the UCSD Eating Disorders Treatment and Research Center. She currently conducts the clinic’s week-long Intensive Multi-Family Therapy Program and works within the adolescent day treatment program, providing individual, family, and group psychotherapies. She specializes in family based treatments and behavioral parent management training. In addition to her clinical work, she is also involved with conducting research in eating and weight issues and is involved with our clinic’s efforts to develop and improve current treatments for eating disorders based on neurobiological findings. Other research interests include pediatric obesity and emotion regulation in bulimia nervosa.

Please RSVP to drmuhlheim@gmail.com (2 H’s in Muhlheim)

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

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Radiant Sunbeams – guest post by Katie Grubiak, RD

sea lion

She sat there taking in the radiant sunbeams, soaking in every last ray upon her chest before the sun set on the first day of 2015.  The concepts of a New Year and its resolutions were non-existent, so she wasn’t genuflecting to the next 364 days ahead of her. She was just there, present to the sensations of her body gilded by the setting sun.  Yes, fully present she was in her beautiful bold black body on a rock.  As I stood on the Malibu shore looking out at this glorious being of nature on 2015’s first day, I was reminded of the power of our inner voice that can stand alone with valor.  Along side the negative thoughts of hating one’s body, dieting, and comparing one’s appearance and life to others is an inner voice that can lead us to follow a life of true balance and wellbeing.  We can have a loving dynamic with food and move through space (aka exercise) from a joyous, intuitive place.  By deeply listening to the body’s signals of hunger and fullness and what foods/nutrients are calling to us, we come closer to hearing the tones of the body’s fine tuning. Through breathing/stretching/moving mindfully, we can bring the body’s alignment, organs, and systems back into homeostasis. Believe that the body has biological intelligence far beyond what the mind can comprehend or control. Be the warrior, protecting the body from shame and allowing its intelligence to fully emerge and be seen.  How did our perceived value come down to meeting or not meeting a New Year’s resolution with a certain number on a scale or to looking like that image (probably photo shopped) in that magazine in order to be included in a supposed upper echelon?  Who tells us who we are? Well hopefully, it is our compassionate inner voice. She, the Sea Lion, has no shaming mind or shaming society.  She is who she is, allowing light to always come in. For us it’s a choice. What truth will you listen to? What voice will you speak from? Will you stand present on your own rock to allow the radiant sunbeams to come in…. harmonizing with the ones that radiate out from within you?

by Katie Grubiak, RDN, Registered Dietitian Nutritionist Specializing in Eating Disorders Dancer/Yogi/Mover & Believer of a life most beautiful

Katie Grubiak is a Registered Dietitian with a focus on blending Western & Eastern philosophies regarding nutritional healing.  In addition to nutritional counseling, Ms. Grubiak guides individuals through movement and breath techniques that open and warm the body and help with physical and emotional flexibility, strength, and self-acceptance/body image. For further information about her services, contact her at katiegrubiak@hotmail.com or 213-249-2110.

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Fall 2014 LACPA Eating Disorder SIG events

The Los Angeles County Psychological Association Eating Disorder SIG is kicking off the membership year with 2 great events.  Join LACPA now to take advantage of these and other events. 

1)  Date:  Thursday, October 23T-FFED

Time:  7- 8:30 pm

Presenter:  Dagan VanDemark

Title: TRANSforming Eating Disorder Recovery: Deconstructing the Overrepresentation of Eating Disorders in Trans and Gender Diverse Individuals, and How Healthcare Professionals Can Better Serve Our Communities

While under-treated and still under-researched, preliminary studies and countless anecdotes demonstrate that transgender people suffer from eating disorders disproportionately. This workshop will introduce how trans and gender-diverse people are vulnerable to and struggle with EDs, and conduct a basic training for health professionals looking to offer more trans-friendly, gender-literate and accessible care.  

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Dagan VanDemark is the Founder and Executive Director of the pending non-profit T-FFED: Trans Folx Fighting Eating Disorders, based in LA but quickly gaining national reach. Dagan, a genderqueer trans boi, battled bulimia/EDNOS for fifteen years. They have a B.A. in Gender Studies from CSULB, a certificate in Grant Writing and Administration from CSUDH, and they are enrolled in both the Non-Profit Management certificate program at UCLA and a transgender leadership initiative through Gender Justice LA. They speak on university panels about gender variance and sexual diversity, and write/blog extensively about transgender communities’ experiences with eating disorders.

2)  Date:  Wednesday, December 3Aimee Liu

Time:  7:15 – 8:45 pm

Presenter:  Aimee Liu

Title: The Stages of Recovery 

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Aimee Liu is the author of Restoring Our Bodies, Reclaiming Our Lives (Trumpeter Books, 2011), a benefit project for the Academy for Eating Disorders, and of Gaining: The Truth About Life After Eating Disorders (Wellness Central, 2007), a sequel to her acclaimed 1979 memoir Solitaire.  Her novels include Flash House (Warner Books, 2003), Cloud Mountain (Warner Books, 1997), and Face (Warner Books, 1994).  She also has co-authored more than seven nonfiction books and written numerous articles on medical, psychological, and political topics. She earned her MFA from Bennington College and now teaches in Goddard College’s  MFA in Creative Writing Program. 

More information is available at www.gainingthetruth.com

Please RSVP to drmuhlheim@gmail.com (2 H’s in Muhlheim)

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

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Ten Facts About Weight Stigma – Guest post by Liliana Almeida, M.A.

As a follow-up to last week’s Weight Stigma Awareness Week, here are 10 facts about weight stigma.
Liliana Almeida, M.A.

By: Liliana Almeida, M.A.,

Registered Psychological Assistant to Lauren Muhlheim, Psy.D.

 

  1. Weight stigma is a bias or discrimination relating directly to weight. Despite the fact that more than half of U.S. citizens are overweight, our society holds a strong negative bias against fatness.
  2. The media reinforces weight stigma. The media, such as news media, displays obese persons in stigmatizing ways by depicting them sitting and eating unhealthy foods, wearing ill-fitting clothes, headless, or with their abdomens showing.
  3. Weight stigma is based on the belief that obesity is under one’s personal control. This belief suggests that obese persons are undisciplined and inactive. However,when obesity is attributed to uncontrollable factors such as diabetes or hypertension, people’s attitudes change. 
  4. Weight stigma exists in romantic relationships. Romantically,obese partners are less preferred.  They are less preferred in comparison to those who are in wheelchairs, mentally ill, or those who have sexually transmitted diseases.
  5. Weight stigma starts as early as preschool.  Children ages 3-5 negatively characterize overweight children as mean, ugly, stupid and sloppy.As children get older they start believing their overweight peers are lazy, less popular, and less happy. College students report that their overweight peers are lazy, self-indulgent, and less attractive, with low self-esteem and deserving less attractive partners.
  6. Teachers have a weight bias towards heavier students. They believe their overweight students lack self-control and are less likely to succeed.
  7. Health professionals are also biased. Health professionals treating individuals with eating disorders report believing that obese patients do not comply with treatment recommendations and perceive poor treatment outcomes. Those strongly biased believe obesity is due to overeating and lack of motivation.
  8. Overweight or obese individuals have internalized stigma. The most common anti-fat bias among overweight individuals is the belief that they are lazier and less motivated than thinner individuals. The failed attempts of overweight individuals to lose weight may cause them to begin to internalize society’s beliefs that they are lazy and lack will power.
  9. Weight stigma increases binge eating. Weight stigma causes psychological distress such as depression, anxiety, and low self-esteem. It is also associated with poor body image and increased fear of fat.
  10. Weight stigma experiences are as common as other forms of discrimination. In women, it is as common as racial discrimination. In some cases, it is more common than gender and age discrimination. 

Liliana Almeida, M.A., is a fourth year Clinical Psychology Ph.D. student at the California School of Professional Psychology at Alliant International University in Los Angeles. She received her M.A. from The New School and her B.A. from Rutgers University. During the last 7 years she has researched eating disorders, obesity, and weight stigma. Her clinical experience includes working with diverse clients in a community mental health center providing cognitive-behavioral and psychodynamic psychotherapy in English and in Spanish.

Liliana will be working under my supervision and is available to work with adult and adolescent clients with eating disorders, anxiety, and depression.  She will provide services in English and Spanish as well as her native Portuguese and will be able to provide some low-cost therapy to those in need.

If you are interested in more information, please visit Liliana’s website or contact me at 323-282-3572 or drmuhlheim@gmail.com

References 

Ashmore, J.A., Friedman, K.E., Reichmann, S.K., &Musante, G.J. (2008). Weight-based stigmatization, psychological distress, & binge eating behavior among obese treatment-seeking adults. Eating Behaviors, 9, 203-209.

Chen, Eunice & Brown, Molly. (2005). Obesity Stigma in Sexual Relationships.  Obesity Research, 13, 1393-1397.

Cramer, P., & Steinwart, T. (1998). Thin is good, fat is bad: How early does it begin? Journal of Applied Developmental Psychology, 19, 429-451.

Friedman, K., Reichmann, S., Costanzo, P., Zelli, A., Ashmore, J., & Musante, G. (2005). Weight stigmatization and ideological beliefs: relation to psychological functioning in obese adults. Obesity Research, 13, 907–916.

Latner, J., Wilson, T., Jackson, M., & Stunkard, A. (2010). Greater history of weight-related stigmatizing experience is associated with greater weight loss in obesity treatment. Journal of Health Psychology, 14, 190-199.

Puhl, R., Andreyeva, T., & Brownell, K. (2008). Perceptions Of Weight Discrimination:Prevalence And Comparison To Race And Gender Discrimination In America. International Journal of Obesity, 992-1000.

Puhl, R., & Latner, J. D. (2007). Stigma, obesity, and the health of the nation’s children. Psychological Bulletin, 133, 557-580.

Puhl, R., Latner, J., King, K., & Luedicke, J. (2013). Weight bias among professionals treating eating disorders: attitudes about treatment and perceived patient outcomes. International Journal of Eating Disorders, 1-11.

Puhl, R., Lee Peterson, J., DePierre, J., & Luedicke, J. (2013). Headless, hungry, and unhealthy: A video content analysis of obese persons portrayed in online news. Journal of Health Communication, 1-17.

Stice, E., Presnell, K., & Spangler, D. (2002). Risk factors for binge eating onset in adolescent girls: a 2-year prospective investigation. Health Psychology, 21, 131-138.

Tiggemann, M., & Wilson-Barrett, E. (1998). Children’s figure rating: relationship to self-esteem and negative stereotyping. International Journal of Eating Disorders, 23, 83-88.

Wang, S. S., Brownell, K. D., &Wadden, T. A. (2004). The influence of the stigma of obesity on overweight individuals. International Journal of Obesity, 28, 1333-1337.

 

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LACPA Eating Disorder SIG upcoming events (Fall 2014)

I am excited to announce the next 3 upcoming meetings of the Los Angeles County Psychological Association Eating Disorder Special Interest Group (LACPA ED SIG).  We have amazing speakers lined up.  The LACPA membership year begins in September, so now is the time to join or renew to maximize your benefits.  SIG events are open only to LACPA members, but are FREE.  For information on membership, see the LACPA website. www.lapsych.org.  One does not need to be a psychologist to join LACPA; other professionals may join as well.

Slide1

Dr. Stacey Rosenfeld

Date: Thursday, August 28th

Time: 7-8:30

Title: Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight

Presenter: Stacey Rosenfeld, Ph.D.

Location: The office of Stacey Rosenfeld, PhD (2001 S. Barrington Avenue, Suite 114, Los Angeles)

BIO: Stacey Rosenfeld, PhD, is a clinical psychologist, licensed to practice in New York and California, who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly-praised Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight, inspired by her award-winning blog of the same name, she is often interviewed by media outlets as an expert in the field.

Dr. Rosenfeld is also the founder of the LACPA ED SIG but will be leaving the group in the fall due to relocation.  This will be a unique opportunity to hear her speak and also to acknowledge the contributions she has made to the Los Angeles community during her fruitful three years here.

Baumann113lo-res

Maggie Baumann, MFT, CEDS

Date: Tuesday, September 16th

Time: 7-8:30pm

Title: Pregnancy & Eating Disorders: Journey Through the Facts and Recovery

Presenter: Maggie Baumann, MFT, CEDS

Location: The office of Stacey Rosenfeld, PhD (2001 S. Barrington Avenue, Suite 114, Los Angeles)

Bio:  Maggie Baumann is a psychotherapist in Newport Beach who specializes in treating people struggling with eating disorders, including pregnant women and moms with eating disorders. She is a former board member for the Orange County Chapter of the International Association of Eating Disorder Professionals (IAEDP) and serves as a committee member on the national IAEDP certification board.

Maggie has been a featured guest on nationwide talk shows and TV segment profiling pregorexia and moms with eating disorders. She was a mental health blogger for Momlogic.com, where she shared her own story of suffering from pregorexia over twenty-five years ago. Additionally, Maggie serves as a guest eating disorder expert for KidsinTheHouse.com, a video parenting resource. She is also authoring a chapter on eating disorders and pregnancy for an upcoming book on Eating Disorders in Special Populations (publication date: 2015). Now, Maggie has partnered with Chicago-based residential treatment center, Timberline Knolls, in hosting their Lift the Shame eating disorder support group the first web-based support group for pregnant women and moms with eating disorders. Lift the Shame, is a free group and has members from across the US and abroad.

T-FFED

T-Ffed: Trans Folx Fighting Eating Disorders

Date:  Thursday, October 23

Time:  7- 8:30 pm

Title: TRANSforming Eating Disorder Recovery: Deconstructing the Overrepresentation of Eating Disorders in Trans and Gender Diverse Individuals, and How Healthcare Professionals Can Better Serve Our Communities

Presenter:  Dagan VanDemark

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Dagan VanDemark is the Founder and Executive Director of the pending non-profit T-FFED: Trans Folx Fighting Eating Disorders, based in LA but quickly gaining national reach. Dagan, a genderqueer trans boi, battled bulimia/EDNOS for fifteen years. They have a B.A. in Gender Studies from CSULB, a certificate in Grant Writing and Administration from CSUDH, and they are enrolled in both the Non-Profit Management certificate program at UCLA and a transgender leadership initiative through Gender Justice LA. They speak on university panels about gender variance and sexual diversity, and write/blog extensively about transgender communities’ experiences with eating disorders.

Please RSVP for any or all of the 3 events to drmuhlheim@gmail.com

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Parental direction works, but don’t expect your kid to be happy about it: Research on The Family Meal in FBT

Slide1Parents charged with helping their children to recover in Family-Based Treatment often wonder 1) how to actually get their children to eat and 2) whether they will harm their children or the parent-child relationship by requiring them to eat. A recent study addressed these concerns by looking at the family meal.               

How do parents of adolescent patients with anorexia nervosa interact with their child at mealtimes? A study of parental strategies used in the family meal session of family-based treatment

Hannah J. White BSc (Hons), Emma Haycraft PhD,*, Sloane Madden MD, Paul Rhodes PhD, Jane Miskovic-Wheatley DCP/MSc, Andrew Wallis MFAMTher, Michael Kohn MD and Caroline Meyer PhD (Article first published online: 26 JUN 2014)

The above study in the International Journal of Eating Disorders looked at the family meal in Family-Based Treatment (FBT), the best-researched outpatient treatment for adolescent anorexia. In FBT, the family plays a central role in treatment. Parents take responsibility for weight restoration and interruption of eating disorder behaviors, and family meals are an essential part of this process. Typically the second session of Family-Based Treatment is a family meal in which the family brings a picnic meal to the therapist’s office. The goal of the session is for the therapist to empower the parents to get their child with anorexia to eat one bite more than the child was prepared to eat.

The strategies used during mealtimes by parents of adolescents with anorexia have not been previously documented. Some believe that the eating habits of these adolescents have regressed and that the adolescents should be viewed as younger children who need more feeding assistance from their parents. Thus, parental strategies used to encourage eating would be similar to the strategies used by parents of younger children with and without feeding problems, which have been studied: these parents have been noted to use both encouragement and pressure to eat. Little is known about the response of adolescents with anorexia to their parents’ attempts to get them to eat.

The purpose of this study was to examine the strategies used by parents and the results. The study included 21 families with children between the ages of 12 and 18 who were undergoing FBT for adolescent anorexia.

The main aims of the study were:

1)   to identify mealtime strategies used by parents during the family meal session of FBT.

2)   to explore the relationships between these strategies and parental ‘success’ in encouraging eating.

3)   to explore the relationships between these strategies and their results with the emotional tone of the mealtime.

While this research was conducted in an artificial setting – a therapist’s office and in the presence of the therapist – the findings should be applicable to family meals occurring in the home.

Specifically, the researchers found:

1)   parents used a variety of strategies to prompt the child to eat: direct eating prompts (e.g., “You’ve got to eat all your eggs” or “Pick it up and eat it”), non-direct eating prompts (e.g. “Keep going” or “Why don’t you eat some more pasta?”), physical prompts (e.g., pushing a plate of food towards the adolescent), autonomous comments (e.g., “Do you want another one?” or “Which one do you want?”) and information provision (e.g., “Your body needs the calcium” or “This will make your bones strong”).

2)   direct, non-direct, and physical prompts were more successful in getting adolescents to eat than providing information about the food or offering food-related choices to the adolescent.

3)   in general, the more the parents prompted the child to eat and the more successful they were, the more negative the adolescents became. It makes sense that attempts to encourage eating, which contradict the anorexic tendencies, would cause psychological distress and a more negative emotional tone.

The authors conclude “It is interesting that a behavioral focus on eating (i.e., verbal and physical prompting) was associated with parental success as opposed to other strategies such as offering choices to the adolescent or consequences. This indicates that parents implementing a direct focus on food may be central to eating behavior and supports the emphasis on behavioral change rather than insight which is central to FBT.”

Keeping in mind that this is only one small study, the results are consistent with my observations of family meals in my practice and reports from parents refeeding their adolescents:

  1. parents need to directly prompt or pressure their child with anorexia to eat.
  2. offering choices and providing information is generally less effective in getting children with anorexia to eat.
  3. the more the parents pressure the child and the more the child eats, the more negative and upset the child becomes.

This study highlights the paradox parents face in implementing FBT. When a child is in distress, the parental instinct is to try to soothe them. Intentionally upsetting the child runs counter to a parent’s nature. However, for children with anorexia, food is medicine. The best measure of the parent’s success in FBT is the amount of food consumed. Parents should expect that their child will have a negative reaction to both pressure to eat and the eating itself. This negativity is not a sign of failure, but a reaction to a treatment that is working.

While these interactions often lead to more short-term conflict and distress, parents must persist and weather the storm in order to support their child’s recovery.  Over time, this persistence will challenge the anorexia and encourage change and recovery.

 

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Katherine Grubiak, RD

Katherine Grubiak, RD

Katherine Grubiak, RD

On the occasion of the one year anniversary of my affiliation with the awesome, Katherine (Katie) Grubiak, RD, I want to highlight her fabulous work and contribution to my practice.

Eating disorders are best addressed by a multidisciplinary approach.  Thus, I was extremely excited when, one year ago, I moved to a larger space and arranged an affiliation with Katherine Grubiak, RD, who works part-time in my suite.  Ms. Grubiak brings a wealth of experience with eating disorders in both adolescents and adults, and her approach is consistent with the latest evidence-based treatments.

Our clients benefit from our integrated approach for eating disorders and we tailor treatment to each client or family.  Additionally, we offer services as a team or individually. This benefits our clients who already have a dietitian or therapist and are seeking to add one member to their treatment team.

Ms. Grubiak, in addition to nutrition counseling sessions at the office, also provides additional support to those seeking help with preparing, portioning, or eating meals.  These may occur in the client’s home, office, school, or location of choice (restaurant, supermarket, etc.).  

Katherine Grubiak, RD/Biography

Katherine Grubiak is a Registered Dietitian with a focus on blending Western & Eastern philosophies regarding nutritional healing.  She graduated from the University of Texas at Austin and first pursued a career in public health surrounding herself with different cultures and a mission to honor all those seeking healthcare nutritional support.

Ms. Grubiak began her Nutrition career working in Maternal Child Health Nutrition with a focus on Gestational Diabetes Management & breastfeeding support as a Certified Lactation Educator (CLE).  She later became a dietitian for the UCLA Arthur Ashe Student Health & Wellness Center seeing students with various medical issues.  In this position, she worked closely with the UCLA Counseling and Psychological Services Center to provide treatment for college students with eating disorders and was involved with the Health Center’s Weight Management and Diabetic Programs.

This experience led Ms. Grubiak to pursue her next position as full time Registered Dietitian and Director of Clinical Services for California Center for Healthy Living, an innovative and comprehensive center promoting healthy relationships with food, fitness, and body image for children, teens, and adults of all ages. The focus here was on prevention and treatment of eating disorders and family involved therapy.  She enjoys working within a multi-disciplinary team believing that holistic care means having all areas of health supported.

Ms. Grubiak also has a professional dance background and taught for the non-profit dance school Everybody Dance in Los Angeles.  She utilized nutrition and alternative medicine including yoga to heal herself from dance injuries and spread the word to her students.

Ms. Grubiak’s belief is that a practitioner needs knowledge, compassion, patience, and creativity to inspire change.  The practitioner must honor the individuality and goals of each person who enters her care. There should be no limitations on their journey or their healing.  She has experience working with clients of all ages and across the spectrum of weight and wellness.  She is available to work with adults, adolescents, families, and parents.

She can be reached at 213-249-2110.

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Psychological assistant providing low cost treatment for eating disorders

I remain committed to the practice of and dissemination of evidence-based treatments. To that end, I am excited to announce that I have added a registered psychological assistant to my practice in Los Angeles:

Liliana Almeida, M.A, Clinical Psychology Ph.D. Student, PSB-94020579

Liliana Almeida, M.A.

Liliana Almeida, M.A.

 

Liliana Almeida, M.A., is a fourth year Clinical Psychology Ph.D. student at the California School of Professional Psychology at Alliant International University in Los Angeles. She received her M.A. from The New School and her B.A. from Rutgers University. During the last 7 years she has researched eating disorders and obesity. Her clinical experience includes working with diverse clients in a community mental health center providing cognitive-behavioral and psychodynamic psychotherapy in English and Spanish.

Liliana will be working under my supervision and is available to work with adult and adolescent clients with eating disorders, anxiety, and depression.  She will provide services in English, Spanish, and Portuguese and will be able to provide some low-cost therapy to those in need.

Portuguese

Eu sou uma assistente de psicologia (PBS-94020579) para Lauren Muhlheim, Psy.D., psicóloga clínica especializada no tratamento cognitivo-comportamental de perturbações alimentares. Como assistente de psicologia, eu forneço psicoterapia cognitivo-compartamental em Português sob a licença da Dra. Muhlheim (PSY 15045) para adolescentes e adultos que sofrem com depressão, ansiedade e pertubações de o comportamento alimentar.

Spanish

Soy una asistente de psicología (PBS-94020579) para Lauren Muhlheim, Psy.D., una psicóloga clínica especializada en el tratamiento cognitivo-conductal de los trastornos alimentarios. Como asistente de psicología yo proveo terapia cognitivo-conductal en Español bajo la supervision y licencia de la Dra. Muhlheim (PSY 15045) para adolescentes y adultos que sufren de la depresión, ansiedad y de los trastornos de la conducta alimentaria.

If you are interested in more information, please visit Liliana’s website or contact me at 323-282-3572 or drmuhlheim@gmail.com or Lilian directly at lilyalmeida85@gmail.com

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AED Tweetchat on Diabulimia

I have to admit that, when a colleague on the Academy for Eating Disorder Social Media Committee that I was co-chairing proposed “diabulimia” as an idea for a tweetchat, I was not particularly excited.  As an eating disorder specialist in outpatient private practice, I have not professionally encountered clients with diabetes and eating disorders.

Since we could not easily identify any experts on the topic who also tweeted, the idea languished until the International Association of Eating Disorder Professionals scheduled an event on the topic in my area.  John Dolores , JD, PhD, a licensed clinical psychologist and Executive Director of Center for Hope of the Sierras, was the guest speaker.

Prior to attending his talk, I had the luck at the FEAST conference to sit next to Dawn Lee-Akers, CFO at Diabulimia Helpline.  Together Dawn and Dr. Dolores educated me on the severity of ED-DTM1 (popularly referred to as “diabulimia”) and the need to draw more professional and public knowledge about this issue (and both agreed to be involved in the chat).

As a result, I was really excited to be involved in helping prepare for the AED twitter chat on the topic this week and to do my part to bring attention to the issue.  It was a great and informative chat and I hope you’ll read the entire transcript available here.

Some highlights of what I have learned:

  • Diabulimia is a media term; many providers prefer ED-DMT1.  It is most commonly the coexistence of Type I diabetes and an eating disorder with manipulation of insulin to lose weight.  In this case, the insulin manipulation is considered an inappropriate compensatory behavior (hence the use of the term diabulimia).  The individual may meet criteria for Bulimia Nervosa or OSFED.  It is also possible to have Type II diabetes and an eating disorder, which may be included in diabulimia if insulin manipulation is involved.  Additionally, some people can have diabetes and an eating disorder that are totally unrelated.
  • Women with Type I diabetes are 2.4 times more likely to develop an eating disorder than their non-diabetic peers.  Statistics vary quite significantly with a reported 45-80% of Type I diabetics reporting binge eating.  Multiple studies show 30%-35% of women with Type I diabetes report restricting or omitting insulin in order to lose weight.
  • Higher rates of eating disorders among people with diabetes are not surprising due to the way diabetes has traditionally been treated.  The traditional diabetes ‘diet’ focuses on low carbs and high protein, which encourages restriction, which in turn can lead to binge eating.  Diabetes management includes a lot of focus on numbers and on control which may feed perfectionism.  Patients with diabetes often lose weight pre-diagnosis, and gain weight when they start insulin, so come to associate insulin with weight increase.  They quickly learn that they can manipulate their weight by under dosing with insulin.
  • The effects of compensation by insulin are even more devastating than other forms of dietary compensation.  Patients with diabulimia are at risk for serious medical consequences.  The most dangerous short-term consequence is diabetic ketoacidosis, which requires immediate hospitalization.  Longer-term consequences include peripheral and autonomic neuropathy, retinopathy, cardiovascular disease, and even renal failure.  Some of the consequences are irreversible.
  • Diabulimia requires a specific and sensitive treatment approach from a coordinated team of professionals with expertise in diabetes and eating disorders.  The team should include nursing, endocrinologist, dietitian, therapist, and diabetes educator.  It is critical that the team use a consolidated approach and not treat the diabetes and eating disorder separately.
  • Intuitive eating, CBT, DBT, & ACT are successful in the treatment for comorbid diabetes and eating disorders.  The treatment of diabulima requires medical oversight, including regular monitoring of blood glucose, management of certain side effects of insulin re-introduction, and treatment of new or worsening diabetes complications.  Eating disorder patients with comorbid diabetes are more likely to be medically unstable and need inpatient treatment.

With diabetes on the rise and numerous prevention efforts aimed at preventing obesity, I was left wondering:  where are the prevention efforts for the even deadlier combination of diabetes and eating disorders?  For such efforts, eating disorder professionals and organizations must work together with diabetes professionals and organizations.  We invited several diabetes organizations to join our chat, and fortunately, a few did.  We must continue to raise attention to this problem and reach out to others outside the eating disorder field.

Resources:

  • The Diabetes Eating Problem Survey (DEPS-R) can be used by providers to assess whether patients with diabetes may have an eating disorder.
  • Diabulimia Helpline maintains a list of US treatment centers that have specialized programs to treat comorbid Diabetes and Eating Disorders.
  • Diabulimia Helpline recommends this video as the best overview on Diabulimia for patients, family and professionals.
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Recognizing and Managing the Subtler Signs of Starvation in Children with EDs

This interaction on twitter caught my eye:

Slide1Watching cooking shows, collecting and reading recipes, and cooking for others (but not eating it oneself) are some of the earliest signs of anorexia that are often missed and misinterpreted by parents.  In Keys’ landmark study “The Biology of Human Starvation” male volunteers were put on starvation diets.  According to Keys, food became “the principal topic of conversation, reading, and daydreams.”  The volunteers studied cookbooks and collected cooking utensils.  Three of them went on to become cooks even though they’d had no interest in cooking before the experiment.  When starving, people may obtain vicarious satisfaction from cooking and watching others eat.

In my own experience, I contracted severe food poisoning during my second pregnancy.  Unable to eat without severe consequences, my doctors instructed me to forgo solid food for a full week.  I remember clearly that I spent the week lying in bed (entertaining my toddler) and watching cooking shows.  It seemed nonsensical to me at the time, like an unusual form of self-torture.  But, now I know it was an attempt to vicariously soothe my intense hunger.

In her book Brave Girl Eating, Harriet Brown discusses how her daughter went through a “foodie” phase during the onset of her anorexia.  I have seen a similar profile in a number of my young clients.  Parents do not usually think these are signs of trouble and are more often impressed by their child’s sophistication.  Some of the less obvious early signs of starvation parents should watch for include:

  • Reading recipes
  • Blogging about food
  • Cooking food they do not eat
  • Watching cooking shows

Of course, not every child who shows a strong interest in cooking has or will develop anorexia, but it is something that should pique a parents’ interest.

My own daughter went through a phase where she was obsessed with cooking and watching cooking shows.  It so happened that she was not eating enough at this time, which coincided with the start of her adolescent growth spurt.  I did an early FBT-like intervention and she gained and grew; as she did, the obsession with cooking abated.  Was this merely a passing phase or anorexia averted?  I’ll never know, but I’m glad I intervened.  (More about that in future post.)

When a child with a diagnosis of anorexia shows these behaviors, I recommend that they be stopped.  In FBT, parents take charge of their child’s food and food environment.  Food is the child’s medicine and the number one priority.  For this reason, vicarious gratification of hunger should be removed.  Children with anorexia should not be watching cooking shows, reading recipes, or cooking.  I usually recommend that children do not participate in preparing their own food at all in Phase 1.  In Phase 2, children gradually get involved in food preparation again, but the usual rule I recommend is that if they make something, they must eat it.

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