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Anonymous

Thank you to everyone who has contributed to this thread. The variety of comments, from the personally passionate to the plainly informative, has been extremely valuable to me on a personal and professional level. As a new physician beginning residency, it is helpful to hear the diverse and at times conflicting experiences of those who suffer with EDs and those who are parents or children of those who suffer. Unfortunately, both medical training and our medical system are still greatly lacking when it comes to integrating physical, emotional and spiritual models of disease and treatment. Cooperation among the various professional fields, clinicians and researchers is impeded by inefficiencies, funding, politics, tradition, and much more. Our medical model is also traditionally based on the exclusion of the patient and/or family. No doubt, the public needs to be better educated and informed of their choices. I do hope that the changes we will inevitably need to make in our health care system will serve to increase cooperation at all levels and lead to better understanding and treatment of EDs and other complex mental and/or brain diseases.

Ultimately, the cooperation necessary to make these advances relies to a great degree on our individual abilities and willingness to acknowledge our personal mistakes and responsibilities. It is my personal experience, both suffering with an eating disorder and as the daughter of a mother with an eating disorder, that has led me to arrive at this opinion. I, like some of the others with EDs who have commented, can identify with the "invasion of boundaries" described by Dr. Poppink, however I did not interpret her article as necessarily placing blame on parents. Having fault or having contributed to one's own or another's emotional or physical pain, while almost unbearable to acknowledge, is not necessarily an unwelcome reality. In many cases, it means that there is something over which one has power and responsibility and therefore can change. My mother and father (who was an addict and alcoholic) may have influenced the development of my eating disorder with their inability to provide or model ideal boundaries. However, as we have all learned to be more honest with ourselves and each other, we have also contributed to each other’s recovery and improved relationships within the family. Likewise as a professional, I will need to remain always aware of the biases inherent in my limited experiences and to be quick to recognize that I can never attain complete knowledge of the diseases I treat, even if practicing in a highly specialized field.

By sharing this personal example, I do not dismiss the likelihood of genetic or other biological factors contributing to my eating disorder. Nor do I wish to negate the possibility that "boundary invasion" may play little to no role in the etiology of some eating disorders. Prior to medical school, I worked for a child and adolescent psychiatrist specializing in brain SPECT imaging. I was introduced to Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS), a controversial syndrome characterized by symptoms suggestive of OCD or tic disorder following a streptococcal induced autoimmune reaction affecting the basal ganglia. A rare PANDAS associated form of anorexia nervosa (PANDAS-AN) has also been proposed, in which the resulting obsessive/compulsive symptoms include fears surrounding food and body weight. ( Linda, I am curious if this was the diagnosis for the AN your son suffered following “glandular fever”.) However, research and evidence are still lacking to prove or disprove the validity of PANDAS and an associated PANDAS –AN. The following review articles can provide more information on this topic:

PANDAS anorexia nervosa--endangered, extinct or nonexistent? Puxley F. Midtsund M. Iosif A. Lask B. International Journal of Eating Disorders. 41(1):15-21, 2008 Jan

Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update. Shulman ST. Curr Opin Pediatr. 21(1):127-30, 2009 Feb

I feel fortunate to be beginning my career with the resources and technology that are allowing more information and voices to be shared so readily. The scientific discoveries are also bringing more hope for all affected by EDs and other complicated mental/brain disorders. Perhaps, as suggested by previous comments, we will be able to specifically identify various etiologies for EDs and one day may be able to more precisely individualize treatment and referrals, avoiding the frustration and danger of unnecessarily prolonged misdiagnosis or ineffective treatment. Let's continue this discussion here and elsewhere for the benefit of all.

Richelle Hammond D.O.

June 8, 2009 - 12:13am

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