Dysfunctional families are a favorite subject of the movies but it is rare when a film can provide a new perspective to my readers with professional or personal experience in this area. Oscar night made me think of the Danish film (with subtitles) called Festen (Celebration) which begins as family, friends and business associates gather for a banquet to celebrate the 60th birthday of a wealthy family patriarch. A tragedy has occurred in the family recently. One family member believes this event was linked to past abuse and, to put it mildly, is interested in clarifying the connection.
Archive for the ‘Stress Illness Causes’ Category
Childhood Stress in Film: Festen (1998)
Monday, March 8th, 2010Self-Care Skills
Tuesday, March 2nd, 2010Are you the kind of person who cares for everyone but yourself? In #4 of my series of posts about the DSM-5, I proposed a new definition for Complex Somatic Symptom Disorder. Part B of the definition included the concept that symptoms improve in response to treatment of ongoing social or psychological stresses including insufficient self-care skills. In this post I want to elaborate on the latter.
Anorexia Anecdote (8)
Thursday, February 18th, 2010To help Antoaneta understand emotions about sexual abuse in her childhood, I began by asking her to imagine how she would feel watching a child she cares about growing up exactly as she did. Most of my childhood stress survivors spent years learning to suppress feelings connected to their abuse. As a result, they find it difficult to consciously connect with those emotions. But if they imagine the same experience being inflicted on an innocent child, usually they begin to experience those long-buried emotions. Once they have this connection, the next step, when they feel ready, is to write about what they are feeling. Writing has an almost magical ability to pull out emotions of which people are only slightly aware.
Anorexia Anecdote (7)
Wednesday, February 17th, 2010The second part of Antoaneta’s treatment for anorexia focused on unexpressed outrage about her sexual abuse in childhood. To survive the abuse, many children find a place to lock emotions away. By the time they become adults, their ability to experience those feelings is limited. As their self-esteem recovers during the adult years, recognition of how wrongly they were treated grows and pressure to express the associated emotions becomes compelling. Lacking facility in verbalizing those feelings, many of my patients (including Antoaneta a few years earlier) express them somatically (which means via the body) which results in physical symptoms. In others, such as Antoaneta during the time of her anorexia, the emotional pressure causes a sense of chaos for which tight control over eating and weight provides some relief. The common source of both the physical symptoms and the anorexia lies in the unexpressed outrage at maltreatment in childhood. This is why treatment methods developed to relieve physical symptoms also succeeded in relieving Antoaneta’s anorexia. The key is to help the patient learn to express the emotions verbally. More in the next post.
Anorexia Anecdote (6)
Tuesday, February 16th, 2010The first part of treating Antoaneta’s anorexia focused on her low self-esteem. I deliberately avoided discussion of eating habits, body image or weight.
Anorexia Anecdote (5)
Monday, February 15th, 2010Over 6-8 months, my visits with Antoaneta (every 2 weeks at first, then less often) led to complete relief of her anorexia nervosa. Her weight dipped from 110 lbs (50 kg) at our first encounter to 104 lbs (47 kg) but then began to rise steadily, reaching 121 lbs (55 kg) at our last visit and later achieving a plateau of 140 lbs (64 kg) where she has remained for the last 4-5 years.
Anorexia Anecdote (4)
Friday, February 12th, 2010Antoaneta’s refusal to accept counseling for her anorexia nervosa from anyone but me created the most challenging ethical dilemma I ever faced involving one of my own patients. Fortunately I served for many years as Ethics Director for my hospital and for my medical group and I had learned when faced with two bad options, to try to find a third way.
Anorexia Anecdote (3)
Thursday, February 11th, 2010When Antoaneta insisted she would allow no one but me to counsel her about her anorexia nervosa, my first reaction was that this was analogous to asking a dermatologist to treat your heart attack or a plumber to fix your computer. Even among therapists experienced in treating anorexia, success rates are not ideal. As the NIMH Eating Disorders site puts it, “no specific psychotherapy appears to be consistently effective for treating adults with anorexia.”
Anorexia Anecdote (2)
Wednesday, February 10th, 2010Continuing the story of Antoaneta, I was glad to find that her nutritional status was still within normal values despite her profound weight loss to 110 lb (50 kg) and body mass index of just under 18 (normal 20 – 25). However, a review of her chart revealed steady loss of 7-8 lbs (3.5 kg) every month for over a year and it was clear she would soon be in serious, potentially life-threatening trouble.
Anorexia Anecdote (1)
Sunday, February 7th, 2010Caring for the patient I am about describe was so challenging it could have cost me my job.
Antoaneta was a middle-aged native of an eastern European country who came to the U.S. at age 10. She spoke perfect English with a charming accent and I recalled treating her for irritable bowel syndrome a few years earlier. Now she was referred for a nutritional evaluation. (In addition to my work as a gastroenterologist, I also directed the nutrition support team at the hospital.) The reason for this was that she had steadily lost a total of 113 lbs (51 kg) over the preceding 15 months due to anorexia nervosa. Her primary clinician had already checked for other conditions that might have caused her weight to fall from 223 lbs (101 kg) to 110 lbs (50 kg) on a 5′ 6″ (1.68m) frame but found no other problems.
