Thursday, July 30, 2009

How can yoga help in healing from an eating disorder?

by Mary Laffey Adams, RN, MSN, Holistic nurse, Kripalu yoga instructor

As a Kripalu yoga instructor at McCallum Place for the past seven years, I have seen those who participate in the yoga sessions during treatment reap many benefits. Patients leave at the end of our hour-long group saying things such as: “I feel so much more relaxed!” “I am calmer now.” or “My thoughts have settled down.” Such are the gifts of yoga, a physical, mental and spiritual practice, that one ancient sage guaranteed would “still the fluctuations of the mind.”

In our yoga sessions, we get to that quieter place in the body and mind by going through what I think of as the back door. I like to take everyone around that way because the eating disorder (ED), as patients often personify the eating disorder mind, is at the front door, keeping constant watch for any intruder (healthy eating, attitudes, thoughts, and actions) who might ask him to leave. With ED looming over everything, the body and mind are in a continuous state of stress. Breathing becomes restrained and shallow, digestion is inefficient, muscles are tense, jaws are clenched, the heart is compromised; the body chemistry and physiology are in the state of high alert. Tension is held throughout the body and this strain becomes habitual.

Being compassionate is the first step into the backdoor of calm awareness. So, as we come to the yoga mat and do something as sweet as take a deep breath and let out a soft sigh and relax the shoulders just a bit, we are offering our bodies a little oxygen, a little acknowledgement that things have been tough and a little release and opening. The body and mind start to get the message, “everything is already okay.” ED is oblivious to what is slipping in: comfort in the body, mind and spirit.

We focus a lot on the breath in our yoga sessions. A nice, big cleansing breath or a long, slow breath is so nourishing! It never fails, after a few minutes of breathing we can hear tummies rumble. This is because the relaxation response starts to kick in and when the body is in a calm, relaxed state, the digestive track says, “Okay, let’s get moving!”

In addition to breathing and relaxing, we also focus on feeling, watching and allowing sensations in the body. ED will have people constantly judging body places like the belly, thighs, arms, wrists, and ED will never have anything good to say about any of them. Feeling sensations takes us away from the habitual criticism of body places because we are not really feeling the tissue, but rather feeling what going on around, inside, between and beyond the tissue. We might start with a safe place, like the palm of the hand and tune-in to the sensation in that area. Words such as tingling, humming, vibrating, or whooshing are used to describe these new feelings that may never have been noticed before. The habit of criticizing is absent because this is a novel way of feeling the body that does not allow for evaluation, we are simply watching and allowing whatever is “happening” there. Patients often voice relief and a sense of freedom, having felt their bodies in this new way.

These simple Kripalu yoga practices of breathing, relaxing, feeling, watching and allowing, help in the healing from an eating disorder. They aid digestion, trigger the relaxation response, and offer a new way of experiencing the body. Most importantly, the door of calm awareness is opened, the true, healthy self is waiting inside, and there is a sense of coming home.

Thursday, July 16, 2009

Insurance Coverage and Eating Disorders

by Suzanne Rogers, Marketing Intern

Let’s put it out on the table right now so that nobody is shocked a few paragraphs into this blog: On average, eating disorder treatment can range anywhere from $800 per day to $2500 per day. There is no “instant cure” for eating disorders, despite what some may believe; thus, the monthly cost of treatment for one individual can range from about $24,500 to $77,500. Oftentimes, those who suffer from an eating disorder need much more than a few weeks or a month of treatment to fully recover. Some parents take out second mortgages or dip into their 401K’s. According to the Mental Health Parity Act of 1996, insurance companies are required to pay for coverage. This blog will help to explain why this usually does not happen.

The Mental Health Parity Act was originally introduced to Congress more than a decade ago, in 1996. This act requires that insurance companies treat mental disorders equally with physical disorders. For example, if Jane is treated for strep throat at Dr. Bob’s office, insurance will cover the cost. If Jane then goes to Dr. Joe’s facility for eating disorder treatment, insurance should cover the cost, but usually they do not. Most insurance companies limit eating disorder mental health treatment to whether the person is suffering from medical complications from the eating disorder. Others have an annual cap on how many days a patient can benefit from in-patient care, which is usually anywhere between 15 and 30 days. On average, treatment is needed from anywhere between six and twelve weeks to fully recover.

The mental health parity bill was finally passed in November 2008 and will go into effect in January of 2010. What is unknown to many is that this mental health parity bill was pending in the federal legislature for more than a decade because the House and the Senate were unable to agree on the terms of the bill. The bill would make it illegal for insurance companies to place dollar amounts and/or limits on treatment for mental illnesses. Fortunately, we appear to be only six months away from these changes. Unfortunately, the bill has two red flags.

While the bill does call for mental health parity, the law leaves the definition of mental health up to individual states and insurance companies. This means that many states can continue to discriminate against those with some mental illnesses and deny treatment coverage to those who suffer from eating disorders or other deadly psychiatric afflictions. (Interestingly enough, the National Institute for Mental Health confirms that anorexia is a “brain disorder” that can be treated with appropriate mental and physical treatments.) The second red flag is that while insurance companies will now be required to cover mental health, according to their definition, equally with physical health conditions and substance abuse, they will not be required to cover all of them. According to the law, if an insurance company covers mental health and substance abuse it must be done with an amount or level that is considered to be average.

Alaska and Wyoming are the only two states that have not adopted some form of parity, as of July 2008. Out of the 48 states that have adopted a form of parity, only 23 have comprehensive parity laws. The states that are remaining have a plethora of restrictions. Missouri, home of McCallum Place, has mental health parity, but with limits on the coverage. Anorexia nervosa, bulimia nervosa and “other severe eating disorders” are covered, as long as they are listed in the individual plan. Idaho, on other hand, offers mental health parity for state employees only.

Patients who are in treatment at McCallum Place face numerous challenges when it comes to receiving coverage for treatment. Deb Dettmann, MSW, of McCallum Place said that the most frustrating aspect about treatment coverage in general is that insurance companies disagree with how long one should be in treatment for an eating disorder; insurance companies stop seeing the medical necessity long before the treatment team does. This has long-lasting consequences. For a patient who is discharged before going through the entire duration of treatment, relapse is most likely going to occur. In severe cases, this may lead to death. Jennifer Kamer, MA, PLPC, Marketing and Admissions Coordinator at McCallum Place, sees firsthand the sadness and frustration that patients experience when finding out that treatment is ceasing or when treatment isn’t an option at all due to lack of coverage. “No one can get better with 10 or 20 days of treatment. It’d be like giving a cancer patient one-third of chemotherapy treatment; doctors won’t do that. But doctors who are on staff with insurance companies make these decision everyday,” she said.

The good news in regards to the Mental Parity Act is that if your state currently covers eating disorder treatment, it will continue to do so. Dr. McCallum, who doesn’t feel it is helpful to villanize insurance companies, simply wants more education about eating disorders in the eyes and ears of the public so that everybody can have a correct understanding of what an eating disorder is and how it needs to be treated. She also wants better legislation to give those who suffer from an eating disorder the care that is needed.

House Bill 519, sponsored by Rachel Storch and co-sponsored by Rick Stream, is the first eating disorder specific bill introduced in Missouri. HB 519 requires insurance companies to provide coverage for the diagnosis and treatment of eating disorders. On May 5 of this year a public hearing was held and many, including Dr. McCallum, testified on behalf of this bill. While it is too late in the session to pass this bill, supporters are doing all they can to ensure that this bill will be passed in the future. To learn more about HB 519 visit .

The National Eating Disorder Association (NEDA) created the STAR Program (States for Treatment Access and Research) to fight for better access to eating disorder treatment by speaking with state legislatures, mobilizing members, and forging alliances with others who share this vision. Visit to learn more or to find out how you can get involved.

Thursday, July 2, 2009

"Help! I know someone with an eating disorder. Now what do I do?"

by Suzanne Rogers, Marketing Intern

In the United States, as many as 10 million females and 1 million males are suffering from an eating disorder such as anorexia nervosa or bulimia nervosa. Millions more are suffering from binge eating disorder. Nearly half of all Americans know someone with an eating disorder. Wanting to help your loved one recover from the eating disorder may not be as easy as you think it is. You may assume that the first step in helping your loved one to recover is to confront her and attempt to talk her out of having an eating disorder. While this mistake is commonly made, it is important to realize and accept that this method will NOT “cure” the one suffering from disordered eating. If someone has been diagnosed with diabetes, he or she can’t choose for it to go away; remember that those suffering from an eating disorder cannot just choose for it to disappear. The first step on the path to helping your loved one recover is to educate yourself. This will benefit the both of you. There are many excellent and up-to-date resources available; it’s just a matter of knowing where to find them. At the end of this blog I will list a few of the many resources that are available.

Eating disorder statistics are staggering! Let’s begin by recognizing some of these facts and statistics*. Eating disorders are more common than Alzheimer’s disease in the United States. Despite the prevalence of eating disorders, there is inadequate research funding. Eating disorders are the third most common chronic condition among adolescent girls along with obesity and asthma. Anorexia nervosa has the highest premature mortality rate of any psychiatric disorder. The majority of deaths are due to physiological complications. More than 50 percent of eating disorder cases are chronic. Keep these facts in mind as you continue to walk down the path of recovery with your loved one. Remember that eating disorders are potentially life-threatening, but there is help available and recovery is possible.

Next, I want to address the different types of eating disorders. Anorexia nervosa (AN) is a serious, potentially life-threatening eating disorder. It is characterized by self-starvation and excessive weight loss. Symptoms include loss of menstruation (the starvation state suppresses sex hormones) and feeling “fat” despite dramatic weight loss. Bulimia nervosa (BN) is a serious, potentially life-threatening eating disorder characterized by cycles of bingeing and compensatory behaviors such as self-induced vomiting or the use of laxatives. The compensatory behaviors are designed to undo or compensate for the effects of binge eating. Symptoms include eating beyond the point of comfortable fullness and repeated episodes of bingeing and purging. Eating disorder not otherwise specified (EDNOS) is a category of eating disorders that don’t meet the criteria for a specific eating disorder, such as anorexia nervosa. Binge eating disorder (BED) is characterized by recurrent binge eating without the regular use of compensatory behaviors to counter the binge eating. Binge eating disorder is considered to be an EDNOS.

There is no single cause for why someone develops an eating disorder. While eating disorders may begin with preoccupations about food and weight, they are usually about much more than food. Psychological factors, such as low self-esteem and feelings of inadequacy, can contribute to developing an eating disorder. Troubled family and personal relationships and a history of physical or sexual abuse are considered to be interpersonal factors that can also contribute to the development of an eating disorder. Furthermore, social factors also contribute to developing an eating disorder. For example, the media’s narrow definition of beauty that includes only those who meet a specific size and weight requirement. (This is so prevalent in our daily lives; just take a look around the next time you are in line at the grocery store.) Current research also suggests that genetic contributions play a role in the development of an eating disorder.

Love and support for the person struggling with disordered eating is crucial. Express your concerns in a loving, non-confrontational manner. Pick a place that is private and tell your loved one the concerns you have by using specific examples, such as a pattern of exercise. Explain that these examples lead you to believe that there is a problem that needs professional help. Ask your friend to discuss the behavior(s) with a professional and offer to go with him or her to the appointment. Avoid placing blame, shame, or guilt on your loved one. Avoid making accusatory statements such as, “You just need to eat.” Rather, use “I” statements such as, “It makes me afraid to hear that you’re vomiting.” Avoid offering simple solutions. For example, “If you would just stop, then you will be fine!” Continuously support your loved one because the recovery process will take time.

Put yourself in your loved one’s shoes. You may be thinking, “Why can’t she just eat something?” This is impossible because her behavior, such as restrictive eating, “works” for her on some level. It helps her manage anxiety and cope with fears about loss of control. She may think to herself, “My eating is the one thing I can control.” Perhaps your loved one suffers from bulimia nervosa. You may be thinking, “Why can’t he just stop purging?” Purging allows him to eat without fearing weight gain. The numbing sensation that is felt during a bingeing and purging cycle calms him. The purging behavior is addictive. (The American Medical Association concluded that addiction is a disease that is chronic in nature, like cancer, diabetes, or bipolar disorder. “Anatomy of a Food Addiction” by Anne Katherine, M.A. can help to explain this subject further.)

Below are three resources to help educate you about eating disorders. While these three resources provide excellent information, keep in mind that there are many other trustworthy resources, too. Don’t be afraid to ask for help. There are support groups available for family members and friends of someone who has an eating disorder. contains a vast amount of information and resources pertaining to eating disorders. You can find a local support group under the “Treatment” section.

The National Eating Disorder Association (NEDA) is a non-profit organization committed to supporting those who suffer from eating disorders as well as their family and friends. In 1999, NEDA established a toll-free helpline and their website,, has more than 50 million hits each year.

The Academy for Eating Disorders (AED) is a global professional association that is committed to leadership in eating disorders research, education, treatment, and prevention. On their website,, you are able to find a trusted professional in your area by typing in information such as your city and zip code.

The Admissions Department at McCallum Place welcomes phones calls or e-mails in order to answer any questions you may have, whether or not it is you or a loved one suffering from an eating disorder. All information is free of charge. Visit our website, for contact information.

*Facts provided by the National Eating Disorder Association