Friday, April 24, 2015

Understanding Binge-Eating Disorder

Many of us have had the experience of over-eating to the point of abdominal pain. Just think about your last Thanksgiving feast: how many people pushed away from the table, groaning with discomfort, loosening their belts, unsnapping the waistband of their jeans? Occasional over-eating is not a clinical diagnosis, but more usually a sign of distracted eating, intense enjoyment of a particular meal, or a result of indulging in a special treat. Binge-Eating Disorder, however, is a serious eating disorder that can have life-threatening consequences.


Specific behavioral and emotional characteristics are present for clients with Binge-Eating Disorder(BED), including: 
1. Recurrent episodes of binge eating, characterized by eating much more food in a specific amount of time than most people would, and feeling a lack of control over the eating episode.
2. Binge eating episodes include three or more of the following components:
      A. Much more rapid eating than normal
      B. Eating until uncomfortably full
      C. Eating large amounts of food when not hungry
      D. Eating alone out of embarrassment about the amount one is eating
      E. Feeling disgusted with oneself,  depressed or very guilty afterward
3. The person feels marked distress about his/her binge eating.
4. Binge eating occurs at least once a week for three months.
5. The binge eating is not associated with the recurrent use of compensatory behavior (i.e., over-exercising, abuse of laxatives) like in bulimia nervosa, and doesn't occur only during the course of a person suffering with bulimia or anorexia nervosa.


Various treatment options exist for BED. Inpatient, partial hospitalization, intensive outpatient and outpatient therapy modalities provide the appropriate level of care and oversight for clients' differing needs. Besides counseling, the treatment team also includes a nutritionist, medical doctor and psychiatrist to help manage the client's physical health. Obtaining a comprehensive evaluation from a certified physician or therapist specializing in eating disorders is essential to ensure the correct level of care is initiated, and to screen for other co-morbid diagnoses, including substance abuse, personality disorders, depression and anxiety. Like all eating disorders, recovery from BED can be a lifelong process. But early intervention and a commitment to the therapy process can provide BED sufferers with the skills and resilience to triumph over this complicated disease. 

Thursday, April 16, 2015

Tracking Teen Development: When to Intervene

Seemingly out of nowhere, my previously sweet, considerate and affectionate 15-year-old son is sometimes replaced by a surly, disrespectful and eye-rolling teenager who doesn't hesitate to point out my every shortcoming and flaw. In the past, my son would join me in our "Car Dancing"--maniacally rocking out to our favorite songs on the radio. Now, he FORBIDS me not only from dancing in the car, but even singing along (which, of course, necessitates my immediate need to belt out song lyrics as loudly as I can WITH THE WINDOWS DOWN). His behavior irritates and frustrates me, but I am  familiar  enough with adolescent development to understand my son is a typical teenager. But how do we tell the difference between normal adolescence and behavior that indicates a need for intervention?


According to experts Dinkmeyer and McKay's seminal books on parenting, teens can generally be grouped into three categories. Review these attributes and behaviors and consider where your teen falls:

Typical Teenager--This teen exhibits a greater interest in friends than in family. He may try out different values as a way of separating and creating a sense of self distinct from his family. She may experiment with smoking cigarettes, trying alcohol, swearing, and minor rule-breaking at home or school. Lying, pushing againt established boundaries and occasional disrespectful behavior fall into this category.

At-Risk Teenager--This teen may isolate from family, demonstrate a more consistent use of  alcohol or marijuana, and express less interest in school or other achievements. She may experience conflict with authority figures, disregard house rules, engage in sexual experimentation at an earlier age or deliberately express disregard for family values and activities.

Out-of-Control Teenager--This adolescent regularly uses substances, may he skipping classes or even dropping out of school. He may be sexually active indiscriminately or engage in risky behaviors. He may be involved in the juvenile justice system, and have difficulty in sustaining healthy relationships.  A high level of disengagement from prosocial activities and an investment in dangerous or unhealthy behaviors is a consistent theme.

Clearly, at-risk and out-of-control adolescents are in need of immediate interventions, including a referral to counseling. Typical teens, however, can also benefit from individual, family or group counseling. This challenging and vulnerable stage of development is a time ripe for growth and insight. Counseling can provide teens -- and exasperated parents -- with support, education and skills to navigate these years with limited eye-rolling and exaggerated sighs. Just don't expect car dancing lessons. Some talents are simply inborn.

Wednesday, April 15, 2015

Parental Guiding Suggested

Wiping runny noses. Driving carpool. Answering the same question 12 times. Scheduling doctors' appointments. As parents, we expect and accept that these tasks are everyday obligations in our roles as caretakers. As the American population ages, however, many adults find themselves in the role of caretaker for their parents as well, with sometimes ambivalent feelings  about the tasks involved in this balancing challenge.


Different cultures approach aging, and caring for the aged, with varied perspectives. While some families believe that caring for aging parents is always the responsibility of family members (usually the adult children), others feel that older folks receive the best, most informed care from trained providers, whether in-home care or professionally-staffed facility. No single approach works for all families, nor for the needs of each aging member.  If you are exploring the best care options for your aging parent, consider the following points:

1. Call your township. Most areas have a senior services department, which can help schedule Meals  on Wheels and volunteer visits, offer financial or transportation assistance and suggest area resources to help you and your parent.
2. Establish a "treatment team." With your parent's doctor as the center point,  develop
circle of providers to help manage your parent's needs. Consider a counselor, home health staff, nutritionist, physical therapist, attorney and accountant who specialize in older clients--whoever can best advise you and your parent and sustain his independent functioning for as long as possible.
3. Research options sooner, rather than later. Aging people's health status can change quickly. Start looking into different levels of care, including assisted living, independent living and nursing home facilities, so you and your parent are not caught off guard if the need arises.
4. Join a support group. Just as your parent can benefit from time with his peers at the senior center, caregivers can get replenished, educated and understood by peers experiencing the same developmental milestones. Check with local hospitals, senior centers, and your parent's physician for referrals to area support groups for adults caring for aging parents. 
5. Keep communicating. The changes and limitations that come with aging can be challenging to accept--for both parent and adult child. Talk regularly about your feelings about your parent's functioning, your fears and concerns for them and your opinions about their care options. Encourage your parent to share her feelings with you. When we love someone, we sometimes "hide" truths from them that we fear may be upsetting. In reality, the "known" is much easier to cope with than the "unknown." Whereas we are unable to craft a response to the unknown, with the known, we are empowered to act and choose. 

Tuesday, April 7, 2015

Better Safe than Sorry?

Our family has just begun navigating the college exploration process. My son is actively researching various schools for programs heavy in the arts -- film, screenwriting, directing. We, as parents committed to bankrolling (at least in part) his higher education, are studying our income flow and funds management to see how to make his dream work without crippling our family's future. From day one, I've voiced unequivocal support for my son's pursuit of his dreams. Whether it was Broadway or Wall Street, I let him know that I'd be behind him no matter what. Now, however, I find myself examining my parenting values with a more critical eye.

It was easy to champion singing lessons, acting class and play auditions when my required investment included chauffeuring, soliciting for ads for the play program and donating old clothes for use as costumes. I find myself questioning whether a degree in filmmaking or screenwriting is my son's wisest educational course. Should I suggest accounting? Health care? Some profession in high demand, that risks less personal rejection than the arts? Or do I live my long-stated values that life is too short not to go after your dreams, that taking risks is a valiant and worthy endeavor? That a steady paycheck in an unfulfilling career may not cushion him from regret? Do I truly believe that creative expression and fulfillment is worth the possibility that my son may have to work several jobs while he tries to craft his masterpiece? I wrestle with what is "best", what is "sure", what is "reasonable." And then I remember the joy in his voice when he first discovered show tunes, the pride in his face when he "screened" his first film. I remind myself of the parenting truth I value above all others: to love him as he takes flight -- not to guide his direction or his landing.