0:04

Welcome to the Attention Deficit

0:07

Disorder Expert Podcast series by

0:09

Attitude Magazine. Hello

0:15

everyone! I'm Carol Fleck and on

0:18

behalf of the Attitude team. I'm

0:21

pleased to welcome you to today's

0:23

A D H D Experts Presentation

0:25

titled. Eating. Disorders Co morbid

0:27

with A D H D. What?

0:30

You need to know about our fifth.

0:32

Anorexia. And others. This.

0:35

Week is National Eating Disorders

0:37

Awareness week. To. Recognize

0:40

this important issue. Attitude has

0:42

partnered with the National Center

0:44

of Excellence for Eating Disorders

0:46

to bring you today's presentation.

0:49

The. National Center is the nation's

0:51

first center of excellence. Dedicated.

0:54

To eating disorders. It. Was

0:56

founded in twenty eighteen. By.

0:58

The Substance Abuse and Mental

1:00

Health Services Administration. It's

1:03

mission to improved the education

1:05

and training that health care

1:07

providers receive. An to

1:09

promote public awareness of and

1:11

treatment for eating disorders. Leading.

1:14

Today's presentation is Doctor Christine

1:16

P. She's. The Director

1:18

of the National Center Of Excellence For

1:21

Eating Disorders. Doctor. Paint

1:23

is also an associate professor of

1:25

Psychiatry at the University of North

1:28

Carolina Chapel Hill. And. A

1:30

licensed psychologist. At

1:32

You and See She serves patients with

1:34

eating disorders. Supports. Health care

1:36

providers in the you will c while

1:39

being program. And. Provides behavior

1:41

of medicine interventions to patients

1:43

in various medical settings. In.

1:47

Today's web and are we'll talk

1:49

about the symptoms and treatments for

1:51

different types of eating disorders. Research.

1:54

Has mainly focused on eating disorders

1:57

like and alexia or lamia and

1:59

been. The Eating Disorder. Others

2:02

including avoiding restrictive food

2:04

intake disorder. Where. Are

2:06

said. Are under studied in

2:08

comparison. Our. Expert will talk

2:11

about the it's relatively new diagnoses.

2:14

How to address eating disorders and people with

2:16

A D H D. And. When

2:18

you should seek a specialist for clinical

2:20

care. So. Without

2:22

further ado, I'm so pleased to up

2:24

and daughter Christine P. Thank.

2:26

You so much for joining us today

2:29

and leading this discussion. Hello

2:33

everyone thank you so much for having

2:35

me here this afternoon or perhaps the

2:37

Fourteen wherever you might be Some am

2:39

really pleased to be here to talk

2:41

to You are a little bit about

2:43

eating disorders and I'm specifically a couple

2:45

a diagnoses that maybe don't always get

2:47

that much attention as somebody others do

2:49

and I'll spend some some other time

2:52

during our presentation today. really focusing on

2:54

the intersection between eating disorders and individuals

2:56

have a D H D I'm family

2:58

for you to be able to give

3:00

you some information that I'm hoping will

3:02

be really. Practical and really helpful. Was

3:06

all of that said? Am. I wanted

3:08

to kind of unpack a few things

3:10

before diving into some of the heart

3:12

of the preseason. So first and foremost,

3:14

why even talk about eating disorders? Why?

3:16

this topic is worth discussing with an

3:19

audience like you All Hoops primarily focus

3:21

on attention deficit hyperactivity disorder. So.

3:24

Distant from the giving you a little

3:26

bit of the skull. Eating disorders are

3:28

conditions that effect of roughly twenty eight

3:30

million Americans at some point in their

3:33

lifetime stuff almost nine percent, or a

3:35

little above nine percent of the Us

3:37

population. So we're talking about a significant

3:39

number of people school, at some point

3:41

struggle with some form of eating the

3:44

college. He and I think about the

3:46

number that a lot of people are

3:48

sometimes surprised by because I think that

3:50

unfortunately, there are these stereotypes about eating

3:53

disorders affecting relatively few people. Them being

3:55

kind of way or the conditions are disorder

3:57

but in reality the data that your see

3:59

the are actually one that were published and

4:01

back in July of twenty twenty each in

4:03

collaboration with the white economic than a few

4:05

eating disorder programs and and so you know

4:07

those feet are really showing that of these

4:09

are much more common and maybe we might

4:11

have once thought. Unfortunately, eating

4:14

disorders are also conditions that are deadly and

4:16

that same report reported that somewhere around ten

4:18

thousand people will die each year as a

4:20

direct result of their eating disorder. That kind

4:23

of sober and me think about the fact

4:25

that these are common and also really likes

4:27

to make me. In

4:30

addition to that eating disorders are conditions

4:32

that have an enormous toll on the

4:34

Us. Helps your sister. So deloitte as

4:36

a an organization our company that I'm

4:38

sure many of you are familiar with

4:40

on and what they did without a

4:42

lot of the overall cost of eating

4:44

disorder treatment in a single year. And

4:47

what you can see here are several

4:49

different numbers. The first as the total

4:51

health care system cost and that was

4:53

around four point six billion dollars associated

4:55

with the treatment of eating disorders. Nothing

4:57

to be everything from. In a routine time.

4:59

Eerie care. Visits all the way through meeting

5:01

inpatient hospitalization for folks that are really excuse

5:03

and us up far right number that you

5:06

might see I'm a hundred and seven point

5:08

six million dollars for though the people might

5:10

be. Listen again. In

5:13

addition to the actual cost associated with

5:15

treatments, the Deloitte Report found that eating

5:17

disorders also have a significant impact on

5:19

society, he American workforce and businesses that

5:21

when you think about it as might

5:24

be people who are taking time off

5:26

of work. To seek treatment? Maybe these

5:28

are people, are parents, are caregivers. Were

5:30

taking time off of work to tear

5:33

for six. Love what six Loved ones

5:35

is Might be people who are meat

5:37

eating to take multiple days off for

5:40

different doctors appointments even if they're not

5:42

going into an inpatient treatment for example.

5:44

And so what? They found that if

5:47

you added up all of the treatment

5:49

costs in addition to all sort of

5:51

the social or economic costs associated with

5:54

eating disorders, these conditions cause the Us

5:56

economy sixty four billion dollars and a

5:58

single year. So. A

6:00

pod and some sort of how

6:02

to reflect a little bit on

6:04

that number. Sixty four billion dollar

6:06

than a single year is an

6:08

astronomical cost. So I think what

6:10

I'm trying to do here with

6:13

this overall foundation of information is

6:15

really lay the groundwork that eating

6:17

disorders or conditions are common, their

6:19

life threatening. it's and they are

6:21

costly. And so I think

6:23

it's important that when we're having these

6:25

conversations about eating disorders and other mental

6:27

health condition that were thinking about how

6:29

much more complicated that guess when there

6:31

are two, three, four different diagnoses on

6:33

board a difficult time. So.

6:37

In. Addition to maybe for a d mystifying

6:39

some of what we think about when

6:41

it comes to eating disorders. I also

6:43

wanted to do a little bit as

6:45

Best Boston when it comes to these

6:47

conditions. Unfortunately for many years and even

6:49

still to this day there was a

6:51

very strongly held predominant stereotype about who

6:54

is affected by an eating disorder. The

6:56

stereotype that most of you are probably

6:58

familiar with is that have a young

7:00

says gender bias fairly affluent female about

7:02

and to be the mental image that

7:04

people come up with when they thing

7:06

about. Who struggled with an

7:08

eating disorder that in reality

7:11

reflects the smallest. Proportion of

7:13

people who may be diagnosed with his

7:15

condition. At some point in their

7:17

lifetime because we know after decades

7:19

of research that eating disorders do

7:21

not discriminate day happy and it

7:23

to just about any one irrespective

7:25

of your sex assigned at birth,

7:28

your gender expression, if your race

7:30

or ethnicity, sexual orientation, your economic

7:32

status, or your ability status and

7:34

is one of those sort of

7:36

equal opportunity disorders and without something

7:38

that and I think that's not

7:40

necessarily fact that the Danish and

7:42

I do think it's really important

7:45

that. We are doing everything we Chanda

7:47

sort of debug that old stereotype that old

7:49

miss about who looks like they have an

7:51

eating disorder. One thing that I think it

7:53

also really important is to think about. The

7:56

sack of eating disorders also occur throughout the

7:58

lifespan. These are not conditions that. The

8:00

only affects children and adolescents and feet

8:02

are conditioned for some people them if

8:04

they might started and children not the

8:06

childhood and adolescence but they may have

8:09

sort of and continued to stay the

8:11

course or all of adulthood. There are

8:13

also some individuals that will develop their

8:15

eating disorder in adulthood, having never struggled

8:17

with anything like that and childhood. Above

8:21

and beyond all of that, we also know

8:23

that eating disorders don't have a particular look.

8:25

You do not have to be under weight

8:27

in order to have an eating disorder. You

8:30

also don't have to be overweight or struggle

8:32

with obesity in order to have an eating

8:34

disorder. Eating disorders can occur at all body

8:36

shapes and that always some were thinking about

8:39

who we should be screening. It's how we

8:41

should be thinking about how these disorders present.

8:43

I think it's really helpful to do some

8:46

of this nest nest egg so that we're

8:48

trying to remove them. Are those old stereotypes?

8:50

And maybe we're starting to think about other

8:52

people either in clinical practice and our community

8:55

and our families who might be struggling with

8:57

eating disorders. And it's one we start to

8:59

do that that we start to do a

9:01

much better job of screening for these conditions

9:03

and making so. The folks are really getting

9:05

on the under the care that they eat.

9:09

So with all that said, I think some

9:12

sort of just drive that the point home

9:14

a little bit further. Although there might be

9:16

a particular image that comes to mind when

9:18

you hear the term eating disorder, reality is

9:21

is that it's much more likely to see

9:23

the people that are pictured here on the

9:25

screen either. people of different eight Rangers body

9:27

soccer sizes and shapes. People of different races

9:30

and ethnicities. These. Are people that are in

9:32

your community There, Your neighbors, the your family

9:34

member of the your colleagues. So. I think it's

9:36

important that that will be the stance of are holding

9:38

as we're starting to think a little bit about this

9:40

condition. Now

9:42

with all of that in mind, I do want

9:45

to do just a little bit a quick review

9:47

on what eating disorders are and how we define

9:49

those conditions are mostly. Today we're going to be

9:51

talking about a couple of condition that may be

9:53

don't get as much airtime as others but since

9:55

we're going, are we talking about eating disorder? That

9:58

a whole I do just wanna do it. What

10:00

could you to make sure that upsets a

10:02

shared understanding of what eating disorders are we

10:04

think about? and clinically at least. Some

10:07

We Think About eating disorder diagnoses.

10:09

I've actually intentionally started here on

10:11

the screen with a diagnosis that

10:13

some of you might not be

10:16

familiar with but is actually the

10:18

most common eating disorder. Diagnosis is

10:20

what we call other specified feeding

10:22

an eating disorder or off said.

10:24

This is essentially people who are

10:26

not meeting criteria are still criteria

10:28

for any single eating disorder. They

10:30

might not meet every single diagnostic

10:32

criteria. For binge eating disorder speedy they

10:34

don't me every criterion. For believe me on

10:37

are both us and this. Is actually be

10:39

most common eating disorder recent season.

10:41

Is might be folks at a handful of

10:43

symptoms from one disorder, handful of symptoms from

10:45

another disorder, and that kind of puts them

10:47

in this off that category. The

10:50

other diagnosis I've listed my pillow that is

10:52

the Cops Binge Eating Disorder and this is

10:54

a diagnosis. I'm so many of you are familiar

10:56

with. A part of why I

10:58

decided to listen in this order is

11:01

it Binge Eating Disorder is actually the

11:03

second most common eating disorders. I feel

11:05

if we were to shake off fed

11:07

off the table and really just look

11:09

at the false rafol diagnoses Binge eating

11:11

Disorder actually the most common. and then

11:13

we think about binge Eating Disorder. I

11:15

want to be really clear here that

11:18

the defining feature this diagnosis is having.

11:20

These were current binge eating episodes. These

11:22

are people that are having leave binge

11:24

eating episodes where they feel out. Of

11:26

control a cannot stop eating.

11:28

Once they started and often times

11:30

they feel guilty. Ashamed or disgusted

11:33

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12:05

Anorexia Nervosa Another condition that many of

12:08

you are probably familiar with. I want

12:10

to be clear here to that the

12:12

defining feature of Anorexia Nervosa the not

12:14

actually. Being underweight or send the

12:16

defining feature of Anorexia Nervosa is

12:18

a fear of weight gain or

12:21

a fear of fact That's. That

12:23

people become so afraid of that that they

12:25

end up eating less and less throughout the

12:27

day or throughout a period of time. And

12:29

some of those people. May become

12:31

very center underweight. However,

12:33

the one of the diagnoses that will

12:35

talk about here specifically is what's called

12:37

a typical Anorexia Nervosa and this is

12:39

a diagnosis that we really think about

12:41

it. Anorexia nervosa and higher weight bodies

12:43

stay up all the same, so the

12:45

signs and symptoms as somebody with correct

12:47

the a nervosa accept a Derby am

12:49

I may never get significantly loud and

12:51

will take a more close look at

12:53

that year and subsequent slides. Blame

12:57

ya Nervosa again at another diagnosis I'm

12:59

sure many of you are familiar west

13:01

and the defining features year as again

13:03

the same for the binge eating episodes

13:05

that we might see and binge eating

13:08

disorders, but they're usually them paired with

13:10

something that we call and inappropriate compensatory

13:12

behavior for someone to sort of trying

13:14

to get rid of or make up

13:16

for the calorie the face eaten during

13:18

that binge eating episode. Commonly these are

13:20

things like self induced vomiting, abuse of

13:22

lox, erratic at last it is a

13:24

direct and sometimes exercise. And and

13:26

again, if is something that I think most people

13:29

have some sort of conceptualization for. The

13:31

other diagnosis that will talk a little

13:33

bit more at length about today something

13:35

called avoidant restrictive Food and Take disorder

13:38

or or said and the defining feature

13:40

here is a persistent and pervasive eating

13:42

are cheating disturbance in which someone is

13:44

simply not meeting all of their nutritional

13:46

be. Now for those of you that

13:49

are listening closely you might be thinking

13:51

well how about different than Anorexia Nervosa

13:53

as much just what she talked about

13:55

but really are call it and Anorexia

13:57

Nervosa The defining feature is that. The

14:00

we gain a sphere of fat

14:02

so that individual intentionally stop eating

14:04

right where they eat very little.

14:07

And avoid a restrictive food intake disorder

14:09

or are fed. These people don't

14:11

necessarily have that fear factor. Fear of

14:13

weight gain? These are people who are failing to

14:15

meet the nutritional needs. A lot of other reasons

14:17

I will talk about some of those your shortly.

14:21

So. I wanted to take a

14:23

closer look at the diagnosis of a

14:25

typical Anorexia Nervosa. It's something that currently

14:28

is classified as part of that off

14:30

that category that we talked about. And

14:32

but for sake of argument, what I

14:35

put you on the screen are be

14:37

current diagnostic criteria for Anorexia Nervosa or

14:39

Syrian A is having that dietary. Restriction

14:42

meeting that you're just not. Eating a lot

14:44

throughout the day or you caught a whole

14:46

food groups leading. She was significantly lower body

14:48

weight and we can talk about with that,

14:51

but I'm just gonna leave that for their

14:53

on the table for assessing perjury and for

14:55

anorexia. Nervosa is this intense. Fear of

14:58

gaining weight or intense fear becoming fat

15:00

or for some people behavior that interfere

15:02

with any sort of weight gain even

15:05

though they know they're at a low

15:07

body weights. And then the third criterion

15:09

is this disturbance in self. proceed, Wait

15:11

for shape or a lack of recognition

15:14

of the seriousness of nobody. Way to

15:16

begin with, sort of the body image

15:18

component they want us to hear on

15:21

the right side of the screen or

15:23

the diagnostic criteria for a typical Anorexia

15:25

Nervosa. What you can see that they're

15:28

the exact same as for anorexia Nervosa.

15:30

Except for the week Criterion except for

15:32

Criterion A. So these are people that

15:34

are having adapt to be exact same

15:37

eating disorder, cognitions, the exact same behavior.

15:39

These might be people who are eating

15:41

as little as a thousand five hundred

15:43

calories and a single day. Sunday may

15:45

be having the same sort of intrusive

15:47

thoughts about their body weight and shape,

15:49

or about food as people who are

15:52

a very low wage on, but death

15:54

diagnosis is one that often times five

15:56

under the radar because there aren't necessarily

15:58

physical manifestations of it. The might

16:00

not be people that are at really

16:02

loud the I'm eyes and in fact

16:05

for many people these are individuals who

16:07

start at higher body weight or live

16:09

in larger body. And so when they

16:12

lose a fair amount of weight let's

16:14

say they lose thirty forty fifty pounds.

16:16

They may inadvertently actually just get congratulated

16:19

for their weight off because our society

16:21

is really focused on fighting obesity and

16:23

is really focused on and sort of

16:25

weight management. So because of that when

16:28

a body gets smaller. but it started.

16:30

At a large replace those individuals

16:32

are real risk for never been

16:34

detected with a typical anorexia nervosa

16:36

even though it's a very serious

16:38

condition, So with

16:40

all of that in mind, Spike Lee summit

16:43

a warning signs or symptoms associated with a

16:45

typical anorexia nervosa. Know it's one thing to

16:47

see if that a diagnostic criteria on the

16:49

screen but it's different to think maybe more

16:51

illustrate of or a little bit more concretely

16:54

about what those signs and symptoms may be.

16:56

So one thing you might notice and people

16:58

as skipping meals and maybe eating the less

17:00

than what is typical or was needed for

17:02

the individual human see the Peter Pan a

17:04

foot pushing food around on their plate. or

17:07

maybe there's you know eat a very small

17:09

portions of the. Paris knew what they

17:11

typically dead, and some people also explicitly

17:13

express a fear of gaining weight or

17:15

be perceived as overweight. I'm for people

17:18

that live in larger body weight stigma

17:20

is a real thing that they are

17:22

dealing with on a daily basis and

17:24

then maybe a desire to really protect

17:26

themselves. Sees me from

17:28

some about weed stigma so they might

17:31

be and really focused on losing weight,

17:33

even in really risky ways. Many

17:36

people also have the sense of distorted

17:38

self image. old are they really critical

17:40

of their own body weight or shape?

17:42

and some people find that they're really

17:44

preoccupied with wait food calories, fat grams.

17:46

All of those were the same that

17:48

are kind of com and in a

17:50

dieting mindset. and and I'm a also

17:52

be things like or refusal to eat

17:54

certain foods you know, maybe the colossal

17:56

food categories like carbs and fats. Those

17:58

sorts of things in an effort. Again,

18:00

try and limit what they're eating. Trial

18:02

today. I want to be clear here:

18:04

a feat, Signs and symptoms that you're

18:06

seeing. These are not sufficient to diagnose

18:08

an eating disorder, speed or not sufficient

18:10

to say that someone had a typical

18:12

anorexia nervosa Us because you life eat

18:14

lots of the signs and symptoms and

18:16

somebody is perfectly healthy. The really isn't

18:18

any any other sort of eating pathology

18:20

going on, but I think collectively it's

18:22

helpful to have some sense of these

18:24

signs and symptoms for the have something

18:26

to kind of be thinking about in

18:28

this discussion. I

18:32

wanted to do the same closer. Look for

18:34

the diagnosis. Of our said it's so

18:36

what you're seeing here on the screen

18:39

are the diagnostic criteria for this condition

18:41

and what you can see and it's

18:43

a little bit downfall. Tiny packets for

18:45

us that I'm in criterion A you

18:48

can see is that there has to

18:50

be a feeding disturbance that present as

18:52

a failure to meet appropriate nutritional be

18:54

so of kind of a dense statement

18:57

so essential that I would say that

18:59

there's something off in someone's eating pattern

19:01

or eating habits that leading them to

19:03

not get enough calories. Nutrients.

19:05

Vitamins and throughout the day. Know

19:08

I mentioned before that there are

19:10

some different types of our said

19:12

are different types of reasons why

19:14

people might not be meeting your

19:17

nutritional needs. But you're

19:19

not seeing here is com a few

19:21

of those reasons number One. Some

19:24

people may find that they are simply not

19:26

meeting. No nutritional mean. Because

19:28

they don't prioritize eating. Now I want

19:30

to say here this is an oh

19:32

I just got busy at work one

19:34

day skipping a meal, Or guy works,

19:36

do lunch. Whatever I'd be. Stuff now

19:38

we're talking about here has a pretty common

19:40

thing for to have people experience or talking

19:42

about. of these people who are saying i

19:45

feel hungry, I have hunger and society to,

19:47

but I just don't kill enough to get

19:49

up and make a meal and get myself

19:51

something to eat. I just can't motivate myself

19:54

to do that. Rights And this isn't a

19:56

one day or a one week kind of

19:58

saying. It's a pervasive, persistent. There

20:01

are also people who are not

20:03

meeting nutritional needs because they have

20:05

deal issues with the sensory characteristics

20:07

associated with food. For those might

20:09

be things like the texture, the

20:11

smell, the taste, the shape of

20:13

the color, any of those sorts

20:15

of things, Might lead people to

20:17

start with t routinely cutting. Certain

20:19

foods out of their diets to the point where

20:21

they can actually become boehner este. And

20:24

others a third category of people with are

20:26

said to find that they are not able

20:28

to meet their nutritional. Needs. Because

20:30

they're afraid of some of the adverse consequences

20:33

of needing to these maybe people who have

20:35

had soaking accident in the past or maybe

20:37

they've had really bad bout of stomach upset

20:39

or g i distress in some way that

20:42

today's learned that if I eat and gonna

20:44

have stomach upset or if. I eat what

20:46

if I'd show and that leads people to

20:48

stop eating. So. That they become malnourished

20:50

and of by so again. When we

20:53

think about that feeding, the So then

20:55

it might show up in a lot

20:57

of different ways, but universally, what we're

20:59

seeing and are fed is that this

21:01

might be associated with weight loss. significant

21:04

nutritional deficiency some folks ever heard of

21:06

relying entirely on things like two feet

21:08

in your nutritional supplements, and almost invariably

21:10

people are having really significant impact on

21:12

our psycho social functioning. We

21:15

also want to be clear that when it

21:17

comes to are fed what we're talking about

21:19

here and from the dietary changes, his can't

21:21

necessarily be something that's a cultural practice because

21:24

we wouldn't diagnosed without if it's a part

21:26

of their religious beliefs are part of their

21:28

cultural heritage and you can actually be diagnosed

21:30

with Anorexia, Nervosa, or Billie. The and are

21:32

both that and our fate of the same

21:34

time speed are mutually. Exclusive diagnoses.

21:37

The other thing we like to note is

21:40

that when it comes to this kind of

21:42

eating disturbance or feeding to serve and it

21:44

can't necessarily be explained by another medical disorder.

21:46

So for example of somebody is going to

21:48

chemotherapy not at all uncommon for them to

21:50

have changes and from the their appetites not

21:52

being able to feed themselves while and asked

21:54

I'm so it has to go above and

21:56

beyond what might be expected in a medical

21:58

condition or if it's. The medical condition than

22:01

it would be a reason to rule out

22:03

a diagnosis of our said. Of

22:05

similarly to what we did when it

22:07

comes to am ah the A typical

22:10

Anorexia Nervosa diagnosis approximately about signs and

22:12

symptoms associated with this condition. However, am

22:14

I got ahead of myself? am I

22:16

did go on to explain three different

22:19

proposed sub types of are fed here

22:21

on the slide of what you could

22:23

see. It's basically what I went over

22:26

just a moment ago about there being

22:28

a stencil. Any type of are fed

22:30

or folks are concerned about the different

22:32

sensory characteristics associated with food. People who.

22:35

Have a lack of interest in food or

22:37

eating and then know soak that are afraid

22:39

of those averse have consequences. they have that

22:41

fear based reactions food So you might be

22:43

thinking about people in your life who span

22:45

you know have a diagnosis of our shared

22:47

and you might think about you know what

22:49

kind of category data they tend to put

22:51

that question. When

22:53

it comes to possible warning signs or symptoms

22:56

that this condition what we know that there

22:58

can be saying like a sudden refusal to

23:00

eat food at Somebody Wants Eight really regularly

23:03

the time that we often hear from pieces

23:05

and from families that there were certain seafoods

23:07

in. the thing that they knew that they

23:09

could eat day in day out. What? I'm

23:12

gonna be hard for them or something so

23:14

faces change and they can change on the

23:16

what sort of things like a whim right

23:19

there might be saying like eating very very

23:21

slowly, appearing distracted while eating or even forgetting.

23:23

To eat some folks that are fed

23:25

are very specific about the for an

23:28

ah. the food is prepared even specific

23:30

for an certain sheets of food.

23:32

So commonly was your things from children

23:34

or adolescents with are fed school only

23:37

eat one very specific type of chicken

23:39

nuggets. It has to come from

23:41

a specific plan. It has to be

23:43

a certain sheath. It cannot be any

23:46

other shape, It cannot be any other

23:48

brand. Sometimes it's certain restaurant I

23:50

will only eat chicken nuggets at this

23:52

particular. Restaurant and from no other place.

23:54

even though common everyday may know that if

23:57

all chicken it's all Florida you know a

23:59

chicken Nuggets for their something about the eating

24:01

disorder that doesn't allow them to sort of

24:03

do that in a rational way. brave. Com

24:06

and again for children and adolescents who

24:08

might be struggling with his condition stuff

24:10

for a long malnourishment mainly to spend

24:12

his height. And weight Those really important are

24:15

you trying to catch? These conditions are really. All

24:19

that said, what are we know about

24:21

A D H D Our fate of

24:23

a typical Anorexia Nervosa How do these

24:25

work together? Hobbies condition that sort of

24:27

my coworker over by I wanted to

24:30

present them with the data and what

24:32

you're going to see here and the

24:34

subsequent fide are a number of different

24:36

and data points with respect to these

24:38

overlapping diagnoses. And what you can see

24:40

here is that overall if we think

24:42

about eating disorders as a whole, not

24:44

so, Not Just Are fed are not

24:47

just a typical Anorexia Nervosa. There

24:49

is significant overlap between those of a

24:51

D H D and those with eating

24:53

disorders. Probably not something that will come

24:55

as a surprise to many of you

24:57

here in the audience. I think it's

24:59

important to note that these come from

25:01

a large population based studies, So this

25:04

isn't just a small cluster of patients

25:06

in Nebraska are small cluster a piece

25:08

and pure North Carolina. These are from

25:10

samples that are representative of the entire

25:12

country to those of us that are.

25:14

Researchers often feel much more confident about

25:16

the number that we feel when. They

25:18

come from the population that are more

25:20

were a reflective of the entire community

25:23

throughout the Us. What one of these

25:25

studies found are Several of the study

25:27

found that adults with a D H

25:29

D for almost three times more likely

25:31

to have been diagnosed with an eating

25:33

disorder spend their nine eighty. Eighty two

25:36

years. And a very similar vein

25:38

adolescent with a D. H D for

25:40

up to three times more. Likely to have

25:42

had an eating disorder at some point

25:44

in their lifetime. The were talking about

25:46

magnitude of risk when it comes to

25:49

eating disorders. If you're somebody that already

25:51

charity that A D H D diagnosis.

25:55

wealsoknowthatadhdcommorbidityvariedbydiagnosis,soon.

26:00

Look at the literature were thinking about

26:02

all eating disorder diagnoses the highest risk

26:04

for an eating disorder diagnosis if you've

26:06

been diagnosed of a D H D

26:08

is a binge eating disorder. To the

26:10

folks that are having those were current

26:12

type of binge eating episodes the second

26:14

highest risk isn't a lenient are both

26:16

earth and the third highest risk it

26:18

for anorexia nervosa. Again these are based

26:20

on large population be studies or the

26:22

U S. What

26:26

you're seeing here in this next slide a

26:28

sort of a visual represents represents he said

26:30

at some of what I've described in the

26:32

previous slide. What you can see here are

26:34

a couple of different grass. I'm on the

26:37

far less you are seeing two different bars

26:39

as a dark gray bar and a light

26:41

grey bar. And the dark grey bar is

26:43

though that a D H D The light

26:45

grey bar or those without a D H

26:47

D And what. you can see that the

26:50

individuals with a diagnosis of a D H

26:52

D are significantly more likely to have been

26:54

diagnosed with any clinical eating disorder. These

26:57

authors actually looked at specific eating disorder

26:59

behaviors and mailbox further of comparing those

27:01

thing to group those with a D

27:03

H D and those without a D

27:05

H D and you can see in

27:07

the middle of your screen is that

27:09

for individuals who are experiencing binge eating

27:11

episode and purging behavior and self self

27:14

induced vomiting fast dame those sorts of

27:16

things and those are the purging behaviors.

27:18

What they found is that though that

27:20

a D H D or sick again

27:22

significantly more likely to be struggling with

27:24

all sorts of symptoms. And people who

27:26

did not have a D H D

27:29

and the same thing is true when

27:31

it comes to restricted behaviors and we

27:33

talk about restrictive behaviors, we mean thing

27:35

that are consistent with anorexia nervosa so

27:37

eating very little calories, limited variety of

27:39

foods. And what again you can see is

27:41

that people would a d. H D are much

27:43

greater risk. And those with out for

27:45

restricted eating. Disorder behaviors. Now,

27:49

when we seek a little bit more specifically

27:51

about a typical Anorexia I'm of you might

27:53

be wondering, Well, what's the overlap there for

27:56

that specific diagnosis? The challenges that there are

27:58

very few data regarding Oh, barbarity between a

28:00

D H D and a typical Anorexia Nervosa.

28:03

And as a number of different reasons for

28:05

this number one, a typical Anorexia Nervosa is

28:07

just a new were diagnosed as but above

28:09

and beyond That as I mentioned before, it's

28:12

a diagnosis. It's very likely to go undetected.

28:14

It flies under the radar, so it's hard

28:16

to catch in the first place. But above

28:19

and beyond that because of the A D

28:21

H D literature and that document are great

28:23

for binge eating. Most of the literature focuses

28:25

on bench type disorders in the context of

28:28

a D H D to there's just. Variable

28:30

data for us to go by. With

28:33

all that said though, V data on

28:35

a D H D and restricted eating

28:37

so the Ip again I'm calorie counting

28:40

calories limits eating a limited variety of

28:42

food. There are some data on that

28:44

and they're more meaningful. One of these

28:46

studies found that adulthood a D H

28:49

D or up to five times more

28:51

likely to report. Restrictive behaviors than

28:53

their peers without a D

28:55

H D V. Were surfing eating

28:58

behavior that they were looking that in

29:00

this study or thing by using weight

29:02

loss pills, fasting are skipping meals and

29:04

expressing that fear of gaining weight or

29:06

fear of fat. Interestingly,

29:08

there are some data that also suggests

29:10

that hyperactivity symptoms to specifically may be

29:12

associated with restrictive eating. What's even more

29:15

interesting about that is that they only

29:17

seem to find a relationship among boys

29:19

and fan, but not in women and

29:21

girls. For this idea that that hyperactivity

29:24

kind of profile may actually be more

29:26

associated with restrictive eating or we tend

29:28

to see there's really only and boys

29:30

and men and not necessarily and women

29:32

and girls snap A way to think

29:35

that with a grain of salt Though

29:37

because these studies. Are very new. They're

29:39

based on very limited data so I wouldn't

29:41

take this is sort of gospel truth or

29:43

what I would say is that there does

29:45

seem to be this interesting association addict. I'd

29:47

be happy to take some questions about that.

29:50

And towards the end of the presentation today.

29:53

When. We think a little bit about the com

29:55

or betty between are fit in a D

29:57

H D again as pretty limited data here.

30:00

They mentioned before, just like with a

30:02

typical anorexia nervosa, our fate as a

30:04

new were diagnosed it so by nature

30:06

we just have less data available about

30:08

it and and again a previous literature

30:10

has will focus on binge eating, over

30:12

eating and obesity each specially in the

30:14

context of a D H D. And

30:16

so because of that restricted eating disorder

30:18

may not necessarily be the primary focus

30:20

sophie where the study looking at eighty

30:22

Hd and eating disorders maybe they didn't

30:24

even bother to ask the restrictive eating

30:26

disorder question. They they only lofted binge

30:28

eating For example, Gonna

30:34

work. Yeah, there we go. Okay, so

30:36

what we do know however is that

30:38

some only evidence indicates that there is

30:40

an increased risk for our said among

30:42

individuals with a D H D. About

30:44

one study reported that ten percent of

30:47

children and adolescents with are fed had

30:49

also been diagnosed with a D H

30:51

D at some point in their lifetime.

30:53

An interesting way, if you remember some

30:55

other some types that we talked about,

30:57

there was actually a specific association where

31:00

they found that those with are fed

31:02

and that sensory some five Again, Those

31:04

folks that have difficulty wix the

31:06

sensory characteristics associated with food. That

31:10

particular some types was associated with a

31:12

greater than to time with the odds

31:14

of having any kind of current or

31:16

lifetime neurodevelopmental or disruptive disorder. So again

31:18

that may not necessarily be a D

31:20

H D specific but if we think

31:23

about sort of the spectrum of those

31:25

disorders or finding that maybe those folks

31:27

with and the sensory said sensitivity each

31:29

maybe at particular risk for that type

31:31

of neurodevelopmental are disruptive disorder. Another

31:36

of those studies found that twenty six

31:38

percent of adults with are fed also

31:40

had a few diagnosis of a D

31:42

H D start a pretty staggering number

31:44

there that you know centrally one in

31:47

four people that are gonna be some

31:49

having a call morbid are fed and

31:51

a D H D diagnosis. And then

31:53

there was also another study that looked

31:55

at children receiving inpatient treatment for an

31:57

eating disorder and they found that those

31:59

two. What are fed were also more

32:01

likely to have a D H D and

32:03

those individuals who had Anorexia Nervosa so very

32:05

commonly for Npc treatment of an eating disorder

32:07

is usually folks at Anorexia Nervosa who are

32:09

the very low weight and now more and

32:11

more commonly it's children adolescents with our said

32:13

who have lost so much weight as a

32:15

to come out Irish and they have to

32:17

go to the hospital And so this study

32:19

was looking at both groups that have children

32:22

who are on their unit and they found

32:24

that those that are fed which are likely

32:26

to have a D D H D diagnosis.

32:29

Collectively, what are some of the clinical implications

32:31

of this? When I think about a Concretely,

32:33

I think it's important to really think about

32:36

those with a D H D being at

32:38

risk for a variety of eating disorder, thoughts

32:40

and behaviors, not just binge eating. So you

32:42

know if you've seen breathing cases before, maybe

32:45

you're reading different literature. A doesn't mean that

32:47

the old literatures bomb I think it's just

32:49

that it's to narrow it doesn't It doesn't

32:51

widened out and out to be adequately capture

32:53

with to for every one. Also,

32:56

space on the literature that is out

32:58

there sampling shoulder with a D H

33:00

D should be monitored for eating disorder

33:02

symptoms while or children and then again

33:04

throughout their adolescent well into adulthood again

33:06

just knowing that number of three times

33:09

as likely to have these new feed

33:11

for and childhood and adolescence. Also,

33:13

keep in mind that in clinical contacts

33:16

are said in a typical anorexia nervosa.

33:18

maybe over last. Even and very

33:20

routine eating disorder screening. Yeah,

33:22

we talked a little bit today about how

33:24

there's been kind of this predominant focus on

33:27

a D H D and binge eating or

33:29

obesity And so though that how that kind

33:31

of hyperactivity breathing sheesh and may actually sort

33:33

of be protected from eating. Disorder screening because

33:35

are thinking while these folks are the hyperactive

33:37

for it or not been cheating or not

33:40

overweight, why would we even bother to screen

33:42

for an. Eating disorder and it gets

33:44

even more complicated for male because mailed

33:46

are ready at risk for not being

33:48

screened for eating disorders because of that

33:50

old stereotype. That. We talked about before. So

33:53

again, with all of that in mind, I think it's

33:55

very clear that we need some additional research. We need

33:57

to know more about the conditions and how they work

33:59

together. But the emerging evidence would

34:01

really indicate that there is a real

34:03

risk for eating. Pathology across the spectrum

34:05

not have been cheating. So

34:08

what can you do if you're worried about a

34:11

child or a loved one? minutes of offline of

34:13

lot of different resources. and for those of you

34:15

who might be listening and vs apathetic your by

34:17

video I want to underscore the you'll have access

34:19

to the fly than all of the hyperlinks that

34:22

are embedded in them. Stuff we don't be like

34:24

you have to memorize any of the website that

34:26

we're talking up here but if you are interested

34:28

in learning more course and then upon our website

34:30

and feed us stock or city you can learn

34:33

more about eating disorders and screening protocol if you

34:35

know what you might do. If you're a lot

34:37

want our family members and. All of our

34:39

resources are available for free. Is

34:42

also an organization called Feast. I can

34:44

never remember the acronym, but it's families

34:46

empowered and supporting those with eating disorders.

34:49

I think I'm and they are exclusively

34:51

a parent and caregiver organization. Spare Just

34:53

a fantastic group that does everything a

34:55

chance to equip parents and caregivers with

34:58

the skill that they need in order

35:00

to support their loved ones as are

35:02

going to an eating disorder. They have

35:04

a caregiver to care for, have like

35:07

a thirty day course and you can

35:09

just get like a lesson per day.

35:11

Into your email some and they

35:13

have a support group specifically for

35:15

parents and siblings. A People with Eating

35:17

disorders. The really? just a fantastic

35:19

organization. Be

35:21

National Eating Disorders Association is another organization that

35:24

many of you I'm sure familiar where they

35:26

have a lot of free resources, an

35:28

educational material on Eating disorders and other National

35:30

Alliance for Eating Disorders, and in fact

35:32

they have a whole landing page on how

35:35

you might help a loved one with various

35:37

do's and don'ts. For

35:40

those are looking to go beyond just learning

35:42

more, there's also ways to get support. So

35:44

damn the National Alliance for Eating Disorders has

35:46

a variety of the poor group I think

35:48

of this point they're offering support group. At

35:51

least five, maybe six days a week. And

35:53

they have a variety of different groups, whether

35:55

they're for parents and caregivers, people who are

35:57

actively struggling to have groups for the other,

35:59

Could you pass community? They have groups for

36:01

those that live in larger body. So really

36:04

a variety of things they are. The great

36:06

thing about these is that are all clinician

36:08

mad their virtual and they're free. And

36:11

a similar vein. another organization called Anorexia

36:13

Nervosa and Disorders also offers peer support

36:15

group for I'm pretty much the seizure

36:17

and three or four days a week

36:19

I think. looking at her at our

36:22

calendar and again they have walked the

36:24

different types of foods and that really

36:26

sort of be a good fit no

36:28

matter who you might be. There's

36:31

another organization that does it, it'll heal.

36:33

This is a group that is really

36:35

designed to help you get help solve.

36:37

State do things like provide a some

36:39

treatment scholarships these are they might provide

36:41

direct cash assistance for those that are

36:43

an eating disorder treatment but they also

36:46

have a clinical assessment program so if

36:48

you're not sure if you or your

36:50

loved one have an eating disorder you

36:52

can schedule a free assessment with projects

36:54

your. Above

36:56

and beyond that, there's also a website of

36:58

sight signed eg. how.com and this is a

37:01

searchable database of individual providers and also treatment

37:03

centers that specialize in the treatment of eating

37:05

disorders. A new consensus based on your geographical

37:07

location you can search of based on your

37:10

insurance type, a tie for treatment that you're

37:12

looking for, and the nice thing as that

37:14

you'll see on screen of course when you

37:16

visit as well as a toll free number

37:19

for their helpline If for some reason you're

37:21

coming up with a bunch of to sag,

37:23

there's nothing in your area, There's nothing with

37:25

your search. Parameters: You can call that number

37:27

and they can assist you. And because they're

37:29

trained clinicians who are on that mind who

37:31

often times of other information at their disposal

37:34

and may be able to help you get

37:36

connected with tree and. Lastly,

37:39

I want to make one plug on. Given

37:41

that I said that we need more research,

37:43

we need to understand these conditions better. There's

37:45

an opportunity for you and your loved ones

37:48

to be involved in this groundbreaking research. and

37:50

so the National Center of Excellence for Eating

37:52

Disorders. I had up as an organization that

37:54

physically base at the University of North Carolina

37:57

at Chapel Hill where and faculty there is

37:59

a world researcher at You and V but

38:01

Honey Mustard if you like who is the

38:03

for most researcher and the genetics of eating

38:06

disorders and she is actually leading than the

38:08

world and the first genetic studies looking at

38:10

are fed and they are looking for people

38:12

to contribute to their research. So I have

38:15

provided the web and and a hyperlink to

38:17

that research study. For that you can learn

38:19

more see if you're eligible. It's all stuff

38:21

that you can do at home and it

38:24

helps to contribute to the science so that

38:26

we understand these conditions better. So I wanted

38:28

to leave with that particular Tommy. Chiefs are

38:30

interested, but at this time I'd love to be

38:32

able to transition over to any question that might

38:34

be coming in and I'm happy to have a

38:36

discussion about whatever feel fell events. Thank you so

38:39

much for your attention today. Thank.

38:41

You so much faster! p For

38:43

such an illuminating presentation before we started

38:45

Q and A: I'd like to share

38:48

the final results from today's poll

38:50

Question: How. Has having

38:52

a D H D impacted the

38:54

ability to manage an eating disorder.

38:56

For you. Your. Child or your

38:58

patience hearsay, he said. Twenty.

39:01

Three percent said challenges with impulse

39:03

control and emotional to strike. Elation.

39:06

Twenty. Percent said increase difficulty

39:08

in establishing and maintaining.

39:10

Routines. Eighteen percent

39:13

said difficulty. In focusing

39:15

on an inherent adhering to

39:17

a structured meal plan. On

39:20

and then to see percent said

39:22

impact as executive functioning on meal

39:24

prep, I'm planning. Thirteen.

39:27

Percent says appetite suppression as a

39:29

side effect of medication. Not.

39:31

Too surprising their i'm Not

39:34

Here questions. On

39:36

why are people with a D H

39:38

D more prone to eating disorders and

39:40

are said in particular. Yeah,

39:44

that's a great question, you know? I think unfortunately

39:46

we are so far from really.

39:48

Having a call Zola Phoenicians for this

39:50

overlap and I think some of what

39:52

has been hypothesized in the literature when

39:54

it comes off with binge eating for

39:57

there's a boast information about that if

39:59

we discussed. I'm A with been

40:01

hypothesized is that both conditions are ones

40:03

that are characterised by impulsivity. People would

40:05

binge eating are prone to binge eating

40:07

in an impulsive fashion in much the

40:09

same way that you might see how

40:11

to show up in a D H

40:13

D The maybe there's some sort of

40:15

underlying impulsivity factor that make somebody around

40:17

to developing both a D H D

40:19

can binge eating. Now when it comes

40:21

to a typical anorexia nervosa are are

40:23

said, I think it's really hard to

40:25

say, especially early on. But if you

40:28

think a little bit about some other.

40:30

Data that I presented a few: five

40:32

the girl and there was that one

40:34

say that looked at that sensory some

40:36

type of are fed and so maybe

40:38

there's something where kids with a D

40:40

H D or even adults have a

40:42

d H D are just sort of

40:44

more biologically predisposed to have difficulty with

40:46

sensory territory. Six with food and so

40:49

maybe that makes them more vulnerable to

40:51

going on to develop something like are

40:53

fed. What I do want to say

40:55

is that we know that eating disorders

40:57

or I am logically base condition these

40:59

are not. Something that somebody chooses.

41:01

These are not conditions that happened

41:03

just because we haven't from live

41:05

in a culture Are those factors?

41:08

Absolutely. But if cultural alone. Was

41:10

going to be the major factor. And

41:12

everyone in the culture would have an eating

41:14

disorder. I think it's important. really. think about

41:16

some of the biological bases of these disorders

41:18

and how they make make somebody prone to

41:20

developing either or false. I know that's not

41:23

a sort of an exact answer to your

41:25

question, but I'm hoping that helpful. And

41:28

how we present an eating disorder

41:30

some developing Is that possible? It's

41:34

absolutely possible and I love this. questions and

41:36

part of why I love this question of

41:38

because I'm all in the literature whether it's

41:40

just an eating disorders or are out mental

41:42

health and really throughout most medical conditions to

41:45

would tell us that the earlier we can

41:47

do something about a problem of better the

41:49

prognosis the prevention is really were attached. If

41:51

we can either prevent the symptoms all together

41:54

nicely the gold Standard race but if we

41:56

can test them as early on as possible

41:58

and prevent them from ever. Needing to

42:00

feel echelon like myself are also a

42:03

really important goal. When we think about

42:05

prevention, I think a lot of it

42:07

really hasn't do with number One. Understanding

42:10

is in our family history of beauty

42:12

disorders or other condition, the commonly coworkers

42:14

and if so, how do we think

42:16

about the be been more mindful about

42:19

the environment. Given that underlying genetic risk,

42:21

we think about the environment. I think

42:23

it's really important that we're doing things

42:26

that help set kids and adults up

42:28

for success comes to their relationship. With

42:30

food and with their body. So and for

42:32

those of you in the audience their parents

42:34

are caregiver. Pick a little bit about the

42:36

way that you talk about your own by

42:38

and funny or kids think about the way

42:40

that you talk about your relationship with food

42:42

and funny. Your kids are soaking all that

42:45

information up their learning from you And so

42:47

if you are setting what looks like may

42:49

be a more balanced or more healthy relationship

42:51

with food and with your body That helps

42:53

to set that up a role model that

42:55

for your kids. We also

42:57

know that things like regular family meals

42:59

or protective against eating disorders and people

43:01

that have good access to general mental

43:03

health services can also be protective against

43:05

eating disorders. So again I think a

43:08

lot of us who we have to

43:10

do with thinking about wellness as a

43:12

whole not just. Eating disorder, sense of

43:14

self, On

43:17

we have of course quite a few

43:19

questions around our said in addition to

43:21

their previous one. To.

43:23

One is how this one determine if

43:25

their child has are said or he's

43:27

just a picky eater. Yeah.

43:30

That's a great question and wanna be got a lot

43:33

and. It's sauce. I

43:35

think as a parent to maybe tell the

43:37

difference between picky eating and are fed because

43:39

sometimes they can look very similar and sometimes

43:41

kid from tantrums about things because they just

43:43

simply don't want a cross could offer their

43:45

sandwich that a frightened and assessed that shit

43:48

of stuff and that you did So I'm

43:50

or maybe kids you know only like to

43:52

eat certain vegetables or fruit and nothing else

43:54

but when it comes to a diagnosis of

43:56

are fed this tends to be a much

43:58

more pervasive and purse. And outer

44:01

so for example, Of

44:03

this isn't something that happens for a

44:05

short period of time, only in certain

44:07

contexts is tend to be something that

44:10

it's happening day in day out for

44:12

extended period time and often leads to

44:14

been malnourished. But I would say that

44:16

it's uncommon I think for most children

44:18

to are picky eaters to become malnourished.

44:21

Whereas in our said those rigid seed believed

44:23

those rigid food was are so entrenched that

44:25

there's really no moving them and it's easy

44:28

for kids to be cabal nourished. So what

44:30

I would say as if you are at

44:32

all concerned or if you're not sure it's

44:34

worth getting an assessment, it's worth finding out

44:37

a little bit more. Talk to your pediatrician,

44:39

talk to have to talk to them about

44:41

how to get on linked up with i'm

44:43

an eating disorder resources that might be in

44:46

your area or use some of the resources

44:48

and I provided here today. but I think

44:50

if you are not. Sure if we're

44:52

talking to a specialist to either rule

44:54

in an eating disorder diagnosis or what

44:56

how and where you can sunlight. And

45:00

I have two questions one from a

45:02

parent and one some new a practitioner

45:04

to and the parents said had a

45:06

huge screen for our said. And.

45:09

A practitioner said what tools are

45:11

questions t used. To

45:13

screen to help to prompt

45:15

a diagnosis. Be. Yeah, that's

45:18

a great question felt for. Parents

45:21

are caregivers. What I would say

45:23

is that they're unfortunately really aren't

45:25

any validated measures. For parents,

45:27

are caregivers to screen for

45:30

these eating or feeding. Difficulties Often

45:32

times though, I would say that parents

45:34

are best allies and hoping to determine

45:36

whether or not and of these diagnoses

45:38

are present specifically and little one. Because it's

45:40

hard for little ones be able to

45:42

describe their experiences. What I

45:44

would say this your a parent or a

45:46

caregiver is to just simply makes an observation:

45:48

What are you noticing? What's. Changing and

45:50

years help eating behaviors. And what's

45:53

changing in terms of their weight or save

45:55

money and noticing and terms of some some

45:57

difficulties with eating and if they tend to

45:59

be. I've learned or you

46:01

find that they're really pervasive throughout Martha

46:04

different contexts that will be returned to

46:06

have a further discussion with health care

46:08

provider. For the health care provider who's

46:11

asking this question, there are a few

46:13

validated measures I'm looking at. diagnosis of

46:15

are fed. however they mostly be used

46:18

to the research contact and unfortunately there

46:20

is nothing that's appropriate for use and

46:22

primary care because all of the screening

46:24

measure that exists for our said are

46:27

probably. I would say at

46:29

least fifteen items on that for there might be

46:31

some. There are a little bit shorter but those

46:33

are really unwieldy for primary care so I'm not

46:36

sure if you haven't been a primary care setting

46:38

a where you might be working bus and there

46:40

are a few. One of the night I remember

46:42

what the and I A as I can what

46:44

the and stands for and there's one called the

46:47

Party T A R D I that's actually an

46:49

interview again. both of those required readings of you

46:51

know actually how to administer them. So am I

46:53

would say that again if you are the provider

46:56

unsure and see if you can get them linked

46:58

up. With an eating disorder provider who

47:00

could do especially assessment. On

47:03

we hang quality questions around.

47:06

I'm. using. Stimulant

47:08

medication which. For

47:10

some people decide affect his appetite suppression.

47:12

Ah but as you have an eating

47:14

disorder, what can you do in a

47:17

situation like that and. Which. To

47:19

treat. First. And how do you treat

47:21

both? Yeah

47:23

it's really complicated on. When I was doing some

47:26

path for this talk I was looking at them

47:28

the the literature on still might stimulate use among

47:30

people with. A D H D as well as

47:32

an eating disorder diagnosis. And the jury's

47:34

kind of our oddest. Be honest with

47:36

you all, and I don't think they're

47:38

very clear path with one study that

47:40

I looked at that indicated that they

47:42

were actually really successfully able to me

47:44

feed and read nourished children who are

47:46

on him in pieces, Eating Disorders units

47:48

who had our fair anorexia Nervosa I

47:50

had lost a significant amount of weight.

47:52

They were able to wait restore those

47:54

kids, even while they stayed on a

47:57

stimulant medication. so I certainly think it's

47:59

possible. am I. One of the challenges

48:01

is that if you are on a stimulant

48:03

medication, it's just gonna require more work to

48:05

make sure that your child or the your

48:08

loved one or you yourself are not and

48:10

sort of artificially nice game on any eating

48:12

disorders and some that might be. I'm sort

48:15

of at bay I, so if you're somebody

48:17

who's honest, simulate medication, making sure that you're

48:19

not just the line on your stomach to

48:21

tell you when you're hungry. It might be

48:24

doing things like making sure that there are

48:26

timer set for meals and snacks, speaking so

48:28

that your eaten by the clock. Vs

48:30

just eating by your stomach. Answer

48:33

that you're not inadvertently maybe exacerbating

48:35

an underlying eating disorder. On

48:40

someone as how do we support our

48:42

children who are going through the struggles

48:44

What should we say are not say

48:46

to them. And. So.

48:49

One thing that immediately comes to mind for me is that

48:52

if you are. Apparent her caregiver who was

48:54

already. Noticing or is aware that your

48:56

child struggling in this way as the

48:58

first step is just having a observation

49:00

and being able to identify that this

49:02

is what's going on in your child

49:04

again but one I would say. Secondly,

49:06

The Feast organization. That I

49:09

outlined in the pre that he said

49:11

as a ton of information because it

49:13

was really developed in is currently overseen

49:15

by people who sat exactly where you

49:17

have parents who have been in the

49:19

struggle of an eating disorder with their

49:21

children and they're there to help provide

49:23

community, create supportive resources and so I

49:25

would encourage you to really and take

49:27

a look at their resources which are

49:29

also free but generally speaking hear what

49:31

I would say is that. Often.

49:33

Times What is most important is

49:36

a sense of stability. And

49:38

a sense that and they're not alone right?

49:40

When it comes to fighting with eating disorders,

49:43

one of the thing that often gets done

49:45

on for children and adolescents with these conditions

49:47

is a reminder that who you're fighting or

49:49

what you're fighting is the eating disorder and

49:51

not a kid. It's so important to create

49:53

a space between the two because the. Enemy

49:56

here is the eating disorder knock your

49:58

kid and so reminder of. Pitino

50:00

an eating disorder. The condition that sort of

50:02

hijack your brain doesn't allow you to think

50:04

the way that you normally do it up

50:06

and allow you to process your emotions and

50:08

the way that you typically do. and I'm

50:10

sure that those really hard and scary let's

50:12

talk about that rates and I think we're

50:14

mind in both yourself as the parents and

50:17

also your child that if the eating disorder

50:19

that was all of this that you are

50:21

fighting that eating disorder together I'm and that

50:23

you'll do what it takes to really get

50:25

them the other side. Pay.

50:29

Someone. Asks how young can a

50:31

person be to receive a diagnosis

50:33

of our said of frankly any

50:35

eating disorder. Yeah.

50:38

You know a complicated and because especially

50:40

we get into the very little ages

50:42

it's so hard for little kids to

50:44

be able to articulate with them of

50:46

their experience is I'm in ways that

50:48

sort of back on to our diagnostic

50:51

criteria rates on I will say that

50:53

is we have seen eating disorders and

50:55

children as young as age sex I'm

50:57

I know some clinicians the probably feel

50:59

eating disorders I'm in children younger than

51:01

that I think will get murky on

51:03

The lower end of that age range

51:05

is the extent to which and it's

51:07

an eating. Disorder. Or maybe some other sort.

51:09

Of seating disorder right like largest.

51:12

Mit things like failure to thrive for

51:14

example, that isn't an eating disorder but

51:16

at bay sort of present as one,

51:18

so I think he gets really complicated.

51:20

But I would say that in those

51:22

really young ages I work very closely

51:24

with your pediatrician and the other specialists

51:27

if there are questions, but I'm realistically

51:29

we don't necessarily have. A. Floor for

51:31

Eating Disorder agents. On

51:34

someone right to. She was a

51:36

lot with adopted kiddos mans. They're

51:38

supposed to trauma many of them

51:40

and they have eating disorders and

51:42

she's asking what causes this. Wasn't

51:46

an election I should say sir, Yeah,

51:48

you know I think that's an overall.

51:50

If you look at the literature on

51:52

eating disorders, we know that there tends

51:54

to be a real predominance as folk

51:56

that have a history of traumatic experiences

51:58

Sweater that and child. Adolescents

52:00

are adult power to doesn't really matter age

52:03

range. We just know that attempts to be

52:05

a lot of overlap between eating disorders and

52:07

trauma. Some in terms of why that might

52:09

be, you know, I think the Pommel reasons

52:12

or the million dollar question right? And

52:14

I don't know that we necessarily have answers

52:17

that unless moments when I will stay as

52:19

that for many people. There.

52:21

Traumatic experiences are things that almost irrevocably

52:23

affects the way that they regulate their

52:25

emotions. A way that they have a

52:27

sense of safety in the world. It's

52:29

the way in which they may interact

52:32

in our personally with other people. All

52:34

of those things are actually very important

52:36

when it comes to eating disorders. So

52:38

there are several theories looking at eating

52:40

disorder behavior as a way to regulate

52:42

of oceans. For example, binge eating might

52:45

be something that you do when you're

52:47

feeling really upset, her anxious and it

52:49

makes you feel better. For. A short

52:51

period of time and there's also indication

52:53

that and things like losing weight or

52:55

become a you know, sort of more

52:57

normative in terms of what society wants

52:59

you to look like, Health of people

53:01

Board A to make you feel maybe

53:03

a little bit more safe and your

53:06

environment more accepted by your peers and

53:08

but above and beyond all of that

53:10

eating disorders or condition that flies in

53:12

secrecy and if they were condition that

53:14

everybody wanted to shine bright light on

53:16

that, I think people would seek treatment

53:18

a lot are readily. but because of

53:20

that when. You add in the piece of

53:22

trauma where there is inherently a lot of

53:24

shame and a lot of frequencies. It just

53:27

creates a clinical picture that much more complex.

53:29

Stokes Am. And. Again, not so

53:31

that is that, a direct answer to the question that

53:33

you have, but I'm hoping that it kind of provides

53:35

a little bit more context. They're. How

53:39

do you feel about exercise as

53:41

action? Is this a sign of

53:43

anorexia? Someone asks. Yeah,

53:45

you know the term exercise addiction

53:47

itself is something that's more of

53:50

sort of a colloquial term than

53:52

it is like a clinical diagnosis

53:54

or I would say is that

53:57

people who have mal adapted exercise

53:59

pattern. You might see that

54:01

regularly and something like believe me, a

54:03

Nervosa where the exercise is actually the

54:06

way to go, compensating for the bench

54:08

and and we also very commonly fear

54:10

and anorexia nervosa. both wrestled Anorexia nervosa

54:13

and a typical anorexia nervosa. You can

54:15

see that sort of mal adapted exercise.

54:17

Relationship for folks are exercising even

54:19

if they're sick or injured people.

54:22

That some push themselves the very limits on

54:24

even if you know I'm it's contra indicated

54:26

to their health because are not eating enough

54:28

to really fuel that activity and thought I

54:31

would say is it may not necessarily be

54:33

something that is like a slam dunk and

54:35

terms of whether or not somebody have an

54:37

eating disorder it is something that often show

54:40

that the part of a clinical picture. And

54:42

says hey. I'm.

54:46

A few we had a

54:48

few questions around to an

54:50

Hathaway Bracey influence of social

54:52

media inspired diet, celebrity beauty

54:54

culture, Boy

54:57

that's like a whole other person hidden in

54:59

an excellent question. why are we have and

55:01

the whole they talking about why would say

55:03

is that first and foremost. Have

55:06

a conversation with your kids about social media,

55:08

have a conversation with them about what

55:10

they're looking at, and encourage them to be

55:12

savvy consumers of the information that they're

55:14

seeing, so you might see something that you

55:16

know. What Somebody, Ethan A Day. For.

55:19

What tells you that they're an expert? What

55:21

told you that there were in the information

55:23

that they're giving you a safe or reliable

55:25

in comparison to somebody else? I have them

55:27

sort of do a little bit of that

55:29

and critical thinking. Again, age appropriate, right?

55:32

And I think also be aware of what

55:34

you with a parent are able to control

55:36

many of the social media companies. To conclude

55:39

that you are able to kind of over

55:41

see in some way com and then certainly

55:43

there are some and federal movement afoot to

55:45

make sure that some parents and caregivers had

55:48

a greater sense of knowing how to protect

55:50

their kids from some the harms that are

55:52

out there and but it is a is

55:54

a pretty face that's for sure. She.

55:57

Asks loaded space.

56:00

The only have one at how

56:02

do we stop emotional eating Only

56:04

give up. Said we eat something

56:06

we comfort ourselves in this way

56:08

actually break this cycle. Yeah,

56:10

he was a really common phenomenon and

56:12

I think I might answer that question

56:14

a little bit differently than United the

56:16

Plate and I actually just sort of

56:18

offer. The emotional eating in and of

56:20

itself is not something that is necessarily

56:22

bad or an eating disorder. Almost everyone

56:24

in the world will experience emotional eating

56:26

at some point in their lifetime. A

56:28

dozen been I've been in one of

56:30

the world has an eating disorder I

56:32

It's sort of us human experience. I

56:35

would say that if you're concerned that

56:37

it's your primary coping mechanisms, forfeits of

56:39

the thing you go to over. And

56:41

over again I would think about his

56:43

maybe getting involved in some general mental

56:45

health counseling or maybe even to medication

56:47

to help reduce your vulnerability to that

56:49

emotional eating. Are there certain stressful situations

56:51

that you know tend to trigger that

56:53

for you? How can you may be

56:55

addressed the mother proactively for that? You're

56:58

not as heavily impacted afterwards, and other

57:00

other coping strategies that you can rely

57:02

on are developed with the help of

57:04

a therapist or a loved one How

57:06

Kitchen Over the Hump Because usually be

57:08

emotional eating itself in that the. Problem

57:10

is the underlying thing that makes you vulnerable

57:12

to it though if you can address and

57:15

of those pieces sometimes of the better success.

57:21

And. Far less

57:23

question on. We.

57:25

Have on to it is too.

57:27

Similar questions one is on my

57:29

teenage son won't eat more than

57:31

five cats five hundred calories a

57:33

day. What can I do? And

57:35

then a similar question was. On

57:38

my teenage son is.

57:42

Is that the? how do I know? is he

57:45

has an eating disorder. I. Had

57:47

is. it manifests typically in an.

57:49

Older. Team Boy. Yeah.

57:52

And as boy I wish I had a typical of

57:54

what it looks like in teenagers are boys But I

57:56

would say is that if you as a parent. Or

57:58

guardian. Or about one. Concerned it

58:00

worse being in touch with your pediatrician

58:02

or any other resources I provided here

58:05

to get some additional assessment on especially

58:07

if you're noticing that their the dramatic

58:09

change in their eat and dramatic changes

58:11

in their wage irrespective of what they're

58:14

starting weight was is worth getting an

58:16

assessment because it's really hard to tell

58:18

is this sort of an oddity in

58:20

there eating versus a more pervasive problem

58:23

without working with a specialist? So I

58:25

would say it's so important pay attention

58:27

to your got in terms of something

58:29

is. Telling me something is wrong here, something

58:31

is off your this isn't normal for my

58:34

kid and then work with your health care

58:36

providers to help get you. The answer is

58:38

that you might beat the zero difference between

58:40

how these might not have since it's might

58:43

manifest between girls and boys. Great

58:45

question. I don't know that we have

58:47

actually gotten that the Pacific, especially when

58:49

it comes to our fad or for

58:51

a typical anorexia nervosa. I would say

58:53

that. Restriction. As receptionist

58:55

restrictions on kids will cut out huge

58:57

numbers of calories a little skip me

58:59

all the know sort of thing. So

59:01

I think if release and tends to

59:03

look very similar whether it's boy or

59:05

girl I would say that maybe the

59:07

major difference is that sometimes it is

59:09

more notable and boys because it's expected

59:11

that they're supposed to be eating a

59:13

lot or they're supposed to be a

59:16

much bigger appetite and girls do so.

59:18

Sometimes I might be more socially acceptable

59:20

for girls are for women to eat

59:22

less or restrict, but it's less socially

59:24

acceptable for men. And for boys and so sometimes

59:26

the I stand out a little bit more. Yeah,

59:29

okay with Rcp. Thank you so

59:31

much for joining us today and

59:33

for sharing your expertise! Ceasar A

59:35

D H D Community! We really

59:37

appreciate it. Thank. You for

59:39

having me with pleasure. And

59:41

thank you to today's listeners. If

59:44

you would like to access the

59:46

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