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Old 05-01-2010, 12:45 PM   #1
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Default I really need some advice.

Hi Everyone,

I have had a very strange week, and I could use some input from other women who might understand what I am going through.

I have suffered from binge eating my entire life. I also suffer from depression, anxiety and PCOS. Alcoholism and addictions are rampant in my family. This is all connected. I've done a lot of reading about it, and I've come to realize that there is both a physiological and psychological basis for the way that I self-medicate with food.

I finally saw a shrink about it in January, who decided to refer me to an eating disorder specialist. This has been a very long process - long waitlist, etc. While waiting to see the ED guy, I saw an endocrinologist about my PCOS, who put me on metformin (Glumetza). It has really helped with the physiological basis for my binges.

After 5 months, I finally saw the ED guy this past Tuesday. I am so, so upset about what happened. I got there and had tons of paperwork to fill out re: my history (family, health, dieting, etc.). Then I had an hour interview with a psychologist on his team. Then I filled out more paperwork while the psychologist talked to him. Then they called me in.

So the first thing the ED guy says is "Good for you for making it to law school." Then he gives me a few lines about how what really matters in life is health and personality, and that if you have a good personality, people will think you're attractive. I'm sitting there and thinking, ok buddy, save this sh*t - I already know it.

Then he says he has to treat my eating issues as a medical issue. That's fine, I understand. I told the psychologist who interviewed me that I am now on metformin to prevent me from getting diabetes, because women with PCOS are prone to it and I finally saw an endocrinologist who convinced me I should do this for preventive reasons. I also told her that since I started taking met, it has actually curbed my urge to binge because things are working better - but the psychological need to binge is still there.

So what does the ED guy do? He tells me he wants to put me on a new anti-depressant (Wellbutrin), which has the side effect of appetite loss and therefore, weight loss. Keep in mind, I am already on Celexa (the generic version). Then he starts lecturing me on things not to eat -as if I don't already know, and as if I don't make myself feel like crap EVERY SINGLE DAY for not only eating the "wrong" things, but for eating, period. And, to make things worse, he doesn't even grasp the latest science behind how people should actually be eating, especially women with PCOS (low carb is the best way to go).

So I tried to argue with him re: the new anti-depressant, about how I've read a lot about the reasons to be skeptical about their effectiveness and that I didn't want to be on anti-depressants forever, but he wasn't having it. I didn't have a chance to even tell him how much it scares me to be on medication for the purposes of weight loss, because I'm terrified of what would happen when I go off it. How is this a solution for dealing with my urges to binge, and essentially, to hurt myself with food????

I have another appointment with him in 3 weeks. I already called and told his assistant that I'm not taking the Wellbutrin, and that I already know the things I SHOULD do about my weight, but I have trouble doing them and that I felt he was patronizing and judgmental. I need therapy, not more judgment or more meds. Geezus.

Ok, maybe I need more meds - but to jump to that right away? And to give me samples of a particulary strong anti-depressant in the hopes that it will make me lose weight, and not even without thinking about the long-term effects it might have on me?

I mean, seriously - would he tell an anorexic patient the first time he meets her that he's going to prescribe her an anti-depressant because it's primary side effect is an increase in appetite and therefore weight gain? How can he not understand how this would make someone FEEL?

I'm not really sure what my question is here. Maybe I just needed to vent. I am just so disappointed, and so tired of trying to deal with this one my own.
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Old 05-01-2010, 01:28 PM   #2
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I'll tell you something: for all the press that the "obesity epidemic" gets, actual medical professionals apparently don't get much training in how to deal with it. I've heard so many stories of people sitting in their GP's office, sobbing about how much they need to lose weight, and being given a "diet" that seems like an article in a woman's magazine--a list of "food do's and don'ts" and perhaps the recommendation to get "Regular exercise", but no advice on how to remake all your eating habits, what specific types of exercise you can do and how to slowly ramp it up, no advice on macronutrients or even calorie counting. My ob-gyn said "try weight watchers". When I said I didn't like the group sessions idea, he just shrugged.

And god, the ignorant advice people get from nutritionists and personal trainers: I had a nutritionist--an adjunct instructor at a university--tell me that weight leaves the body primarily through urination, an error so profound it raised concerns about everything else he said. We've had people here whose trainers told them to eat every crazy diet out there.

I am sure there are competent professionals out there, but they are more rare than hen's teeth, and an M.D. doesn't seem to mean any particular training in this field. In fact, nothing to do with "weight management" is even a board-certified specialty: you can do a residency in Radiation Oncology or Otolaryngology or Neurological Surgery, but no program is dedicated to help educate doctors about weight management.

In the end, the only thing that has worked for me is getting obsessive about learning about this crap myself. Reading, reading, reading--and always critically, because lots of what's out there is wrong. For all that obesity is killing us, there simply don't exist medical professionals to deal with it in the same way that they exist if you have cancer or gout or even, god help us, acne.
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Old 05-01-2010, 01:49 PM   #3
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best people to tell you that is a dietitian, see if you can talk to one for diabetes. They generally have the information to help you PREVENT it and what you can do to get there. My sister in law is one and has been nothing but helpful.
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Old 05-01-2010, 01:55 PM   #4
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What are the qualifications of this ED specialist? In my opinion, you should go to a behavioral psychologist. If you can find a health/behavioral psychologist, that would be even better, but they're rare. I think a lot of people in the weight loss industry think that everyone who has food issues just doesn't know how to eat right. They don't realize that most of us who have had life long weight struggles know better than most thin people--we just haven't applied it long-term as we should have, for whatever reason. Getting to that reason and dealing with the obstacles that we have to overcome in the long term will help immensely. That's why I recommend general therapy instead of specialized. Behavioral is ideal for people with ED because EDs are behavioral issues.

I was on Welbutrin for over a year. It saved my life, but it didn't do anything for my hunger issues. It didn't help me stop smoking, either, though they claim that's a side effect, too.

If the Celexa (sp?) is helping your depression and the met is helping your binging in any way, I don't see any reason to change it. But if Celexa is not doing such a good job, I highly recommend Welbutrin because it worked so well for me, but not because of any claims of hunger control.

If it were me, I'd cancel my appointment and find someone else. I had to try five different psychologists before I found THE ONE. If your first appointment doesn't go well, none of the following will. Trust me, I know. I stuck each one out for three sessions, and basically lost 4 months of what could have been a healing time for me.
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Old 05-01-2010, 01:57 PM   #5
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In fact, it looks like no "professional" certification involving weight management--not a Registered Dietitian or a nutritionist (which has no legal definition, most places) or any other title I can find requires more than a bachelor's degree. And while a B.S. is not to be sneered at, it doesn't make you a specialist in anything: it's what, maybe 15 classes in that specialty?

If you go here, there is a link on the right to a pdf of State University's required courses for a Food and Nutrition Science degree. I count 10 courses (+ a few labs) that are specifically aimed at "food and nutrition": the program as a whole looks perfectly rigorous, with classes in things like microbiology and organic chem, but it does what any good undergraduate program does--gives you a broad base of knowledge and a bit of specialization. It's nothing like the depth of knowledge you need to really be an expert at one particular thing--that is what advanced degrees and professional school are for. But the most authoritative certification we have in weight management requires only the B.S.
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Old 05-01-2010, 02:16 PM   #6
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Thanks so much, all of you, for chiming in. It makes me feel like I'm not absolutely NUTS to be disturbed at this guys approach.

Schmead - I completely agree that there is far too little emphasis in med schools on nutrition, weight management and how to help people with issues with their eating. It's crazy, because it's something that is so fundamental to a person's health. I find it that much more frustrating, because health professionals can be so judgmental when dealing with someone who is overweight - and they often aren't up to date on the latest science. That's what really bothers me, and frankly, scares me.

Luciddepths - Thanks for your input. I have seen a dietician, and she told me that it's obvious that I know what I should do for my conditions (PCOS and pre-diabetes) - but that I need to deal with the underlying issues behind my eating behaviors before anything will really stick ...

Eumie - Thank you so much for your advice. This ED guy is a psychiatrist, who apparently specializes in addictions and eating disorders. The impression I get is that he is the only guy in the city I live in who I can go to for this, and that makes me so sad, because everything he said just doesn't make any logical sense to me. I agree that I need behavioral psychotherapy. It's just so frustrating, because I now have to go back to the general psychiatrist to have him refer me to another specialist (long convoluted process). Since I'm Canadian, psychiatrists are free under the public system - but psychologists are not. I would go to a psychologist, but they are so expensive, and I'm dealing with a lot of financial stress and uncertainty at the moment (my current job finishes in July, and I have nothing else lined up right now...). I don't know, maybe I have to talk to my parents about a loan or something - but telling them about this makes me queasy, especially since I had such a chaotic childhood and I am very uncomfortable talking to them about my weight or health.

I will do something - thanks for all the suggestions so far, and keep 'em coming! I really need the support right now.
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Old 05-01-2010, 09:24 PM   #7
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Mo, I'm so sorry that session did not go well just when it sounded like you really needed a very positive experience.

The older I get the more I realize that no matter what sort of professional we go to whether it be psychiatrist, psychologist, doctor, nutrition, or personal trainer (etc.) we really need to take ownership for our own recovery and growth. Research before and after any session you have with a professional to be well informed and prepared before you go in and to check anything that was said during the session. I'm so proud of you for saying no to taking the Welbutrin when I didn't feel right. You seem to be getting very informed as well, this is really going to help you on your journey.

I'm not going to give you this direct advice since every situation is different and you need to do what is best for you. But I will caution you against letting any psychological disorder label stick. In my teens and early twenties I was dealing with heavy depression and all the problems that spin off of it - self medication with drugs and food and destructive, harmful behaviors. Several years I suffered before I was diagnosed and when I was diagnosed I was so relieved. There is plenty of "research" out there that says that depression is a physiological disorder. The relief came from thinking that if it was a physiological disorder and if I just took medication I would get better.

6 years into it after I had taken almost every anti-depressant that was being produced, had cycled through so many professionals (psychiatrists, psychologists, counselors, and doctors) I can't even remember them all, and read countless books and research; I was not even close to being better. Everything I was reading told me that I would need to be on medication for the rest of my life.

After six years I had more than enough. I got angry, stubborn, and determined. I stopped seeing every professional and taking medication. I disowned my own diagnosis and the lifetime of medication. I took responsibility for my actions. I changed how I thought, what I did, who I interacted with. I was ruthless about bringing every positive influence into my life I could and cut ties with every negative influence (this included people). I became very conscious of how I was feeling and what was influencing me. Then I started getting better. I'm not saying it was easy nor right for everyone, but it was what ultimately worked for me.

My ultimate healing came right before becoming a Christian about five years ago. But that is another long, involved story that many of you likely would have problems believing. (But if anyone wants to hear it send me a PM.) I can safely say right now that I will never have the same problems with depression that I once had and I know I won't need lifetime medication.

I'm sorry for the length of the story, but I wanted you to see how important it was for me to be incredibly active in my own healing and not put too much faith into professionals and medication and why I encourage you to consider it as well.

I know you can get better and there is a healthy, happy life just waiting for you.
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Old 05-02-2010, 10:11 AM   #8
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Quote:
The older I get the more I realize that no matter what sort of professional we go to whether it be psychiatrist, psychologist, doctor, nutrition, or personal trainer (etc.) we really need to take ownership for our own recovery and growth. Research before and after any session you have with a professional to be well informed and prepared before you go in and to check anything that was said during the session. I'm so proud of you for saying no to taking the Welbutrin when I didn't feel right. You seem to be getting very informed as well, this is really going to help you on your journey.
Thank you so much. I also agree that patients need to be as fully informed as possible before going into a session with any kind of "expert." There is so little out there that can really be treated as uncontested fact, and I think people need to know what is and what isn't something you can take as given. We have this tendency to treat doctors as gods or something, and it's not at all warranted.

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But I will caution you against letting any psychological disorder label stick.
YES. When I saw the first shrink, who eventually referred me to this ED quack, he said that he thought I am bulimic. I was like, whoa. It was the first time I'd ever been labelled like that. It took me a long time to get used to saying that I am prone to depression and anxiety - but an "official" eating disorder? What was I supposed to do with that? And then, the jerk refers me to the ED guy, and all the while, keeps saying he can't talk to me while I'm on a gigantic waitlist, because he's not "qualified." Geezus. That label stuck with me for a while. And you know, I've been thinking exactly what you've written above - I need to not define myself according to these shrinks' labels - especially since they aren't exactly doing anything for me that inspires confidence.

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After six years I had more than enough. I got angry, stubborn, and determined. I stopped seeing every professional and taking medication. I disowned my own diagnosis and the lifetime of medication. I took responsibility for my actions. I changed how I thought, what I did, who I interacted with. I was ruthless about bringing every positive influence into my life I could and cut ties with every negative influence (this included people). I became very conscious of how I was feeling and what was influencing me. Then I started getting better. I'm not saying it was easy nor right for everyone, but it was what ultimately worked for me.
I have been through very much the same thing myself. Believe it or not, I am a million times better now, after I left home, started pursuing a career path that makes me a lot happier than the one I tried to fit into in my early twenties, and stopped letting fear get in my way. If anything, I think what's going on now with me just means I have to do something very much like this again ... I'm due for major change. I can feel it.

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My ultimate healing came right before becoming a Christian about five years ago. But that is another long, involved story that many of you likely would have problems believing. (But if anyone wants to hear it send me a PM.) I can safely say right now that I will never have the same problems with depression that I once had and I know I won't need lifetime medication.
I'm very happy you found the right thing for you .

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I'm sorry for the length of the story, but I wanted you to see how important it was for me to be incredibly active in my own healing and not put too much faith into professionals and medication and why I encourage you to consider it as well.
Don't apologize. This was incredibly helpful and EMPOWERING to read.

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Old 05-02-2010, 12:40 PM   #9
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CheekyMo27, just one question: Do you engage, or have you engaged in the past, in bulimic behaviors?

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Old 05-02-2010, 01:46 PM   #10
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CheekyMo27, just one question: Do you engage, or have you engaged in the past, in bulimic behaviors?

Jay
Not what people think of as bulimia per se. I'm not a purger in any traditional sense - which is why the label surprised me. I wasn't sure how it was that the psychiatrist decided that I could be bulimic. I imagine it had something to do with the fact that I do binge, and then I obsess about "undoing" the damage through exercise, etc.
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Old 05-02-2010, 03:36 PM   #11
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I'm doing psychology at university at the moment and I also do a clinical interviewing workshop as part of it. What I have learned is that in a therapy situation the CLIENT must always be in control. What they want goes and you must be comfortable with your therapist. Even if it's as simple as the way they look, you have the right to change who you see because it's your life and your therapy and it should go the way YOU want it to. It should be the one place where you have absolute control. You have no obligation to this guy and his approaches clearly don't work for you. Remember, you are in control, he should respect that and you are perfectly within your rights to do or say anything when it comes to therapy

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Old 05-02-2010, 04:15 PM   #12
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According to some sources, bulimia is characterized by binge eating followed by "compensatory behaviors." In what they call the "non-purging type" of bulimia, which is rarer, the individual may exercise or fast excessively. So that's probably where the diagnosis came from.

I've read that Cognitive Behavioral Therapy is often successful in treating the condition, with or without antidepressants. It basically teaches you how to change your thoughts. Check it out--perhaps you can find someone who specializes in it.

I would encourage you to hang in there and see if you can work out a treatment plan. I know you're scared and annoyed right now, but maybe trying a few different things might give good results. And if not, then nothing is lost by trying.

I think you are really brave to confront your issues and try to find help. Here's hoping that you can get what you need and that you can avoid antidepressants in the future, if not right away.

Jay
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Old 05-02-2010, 11:21 PM   #13
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Jynx - I really appreciate your perspective, and I wholeheartedly agree!!

Jayell - Thanks for the information. I am definitely going to hang in there, see the ED guy at the next appointment (two weeks from now) and ask about CBT. I really hope it's the case that he's open to working with me in other ways ...
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Old 05-02-2010, 11:40 PM   #14
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As someone who's also traveled the world of mental/behavioral health, both professionally and personally, I would say that if you don't like this ED guy, and if you feel like he's patronizing and not being helpful, that's best reason to find someone else. Jynx said it best:
Quote:
in a therapy situation the CLIENT must always be in control.
. This ED guy may have training and experience, but only YOU are the expert on YOU (I know that sounds kind of silly, but I really do believe that. Doesn't matter if I originally got it out of a class lecture :P)

One of the most important things someone in this field has to do is build rapport with the person their working with. And if you feel like this guy's offensive or he's fake it...it doesn't matter what good information he might have (although based on what you said about him, I'm not sure if he does have any good information) isn't going to matter, because he hasn't built up any trust.

Don't be afraid to keep trying to find someone new. I always hated doing it (I'd rather just, you know, find someone and start) but it really will make a difference. You said this guy is the only person in your city you can go to...is there maybe someone in the next town over? I don't know the particulars about where you live or your transportation abilities, but it might be worth looking at if you can manage it.)

Good luck!
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Old 05-03-2010, 12:00 AM   #15
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I'm a librarian, so here's a book suggestion: The Beck Diet Solution by Judith Beck. She teaches you how to use CBT techniques to handle eating issues. If you try it, and like it, there's a group of us working through it every day on 3FC in the Diets section.

Hang in there. That's a lot of disappointment added on top of other stuff, so be gentle and take care of yourself.
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