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Face to Face with EDs: An Interview with Harry A. Brandt, M.D.

by angelique on February 21st, 2008

Today on “Face to Face with EDs”, we have the pleasure of meeting with Harry A. Brandt, M.D., director of the Center for Eating Disorders at Sheppard Pratt.  He’s been working with ED patients for over 20 years and gives us advice for family members and loved ones…

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Breaking the Mirror (BtM): 

What advice would you have for individuals who want to help a loved one with an eating disorder but do not know where to start?

Dr. Harry A. Brandt (HB):

Prior to approaching your loved one with this issue, we recommend you do some research on what resources might be available.

When first approaching the individual, find a time to talk where neither of you will be rushed, allowing the opportunity to open the door to the discussion without stress and distractions from the outside world. Speak about your concerns using specific examples of things you have seen in reference to their behaviors, and your belief that professional help could be warranted.

Avoid trying to diagnose and avoid being technical. Instead, offer to assist with setting up a first-time appointment with a professional with some specific eating disorders experience or at a local center designed for the treatment of eating disorders. Even if the individual is defensive or not ready to jump into eating disorders treatment, an outside expert opinion may help shed light on the severity of the problem.

If the loved one is an adult, and not open to help of any kind, do not get into a power struggle over this issue. Let them know your feelings and concerns, and let them know that you are open to talking about this issue whenever they are ready. When talking with them, throughout the conversation use “I” statements in reference to their behaviors - i.e. “I am concerned because I have heard you throw up on a number of occasions after meals.” This will help the loved one hear what you are saying as a point of concern, rather then an attack. 

There are situations where an internist or family practitioner can be helpful, particularly if there are signs of medical deterioration or danger.

BtM:

What are some of the biggest mistakes you’ve seen family members and friends make (usually innocently) when they are trying to help a loved one who is in treatment for an eating disorder?

HB:

One common mistake is putting too much emphasis on the act of eating as the cure all for the illness.  What may be surprising for some to hear is that the more the focus is on getting the individual simply to eat, the more the individual does not want to.

Eating disorders in reality have little to do with food and weight, although from the outside this appears to be “the issue.” Rather, an eating disorder is often about the underlying issues and distortions in thinking, and these differ widely from person to person.

Rather than emphasizing the food piece, it is helpful to focus on underlying feelings and anxieties, and what is going on in their lives. In regards to the food, one might ask the affected individual what they would find most helpful. Allow them to lead you in how to help them.

Unless you are involved in specific therapy that directs you on how to be engaged around the food at the table, try not to become the food police. Refrain from staring at them while they eat, or noting each thing they do or do not eat. Instead, try to engage them in non-food related conversation to allow the table to be a less stressful place to be.

Coming across as too forceful often causes an individual with an eating disorder to become defensive or retreat, instead of engaging with you more around food and treatment issues.

On the flipside, we have also seen family members who become too passive or avoidant — who see their child engaging in eating disorder behaviors but do not get involved in helping them make healthier choices.

Often, family therapy is an important component of eating disorder treatment, but sometimes we find that there are family members who cannot or will not participate. Particularly with adolescent patients, family therapy is key in encouraging behavior change in the individual with the eating disorder.

BtM:

Is therapy useful for immediate family members (and perhaps friends) of someone with an eating disorder?

HB:

Absolutely. We provide family therapy for patients in our inpatient and day treatment programs, and recommend it in many cases for our outpatients.

At times, the family may not or cannot be involved in the family therapy, and patients will bring in their close supporters to be involved in their treatment. We also offer a support group that is open to friends and family, which can be a great support for everyone involved.

Eating disorders affect not only the individual with the identified problem, but their families as well. In this regard, individual therapy is also often helpful for family members.

At this time we are involved in an international study to help determine which variety of family therapy is most effective with adolescents with anorexia nervosa (AN). Two forms of family therapy - behavioral family therapy and systems family therapy — have been proposed to be effective for this population, and will be used in this study.

In addition to the family therapy component, fluoxetine (the generic equivalent for Prozac) may help reduce anxiety, depression and/or compulsive tendencies.

We need families with adolescents between the ages of 12 and 18 with a diagnosis of AN to participate. The study involves completing interviews and questionnaires. Families will participate in 16, one hour sessions over a period of nine months.

The study medication (fluoxetine or placebo) will be given for an additional six months (for a total involvement of 15 months.) Family therapies and medication based treatments are free. To obtain more information on the study, please contact Courtney DiLallo, study manager at 410-427-3851 or cdilallo@sheppardpratt.org.

BtM:

Any additional advice for those who are close to someone who is struggling with anorexia, bulimia or binge eating disorder?

HB:

Seek support for yourself. It is very hard to watch someone you love suffer and regardless of their decision to be involved in treatment, you can benefit from the support of a professional as well - either individually, in a support group or via online support.

Our discussion board, which can be reached via our website at www.eatingdisorder.org, is one option of many that are out there which provide an opportunity for friends and families to reach out for support from other individuals who are in similar situations.

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I truly thank Dr. Brandt and his staff at the Center for Eating Disorders at Sheppard Pratt for all their insights.  I invite you to stop by their newly-formed blog for more information:  www.eatingdisorder.org/blog.

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POSTED IN: Center for Eating Disorders, Interview