Drawing back the curtain on binge eating

With psychiatrists mulling whether to classify binge eating as a bona fide eating disorder -- laid out in a package of stories in today's Health section -- the blog Jezebel launches a more personal discussion of the problem.

That post notes: "As someone who has been fortunate enough to receive proper treatment for an eating disorder, I find it somewhat troublesome that the concern over including binge eating disorder in the DSM comes back to worrying about doctors over prescribing medication or patients who rely on the diagnosis as some excuse to continue engaging in unhealthy behavior. ... I was able to get proper treatment because my eating disorder was clearly defined in the DSM."

People who have struggled with binge eating then weigh in. Others opine about the merits of the DSM classification.

Here's the L.A. Times' story, by staff writer Melissa Healy: Is binge eating a psychiatric disorder?

It begins: "Rina Silverman's refrigerator is almost always empty. She keeps it that way to avert episodes of frantic food consumption, often at night after a full meal, in which she tastes nothing and feels nothing but can polish off a party-sized bag of chips or a container of ice cream, maybe a whole box of cereal. The food she's eating at these moments hardly matters."
 
And here are the related stories in the package:

Trying to define binge eating disorder

Binge eating: Is it a form of addiction?

Holidays can feed binge eaters' problems

And for more on binge eating, check out this collection of information, tips and resources from helpguide.org.

— Tami Dennis

Photo: For binge eaters, one serving isn't enough.

Credit: Tim Boyle / Getty Images

When making public statements, shouldn't those statements actually state?

When news breaks out, organizations frequently offer up their two cents on the topic at hand. Sometimes these statements clarify the issue or a group's stance -- but only sometimes.

Today, we received this official statement from the American Psychiatric Assn. on the Fort Hood, Texas, shootings:

“The American Psychiatric Association is saddened and shocked by the events at Fort Hood on Thursday, November 5. Our hearts are with the soldiers, the families, and all the members of the Fort Hood and military community affected by this tragedy.”

Couldn't the same be said of most people's reactions -- and the location of their hearts? Here's what the position looked like in its entirety.

And last week, there was this from the National Women's Law Center on the gang rape of a 15-year-old California girl who'd attended a dance:

“The circumstances reported about this brutal assault, as well as the shocking inaction of those who stood by and watched it happen, are shocking – and should be widely condemned."

Again, society didn't seem to need much urging.

If you're going to make a statement, then do so. Here's one this week from the National Right to Life Committee on a legislative move in the House:

"The Ellsworth language is a political fig leaf made out of cellophane -- it directs the federal Secretary of Health to hire a contractor to deliver to abortion providers the payments for elective abortions, payments that are explicitly authorized by the bill [on page 110].  This is a money-laundering scheme -- a federally funded 'bag man' will deliver government funds to abortionists.  This is federal funding of elective abortion."

Here is that statement in its entirety.

Whether you think the statement is an accurate reflection or a grotesque parody of the current political debate, at least there's a point in saying it.

-- Tami Dennis

Photo: Sometimes the point isn't what is said, just that something is said.

Credit: Los Angeles Times

Practice may not make perfect, but it could bring increased happiness later

Frustrating though trying and trying again may be at the time, such practice appears to pay off psychologically down the road.

In a study assessing various factors affecting   overall well-being and hourly well-being, researchers at San Francisco State University and elsewhere asked several hundred people to provide accounts of their behavior, their feelings of enjoyment and stress, and the overall satisfaction of their psychological needs on two separate days.

They found that behaviors designed to enhance  feelings of autonomy (doing what one wants rather than what one is told) and relatedness (a sense of connection to others) made people feel good at the time. Behaviors designed to enhance competence didn't. Such activities are stressful, as it turns out, and they tend to make people feel less than satisfied at the time.

At the same time, feelings of competence -- as with autonomy and relatedness -- were linked to overall satisfaction, or happiness with life.

The researchers write in their conclusion: "The momentary stress and lack of enjoyment may explain why individuals do not always pursue those competence-promoting behaviors that will ultimately maximize well-being. Therefore, because optimal well-being cannot be attained if fulfillment of one's psychological need is pursued at the expense of another need, optimal well-being likely cannot be attained by only selecting enjoyable and stress-free behaviors."

In other words: Practice anyway. (And yes, dear, that means you -- and yes, I'm talking about the flute.) It's good for you.

The study was published online this week in the Journal of Happiness Studies. Here's the abstract and the more complete, and reader-friendly, news release. The fact that there is such a journal boosts my happiness just a bit. So does flute practice.

-- Tami Dennis

Photo: Acquiring competency is stressful, which decreases happiness. But practice builds competency, which increases happiness. Got it? Here, Hamilton High School students rehearse "The Magic Flute." Credit: Los Angeles Times

Rejoice! Daylight saving time is ending

Please. No more bemoaning the end of daylight saving time, which -- finally -- comes to an end this year on Sunday. Up until 2007, it ended in October, and some computers and electronic devices (such as the L.A. Times-tether Blackberry) are still operating under that assumption.

The extension of afternoon-daylight hours does us no favors when it begins in the spring. Its accompanying loss of an hour of sleep can lead to alertness problems and, as a result, accidents. Here's a new study from Medical News Today explaining that effect.

And its end has little to do with seasonal-affective disorder or winter blues or whatever you choose to call that annual fall mood decline. Take a read of this L.A. Times story from the spring of 2007, when the current expansion of daylight saving time began.

It notes that the extension, which was supposed to give people extra light later in the day, can actually make them feel less sunny. As one expert on biological rhythms says in the story: "It's the early morning light exposure that allays the symptoms of winter depression. The later the sun rises, the more likely we are to get depressed."

That's not to say you're not affected by the dwindling amounts of daylight. Here's a quick primer on seasonal affective disorder from FamilyDoctor.org. (Beware the possibly increased craving for sweet or starchy foods -- and note that tanning beds are not an appropriate treatment.) And here's another primer from Mayo Clinic.

But it does suggest that the lack of afternoon barbecues isn't the culprit.

Here's a quick explanation from National Geographic of how this whole clock shuffle began.

-- Tami Dennis

Photo: Early morning sunlight does a body, and mind, good. (Here, ducks take flight just past dawn from Little Lake near the Eastern Sierra Mountains. You're feeling better just looking at this photo, right?)

Credit: Allen J. Schaben / Los Angeles Times

Considering retirement? Working might keep you healthier

As baby boomers reach retirement age, more are opting to continue to work, whether for economic reasons, or because they simply like to work. That employment can provide more than a paycheck -- working, it seems, has pretty good mental and physical health benefits as well. 

A new study in this month's issue of the Journal of Occupational Health Psychology examined data on 12,189 retirees from the Health and Retirement Study, sponsored by the National Institute on Aging. The first four waves of the study (1992, 1994, 1996 and 1998) were included, in which people age 51 to 61 were surveyed about their health, finances, employment history and current work or retirement.

The researchers coined the term "bridge employment" to describe the transition period between full-time work and full-time retirement, in which people work part time, are self-employed or temporarily employed.

Men and women in that bridge employment category reported fewer major diseases and functional limitations compared with those who were in full retirement. Mental health was better as well, but only for those who kept working in their previous careers. Those who chose a different career path didn't show the same benefits. Choosing another career, the authors believe, could prove stressful while people adjust to new roles and a new workplace. Also, some who choose new jobs do so out of financial need, which may add additional stress.

In the study, the authors wrote: "when the retirees engage in bridge employment, they are likely to keep their levels of physical activities and mental activities through daily work. In addition, working after retirement increases retirees' role embeddedness, which has been shown to benefit health maintenance."

Going into full retirement, they add, could lead to less social contact and fewer daily activities, perhaps making them less likely to fight off major diseases and more likely to see a decrease in daily function.

In a news release, co-author Mo Wang of the University of Maryland said, "Given the economic recession, we will probably see more people considering post-retirement employment. These findings highlight bridge employment's potential benefits."

-- Jeannine Stein

Photo: Robert Durell / Los Angeles Times

Religion: The heart believes what it will, but the brain behaves the same either way

Religious believers may seem to share little with nonbelievers when it comes to thinking and judgment. But a new study by UCLA researchers finds that both Christians and nonbelievers use the same parts of the brain when asked to label articles of religious faith as true or false. A report summarizing the study is published today in PLoS ONE.

For both groups, the act of judging religious assertions increased activity in several regions of the brain  collectively thought to play key roles in emotional judgment, processing uncertainty, assessing rewards and thinking about oneself. 

The 15 Christian believers and 15 nonbelievers whose brains were scanned while assessing the truth of religious tenets were alike in one other respect: Both groups took longer to respond when they were asked to declare their own belief or disbelief in matters of faith than when they were asked to label neutral matters of fact true or false. It's not clear whether their responses were slowed by uncertainty in the face of the great questions, an emotional response to religious belief or a quick check of each individual's own place in the universe or the prospect of entry into heaven or hell.

When asked to consider the veracity of neutral claims (for instance, "Alexander the Great was a very famous military leader"), both groups tended to use parts of the brain that are strongly associated with memory retrieval.

"There is, of course, no reason to expect that any regions of the human brain are dedicated solely to belief and disbelief," the authors wrote. But, they added, the study showed that the opposing mental states of belief and disbelief are "intimately tied to networks involved in self-representation and reward."

One of the study's authors, Sam Harris, is the author of two bestselling books, "The End of Faith" and "Letter to a Christian Nation." Harris recently completed a doctoral dissertation in cognitive neuroscience at UCLA.

-- Melissa Healy

A nod to prostate cancer, vegetarianism, rehab, recovery awareness

Pity the awareness raiser who has little to use but a calendar date that rolls around once every year. But try they must. And so in the last five days alone, we've been told:

- "This week, the NFL and the American Urological Association Foundation (AUAF) launched on a campaign for men called “Know Your Stats” in honor of September’s Prostate Cancer Awareness Month." 

- "We hope to coordinate an interview for Suicide Prevention Month (September)."

- "Sept 20-26 is National Rehabilitation Week, and (Julia) Keller’s new young adult novel -- based on her personal and professional experiences, and written from the point of view of a young teenage girl -- tells the story of a family coping with the return of a severely injured soldier father."

- "Following is some detailed information which you may find interesting for a story in support of World Vegetarian Day and Vegetarian Awareness Month throughout the month of October." 

- "With National Breast Cancer Month coming up in October, we thought information on a new breast cancer radiation technique with proven life-saving benefits would be of interest." (This was just one of the breast-cancer-awareness suggestions received this week.)

- "The celebration, Batter Up! A Home Run for Recovery Month was part of National Alcohol and Drug Addiction Recovery Month celebrated annually in September."

- "The webinar, which comes on the final day of National ADHD Public Awareness Month, will report on published research on the effects of the Transcendental Meditation technique for improving academic achievement and executive brain function while reducing learning disorders, anxiety, depression, metabolic syndrome, diabetes, and heart disease."

We give in. Coming soon: A special Health section issue with no news or trends or context, just efforts to make you aware. (Kind of like this blog post.) 

Until that carefully unspecific time, allow me to recommend the list of 2009 National Health Observances. It's one-stop shopping for those who need to know which diseases, conditions and issues warrant awareness today, this week, this month.

After I make it through my inbox, I'll really have to figure out whose idea that was.

-- Tami Dennis

Photo: Even the NFL is on the game.

Credit: Matthew Emmons / US Presswire

Psychiatrists lay down the rules for prescribing to kids*

A psychiatrist contemplating the prescription of psychotropic medications to a kid should open communications to the child's pediatrician. He should ensure that the child and her family grasp the objectives, side effects and benefits of the proposed medication, and agree it's needed. The psychiatrist should have a detailed plan to monitor the effects of the medication and change or discontinue the drug if it's not getting the job done or has untoward side effects.

A psychiatrist should precede any prescription-writing with a full psychiatric work-up and medical history, ruling out the possibility that behavioral or emotional symptoms are the result of underlying physical illness, or that drugs could do harm. And she should be wary of prescribing medication in cases where a child's home situation is so chaotic that a medicine's ill effects might be missed or an improper dose could be taken.

All are reasonable enough principles, and doubtless widely practiced already. But against the backdrop of steep increases in the pediatric use of psychiatric medication, all are principles that the American Academy of Child & Adolescent Psychiatry  today saw fit to enshrine in a new "Practice Parameter on the Use of Psychotropic Medications in Children and Adolescents," and to publish in the September issue of the academy's official journal.

The document "is not meant to reduce prescribing," said Johns Hopkins University psychiatrist John Walkup, the lead author of the "practice parameter" document. "Rather," he said in a news release accompanying the article's release, "it is a call to action to create a systematic and comprehensive approach to using medications in children safely and effectively."

The AACAP's to-do list for psychiatrists comes as many health professionals express concerns that--stretched thin by the needs of kids with behavioral, emotional and academic problems--physicians may be too quick to diagnose and medicate problem behaviors. The AACAP's "work group on quality issues," wrote that health insurers' reluctance to reimburse for time-consuming psychotherapy--which for many pediatric conditions is the preferred first treatment--has driven some of the increased reliance on drugs to treat kids. And though the drafters cautioned that "it is difficult to quantify and to prove conclusively," they allowed that the extensive marketing of psychiatric medications to physicians, patients and insurance administrators may have helped fuel the dramatic rise in prescriptions for kids.

When physicians fail to practice a "rigorous consistent approach to assessment and treatment," the document states, children and their families grow discouraged by treatments that don't work or come with unacceptable risks. "It is also possible that poor quality of psychiatric care may affect the public's perception of prescribers of psychotropic medications and lead to a loss of public support for psychiatric treatment services."

-- Melissa Healy

*Editing changes have been made in this post

  

A shampoo, blow-dry and some health advice

Hair stylists do more than make us look good--they can also be a confidante, friend, shoulder to cry on, and advice-giver.

That's why a team of researchers from Ohio State University decided to study the relationship hair stylists have with their older clients, and see how that relationship could ultimately improve the health of those clients. And what a relationship they have--among 40 stylists in the Columbus, Ohio, area who filled out surveys, more than half said they felt very close to their older clients. Said one stylist, "I have been seeing some of my clients for almost 40 years, so I have become very close, like family."

Part of that closeness comes from the information clients share about their personal lives. According to the survey, stylists said clients talk about physical health problems, family, financial and emotional problems, and anxiety and depression.

The stylists didn't just listen--they offered support and sympathy, tried to cheer up their clients, gave advice, and often tried to get their clients to speak with someone. The stylists felt they were able to spot signs and symptoms of depression, dementia and self-neglect. Almost two-thirds said they would refer older clients to a mental health expert if necessary, but some said they didn't know much about such services in their community.

"We can't expect them to do everything, but our results suggest that most stylists care about their clients and would be willing to help them," said Keith Anderson, co-author of the study and assistant professor of social work at Ohio State University. Anderson believes there could be a program that encourages stylists to identify mental health and other issues in older clients, much like the "Cut It Out" program that enlists salon workers to spot warning signs of domestic abuse and refer clients to local service.

The study was published recently in the Journal of Applied Gerontology.

-- Jeannine Stein

Photo credit: Ken Hively / Los Angeles Times

College students pack a heavy bag of mental illness

Loading up the car for college? The American Psychiatric Assn. reminds us that while college can be a time of great hope and exuberance, that's not always the case: Its 2008 American College Health Assn. Survey found that 30% of college students reported that at some point in the last 12 months, they had felt so depressed it was hard to function. And 49% reported that in the same period, they had experienced overwhelming anxiety.

Ten percent of those surveyed said they had been diagnosed or treated for depression, and 6% reported they had seriously considered suicide. And a study published December 2008 in the Archives of General Psychiatry found that alcohol disorders affected roughly one in five college students. The next-most-common class of disorders were personality disorders, affecting about 17.7% of college students.

We know from the website Active Minds, devoted to "changing the conversation about mental health on college campuses" and to providing mental-health resources to college students, that an average of 1,100 college students die by suicide each year. Sure, there's beer-pong and all-night partying. But there's crushing pressure as well, and it can take a toll on students' mental health. (To find a chapter, or start one on your campus, look here.)

The Los Angeles Times' Shari Roan wrote back in September 2007 about the growing demands on college mental health services, and some of the dilemmas they face in serving troubled students on the cusp of adulthood. Now would be a good time for parents and students alike to revisit that article. 

-- Melissa Healy