Doctor Sheds Light on Treating Eating Disorders

March 5, 2007 — -- While eating disorders affect millions of Americans, until recently, people in the medical community didn't fully understand them.

Dr. Ira Sacker changed that 20 years ago when he wrote "Dying to Be Thin," the book that revolutionized how people regarded eating disorders.

For more than 35 years, Sacker has been working with anorexics, binge eaters and bulimics, and shedding light on conditions that were long in the shadows.

Now, Sacker is out with a new book, "Regaining Your Self," in which he pioneers advice on how to fight eating disorders.

His new approach deals with more than just getting people to eat. Instead, he focuses on dealing with the patient's lack of personal identity.

Just as his first book did, "Regaining Your Self" is poised to revolutionize how the world thinks of eating disorders. You can find more at www.sackermd.com.

INTRODUCTION

Discovering the Self

My first patient with anorexia was sixteen years old and on the brink of death from malnutrition. I had no idea what to do.

Until a few days before, I had been a young resident in pediatrics at New York University and Bellevue Hospital Center. On that day in 1970, I was a brand-new fellow in adolescent medicine at Los Angeles Children's Hospital. I had arrived at the hospital first thing that morning, bleary-eyed and jet-lagged, expecting to spend the day meeting the big shots who had started this pioneering program. Instead, when I introduced myself to the head nurse, she said, "Your patient is waiting for you on the adolescent floor."

"Excuse me?" I said. "Isn't there some sort of orientation I need to have first?"

"We'll get to the orientation later," she replied. "They want you up there now."

I was a little surprised and not feeling particularly confident, but I was eager to make a good impression and begin work in my new position. I was also so new to the hospital that I had to ask how to get to the adolescent floor. From inside the elevator as it approached the ninth floor, I could hear enraged screaming. As I arrived in the reception area, I saw where all the noise was coming from: A teenaged girl was in a hair-pulling tug-of-war with her mother, all the while cursing her at the top of her lungs. The mother seized the girl's handbag and turned it upside down. Dozens of tiny white pills spilled out all over the floor.

I knew right away this was my patient. I was still a young doctor back then, but I had been in medicine long enough to realize that the hospital staff had dealt with this girl before. They knew I was coming and were taking advantage of the new guy by passing a difficult patient off to me.

The nurse behind the reception desk took one look at me and pointed at the battle going on before us. "You must be Dr. Sacker," she said. "That's Julia. You can use exam room A."

I somehow managed to get Julia and her mother into the exam room without getting punched in the process. When I was able to take a closer look at Julia, I was shocked. This blue-eyed, blond girl was about five foot four and terribly underweight. She looked as if every bone in her body could break at any moment. She was so thin I couldn't understand how she could even stand up, much less put up such a fight. In fact, I couldn't really understand why she wasn't dead.

Putting on my best professional manner, I introduced myself: "Hi, I'm Dr. Sacker, the new fellow in adolescent medicine."

Her response was short and to the point: "I don't want to talk to you." Then she resumed screaming at her mother.

Still using my best professional manner to cover the mounting panic I was feeling, I tried to get her to calm down. I looked over to her mother and realized immediately that there wasn't going to be any help there. Julia's mother was in shock and clearly needed someone else to handle this. All I could get out of her was that her daughter had been diagnosed with anorexia nervosa -- a disease I had vaguely heard of but never seen, much less treated.

I tried again and still couldn't get through to Julia. I couldn't even begin to take a history. Finally, I sent her mother out of the room, and Julia calmed down enough for me to get some much-needed information. She told me those tiny white pills were to suppress her hunger. I told her she needed to be hospitalized, now.

She looked at me, laughed, and refused -- totally, absolutely, adamantly.

I was at a loss. If this girl didn't get medical attention at once, she was going to die. I called my supervising physician (whom I had yet to meet face-to-face). Trying to sound competent and unflustered, I told him my patient was out of control, needed immediate treatment, and was refusing voluntary admission. What was I supposed to do now?

He told me that if she obviously needed treatment but was refusing admission, she had to be sent to the county hospital's general psychiatric unit. The procedure, he said, was to call a county ambulance. The attendants would come and put her in restraints; then they would drive off with her, and with any luck I'd never see her again.

Great, I thought. It's not even nine in the morning of my first day and I'm having my first patient put into restraints and sent off in an ambulance. I followed procedure. Julia was taken away. Her mother left. OK, not my problem anymore -- next patient, please.I spent the rest of the day seeing adolescents in the outpatient clinic, and by the end of the day I felt like a real doctor again. I was also completely wiped out from the combination of stress and jet lag. I went home to my new apartment and collapsed into bed.

At three in the morning, the phone rang. It was a state police officer. He told me that he had a missing person named Julia in custody. She had managed to escape from the county psych unit and make her way home to her mother's house. Her mother, however, had refused to let her in, and Julia had then proceeded to break every window in the house. That was amazing enough, but what the officer said next just astonished me: "She says you're her doctor. What do you want to do?"

Good question, I thought. "Put her on the phone."

"I'll come to the hospital," Julia said. I didn't have to say anything. She had clearly figured out for herself that between the county psychiatric unit and me, I was the better choice.

The next morning, Julia was waiting for me. She was calm, controlled, and ready to be admitted. At this point, understandably, it was her mother who was the wreck. We once again went into an exam room, and now Julia was willing to give me her medical history. She had been restricting her food intake and using appetite suppressants for more than eighteen months. She had lost forty pounds.

I told her that while I could treat her medically and save her from dying of self-starvation, she also needed psychiatric care. I very frankly told her that I didn't know anything about anorexia. As it turned out, the psychiatrist who was called in to evaluate her didn't know anything about anorexia either. In 1970, very few did.

Julia's psychiatrist gave her large doses of heavy-duty tranquilizers while I worked out a nutrition plan that would gradually help her regain weight without causing additional medical problems. At first we had to give her a liquid formula using a nasogastric tube -- an unpleasant procedure for everyone.

During the first week Julia was on the adolescent floor, I was very worried about her. I was afraid she would die of severe malnutrition despite our efforts. It was clear from the start that her sole goal and interest in life was to lose as much weight as she possibly could. Other than that, all I could tell about her was that she was an angry young woman.She refused to talk to the psychiatrist, saying instead that she wanted to talk to me. But I protested, saying, "I don't know anything about anorexia. I don't think I can help you." And yet, at the same time, I felt drawn to Julia -- something about her behavior reminded me of myself. My own adolescence hadn't been easy, and deep down I thought I understood, at least a little, how she felt. Like me at that age, she had not a clue as to her own identity.