Increased Precautions We're Taking in Response to COVID-19
As updates on the impact of the coronavirus continue to be released, we want to take a moment to inform you of the heightened preventative measures we have put in place at McCallum Place Eating Disorder Center to keep our patients, their families, and our employees safe. All efforts are guided by and in adherence to the recommendations distributed by the CDC.

Please note that for the safety of our patients, their families, and our staff, on-site visitation is no longer allowed at McCallum Place Eating Disorder Center.

  • This restriction has been implemented in compliance with updated corporate and state regulations to further reduce the risks associated with COVID-19.
  • We are offering visitation through telehealth services so that our patients can remain connected to their loved ones.
  • Alternate methods of communication for other services are being vetted and may be offered when deemed clinically appropriate.

For specific information regarding these changes and limitations, please contact us directly.

CDC updates are consistently monitored to ensure that all guidance followed is based on the latest information released.

  • All staff has received infection prevention and control training.
  • Thorough disinfection and hygiene guidance has been provided.
  • Patient care supplies such as masks and hand sanitizer are being monitored and utilized.
  • Temperature and symptom screening protocols are in place for all patients and staff.
  • Social distancing strategies have been implemented to ensure that patients and staff maintain proper distance from one another at all times.
  • Cleaning service contracts have been reviewed for additional support.
  • Personal protective equipment items are routinely checked to ensure proper and secure storage.
  • CDC informational posters are on display to provide important reminders on proper infection prevention procedures.
  • We are in communication with our local health department to receive important community-specific updates.

The safety of our patients, their families, and our employees is our top priority, and we will remain steadfast in our efforts to reduce any risk associated with COVID-19.

The CDC has provided a list of easy tips that can help prevent the spread of the coronavirus.

  • Avoid close contact with people who are sick.
  • Cover your cough or sneeze with a tissue and then immediately dispose of the tissue.
  • Avoid touching your eyes, nose, and mouth.
  • Clean and disinfect objects and surfaces that are frequently touched.
  • Wash your hands often with soap and water for at least 20 seconds.
  • Stay home when you are sick, except to get medical care.

For detailed information on COVID-19, please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html

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Make My Anxiety Better, but Don’t Make Me Gain Weight

Lots of patients come to me struggling with anxiety and eating disorders and aren’t ready to address the eating disorder, but want their anxiety to get better. Their anxiety is often super distressing, and they want relief from their suffering. On the other hand is the patient’s eating disorder, which they may not want to address or even acknowledge its existence.

Trust me, I want to provide relief for the patient’s anxiety. I understand patients with eating disorders are often greatly suffering from their anxiety symptoms as well. I’m often stuck in a catch 22. Patients want to get treatment for their anxiety, but treat their eating disorder? No way! Here’s the problem: I can’t treat one without treating the other.

Anxiety disorders are what we call ego dystonic, meaning they’re distressing to the individual and the individual recognizes that it’s a problem. However, eating disorders for some patients, can be ego syntonic, meaning they’re not distressing and the individual doesn’t see them as a problem. It’s really difficult to treat people for a disorder they don’t recognize is a problem.

Anxiety disorders are hugely prevalent in patients with eating disorders. About two thirds of people with an eating disorder also have an anxiety disorder. This makes sense to me. People struggling with general anxiety, worry, and obsessional thinking might find these thought patterns eventually start to zero in on eating and exercise behaviors. A patient suffering with both anxiety and an eating disorder are often in a nutritionally deficient state. This is a key difference.

When a person is in a nutritionally deprived state, his or her brain isn’t functioning at full capacity. Dr. Kim McCallum, the founder of McCallum Place Eating Disorder Centers, calls it “hungry brain.” Malnourished individuals experience rigid and perseverative thinking, which are often hallmarks of anxiety disorders. As you can see, symptoms of malnourishment often mimic anxiety symptoms.

We also know that the mainstays of treatment for anxiety (antidepressants) aren’t effective if a person is underweight. Antidepressants work by modulating neurotransmitters. Neurotransmitters are derived from nutrients, and if you don’t have enough nutrients available you can’t make neurotransmitters for the medications to work on. To put it simply, if you don’t have the ingredients (the building blocks for neurotransmitters), you can’t make the recipe for improvement in symptoms (changed levels of neurotransmitters).

SSRI diagram

Like my drawing?  I was impressed with myself 🙂

So when someone comes to me in a malnourished state wanting help just for their anxiety disorder my response has to be, “I need to help your eating disorder or else your anxiety won’t get better.”  It would be impossible for me to make a person’s anxiety better if they’re in a malnourished state.  So try to be open to what your mental health care provider recommends when treating your anxiety…and your eating disorder.

 

References
Kaye WH, Bulik MC, Thornton L, Barbarich N, Masters K. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry. 2004;161(12):2215–21.
Gregertsen Eva C., Mandy William, Serpell L.  The Egosyntonic Nature of Anorexia: An Impediment to Recovery in Anorexia Nervosa Treatment.  Frontiers in Psychology.  Volume 8, December 2017, Article 2273.  URL=https://www.frontiersin.org/article/10.3389/fpsyg.2017.02273
Jimerson DC, Lesem MD, Kaye WH, Brewerton TD. Low Serotonin and Dopamine Metabolite Concentrations in Cerebrospinal Fluid From Bulimic Patients With Frequent Binge Episodes. Arch Gen Psychiatry. 1992;49(2):132–138. doi:10.1001/archpsyc.1992.01820020052007
Josefina Castro-Fornieles, Elena de la Serna, Anna Calvo, Anna Blázquez, Jaime Moya, Luisa Lázaro, Susana Andrés-Perpiñá, María Teresa Plana, Laia Gil, Itziar Flamarique, Esteve Martínez, Jose Pariente, Elena Moreno, Nuria Bargallo,  Functional MRI with a set-shifting task in adolescent anorexia nervosa: A cross-sectional and follow-up study, Neuropsychologia, Volume 131, 2019, Pages 1-8, https://doi.org/10.1016/j.neuropsychologia.2019.05.019.
Martine F. Flament, Hany Bissada, Wendy Spettigue, Evidence-based pharmacotherapy of eating disorders, International Journal of Neuropsychopharmacology, Volume 15, Issue 2, March 2012, Pages 189–207, https://doi.org/10.1017/S1461145711000381
Phillipa J. Hay, Angélica M. Claudino, Clinical psychopharmacology of eating disorders: a research update, International Journal of Neuropsychopharmacology, Volume 15, Issue 2, March 2012, Pages 209–222, https://doi-org.beckerproxy.wustl.edu/10.1017/S1461145711000460

 

About Celeste Herleth, M.D., Psychiatrist

Dr. Herleth graduated from Tulane University School of Medicine in 2009. She completed her residency in psychiatry at Barnes Jewish Hospital in St. Louis. She has been board certified in psychiatry since 2013. Prior to her work with McCallum Place, she served as the medical director of the anxiety disorder program at St. Louis Behavioral Medicine Institute. She also has been the director of the eating disorder team at Washington University in St. Louis’s undergraduate campus. Her interests include treating eating disorders, eating disorders in athletes, and anxiety disorders.

View all posts by Celeste Herleth, M.D.