AdvanceAcclaim for Next to Nothing ‘‘Wise, hopeful, funny, and inspiring. Next to Nothing unravels the mys- teriesofeatingdisordertreatmentandrecovery.CarrieArnoldmakessense outoftheconfusionassheguidesusalongherpersonaljourneyofhealing. IwishmyfamilyandIcouldhavereadthisbookduringmystrugglewith anorexiaand bulimia. This isamust-read!’’ –Jenni Schaefer, author of Life Without Ed: HowOne Woman Declared Independencefrom Her Eating Disorder andHowYou CanToo ‘‘In this well-written and readable book, Carrie Arnold guides the ado- lescent with an eating disorder through what to expect in the recovery processusingherownoften-bumpyrecoveryasillustration.Providingtips foreverydaysurvivalintherealworldandabroaderviewtohelpstaythe coursetohealth,hermessageisapowerfulandencouragingone,madeall the more believable to the adolescent sufferer because she has been there. Carrie also provides information on internal thoughts of the eating dis- order that can help parents gain insight into what their adolescent is ex- periencing and how they might respond.’’ –KathleenA. Mammel, M.D., Chief, Adolescent Pediatrics, WilliamBeaumontHospital, and Clinical Assistant Professor of Pediatrics, Wayne StateUniversity ‘‘Humor and stark honesty are Arnold’s trademarks. Most writers un- critically throw in everything that has ever been said of eating disorders; Arnold pares itdown to up-to-date andaccessible science.Thisbookisa wonderfulcombination of wit and wisdom.’’ –Laura Collins, author of Eating with Your Anorexic ‘‘Thisbookisaninsightfulaccountofoneperson’sstrugglewithaneating disorder.Itoffersahelpfulmixofinformation,rangingfromthepersonal totheprofessional.Iexpectthisbookwillbehelpfultoyoungadultswith an eating disorder and their families.’’ –Daniel leGrange,Ph.D., AssociateProfessor of Psychiatry and Director, Eating Disorders Program at The University of Chicago The Annenberg Foundation Trust at Sunnylands’ AdolescentMental Health Initiative PatrickE. Jamieson,Ph.D.,series editor InadditiontoNexttoNothing,otherbooksinthis seriesforyoungpeopleareplannedonthefollowingtopics: BipolarDisorder(2006)—nowavailable: MindRace:AFirsthandAccountofOneTeenager’s ExperienceWithBipolarDisorder, byPatrickE.Jamieson,Ph.D.,withMoiraA.Rynn,M.D. Depression(2007)—nowavailable: MonochromeDays:AFirsthandAccountofOneTeenager’s ExperienceWithDepression, byCaitIrwin,withDwightL.Evans,M.D.,andLindaWasmerAndrews SocialAnxietyDisorder(2007)—nowavailable: WhatYouMustThinkofMe:AFirsthandAccountofOne Teenager’sExperienceWithSocialAnxietyDisorder, byEmilyFord,withMichaelLiebowitz,M.D.,andLindaWasmerAndrews Schizophrenia(2007) Me,Myself,andThem:AFirsthandAccountofOneYoungPerson’s ExperienceWithSchizophrenia, byKurtSnyder,withRaquelE.Gur,M.D.,Ph.D.,andLindaWasmerAndrews Obsessive-CompulsiveDisorder(2008) TheThoughtthatCounts:AFirsthandAccountofOneTeenager’sExperienceWith Obsessive-CompulsiveDisorder,byJaredDouglasKant,withMartinFranklin,Ph.D., andLindaWasmerAndrews SubstanceAbuse(2008) ChasingtheHigh:AFirsthandAccountofOneYoungPerson’sExperienceWith SubstanceAbuse,byKyleKeegan,withHowardB.Moss,M.D.,andBerylLieffBenderly SuicidePrevention(2008) EightStoriesUp:AnAdolescentChoosesHopeOverSuicide, byDeQuincyA.Lezine,Ph.D.,withDavidBrent,M.D. Alsoavailableintheseriesforparentsandotheradults: IfYourAdolescentHasDepressionorBipolarDisorder(2005) DwightL.Evans,M.D.,andLindaWasmerAndrews IfYourAdolescentHasanEatingDisorder(2005) B.TimothyWalsh,M.D.,andV.L.Cameron IfYourAdolescentHasanAnxietyDisorder(2006) EdnaB.Foa,Ph.D.,andLindaWasmerAndrews IfYourAdolescentHasSchizophrenia(2006) RaquelE.Gur,M.D.,Ph.D.,andAnnBradenJohnson,Ph.D. Next to Nothing A Firsthand Account of One Teenager’s Experience With an Eating Disorder Carrie Arnold withB.TimothyWalsh,M.D. The Annenberg FoundationTrust atSunnylands’ AdolescentMentalHealth Initiative 1 2007 1 OxfordUniversityPress,Inc.,publishesworksthatfurther OxfordUniversity’sobjectiveofexcellence inresearch,scholarship,andeducation. TheAnnenbergFoundationTrustatSunnylands TheAnnenbergPublicPolicyCenteroftheUniversityofPennsylvania OxfordUniversityPress Oxford NewYork Auckland CapeTown DaresSalaam HongKong Karachi KualaLumpur Madrid Melbourne MexicoCity Nairobi NewDelhi Shanghai Taipei Toronto Withofficesin Argentina Austria Brazil Chile CzechRepublic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore SouthKorea Switzerland Thailand Turkey Ukraine Vietnam Copyright#2007byOxfordUniversityPress,Inc. PublishedbyOxfordUniversityPress,Inc. 198MadisonAvenue,NewYork,NewYork10016 www.oup.com OxfordisaregisteredtrademarkofOxfordUniversityPress Allrightsreserved.Nopartofthispublicationmaybereproduced, storedinaretrievalsystem,ortransmitted,inanyformorbyanymeans, electronic,mechanical,photocopying,recording,orotherwise, withoutthepriorpermissionofOxfordUniversityPress. LibraryofCongressCataloging-in-PublicationData Arnold,Carrie,1980– Nexttonothing:afirsthandaccountofoneteenager’sexperiencewithaneatingdisorder/ byCarrieArnoldwithB.TimothyWalsh. p. cm.—(AnnenbergFoundationTrustatSunnylands’adolescentmental healthinitiative) ‘‘TheAnnenbergFoundationTrustatSunnylands,theAnnenbergPublicPolicyCenter.’’ Includesbibliographicalreferencesandindex. ISBN978-0-19-530965-2;978-0-19-530966-9(pbk.) 1. Arnold,Carrie,1980—Mentalhealth. 2. Eatingdisordersinadolescence—Patients— Biography. 3. Eatingdisorders—Treatment. I. Walsh,B.Timothy,1946– II. Title. RJ506.E18A762007 618.92'85260092—dc22 [B] 2007004753 9 8 7 6 5 4 3 2 1 PrintedintheUnitedStatesofAmerica onacid-freepaper Contents Foreword ix Preface xiii One A Very Heavy Weight: Life With Anorexia and Bulimia 1 ConsumedbyED 2 Obsessing About Food 4 Grabbing Hold of Recovery 7 The Face in the Mirror 9 Two Evolution of an Eating Disorder 12 Inthe Beginning 13 JustFive Pounds... 16 Atlanta, GA 17 Impatient Inpatient 20 Treatment inPhiladelphia 23 Hospitalization, Take Two 25 vi Contents Three The Basics: What You Need to Know About Eating Disorders 27 Eating Disorders Defined 28 What Causes Eating Disorders? 33 Medical Dangers 46 Diseases That FrequentlyCo-occur With Eating Disorders 49 DiagnosticMigration 53 So, What Next? 54 Four After the Diagnosis: Getting the Right Treatment for You 55 Seeking Help 56 Goals of Treatment 58 Starting Treatment 59 Close-up onthe Treatment Team: WhoThey Are and What TheyCan DoforYou 61 Intensive Treatment Options 77 Recovery inAny Setting 82 Five The Personal Challenges of Recovery: Practical Tips 84 Accepting That YOUHave anEating Disorder 85 Strategies and Techniquesfor Maintaining Recovery 85 Medical Issues inRecoveryand Beyond 97 Foodfor Life 98 Recovery at All Costs 100 Six Dealing With the World While in Recovery 101 Talking toFamily and Friends About YourEating Disorder 102 Enlisting Support During Recovery 103 Dealing With Dumb Comments,Part I 105 Contents vii Everyday Life: The 23hoursEach Day WhenYou’re Not inTherapy 106 Walking the Walk and Talking the Talk 110 Seven Relapse: There and Back Again 112 OneStep Forward,Two Steps Back 114 Return to Anorexia 117 Back in Residential Treatment 120 Relapse Prevention 120 Dealing With DumbComments, Part II 122 Eight Closure 124 Appendix: For Caregivers of Young People With Eating Disorders 129 Some Frequently Asked Questions for the Recently Diagnosed 137 Glossary 147 Resources 151 Bibliography 159 Index 161 This page intentionally left blank Foreword The Adolescent Mental Health Initiative (AMHI) was created by The Annenberg Foundation Trust at Sunny- lands to share with mental health professionals, parents, and adolescents the advances in treatment and prevention now available to adolescents with mental health disorders. The Initiative was made possible by the generosity and vision of Ambassadors Walterand Leonore Annenberg, andtheproject was administered through the Annenberg Public Policy Cen- ter of the University of Pennsylvania in partnership with Oxford University Press. The Initiative began in 2003 with the convening, in Phi- ladelphiaandNewYork,ofsevenscholarlycommissionsmade up of over 150 leading psychiatrists and psychologists from around the country. Chaired by Drs. Edna B. Foa, Dwight L. Evans, B. Timothy Walsh, Martin E. P. Seligman, Raquel E. Gur, Charles P. O’Brien, and Herbert Hendin, these com- missions were tasked with assessing the state of scientific re- search on the prevalent mental disorders whose onset occurs predominantlybetweentheagesof10and22.Theircollective ix