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Overcoming an eating disorder: a glimpse into one woman’s journey Cynthia Nelson, a 31-year-old Houstonian, understands the impact of eating disorders. She struggled with anorexia nervosa for 11 years and says she still battles negative thoughts about her size almost daily. Nationally recognized experts will discuss eating disorders treatment at the 2008 Eating Disorders Conference of Houston: Perspectives on Treatment and Prevention, on Friday, February 22, at the “Negative self-image is one of the most difficult things to change when treating an eating disorder and is the last symptom to resolve from treatment,” says Theresa Fassihi, PhD, a psychologist with the Eating Disorders Program at The Menninger Clinic, who will be presenting at the conference on self-image and the risk for relapse. “If a patient does not make some improvement on body image issues early in treatment, it is a significant risk factor for relapse into the eating disorder.” Cynthia attests to the difficulty of reaching the decision to “give up your eating disorder” in order to get on the road to a healthy weight and eventually, recovery. Cynthia explains that her eating disorder became such a part of her identity that the thought of giving it up seemed impossible. At age 17, when Cynthia was first diagnosed with anorexia, her eating disorder began to rule her life. As a perfectionist, being skinny became her way of trying to feel good enough at something, please everyone and eventually became her primary focus. “Being from an affluent area where everything is important, from your grades to how you look, I remember being self-conscious about my body beginning in junior high school,” says Cynthia. “My junior year is when I remember noticing models on TV and in magazines and thinking how great it would be if I looked like them. I started losing weight to look better and to be accepted by everyone. Eventually it was the only thing I could think about.” During her senior year in high school, Cynthia’s eating disorder escalated to the point her parents decided to find an outpatient treatment program for her. Because the eating disorder had consumed her entire identity, Cynthia didn’t care to engage in treatment. She was eventually hospitalized and fed through a feeding tube. Although she was close to dying, all she cared about was losing weight. She was stabilized enough to enter a treatment center specifically for people struggling with eating disorders. That is where she learned about anorexia and the underlying reasons for why she was starving herself. Treatment professionals helped Cynthia learn how to make use of therapy and gain weight. It would take 10 more years of therapy followed by relapses and several more hospitalizations for Cynthia to struggle through giving up, one piece at a time, the eating disorder that defined her. According to Dr. Fassihi, “on average, it takes three to seven years for people with eating disorders to fully recover and lapses or relapses are a common part of the process. With treatment and hard work, up to 90 percent of people with eating disorders can fully recover.” “I experienced a lot of self-hatred, mostly because I never thought I lost enough weight,” Cynthia explains. “My sister and friends didn’t like to go to the mall with me because the entire time I would compare myself to others, constantly afraid there was someone skinnier than me.” Cynthia counts her blessings that her family did not give up on her. She said it wasn’t easy for them. “It was difficult for my younger sister, who was afraid I was going to die. Plus, there was some denial from my family at first, but they got through that and learned how to offer support for someone with an eating disorder, which was critical during the long recovery process.” During her last hospitalization, Cynthia achieved a normal weight and has been able to maintain her weight for the past five years. Cynthia continues to see a therapist and dietitian to help her stay on track. She said her obsession with body image remains a challenging part of her life, but she is determined not to miss out on anything else in life like she did when her life was consumed by anorexia. Although Cynthia had to wait a year after high school to go to college, because of her struggles with anorexia, she was able to complete an undergraduate degree in philosophy and biology and obtain a master’s degree in public health. She is currently enrolled in a master of science physician assistant program. Upon graduating, she plans to work in pediatrics and clinical research. She believes the most important message she can convey to parents and families of people with eating disorders is to catch the signs of the disease early. Eating disorders experts agree, people with eating disorders have a better chance of recovering if they enter treatment within the first six months of any signs of an eating disorder. “Early intervention offers the best prognosis for recovery, and recovery tends to happen more quickly because the behaviors are not as entrenched,” says Dr. Fassihi. Additional topics to be covered at the Eating Disorders Conference of Houston include the prevention of eating disorders and obesity in children. In the More about the conference and speakers can be found at http://www.menningerclinic.com/calendar/EatingDisordersConf.pdf. The conference is underwritten by the Stanford and Joan Alexander Foundation of For more information, call Menninger at 713-275-5060. ### The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to For interviews with Cynthia or other persons recovering from eating disorders, call Shelli Manning at 713-275-5031 or e-mail smanning@menninger.edu. Help your teen through a breakup “Some relationships may seem so intense and so necessary that teenagers harm themselves when the relationship ends,” says Norma Clarke, MD, a child psychiatrist at The Menninger Clinic and medical director of The Clinic’s Adolescent Treatment Program. Dr. Clarke says she has treated patients who have attempted suicide, cut themselves and abused alcohol or drugs because they have trouble dealing with a breakup. An argument with a boyfriend or girlfriend is the second most common reason that teens attempt suicide, according to an A breakup signals to parents to be alert for signs of trouble in their teen’s emotional health, because they often keep their feelings secret. “If your teen falls off the deep end and you have a sense that you are losing control of him or her, you need to intervene,” says Dr. Clarke, also an assistant professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. Sudden changes in your teen’s behavior may also be signs that he or she is having relationship problems, she adds. Signs a relationship have gone too far
What parents can do
“Parents tend not to talk to kids about relationships or sexual behavior,” Dr. Clarke says. “Keeping an open line of communication about friends of all types, activities and expectations is more welcomed by your child than may be apparent. I don’t think parents realize the impact they have on their teenager’s behavior.” The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to
“Negative self-image is one of the most difficult things to change when treating an eating disorder and is the last symptom to resolve from treatment,” says Theresa Fassihi, PhD, a psychologist with the Eating Disorders Program at The Menninger Clinic, who will be presenting at the conference on self-image and risk for relapse. The conference, open to health professionals for continuing education credit as well as families and the public, kicks off National Eating Disorders Awareness Week, February 24 to March 1. Additional topics covered at the conference will include the prevention of eating disorders and obesity in children. In the Award-winning author and eating disorders expert Margo Maine, PhD, will deliver the 9 am keynote address, titled, “What’s Age Got to Do With It? Adult Women, Eating Disorders & Body Image Despair.” Dr. Leslie Goldman, noted health writer and author of Locker Room Diaries: The Naked Truth About Women, Body Image and Re-imagining the ‘Perfect’ Body, will deliver the noon luncheon presentation. Goldman will share her personal experience with anorexia and her success after medication and therapy, and stories about the women she interviewed for her book. The conference will feature a panel discussion at 1:30 pm on prevention of eating disorders. Panelists include:
Between sessions, conference attendees may also view informational exhibits on eating disorders, including interactive exhibits on self-image, and obtain information about treatment resources. The conference is underwritten by the Stanford and Joan Alexander Foundation of The conference schedule and online registration form are accessible at: MenningerClinic.com, HPAonline.org; HAMFT.org and MHAHouston.org. For more information, call Menninger at 713-275-5060. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to
Don’t:
If you suspect someone at your dinner or party has an eating disorder, talk to that person at a later time about your concerns, Dr. Fassihi says. Encourage him or her to see an eating disorder specialist to be evaluated for an eating disorder. If your friend or loved one denies a problem, emphasize the tremendous health risks of eating disorders, especially heart problems, permanent bone loss and death. Early intervention offers people with eating disorders the best prognosis.
The Menninger Clinic unveils plans for Mental Health Epicenter;
Menninger’s Miracles in Mind campaign has raised $69.3 million, and is more than half way to its goal of $125 million. $65.8 million will go toward building the first phase of The Clinic’s new campus. $3.5 million will benefit treatment, research and education programs. Construction on The Epicenter is expected to begin in fall 2008, with a target completion date of summer 2010. “The Epicenter will be a beacon of hope to persons suffering from mental illness and the people who love them,” says Ian Aitken, Menninger CEO and president. “Thanks to the generosity of our supporters, we will achieve our goal to improve mental health worldwide, prevent mental illness and eliminate stigma.” One in five Americans suffers from mental illness. The Menninger Mental Health Epicenter will provide much-needed mental health services for the Research and treatment priorities for The Clinic will include: substance abuse and addictions, personality disorders, mood disorders, anxiety and obsessive-compulsive disorders, trauma-related disorders and neuropsychiatric disorders. The Clinic will also continue to offer comprehensive diagnostic assessments for persons who have complicated symptoms or desire a second opinion. Menninger’s collaboration with “The Epicenter will help advance Houston as a center for excellence in mental health treatment, education and research and to continue to attract leading scientists and clinical specialists to Houston,” says Stuart Yudofsky, MD, D.C. and Irene Ellwood Professor and chairman of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, and chairman of Psychiatry at The Methodist Hospital. “By encouraging collaboration across disciplines, The Epicenter will be a catalyst for exciting new discoveries about the brain and behavior.” The Epicenter will significantly increase the number of mental health professionals Menninger will train to help alleviate shortages locally and nationally. Educating the public about mental health and effectiveness of treatments for mental illness will also be a major focus of The Epicenter, helping to erase the stigma that prevents many people from seeking treatment. Plans for Phase I of The Epicenter include a 144-bed inpatient specialty psychiatric hospital, a brain and behavior research center, administrative buildings, educational facilities, wellness center, nondenominational chapel, dining center and features including meditation and sculpture gardens. The Clinic will cover approximately half of the 50-acre campus. Phase II building plans include facilities for aftercare services for patients, headquarters for mental health organizations, training and education, and an international leadership program. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Psychiatric problems in teens difficult to pinpoint HOUSTON, TX—(October 17, 2007)—Your teen is moody. He’s not doing well in school. He wants to be left alone. Does he have a learning disability? Depression? Or maybe he’s just a normal teen? Pinpointing a diagnosis of psychiatric and behavioral problems in teens can be tricky, even for experts in mental health. The human brain is still developing during adolescence, and as any parent of a teen can attest, mood and behavior can fluctuate wildly at this age. “Teens are by nature secretive and it is sometimes very hard to figure out what is normal and what is not about teen behavior,” says Norma Clarke, MD, medical director of the Adolescent Treatment Program at The Menninger Clinic in Houston. “Also, teens can behave very well in a psychologist’s or counselor’s office, which makes it harder to arrive at a diagnosis.” That’s the first challenge, Dr. Clarke adds, because an accurate diagnosis is an essential step in treating mental illness. For teens struggling with psychiatric or behavioral disorders it can mean the difference between progressing in treatment or remaining stuck in their current situation and often unhealthy pattern. By adolescence, many teens in treatment for behavioral or psychiatric issues have received multiple diagnoses—ranging from ADHD to bipolar disorder. Mood swings and irritability are a common symptom of many disorders, but, depending on the diagnosis, treatment can be drastically different, including the medication and therapy prescribed. When individuals don’t respond to treatment that is not suited for them, they feel like failures. “They feel that they are broken for life,” Dr. Clarke says. “They feel hopeless and think there is something so wrong with them. It affects their self-esteem and their ability to make friends and become the best they can be.” Many parents of teens struggling with psychiatric or behavioral disorders feel helpless because they can’t help their child, Dr. Clarke adds. Menninger recently launched its Adolescent Assessment Program to provide troubled teens and their parents with more clarity around the problems and issues confronting teens. An accurate diagnosis is one aspect of this clarification. While brief, the two-week evaluation is intense and allows the patient, parents and treatment team to get to the heart of the matter. The Program fits the needs of teens and families who aren’t making progress in their treatment and who desire a second opinion. During their two week assessment at Menninger, patients meet with members of the evaluation team, which includes a psychiatrist, psychologist, internist, social worker, rehabilitation specialist, addictions counselor, nursing and senior staff specialists. The treatment team considers patient and family history, parent and patient reports, psychological testing, past treatment records and observations during the patient’s stay. The Program also uses neuropsychiatric diagnostic tools including magnetic resonance imaging (MRI), to pinpoint the possible causes of behavioral and psychiatric problems in patients and rule out an underlying medical condition, such as a brain injury. Patients participate in individual, group and family therapies and learn about coping strategies. Mental health professionals also review medications and other prescribed interventions. Close to the end of the assessment period, team members share their findings during a conference and discuss the patient's diagnoses and treatment goals. Following this conference, the team shares these findings with the adolescent and the parents and involves them in discussing options for next steps in the treatment process and ways to support the teen academically and socially. Patients may continue treatment at Menninger or other programs if indicated. Armed with answers, teens and parents can make decisions about future treatment methods, schooling and life. With their newfound clarity, they also regain hope. “Once they are pointed in the right direction, teens can make positive strides toward recovery and learn how to lead successful lives,” Dr. Clarke says. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Self-injury not limited to teens “Stereotypically people think that self-injury happens only among teenagers and young women, but it also happens with older, middle-aged females and males,” says Harrell Woodson, PhD, director of the Menninger Hope Program, which treats adults with mental illness. The Program is participating in a Clinic-wide initiative to learn more about self-injury and to develop new protocols to treat it, since it is a frequent health issue among Menninger patients. Older patients who injure themselves—commonly by cutting or burning the skin, or banging their heads repeatedly against the wall—are more difficult to treat, Dr. Woodson says. They may have been injuring themselves for such a long time that the behavior has become deeply ingrained. Self-injury can be a sign of a psychiatric disorder, and is common among persons suffering from severe borderline personality disorder, depression or psychosis. While the number of adults who purposely injure themselves is unknown, the behavior may be underreported because many persons who self-injure hide it from others. Left untreated, self-injury and the mental illness that often accompanies it can become dangerous. While most persons who self-injure are not attempting suicide, they may accidentally kill themselves if their behavior goes too far. “Self-injurious behavior can cause irreparable physical damage and can even lead to death, from cutting too deeply, getting an infection or going into shock,” Dr. Woodson says. Why would adults want to hurt themselves?
Treatment Instead, mental health professionals work together with patients to determine how motivated they are to stop their self-injurious behavior. The desire for behavior change needs to come from the patient rather than as a demand from the mental health professional or family members, Dr. Woodson says. Motivational interviewing techniques put the majority of the responsibility for behavior change in the hands of the patient. “With motivational interviewing, you capitalize on the patient’s ambivalence—in terms of the pros and cons of continuing that behavior, in a non-confrontational way,” Dr. Woodson continues. “Traditionally, admonishing people about the consequences of self-injurious behavior doesn’t work very well.” The treatment team on Hope works with patients to discover what triggers a person to self-injure and to develop alternative coping strategies meaningful to that person. One alternative some mental health professionals suggest is to have patients place a rubber band around their arms. Snapping the rubber band creates some pain but no lasting injury. Treatment may also include medication, especially when self-injurious behavior is tied to psychosis, and group therapy. Patients in group therapy discuss what they could do differently in response to particular stressors, situations, thoughts and feelings rather than harming themselves. Groups are an effective form of treatment for self-injury, Dr. Woodson says, because patients learn new insights and adaptive behaviors from their peers as well as receiving support and encouragement. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to High-tech diagnosis yields vital clues into mental illness “Even though a patient may have a straightforward mental health diagnosis or diagnoses, the neuropsychiatric approach can help us rule out medical or neurological reasons for the patient’s symptoms before we settle on a psychiatric reason,” says Florence Kim, MD, director of the Menninger Comprehensive Psychiatric Assessment Service. Launched in April, the Assessment Service provides adults who have behavioral and psychiatric issues with a thorough two-week assessment, including extensive neuropsychiatric testing. The service is designed as one stop for thorough assessment for individuals who are not making adequate progress in other treatment settings, desire a second opinion, require a thorough psychiatric assessment to determine what treatment program may fit their needs or who were referred by their clinician. Patients in the program also undergo a psychiatric evaluation, extensive neuropsychological testing, psychological testing, psychosocial evaluation, a family system study and a neurological consult. Menninger’s affiliation with Baylor College of Medicine provides patients with access to consultants in neuropsychology and neurology for help with brain disorders such as stroke, Alzheimer's disease, multiple sclerosis and traumatic brain injury. The Assessment Service also offers genotyping for patients who don’t respond well to psychiatric medications. A simple blood test can reveal whether a patient may metabolize a drug too fast, which provides the patient with little benefit, or metabolizes the drug too slowly, which can increase the amount of drug that builds up in the body, causing side effects such as nausea. Currently, doctors prescribe psychiatric medications based on their experience of what works best, but they can’t predict how medications will work in each individual patient. As a result, patients may spend several months or years trying to find the best medication with the fewest side effects. The battery of tests used in the assessment yields a wealth of information, providing unique insight into the patient’s mental and behavioral health, in addition to the patient’s personal history. In some cases, the information may reveal an underlying medical condition, such as dementia or damage caused by a brain injury. It may also help better diagnose the type and the severity of mental illness or behavioral disorder the patient may have. The evaluation looks at all facets of a patient’s life and clinical picture before making treatment recommendations. “One of our recent patients, an 18-year-old, came into the program as result of an intervention,” Dr. Kim says. “He had been labeled with a diagnosis, but as a result of our examinations, we were able to clarify that diagnosis. He told us, ‘finally, someone understands what’s going on.’” As a result of his assessment, the patient changed his plans and immediately sought treatment. At the end of a two- to three- week evaluation, the assessment team provides patients with findings and recommendations for their next steps. About half of patients choose to remain at Menninger for their treatment. Patients may also use the assessment to help guide their treatment at other psychiatric facilities, or outpatient treatment. Dr. Kim sees the Assessment Service as an increasingly valuable tool to diagnosis and treat patients with psychiatric disorders. “We are at the beginning of a new age in terms of what we can do for people with psychiatric illnesses,” she says. “In the next 20 to 30 years, we are going to see an explosion in brain research, and we’ll understand so much more about the genetic basis for many conditions. It’s a very exciting time.” The Menninger Clinic is an international specialty psychiatric center, providing innovative programs in treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to The Menninger Clinic ranks 7th in national survey of best psychiatric hospitals Psychiatric hospital ratings are based on the cumulative results of board-certified psychiatrists surveyed in 2005, 2006 and 2007. The psychiatrists were asked to list the five psychiatric hospitals in the Menninger’s six inpatient programs and two diagnostic services specialize in treating adolescents and adults who have a difficult-to-treat psychiatric disorder that may also be complicated by an addiction or other co-occurring psychiatric disorders. The Clinic also operates active research and education programs through its affiliation with Baylor College of Medicine in “Consistently ranking among the best psychiatric hospitals in the country is especially gratifying, because it validates the high quality of care we provide to persons with serious mental illness,” said Ian Aitken, Menninger president and CEO. “Menninger will continue to build on our more than 82-year legacy as a leader in mental health and develop new advancements in mental health research and treatment that will benefit patients.” A complete list of rankings is available from U.S. News & World Report. The Menninger Clinic is an international specialty psychiatric center, providing innovative programs in treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Painkiller abuse continues to grow; new treatments offer hope More than 6 million Americans abuse prescription drugs, according to the U.S. Drug Enforcement Administration. One in 10 teenagers admits to abusing painkillers, such as Vicodin and Oxycontin. Painkillers cause more overdoses than cocaine and heroin combined. "Access to prescription painkillers has never been easier," says addictions psychiatrist Donna Yi, MD, associate chief of staff and clinical director for The Menninger Clinic and assistant professor in the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine. "Many people start taking prescription painkillers for a legitimate reason, for pain after surgery or childbirth, or to deal with chronic pain. As the sense of euphoria and relaxation provided by the drugs gets reinforced, they become increasingly reliant on the drugs even when they no longer need them for pain." Once hooked, patients may doctor shop to get multiple prescriptions to painkillers, forge prescriptions, order painkillers from web sites that don't require prescriptions or take a road trip to Mexico to supply their habits. Teenagers can get prescription painkillers from their parents' medicine cabinets and their friends—even dealers. Because prescription painkillers are so readily available, they don't have the stigma of illegal drugs, like heroin. Yi adds that it may seem much easier and acceptable to swallow a pill than to find a vein, inject yourself with a drug and risk getting AIDS or overdosing. The word "heroin" instantly evokes a negative image—usually that of someone homeless and on the street. However, like heroin, prescription painkillers such as Oxycontin and Vicodin stimulate opiate receptors in the brain, relieving pain and providing a sense of euphoria, and are highly addictive and difficult to quit without medical intervention. Because opiates are so rewarding and reinforcing, once a person stops using them, the body goes into shock and withdrawal. Symptoms of withdrawal are similar to a severe case of the flu and may include fever, vomiting, diarrhea, muscle and bone pain, insomnia, cold flashes with goose bumps and involuntary leg movements. To avoid pain, many people abusing painkillers keep using. New medications help painkiller abusers avoid the painful symptoms of withdrawal and cut the time of withdrawal. The drug buprenorphine was approved by the FDA in 2002 to help ease the symptoms of detoxification and radically decreases the time of detox from an average of two weeks to one or two days. Buprenorphine is a safer alternative to methadone and is available in a convenient pill form. The medication speeds a patient's entry into treatment, cutting down the time he or she is in bed and feeling uncomfortable withdrawal symptoms and drug cravings. Staff at The Menninger Clinic, trained by addictions psychiatrist Dr. Thomas Kosten, began administering buprenorphine to patients undergoing detox in 2007. Kosten, Jay H. Waggoner Professor of Psychiatry & Behavioral Sciences at the Menninger Department of Psychiatry at BCM and research director of the Veteran Affairs National Substance Use Disorders Quality Enhancement Research Initiative, played an instrumental role in discovering the proper dose of the drug to treat humans with opiate dependence. Patients may have accompanying mental illness and issues driving their addiction, such as anxiety, depression, life stresses, relationship problems, personality disorders or poor coping skills. A successful treatment program for addiction includes a thorough patient assessment and offers group and individual therapy, psychoeducation and access to self-help groups. Patients' families are also involved in the treatment process. Relapse rates for patients who abuse painkillers are high, so creating a relapse prevention plan is crucial. Patients at Menninger leave with a wellness plan that might include appointments with therapists, support group meetings and exercise to improve their mood and health. Patients also learn the signs and symptoms that constitute a lapse, so they can stop a full-blown relapse. Some patients may also need medications on a continual basis, such as prenorphine or naltrexone, to help them avoid relapse. Both buprenorphine and naltrexone block the effects of opiates on the body. Patients who take buprenorphine, however, will feel mild withdrawal symptoms if they stop taking the drug—reminding them to consistently take their medicine. Doctors often prescribe a version of buprenorphine, combined with another opiate-blocker, naloxone, to guard against the intravenous use of buprenorphine. If the drug combination is injected, the naloxone can cause that person to quickly go into withdrawal. "As the supply and variety of painkillers increase, more people will try them for non-medical reasons, and some will become addicted," Yi says. "Increased awareness, new medications used to treat painkiller abuse and novel therapies offer hope for people struggling with painkiller abuse." (Editor's note: For more news on addiction, visit Baylor College of Medicine's addiction Web package. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Hoarding behavior poses health risks, needs professional help But the problems of people who compulsively hoard clutter go beyond a disorganized home and can’t be solved neatly in a half-hour home organization show or magazine article. Hoarders have a brain disorder resulting in an all-consuming compulsion to collect that often cuts them off from society and damages their relationships. In severe cases, clutter can get so out of control it can endanger lives—as in the case of a “Hoarding is different from being disorganized or not prioritizing,” says John Hart, LCPC, a behavior therapist with the Menninger Obsessive-Compulsive Disorders Treatment Program who treats patients who hoard. “If there is a pathological accumulation of stuff in their home, then something has gone pretty desperately wrong.” A sub-type of obsessive-compulsive disorder, hoarding is the compulsion to collect and store items considered by most people to be worthless or useless. Little is known about what causes hoarding, but like many mental disorders, it is believed in part to have a genetic cause. In some cases, a loss or other significant life event can trigger hoarding behavior. Hoarding behavior may also be present in persons with dementia. The motivation driving the compulsion to hoard varies among persons with the behavior. Some persons who hoard receive pleasure out of collecting items they want, for example a person who loves to shop sales. Even when their purchases begin to overtake their house, they may not think they have a problem. “Friends and family may see the hoarding as a bigger problem than the person who hoards,” Hart says. “They come to visit and there is no place to sit down because of all the clutter.” Other persons who hoard may feel they have no control over their behavior, for example, they feel they must hold on to every piece of mail with their names on it, in case they need it some day, or out of fear of someone using that information against them. Some persons, out of love for animals, may keep too many pets in their home—another form of hoarding. Persons who hoard often have extreme problems with making decisions. Instead of facing the decision to throw something away, they just avoid it. “They have a hard time seeing the big picture,” Hart says. “They don’t see how a little decision, like keeping an old magazine because they haven’t yet read it, can turn into a whole big mess. They have a hard time moving from the particular to the general.” Well-meaning family and friends may try to help by clearing all the clutter away from the hoarder’s home—a temporary solution at best. Without mental health counseling, hoarders usually will go back to hoarding again. For severe cases of hoarding, inpatient treatment may help by removing the person from their hoarding environment and evaluating whether they may also have a co-occurring psychological problem, such as depression or anxiety, Hart says. Patients in the Menninger OCD Treatment program who hoard participate in cognitive behavioral therapy and learn decision making skills. They also work on their beliefs about hoarding, and learn to understand their emotional reaction when they throw items away. For treatment to be successful, it must also happen where the patients hoard. “It is important that they receive some sort of therapeutic help in the home,” Hart says. “It is usually the best strategy for the therapist to train family or friends or volunteers how to help.” The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Web site to mark progress, promote Epicenter The site:
As the campaign moves forward, we invite you to visit MiraclesInMind.com. This summer, Menninger will expand the site to spotlight philanthropic gift announcements, comments from donors and the forthcoming campaign newsletter. Second annual Menninger luncheon exceeds expectations The event raised $150,000 to support research for the treatment of obsessive-compulsive and anxiety disorders. The luncheon, presented by the MBM Foundation Board of Visitors, was chaired by Charles LeMaistre, MD, and Andreae Behlen LeMaistre. The highlight of the program was the presentation of the Menninger Hope Award in memory of the late Lee Hage Jamail for her exemplary achievements in mental health. Dr. Kim heads new Assessment Service
Dr. Kim is a board-certified adult psychiatrist with additional subspecialty training in neuropsychiatry. Prior to joining Menninger, she served as medical director of Neuropsychiatry Programs in the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine (BCM). “The Menninger Clinic is fortunate to have Dr. Kim join our staff,” says Donna Yi, MD, associate chief of staff and clinical director for The Menninger Clinic. “She brings diagnostic and research expertise in the area of neuropsychiatric disorders and is highly regarded for her clinical acumen.” Dr. Kim will oversee Menninger’s new Assessment Service. The service is designed for individuals who are not making adequate progress in other treatment settings, desire a second opinion, require a thorough psychiatric assessment to determine what treatment program may fit their needs, or who were referred by their clinician. The service provides individuals with behavioral and psychiatric issues with a thorough two-week assessment, including extensive neuropsychiatric testing. “Our Assessment Service adds a valuable diagnostic dimension to the patient’s care from the outset that will help inform and drive his or her subsequent treatment,” Dr. Kim says. Dr. Kim had been at Baylor College of Medicine since 1994, completing medical school, residency and fellowship training. She completed her undergraduate studies at Harvard University, where she graduated magna cum laude with a bachelor of arts degree in anthropology. In addition to her clinical work in neuropsychiatry, Dr. Kim has been active in research, participating in the master’s degree program of the BCM Clinical Scientist Training Program. Her research has focused on cognition in bipolar disorder and psycho-oncology. Honors received include a National Alliance for Research in Schizophrenia and Depression (NARSAD) Young Investigator Award, BCM Mentored Clinical Investigator Award, American College of Psychiatrists Laughlin Fellowship, American Psychiatric Association (APA)/Lilly Resident Research Award, National Institute of Mental Health/Upjohn Outstanding Resident Research Award, APA/Program for Minority Research Training in Psychiatry Research Fellowship and the American Psychiatric Institute for Research on Severe Mental Illness Fellowship. Dr. Kim also is the author of several book chapters and the co-editor of the book, Neuropsychiatric Assessment, in the Review of Psychiatry series. The Menninger Clinic is a nonprofit international specialty psychiatric center, providing innovative programs in treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Can you exercise too much? Mental health experts say yes. Are you exercised obsessed, or just an avid exercise enthusiast? That depends on your attitude, say mental health experts. If you exercise frequently because you enjoy it and you like the health benefits it provides, you have the right reasons in mind. If you exercise because you feel compelled to do so, and in spite of having injuries, you may be at risk for developing an exercise disorder. “There is no set formula or standard that reveals how much exercising is too much,” says Theresa Fassihi, PhD, a psychologist with the Eating Disorders Program at The Menninger Clinic. “But if exercising is interfering in a person’s life, and it is compulsory, then it may be a problem.” Dr. Fassihi treats patients in the Eating Disorders Program who over exercise in an attempt to burn off calories, build muscle or attain physical perfection. It is common for patients with exercise disorders to also have an eating disorder, Fassihi says. Problems occur when body perception doesn’t match reality. As with eating disorders, persons involved in activities or professions that require physical beauty or high levels of physical performance—such as athletes and dancers—are particularly vulnerable to developing exercise disorders. High achievers with perfectionist personalities are also vulnerable. Both men and women can have an exercising disorder, but they often have different goals for their exercise regimens. Women seek the “lean look” and typically exercise aerobically to become thin. Men want to bulk up and lift weights to increase muscle mass. “If you have an exercising disorder, you also may be very preoccupied about your body’s appearance, weight and muscle mass.” Dr. Fassihi says. “You spend a lot of time looking at yourself, scrutinizing yourself, measuring yourself and constantly working out to create the muscle mass or lean body that you want.” Distorted body image, also called body dysmorphia, is a common component of an exercising disorder. Persons with body dysmorphia have a distorted view and exaggerated vision of their appearance—thin women may think they are too big, and muscular men may think they are too puny or scrawny. The obsession with being too small or frail is a subtype of body dysmorphia called muscle dysmorphia, nicknamed bigorexia, which is most common in men. Men with muscle dysmorphia constantly weight train and exercise to achieve a more muscular or perceived “manly” body. To achieve their ideal body or fitness goals, many persons with exercise disorders also restrict their calories, based on the mistaken belief that they will build a higher proportion of muscle if they restrict their food intake while exercising, Dr. Fassihi says. Instead, they lose both muscle and fat, putting their health at risk. “Over exercising can cause significant damage to the body,” Dr. Fassihi adds. “It can increase the risk of injuries for both men and women. Women may be more at risk for osteoporosis if they are over exercising and restricting their food intake, and they may stop menstruating completely. Men may use steroids and protein powders to help them achieve their goals, leading to other health problems.” Over exercising can also cause stress fractures, which can impede walking. Constant repetitive exercise can cause wear and tear on the body’s muscle, bones and joints--in severe cases making joint replacement surgery necessary at a young age. Despite their health problems, many persons who over exercise are reluctant to admit their behavior is problematic, Dr. Fasshi says. Exercise provides them with a sense of control, power, and in some cases, superiority. Exercise also relieves anxiety and releases endorphins, which provide a sense of euphoria. Because of the positive aspects of exercise, and its value in our achievement and appearance oriented-society, treatment for exercise disorders can be difficult. “If you give up an addiction that is bad for you, you give it up cold turkey. However, you can’t give up exercise completely, because it is healthy,” Dr. Fassihi says. “You want to learn how to exercise moderately in a healthy way. That’s very tough without help from a professional.” Staff members with the Eating Disorders Program at Menninger work with patients who over exercise to help them recognize normal levels of exercise. At the beginning of treatment, patients are limited to the mildest physical activity, such as walking, in an attempt to increase their body weight to normal levels. As treatment progresses, patients may increase their amount of exercise. By the time they leave Menninger, patients are exercising moderately every other day, for about four hours a week. Men and women also learn to confront their anxiety about not exercising, and learn other methods to help them relieve their anxiety—such as relaxation and breathing exercises. They may also participate in a body image group to identify negative beliefs they have about their bodies and how to dispute those beliefs. With treatment, patients realize the toll that over exercising has taken on their lives. “Over exercising interferes with their quality of life because they devote so much of their time to exercise to the exclusion of anything else,” Dr. Fassihi says. “Their time is not available for socializing, relationships or work. It is all consuming.” Sidebar:
If you believe you have an over exercising disorder or at risk for developing an over exercising disorder, seek help from a trusted advisor, such as a coach or teacher, or a doctor or mental health professional. The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Houston in 2003 and is affiliated with Baylor College of Medicine and The Methodist Hospital. For 16 consecutive years, Menninger has been named among the leading psychiatric hospitals in U.S. News & World Report’s annual ranking of America’s Best Hospitals. Menninger experts discuss effects of Virginia Tech shooting Survivors of Virginia Tech shooting may be traumatized
Each person will respond in his or her own way to the effects of the tragedy. Persons who have been through previous traumatic losses or events may experience more intense reactions and need more time to recover. However, most survivors have resilience and skills that will keep them from developing long-term effects or mental health disorders Achieving a balance between grieving for losses and participating in activities that take the mind off of intense feelings can help restore survivors’ well being. Finding meaning and benevolence in the world will provide hope necessary for recovering from the effects of the Virginia Tech shooting. Posttraumatic stress disorder, other anxiety disorders, depression, self-harm and chemical dependency may result from surviving a traumatic event. For more than a decade, Menninger clinicians have been developing and applying interventions for individuals with trauma-related disorders. “Our goal in processing trauma is to make sense of trauma as a meaningful experience. The goal is not to rid the mind of traumatic memories, but rather to make it more bearable to have the memories in mind when inevitable reminders occur. A trusting environment for treatment, social support, a safe place to express emotions, a daily routine, and an understanding of the effects of trauma and treatment are so important to trauma recovery,” said Jon Allen, PhD, senior Menninger psychologist, author of Coping With Trauma and co-author of Restoring Hope and Trust. “It’s unrealistic to expect that you can bleach the trauma out of your mind. What treatment can help you do is learn how to cope with the experience, with the memories and to live in the present,” added Lisa Lewis, PhD, Menninger psychologist and co-author of Restoring Hope and Trust. Impact of Virginia Tech media stories on Americans Repetitive images of the Virginia Tech shooting can have the same effect as seeing the 9-11 terrorist attack aftermath. Menninger experts advise:
Psychologists cited in the news release are Menninger mental health professionals and faculty members of the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine. The Menninger Clinic is a nonprofit international specialty psychiatric center, providing innovative programs in treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Rice historian to speak about impact illness on Rice University founder, at second annual Menninger luncheon The public is invited to the luncheon, which is sponsored by the Board of Visitors, whose members support the work of The Menninger Clinic. The luncheon begins at noon at the Houston Marriott Medical Center Hotel, In his keynote address, Dr. Boles will draw on information from his upcoming biography on Dr. Lovett titled, “University Builder: Edgar Odell Lovett and the Founding of the Rice Institute.” Individual tickets for the luncheon start at $150. Table prices range from $1,000 to $15,000. Deadline for reservations is May 1. For more information, or to make reservations, call 713-275-5028. “University Builder,” to be published by Louisiana State University Press in November 2007, covers how Dr. Lovett brought a world-class institution of learning to “In some ways his family’s mental illness didn’t affect Dr. Lovett’s career,” Dr. Boles says. “In subtle ways it changed him. It made him more serious, less contemplative. Dr. Lovett had to learn to compartmentalize. At one point in his life, his son was in a mental institution and his wife was bed ridden, but no one knew about it.” The stigma of mental illness continues to this day. Through events like the Menninger Luncheon, The Menninger Clinic is working to overcome stigma and increase awareness about mental illness in the community. Proceeds from the luncheon will fund continuing hospital-based research for the treatment of obsessive-compulsive and anxiety disorders. The Menninger Clinic is a nonprofit international specialty psychiatric center, providing innovative programs in treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Families need help to deal with aftermath of suicide attempts The repercussions from a suicide attempt can go on for years, according to treament team members with the Adolescent Treatment Program at The Menninger Clinic. Guilt and shame over a suicide attempt prevent many families from getting the help they need to work through the crisis. An estimated 30 percent of families of children who attempt suicide seek family therapy, according to a study published in the Journal of the American Academy of Child and Adolescent Psychiatry in 1997, and about 77 percent of families referred to treatment after an adolescent attempts suicide drop out according to a 1993 Journal study. Many families don’t pursue treatment because they deny or minimize their child’s suicide attempt. Teenagers who attempt suicide may also not admit they tried to kill themselves. Complicating matters, teenagers may attempt suicide while in treatment for mental illness, such as depression or substance abuse. Families are reluctant to put their trust in the mental health system again--feeling it failed them. That’s unfortunate, because families desperately need support and direction after a child attempts suicide. Depression, which leads to suicidal thinking, affects the entire family unit. To move past the tragedy, families must address the issues that the suicide caused, and continues to cause, in their lives. Chief among the issues is the family’s increased sense of responsibility for the child who attempted suicide. Worried about a repeat suicide attempt, family members, and parents in particular, feel that they have to watch their child constantly—in some cases, sleeping at the foot of the child’s bed every night to make sure he or she won’t attempt suicide. Parents feel a huge obligation to watch over their child. At first it may seem somewhat comforting to the child, but then the parents become so intrusive in the child’s life he or she thinks, "I can’t live like this anymore." Helping families reach that middle ground between protecting and smothering their children is a main goal for family therapy at the Menninger Adolescent Treatment Program, which treats adolescents age 12 to 17. Patients in the inpatient treatment program struggle with family, school and social difficulties because of depression, anxiety, or other psychiatric illness or substance abuse. Some patients also have attempted suicide once or multiple times. The treatment team recommends individual therapy as well as appropriate psychiatric medication for children who attempt suicide, as most are quite depressed and feel hopeless. Their parents and other children in the family may also benefit from individual therapy, especially if they found them after the attempt. Often siblings are just as stressed out as the parents because they find the brother after the overdose, or they are the ones in the background while Mom and Dad and the brother are having all of the conflict. Working with therapists at Menninger, patients in the Adolescent Treatment Program learn to develop agency, or the ability to take action and exert control, over their mental illness and suicidal feelings. They learn skills to cope, ways to self-soothe and to seek out sources of support other than their parents. They also learn to share their thoughts and feelings with their parents, and to communicate with their parents if they are feeling suicidal. Parents, in turn, learn how to listen and not overreact. When parents witness that their child is handling his or her feelings better, and knows when to seek help, it lowers their anxiety. Family therapy immediately following a suicide attempt may not be productive, because emotions are raw, and the suicide attempt is still fresh in the family members’ minds. Once the child who attempted suicide learns how to deal with his or her hopelessness and depression, and the parents begin to deal with their own anxieties and guilty or angry feelings, then they may be ready for family therapy. Family therapy helps family members learn how to communicate better with each other and express their feelings more constructively. Sidebar: Is my child contemplating suicide? Even in the most open families, teens may still be hesitant to tell their parents they are depressed or thinking about suicide. However, an estimated 80 percent of individuals who attempt or commit suicide give out signs. Following are warning signs of suicide to watch for from the National Youth Prevention Commission:
The Menninger Clinic is a nonprofit international specialty psychiatric center, providing innovative programs in treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to
In her new position as program director, Dr. Lloyd will supervise administrative and clinical aspects of the program and provide group and individual therapy. Dr. Lloyd has consulted with the business community on issues such as improving workplace communication, enhancing employee satisfaction and providing assistance and clinical services to employees coping with traumatic incidents in the workplace. She is a Dr. Lloyd was previously an administrator and long-time faculty member at The University of Texas Health Science Center at As the founding director of the Student Counseling Service, she was responsible for mental health services for more than 3,500 health professional students and graduate students pursuing careers in medical research. Dr. Lloyd’s special interests include depression, posttraumatic stress disorder and providing mental health services to healthcare professionals. She is an active researcher and has published extensively on stress and mental health problems among health professional students. Dr. Lloyd has also studied psychosocial risk factors for depression, including the study of stressful life events, personality factors, parenting experiences during childhood and social support. In addition, Dr. Lloyd has served as a reviewer for several prominent psychiatric and psychological journals. The Menninger Clinic appoints O’Malley director of Compass Program |
Menninger will be located within a 10-minute drive from the Texas Medical Center on South Main Street, 
