Anorexia in Adults (cont.)

In California there is parity. There are certain exceptions. For example, the parity extends to group policies but not individual indemnity plans, and in policies that are covered by parity, eating disorders are treated no differently than medical conditions.

MEMBER QUESTION:
My experience has been the opposite. I was allowed 30 days max inpatient and then had to apply each week for day treatment. It was hard enough getting the time off of work, but insurance did not allow it. I have relapsed twice since then. I think if I'd had adequate treatment -- intense and prolonged -- I may not have.

STROBER:
I agree. The doling out of benefits for an illness like anorexia nervosa is unfortunate and irrational, and it is certainly possible that had you received a more sustained and intensive treatment, your risk of relapse may have been reduced.

MEMBER QUESTION:
Are eating disorders considered an addiction? What makes the mind flex back to it like a bungee cord. Is it psychological, physiological or what? I've beaten alcohol, speed, and even cocaine addictions. What makes anorexia so strong?

STROBER:
The strength of the illness is likely due to the person's susceptibility to extreme fear and anxiety, and this extreme sensitivity to fear is likely due at least in part, to a biological susceptibility, the exact nature of which is not known, but likely the result of those systems in the brain that regulate fear and the regulation of the extent to which we fear. So if those systems are overexpressed, such that the person is more likely to fear, and less likely to regulate or extinguish fear, then the preoccupation of weight and fear of weight gain lingers on and is more compulsive.

Life events can certainly add to this and further sensitize a person to fear and threat. The basis for this notion is that upwards of 60%-70% of people with anorexia nervosa have anxiety or anxiety disorders unrelated to fear of weight or eating prior to the onset of dieting and weight loss. And anxiety disorders are also elevated in the relatives of people with anorexia nervosa.

MODERATOR:
Dr. Strober, we are almost out of time. Before we wrap things up for today, do you have any final comments for us?

STROBER:
Information about the UCLA program is available by accessing the web at www.npi.ucla.edu or simply by "googling" UCLA Neuropsychiatric Hospital.

MODERATOR:
You have a new book coming out in the fall, Just a Little Too Thin (Da Capo Press) with Meg Schneider. Will you join us again to discuss it?

STROBER:
Absolutely. I'll be happy to come back.

MODERATOR:
Our thanks to Michael Strober, PhD for joining us today.



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