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A cycle of behaviors drives anorexia, similar to addiction

Robinson Professor Angela Guarda helps patients break the cycle and eat healthily
Posted August 7, 2017

The research of Angela Guarda – the Stephen and Jean Robinson Associate Professor in Psychiatry and Behavioral Studies – helps inform patient care. The research of Angela Guarda – the Stephen and Jean Robinson Associate Professor in Psychiatry and Behavioral Studies – helps inform patient care.

One of the biggest misconceptions about eating disorders is thinking they are a choice, according to Angela Guarda, MD, A&S '85, who directs the Johns Hopkins Eating Disorders Program, “rather than serious behavioral illnesses caused by a combination of genetic and environmental factors.”

"Although often perceived as trivial, anorexia is actually the most lethal psychiatric condition," says Guarda, who is the Stephen and Jean Robinson Associate Professor in Psychiatry and Behavioral Studies.

Eating disorders afflict five to seven percent of the population and can affect people of all ages and genders, but one challenge for clinicians and loved ones is the ambivalence of many patients toward treatment, Guarda explains. "They know they need help, but treatment is anxiety provoking," she says. “And over time, dieting, exercising, binging, or purging behaviors take on a life of their own and become a cycle that’s hard to stop, similar to addiction.”

Patient Angelica Schlehr knows this all too well. As old issues with perception and self-worth forcefully resurfaced in the fall of 2016, the 38-year-old teacher and mother of seven became increasingly determined to restrict her diet and weigh less than 100 pounds.

"I just wanted to waste away," she says of her time before entering the inpatient unit of the Johns Hopkins Eating Disorders Program, adding depression had also become a factor.

Guarda explains the inpatient program as a two-step process. "Our first step in treatment is to help patients weight-restore – so that starvation doesn't perpetuate the thoughts and feelings associated with anorexia – and to eat a wide range of foods in regular meals," she says.

The next step is to become comfortable with eating meals independently in a real world environment, while living in the hospital-affiliated Jefferson House and attending the partial hospitalization program, where the treatment focus shifts to relapse prevention. Close collaboration with other Hopkins Medicine specialists allows Guarda’s team to take on the most medically complex cases, she adds.

"My goal is to set a standard of care for eating disorders, especially intensive treatment," says Guarda, who has used the support from Stephen and Jean Robinson to publish clinical outcomes research and to conduct pilot studies examining physiological and neurocognitive changes that may contribute to the driven nature of eating disorders. The results of this research then help to inform patient care. The professorship has also supported the hiring of research fellows and the creation of an annual symposium to educate practitioners about properly diagnosing such disorders.

"My husband and I decided to endow the professorship to thank Dr. Guarda and for her to have the resources to do her research," says Jean Robinson, who credits Guarda as the first physician to fully diagnose and enact an effective treatment plan for her daughter Stephanie, who had developed an eating disorder as a consequence of another medical illness.

Along with financial support, Robinson has organized successful fundraisers and also volunteered with the program, working with a designer to renovate Jefferson House and the outpatient office suite.

"They have nailed the program through research and through implementation," says Schlehr who has now moved to the partial hospital. "When I go home I actually have a plan to follow. I have hope now. I have hope for my future."

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