Eating Disorder Screening Tool

Binge Eating Disorder (BED) in children is often mistaken for a lack of willpower. At Kartini Clinic, we view pediatric BED as a serious brain disorder with biological and neurological components. This medical perspective removes stigma and allows for proper, evidence-based, multidisciplinary treatment.

It is with decidedly mixed emotions that we announce our founder and chief medical officer, Julie O'Toole MD, MPH, will retire at the end of this year. First I'd like…

We just graduated an 11 year old boy from the Kartini Clinic and on his way out, proudly, he showed me a project he had been working on. He was…

When patients graduate from the Kartini Clinic I am often asked by the anxious/happy parents how they are to deal with any eating disorder symptoms going forward.  What if they…

We had a therapy dog at Kartini Clinic for many years, and when the honorable Cleo, a black standard poodle, died it left a hole in our hearts. I’ll never…

It’s lunchtime at Kartini Clinic, and patients in our partial hospitalization program are settling in for their midday meal. Joining them at the table is Nutrition Counselor Annastacia Weiss. Annastacia…

In the treatment of children and adolescents with eating disorders, depression is a not uncommon finding. Sometimes we identify it on admission to Kartini Clinic, sometimes it has already been…

Mood is a hard thing to measure, a chimera at times, hard to grasp, hard to define. Good mood, while often eluding exact definition, is obvious to the observer: the…

For many years I have been saddened by our inability to help families with a child with selective eating. This condition is described here and here.  And since, for the most…

This video shows an 11 year old boy who has struggled with classic anorexia nervosa, including fear of fat, self-denial, increased and compulsive exercise, weight loss and intrusive thoughts of…

This is an update to a post originally shared on November 30, 2010. When we discharge a patient from Kartini Clinic back to their primary care provider, it is usually…

1) Weight loss in children isn’t normal Imagine you’re a parent of a bright, active 12 year old boy. He gets good grades and has lots of friends. He excels…

In 1998 when Kartini Clinic was founded to serve children with “all conditions of disordered eating,” those with anorexia nervosa (AN) represented the majority of our young patients. At the…

We are pleased to present a guest blog this week, written by a Kartini Clinic parent. We hope you enjoy her first-hand tips for traveling with a child on the…

This post was originally published March 31, 2016.  In few fields have the twin forces of genetics and neurobiology worked as synergistically to profoundly change conceptualization and treatment as they…

Oh God, it’s so hard. Hard for the kids. Hard for the parents. Hard for me. Resting an injury is not an easy concept when you don't feel direct and…

When I was a pediatric resident in Honolulu, Hawaii, I had the great and unusual opportunity to spend time with patients with a condition now largely unknown to most American…

Anorexia nervosa is a complex illness, like most illnesses that involve the brain. There is a wide spectrum of severity, ranging from cases that easily turn around with re-feeding and…

If, like me, you have a roof over your head, heat, light, internet and food, reflect for a moment on how fortunate we are. Many people mistake their good fortune…

In general I do not especially like using the trivializing nickname “ED” to refer to a punishing condition like anorexia nervosa , but many of our families do. Perhaps this…

I feel so weary writing this, I almost can’t start. And I am not talking about provider fatigue, for that is a different subject altogether, and an important one. No,…

Parents, doctors, therapists, dietitians and patients: don’t even think about using BMI as a measure of “state!” You have heard me say in my blog posts many times that, at…

Late in the afternoon on the day before Thanksgiving, a mother of a former patient emailed our clinic and here is what she said: She wanted to call and let…

This post was originally published on November 23, 2010. Thanksgiving is one of my favorite holidays. As is probably true for many of you, it's all about giving thanks, and…

This post was originally published on November 30, 2010. Reading through the latest comments on Laura's Soap Box, and those on Around the Dinner Table message board, I see many…

Inching our way forward into medical care that is truly collaborative, we face many challenges. The first is internal: our medical training (pretty much no matter when we trained) reflects…

A couple of weeks ago, a reader comment on a discussion about hyper-palatable foods (HPF) brought to mind an issue I’ve heard before, one which highlights a key misunderstanding about…

Part of any successful voyage, especially one that involves reaching a critical destination for you and your loved ones, involves deciding when to keep rowing and when it would be…

One of the most common comments and questions we get about our ordered-eating family-style meals is about whether or not such eating is “normal” and whether it doesn’t represent some…

Whichever genius came up with the pithy “first do no harm” knew what they were talking about, or at least had a profound understanding what evil could be committed in…

I was reading an online opinion piece by one of my colleagues, Dr Ovidio Bermudez, who like me is an adolescent medicine physician and eating disorder doctor.  This one sentence…

This blog post is about a useful, if prosaic, product we use in the initial phases of re-feeding at Kartini Clinic. I hope this post is helpful to parents looking…

Binge-Purge Anorexia vs Bulimia: what's the difference? It has now been three years since the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published and it’s time for…

Recently, while responding to a struggling parent who had posed a specific concern on the F.E.A.S.T. website, I used the word "remission." Another mother on the forum responded that she…

As some of you already know, at Kartini Clinic we specialize in children and teens with all conditions of disordered eating—but our deepest specialty is children ages 12 and under.…

The acceptance and success of family based treatment interventions in the world of eating disorders has been one of the major mental health breakthroughs of the past few decades. Empowering…

In the 2000’s and even earlier, it became apparent that the systems of classifications used to define eating disorders were inadequate to describe the entire spectrum of clinical presentations, especially…

June 2nd, 2016 will mark the first World Eating Disorders Action Day, an internationally-recognized day during which members of the eating disorder community, including affected individuals and their families as…

When the care you’re receiving just isn’t good enough The other day I received a call from a distraught sister-in-law who was visiting my niece, her daughter, in a developing…

As I have said many times in the past, complete weight restoration is the conditio sine qua non of childhood eating disorder treatment -- if you do not get weight…

  Coming to terms with the unhealthy side of exercise as the parent of an eating disordered child One of the most challenging issues faced by all eating disorder providers…

To say, as adult physicians do, that lifetime mortality from anorexia nervosa is somewhere around ten percent of patients is important and true. It is also, however, an understatement of…

Settings and approaches to treatment The acute medical management of children with eating disorders can take place in several very different settings, depending on the severity of the illness and…

When the NYTimes prints a story, it tends to generate conversation, whether we live in New York, Florida, Texas, Utah or Oregon; such is its influence and reach. On March…

At Kartini Clinic we have long been aware of the problem of hypophosphatemia (low blood phosphorus) with refeeding. In past decades when nearly all of our patients came to us…

History is funny. When looking back over social mores and people’s thinking from decades ago, generations ago, even centuries ago, we often find ourselves puzzled. How could nearly everyone have…

Publishing a letter from a grateful parent might strike some as self-serving but I’m putting this one out there anyway because I believe that all of us, but especially our…

About food: potatoes This is the second installment of a series on common food ingredients; the first was about corn. At Kartini Clinic we spend our lives restoring the health…

On February 9 at 10:30 AM PST / 1:30 PM EST, Dr. Julie O'Toole, founder and Chief Medical Officer at Kartini Clinic for Children and Families in Portland, Oregon will…

We have been informed (and warned) that the world of laboratory medicine is about to be revolutionized.  Recently for example a company in Silicon Valley called Theranos has been touted…

Kartini Clinic has a new home, and we are excited for a number of reasons. For starters, this time around we were able to design our units especially for our…

I get asked all the time: will the “extra weight” come off her stomach or his face?  Many people are appalled to hear that parents whose child was starved and…

Medicine is moving at the speed of light.  And that’s a good thing.  We have a long road ahead of us to move out of the pre-scientific eras, where no…

On  Science Friday recently Ira Flato interviewed Professor Susan Swithers about her research on artificial sweeteners.  You know the keywords: Splenda, Stevia, Equal, diet soda, zero calorie drinks, sugar-free gum….…

Determining "ideal" body weight in children who suffer from anorexia nervosa is complex. Pediatric patients cannot be treated like "little adults". An example of this principle is the way medication…

Not every young patient with anorexia nervosa will need medication, but many will.  It has been our experience that the SSRIs such as Prozac, Zoloft, Paxil, etc are not very…

Another episode at the doctor's office with my husband has prompted more reflection on the state of medicine in general.  In this case this is the third time we have…

For years now we have keenly felt a need to share Kartini Clinic treatment results with colleagues and with our families in order to answer some basic questions about two…

Treating food phobia is hard. Sometimes it is so hard, we almost resolve to stop doing it. But then we get a call about a young child whose parents are…

This last weekend was a nightmare, the kind that recedes into the depths of denial and forgetting as quickly as it can.  That is the nature of trauma.   My…

We all know there are many ways to skin a cat, and perhaps the best way is to use all the tools at one's disposal.  At Kartini Clinic we use…

There is always a lot of talk and anxiety about a so-called "ideal body weight" (IBW) in patients with anorexia nervosa. It is sometimes called "expected body weight" "goal weight"…

Together with members of my clinical team I recently attended the Columbia River Eating Disorder Network's annual conference, where the key note speaker was a well-known local psychoanalyst, Dr. Kathy…

I have decided to share some case histories from my files for several reasons: to introduce the secret language of eating disorders to those who do not speak it, to…

I have decided to share some case histories from my files for several reasons: to introduce the secret language of eating disorders to those who do not speak it, to…

There are two posts I hope to make people aware of, beyond the mere fact of a link on our website to them: This one is simple: a fact sheet…

Over the past several weeks there has been a burning controversy on the Academy for Eating Disorders' email listserv that started when I used the term "brain disorder" to describe…

Over the years Kartini Clinic has been an enthusiastic proponent of research in our field, contributing to and even initiating research projects whenever we could. But recently I have had…

The recent tragic death in hospital of a young teen in the northern UK, as well as the death of the French model Isabelle Caro while hospitalized, and the subsequent…

"Charlotte," the mother of a child with an eating disorder, and an active blogger on F.E.A.S.T., sent me a film she made which I must share with all of you.…

At Kartini Clinic we are always searching for new ideas and new ways to treat children and youth with eating disorders. Over the years I have had many off-the-cuff suggestions…

Blog:  Some Weird things about Fat & Obesity There is an epidemic of obesity in this country and, more recently, in Europe and China, based on our slacker lifestyle, our…

I am writing this blog to connect our parents and readers to a study on the effects of treatment for anorexia nervosa on the parents of children who suffer from this…

Some doctors who work or "moonlight" (i.e. work as consultants) are what I refer to as "physician ladies of the night." Ladies of the night?! Could she mean what I think…

Sometimes we say things so frequently, or they are bandied about in public so often, that we come to believe them, true or not. Often, when that is the case,…

On the BBC's website this week it's a race to the bottom between the author of the article (a surgeon) and its first commentator, to see who can show the…

At the Kartini Clinic we are grappling with the concept of providing our patients with tailored aftercare treatment at a distance. Why? Many reasons: sub-specialty eating disorder treatment does not…

It is common to think of prominent figures, whether politicians, scientists, professors at famous universities or movie stars as having access to the bully pulpit when it comes to talking…

So you think medicine is always about science? You think that everything in the medical industry is about evidence, experience and reason? Think again. Medicine is as prone to fads…

We live in the proverbial Dark Ages when it comes to thinking about the control and maintenance of weight in humans. At some future date, when the real biology of…

I've often wondered why it is that we've been successful in treating children with food phobia while so many other facilities fail to do so. I don't say this to…

Haley is a sweet little girl from the southern part of our country who had a big problem: for more than a month, following a dental procedure, she had been…

I spend a lot of time thinking about childhood anorexia nervosa and have both written and lectured on my belief that anorexia is a highly heritable brain disorder initiated by…

If your chi ld had a severe medical condition requiring specialized surgery or treatment and the answer to "where should my child be treated?" was the Mayo Clinic, likely you…

Mental health providers can be as misguided as medical providers, that is clear. Many practitioners in both fields learn about eating disorders during their training and what they have learned…

I know it is controversial to write about the shortcomings of some of my physician colleagues; in medicine it is rarely done. But if we won't advocate for children who…

Wikipedia says: "In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and…

One of the many focuses of distress for our families can be their understandable concern for the other children in the family. While only one child may be being treated…

Every day some family in our practice struggles with their insurance company over eating disorder treatment. It is not enough to provide the best, most up-to-date and effective treatment for…

What would it be like if we could add a blood test to our evaluation of a patient with anorexia nervosa? This might sound an outlandish question but recent published…

Sometimes our work brings tears to our eyes.Today I discharged four year old Gabriel after one week's intensive treatment for food phobia in Kartini Clinic's Food Phobia treatment program. Jill,…

Editors' Note: We have asked our clinical staff to respond to a recent study suggesting that certain web sites may be undermining eating disorder treatment and complicating recovery from these…

This week's blog is an excerpt from my upcoming guide to eating disorder treatment, Give Food A Chance (PSI Press, 2010).  This excerpt deals with the essential role of the…

In the next few blogs I am going to excerpt a few relevant parts from my upcoming book about eating disorder treatment called Give Food A Chance, to be published…

Previously I have discussed relapse.  Now here's a short list of concerning early signs of an eating disorder to be aware of. These symptoms, should they occur, must prompt a…

In this blog I am going to share a short poem written by a ten year old girl with anorexia nervosa who came to Kartini Clinic years ago for eating…

This is an excerpt from my upcoming book Give Food A Chance (to be published this summer by PSI Press) taken from a chapter about parents, their essential roles in…

Occasionally our team will ask our psychologist, Dr. Rebecca Seifert, to do psychological testing on a patient.  Such testing is time consuming and expensive.  Why do we do it and…

This is a blog about excess. And because it is a Kartini blog, it is about food. How can we find our balance in this country with one large contingency…

I recently engaged with fellow eating disorder treatment providers in an online discussion about the biological basis of anorexia nervosa. I want to share parts of that discussion and my…

The answer is, without a doubt, a resounding Yes. Whatever the collective merits of the Patient Protection and Affordable Care Act, signed into law by President Obama on March 23,…

DSM-V: A Rose by any other name... It is true that childhood-onset anorexia nervosa would be the same illness no matter what we called it, so why does it matter…

Anyone with any experience - personal or professional - of eating disorders will know the lengths individuals or families often have to go to get proper treatment. I speak on…

From the world of public health and the campaign against tuberculosis comes critical information relevant to our patients with eating disorders.  As many of you know, we have found the…

I can't keep quiet about it.  All over this country we are talking about the outrageous cost of medical care, trying to tease out the reasons medical care seems to…

I often have to counsel families to appeal denied claims, especially from mental health insurers who are hired by larger health plans to "administer" mental health benefits. In my experience…

That light we can see at the end of this long, dim tunnel is the lantern of hope.  Sound corny?  It wouldn't if you had been afraid to go to…

Dear Kartini Families - We don't usually wade into politcal issues on this blog, but these are desperate times for many of our families, and we are determined to advocate…

Although most of us would agree that classes on health and fitness can be fun and informative for many kids, they can be stressful for some and positively destructive for…

I have been silent here on my blog over the Christmas and New Year's holiday, traditionally a hard time for our patients.Christmas and Hanukkah, with all of the candies and…

Dear Readers, We get a lot of questions about the use of hypnosis in eating disorder treatment, so I thought it would be useful to have Bart Walsh LCSW write…

My team shudders to hear it:  "I've got an idea…"  "I wonder what would happen if…"  since those words are usually the prelude to me revamping one of our programs…

This past week the world of doctors, dieticians and parents lost a quiet, gentle leader.  Dr. William Connors was considered by many to be the first guru of all low…

I gave a talk a few nights ago at Catlin Gabel School, a private school in Portland Oregon.  We spent a long time afterwards just talking with the school counselors…

It's 1959, a mild day in California and we kids are playing outside.  There are four of us and four of our friends, we range all over the neighborhood and…

At the Kartini Clinic we tell our parents (over and over again) "Please don't let anyone one, even another doctor's office, weigh your child while they are in treatment here."…

It's not every day that I have an epiphany about anorexia nervosa.  But today I was (re)taught something by a young man I know, respect and treat.  It wasn't entirely…

I have blogged on food phobia before, but today it was two desperate phone calls from across the country that spurred me to revisit this issue.  The ages of the…

Scene:  hospital bedside, the doctor is making rounds.  The patient, a 16 year old boy, is in his hospital bed having been admitted earlier that day.  His mother is next…

The Future of Psychotherapy for Mentally Ill Children and Adolescents by John S. March is not the kind of article I usually read — or so I thought until our…

On July 8th, 2009 The Oregonian ran an article about eating disorders featuring a large, glamorous photo of a "recovered patient": a beautiful young woman in a slim dark dress…

[editor's note: from time to time I invite other staff members to write about issues I think may be of interest to our families. This week's guest blog is written…

I just read a parent's thread on Laura Collin's FEAST website called "Eating Too Much". It made my hair stand on end. And it clearly resonated with more than one…

I am a gardener when I am not in the clinic. It used to be that I did all my best thinking in the shower. Now I do it in…

How can we do it better?   Clayton M. Christensen, Professor of Business Administration at Harvard Business School, in an article for CNN Politics.com wrote:"Patients want correct diagnoses and effective…

As we all know, weakening of bones is one of the most concerning effects of the malnutrition associated with anorexia nervosa (AN) in girls and boys. What is the problem?…

A note from the editor: We are pleased to announce the launch of a new feature to our blog that will allow viewers to leave comments and share their thoughts…

It is no secret to anyone who is breathing that our economy has taken a few terrifying turns these past four months or so and has slowly but surely begun…

Happy Holidays and Holy Days to all our Kartini Clinic friends. This blog is a quote from one of my "most admired" pediatricians and another doctor named Joshua Sparrow on…

Water Loading Before Appointments In my previous blog I discussed falsifying weight by wearing weights. This time I would like to discuss a much more common circumstance in which a…

I remember the first time a patient of ours was "caught" wearing weights. I was examining her with her mother and a young resident pediatrician in the room. I noticed…

I got off the phone with a college student health doctor last week with the sinking feeling that I get when I have not been able to convey the rationale…

By Julie K. O'Toole MD, MPH I have decided occasionally to write about topics that may be of more interest to practicing physicians and other providers confronted with difficult or…

This morning I was reading a mother's cry for help on Laura Collins' blog "Around the Dinner Table." The scared mother spoke of her 10 year old daughter's struggle and…

  Reporting on a new article I just reviewed an article which should help us answer the question: how much will my young daughter with anorexia nervosa need to weigh…

Most of you will have heard me say that weight restoration is the cornerstone of treatment in childhood anorexia nervosa, without which you get nothing. It makes sense, you say?…

I have been asked many times to explain why I went into the treatment of pediatric eating disorders. Did I have an eating disorder myself? Did I have a family…

Why research matters We are all busy at the Kartini Clinic, from the front office folks who answer calls, take messages, deal with upset or even irate parents, to the…

Here it goes: my first blog at the age of nearly 58. Yes that's right, kids, if you are reading this, you now know how old your doctor is. See…