A comprehensive diagnostic evaluation that is efficient but sensitive.
A respectful and informative interchange about individual treatment options.
An opportunity to collaborate in planning and beginning treatment.
THE NY TIMES QUOTES DR. BRAUN
NATIONAL DESK MORE MEN MAY SEEK EATING DISORDER HELP By Susan Gilbert
THE
number of young men being treated for eating disorders at a
metropolitan New York hospital has been rising, a study there has
found. Experts say the results may indicate either that the number of
men who have such problems has increased or that more such men are
seeking treatment. Researchers at New York Hospital-Cornell
Medical Center's Westchester Division, in White Plains, examined the
records of patients admitted to its eating-disorders unit from
September 1983 to July 1995. No men were treated there until 1988. That
year, the first two were admitted, accounting for 4 percent of all the
eating disorder patients, the study found. From then on, the number of
male patients rose steadily, reaching 13 percent in 1995.
The
study was presented at the annual meeting of the American Psychiatric
Association in New York in May and is being prepared for publication.
The
meaning of the findings is unclear, said Dr. Devra L. Braun, an author
of the study and the former chief of the in-patient eating disorders
service at the medical center.
"We think that the findings
suggest that the incidence of men with eating disorders may be
increasing or that more men with eating disorders are willing to come
in for treatment," Dr. Braun said.
Dr. Braun emphasized that
eating disorders still affected far more women than men. During the
study period, the unit treated 621 women and 39 men, she said.
And
while other studies have suggested the number of men with eating
disorders has increased, still others have found the rate to be
unchanged, said Dr. Braun, who is now assistant medical director of the
Northeast Center for Trauma Recovery in Greenwich, Conn.
A
study of rates of anorexia nervosa among 13,559 people in Rochester,
Minn., concluded that the incidence among men remained relatively
constant, at about 1.8 cases per 100,000 people, from 1935 through
1984.
"We have figures through 1990, but we're not noting any
major change," said Dr. Alexander R. Lucas, a psychiatrist at the Mayo
Clinic in Rochester and the lead researcher in the study of the eating
disorder, which is characterized by behavior like self-induced
starvation and excessive exercise.
He also said that this
research did not reflect the percentage of men with the condition who
were being treated. He agreed with Dr. Braun that it was possible that
more men with eating disorders were seeking help.
"The general
impression is that more men are being treated for eating disorders,"
said Dr. James B. Wirth, director of the Johns Hopkins Eating and
Weight Disorders Program in Baltimore. "I can't say we've seen an
increase, but we haven't collected the data. It's a good thing this
study was done."
Dr. Wirth said several recent studies had
identified characteristics of men with eating disorders, finding for
example, that homosexuals, competitive wrestlers and men who had
suffered child abuse might be at relatively high risk for eating
disorders.
Dr. Braun and her colleagues sought to identify the
similarities and differences between men and women with such disorders
by interviewing 37 female patients and 37 male patients.
In
both groups the severity of the illnesses was similar, as was the
incidence of other psychiatric disorders. For example, 61 percent of
the men and 57 percent of the women suffered from mood disorders,
primarily depression. Men and women also scored high on psychiatric
tests that measured body dissatisfaction and a drive to be thin.
But
the study found that men were much more likely than women to be
involved in occupations and sports that have been linked to eating
disorders, like dancing, modeling, swimming and wrestling. Thirty-seven
percent of the men had jobs or played sports for which weight control
was important, compared with just 13 percent of women.
The
study also found that weight control methods differed significantly
between men and women. ''The men exercised more and dieted less,'' Dr.
Braun said. Half of the women used diet pills regularly and nearly
two-thirds used laxatives. By contrast, just one-quarter of the men
used diet pills and fewer than one-third used laxatives.
Fourteen
men in the study had anorexia nervosa, an extreme obsession with
thinness in which body weight is 15 percent below normal. Eight men had
bulimia nervosa, a syndrome characterized by binge eating and purging
about twice a week for three months. Nine men had both disorders and
six had symptoms of one or both disorders that were not severe enough
to meet the standard diagnostic criteria. For two of the men, medical
records contained insufficient information to make a diagnosis.
August 28, 1996, Wednesday Copyright 2002 The New York Times Company
Dr. Braun was the lead author of the article ADHD in Adults: Clinical Information for Primary Care Physicians.
This article was written to educate primary care doctors about ADHD and
how to treat it. It appeared in the peer-reviewed journal Primary Psychiatry. You can access the article, via the following link: (cut and paste the bold letters below into your browser window): http://www.groupadpsych.org/pdf%20files/ADHDforPCP.pdf
DR. BRAUN IN GREENWICH MAGAZINE ON HYPNOSIS
HYPNOSIS Excerpted from Greenwich Magazine,2004 On Health supplement, (57)7,pg. 41-3.
"'IT
WAS THE BEST THING THAT HAPPENED TO ME,[DR. BRAUN'S PATIENT]... SAYS.
IF NOT FOR HYPNOTHERAPY AND DR. BRAUN', she adds, 'I MIGHT NOT BE
DRIVING YET.'"
"Life had been rolling along pleasantly for
Rose Jacobs. Then came the accident that turned everything upside down.
She was driving on Route 1, less than a mile from her Greenwich home,
on the way to visit a friend, when a teenager in a hurry wheeled his
car out from a side street, smashing into hers.
"Rose, who asked
that her real name not be used, could have been killed. If she had
failed to fasten her seat belt, she believes she would have been flung
through the windshield. As it was, she was hospitalized with a
fractures sternum, not slight injury for anyone, let alone a senior
citizen.
"Worse was the psychological impact. Even after Rose
recovered from her physical injuries, she wanted nothing to do with
driving. Just being a passenger in someone else's car set her heart
pounding. And when she passed the place where the accident occurred,
her anxiety went through the roof. 'I was a big wreck.' She says.
"Six
years since the accident, Rose is a wreck no more. She drives
unhindered to the supermarket, art class, church, wherever. Nor does
she freeze up like she used to when she drives on I-95, a fear that
pre-dated her accident.
"It wasn't long-term psychological
counseling or anti-anxiety drugs that gave Rose back her independence.
It was, in fact, a form of therapy dismissed by some as the stuff of
nightclub acts, but which is finding growing application in the
treatment of all kinds of medical and psychological ills - hypnosis.
"DR.
DEVRA BRAUN, THE PSYCHIATRIST WHO TREATED ROSE AFTER THE ACCIDENT,
NEEDED BUT A FEW SESSIONS to teach the patient relaxation techniques
and, under hypnosis, mentally 'pre-play' each step of driving a car -
climbing in, turning on the ignition, pulling out from the driveway.
Overcoming her fears in 'rehearsal', Rose soon did the same in an
actual road test. These days, she never thinks twice about getting
behind the wheel.
"'Hypnosis is not the right treatment for
every patient,' says Dr. Braun, who is on the clinical faculty at Weill
Medical College of Cornell University and has a private practice in
Greenwich. 'But it's a wonderful adjunctive treatment.'
"In
other words, it's another tool of the healer's trade. It's a powerful
one, however. Increasingly, hypnosis is used to treat depression,
anxiety, panic attacks, post-traumatic stress and phobias...."
"In
recent years, researchers from Harvard and other institutions have
begun to crack the mysteries of hypnosis. Widely touted is a study that
appeared in the American Journal of Psychiatry four years ago, which
used brain scans to show that subjects under hypnosis could perceive
colors when, in fact, they were seeing images with shades of gray, and
vice versa. Activity in certain regions of the brain proved that those
under hypnosis believed their perceptions to be true, as opposed to
simply trying to please the researchers..."
"Good candidates are
those who tend to become engrossed in activities, such as reading,
movies, or music. Dr. Braun offers hypnosis when appropriate, if, like
Rose Jacobs, a patient is curious and interested in pursuing it. Those
with a strong ability to concentrate, the psychiatrist says, often do
well with hypnosis."
"As with any form of therapy, the
patient-therapist bond is critical. Hypnosis can be devastating when
practiced by someone unqualified or unscrupulous. Besides being a
licensed professional, the therapist should have accreditation from the
Society for Clinical & Experimental Hypnosis or the American
Society of Clinical Hypnosis."
"Used properly and under the
right circumstances, hypnotherapy can do a world of good. Rose Jacobs,
for one, shudders to think of all she would have missed and what an
imposition she would have been on others had she gone without help."
"'It
was the best thing that happened to me, she says. 'If not for
hypnotherapy, and Dr. Braun,' she adds, 'I might not be driving yet.'"
Dr. Braun quoted in Stamford Advocate
SEASON OF DARKNESS: Lack of light can negatively affect people's moods --------------------
By Ray Hogan Staff Writer
December 21, 2004
First, the good news: The days get longer starting tomorrow.
The
bad news? For the next few months, many of us will commute to and from
work in darkness. While few find the short days reason to celebrate,
the ramifications can run deeper.
The lack of sunlight can have
an adverse effect on people's moods and mental health and lead to
seasonal affective disorder, perhaps more commonly known as the winter
blues. The disorder can range from mild irritation to deep depression.
Symptoms may include lethargy, increased appetite for carbohydrates,
weight change, increased sleep, loss of interest in activities that
normally provide pleasure, and, in severe cases, inability to carry on
with daily activities.
Dr. Dan Oren, adjunct associate professor
of psychiatry at Yale School of Medicine, defines SAD as "a recurrent
pattern of major depression in the fall and winter seasons returning to
normal in spring and summer on a regular basis."
Its cause is
unknown, but it is linked to lack of daylight and is more prevalent in
areas of least daylight, Oren says, noting that in Florida it affects
about 2 percent of the population while in Vermont, those numbers waver
between 12 percent and 15 percent. In the our area, statistics show an
occurrence rate of about 10 percent. SAD hits hard in January.
While
a lack of serotonin and increased melatonin are the two most studied
areas of SAD's origins, conclusive evidence doesn't exist.
"That's
the prevailing theory, the decreased lack of sunlight causes hormonal
changes in the system and increased levels of melatonin increases with
increased darkness," says Dr. Norma Kirwan, director of outpatient
behavioral health services with Stamford Health System.
Modern study of SAD is only 20 years old, yet its history goes back to the beginning of mankind.
"It's
an ancient wisdom that recurs throughout medical literature," Oren
says, noting you can find references to it in the writings of
Hippocrates and see real proof in the North Pole expeditions. There,
Oren says, "hale and hearty men developed severe depression that didn't
lift until the sunlight returned."
Dr. Devra Braun, a clinical
assistant professor of psychiatry at Weill Cornell Medical Center and
medical director of Integrative Medicine and Psychotherapy of
Greenwich, also takes an evolutionary approach to explaining the
disorder and notes it has to do with sunlight rather than temperature.
"All
these primitive cultures and modern religions, Hanukkah is the festival
of lights, Christmas has Christmas lights, were affected by the
decreasing photo period. Your brain responds to that, so for people it
really becomes an issue," she says. "It is probably related to
hibernation and (in the winter) how little you could do after dusk."
Before
electricity and other modern conveniences, venturing out after dusk
meant running the risk of being eaten or expending valuable calories
needed for daylight hours, she says. She notes feasts like Thanksgiving
were likely ways to overload on calories for the bleak season that
followed.
"The speculation is SAD is a disease that's more of a
problem in modern society than in historical society," Oren says. "It's
perfectly reasonable. In the winter months when there wasn't much to
do, it was OK to do less. Modern industrial society is reluctant to
allow for a slowdown."
SAD afflicts more women than men. Normal
depression affects women 40 percent to 60 percent more than men.
According to Oren, SAD affects women three to four times more than men.
The disorder is most noticeable during post-pubescence and the years of
reproductive fertility (ages 13 to 50) for women. Research has yet to
explain why.
"Most people say, 'I tend to get more depressed
this time of year.' Sometimes they equate it with the holidays and the
stress related to it," says Kirwan. "They don't see it as something
that can be treated. If it's serious enough, they should see a mental
health professional."
SAD can intensify during the holidays,
which adds to stress when people feel the financial crush and the need
to idealize the season. It can lead others to believe they are
suffering from the disorder when they are simply feeling seasonal
pressures. "Some people that think they have winter depression just
might have a lot of stresses around the holiday and the expectation of
having this great, harmonious Christmas," Braun says.
Although
the FDA hasn't approved treatments for SAD, there are things people can
do to combat it. For people with mild blues, taking a walk in the
morning or afternoon can have tremendous effects even on a cloudy day.
Braun notes that walking along a beach on a cloudy day provides
exposure to 50,000 lux, or units or illumination, whereas indoor
lighting gives off about 50.
A winter trip to a more friendly
climate, whether in the sun of the Caribbean or skiing in Colorado, can
be beneficial, although the symptoms of SAD can creep back upon return,
Oren says. Exercise is also a useful defense against depression of any
form.
In more severe cases, antidepressants and light therapy
are the two most common treatment methods. "Some people prefer the
simplicity of taking a pill once a day and some people prefer the
naturalness (of light) once a day," Oren says. "One is treating the
exact deficiency and the other is making up for it."
Light
therapy involves exposure to intense light under specified conditions.
Recommended systems consist of fluorescent bulbs in a box that has a
plastic diffusing screen. Users are asked to sit at close range to the
device for anywhere between 15 minutes and 2 hours daily. Recommended
systems can be found on the Web sites for Society for Light Treatment
and Biological Rhythm, of which Oren is a former president
(www.sltbr.org), or the Center for Environmental Therapeutics
(www.cet.org).
Braun says that both can work but have drawbacks;
she suggests people with SAD first try natural approaches like outdoor
exercise. "(A light box) isn't that practical to sit in front of for
even 30 minutes," she says. As for antidepressants, she doesn't believe
enough studies have been done about what happens when you put someone
on pills for a few months and then take them off.
SAD may be no more prevalent than it was ages ago, but it's a much talked about and researched topic.
"It's
been a fairly significant interest for the last 20 years," Oren says.
"There's been more publicity about it. At first, there were a lot of
psychiatrists who were skeptical but then they began to see it. There's
a greater acceptance. As a physiological phenomenon, it takes away from
the stigma. There was a time when it would be blamed on a bad incident
in one's childhood. Now we see it as a vulnerability that one
inherits."
Copyright (c) 2004, Southern Connecticut Newspapers, Inc.
--------------------
This article originally appeared at: http://www.greenwichtime.com/features/scn-sa-season1dec21,0,5125675.story
Visit The Greenwich Time online at http://www.greenwichtime.com
OUR SPECIALTIES
stress
management
self-hypnosis
and visualization skills
integrative
treatment of eating disorders
insight-oriented psychotherapy
cognitive-behavioral therapy
effective
treatment for depression and anxiety
expert use of
a broad range of medications
CARE PHILOSOPHY
At IMAP, we
believe in integrating cutting edge medication management into the care of the
whole patient, balancing the needs of body and mind. Dr. Braun or Ms. Smith work
one-on-one with patients, using medications in tempered combination with stress
management skills, insight-oriented psychotherapy and cognitive behavioral
therapy. Whether you choose to work with Dr. Braun or Ms. Smith, you will have
the opportunity to select from an appropriate range of treatments which may
include self-hypnosis, visualization, mindfulness and relaxation techniques, as
well as medication.
Perhaps most importantly, both Devra Braun and Linda
Smith are committed to really listening to the individuals who come in for
consultation. You can expect collaborate with our patients and together map out
a plan for effective individualized treatment. With information and stress
management training, the patient is empowered and the doctor-patient
collaboration has its best chance for success.
In the best of
psychological medicine, the therapist is the incubator, the patient the egg. The
therapist helps to create the conditions which allow the patient to realize his
or her potential.
ABOUT LINDA M. SMITH, APRN
Linda M. Smith is
a Psychiatric Nurse Practitioner with up-to-date expertise in both psychotherapy
and medication management. Working in collaboration with Dr. Devra Braun for the
past five years, she offers a selection of affordable therapeutic services
tailored to the individual. These include targeted psychotherapy and cognitive
behavioral therapy, medication management, hypnotherapy and self-hypnosis
training, as well as a range of mind-body stress management techniques, offered
in an atmosphere of partnership and care.
Education Post
Masters Certificate (Psychiatric Nurse Practitioner), Fairfield U.,
2001 M.Sc.A. (Nursing-Health Promotion, Research Major), McGill University,
1988 B.Sc.A. (Nursing, Cum Laude), Alfred University,
1982
Licensure and Certification Advanced Practice Nurse, State
of Connecticut, since 2002 Family Psychiatric & Mental Health Nursing
Practitioner, American Nurses Credentialing Center, since
2002
Academic & Administrative Appointments Psychiatric
Consultation Liaison, Greenwich Hospital, Greenwich, CT, since
2001. Psychiatric Consultant, Med Options, Fairfield County, CT. Wellness
Consultant, Equipoise Wellness Center, Rochester, NY,
1997-1999 Professional Development Consultant, McGill University
Health Center, Montreal, Quebec, 1989-1998 Chief of Geriatric Consultation
Service, McGill University Health Center, Montreal, Quebec,
1985-88
Awards & Honors Appointed Honorary Member of Nurse
Psychotherapists of Connecticut, Fairfield University, 2001 Managerial Award
for Outstanding Contribution to the Organization, Jewish General Hospital,
1989
ABOUT DEVRA BRAUN M.D.
Devra Braun, M.D.
is a Clinical Assistant Professor of Psychiatry at Weill Cornell Medical
College, where she teaches and supervises. She is also a member of the Medical
Staff at Greenwich Hospital, a teaching affiliate of Yale. She founded
Integrative Medicine and Psychotherapy of Greenwich, LLC in 2002, after six
years as Assistant Medical Director of the Northeast Center for Trauma Recovery.
Dr. Braun maintains up-to-date expertise in the use of psychiatric
medications. However, she believes in integrating medicine into the care of the
whole patient, balancing the needs of body and mind. She believes in using
medications in tempered combination with stress management skills,
insight-oriented psychotherapy and cognitive behavioral therapy. She teaches
patients to use sophisticated stress reduction techniques which incorporate
visualization and mindfulness. And most importantly, she listens to her
patients, so that she and her patients can together come up with a plan for
individualized treatment that will work.
Dr. Braun has been a Board
Certified Psychiatrist for more than a decade. She is a certified hypnotherapist
and consultant for the American Society of Clinical Hypnosis and a member of the
National Board for Certified Clinical Hypnotherapists. She is an active member
of the American Society of Clinical Psychopharmacology and a member of the
Integrative Medicine committee and the Pharmacy committee at Greenwich Hospital.
She does not receive any funding or support from drug companies.
Dr.
Braun is the author of numerous professional articles on subjects including
eating disorders, stress management, winter depression, ADHD in adults and the
stresses of pregnancy. Dr. Braun has particular expertise in treating
depression, anxiety, and eating disorders including binge eating, anorexia and
bulimia. In recent years, she has taught a number of courses in these subjects
for her professional colleagues, including a Harvard Medical School-sponsored
workshop on the treatment of bulimia and trauma. and a hypnotherapy training
course for the American Society of Clinical Hypnosis.
She spent ten years
at the New York Presbyterian Hospital, Westchester Division. In 1996, when she
left the Hospital for outpatient practice, she was Director of the Inpatient
Eating Disorders Service and a residency training coordinator. She had also
received a reseach grant from the National Institute for Mental Health
(1995-1997).
She has presented Grand Rounds on the medical uses of
hypnosis at both Greenwich Hospital and the New York Presbyterian Hospital. She
is the lead author of a review article about Attention Deficit Disorder in
Adults which was published in September, 2004 in Primary Psychiatry, a journal
for primary care doctors.
