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Why do some people recover anorexia nervosa relatively quickly while others seem to struggle for years or decades? Does it depend on the person’s desire to get better? Their willpower? How much they are willing to fight? Is it just that some try harder than others? Some might say yes, but most will correctly realize that the picture is much, much more complex.
We can spend hours talking about barriers to treatment, but in this post I want to talk about something slightly different, somethi........ Read more »
Zerwas, S., Lund, B., Von Holle, A., Thornton, L., Berrettini, W., Brandt, H., Crawford, S., Fichter, M., Halmi, K., Johnson, C.... (2013) Factors associated with recovery from anorexia nervosa. Journal of Psychiatric Research. DOI: 10.1016/j.jpsychires.2013.02.011
When it comes to eating disorder treatment, few (if any) approaches are as divisive as Family-Based Treatment, also known as the Maudsley Method (I’ll use the terms interchangeably) . When I first heard about Maudsley, sometime during my mid-teens, most likely through an ED recovery community on Livejournal, I thought it was scaaary. But as I’ve learned more about it, my opinion changed (although, it does still seem kind-of scary).
As a side-note: I know many peop........ Read more »
Smith, A., & Cook-Cottone, C. (2011) A Review of Family Therapy as an Effective Intervention for Anorexia Nervosa in Adolescents. Journal of Clinical Psychology in Medical Settings, 18(4), 323-334. DOI: 10.1007/s10880-011-9262-3
When most people think of bulimia nervosa, they think of binge eating and self-induced vomiting. While that is not incorrect, it is not the full picture either. In the current edition of the Diagnostic and Statistical Manual (DSM-IV), there are two subtypes of bulimia nervosa: purging (BN-P) and nonpurging (BN-NP). The difference lies in the types of compensation methods: patients with BN-P engage in self-induced vomiting, or the misuse of laxatives, diuretics, or enemas whereas patients with BN........ Read more »
van Hoeken, D., Veling, W., Sinke, S., Mitchell, J., & Hoek, H. (2009) The validity and utility of subtyping bulimia nervosa. International Journal of Eating Disorders, 42(7), 595-602. DOI: 10.1002/eat.20724
I defended my MSc degree on Tuesday and I’m not going to lie: I was pretty symptomatic with bulimia in the days prior to my defence. As I was explaining to my boyfriend, the anxiety-reducing effects of purging are so powerful, and the compulsion to binge and purge (when I’m stressed/anxious/”not okay”) is so strong that it is much easier to do it, get it over with, and continue working (in a much calmer state).
I’ve mentioned before, for me, purging is very anxiety-........ Read more »
Smyth, J., Wonderlich, S., Heron, K., Sliwinski, M., Crosby, R., Mitchell, J., & Engel, S. (2007) Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. Journal of Consulting and Clinical Psychology, 75(4), 629-638. DOI: 10.1037/0022-006X.75.4.629
The first published case of a late-onset eating disorder (at the age of 40) was in 1930 by John M. Berkman. In 1936, John A. Ryle published a case study of an eating disorder in a 59-year-old woman. Just how common are eating disorders in late middle-age or elderly individuals?... Read more »
I see this on an daily basis: patients with subtreshold eating disorders feeling invalidated and “not sick enough.” They are struggling so much, but maybe they still have their periods, or maybe their weight isn’t quite low enough, and so they often (but not always, thankfully) get dismissed by doctors, other healthcare professionals, and insurance companies. Do you think you really need this treatment, maybe you can just focus on eating healthier? You know you are not fat, you........ Read more »
Le Grange, D., Crosby, R., Engel, S., Cao, L., Ndungu, A., Crow, S., Peterson, C., Mitchell, J., & Wonderlich, S. (2013) DSM-IV-Defined Anorexia Nervosa Versus Subthreshold Anorexia Nervosa (EDNOS-AN). European Eating Disorders Review, 21(1), 1-7. DOI: 10.1002/erv.2192
In my last post I talked about some methods that scientists use to study the genetics of eating disorders. I focused on a subfield of genetics called behavioural genetics (which you can think of as a field that attempts to understand, in part, the interplay of genetics and environment in behaviour). In this post I’ll shift gears and focus on molecular genetics. I’ll be working of the same review paper by Drs. Zerwas and Bulik (2011). Molecular geneticists study the structure and........ Read more »
Today I thought I’d take the time to do an overview of what researchers know about the genetics of eating disorders and try to clear up some common misconceptions. The bulk of the content in this blog post comes from a very nice review paper published in 2011 by Drs. Stephanie Zerwas and Cynthia Bulik on the genetics and epigenetics of eating disorders. In an effort to keep blog posts short, this will be a multi-part mini-series.
When it comes to the genetics of eating disorders, there are........ Read more »
Refeeding syndrome (RS) is a rare but potentially fatal condition that can occur during refeeding of severely malnourished individuals (such as anorexia nervosa patients). After prolonged starvation, the body begins to use fat and protein to produce energy because there are not enough carbohydrates. Upon refeeding, there’s a surge of insulin (because of the ingested carbohydrates) and a sudden shift from fat to carbohydrate metabolism. This sudden shift can lead to a whole set o........ Read more »
This week, a team of researchers from the University of Toronto published a paper in The Lancet describing the results of a small study using deep brain stimulation (DBS) to treatment severe/chronic anorexia nervosa. Major news outlets, including the BBC, reported on the findings. A few people emailed and messaged me asking me to do a post about it (which is cool! I love it!). So here it is.
DBS is a surgical procedure that involves implanting an electrode that delivers electrical........ Read more »
Lipsman, N., Woodside, D., Giacobbe, P., Hamani, C., Carter, J., Norwood, S., Sutandar, K., Staab, R., Elias, G., Lyman, C.... (2013) Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial. The Lancet. DOI: 10.1016/S0140-6736(12)62188-6
The link between urban living and mental disorders such as schizophrenia and depression has been known for quite some time (Sundquist et al., 2004). In one study, Sundquist et al found that individuals living in a densely populated area had a 68-77% higher risk of developing psychosis and 12-22% higher risk of developing depression.
The question then arises, do eating disorders follow a similar pattern? And if yes, what are some possible explanations? Certainly we know that both genetic and envi........ Read more »
VAN SON, G., VAN HOEKEN, D., BARTELDS, A., VAN FURTH, E., & HOEK, H. (2006) Urbanisation and the incidence of eating disorders. The British Journal of Psychiatry, 189(6), 562-563. DOI: 10.1192/bjp.bp.106.021378
Many–myself included–assume that emphasizing the biological basis of mental disorders will reduce mental health stigma. The idea is that it will place less blame and personal responsibility on the affected individual.
Still, when it comes to raising awareness and reducing stigma, we need to make sure that our assumptions hold up to the evidence, otherwise we run the risk of playing a game of broken telephone. Given that this is Eating Disorder Awareness Week in the United States, th........ Read more »
Angermeyer, M., Mnich, E., Daubmann, A., Herich, L., Wegscheider, K., Kofahl, C., & Knesebeck, O. (2013) Biogenetic explanations and public acceptance of people with eating disorders. Social Psychiatry and Psychiatric Epidemiology. DOI: 10.1007/s00127-012-0648-9
I remember cutting baby carrots into 6 pieces. Rushing home to eat because I wasn’t “allowed” to eat after 7 pm. Eating the exact portion size–no more, no less. (Oh the rules. I don’t miss them.) Rigid food rules are very common among eating disorder sufferers. These rules can be about anything: the foods you are allowed to eat, how you are allowed to eat them, the time you are allowed to eat them, and so on.
But where do they come from? Why do some indivi........ Read more »
How many professionals that treat eating disorders have a personal history of struggling with an eating disorder? It is a crucial question to ask (and answer) because there are important implications for patient treatment and for the health of the afflicted professionals. It is true that many (or most?) individuals who go into mental health do so because of personal experiences–whether due to their own personal history or the experiences of a loved one–so it is useful to ask, just ho........ Read more »
BARBARICH, N. (2002) Lifetime Prevalence of Eating Disorders Among Professionals in the Field. Eating Disorders, 10(4), 305-312. DOI: 10.1080/10640260214505
Puberty at an early age increases the risk for disordered eating behaviours such as bingeing and purging (Jacobi et al., 2004; Kaltiala-Heino et al., 2001). What’s more, the hormone estradiol moderates the risk of disordered eating behaviours. More precisely, in a group of twins with low estradiol levels, differences in disordered eating are likely due to environmental factors (such as family, school, friends), but in a group of twins with high estradiol levels, the differences in dis........ Read more »
Baker JH, Thornton LM, Bulik CM, Kendler KS, & Lichtenstein P. (2012) Shared genetic effects between age at menarche and disordered eating. The Journal of Adolescent Health, 51(5), 491-6. PMID: 23084171
When we think about eating disorders, we tend to think about eating disorder subtypes: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder. A lot of previous work has shown that individuals with AN and BN tend to be anxious, depressed, perfectionistic, and harm-avoidant. Patients with AN also tend to score low on novelty-seeking, impulsivity, and self-directedness, whereas patients with BN score high on novelty-seeking and impulsivity. More recently, however, some researchers ........ Read more »
Wagner, A., Barbarich-Marsteller, N., Frank, G., Bailer, U., Wonderlich, S., Crosby, R., Henry, S., Vogel, V., Plotnicov, K., McConaha, C.... (2006) Personality traits after recovery from eating disorders: Do subtypes differ?. International Journal of Eating Disorders, 39(4), 276-284. DOI: 10.1002/eat.20251
I used to call them bingeing and purging marathons. If I binged and purged in the morning, chances were, I’d binge and purge throughout the day. The next time I’d eat, I was likely to end up–whether I wanted to or not–bingeing and purging. Not all individuals with bulimia nervosa binge and purge every day (or purge everything they eat, for that matter), but many do, and some binge and purge multiple times a day. In recovery, many people start by trying not to binge and purge before a c........ Read more »
Johnson, W., Jarrell, M., Chupurdia, K., & Williamson, D. (2010) Repeated binge/purge cycles in bulimia nervosa: Role of glucose and insulin. International Journal of Eating Disorders, 15(4), 331-341. DOI: 10.1002/eat.2260150404
Eating disorders are mental disorders with physical complications. Sometimes lots of them. I’ve blogged before about medical complications that are likely to come up in an emergency room setting, but that was a while ago. So I thought that today I’ll focus specifically on medical complications that occur in bulimia nervosa as a result of purging (self-induced vomiting, laxative abuse, and diuretic abuse).
These complications are particularly important because (1) patients with ........ Read more »
Mehler, P. (2010) Medical complications of bulimia nervosa and their treatments. International Journal of Eating Disorders. DOI: 10.1002/eat.20825
Anxiety disorders (ADs) are common among patients with eating disorders. In one study of female inpatients, around 50-65% had a comorbid anxiety disorder (see my post here). Anxiety disorders in patients with anorexia nervosa (AN) typically begin before the eating disorder and often persist after weight restoration and recovery (Bulik et al., 1997; Casper, 1990). Moreover, previous twin studies have suggested that there’s a “correlation between eating disorders and certain anxiety an........ Read more »
Strober, M., Freeman, R., Lampert, C., & Diamond, J. (2007) The association of anxiety disorders and obsessive compulsive personality disorder with anorexia nervosa: Evidence from a family study with discussion of nosological and neurodevelopmental implications. International Journal of Eating Disorders, 40(S3). DOI: 10.1002/eat.20429
Last week, I blogged about a study that examined personality traits and clinical variables associated with excessive exercise in eating disorder patients. In that study, 2 out of 5 participants engaged in excessive exercise Today, I’m going to discuss a study that suggests over-exercise in disordered eating patients is associated with suicide behaviour.
Suicide rates in eating disorder patients are high. One meta-analysis suggested that out of all eating disorder related deaths, 1 in ........ Read more »
Smith, A., Fink, E., Anestis, M., Ribeiro, J., Gordon, K., Davis, H., Keel, P., Bardone-Cone, A., Peterson, C., Klein, M.... (2012) Exercise caution: Over-exercise is associated with suicidality among individuals with disordered eating. Psychiatry Research. DOI: 10.1016/j.psychres.2012.11.004
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