Posts
June 08, 2013
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Posttraumatic stress disorder (PTSD) is 3-5 times more prevalent in individuals with bulimia nervosa (BN) than those without (Dansky et al., 1997). However, the relationship between PTSD and BN–in particular, how PTSD might affect or moderate bulimic symptoms–remains largely unexplored. In a recent study, Trisha Karr and colleagues followed 119 women (20 with PTSD and BN, and 99 with BN only) for 2-week period to investigate whether participants with comorbid PTSD + BN differ
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June 05, 2013
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Is anorexia nervosa a subtype of body dysmorphic disorder (BDD)? Well, probably not, but don’t click the close button just yet. In this post, I’ll explore the relationship between anorexia nervosa and BDD, and discuss how understanding this relationship might help us develop better treatments for both disorders.
Despite the fact that there are obvious similarities between the disorders, studies exploring the relationship between BDD and AN are few and far between. In a recent
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May 24, 2013
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The Tripartite Model of body image dissatisfaction postulates that three factors (peers, parents, and media) affect body image dissatisfaction and disordered eating through thin-ideal internalization and appearance comparison.
Thin-ideal internalization is the extent to which one accepts or “buys into” socioculturally defined beauty standards of thinness. The idea is that the more someone internalizes these standards, the more likely they are to engage in behaviours to achieve
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May 06, 2013
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The 2013 International Conference on Eating Disorders (ICED) ended on May 4th. I thought I’d reflect on the experience (short version: it was awesome and I’m so glad I went!). Please note, the following is in no way comprehensive, representative, or scientific.
There were a lot of overlapping events at the conference, which meant that I could only attend a fraction of the events. I highlighted in yellow the workshops/panels/presentations I attended. There are more details about the
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April 29, 2013
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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,
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April 22, 2013
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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, I thought it was scaaary. But, as I’ve learned more about it, I began to realize it is not as scary as I originally thought.
As a side-note: I know many people reading this post will know more about Maudsley than I ever
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April 18, 2013
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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
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April 15, 2013
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I defended my MSc 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
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March 30, 2013
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1:38 PM | Eating Disorders in the Elderly
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?
There aren’t a lot of studies on this topic, but the the above figures illustrate that there’s a significant minority of elderly individuals who struggle with eating disorders or disordered eating.
What
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March 25, 2013
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4:08 AM | Are There Any Meaningful Differences Between Subthreshold and Full Syndrome Anorexia Nervosa?
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,
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March 18, 2013
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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
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March 16, 2013
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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
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March 13, 2013
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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 of
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March 08, 2013
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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
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Lipsman, N., Woodside, D., Giacobbe, P., Hamani, C., Carter, J., Norwood, S., Sutandar, K., Staab, R., Elias, G., Lyman, C. & Smith, G. (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
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March 04, 2013
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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
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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
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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
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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
Citation
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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
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February 28, 2013
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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,
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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
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February 25, 2013
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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
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Brown, A., Parman, K., Rudat, D. & Craighead, L. (2012). Disordered eating, perfectionism, and food rules, Eating Behaviors, 13 (4) 347-353. DOI: 10.1016/j.eatbeh.2012.05.011
Citation
February 21, 2013
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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
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BARBARICH, N. (2002). Lifetime Prevalence of Eating Disorders Among Professionals in the Field, Eating Disorders, 10 (4) 305-312. DOI: 10.1080/10640260214505
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February 18, 2013
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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
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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
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February 15, 2013
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4:58 AM | Personality Traits after Recovery from Eating Disorders: Do Anorexia and Bulimia Patients Differ?
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
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Wagner, A., Barbarich-Marsteller, N., Frank, G., Bailer, U., Wonderlich, S., Crosby, R., Henry, S., Vogel, V., Plotnicov, K., McConaha, C. & Kaye, W. (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
Citation
February 10, 2013
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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
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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
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February 08, 2013
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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 today I’ll focus specifically on medical complications that occur in bulimia nervosa (BN) as a result of purging (self-induced vomiting, laxative abuse, and diuretic abuse).
These complications are particularly important because patients with BN
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Mehler, P. (2010). Medical complications of bulimia nervosa and their treatments, International Journal of Eating Disorders, DOI: 10.1002/eat.20825
Citation
February 05, 2013
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4:56 AM | Is Anorexia Nervosa An Anxiety Disorder?
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
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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
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February 03, 2013
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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 5
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Smith, A., Fink, E., Anestis, M., Ribeiro, J., Gordon, K., Davis, H., Keel, P., Bardone-Cone, A., Peterson, C., Klein, M. & Crow, S. (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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Editor's Pick
January 30, 2013
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Ambivalence is a great word to describe how many eating disorder patients feel about recovery. Many people that follow my Science of Eating Disorders tumblr run thinspo blogs. But, they follow me, and many probably follow fyoured, which offers pro-recovery advice. Many people might want to recover someday, but they feel they can’t let go of the behaviours now. They are not denying their illness, or that recovery will happen, or that it really IS a disorder, but, right now,
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January 27, 2013
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4:35 AM | Excessive Exercise in Eating Disorders
Excessive exercise (EE) is common among eating disorder patients. Indeed, in the study I’ll write about today, 39% of patients engaged in EE. Previous studies have tried to find psychopathological and personality correlates of EE but the results have been inconsistent. Some studies have suggested that impulsivity and addictiveness are highly correlated with EE whereas others found that anxious and depressive traits were more closely associated.
In this multi-site study,
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Shroff, H., Reba, L., Thornton, L., Tozzi, F., Klump, K., Berrettini, W., Brandt, H., Crawford, S., Crow, S., Fichter, M. & Goldman, D. (2006). Features associated with excessive exercise in women with eating disorders, International Journal of Eating Disorders, 39 (6) 454-461. DOI: 10.1002/eat.20247
Citation
January 26, 2013
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Since the late 1990′s, Remuda Ranch Program for Eating Disorders has experienced a 400% increase in patients 40 years of age and older, according to the authors of this paper. However, we don’t really know what the similarities and differences are between women who develop eating disorders in adolescence and those who develop their eating disorders in midlife (40-65 years of age).
In this paper, Edward Cumella and Zina Kally present a summary of 50 women who first developed eating
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Cumella, E. & Kally, Z. (2008). Profile of 50 Women with Midlife-Onset Eating Disorders, Eating Disorders, 16 (3) 193-203. DOI: 10.1080/10640260802016670
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January 24, 2013
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There is a common misconception that eating disorders somehow disappear during pregnancy; that becoming a mother stops all those silly worries about being slim and attractive. This is not necessarily the case, but unfortunately, there is a lot of stigma associated with talking about disordered eating behaviours during pregnancy. Openly admitting to it is an invitation, it seems, to being called selfish and vain. The implication is that eating disorders are something only young girls struggle
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Tierney, S., Fox, J., Butterfield, C., Stringer, E. & Furber, C. (2011). Treading the tightrope between motherhood and an eating disorder: A qualitative study, International Journal of Nursing Studies, 48 (10) 1223-1233. DOI: 10.1016/j.ijnurstu.2010.11.007
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