105 posts · 38,502 views
The challenges of treating anorexia nervosa are plenty; some of these challenges — like low prevalence rate and high treatment dropout rate — make conducting randomised controlled trials aimed at identifying effective treatment methods really hard as well.
So I was pretty excited about the recently published randomised controlled trial comparing focal psychodynamic therapy (FPT), cognitive behaviour therapy (CBT), and optimised treatment as usual in adult (a harder to treat ........ Read more »
Zipfel S, Wild B, Groß G, Friederich HC, Teufel M, Schellberg D, Giel KE, de Zwaan M, Dinkel A, Herpertz S.... (2013) Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet. PMID: 24131861
Good health is more than just the absence of illness; it is more than just the absence of dysfunction. Good health — that is, mental, social, and physical health — requires the presence of wellness, or the ability to function well.
In this respect, with regard to eating disorders, most research has focused on assessing (health-related) quality of life and subjective well-being of eating disorder patients, often focusing on things like body satisfaction, self-este........ Read more »
Tomba E, Offidani E, Tecuta L, Schumann R, & Ballardini D. (2013) Psychological well-being in out-patients with eating disorders: A controlled study. International Journal of Eating Disorders. PMID: 24123214
Cognitive-behavioural therapy (CBT) is commonly described as the evidence-based treatment for bulimia nervosa. But do the findings from nearly perfectly crafted trials, with stringently followed protocols and “ideal” participants apply to the “real world”? How generalizable are the findings from carefully selected participants to clinical populations where, for one, the prevalence of psychiatric comorbidities is relatively high?
In other words, CBT has been shown to be efficacious ........ Read more »
Waller G, Gray E, Hinrichsen H, Mountford V, Lawson R, & Patient E. (2013) Cognitive-behavioral therapy for bulimia nervosa and atypical bulimic nervosa: Effectiveness in clinical settings. International Journal of Eating Disorders. PMID: 23996224
Genetics play an important role in the development of eating disorders and disordered eating behaviours. To date, many (over 30!) twin studies have been done and all but two found significant genetic effects on the development of eating disorders and disordered eating. However, no methodology is without limitations and tentative conclusions become more convincing when the findings are confirmed using different experimental approaches.
Twin studies, while they offer many advantages, are n........ Read more »
Klump KL, Suisman JL, Burt SA, McGue M, & Iacono WG. (2009) Genetic and environmental influences on disordered eating: An adoption study. Journal of Abnormal Psychology, 118(4), 797-805. PMID: 19899849
Restricting, bingeing, and purging are powerful ways to regulate emotional states. However, these behaviours probably play different roles in emotional regulation. Whereas restriction is hypothesized to pre-empt the onset of highly emotional states, bingeing and purging is thought to act as a coping mechanism to deal with overwhelming emotional states once they’ve already been activated.
If this is true, we would expect to see more variability (or fluctuation) in the intensity and ........ Read more »
Vansteelandt K, Probst M, & Pieters G. (2013) Assessing affective variability in eating disorders: Affect spins less in anorexia nervosa of the restrictive type. Eating Behaviors, 14(3), 263-8. PMID: 23910763
What is different about anorexia nervosa sufferers that, in contrast to most dieters, enables them to maintain a persistent calorie deficit? Although no one can truthfully claim they know the full answer to that question, we do know that part of the answer most likely lies with serotonin (5-HT), a molecule that neurons use to communicate with each other.
I’ve written about serotonin in the context of anorexia nervosa before, so I’ll just do a brief summary of the impor........ Read more »
Kaye WH, Barbarich NC, Putnam K, Gendall KA, Fernstrom J, Fernstrom M, McConaha CW, & Kishore A. (2003) Anxiolytic effects of acute tryptophan depletion in anorexia nervosa. The International Journal of Eating Disorders, 33(3), 257. PMID: 12655621
Cholecystokinin (CCK) is a digestive hormone that stimulates fat and protein digestion, and promotes the feeling of satiety. CCK is released after food consumption to promote digestion (by releasing digestive enzymes from the pancreas and stimulating bile secretion). In rats and monkeys, injection of CCK induces satiety, though it seems (from what I’ve skimmed), the extent to which CCK regulates food intake in humans is not well-established. Previous research on the role of CCK in a........ Read more »
Cuntz U, Enck P, Frühauf E, Lehnert P, Riepl RL, Fichter MM, & Otto B. (2013) Cholecystokinin revisited: CCK and the hunger trap in anorexia nervosa. PloS ONE, 8(1). PMID: 23349895
Is banning content that is thought to “promote” eating disorders such as anorexia nervosa (pro-ana) a good idea? I want to put aside the question of whether the goal is even possible (I would argue that it is not) and focus instead on what might happen if pro-ana content is banned or threatened to be banned from mainstream social networks, blogging platforms, and web hosts.
If you only read mainstream news media, you might think that pro-eating disorder websites are evil commun........ Read more »
Casilli, A, Pailler, F, & Tubaro, P. (2013) Online networks of eating-disorder websites: why censoring pro-ana might be a bad idea. Perspectives in Public Health, 133(2), 94-5. PMID: 23467530
Anorexia nervosa was first described in the medical literature in 1689 by Richard Morton. It has been over 300 years since then and AN continues to be one of the deadliest psychiatric disorders. If not treated early, it runs the risk of becoming deeply entrenched and highly resistant to treatment.
Moreover, established treatments for related disorders like bulimia nervosa and depression, such as cognitive behavioural therapy and antidepressants, are rather ineffective in treating anorexia ........ Read more »
Women with bulimia nervosa are three times more likely to struggle with PTSD than women without eating disorders, according to a study by Dansky and colleagues (1997). In that study, 37% of individuals with bulimia nervosa had lifetime PTSD, compared to 12% of women without eating disorders. That’s almost two in five.
Treating eating disorders is hard, but treating eating disorders with comorbid conditions is way harder. There is no consensus, it seems, as to what disorder(s) to tre........ Read more »
Mitchell KS, Wells SY, Mendes A, & Resick PA. (2012) Treatment improves symptoms shared by PTSD and disordered eating. Journal of Traumatic Stress, 25(5), 535-42. PMID: 23073973
I have often heard anorexia nervosa sufferers complain of “memory gaps,” particularly during the times they were really sick. As if they weren’t really there. It can be scary and unnerving, to say the least. A few months ago, a Tumblr user asked me about this:
I researched the question a bit myself and what was meant to be a short responses turned into a 1,000+ word answer.
In this post I’ll expand on my answer, and so it will be different from what I usually ........ Read more »
Witte AV, Fobker M, Gellner R, Knecht S, & Flöel A. (2009) Caloric restriction improves memory in elderly humans. Proceedings of the National Academy of Sciences of the United States of America, 106(4), 1255-60. PMID: 19171901
Martin, C., Anton, S., Han, H., York-Crowe, E., Redman, L., Ravussin, E., & Williamson, D. (2007) Examination of Cognitive Function During Six Months of Calorie Restriction: Results of a Randomized Controlled Trial. Rejuvenation Research, 10(2), 179-190. DOI: 10.1089/rej.2006.0502
Vreugdenburg L, Bryan J, & Kemps E. (2003) The effect of self-initiated weight-loss dieting on working memory: the role of preoccupying cognitions. Appetite, 41(3), 291-300. PMID: 14637328
Kemps E, Tiggemann M, & Marshall K. (2005) Relationship between dieting to lose weight and the functioning of the central executive. Appetite, 45(3), 287-94. PMID: 16126305
Nikendei C, Funiok C, Pfüller U, Zastrow A, Aschenbrenner S, Weisbrod M, Herzog W, & Friederich HC. (2011) Memory performance in acute and weight-restored anorexia nervosa patients. Psychological medicine, 41(4), 829-38. PMID: 20529417
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 dif........ Read more »
Karr, T., Crosby, R., Cao, L., Engel, S., Mitchell, J., Simonich, H., & Wonderlich, S. (2013) Posttraumatic stress disorder as a moderator of the association between negative affect and bulimic symptoms: an ecological momentary assessment study. Comprehensive Psychiatry, 54(1), 61-69. DOI: 10.1016/j.comppsych.2012.05.011
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. ........ Read more »
Hartmann AS, Greenberg JL, & Wilhelm S. (2013) The relationship between anorexia nervosa and body dysmorphic disorder. Clinical psychology review, 33(5), 675-685. PMID: 23685673
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 ac........ Read more »
Suisman, J., O'Connor, S., Sperry, S., Thompson, J., Keel, P., Burt, S., Neale, M., Boker, S., Sisk, C., & Klump, K. (2012) Genetic and environmental influences on thin-ideal internalization. International Journal of Eating Disorders, 45(8), 942-948. DOI: 10.1002/eat.22056
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
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