Month: February 2013

Framing Eating Disorders As "Brain Diseases" Might Lead to More Stigma

Tetyana 12 Comments

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, the topic is particularly timely. Those of us involved in some aspect of mental health awareness don’t want to be saying “x” only to have be interpreted as “y.”

So, the question is–does a biological or genetic framing of eating  disorders lead individuals to hold more positive views of eating disorder sufferers and place less blame on “weak will”?

This is precisely what Matthias Angermeyer and colleagues asked almost 1,350 individuals … Continue reading →

Rigid Food Rules in Eating Disorders: Is Perfectionism to Blame?

Tetyana 12 Comments

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 individuals have more rules and more ritualistic behaviours than others?

It is a complex question, but a recent study suggests that perfectionism might play a role. Specifically, the authors explored the idea that perfectionism mediates adherence to food rules in disordered eating behaviours. In order words, food rules might be a way in which perfectionism “expresses itself” in eating disorders.

Why perfectionism… Continue reading →

Chewing and Spitting: A Neglected Symptom in Eating Disorders?

Shelly 23 Comments

Eating disorders come in all shapes and sizes, but all of them are characterized by the same goal: to avoid weight gain or induce weight loss. While behaviours such as food restriction, purging, and laxative abuse are relatively well studied, chewing and spitting (CHSP) is not. A simple Google search, however, reveals over 1.5 million results for the term “chewing and spitting.” Results often links to blog posts or Tumblr pages where CHSP sufferers confess their guilt, disgust and obsession with the behaviour.

What is chewing and spitting? How does it relate to other disordered eating behaviours  such as restrictive eating or binge eating?

Chewing and spitting describes the pathological eating behaviour where the individual chews a variety of enjoyable foods, and spits it out to avoid undesirable consequences of weight gain (Mitchell et al, 1988). This seemingly “smart” workaround allows them to enjoy the taste of foods … Continue reading →

Lifetime Prevalence of Eating Disorders Among Eating Disorder Professionals

Tetyana 15 Comments

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 how common are eating disorders among ED treatment professionals?

This is the question that Nicole Barbarich asked in a survey mailed to 823 members of the Academy for Eating Disorders.

Barbarich developed a 14-item self-report questionnaire that assessed everything from basic demographics to personal eating disorder history and their employer’s hiring policies. Out of 823 potential participants, 399 completed the questionnaire.

SUMMARY OF MAIN FINDINGS

Demographics of Survey Responders… Continue reading →

Shared Genetics Between Disordered Eating and Periods (Menses)

Tetyana 5 Comments

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 disordered eating are more likely due to genetic factors. (I blogged about it here.)

Essentially, estradiol partially moderates the extent to which genes affect disordered eating.

This is interesting because the estrogen system has a role in regulating body weight and food intake, influences eating behaviours during the menstrual cycle, and obviously plays an important role during puberty. Moreover, one study showed that estrogen receptor genes (proteins that bind estrogen) are associated … Continue reading →

Personality Traits after Recovery from Eating Disorders: Do Anorexia and Bulimia Patients Differ?

Tetyana 4 Comments

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 began to wonder if there was another way to categorize patients–not according to symptoms, but according to personality traits?

They identified three clusters of personality subtypes that seemed to “cut across” eating disorder diagnoses, outlined below (taken from a previous post):

Three Personality Subtypes in Eating Disorder Patients:

  1. “dysregulated/undercontrolled pattern: characterized by emotional dysregulation and impulsivity”
  2. “constricted/overcontrolled pattern: characterized by emotional inhibition, cognitively sparse representations of self and others, and interpersonal avoidance”
  3. “high-functioning/perfectionist pattern: characterized
… Continue reading →

Bingeing and Purging Marathons: Repeated Binge/Purge Cycles in Bulimia Nervosa

Tetyana 9 Comments

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 certain time of the day–because once they binge and purge, it triggers a continuous cycle of bingeing and purging until they become to exhausted or otherwise end up going to bed.

I always wondered why that was, why was it so hard to keep a single episode of bingeing and purging from initiating a repeated cycle of bingeing and purging?

On … Continue reading →

Medical Complications of Purging in Bulimia Nervosa

Tetyana 1 Comment

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’d 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 often appear healthy and can thus more easily hide their disorder, meaning that treatment is often initiated many years after disorder onset, and the duration of BN is often long, with recovery rates far lower than they should be (in one study, the 5-year recovery rate was a little more than 50%), which means that these complications can persist for many years.

I’ll go through some of the complications of self-induced vomiting, laxative abuse, diuretic abuse, … Continue reading →

Is Anorexia Nervosa an Anxiety Disorder?

Tetyana 11 Comments

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 and depressive disorders, suggesting they comprise a spectrum of inherited phenotypes” (Hudson et al., 2003; Mangweth et al., 2003).

In this paper, Michael Strober and colleagues hypothesized that anxiety disorders and anorexia nervosa share common genetic, neural, and/or behavioural mechanisms. As such, they sought to investigate the association of AN with ADs by studying the prevalence of ADs in first-degree relatives of AN patients and comparing it to the prevalence of ADs in first-degree relatives of … Continue reading →

Over-Exercise is Associated With Suicidality in Individuals with Disordered Eating

Tetyana 6 Comments

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 are suicides. (Keep in mind, these numbers are really hard to pin down as they depend a lot on the sample population, sample size, and how the authors did their statistics, among other things.)

Another analysis found that the standardized mortality ratio (ratio of observed deaths in the study sample/expected deaths in the population of the same age but without the disease/disorder you are studying) for suicide in eating disorders was 31 for patients with … Continue reading →