The 2013 International Conference on Eating Disorders (ICED) ended on May 4th. I thought Iâd 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.
In his keynote speech, Dr. David Barlow wondered whether we are âmissing the forest for the treesâ as he highlighted some of the changes in the upcoming DSM-V (more disorders, more categories, more, as he said, âsplittingâ). Many disorders in the DSM-IV have the same underlying characteristics: high trait anxiety, neuroticism, negative affect, and emotional avoidance. Those of us with eating disorders tend to have difficulties recognizing and experiencing emotionsânot just negative emotions, but all kinds of emotions.
I thought of the lyrics from Silverchairâs âAnaâs Songâ:
For as long as you’re here, We’re not
You make the sound of laughter
And sharpened nails seem softer
And I need you now, somehow
And from Fiona Appleâs âPaper Pagâ:
Might it be more useful to think about what the disorders have in common, as opposed to what differentiates them? The idea is that many mental disorders (OCD, anxiety, EDs, etc) have a common basis and it is the specific differences between individuals that are ultimately responsible for differences in the way these traits manifest.
This idea is not new, but it does have implications for research and for treatment. Importantly, the presence of common features doesnât mean that treatment should be the same for OCD, depression, anxiety, and EDs, of course, but it might lead to more clues about causes and perhaps give us ideas about effective treatments and what we can borrow from other fields.
During the first oral paper presentation I attended, I learned about the Avoidant and Restrictive Food Intake Disorder (ARFID for short.) You can learn more about it here. An interesting question arose during the Q&A period, which was, what proportion of children/adolescents diagnosed with or fit the criteria for ARFID later go on to develop EDs? Are there some ARFID patients who might be too young to express body image disturbances?
Dr. Jenny Thomas presented an interesting talk titled âIs non-fat-phobic anorexia nervosa an artifact of purposeful symptom denial?â About 20% of AN patients are non-fat phobic (NFP), according to earlier research (though I canât help but wonder how biased this number is because of the DSM-IV criteria). She hypothesized that NFP AN maybe partly be âan artifact of socially desirable responding.â NFP AN patients scored higher on a scale that measures a person’s tendency to give socially desirable answers than their fat-phobic counterparts. The conclusion that NFP AN might be partly explained by symptom denial because of the desire to answer what the individual thinks is desirable.
I raised the point that maybe what can be happening (at least some of the time) is the opposite of the situation in AFRID. Maybe saying you are dieting/donât want to get fat is the simplest and most acceptable explanation? Perhaps a subset of FP AN patients cannot express/do not yet understand why they canât eat (perhaps lack of awareness of the anxiety-reducing effects of restriction or perhaps it is just something that’s nearly impossible to explain to peers) and so they say (and believe) that their AN is, at least in part, perpetuated by fat phobia. Thatâs my hypothesis. I think the reality is probably a bit of both. FP and NFP are also not necessary static throughout the course of the disorder.
I suspect that for some, the focus on weight and shape is just a convenient scapegoat. A distraction. Thatâs not to say it is not an important component of the disorder or part of treatment, it can be. Body image is something that affects everyone, regardless of whether you have an eating disorder or not. So, it would be unfair to say it is not a component but Iâm not sure it is as central to the disorder as some think. But, perhaps I’m wrong. It is a very interesting topic, though. I wonder if thereâs any qualitative research exploring body image and fat phobia in AN, I havenât searched around for that.
The second plenary session was on Eating Disorders in Men. Some key points:
- We donât really know the prevalence and incidence of eating disorders in men (numbers vary a lot)
- EDs do not just affect gay or bisexual men, in fact most men with eating disorders are heterosexual
- Our current assessment measures are inadequate in addressing issues that affect males
- We have to be aware of and sensitive to issues that are more specific to male ED sufferers (for example, males are more likely to endorse ‘leannes’ and ‘muscularity’ over ‘thinnes’, they are more likely to binge and exercise, but less likely to abuse laxatives and diet pills, they are also more likely to have premorbid obesity)
- Involvement in sports and not body dissatisfaction seems to be a greater predictor of eating disorders in men
- We have to normalize the idea that men struggle with eating disorders too; males affected by eating disorders are not freaks.
The âGender Ethnicity & Culture IIâ paper session had similar takeaways. Mainly, we have to get better at recognizing and assessing eating disorder symptoms in diverse communities. Just as men and women experience disordered eating symptoms differently and talk about them differently, so do different ethnic groups, and we need to be aware of that  (for example, even using the term “binge” will have different meanings to different people). It is important so that we know what questions to ask and how to communicate. Men and minorities also face tremendous barriers to treatment at every stage, and we have to begin to remedy that by, in part, raising awareness about the fact that eating disorders cut across race, age, gender, sexuality, socioeconomic status, and so on.
As I mentioned on Twitter, one of my favourite parts of the conference was probably the “Meet the Experts” session. I, along with 3 others, spent about two hours talking to Dr. Michael Strober and Dr. Stephen Touyz about treatment of anorexia nervosa. It was very interesting to be among clinicians, as a patient, and listen to them discuss and answer complex questions about treatment. Two of the participants had questions about their patients and significant amount of time was spent discussing the cases. It was fascinating to see the thought process and approach that Drs. Strober and Touyz took to the cases.
I think part of the reason I enjoyed it was because the cases were complex and likewise, the approach to treatment was complex, too. My impression–and this could be due entirely to the workshops/presentations I chose to attend–was that a lot of the focus on treatment and recovery was centered around adolescents. The patients discussed in these cases were not adolescents, they were around my age. Although the session left me feeling sad (really sad), I was happy to see what I thought was a realistic approach to treatment and recovery that I felt was often missing during when the discussions centered around manualized treatment protocols and/or treating individuals who are sick for a relatively short period of time.
Of course, I completely understand that manualized treatment is not going to be applied in real life the way it is applied in a study. People mix-and-match.
I found it oddly reassuring to hear from Drs. Stober and Touyz that the outcome for one of the patients is not good. I obviously don’t mean it is reassuring that the outcome is not good. It was nice to get a realistic and honest assessment, as opposed to the fluffy ‘Everyone can recover’ rhetoric which is blatantly untrue for a myriad of reasons. Do I think full recovery is possible? Yes. Do I think it is possible for everyone? No.
I think I’ll stop here. This was one of the hardest posts to write, to be honest, but I’ll publish it anyway because I promised I’d write a reflection. I learned a lot of things but I skipped a lot because I’m planning to blog about research that was discussed as opposed to ramble on and on about my own thoughts. If you have any specific questions, just ask in the comments section!
And here’s a photo of me with Dr. Cynthia Bulik:
Thanks very much for sharing you thoughts. I’m not sure quite how these sorts of conferences work, but was it difficult attending and taking part in workshops etc as a ‘patient’? Do people tend to comment on their own experiences, or are the observations suppsoed to come from research and/or clincial practice?
I find your comments on fat phobia really intersting. Personally, I was never quite sure whether it was fat per se that I didn’t like or was trying to control, simply that ‘thin’ was as convenient a name as any for what I became focused on. Given that FP and NFP vary as you say, and that patients ‘story’ their illnesses differently dending on lots of personal / cultural / social / other variables, it makes more sense to focus on the simialarities rather than the differences. The narrower the patient profile becomes, the more easily men/different ethncities/ages etc are mis-/under-diagnosed.
Sorry, not really a specific question – just thank you for a great website and an interesting post!
I think it depends on the topic. I know there was one SIG (Special Interest Group) for Professionals in Recovery. I didn’t attend that (obviously, I’m not a professional in this area) but I would assume there was discussion there. There were a few times when it was mentioned, in context of stigma/recovery, but generally no. I would say 95-98% of what was discussed was about research and clinical practice.
I agree with you. I also wonder if ‘fat’ is an appropriate word. I didn’t want anything ‘pinchable’, it is not that I was afraid I’d have a BMI >25 or >30 or whatever, it wasn’t anything like that for me, it was that I didn’t want to have anything I could pinch. That’s not really ‘fat phobic’ though? I don’t know. I think the fact that we often say “I feel fat” when we really mean to say “I feel sad/angry/hurt/ashamed” is a clue that a lot of the time, fat phobia may not really be fat phobia…
“a lot of the time, fat phobia may not really be fat phobia⌔
Agreed.
For me, much of what I experience re:”fat” might be more accurately called “excessive” (which in itself is a kind of shorthand for general “not a good person” kind of feelings, IMO) – physically, emotionally, intrinsically, and in most other respects. I know that’s a cliche, but it’s been interesting to me as I try to do a better job of eating that I have very vivid feelings of concern that what I am eating is “too much” and that’s bad – but it’s pretty unrelated to worry about getting fat, a lot of the time.
Or “unnecessary”, that also seems to emerge as a theme…
Anyway, well said, Anonymous!:
“Given that FP and NFP vary as you say, and that patients âstoryâ their illnesses differently dending on lots of personal / cultural / social / other variables, it makes more sense to focus on the simialarities rather than the differences. The narrower the patient profile becomes, the more easily men/different ethncities/ages etc are mis-/under-diagnosed.”
Yes. For me it is more just a descriptor of feelings I can’t admit to, but at the same time, I do feel “excess.” I realized I wasn’t “fat” — I know my BMI afterall, but it felt like “too much.” There’s “too much” of me. I don’t want it. I want it all gone. But these feelings were much, much more extreme in highschool and almost non-existent when I relapsed to the same BMI 2x thereafter in undergrad and grad school. Still, my body image and how “fat” I feel varies remarkably with my mood. It is like my desire to binge/purge… I am sometimes so unaware of my emotions until they bubble up to the surface and I *have* to deal with them somehow, at which point, all I can feel is the desire to binge/purge. It was similar for me with “fat.”
I don’t think I ever felt like it meant I wasn’t a good person, but I felt “dirty” in an odd way that is hard to explain. I think for a long time I didn’t want anything that would lead me to receive extra attention from the opposite-sex. It had nothing to do with a fear of growing up or anything, and I think almost everything to do with patriarchy and misogyny. I really enjoyed the lack of attention my body received when I was underweight. But, none of this had anything to do with causing my ED, even a little bit, it was a factor that made me not want to weight more, though.
Great post Tetyana- thanks for writing it. Following your tweets etc. I was really wishing I’d gone! I’ll be going to next year’s ICED in NYC, and this post has me excited for it already.
I particularly like to hear that the “meet the expert” session involved discussion of complex cases with complex solutions- I think it is so important for clinicians etc. to recognize the inherent complexity and heterogeneity in eating disorders. I’m also happy to hear that there was a plenary session on eating disorders in men, and a gender & culture session. Like you said, researchers and clinicians need to be more aware & informed of the ways in which eating disorders present in various people and populations, rather than applying a one-size-fits-all mentality.
I’m curious to know whether most of the research presented was largely quantitative, or whether a few quality qualitative studies were presented? I know in one of your tweets you mentioned that there was talk of/you were suggesting that talking to patients was advisable (particularly when discussing recovery)- did you find that researchers were doing this, or just paying lip service to the idea?
“I particularly like to hear that the âmeet the expertâ session involved discussion of complex cases with complex solutions- I think it is so important for clinicians etc. to recognize the inherent complexity and heterogeneity in eating disorders.”
I think you have to have extensive experience and work in a variety of settings to really get the experience necessary to grasp the complexity. That’s what it seems like to me, anyway.
I think everyone at ICED was certainly informed, I mean, these are the people who are going to these conferences and they are involved in getting CE’s and CME’s, etc.. the problem is more of how do we disseminate the information to everyone who is not going to the conferences and even more importantly, to GPs and nurses who are not specializing in ED treatment. That’s the bigger problem.
There was definitely some qualitative research, I think you’ll get a better feel if you flip through the paper and poster presentations (and it will be more accurate than for me to try to guesstimate the ratio of qualitative:quantitative stuff).
I don’t think I can answer your last question, to be honest. I think it depends entirely on the clinician and/or researcher. I know I tweeted something like that, and then Dr. Thomas asked me what exactly I was referring to and I didn’t remember, haha. So, yeah, I don’t remember.
Tanya, I really enjoy your writing and I wish I had as skeptical a mind as you.
I’m curious what, in light of your reflections about Dr. Barlow’s comments about the “splitting” in DSM-V, you think about the National Institute of Mental Health dropping support for DSM-V (http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml)
What implications for ED research do you think that will have?
It’s definitely going to have an impact on research for disorders such as ASD. DSM-V essentially wants to put all syndromic disease that also manifests with ASD features in a category separate from ASD because the genetic cause if known (e.g., Rett Syndrome is no longer an ASD, according to DSM-V).
I don’t know if I can answer that because I don’t write grants on this topic, so I don’t really know. I have often wondered how the DSM-IV limits our understanding of EDs but I’m certainly not alone in that. Maybe someone reading this has a better idea. My initial hypothesis is not a lot…
What impact is it going to have on ASD research, do you think?
Hi Kirill!
To answer briefly: NIMH has what looks like some pretty sweet funding opportunities for ED research that aligns with the RDoC mission:
Section I. Funding Opportunity Description
This Funding Opportunity Announcement (FOA) issued by the National Institute of Mental Health (NIMH) seeks research studies that use dimensional constructs to integrate biology (e.g., brain circuit or physiological pathway) and behavior in the service of advancing the understanding of biological mechanisms and developmental trajectories of eating disorders.
Rationale
Eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and their variants, are a major source of physical and psychological morbidity and constitute the major contribution to excess mortality from psychiatric disorders. Clinical presentations of eating disorders are highly heterogeneous, involving broad and often overlapping symptomatology, which is often further complicated by metabolic and nutritional challenges that result from restricted food intake, excessive exercise, and repeated binge and/or purge episodes. The recognition that relatively specific behaviors, cognitive operations, and affective processes are primarily implemented by particular neural circuits suggests that dysregulated functions and associated neural circuits should be a critical focus of study, and, ultimately, the target of assessment and treatment for eating disorders.
– See more at: http://grants.nih.gov/grants/guide/rfa-files/RFA-MH-14-030.html#sthash.z7GQE7aq.dpuf
So, there’s that; there’s already been a real push for translational research but I think this will bolster that initiative. We’ll probably see more interest in process-level stuff, too, as per the RDoC matrices (valence, arousal/regulatory systems, etc.)
Then again, these changes won’t happen overnight (see http://www.forbes.com/sites/matthewherper/2013/05/08/why-psychiatrys-seismic-shift-will-happen-slowly/. A lot of ongoing research has and will continue to use DSM-IV criteria, etc. for consistency (my lab included; my PI has advised both the DSM and RDoC groups) at least for the time being.
I think the new DSM itself will be beneficial in that the ED criteria revisions are good – they could have gone further, but the changes they made were sorely needed. I’m hopeful that will make ED research more closely match the actual population of those with EDs and allow for more heterogeneous presentations of EDs – DSM-IV criteria are frustratingly limited and those limitations (e.g. the amenorrhea criterion) have been shown to be meaningless in terms of presentation and prognosis. The nice thing about the RDoC initiative, particularly for ED research in my opinion is that it encourages research that cuts across diagnostic/categorical boundaries, and for disorders like EDs where there’s frequent diagnostic crossover, blurring of boundaries between disorders, ED Not Otherwise Specified the most prevalent disorder, this will be super valuable. And hopefully this means that research findings are more meaningful to individuals with EDs, as study participants might more accurately reflect how these disorders look and function in the broader ED’d pop. rather than being homogeneous to the extent that it’s difficult to assume that any findings are valid outside of a narrowly-defined subgroup.
I’m an optimist, clearly. đ Again, I want to emphasize that all of this will play out at what will probably seem like an incredibly glacial pace. Plus most researchers are already pretty wedded to their niches and paradigms (which the current climate in academia more or less necessitates… one of my many problems with that, but that’s another rant for another day.)
(I know you know all that, just wanted to clarify for anyone else reading who might not be as familiar.)
I wonder if/how this has any impact on research in Canada. What’s CIHR’s/NSERC’s position on this? I don’t have a clue.
I think there’s utility in studying both heterogenous groups AND extreme ends of the spectrum (BN w/o AN history and AN-R without b/ping history). Both will be useful in understanding the underlying biology. But when it comes to treatment, we definitely need to include more heterogenous groups. At the same time, it kind of depends at the stage the treatment therapy is in.. since it will also be important to identify what subpopulations respond best to what treatment modalities.
This sounds like a really interesting conference! Thanks for the highlights above đ
As someone who had symptoms of early childhood ARFID (linked to emetophobia and OCD), which later (age 11) progressed to non-fat-phobic restricting AN, I really like the idea of considering a number of disorders as being interrelated.
I always felt that my AN was an extension of childhood OCD and food phobias rather than a discrete disorder. What I can say is that there is No Way that my ARFID was some deliberate food refusal to get my own way. I was very, very frightened of eating certain foods, or eating more than a certain amount because I had (and still have) a HUGE fear of vomiting.
As for non-fat-phobic AN and the suggestion that people with this variant of AN may deliberately deny symptoms…. I find that really unhelpful. In fact, I have always found the notion that people with AN are ‘manipulative’ to be very unhelpful. There have been times during treatment that I have fabricated weight gain, but that has been because I have been terrified of being taken inpatient and having my ‘whole world’ (i.e. routines and rituals) disrupted. In addition, I am scared of angry people and clinicians used to get very angry with me when I lost weight or failed to gain it. To be treated as if you’re a naughty child because you have AN, a condition that feels to be out of your control, is very disheartening.
But in terms of non-fat-phobic AN: I can genuinely say that my anorexic behaviours (food restriction and over-exercising) have never been driven by a fear of fatness. I have never had body dysmorphia. I am not especially confident about the way I look, but that is a separate issue. My anorexic behaviours are compulsive and serve to regulate anxiety and mood. That is all. Nothing more complex. I am a very anxious person with a tendency towards major depression. Period. To have had clinicians disbelieve me when I tell them that I do not fear fatness is unhelpful and has left me feeling hopeless at times.
Anyway, I am really glad you enjoyed the conference đ
I agree 100 percent. Doctors never believe me when I state exactly what you just said and assume it’s typical denial, simply because I don’t fit into a neat and tidy box of ED behavior. I’m not in denial. I’m just not typical.
Great summary, Tetyana. Look forward to more.
I love your theory re AFRID (and would include FAED as well). I have long theorised that fat phobia can be a way of expressing extreme anxiety in a language that modern society understands.
I also think that fat phobia is a red herring and has been a barrier to effective treatment for a long time. (Sorry Prof Fairburn but you are listening to the words, not the anxiety or the emotion!). BDD can be a co-morbid and body dissatisfaction is rife throughout all society. However, I do not believe it is as central to the disorder as some, with vested interests, would have us believe.
I also believe that patients who have had the disorder for a longer time, are older (and had later onset or a relapse at an “adult” age?) require different treatment from a child or an early adolescent. The complexities of their situations can be very different and simplistically trying for a “one treatment fits all” scenario is just schoopid. Every patient is different and gender, race and age should ALL be taken into account when planning and implementing treatment protocols. Individual treatment plans for individual patients….
On the question of “everyone can recover”, I have two thoughts: first, I hope that is what we are all working towards; second: treatment failure (when someone is not recovering) is something that clinicians should be investigating and taking the blame for. It is very important that patients are not blamed for “treatment resistance” (as in depression). Drugs seem to be ineffective for treatment of anorexia nervosa therefore a patient cannot be deemed “treatment resistant” but has been failed by treatment.
What kind of vested interests?
In 100 % concurrence with the above comment by Charlotte..and agree that Fairburn has perhaps “missed the boat” on treatment philosophy. The “red herring” term is appropriate. For me, the anorexia has masked deep depression/avoidant personality issues…and, nearing a programmed entry into the Fairburn unit of an eating disorder Clinique here in France, I am terrified of being, yet again, hospitalized with the same scolding technique used on the unfortunate adolescent patients. I had late on-set anorexia..and force-feeding and release is simply not sufficient “treatment” when the anorexia was not based on “fat phobia”…but rather as a mechanism to reduce anxiety. Thank you for reporting on this amazing conference Tetyana and your gracious partage of information.
I don’t have time to answer in full right now, because I need to leave to catch my bus to Toronto, but I think symptom management and stability is underrated by parents and young clinicians. Perhaps I’ll expand later. Most mental health disorders are something people manage for the rest of their life, I don’t see why EDs are any different. It is not to say ‘full recovery’ isn’t possible, it is just something I find only parents and adolescents talk about. Those my age, we don’t really talk about that. My doctor doesn’t focus on symptom frequency, he asks how I’m doing, how my relationship is going, and so on. Those are the important things. Full recovery? I don’t know what that means to me and I don’t really care. My life is pretty amazing right now. Some people miss the forest for the trees.
So here’s to everyone who is not 100% symptoms free or fully recovered (whatever that means) but have a job, or go to school. Here’s to those of us who are in relationships, who don’t want to get sicker, who don’t want to be emaciated or go back into treatment. Here’s to everyone who is doing better than they were before. Let’s celebrate the progress we’ve made, as opposed to worrying about being fully recovered or about the fact that we might not eat super well, or binge/purge once in a while. If I’m going to be more recovered in the future, great. If not, great. My life is better than it has ever been and for me–and for most people I know who are in their mid 20’s and above, in similar positions–we are focused on living, not on recovery. I just want to give a shout-out to everyone who is doing better than they were a year ago, or two years ago, or people who might be doing worse but are more motivated than ever to get back on track. Give yourself a pat on the back, you all deserve it. Let’s not get too myopic and focus on perfection.
Thank you so much for sharing, Tetyana, and I share your sadness. There is a lot more hope than there used to be, a lot more knowledge – but as someone who has had my ED for a long time now, I feel like there is less hope for those who have had it longer and who are older.. but there is always hope – that’s for sure. Always hope.
I agree it might be better to look at what the disorders have in common – since many of us cycle through the disorders anyway. They are all a slightly different manifestation of the same core disorder IMO.
Also, I’m with you on food/weight/body image being convenient scapegoats.
Thanks again for sharing, especially despite it being so difficult.
“I feel like there is less hope for those who have had it longer and who are older.. but there is always hope â thatâs for sure. Always hope.”
Yes, and I think it is important to focus on improving quality of life and general functioning–not so much on things that can readily be evaluated.
And yes, it was difficult to write but only because it is easier for me to critique a study than to summarize my feelings/experiences about an entire conference!
We know so much about what the disorders have in common (at least in the literature) that I’m happy to see therapies attempting to target those things ALONG with weight/food (like learning to recognize emotions, deal with emotions, etc.. ), because those are the things that are ultimately crucial for long-term recovery. And it is something I still haven’t mastered! But, I’m better now than I was before.
Hi Tetyana,
It was lovely meeting you at ICED and an honor to see you in the audience at my talk on NFP-AN.
I’d like to clarify my belief that NFP-AN is a heterogenous group. Specifically, some individuals may be providing socially desirable responses (as I discussed in my ICED presentation), others have may have no fat phobia at all, and others (as you point out!) may develop fat phobia later in the illness due to clinical expectations or cultural pressures.
I actually just wrote a commentary about the need for further research into this topic in IJED: http://onlinelibrary.wiley.com/doi/10.1002/eat.22098/abstract
This research will be incredibly important since so many of our etiological theories and treatment paradigms (as highlighted by your commenters) focus on body image. If, as your commenters suggest, we as researchers and clinicians have “missed the boat,” this will be a good opportunity to get back on track.
WIth very best wishes,
Jenny
Hi Jenny,
Likewise–it was great to meet you!
I already have the paper you linked to on my harddrive (but have yet to read it). I agree with you, and hopefully that came out in my post. I do think it is a heterogenous group but the data you showed was intriguing. I actually probably would’ve hypothesized the opposite!
I wonder what it would look like if plotted as a dot plot/column scatterplot as opposed to a bar graph. It would be interesting to see the spread of the data points and how it compared to the FP group.
I think it is important for clinicians to listen to their patients as opposed to assuming they are all like this or all like that; as people have commented, it is frustrating when you are wrongly boxed into a particular category. I don’t think this is specific to EDs, I think it is true for everything!
Cheers,
Tetyana
Good question re: scatter. Indeed the variance was high in both the FP and NPF groups. WIll definitely look into this when writing up the manuscript. đ
I forget the n number, but I was wondering if it is large enough, whether you’ll see distinct(-ish) groups? And the ones that don’t score high on the that questionnaire — what’s their underlying ‘reason’ for non-fat phobia. Basically my question is whether it is a spectrum or whether there are several groups (I mean, it is going to always be a spectrum on these questionnaires, I get that, but overall whether it is evenly split or whether it is more clustered). Just random thoughts I had today.
I like using those graphs in favour of bar graphs because they have more information. (Also, box and whisker plots just look really pretty.)
Tetyana, I suspect that body dysmorphia in Eating Disordes is secondary and that focus on this topic is what ‘Experts’ use to gain media attention. My theory needs testing: 20% persons with EDs have body dysmophia as a primary diagnosis, the onset of which can be predicated by environmental factors dominating the individual’s life: comments made by people, perceptual exposure by media, peer group. 80% persons with EDs understand that there body image is merely an attempt to explain the inexplicable.
There you go, I have not said much at all – very much like most of the ED talk and literature.
Your comments on complex cases intrigues me, because I know of ‘Experts’ that are avoidant of such. Even the more valuable class of experts which consists of ‘parents’ and ‘sufferers’ can be intolerant to ‘more’ complex cases. However, complex cases are more likely to provided the greatest insight and learning experience.
Hi John,
Thank you for your comment. It is hard for me to say what the true numbers on BDD and comorbid EDs are, though, going by my recent blog post on the subject, it seems like BDD precedes the ED in more than just 20% of the cases. Moreover, about 20% of AN cases are non-fat phobic, too. (Though I hate that term, I think it is an umbrella term that captures way too many discrete things.)
“Your comments on complex cases intrigues me, because I know of âExpertsâ that are avoidant of such. Even the more valuable class of experts which consists of âparentsâ and âsufferersâ can be intolerant to âmoreâ complex cases. However, complex cases are more likely to provided the greatest insight and learning experience.”
Yes, definitely. I think researchers are more likely to be avoidant of these cases because they are difficult to study: so many confounding factors, for one. Researchers want clean samples. Experienced clinicians, though, I think realize (I hope) that comorbidities are the norm, not the exception. And some can make treatment extremely challenging, particularly under the guidelines that seem to be in use in hospitals and treatments centers (which often do not accomodate for that, I feel). That said, I have not done IP or residential myself, so, I don’t know first-hand, but I can imagine, and from what I see, individuals whose EDs are comorbid with other psychiatric or physical issues are much less likely to get adequate treatment. Period.
Some parents definitely turn a blind-eye to the intolerant cases, I find. It is frustrating.
Tetyana, thank you for your comments.