Author: Tetyana

The Anorexia Nervosa Brain: A Summary of Neuroimaging Studies – Part 1

Tetyana 1 Comment

Journalists like to report on novel and exciting findings regardless of how likely they are to be replicated or how well they fit with everything else known about the topic. It is an all too common occurrence that a small pilot study which has favourable results, creates a buzz and gets into our heads, only to produce negative results once the sample size is increased. But the latter, negative finding, rarely makes it to the printing press. So, we are left thinking the results of the pilot study are correct, when they might be an outlier or a false positive.

Given this, I wanted to summarize an article that provides a critical overview of the current neuroimaging studies in anorexia nervosa. We can use this as an introduction to neuroimaging in AN: to get a sense of the scientific consensus, the trends that emerge and what can be learned from … Continue reading →

Chances Are, What You Know About Eating Disorders is Wrong

Tetyana 19 Comments

Although clinicians (and medical professionals not specializing in eating disorders) often carry a lot of false beliefs about EDs, the public is even worse. Way worse. The portrayal of eating disorders in the news contributes to the myriad of myths and misconceptions that surround EDs. O’Hara and Clegg-Smith wanted to find out how exactly newspapers “contribute to shaping public perception of EDs.” 

It is awful when doctors are dismissive and ignorant, but it is even worse when you encounter these attitudes from your friends and family. When they not only don’t get it, they don’t want to get it. As O’Hara & Clegg-Smith point out, this ignorance and “disconnect potentially prevents timely ED diagnosis and reinforces a stigma that limits treatment availability.”

While researchers and ED specialists increasingly understand that eating disorders are “caused by a combination of genetic and environmental factors” (for example, evidence from twin studies … Continue reading →

Gender Nonconformity, Transsexuality and Eating Disorders

Tetyana 9 Comments

Too many people still mistakenly believe that eating disorders are for the Mary-Kates, Nicole Richies and Lara-Flynn Boyles, or vain adolescent and teenage girls aspiring to be just like them. Actually, as I’ve blogged earlier, even male veterans in late middle age are not immune to struggling with anorexia and bulimia nervosa. All in all, males make up ~ 5-10% of all eating disorder sufferers.

But what about those that dread having to check off “male” or “female” on a data form? What about individuals who feel their gender identity is not the same as their assigned birth sex. Perhaps they were born in a female body, with two XX chromosomes, but they feel and prefer to think of themselves as males, or the reverse? There’s some research (albeit limited, due to the rarity of both gender dysphoria and eating disorders) that suggests these individuals face an increased risk … Continue reading →

When Clinicians Do More Harm Than Good (Attitudes Toward Patients with Eating Disorders)

Tetyana 33 Comments

I was going to blog more about mortality rates in eating disorder patients, but recent ED-related deaths have left a bitter taste in my mouth (huge understatement). So, I’ve decided instead to write about a paper requested by the founder of The Joy Project on clinician reactions to patients with eating disorders by Thomspon-Brenner and colleagues that came out this year.

If you have an eating disorder or are close to someone with an eating disorder, you’ve likely heard many stories about dismissive or down-right negative and harmful attitudes that clinicians often have toward patients with EDs.

I’ve experienced it myself: I had to find another doctor to refer me to an outpatient clinic, because the first one didn’t – he didn’t think I needed help (probably because I was very aware that things were not heading in the right direction even before I was at a low weight). Needless … Continue reading →

EDNOS, Bulimia Nervosa: As Deadly as Anorexia in Outpatients

Tetyana

Eating disorder not otherwise specified (EDNOS), the catch-all diagnosis for eating disorder patients that don’t neatly fit into the DSM-IV anorexia nervosa (AN) or bulimia nervosa (BN) categories, is often thought to be less severe. Patients with sub-threshold AN or BN (missing one or two criteria) fall into the EDNOS (a large proportion, perhaps the majority, of patients). The inherent assumption in the word sub-threshold is that the patient is not as sick. Symptom frequency and behaviours are not that bad.

Increasingly, research is showing otherwise (which comes as no surprise for those of us who have struggled with eating disorders).

One study that has illustrated this quite nicely was published in 2009 by Dr. Scott Crow and colleagues in the American Journal of Psychiatry. Given that most ED mortality research has focused on anorexia nervosa, Crow et al wanted to compare mortality (from all-causes and suicide specifically) in patients … Continue reading →

A Meta-Analysis of Mortality in Eating Disorders

Tetyana

You often hear that anorexia nervosa has the highest mortality rate of any psychiatric illness, but you might struggle to find the rates for bulimia nervosa or EDNOS. Even for AN, the most common cause of death is rarely reported and the reported rates often vary a lot (depending on the study (and the media outlet).

I wanted to find out what are: (1) the mortality rates in BN and EDNOS and (2) the common causes of death in these disorders.  A relatively recent meta-analysis (click here for some background, pros and cons of meta-analyses) of 36 studies, which addressed some of my questions, was published by Arcelus and colleagues.

They excluded studies that had less than 15 patients and/or <1-year follow-up.

SO, WHAT DID THEY FIND?

Mortality in Anorexia Nervosa:

  • 35 studies, mean follow-up time: 12.8 years (maximum 36.2), mean sample size was 361 (maximum 6009).
  • Total
… Continue reading →

EDs Don’t Discriminate: Psychiatric Comorbidity in Men with Eating Disorders

Tetyana

Eating disorders don’t discriminate, they just have a bias (more on this in the future). While the majority of eating disorder patients are females, males suffer from eating disorders as well. In fact, it is about, roughly, a 10:1 ratio.

Men tend to just keep quiet about it (and who can blame them, given the stigma women face, it only gets worse for the men.) But, on the inside, their experiences, thoughts, behaviours and recovery span the same spectrum.

There’s relatively little research out there on men with eating disorders, in large part due to the low prevalence rates which makes it harder to get a large enough sample size. So, you have to get creative, as the authors of this study did: they reviewed the prevalence of eating disorders and comorbid psychiatric disorders using data from the Veterans Affairs medical centers of male patients in the fiscal year of … Continue reading →

Eating Disorders and Psychiatric Comorbidities in Female Inpatients

Tetyana 7 Comments

Patients with eating disorders commonly exhibit comorbid psychiatric disorders, including anxiety, depression and OCD. The presence of comorbid disorders has been shown to exacerbate the severity and chronicity of the disorder, and unfavourably affect treatment outcome. Moreover, comorbid disorders may necessitate specialized treatment plans that take into account all the co-occuring disorders. Recovery from an eating disorder is hard enough, but when it is complicated by depression and severe anxiety, it can be a lot harder.

Nonetheless, commonly co-occuring psychiatric disorders may also provide researchers and clinicians clues about the etiology of eating disorders, the underlying neuronal processes as well as possible pharmacological interventions.

Researchers have been identifying disorders that commonly co-occur with eating disorders and studying the differences in co-morbidity between disorders. I picked one to write about today, it is a study by Blinder and colleagues that came out in 2007. It is by no means the best, … Continue reading →

More on the Problematic EDNOS Category (and Diagnostic Crossover)

Tetyana 2 Comments

I’ve been thinking a lot lately about the eating disorder not otherwise specified (EDNOS) category. ED-NOS is a diagnostic category for all individuals with subthreshold anorexia or bulimia nervosa or those with a mix of symptoms that don’t fit neatly into AN or BN. ED-NOS is essentially everything else. A mixed bag, if you will. It doesn’t tell the clinician nor the researcher anything useful, outside of what it isn’t. So, is there any use for it? If it doesn’t tell the clinician about patient symptoms or guide choice of treatment, why even bother? Does it help researchers understand EDs or do they just want to avoid this messy and heterogenous group (that by the way makes up most of those with eating disorders)? In this entry (and many more to come), I want to further explore these questions.

There’s been a push by researchers to minimize the … Continue reading →

A Case Against Eating Disorder Not Otherwise Specified (EDNOS)

Tetyana 7 Comments

This study is a follow up on the previous study (last entry) which examined the problems with the EDNOS classification, the frequency of transitions between eating disorders and how the DSM should be changed to reflect the clinical reality of eating disorders (and what is the clinical reality?)

In this study, Eddy and colleagues followed 246 women who were initially diagnosed with either AN or BN, for an average of 9 years. The main goal was to study the growing disparity between (1) the consensus that eating disorders are not stable overtime and how (2) the current diagnostic criteria which do not adequately address this, by following the clinical presentation of EDs overtime and providing suggestions for the upcoming DSM-V.

EDNOS is an often ignored category in research–in main part because it is difficult to study such a heterogeneous group. Nonetheless, Eddy et al. summarize some interesting findings … Continue reading →