Author: Tetyana

The Benefits of Starving – Part II (Restricting Reduces Anxiety in Anorexia Nervosa)

Tetyana 10 Comments

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 important points here:

  • Serotonin has a lot of functions in the body; it plays a role in regulating appetite (satiety), sleep, mood, behaviour, learning and memory, and a variety of other things
  • Serotonin has been implicated in obsessionality, harm avoidance, and behavioural inhibition
  • Alterations in serotonin function have been linked to many disorders, including depression, OCD, anxiety, and eating disorders
  • Serotonin is made from tryptophan, an essential amino
… Continue reading →

CCK and the "Hunger Trap" in Anorexia Nervosa (Why Gaining Weight is Hard)

Tetyana 4 Comments

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 anorexia nervosa (AN) has found conflicting results, in part because of methodological issues related to measuring levels of CCK. In a recent study, Cuntz and colleagues (2013, freely available online), having developed a better assay for measuring CCK, wanted to clarify its role in AN patients.

The authors had the following goals and hypotheses (I omitted one):

  • Objective 1: Compare CCK levels between AN patients and healthy controls before and after a meal
  • Objective
… Continue reading →

Why Banning Pro-Ana is a Bad Idea

Tetyana 5 Comments

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 communities seeking to lure unsuspecting young adolescents into a world of extreme dieting, lying, and who knows what else, all under the guise of being a “lifestyle.”

Well, as I’ve blogged before, the picture is not so simple:

Ultimately, it seems that the support on offer on pro-ana websites is—for all the scare stories about “purging tips” and users egging one another on with their latest BMIs—little more

… Continue reading →

The Enigmatic Persistence of Anorexia Nervosa

Tetyana 17 Comments

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 nervosa. Finally, even if significant physical and mental improvements are achieved in treatment, relapse rates for older individuals (even those in their 20s) remain high.

What makes anorexia nervosa so persistent and so hard to treat in individuals who develop it, particularly if it is not treated soon after onset? Why is recovery so hard?

In this paper, B. Timothy Walsh outlines a model based on cognitive neuroscience that attempts to answer these questions:

Its

… Continue reading →

Comorbid PTSD and Eating Disorders: Can Treating One Improve The Other?

Tetyana 7 Comments

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 treat first, or whether they should be treated simultaneously:

Brewerton (2004) suggests that eating problems should be addressed prior to treating PTSD because bingeing and purging contribute to a state of physical and emotional dysregulation. Fairburn (2008), however, suggests that significant comorbid disorders be treated prior to beginning CBT for eating disorders.

The issue is quite complex,

For example, the presence of severe depression, of which hopelessness and difficulty

… Continue reading →

Calorie Restriction, Anorexia Nervosa, and Memory Gaps

Tetyana 48 Comments

This post has been translated into Russian by Polina here.

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:

Hi Tetyana, I’m not sure if this is merely based on my own subjective experience of if there is any grounding at all, but I was wondering if there could perhaps be a link between EDs and a sort of memory loss. It’s hard to describe but I definitely seem to have huge “gaps” in my memory of during that time, as if I selectively block things out. I have limited inaccurate knowledge with regards to memory on a molecular/neurological basis so I do not know if there’s anything there. Perhaps with calorie

… Continue reading →

Posttraumatic Stress Disorder in Women with Bulimia Nervosa

Tetyana 6 Comments

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 a 2 week period to investigate whether participants with comorbid PTSD + BN differed from those with BN only on the:

  1. Levels of negative affect (negative emotional state/mood) and affect variability (fluctuation between negative and positive states)
  2. Frequency of bulimic behaviours
  3. Relationship between emotional states (negative or positive affect) and bulimic behaviours

They used the ecological momentary assessment (EMA) tool to track behaviours and emotional states close to when they occur. I’ve blogged about a study using EMA before (‘What’s The Point of Bingeing/Purging? And Why … Continue reading →

Is Anorexia Nervosa a Subtype of Body Dysmorphic Disorder?

Tetyana 11 Comments

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 paper, published in the Clinical Psychology Review, Andrea Hartmann and colleagues summarized the current state of knowledge in the field. The review compared clinical, personality, demographic, and treatment outcome features of AN and BDD. I’ll summarize the key points of the paper in this post.

(I will be focusing on the relationship between AN and BDD, as opposed to EDs and BDD, because that’s the scope of the review article.)

First, what is body … Continue reading →

The Genetics of Thin-Ideal Internalization

Tetyana 7 Comments

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 their “ideal”, and the more likely they are to develop an eating disorder.

A growing number of of studies have been done evaluating the validity of this model. Although I’m not well-read on the subject, it does seem like there is a growing number of studies showing an association between thin-ideal internalization and disordered eating practices.

But is the picture complete? Are peers, parents, and media the only or even the main factors that influence the extent of … Continue reading →

International Conference on Eating Disorders (ICED) 2013: Personal Reflections

Tetyana 29 Comments

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.

In his keynote speech, Dr. David Barlow wondered whether we are “missing the forest for the trees” as he highlighted some of the changes in the upcoming DSM-V (more disorders, more categories, more, as he said, ‘splitting’). 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 emotions—not just negative emotions, but all kinds of … Continue reading →