Anorexia Nervosa

Treating Severe Anorexia Nervosa in the Community

Tetyana 19 Comments

Can treatment for severe anorexia nervosa be delivered safely in a community setting? According to a recent paper by Calum Munro and colleagues (2014, open access), the answer is yes.

In 2001, a systematic review by Meads, Gold, and Burls found that inpatient treatment is not more or less effective than outpatient treatment for individuals with AN. Of course there will always be patients who will require inpatient care, but given the high cost, lack of clear efficacy, and known risks, it is important to ask if there are better options, particularly for a subgroup of individuals who may not need or may not benefit from inpatient care.

In their paper, Munro et al. describe a program that they’ve developed for treating individuals with severe AN in the community. The program is called the Anorexia Nervosa Intensive Treatment Team (ANITT) service. It is one … Continue reading →

Ambivalence and Eating Disorders: Inpatient Treatment, Belonging, and Identity

Andrea 1 Comment

When Tetyana Tweeted and “Tumblr-ed” (is there a better name for putting something on Tumblr?) a quote from a qualitative research article about ambivalence and eating disorders, I knew I would want to write a blog post about it. Of course, life happened, and so this post is coming a little later than I had intended. Nonetheless, I am happy to be sharing a post about a fresh article by Karin Eli (2014) about eating disorders and ambivalence in the inpatient hospital setting. The article itself is published through PLOS One and so is also open access, in case you are interested in reading the original.

THE STUDY

This article is about one aspect of a larger longitudinal study Eli conducted in Israel between 2005 and 2011. The broader study explores the “sensory experiences” (embodied feelings, sensations, and perceptions) of individuals with eating disorders and how these relate … Continue reading →

Unpacking Eating Disorder Recovery Part 1: The Recovery Model

Andrea 5 Comments

What does eating disorder recovery really look like? When you say the word “recovery,” differences of opinion loom large. The lack of definitional clarity around the concept of recovery came up many times at ICED, and continues to surface in discussions among researchers, clinicians, and individuals with eating disorders themselves. We’ve looked at recovery on the blog before (for example, Gina looked at how patients define recovery here; Tetyana surveyed readers about their perspectives on whether or not they thought of themselves as being in recovery and wrote about it here; I wrote about men’s experiences after recovery here). It’s something of a hot topic in the research literature, too.

My Master’s thesis focused primarily on recovery, with one “take home message” being that there can be a disconnect between what recovery means in treatment settings, in popular understanding, and among individuals who have experienced eating disorders. … Continue reading →

Serious Restrictive Eating Disorders Occur at Any Weight

Tetyana 8 Comments

Although the words “anorexia nervosa” typically conjure up images of emaciated bodies, eating disorders characterized by dietary restriction or weight loss can — and do — occur at any weight. However, precisely because anorexia nervosa is associated with underweight, doctors are less likely to identify eating disorders among individuals who are in the so-called “normal” or above normal weight range, even if they have all the other symptoms of anorexia nervosa.

Clearly, this is a problem.

For one, there is no evidence that eating disorder not otherwise specified (EDNOS) — a diagnosis given to individuals who do not fulfill all of the criteria for anorexia nervosa or bulimia nervosa — is less severe or less dangerous than full syndrome anorexia nervosa. As I’ve blogged about, individuals with EDNOS have comparable mortality rates (see: EDNOS, Bulimia Nervosa, as Deadly as Anorexia Nervosa in Outpatients) and similar (sometimes even more severe) … Continue reading →

Gendering the Pro-Anorexia Paradox: Men in Pro-Ana Spaces

Andrea 12 Comments

When someone says “pro-ana,” what comes to mind? Likely, given the strong reactions pro-anorexia websites provoke, you may be able to conjure up an image of what would take place in such a forum. Thoughts of “thinspiration,” emaciated and waif-like images, and starving tips likely spring to mind, alongside considerations of the dangers of a community that would encourage behaviors that can be very harmful to health.

I’d venture to say that it is unlikely that you have pictured a man participating in these sites. Given that we know that men get eating disorders too, and that they may feel alienated in their struggles, is it surprising that some might seek out online communities, including pro-ana?

As Tetyana noted in previous posts on pro-ana (here and here), these sites can serve a harm reduction purpose and/or provide a space for sufferers to openly and honestly share their struggles … Continue reading →

Hypermetabolism in Anorexia Nervosa

Tetyana 21 Comments

Weight restoration is a crucial component of anorexia nervosa treatment. It is a challenging process for a multitude of reasons. Adding to the complexity and the challenge is the fact that during weight restoration, individuals with anorexia nervosa tend to require increasingly more calories to maintain the same rate of weight gain.

That is, individuals need to continually increase their caloric intake, in steps, sometimes upwards of 100 calories (technically, kilocalories) per kilogram per day, to continue gaining weight. For instance, an individual weighing 45 kg may need to eat 4,500+ calories to continue gaining 1-1.5kg (2.2-3.3lbs) a week. Indeed, studies have found that standard resting energy expenditure (REE) equations tend to overestimate caloric needs at the beginning of refeeding but underestimate them in the later stages (Forman-Hoffmann et al. 2006; Krahn et al., 1993).

After achieving a healthy weight, individuals recovering from anorexia nervosa still typically need to … Continue reading →

Polar Opposites? The Social Construction of Bulimia and Anorexia Nervosa

Andrea 10 Comments

Some might argue that bulimia nervosa is more “hidden” than anorexia nervosa — it is not always obvious that someone is suffering from bulimia (though, I would argue, it is not always obvious that someone is suffering from any eating disorder). Even when it is “discovered,” BN is often placed in opposition with AN — as if the two were polar opposites.

Indeed, attempts to define a phenotype (a set of observable traits or characteristics) for AN and BN tend to oppose the two and to suggest that the people who develop AN are inherently different from those who develop BN. While I believe there is some scientific evidence for personality differences between the two, the degree of diagnostic crossover and symptom variability in eating disorders makes me feel like this split is at the very least overly simplistic.

What is interesting is how BN has come to occupy a … Continue reading →

Energy Expenditure in Anorexia Nervosa Patients

Tetyana 7 Comments

How many calories do patients with anorexia nervosa need to eat to gain a kilo (2.2 lbs)? It seems like a simple question and one that we should have figured out a long time ago, given the importance (err, necessity) of refeeding and weight restoration in recovery from anorexia nervosa.

Unfortunately, research in this area has often led to contradictory results (see Salisbury et al., 1995 and de Zwaan et al., 2002 for reviews). Fortunately, a paper by Stephan Zipfel and colleagues (2013, freely available here) sheds light on one potential cause of the discrepancies.

But first, some definitions:

TDEE stands for total daily energy expenditure. TDEE has three components: resting energy expenditure (REE), dietary-induced thermogenesis (DIT), and activity-induced thermogenesis (AIT). The gold standard for measuring TDEE is through something called the doubly labelled water technique. REE is usually measured through indirect calorimetry. (These techniques were used in this … Continue reading →

Models of Anorexia Nervosa: A Few Insights from Our Animal Cousins

Liz 6 Comments

In 1967, Routtenberg and Kuznesof reported a very peculiar phenomenon in rats:

They discovered that when rats were on a restricted feeding schedule (1 hour per day in their experiment) and had free access to a running wheel, their food intake was significantly lower than in control rats, which were on the same feeding schedule but without access to a running wheel. This discrepancy between increased running activity and decreased food intake caused substantial body weight loss, and if rats were not removed from the experimental setup timely, they would eventually die of starvation. This model, later named the activity-based anorexia (ABA) model, is one of the most widely used animal models for the study of anorexia nervosa (AN). (Source)

Of course, rats are not humans. Nonetheless, animal models of anorexia nervosa can inform us of some of the underlying neuropsychological and physiological influences and consequences of … Continue reading →

Setting a Target Weight: An Arbitrary Exercise?

Tetyana 10 Comments

Achieving a healthy weight is a major goal of anorexia nervosa treatment. Indeed, a healthy weight is often seen as a prerequisite for psychological recovery. The fact that weight restoration is a crucial component of recovery is uncontroversial, the problem arises when it comes to determining what constitutes a healthy weight. How are ideal, optimal, or goal weights set? And who gets to decide?

Despite its recognized importance, there’s surprisingly little consensus on how target weight should be determined. Moreover, as Peter Roots and colleagues found out, when it comes to inpatient treatment centres in the UK and Europe, there is little consistency too.

In a study published in 2006, Roots et al. examined how treatment centres determine, monitor, and use target weight in the treatment of adolescents with anorexia nervosa. They also wanted to know the centres’ expected rate of weight gain, how often patients were weighed, who was … Continue reading →