Anorexia Nervosa

The Sobering Reality (and the Silver Lining) of Treating Anorexia Nervosa in Adults: A Randomised Controlled Trial

Tetyana 5 Comments

The challenges of treating anorexia nervosa are plenty; some of these challenges — like low prevalence rate and high treatment dropout rate —  make conducting randomised controlled trials aimed at identifying effective treatment methods really hard as well.

So I was pretty excited about the recently published randomised controlled trial comparing focal psychodynamic therapy (FPT), cognitive behaviour therapy (CBT), and optimised treatment as usual in adult (a harder to treat demographic than adolescents) anorexia nervosa patients.

Reading the paper, I was pretty impressed with how good the study design was; I’m not going to go into all the nitty-gritty details, but if you have access to and the chance to read the paper, do it. You’ll appreciate, I think, the amount of effort that went into this.

THE STUDY

Patients were recruited from ten universities across Germany. They had to be adult females with a BMI between 15-18 and with … Continue reading →

Bingeing Because Food is Yummy: A Stepping Stone Toward Recovery from Anorexia and Bulimia?

Liz 8 Comments

This may sound counterintuitive at first, but I’m thankful for two aspects of my eating disorder, which I believe helped me make the choice to aim towards recovery: the development of binge eating after chronic food restriction and the physical inability to purge through self-induced vomiting. Like many individuals diagnosed with anorexia nervosa that go on to develop binge eating, I tended to choose high-fat foods and sweets as my “go-to” food items. I had always enjoyed such foods and was a notorious junk food aficionado as a young girl (way before any eating disorder symptoms developed). Once the bingeing behavior started, I couldn’t stop.

Sitting with the discomfort after a binge made me seriously consider whether this was something I could maintain for any lengthy period of time, and that’s when I started getting help. In a sense, I believe my affection for sweet foods, and propensity to binge … Continue reading →

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 →

Excessive, Obsessive, Compulsive? The Links Between OCD, OCPD and Excessive Exercise in Anorexia Nervosa

Andrea 10 Comments

Excessive exercise played a big role in my eating disorder and, predictably, I am drawn to studies that look at the role excessive exercise plays in eating disorder symptomatology, course and outcome. This topic has captured the interest of many eating disorder researchers, with studies revealing that up to 80% of individuals with anorexia nervosa may exercise excessively (Davis et al., 1997), though others suggest more modest statistics, around 39% (Shroff et al., 2006; Tetyana wrote a post about this article here).

Scholars have also noted the potentially obsessive and compulsive nature of exercise among some individuals with eating disorders and have made the natural transition toward examining whether links exist between excessive exercise and obsessive-compulsive disorder (OCD) and/or obsessive-compulsive personality disorder (OCPD) traits (If you are confused about the difference between OCD and OCPD, click here). Young, Rhode, Touyz & Hay (2013… 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 →

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 →

Beyond Simple Solutions: The Need for Complex Ideas in Anorexia Nervosa

Andrea 44 Comments

I often hesitate to make broad, sweeping claims about the nature, cause, and experience of eating disorders and disordered eating. However, if there is one thing I feel absolutely certain saying about these disorders, it is that they are incredibly complex and multifaceted with no “one-size fits all” solution. So, I was quite excited when I came across a recent article by Michael Strober and Craig Johnson (2012) that explores the complexity of eating disorders and their treatment. Both authors have significant clinical experience treating eating disorders.

This article uses cases studies, literature, and the authors’ collective clinical experience to respond to some of the key controversies surrounding anorexia and its treatment. Among the major controversies that have come to light of late, they focus on two:

  1. Genetic/biological causation (Biologically-based mental illness – BBMI)
  2. Family-based treatment (FBT) as the best form of treatment for adolescents

The authors’ exploration of these … 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 →

Dancing Your Way to Recovery from Anorexia Nervosa

Andrea 9 Comments

The idea of including dance and movement in interventions for eating disorders may seem somewhat controversial; generally, exercise and physical activity are discouraged for individuals recovering from eating disorders. Including dance in therapeutic interventions might raise a few eyebrows given the links between appearance-oriented athletic endeavors such as ballet and gymnastics and the development of eating disorders.

However, some therapists and scholars interested in alternative therapies for eating disorders have suggested that certain forms of movement therapy may help individuals with eating disorders connect to their bodies in a different, more positive way.

In 2011, two such scholars from Portugal, Padrão & Coimbra, published a 6-month pilot intervention for individuals hospitalized for anorexia nervosa (AN) based around body movement.

Their aims were twofold:

  1. Find out more about the links between body movement and bodily experience in individuals with AN
  2. Observe the ways in which individuals with AN move
… Continue reading →