Anorexia Nervosa

Dopamine and Anorexia Nervosa: Tackling the Myths – Part II (Contradictory Findings in Preclinical Studies)

Tetyana 2 Comments

This is part II in my series of posts on the role of dopamine in anorexia nervosa. (You can find the first part, which covers the basics of dopamine signalling, here.) In this post I’m going to discuss the findings from preclinical studies (studies in animal models).

I don’t think I’ve talked about animal models of anorexia nervosa before on the blog, but believe or not, they exist. The most well-known one is called activity-based anorexia (ABA). ABA works like this: rats are simultaneously restricted in the amount of food they can eat and given access to a running wheel. As the rats experience a reduction in their caloric intake, they begin to spend more and more time running on the wheel. A similar model with basically the same premise is called starvation-induced hyperactivity. These models are thought to mimic both the restriction/weight-loss and excessive exercise components of anorexia … Continue reading →

Dopamine and Anorexia Nervosa: Tackling the Myths – Part I (Intro)

Tetyana 4 Comments

There is this prevalent myth on Tumblr eating disorder blogs that increased dopamine (DA) receptor activity or increased DA signalling causes anorexia nervosa. It has left me quite perplexed, as I have never come across a single paper that has shown increased DA activity causes anorexia nervosa. My research for this post also left me empty-handed. I have no idea where this myth comes from, but I thought I’d blog about what research on DA activity in anorexia has shown. This topic will take me a few (not necessarily successive) posts to cover. This first post is a very brief introduction to DA signalling.

First, what is dopamine?

DA is a neurotransmitter–a molecule that one neuron releases to another in order to send a signal. Dopamine is released from one cell (the presynaptic neuron) and binds to its receptors on the other (postsynaptic) neuron. There are five different DA receptors … Continue reading →

Extreme Medical Negligence: Failure to Feed Patients with Anorexia Nervosa

Tetyana 15 Comments

They are crazy stories, really. It is hard to believe they are true.

A 28-year-old woman with anorexia nervosa complained about weakness and nausea following the insertion of a feeding tube. Her gastroenterologist sent her to the emergency room (ER). The woman was in the emergency room for two days without receiving any food. She was discharged home after she was told her lab tests and X-rays came back normal.  Unfortunately, her X-rays weren’t normal. Her gastroenterologist determined she had a bowel obstruction and sent her back to the hospital. She lost a substantial amount of weight in those 3 days.

The second story is even worse.

A 26-year-old woman with a feeding tube was discharged prematurely from a residential facility. She began to feel dizzy and weak, and was admitted to a hospital. She did not receive any food for the 6 days she was there, despite extremely … Continue reading →

Anorexia Nervosa: Can We Blame The Season Of Birth?

Tetyana

You might have heard that individuals born between the months of June – August (or sometimes March – August) have a higher chance of developing anorexia nervosa. But is it true? A lot of studies have been done to investigate the question of whether a season of birth (or a month) correlates with a higher risk of anorexia or bulimia nervosa. The results are inconsistent, weak, and fraught with methodological problems.

But first, how could seasons (or the average temperature during birth, or conception) have an effect on the etiology of eating disorders? What’s the hypothesis?

There seem to be two main ideas (summarized in Winje et al., 2012):

  1. alterations in neuropsychological function as a result of sunlight exposure during gestation or postpartum, maternal infections during pregnancy, or nutritional changes (seasonal variation in nutrients, vitamins)
  2. alterations in fertility/reproductive patterns of the parents due to cultural influences, disordered eating in the
… Continue reading →

Are All Anorexia Nervosa Patients Just Afraid of Being Fat? – Part 2

Tetyana 7 Comments

If you’ve been reading this blog for a while (or literature on this topic) you know the answer is no. I’ve blogged about this before, but I think it is a topic that needs a lot more coverage because the myths that all anorexia nervosa patients are just afraid of being fat, that they lose weight just to be thin, and that thin models are to blame for AN are still very common.

As you’ll see, I am not claiming that this isn’t true for some patients. Instead, what I am claiming is that it is not true for all patients.

And a big personal goal of mine with this blog is to broad the conversation about eating disorders. Let’s get away from stereotypes and painting all anorexia nervosa or bulimia nervosa patients in the same light. Let’s instead have meaningful discussions about research on eating disorders, about … Continue reading →

What Makes a Good Nurse? Perspectives of Anorexia Nervosa Patients

Tetyana

Nurses can play an important role in facilitating recovery from anorexia nervosa, particularly in an inpatient or residential treatment setting. But what makes a good nurse from the patient’s perspective? More specifically, what qualities do adolescents with anorexia nervosa consider important and helpful during recovery?

The answer may seem obvious: understanding, empathetic, supportive, non-judgemental, and the like. But those are sort of general characteristics that apply to good friends, family members, partners, doctors, other healthcare professionals, and even teachers.

Joyce von Ommen and colleagues wanted to dig a little deeper than that. They wanted to find out what components of nursing care helped patients restore normal eating and exercise patterns.

In order to find out, they collected interviews from 12 female adolescent patients (mean age of 15, range from 13-17), who were discharged from a specialized eating disorder treatment centre within three months of the interview. The patients were diagnosed … Continue reading →

Weight Restored, Eating Well, But No Menses in Sight? Huh?

Tetyana 5 Comments

It is to be expected that the Diagnostic and Statistical Manual of Mental Disorders, at least when it comes to anorexia nervosa, relies heavily on measures that are hard to quantify and measure objectively. The big exception is amenorrhea: the absence of menses (commonly known as “periods”) for three consecutive months. As I’ve mentioned before, this criterion will be removed from the next edition of the DSM, thankfully. But for now, it is still there.

Perhaps because it is easy to measure objectively, the resumption of menses is often taken to be a marker of “health” and “recovery.”  It is a common goal in treatment for patients to reach a “menstruating weight.”

[Conversely, not losing one’s menstrual cycle is often perceived by the patient that they are not “sick enough.” Their eating disorder is not legitimate because clearly they are eating enough for their menstrual cycle to continue, and thus … Continue reading →

Should Anorexia Nervosa Patients Get the Flu Shot?

Tetyana 2 Comments

Is getting the flu shot a good idea if you have anorexia nervosa? Is it safe?

To be honest, I’ve never asked myself that question before. Last year, when I was underweight, I got a flu shot mainly because the laboratory where I am doing my graduate degree is in a hospital–the same hospital that was at the centre of the SARS epidemic in Toronto–and I didn’t want to put patients at risk. Sure, I spent most of my time staring at worms through a microscope (true story) but in the rare event I ventured outside for a coffee, I didn’t want to cough on newborn.

So I was kind of excited to find out the answer when someone asked me this question earlier today on tumblr. As expected, I didn’t find much information, but I did find one relevant paper published online in 2011 by Arne Zastrow and … Continue reading →

A Study Without a Control Group? Evidence for Enhanced Cognitive Behavioural Therapy for Adults with Anorexia Nervosa

Tetyana 7 Comments

Here’s a quick tip: when a study that purports to find evidence of treatment effectiveness–preliminary or not–doesn’t have a control group (a group that doesn’t undergo treatment but is otherwise similar to the group that does), you should raise your eyebrows. Or shake your head. Or roll your eyes. Whichever you prefer.

Why do we need a control group? If the treatment works, we will see improvement in the patients, so isn’t that evidence enough? Well, no.

[T]he whole idea of an experiment is to identify two identical groups of people and then to manipulate something. One group gets an experimental treatment, and one does not. If the group that gets the treatment (e.g., a drug, exposure to a violent video game) behaves differently than the control group that did not get the treatment, we can attribute the difference to the treatment – but only if we can rest assured

… Continue reading →

Is Anorexia Nervosa a Version of Autism Spectrum Disorders?

Tetyana 9 Comments

Patients with anorexia nervosa often have difficulties recognizing and regulating emotions. This  conclusion that is largely based on data from  common tests such as Reading the Mind in the Eyes assessing  emotion recognition, and questionnaires like Difficulties in Emotion Regulation Scale (DERS) assessing emotion regulation (see my post here).  Although that study compared currently ill patients with healthy controls (thus raising the possibility that the resulting data was due to the effects of starvation or due to the chronic nature of the ED  in the sample, ~7.5 year on average), there is some evidence that some of these difficulties persist post-recovery.

Individuals with autism (ASD, or autism spectrum disorders) also have difficulties with emotion recognition and regulation, leading some investigators to hypothesize that AN and ASD may share common etiology. Providing further support for this hypothesis are studies suggesting that AN might be overrepresented in ASD and … Continue reading →