Eating Disorders

How you doin'? Differences in Psychological Well-being Between Anorexia, Bulimia, and Binge Eating Disorder Patients

Tetyana 3 Comments

Good health is more than just the absence of illness; it is more than just the absence of dysfunction. Good health — that is, mental, social, and physical health — requires the presence of wellness, or the ability to function well.

In this respect, with regard to eating disorders, most research has focused on assessing (health-related) quality of life and subjective well-being of eating disorder patients, often focusing on things like body satisfaction, self-esteem, and positive and negative emotions. There is, however, another way to think about well-being. A model (and assessment scale) developed by Carolyn Ruff, called psychological well-being (also here), aims to assess specific dimensions of functioning that contribute to or make-up well-being. There are six such dimensions.

Ryff Scales of Psychological Well-being:

  1. self-acceptance (positive self-evaluation)
  2. a sense of continued growth and development
  3. a sense of purpose and meaning in life
  4. a sense of self-determination and autonomy
… Continue reading →

Clinical Utility of Weight Suppression in Bulimia Nervosa Treatment – Part II

Jackie 5 Comments

In this post I will continue my discussion on weight suppression in bulimia nervosa (click here to read Part I). Just in case you happen to be reading the posts out of sequence, I will summarize the main points of that entry:

  1. Weight suppression is the difference between one’s current body weight and highest adult body weight.
  2. It has been found that individuals with BN are on average well below their highest historical weights (i.e. they are weight suppressed).
  3. Many studies have consistently found positive associations between WS and the onset and maintenance of BN symptoms.

THE RELATIONSHIP BETWEEN WEIGHT SUPPRESSION AND WEIGHT GAIN DURING BN TREATMENT

Because most individuals with BN have undergone significant weight loss, this makes them susceptible to weight regain — much like obese individuals usually regain the weight they have lost. Indeed, evidence suggests that weight suppression predicts weight gain in individuals with … Continue reading →

HW vs. CW: Weight Suppression in Bulimia Nervosa – Part I

Jackie 7 Comments

HW. CW. LW. GW1. GW2. GW3. UGW.

If you have (or have had) an eating disorder (or dieted and used online forums), chances are you know what those acronyms mean. And if you have browsed blogs written by eating disorder sufferers, chances are you have come across these acronyms too. After all, they are a prominent feature of many such blogs.

If you are lost, I’ll fill you in: the acronyms stand for Highest Weight, Current Weight, Lowest Weight, Goal Weight 1/2/3, and Ultimate Goal Weight (UGW). Unsurprisingly, most individuals with eating disorders, much like dieters, like to keep track of their weight loss — that is, the difference between the highest weight, HW, and the current weight, CW.

Researchers call this difference weight suppression (WS, more specifically, the highest adult body weight) and one’s current weight). It … Continue reading →

The Art of Therapy: Using of Arts-Based Therapies in Eating Disorder Treatment

Andrea 7 Comments

Arts-based therapies are often used to supplement more “traditional” eating disorder treatment protocols in various different settings, ranging from individual therapy to inpatient units. However, as Frisch, Franko & Herzog (2006) note, no published research provides empirical support for the use of arts-based therapies for eating disorder treatment.

You might be wondering: if there is no empirical support, why are clinicians still using these therapeutic practices? You might also be wondering why I’ve chosen to dissect an article from 2006.

I’ll address the first question in this post (teaser: it’s really hard to say!). As for my delving back into the depths of academia, there is surprisingly little literature that touches on arts-based therapy, despite its continued use. This article provides an overview of why this might be, and where we can go from here.

WHAT IS ARTS-BASED THERAPY?

Arts therapy is an umbrella term used to refer … 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 →

Cognitive-Behavioural Therapy for Bulimia Nervosa in the “Real World”: What's the Evidence?

Tetyana

Cognitive-behavioural therapy (CBT) is commonly described as the evidence-based treatment for bulimia nervosa. But do the findings from nearly perfectly crafted trials, with stringently followed protocols and “ideal” participants apply to the “real world”? How generalizable are the findings from carefully selected participants to clinical populations where, for one, the prevalence of psychiatric comorbidities is relatively high?

In other words, CBT has been shown to be efficacious (i.e., it works in a controlled experimental research trial setting) but is it effective (i.e., does it work in a clinical setting where clients might have multiple diagnoses and complex needs)?

This is precisely the question that Glenn Waller and colleagues sought to answer. They wanted to see whether CBT would work in a “routine clinical setting, where none of the exclusion-and protocol-based constraints […] apply.”

PARTICIPANTS

Participants were recruited from a publicly-funded outpatient ED service in the UK. The only exclusion criteria … Continue reading →

Demystifying the Genetic and Environmental Influences on Disordered Eating

Tetyana 8 Comments

Genetics play an important role in the development of eating disorders and disordered eating behaviours. To date, many (over 30!) twin studies have been done and all but two found significant genetic effects on the development of eating disorders and disordered eating. However, no methodology is without limitations and tentative conclusions become more convincing when the findings are confirmed using different experimental approaches.

Twin studies, while they offer many advantages, are not that good when it comes to detecting shared environmental effects on a particular trait (literally, evens that happen to both twins and affect them in the same way). Fortunately, twin studies are just one of several different ways that researchers can use to study heritability. (A quick reminder: Heritability measures the amount of the variability in an observable trait/behaviour that can be attributed to genetic variation. This is NOT the same as stating … Continue reading →

The Impact of an Eating Disorder Prevention Program: The Girls’ Perspective

Andrea 8 Comments

Over the years, I have read a number of articles describing eating disorder prevention programs. Unfortunately, many reveal limited efficacy, and some even highlight detrimental effects. Primary among concerns of those evaluating prevention programs is that even when effective, we often have limited data about the long-term effects of prevention programs. This lack of follow-up limits the ability to draw conclusions about these initiatives and is cause for pause for those interested in implementing strategies to prevent eating disorders.

Further, there is some debate about whether eating disorders are even really “preventable.” Given our understanding of the complex etiology of these disorders, “prevention” can be a loaded word. The nature of the proposed intervention will undoubtedly be heavily swayed toward whichever factor(s) the program’s designer feels is most important in “causing” or contributing to disordered eating (i.e., Is the program tailored toward media awareness? Nutrition? Body image?)

I approached a … Continue reading →

Emotion Fluctuations in Anorexia and Bulimia Nervosa: A Rollercoaster or Not So Much?

Tetyana 2 Comments

Restricting, bingeing, and purging are powerful ways to regulate emotional states. However, these behaviours probably play different roles in emotional regulation. Whereas restriction is hypothesized to pre-empt the onset of highly emotional states, bingeing and purging is thought to act as a coping mechanism to deal with overwhelming emotional states once they’ve already been activated. 

In BN there is abundant evidence that the binge–purge cycle functions as a means of emotion regulation. Binging [and I would arguing purging too! ] facilitates a temporary suppression of painful self-awareness and helps the self to dissociate from painful emotions or to block negative affect as demonstrated in both laboratory studies and diary studies in daily life.

In AN, restrictive eating patterns have been linked with a narrowing of emotional functioning, flattening of affect and lack of outward display of emotion. As such, Waller, Kennerley, and Ohanian (2007) argue that both binge– vomit-cycle and

… 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 →