Psychiatry

Characteristics of Women with Midlife-Onset Eating Disorders

Tetyana 4 Comments

Since the late 1990’s, Remuda Ranch Program for Eating Disorders has experienced a 400% increase in patients 40 years of age and older, according to the authors of this paper. However, we don’t really know what the similarities and differences are between women who develop eating disorders in adolescence and those who develop their eating disorders in midlife (40-65 years of age).

It has been theorized that EDs in midlife may be triggered by midlife transitions, such as loss of parents, siblings, or children; divorce; traumatic illness; and empty nest syndrome (Harris & Cumella, 2006; Maine & Kelly, 2005; Shellenbarger, 2004). […] Two quantitative studies found a high correlation between the fear of aging and disordered eating in older populations (Gupta, 1995; Lewis & Cachelin, 2001).

In this paper, Edward Cumella and Zina Kally present a summary of 50 women who first developed eating disorders at the age of 40 … Continue reading →

Self-Harm is Common Among Adolescents With Eating Disorders

Tetyana 6 Comments

Self-harm or non-suicidal self-injury (SI) are common among adolescents, particularly among adolescents with eating disorders. Previous studies have shown that SI seems to be associated with sexual trauma, mood disorders, and substance abuse. The present study aimed to find out whether (1) SI is associated with any specific eating disorder symptoms, such as bingeing, or purging, and (2) how often clinicians screen for SI behaviours (and whether particular patients are more likely to be screened than others).

Dr. Rebecka Peebles and colleagues looked retrospectively at intake evaluations of 1,432 patients between the ages of 10-21 (mean age 15). Three quarters of the patients were Caucasian, and slightly over 9% were male.  Sixty-three percent had an intake diagnosis of eating disorder not otherwise specified (EDNOS).

MAIN FINDINGS FOR AIM 1

  • Of those screened for SI behaviours, 40.8% engaged in SI
  • Cutting was the most common SI behaviour reported (85%)
  • Bingeing/purging was
… 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 →

3 Personality Subtypes in Eating Disorder Patients: Which One Fits You?

Tetyana 10 Comments

Scientists love classifying and categorizing things they study. But it can be a double-edged sword. Classification can lead to new insights about etiology or new treatment methods. But classification can also hamper our understanding. For example, researchers like to classify and study anorexia nervosa and bulimia nervosa as if they are two wholly separate disorders, but clinicians know that most patients fluctuate between diagnoses, and as a result often fall into the eating disorder not otherwise specified (EDNOS) category.

Nonetheless, if we keep in mind that the way in which we classify things can be very artificial and may not necessarily reflect some fundamental truths about the subject matter, we can focus on extracting the insights gained from the classifications.

In the case of eating disorders, classifying patients into subtypes may be useful for developing successful treatment approaches suited for particular patient subgroups.

Previous research on this topic has identified … Continue reading →

Endophenotypes and Biomarkers in Eating Disorders: Genetic Underpinnings, Personality Traits, Vulnerabilities – Part 2

Saren 4 Comments

This post continues the discussion of the chapter on eating disorders by Carolina Lopez, Marion Roberts, and Janet Treasure from The Handbook of Neuropsychiatric Biomarkers, Endophenotypes and Genes (2009). Part 1 focused on neurotransmitter biomarkers, and this second part will focus on the neuropsychological biomarkers.

NEUROPSYCHOLOGICAL BIOMARKERS

Attentional biases

Attentional bias is the tendency for individuals to attend to or be distracted by emotionally relevant stimuli over neutral stimuli. Attentional biases have been observed in several studies:

  • Current AN and BN individuals showed bias towards food, body-related stimuli.
  • Past AN but not past BN showed bias towards body shape concerns.
  • Both current and “long-term recovered” AN showed “abnormally higher activation in the medial prefrontal and anterior cingulate cortices in response to food stimuli using fMRI [brain imaging]” (232)

These biases can be minimal but annoying: waiting in line at the pharmacy, staring into space and finding your focus … 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 →

Eating Disorders: Do Men and Women Differ?

Tetyana 9 Comments

Given that eating disorders disproportionately affect women, it is not unreasonable to assume that men differ from women in clinical presentation, personality and psychological characteristics. My guess would be that they differ. My reasoning is this: males and females grow up facing different pressures and expectations. Given that, I’d think there would be (perhaps only slightly) different risk factors that predispose men and women to develop eating disorders. Thus, I’d think that different groups of men and women (i.e. with different personality characteristics, psychiatric comorbidities, and life experiences) would be susceptible to EDs. (Hopefully that makes sense.) To answer that question, Dr. D. Blake Woodside and colleagues compared men with eating disorders vs. women with eating disorders vs. men without eating disorders.

Why are females much more likely to suffer from eating disorders than males? It appears that (at least) two arguments have been put forth:

One argument has been

… Continue reading →

Predictors of Diagnostic Crossover and Symptom Fluctuation in Eating Disorders

Tetyana 8 Comments

Symptom fluctuation and diagnostic crossover are common in eating disorder patients. A study by Eddy et al. (2008) – who followed patients over an average of 7 years – showed that crossover between subtypes and full-syndrome diagnoses is very common : of those initially diagnosed with anorexia nervosa, almost 73% crossed over to another diagnosis (between symptoms and to bulimia nervosa). More specifically, roughly 50% experienced fluctuation between subtypes (restricting, AN-R, and binge/purge type, AN-BP) and roughly 35% crossed over to bulimia nervosa (a subset experienced both). Of those initially diagnosed with bulimia, roughly 14% crossed over to AN-BP and of those, 3.91% crossed over to AN-R.

This finding (though, well-known to ED specialists and even more well-known to patients) has important implications for treatment. For example, CBT and anti-depressants seem to have positive results in bulimic patients, but not so much in anorexics. What then, about those that crossover … Continue reading →

Does Too Much Exposure to Thin Models Cause Eating Disorders? Anorexia, Bulimia in Blind Women

Tetyana 42 Comments

As many of you already know, Vogue has recently banned models that are “too-thin” (and “too young”). It is a big step in the right direction, no, a huge step, and one deserving an applause, that’s according to an article on allvoices.com. Cue a drop in the prevalence of eating disorders, right? The logic in most articles, whether implicit or explicit, seems to be: no more skinny models = no more girls aspiring to be like skinny models = no more eating disorders.

Health of models belonging to both genders has been a growing issue in the past, especially after the death of two models in 2006-2007 from what the doctors blame to their acute eating disorders. This important step by Vogue targets not just skinny models, but also the impact they have on the young minds of girls and boys by presenting an image of perfection that

… Continue reading →

EDs Don’t Discriminate: Psychiatric Comorbidity in Men with Eating Disorders

Tetyana

Eating disorders don’t discriminate, they just have a bias (more on this in the future). While the majority of eating disorder patients are females, males suffer from eating disorders as well. In fact, it is about, roughly, a 10:1 ratio.

Men tend to just keep quiet about it (and who can blame them, given the stigma women face, it only gets worse for the men.) But, on the inside, their experiences, thoughts, behaviours and recovery span the same spectrum.

There’s relatively little research out there on men with eating disorders, in large part due to the low prevalence rates which makes it harder to get a large enough sample size. So, you have to get creative, as the authors of this study did: they reviewed the prevalence of eating disorders and comorbid psychiatric disorders using data from the Veterans Affairs medical centers of male patients in the fiscal year of … Continue reading →