Quantitative

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 →

History of Anorexia or Bulimia Nervosa? Are You Putting Your Unborn Child At Risk?

Tetyana 4 Comments

What is the effect of having had an eating disorder on pregnancy? And more specifically, are women who’ve had eating disorders more likely to experience perinatal and delivery complications?

Like with a lot of things, the information out there is mixed. (This is why one study is never enough and replication is crucial.) Early studies seemed to have suggested that women with EDs face an increased risk complications during the last stage of pregnancy and during delivery. On the other hand, subsequent studies done with larger clinical samples didn’t find any major differences between women with and without (a history) of eating disorders.

The authors summarize the current state of knowledge:

In short, the available evidence suggests that both active and past maternal [anorexia nervosa] may be associated with a decreased birth weight and that maternal ED might be associated with pregnancy and postnatal complications. Methodological limitations of previous

… Continue reading →

Eating Disorders Among Lesbian and Bisexual Women

Tetyana 9 Comments

The hardest part of science blogging is picking an article to blog about. In times when I’m indecisive–when I spend hours sifting through the literature, inevitably creating several draft posts before deciding each article isn’t interesting enough–I turn to the list of topics that have been suggested by readers. The last suggestion I received was “eating disorders in the lesbian community.” It is a great suggestion, but I thought my search wouldn’t turn up much. But, to my surprise, it did turn up some studies.

But please, don’t expect too much: it is not a well-studied area, and most of the data comes from self-reported questionnaires, which are not particularly reliable:

  • First, there’s selection bias: the 50% or so of people who return the surveys could be different in significant ways from the 50% that don’t. For example, in a survey about mental health, perhaps individuals that have
… Continue reading →

Can Socioeconomic Status Predict Mental Health Literacy?

Tetyana 3 Comments

Is there an association between socioeconomic status (SES) and mental health literacy? Can we predict the extent of an individual’s knowledge about mental disorders based on how much money they make, how much education they’ve received, or how far up the career ladder they’ve climbed?

That is the question that Olaf von dem Knesebeck and colleagues attempted to answer in a paper published recently in the journal Social Psychiatry and Psychiatric Epidemiology. 

The authors interviewed 2,014 men and women, residents of two German cities Hamburg and Munich, using a telephone survey. The split is roughly 50/50 between men and women respondents and the mean age was 47.5. The authors presented each interviewee with two vignettes out of three (one on depression, one on schizophrenia, and one on eating disorders).

The gender in the depression and schizophrenia vignettes was varied 50/50 between male and female patients, but all vignettes about eating … Continue reading →

Maintaining Change Following Intensive Eating Disorder Treatment

Gina 9 Comments

It is a relatively well known fact that eating disorders have a high relapse rate and many people, myself included, find themselves in multiple intensive – residential, inpatient, even partial hospitalization – treatments. One may ask if such intensive treatments really work or if long term intensive care is just a band-aid of sorts. I know I’ve had to ask myself, “why is this going to work this time when it hasn’t worked in the long run before.”

There is even debate in the field on whether residential treatment actually has evidence supporting its effectiveness (see Tetyana’s post here). I can speak from experience that the various intensive treatments I’ve personally done have saved my life and given me more perspective, skills training, and support than I could have had otherwise. However, despite having made significant changes, I’ve had more than my share of slips and relapses.

I … 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 →

Emotion Recognition and Regulation in Anorexia Nervosa

Tetyana 1 Comment

Should anorexia nervosa (AN) – or subtypes of AN – be classified as part of the autism spectrum disorders (ASD)? That’s a question that has been receiving some attention in the literature in the last few years, although there are only a handful of studies, most of which are small and limited in scope (thus limiting interpretation of the results).

In the Time Magazine article  “A Genetic Link Between Anorexia and Autism?” the author mentions a study – which I decided to cover today – on emotion regulation and recognition in patients with AN. It is not directly evaluating the link between AN and ASD, but it is related and a good starting point. I was originally going to write about two papers, but I will save the other one  (Is anorexia nervosa a version of autism spectrum disorders?) for another time.

The study design in this paper … Continue reading →

Devil in the Details: Can Poor Cognitive Function be Attributed to Anorexia Nervosa Patients’ Obsession with Detail?

Gina 9 Comments

Hi all, Gina here, again. This article is short and sweet, as is my post. I’m becoming increasingly interested in some of the more cognitive aspects of eating disorders and seeing as my background on the subject is pretty limited (re: none, although I’m taking a cognitive science class this term), I was hoping to generate some discussion /or references from readers that I could incorporate into further posts. Cheers!

It has long been suggested that people with eating disorders (in this case, specifically anorexia nervosa) display some core deficits in cognitive ability — namely impairments in executive function (Fassino et al., 2002; Pendleton Jones et al., 1991; Tchanturia et al., 2001, 2002, 2004).

If you’re like me and don’t study cognitive science, executive function basically means that people with AN show abnormal mental rigidity, working memory, capacity to manage impulsive responses (response disinhibition) and abstraction skills (i.e. abstract thinking, … Continue reading →

Financial Burden of Bulimia Nervosa: Cost of Food, Laxatives, Diuretics, and Diet Pills Adds Up

Tetyana 12 Comments

The financial burden of bulimia nervosa can be substantial, and yet little is known about the monetary costs associated with bulimic symptoms. At least little is known in academic circles – there is definitely a lot of anecdotal evidence floating around the internet. I found just one paper from 2009 by Scott J. Crow and colleagues. I stumbled upon it accidentally, actually. I was searching for articles on the economic burden of eating disorders (treatment cost, productivity loss, etc..) for a post I’m planning, but I thought I’d write about this in the mean time.

It is a short paper but I think it is important because it highlights an often overlooked issue.

The method Crow et al used to evaluate how much money individuals with bulimia nervosa spend on food, laxatives, diuretics and diet pills is simple (keep in mind, this hasn’t really been done before). Essentially, they asked … Continue reading →

Should Insurance Companies Cover Residential Treatment for Eating Disorders?

Tetyana 48 Comments

Should insurance companies cover residential treatment for eating disorders?  The price tag is high, about $1,000/day on average, but evidence of treatment effectiveness  is astonishingly low. Practically nil, as I’ve recently discovered. Despite spending my free time punching away different keywords into the PubMed search bar, I came up with very little. And you know what I think? I think treatment centers should be embarrassed. And I think, wow, maybe insurance companies have a point? (A scary thought! I don’t actually think they do, though – but then, I just can’t wrap my head around for-profit healthcare, having lived all my life with socialized healthcare, and loving it.)

Carrie over at ED-Bites recently blogged about the fact that there a dearth of evidence-based treatment for eating disorders. It is a complicated issue, I know, but I do think that any organization or center that offers treatment (especially … Continue reading →