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Attention Deficit Hyperactivity Disorder & Eating Disorders: Is There a Link?

Tetyana 6 Comments

Attention deficit hyperactivity disorder (ADHD), characterized by inattention, hyperactivity, and impulsivity, is a common childhood disorder. ADHD can often persist into adolescence and adulthood. The prevalence of ADHD is thought to be between 6-7% among children and adolescents and ~5% among adults (Willcutt, 2012).

Increasingly, evidence from multiple studies has pointed to comorbidity between ADHD and eating disorders (EDs). For example, one study found that young females with ADHD were 5.6 times more likely to develop clinical (i.e., diagnosable according to DSM-5) or subthreshold (i.e., sub-clinical) bulimia nervosa (BN) (Biederman et al., 2007). Another study found that found that 21% of female inpatients at an ED unit had six or more ADHD symptoms (Yates et al., 2009).

However, most previous studies are limited by the fact that they assessed comorbidity between ADHD and EDs among patients. This limits our ability to generalize these findings to community samples, where many may … Continue reading →

Not Just for Kids: Disordered Eating and Body Dissatisfaction in Midlife

Andrea

When I tell people I research eating disorders I generally get one of three reactions:

  1. They ask me how I got into this research
  2. They tell me a story about themselves or a friend/family member suffering from an eating disorder
  3. They share some knowledge they’ve gleaned at some point about what it looks like to have an eating disorder (often, “aren’t eating disorders most common in teenagers?”)

Those are without question the most common responses I get, ignoring the really horrible outliers. The last item reminds me that there are still extremely pervasive myths about what “having an eating disorder” looks like. Perhaps in an earnest effort to counter such myths, I am always scouring the literature for studies revealing the particularities of eating disorders amongst diverse individuals.

One such group, and one that has been getting more “press” of late is women in midlife. To scan the more recent … Continue reading →

Political Bodies: What is the Impact of National or Regional-Level Eating Disorder Prevention?

Andrea 1 Comment

When it comes to prevention, I’ve noticed a strong interest in working toward large-scale prevention initiatives. I’ve written about prevention before, noting the potential for unintended effects, as well as schoolgirls’ reactions to and acceptance of prevention interventions (here). But what about the larger scale efforts to prevent body image concerns and eating disorders?

Countries from the US to Australia to Israel have taken strides to implement initiatives aimed at improving national body image (a lofty goal? Perhaps.); you might have heard about bans on thin runway models and airbrushing, among other efforts. We know that eating disorders are not solely caused by thin-ideal internalization or bad body image; in fact, body image might not even be that useful of a concept for everyone, as I wrote about here.

However, improving body satisfaction could be a useful end goal in and of itself. Why not … Continue reading →

Energy Expenditure in Anorexia Nervosa Patients

Tetyana 7 Comments

How many calories do patients with anorexia nervosa need to eat to gain a kilo (2.2 lbs)? It seems like a simple question and one that we should have figured out a long time ago, given the importance (err, necessity) of refeeding and weight restoration in recovery from anorexia nervosa.

Unfortunately, research in this area has often led to contradictory results (see Salisbury et al., 1995 and de Zwaan et al., 2002 for reviews). Fortunately, a paper by Stephan Zipfel and colleagues (2013, freely available here) sheds light on one potential cause of the discrepancies.

But first, some definitions:

TDEE stands for total daily energy expenditure. TDEE has three components: resting energy expenditure (REE), dietary-induced thermogenesis (DIT), and activity-induced thermogenesis (AIT). The gold standard for measuring TDEE is through something called the doubly labelled water technique. REE is usually measured through indirect calorimetry. (These techniques were used in this … Continue reading →

For the Health of It: Disentangling “Healthy Eating” and “Orthorexia”

Andrea 14 Comments

When is “healthy eating” not so healthy? The line between “normal” and “pathological” eating behaviours is blurry, to say the least. For some time, researchers have been attempting to define a “new” category of eating disorders: orthorexia. This category would capture “obsessions” with “healthy eating” that are (presumably) not already captured in current diagnostic criteria for eating disorders.

If you’ve been reading my posts for a while, you might already know how I feel about the liberal sprinkling of the suffix “orexia” onto behaviours related to food, exercise and body image (see, for example, my post on “drunkorexia”). The problematics of language use and eating disorders are numerous; we tend to use diagnoses as currency in discussing eating disorders, often glossing over the intricacies of behaviours with food and exercise by lumping them into (continually shifting) diagnostic criteria.

Of course, labeling is necessary to a certain extent. Diagnoses can help … Continue reading →

Eating Disorder Awareness Week: Useful, Useless, or Worse?

Tetyana

National Eating Disorder Awareness Week came and went (in the US, anyway). Posters were shared, liked, and tweeted. Pretty (but often misguided) infographics made the rounds on the internet. Local ED groups visited schools and college campuses to educate students about eating disorders. To, you know, increase awareness. 

The thing is, awareness is not always a good thing. For one, as Carrie over at ED Bites mentioned, there’s a whole lot of misinformation masquerading as fact. And two, awareness campaigns, even when the information in them is correct, may have unintended consequences, like, for example, increasing stigma or self-stigma.

Moreover, not all approaches to increasing awareness or decreasing stigma are equally effective, and the effectiveness of a particular approach may differ depending on the population studied.

So, what about the effectiveness of EDAW? In 2012, Kathleen Tillman and colleagues published a study looking at … Continue reading →

Impossible Binaries? Eating Disorders Among Trans Individuals

Andrea 14 Comments

Recently I was doing some research for an upcoming (and very exciting)  endeavour that involves exploring eating disorders among LGBTQ individuals. As one does, I set about scouring the research literature in this area in the hopes of stumbling across some prior articles on which to hang my proverbial research hat.

As I sifted through the databases, however, my searches kept coming up short. After sending out a call to a list-serv enquiring about the state of the field in this area, I received many responses highlighting the gap that surrounds trans individuals in particular. While this is good news for arguing for the value in conducting research in this area, it is discouraging news when it comes to understanding and attending to the experiences of trans people with eating disorders.

All this is to say, it seems as though now is as good a time as any to dip … Continue reading →

Nothing to SCOFF at: Screening for Eating Disorders in the Emergency Room

Andrea

As many who have suffered from eating disorders know, these illnesses can often go unnoticed for years. Family members and friends might not be the only ones who don’t catch the signs and symptoms of EDs; doctors, too, may not identify the presence of an eating disorder. Whether or not sufferers desire to get help, the symptoms associated with eating disorders often lead many to present at doctors’ offices and emergency departments, suffering from “mysterious ailments.”

In a study by Dooley-Hash, Lipson, Walton & Cunningham (2012, 2013), 16% of youth 14-20 presenting to the emergency department screened positive for eating disorders. The researchers describe their study in two articles published in the International Journal of Eating Disorders in 2012 and 2013. For this post, I’ll focus on the 2013 article, which highlights the patterns of emergency department use of those who present with eating disorders.

Tetyana has previously written … Continue reading →

Setting a Target Weight: An Arbitrary Exercise?

Tetyana 10 Comments

Achieving a healthy weight is a major goal of anorexia nervosa treatment. Indeed, a healthy weight is often seen as a prerequisite for psychological recovery. The fact that weight restoration is a crucial component of recovery is uncontroversial, the problem arises when it comes to determining what constitutes a healthy weight. How are ideal, optimal, or goal weights set? And who gets to decide?

Despite its recognized importance, there’s surprisingly little consensus on how target weight should be determined. Moreover, as Peter Roots and colleagues found out, when it comes to inpatient treatment centres in the UK and Europe, there is little consistency too.

In a study published in 2006, Roots et al. examined how treatment centres determine, monitor, and use target weight in the treatment of adolescents with anorexia nervosa. They also wanted to know the centres’ expected rate of weight gain, how often patients were weighed, who was … Continue reading →

You Sure You Want to Eat That? Perceived Consequences of Eating & Its Relation to Recovery

Jackie 1 Comment

I recently had a total Aha! moment (or a why-didn’t-I-ever-think-of-it moment) when I had chanced upon a recently published article titled “Eating Expectancies in Relation to Eating Disorder Recovery” by Fitzsimmons-Craft and colleagues. The title caught my attention because I had never come across any research tying eating expectancies to eating disorders, though I was familiar with the concept from the health psychology and obesity literature. Eating, as a behaviour and as a mechanism, is incredibly complex, with many factors contributing to why and how we eat; eating expectancies are one such factor.

Expectancy theory, first proposed by Tolman (1932), suggests that expectancies, or assumptions about the consequences of various behaviours, develop as a result of one’s learning history (Smith et al., 2007). Such expectancies are thought to influence subsequent behavioural choices, with one acting to either increase the likelihood of reward … Continue reading →