Review

Is Anorexia Nervosa a Subtype of Body Dysmorphic Disorder?

Tetyana 11 Comments

Is anorexia nervosa a subtype of body dysmorphic disorder (BDD)? Well, probably not, but don’t click the close button just yet. In this post, I’ll explore the relationship between anorexia nervosa and BDD, and discuss how understanding this relationship might help us develop better treatments for both disorders. 

Despite the fact that there are obvious similarities between the disorders, studies exploring the relationship between BDD and AN are few and far between. In a recent paper, published in the Clinical Psychology Review, Andrea Hartmann and colleagues summarized the current state of knowledge in the field. The review compared clinical, personality, demographic, and treatment outcome features of AN and BDD. I’ll summarize the key points of the paper in this post.

(I will be focusing on the relationship between AN and BDD, as opposed to EDs and BDD, because that’s the scope of the review article.)

First, what is body … Continue reading →

Pills for Bites: The Alarming Link between Drug Abuse and Eating Disorders

Shelly 1 Comment

The association between drug abuse and eating disorders (EDs) is not new. Since the 1970s, doctors have reported higher incidents of self-medication and drug abuse in a subset of eating disorder patients. Drugs, in this context, cover everything from laxatives and diet pills, to alcohol and street drugs.

The association between drug use and EDs is not shocking; however, the extent of the problem is likely overlooked.

In a report detailing the most comprehensive review on the topic, the National Center on Addiction and Substance Abuse concluded: “Individuals with eating disorders are up to five times likelier to abuse alcohol or illicit drugs and those who abuses alcohol or illicit drugs are up to 11 times likelier to have eating disorders.”

The report is freely available online and I highly recommend reading the entire document.

SUMMARY OF MAIN FINDINGS

The link between drug use and eating disorders is strong:

  • Between
… Continue reading →

Family-Based Treatment for Adolescents with Anorexia Nervosa: Hype or Hope?

Tetyana 29 Comments

When it comes to eating disorder treatment, few (if any) approaches are as divisive as Family-Based Treatment, also known as the Maudsley Method (I’ll use the terms interchangeably) . When I first heard about Maudsley, sometime during my mid-teens, I thought it was scaaary. But, as I’ve learned more about it, I began to realize it is not as scary as I originally thought.

As a side-note: I know many people reading this post know more about Maudsley than I ever will, so your feedback will be very much appreciated, especially if I get something wrong. I should also mention that I never did FBT or any kind-of family treatment/therapy as part of my ED recovery. (I have done family therapy, but it was unrelated to my ED; it was a component of a family member’s treatment for an unrelated mental health issue.)

In this post, I want to … Continue reading →

Nonpurging Bulimia Nervosa: Where Does It Fit?

Tetyana 5 Comments

When most people think of bulimia nervosa, they think of binge eating and self-induced vomiting. While that is not incorrect, it is not the full picture either. In the current edition of the Diagnostic and Statistical Manual (DSM-IV), there are two subtypes of bulimia nervosa: purging (BN-P) and nonpurging (BN-NP). The difference lies in the types of compensation methods: patients with BN-P engage in self-induced vomiting, or the misuse of laxatives, diuretics, or enemas whereas patients with BN-NP use fasting or excessive exercise to compensate for binge eating.

How common in BN-NP? It is very hard to say. A small population-based study in Finland (less than 3,000 participants) found that 1.7% of the sample that bulimia nervosa, 24% had BN-NP (or 0.4% of the entire sample) (Keski-Rahkonen et al., 2009). (I couldn’t find much else on prevalence of BN-NP.)

Unfortunately, however, there’s been very little research on BN-NP.… Continue reading →

Diabulimia: A Dangerous Duet

Shelly 1 Comment

EDIT: I want to apologize for an oversight in this blog entry. Shelly and I forgot to mention Diabulimia Helpline in our list of organizations that help raise awareness and support sufferers with type 1 diabetes and eating disorders. Diabulimia Helpline is the only non-profit in the US dedicated to “education, support, and advocacy for diabetics with eating disorders, and their families.” I also want to highlight some services that Diabulimia Helpline offers: “a 24 hour helpline available via (425) 985-3635, an insurance specialist to walk clients and/or their parents through the complicated world of getting insurance to cover eating disorders, and a referral service to help people find the treatment centers, doctors, therapists, and counselors that would be a good fit for them on their road to recovery.” – Sincerely, Tetyana

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Type 1 diabetes (DMT1, or T1DM) is a lifelong disease often diagnosed in children or adolescents. … Continue reading →

Binge Eating: When Should We Call It An “Addiction”?

Liz 10 Comments

The recent New York City soda ban controversy has contributed to increased discussion about the “addictive” properties of sugar and its contribution to the obesity epidemic. While I do not deny that there is an overabundance of high-sugar/high-fat foods in the societal milieu, and that the rewarding properties of these foods encourages their overconsumption; I think it is a mischaracterization to refer to the typical overeating associated with the “obesity epidemic” as reflective of a widespread “sugar addiction” that millions have fallen prey to.

Stice, Figlewicz, Gosnell, Levine, and Pratt (2012) have recently released a review in Neuroscience and Biobehavioral Reviews entitled “The contribution of brain reward circuits to the obesity epidemic.” In the paper, the authors elegantly describe the overlap between food and drug rewards while also highlighting major differences.

BRIEF INTRO TO DOPAMINE SIGNALLING

Before discussing the parallels between food and drug rewards, we should first introduce some … Continue reading →

Eating Disorders in the Elderly

Tetyana 2 Comments

The first published case of a late-onset eating disorder (at the age of 40) was in 1930 by John M. Berkman. In 1936, John A. Ryle published a case study of an eating disorder in a 59-year-old woman. Just how common are eating disorders in late middle-age or elderly individuals?

One study of 475 community dwelling elderly women aged 60–70 years found that 3.8% met diagnostic criteria for eating disorders. A study of elderly Canadian women reported that symptoms of disordered eating were present in 2.6% of women aged 50–64 years, and in 1.8% of women aged 65 years or older (Gadalla, 2008). In an investigation of eating disorders in elderly outpatient males, a minority (11–19%) who were undernourished were found to have abnormal eating attitudes and body image, including inappropriate self-control around food (60%), unsuitable eating attitudes (26%), and distorted body image (3–52%) (Miller et al., 1991).

There aren’t … Continue reading →

Demystifying the Genetics of Eating Disorders – Part II

Tetyana

In my last post I talked about some methods that scientists use to study the genetics of eating disorders. I focused on a subfield of genetics called behavioural genetics (which you can think of as a field that attempts to understand, in part, the interplay of genetics and environment in behaviour). In this post I’ll shift gears and focus on molecular genetics. I’ll be working of the same review paper by Drs. Zerwas and Bulik (2011). Molecular geneticists study the structure and function of genes on a molecular level. For example, they try to understand how different mutations or alterations in the genetic code can affect protein function and lead to disease states.

GENETIC ASSOCIATION STUDIES

Genetic association studies are hypothesis driven. This means that researchers make a list of genes that are known to be involved in biological mechanisms or behaviours that are affected in eating disorders, such … Continue reading →

Demystifying the Genetics of Eating Disorders – Part I

Tetyana 9 Comments

Today I thought I’d take the time to do an overview of what researchers know about the genetics of eating disorders and try to clear up some common misconceptions. The bulk of the content in this blog post comes from a very nice review paper published in 2011 by Drs. Stephanie Zerwas and Cynthia Bulik on the genetics and epigenetics of eating disorders. In an effort to keep blog posts short, this will be a multi-part mini-series.

When it comes to the genetics of eating disorders, there are two main questions that research ask: What is the relative contribution of genetic factors to eating disorder behaviours? And what are those genetic factors? I’ll talk about research attempting to answer the first question in this post and the second question in my next post.

In order to understand the role that genetics plays in influencing eating disorder behaviours, researchers use family, … Continue reading →

Avoiding Refeeding Syndrome in Anorexia Nervosa

Tetyana 25 Comments

Refeeding syndrome (RS) is a rare but potentially fatal condition that can occur during refeeding of severely malnourished individuals (such as anorexia nervosa patients). After prolonged starvation, the body begins to use  fat and protein to produce energy because there are not enough carbohydrates. Upon refeeding, there’s a surge of insulin (because of the ingested carbohydrates) and a sudden shift from fat to carbohydrate metabolism. This sudden shift can lead to a whole set of problems that characterize the refeeding syndrome.

For example, one of the key features of RS is hypophosphotemia: abnormally low levels of phosphate in the blood. This occurs primarily because the insulin surge during food ingestion leads to a cellular uptake of phosphate. Phosphate is a very important molecule and its dysregulation affects almost every system in the body and can lead to “rhabdomyolysis, leucocyte dysfunction, respiratory failure, cardiac failure, hypotension, arrhythmias, seizures, coma, and … Continue reading →