Treatment & Recovery

Dancing Your Way to Recovery from Anorexia Nervosa

Andrea 9 Comments

The idea of including dance and movement in interventions for eating disorders may seem somewhat controversial; generally, exercise and physical activity are discouraged for individuals recovering from eating disorders. Including dance in therapeutic interventions might raise a few eyebrows given the links between appearance-oriented athletic endeavors such as ballet and gymnastics and the development of eating disorders.

However, some therapists and scholars interested in alternative therapies for eating disorders have suggested that certain forms of movement therapy may help individuals with eating disorders connect to their bodies in a different, more positive way.

In 2011, two such scholars from Portugal, Padrão & Coimbra, published a 6-month pilot intervention for individuals hospitalized for anorexia nervosa (AN) based around body movement.

Their aims were twofold:

  1. Find out more about the links between body movement and bodily experience in individuals with AN
  2. Observe the ways in which individuals with AN move
… Continue reading →

Factors Associated with Recovery from Anorexia Nervosa

Tetyana 18 Comments

Why do some people recover anorexia nervosa relatively quickly while others seem to struggle for years or decades? Does it depend on the person’s desire to get better? Their willpower? How much they are willing to fight? Is it just that some try harder than others? Some might say yes, but most will correctly realize that the picture is much, much more complex.

We can spend hours talking about barriers to treatment, but in this post I want to talk about something slightly different, something perhaps that is perhaps less “obvious.”

Suppose a group of girls–all roughly the same age, same illness duration, same socioeconomic background and race–enter the same treatment facility. What determines why some will do well in treatment and continue to do well after discharge, whereas others will relapse immediately after discharge, and yet others won’t respond to treatment at all? We know that catching eating … Continue reading →

Patient Perspectives on Anorexia, Treatment, and Therapeutic Alliance

Andrea 5 Comments

Dear Science of Eating Disorders readers, please welcome Andrea, our newest contributor! Below is her introduction and first post.

Hello SEDs readers, my name is Andrea and I’m excited to be contributing to the blog. I have an undergraduate degree in sociology and I am currently a Masters student studying family relations and human development. My research is looking at the experiences of young women in recovery from eating disorders, and uses qualitative methods including narrative interviews and digital stories to explore stories of eating disorders and recovery. I am particularly interested in stories that fall outside of the “norm,” as I feel that we sometimes hear a limited, scripted story of what it means to be someone who has had and recovered from an eating disorder.

I myself am recovered from ED-NOS, and I am happy to be making meaning from my experiences by exploring eating disorders in an … 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 →

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 →

Deep Brain Stimulation for Severe Anorexia Nervosa

Tetyana 15 Comments

This week, a team of researchers from the University of Toronto published a paper in The Lancet describing the results of a small study using deep brain stimulation (DBS) to treat severe/chronic anorexia nervosa. Major news outlets, including the BBC, reported on the findings. A few people emailed and messaged me asking me to do a post about it (which is cool! I love it!). So here it is.

DBS is a surgical procedure that involves implanting an electrode that delivers electrical signals to the brain. DBS is used to treat Parkinson’s disease and other movement disorders with good success, and has recently been implicated in the treatment of OCD and depression as well. (This is a pretty good video explaining how DBS works for movement disorders. There’s lots of information online about how DBS works, so I won’t go into detail here.)

This is not the first … Continue reading →

Personality Traits after Recovery from Eating Disorders: Do Anorexia and Bulimia Patients Differ?

Tetyana 4 Comments

When we think about eating disorders, we tend to think about eating disorder subtypes: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder. A lot of previous work has shown that individuals with AN and BN tend to be anxious, depressed, perfectionistic, and harm-avoidant. Patients with AN also tend to score low on novelty-seeking, impulsivity, and self-directedness, whereas patients with BN score high on novelty-seeking and impulsivity. More recently, however, some researchers began to wonder if there was another way to categorize patients–not according to symptoms, but according to personality traits?

They identified three clusters of personality subtypes that seemed to “cut across” eating disorder diagnoses, outlined below (taken from a previous post):

Three Personality Subtypes in Eating Disorder Patients:

  1. “dysregulated/undercontrolled pattern: characterized by emotional dysregulation and impulsivity”
  2. “constricted/overcontrolled pattern: characterized by emotional inhibition, cognitively sparse representations of self and others, and interpersonal avoidance”
  3. “high-functioning/perfectionist pattern: characterized
… Continue reading →

Dopamine and Anorexia Nervosa: Tackling the Myths – Part IV (Treatment with Antipsychotics)

Tetyana 6 Comments

This is part IV in my mini-series on the role of dopamine in anorexia nervosa. In part I, I did a a little introduction on dopamine and dopamine signalling in the brain. In part II, I discussed preclinical studies using animal models to study the role of dopamine in AN. Finally, in part III, I talked about clinical studies using patients with AN to assess dopamine function. In this final post, I’ll review the evidence for using drugs that modulate the dopamine system in order to treat anorexia nervosa.

It is going to be short, because there’s really not that much evidence that any pharmacological agents help in treating anorexia nervosa. To quote the authors of this review study,

No single psychological intervention has shown clear superiority in treating adults with AN.

Most importantly,

… the first line of treatment for underweight patients with AN should be

… Continue reading →

Mobile Therapy: Using Text-Messaging to Treat Bulimia Nervosa

Tetyana 9 Comments

Cognitive-behavioural therapy (CBT) is one of the most commonly used approaches to treat bulimia nervosa, but even CBT (or any treatment) doesn’t work for everyone. Sometimes, even if CBT is helping, a weekly 50 minute therapy session is just not enough. Moreover, like with many other eating disorder treatments, dropout and relapse rates are high.

Although CBT is effective for 40–67% of patients, efforts are required to augment and improve  treatment to better serve individuals who drop out (0–33%), fail to engage (14%), or relapse (33%). The highest risk period for relapse is in the 6 months after treatment, with risk declining at 4-year follow-up. After 10 years, 11% of individuals originally diagnosed with BN continued to meet full diagnostic criteria for BN and 18.5% met criteria for eating disorder not otherwise specified.

What can be done to help the individuals that don’t benefit (or benefit fully) from CBT, or … Continue reading →

Extreme Medical Negligence: Failure to Feed Patients with Anorexia Nervosa

Tetyana 15 Comments

They are crazy stories, really. It is hard to believe they are true.

A 28-year-old woman with anorexia nervosa complained about weakness and nausea following the insertion of a feeding tube. Her gastroenterologist sent her to the emergency room (ER). The woman was in the emergency room for two days without receiving any food. She was discharged home after she was told her lab tests and X-rays came back normal.  Unfortunately, her X-rays weren’t normal. Her gastroenterologist determined she had a bowel obstruction and sent her back to the hospital. She lost a substantial amount of weight in those 3 days.

The second story is even worse.

A 26-year-old woman with a feeding tube was discharged prematurely from a residential facility. She began to feel dizzy and weak, and was admitted to a hospital. She did not receive any food for the 6 days she was there, despite extremely … Continue reading →