Emotion Fluctuations in Anorexia and Bulimia Nervosa: A Rollercoaster or Not So Much?

Tetyana 2 Comments

Restricting, bingeing, and purging are powerful ways to regulate emotional states. However, these behaviours probably play different roles in emotional regulation. Whereas restriction is hypothesized to pre-empt the onset of highly emotional states, bingeing and purging is thought to act as a coping mechanism to deal with overwhelming emotional states once they’ve already been activated. 

In BN there is abundant evidence that the binge–purge cycle functions as a means of emotion regulation. Binging [and I would arguing purging too! ] facilitates a temporary suppression of painful self-awareness and helps the self to dissociate from painful emotions or to block negative affect as demonstrated in both laboratory studies and diary studies in daily life.

In AN, restrictive eating patterns have been linked with a narrowing of emotional functioning, flattening of affect and lack of outward display of emotion. As such, Waller, Kennerley, and Ohanian (2007) argue that both binge– vomit-cycle and

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The Benefits of Starving – Part II (Restricting Reduces Anxiety in Anorexia Nervosa)

Tetyana 10 Comments

What is different about anorexia nervosa sufferers that, in contrast to most dieters, enables them to maintain a persistent calorie deficit? Although no one can truthfully claim they know the full answer to that question, we do know that part of the answer most likely lies with serotonin (5-HT), a molecule that neurons use to communicate with each other.

I’ve written about serotonin in the context of anorexia nervosa before, so I’ll just do a brief summary of the important points here:

  • Serotonin has a lot of functions in the body; it plays a role in regulating appetite (satiety), sleep, mood, behaviour, learning and memory, and a variety of other things
  • Serotonin has been implicated in obsessionality, harm avoidance, and behavioural inhibition
  • Alterations in serotonin function have been linked to many disorders, including depression, OCD, anxiety, and eating disorders
  • Serotonin is made from tryptophan, an essential amino
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Body Image: Is It a Useful Concept? (Maybe Not So Much)

Andrea 6 Comments

I recently attended the International Society of Critical Health Psychology’s 8th Biennial Conference in Bradford, England. At the conference, I had the pleasure of attending many talks that challenged the way we approach health psychology. Luckily for me, there were several sessions that touched on issues of disordered eating and body image.

One such talk, a panel presentation with Hannah Frith, Sarah Riley, Martine Robson and Peter Branney, challenged attendees to re-think the way we approach body image. When I returned home, I immediately downloaded an article by Kate Gleeson and Hannah Frith (2006) that discusses this same idea and essentially begs the question: Is the concept of “body image,” as it is currently articulated, actually useful?

This might come off as a controversial question; after all, body image is central to many studies (and treatment programs) related to eating disorders. We’re told repeatedly … Continue reading →

CCK and the "Hunger Trap" in Anorexia Nervosa (Why Gaining Weight is Hard)

Tetyana 4 Comments

Cholecystokinin (CCK) is a digestive hormone that stimulates fat and protein digestion, and promotes the feeling of satiety. CCK is released after food consumption to promote digestion (by releasing digestive enzymes from the pancreas and stimulating bile secretion). In rats and monkeys, injection of CCK induces satiety, though it seems (from what I’ve skimmed), the extent to which CCK regulates food intake in humans is not well-established. Previous research on the role of CCK in anorexia nervosa (AN) has found conflicting results, in part because of methodological issues related to measuring levels of CCK. In a recent study, Cuntz and colleagues (2013, freely available online), having developed a better assay for measuring CCK, wanted to clarify its role in AN patients.

The authors had the following goals and hypotheses (I omitted one):

  • Objective 1: Compare CCK levels between AN patients and healthy controls before and after a meal
  • Objective
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Excessive, Obsessive, Compulsive? The Links Between OCD, OCPD and Excessive Exercise in Anorexia Nervosa

Andrea 10 Comments

Excessive exercise played a big role in my eating disorder and, predictably, I am drawn to studies that look at the role excessive exercise plays in eating disorder symptomatology, course and outcome. This topic has captured the interest of many eating disorder researchers, with studies revealing that up to 80% of individuals with anorexia nervosa may exercise excessively (Davis et al., 1997), though others suggest more modest statistics, around 39% (Shroff et al., 2006; Tetyana wrote a post about this article here).

Scholars have also noted the potentially obsessive and compulsive nature of exercise among some individuals with eating disorders and have made the natural transition toward examining whether links exist between excessive exercise and obsessive-compulsive disorder (OCD) and/or obsessive-compulsive personality disorder (OCPD) traits (If you are confused about the difference between OCD and OCPD, click here). Young, Rhode, Touyz & Hay (2013… Continue reading →

Why Banning Pro-Ana is a Bad Idea

Tetyana 5 Comments

Is banning content that is thought to “promote” eating disorders such as anorexia nervosa (pro-ana) a good idea? I want to put aside the question of whether the goal is even possible (I would argue that it is not) and focus instead on what might happen if pro-ana content is banned or threatened to be banned from mainstream social networks, blogging platforms, and web hosts.

If you only read mainstream news media, you might think that pro-eating disorder websites are evil communities seeking to lure unsuspecting young adolescents into a world of extreme dieting, lying, and who knows what else, all under the guise of being a “lifestyle.”

Well, as I’ve blogged before, the picture is not so simple:

Ultimately, it seems that the support on offer on pro-ana websites is—for all the scare stories about “purging tips” and users egging one another on with their latest BMIs—little more

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Perspectives of Siblings of Adolescents with Eating Disorders

Andrea 14 Comments

The experiences of siblings of individuals with eating disorders has received relatively little space in the academic literature to date. Several studies have revealed the disruptions in family life that can occur when a child has an eating disorder (for example, see Hillege, Beale & McMaster, 2005 and Perkins et al., 2004). On the other hand, some studies have shown that siblings of patients with chronic illnesses have both positive (personal growth, responsibility, increased empathy) as well as negative (worry, fear, resentment) experiences.

However, few studies have explored experiences of male siblings, older siblings, or siblings of adolescents with eating disorder not otherwise specified (EDNOS). Consequently, to help fill this gap, Areemit, Katzman, Pinhas & Kaufman (2010) conducted a mixed-methods study looking at experiences and quality of life among siblings of adolescents with eating disorders.

Twenty siblings were recruited from The Hospital for Sick Children in Toronto. … Continue reading →

The Enigmatic Persistence of Anorexia Nervosa

Tetyana 17 Comments

Anorexia nervosa was first described in the medical literature in 1689 by Richard Morton. It has been over 300 years since then and AN continues to be one of the deadliest psychiatric disorders. If not treated early, it runs the risk of becoming deeply entrenched and highly resistant to treatment.

Moreover, established treatments for related disorders like bulimia nervosa and depression, such as cognitive behavioural therapy and antidepressants, are rather ineffective in treating anorexia nervosa. Finally, even if significant physical and mental improvements are achieved in treatment, relapse rates for older individuals (even those in their 20s) remain high.

What makes anorexia nervosa so persistent and so hard to treat in individuals who develop it, particularly if it is not treated soon after onset? Why is recovery so hard?

In this paper, B. Timothy Walsh outlines a model based on cognitive neuroscience that attempts to answer these questions:

Its

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Hide or Seek? Social Support and Eating Disorders

Andrea 5 Comments

Social support has been noted as key in helping individuals with any number of health issues to cope with illness and even thrive in adverse situations (Sarason, Sarason & Pierce, 1990). Individuals with eating disorders may be encouraged, as an adjunct to treatment or even in the absence of formal treatment, to seek out social support to help with the day-to-day management of their disorder (Holt & Espelage, 2002). However, not everyone with an eating disorder seeks out social support; in fact, some may actively avoid seeking support during trying times. To find out more, Akey, Rintamaki & Kane (2012) examined social support seeking among men and women with eating disorders.

The authors interviewed 34 men and women, aged 18-53 (mean age 25) diagnosed with eating disorders and used grounded theory methodology (Glaser & Strauss, 1967) to analyze their data. As explained … Continue reading →

Comorbid PTSD and Eating Disorders: Can Treating One Improve The Other?

Tetyana 7 Comments

Women with bulimia nervosa are three times more likely to struggle with PTSD than women without eating disorders, according to a study by Dansky and colleagues (1997). In that study, 37% of individuals with bulimia nervosa had lifetime PTSD, compared to 12% of women without eating disorders. That’s almost two in five.

Treating eating disorders is hard, but treating eating disorders with comorbid conditions is way harder. There is no consensus, it seems, as to what disorder(s) to treat first, or whether they should be treated simultaneously:

Brewerton (2004) suggests that eating problems should be addressed prior to treating PTSD because bingeing and purging contribute to a state of physical and emotional dysregulation. Fairburn (2008), however, suggests that significant comorbid disorders be treated prior to beginning CBT for eating disorders.

The issue is quite complex,

For example, the presence of severe depression, of which hopelessness and difficulty

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