2009

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 →

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 →

Endophenotypes and Biomarkers in Eating Disorders: Genetic Underpinnings, Personality Traits, Vulnerabilities – Part 2

Saren 4 Comments

This post continues the discussion of the chapter on eating disorders by Carolina Lopez, Marion Roberts, and Janet Treasure from The Handbook of Neuropsychiatric Biomarkers, Endophenotypes and Genes (2009). Part 1 focused on neurotransmitter biomarkers, and this second part will focus on the neuropsychological biomarkers.

NEUROPSYCHOLOGICAL BIOMARKERS

Attentional biases

Attentional bias is the tendency for individuals to attend to or be distracted by emotionally relevant stimuli over neutral stimuli. Attentional biases have been observed in several studies:

  • Current AN and BN individuals showed bias towards food, body-related stimuli.
  • Past AN but not past BN showed bias towards body shape concerns.
  • Both current and “long-term recovered” AN showed “abnormally higher activation in the medial prefrontal and anterior cingulate cortices in response to food stimuli using fMRI [brain imaging]” (232)

These biases can be minimal but annoying: waiting in line at the pharmacy, staring into space and finding your focus … Continue reading →

Endophenotypes and Biomarkers in Eating Disorders: Genetic Underpinnings, Personality Traits, Vulnerabilities – Part 1

Saren

There have been some interesting discussions on the F.E.A.S.T. Facebook group over the past month regarding the role of genetics, personality traits, environmental factors and their role (or lack thereof) in the development of eating disorders and their prognosis. A parent group may seem like an unlikely forum for several hundred-odd comment threads on etiology; however, what we (caregivers, patients or clinicians) believe to underlie these disorders naturally informs our attitudes, decisions and choices with regards to treatment and our relationship to the disorders themselves:

Is this something they will have to manage their entire life?
Does anyone ever fully recover?
I had bulimia as a young adult and now my son has an eating disorder, too – did I pass on “bad genes”, bad habits, or is it a coincidence?
Is her rigidity and anxiety merely a side affect of starvation, or should we treat those as an underlying … 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 →

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 →

Impulsivity in Eating Disorders is Associated with Bingeing/Purging

Tetyana 4 Comments

There is a marshmallow in front of you. Can you wait for twenty minutes, starring intently at the white, soft, cylindrical shaped sweet, to get another marshmallow? Or do you devour it right away, forgoing the opportunity to have two sweets?

I’d probably wait. But that’s only because I don’t like marshmallows, and would be in no rush to consume either one or two of them. What about you?

That’s the famous experiment that’s shown to many first year psychology undergrads (I, too, watched videos of little kids anxious waiting for 20 minutes, or not, in my first year psych class). It was designed to measure delayed gratification, in other words, are you able to wait, to get a reward, to delay gratification?

Leah recently asked whether studies have looked at delayed gratification in eating disorder patients. What I loved about her comment is that she included a hypothesis: “I … Continue reading →

Benefits of Starving and Why You Don’t Have a “Chemical Imbalance”

Tetyana 9 Comments

Most people hate starving, hate prolonged hunger and suck at dieting. Patients with anorexia nervosa (AN), on the other hand, excel in these areas. How can someone like being hungry? How are they able to exert such “self-control”  (as many non-ED people often say) over their food intake? Part of the answer might lie with serotonin. But don’t worry, there’s no “chemical imbalance” – it is much more complex than that.

In this post, I’m going to continue discussing the review article in Nature Neuroscience (2009) by Kaye et al., focusing on what is currently known or hypothesized about the role of serotonin in anorexia (reminder, findings Kaye et al focuses are specific to restricting-type AN and may not apply to AN-BP or BN).

BUT FIRST, A LITTLE NEUROSCIENCE

Serotonin (aka 5-hydroxytryptamine or 5-HT) is a neurotransmitter, meaning that it is a chemical messenger that cells in … Continue reading →

Symptoms in Anorexia: Cause or Consequence?

Tetyana 4 Comments

In 2009, Dr. Walter Kaye and colleagues published an article in the prestigious journal, Nature Neuroscience Reviews, titled “New insights into symptoms and neurocircuit function of anorexia nervosa”. [By anorexia nervosa, Kaye et al. limited themselves to restricting-type anorexics (AN-R), so some but not all findings may extend to bingeing-purging anorexics and bulimics] This review, which is lengthy and will take me a few posts to cover thoroughly, focuses on the “findings from pharmacological, behavioural and neuroimaging studies that contribute to the understanding of appetite regulation, reward, neurotransmitters and neurocircuits that are associated with AN.”

A striking feature of anorexia nervosa is the incredibly uniformity of traits and symptoms that patients experience, as well as the narrow range of onset. While the course of the illness varies from person to person, during the AN-R state, individuals exhibit very stereotypic presentation (and that, of course, may be due to malnutrition … Continue reading →

Gender Nonconformity, Transsexuality and Eating Disorders

Tetyana 9 Comments

Too many people still mistakenly believe that eating disorders are for the Mary-Kates, Nicole Richies and Lara-Flynn Boyles, or vain adolescent and teenage girls aspiring to be just like them. Actually, as I’ve blogged earlier, even male veterans in late middle age are not immune to struggling with anorexia and bulimia nervosa. All in all, males make up ~ 5-10% of all eating disorder sufferers.

But what about those that dread having to check off “male” or “female” on a data form? What about individuals who feel their gender identity is not the same as their assigned birth sex. Perhaps they were born in a female body, with two XX chromosomes, but they feel and prefer to think of themselves as males, or the reverse? There’s some research (albeit limited, due to the rarity of both gender dysphoria and eating disorders) that suggests these individuals face an increased risk … Continue reading →