2013

The Sobering Reality (and the Silver Lining) of Treating Anorexia Nervosa in Adults: A Randomised Controlled Trial

Tetyana 5 Comments

The challenges of treating anorexia nervosa are plenty; some of these challenges — like low prevalence rate and high treatment dropout rate —  make conducting randomised controlled trials aimed at identifying effective treatment methods really hard as well.

So I was pretty excited about the recently published randomised controlled trial comparing focal psychodynamic therapy (FPT), cognitive behaviour therapy (CBT), and optimised treatment as usual in adult (a harder to treat demographic than adolescents) anorexia nervosa patients.

Reading the paper, I was pretty impressed with how good the study design was; I’m not going to go into all the nitty-gritty details, but if you have access to and the chance to read the paper, do it. You’ll appreciate, I think, the amount of effort that went into this.

THE STUDY

Patients were recruited from ten universities across Germany. They had to be adult females with a BMI between 15-18 and with … Continue reading →

How you doin'? Differences in Psychological Well-being Between Anorexia, Bulimia, and Binge Eating Disorder Patients

Tetyana 3 Comments

Good health is more than just the absence of illness; it is more than just the absence of dysfunction. Good health — that is, mental, social, and physical health — requires the presence of wellness, or the ability to function well.

In this respect, with regard to eating disorders, most research has focused on assessing (health-related) quality of life and subjective well-being of eating disorder patients, often focusing on things like body satisfaction, self-esteem, and positive and negative emotions. There is, however, another way to think about well-being. A model (and assessment scale) developed by Carolyn Ruff, called psychological well-being (also here), aims to assess specific dimensions of functioning that contribute to or make-up well-being. There are six such dimensions.

Ryff Scales of Psychological Well-being:

  1. self-acceptance (positive self-evaluation)
  2. a sense of continued growth and development
  3. a sense of purpose and meaning in life
  4. a sense of self-determination and autonomy
… Continue reading →

Clinical Utility of Weight Suppression in Bulimia Nervosa Treatment – Part II

Jackie 5 Comments

In this post I will continue my discussion on weight suppression in bulimia nervosa (click here to read Part I). Just in case you happen to be reading the posts out of sequence, I will summarize the main points of that entry:

  1. Weight suppression is the difference between one’s current body weight and highest adult body weight.
  2. It has been found that individuals with BN are on average well below their highest historical weights (i.e. they are weight suppressed).
  3. Many studies have consistently found positive associations between WS and the onset and maintenance of BN symptoms.

THE RELATIONSHIP BETWEEN WEIGHT SUPPRESSION AND WEIGHT GAIN DURING BN TREATMENT

Because most individuals with BN have undergone significant weight loss, this makes them susceptible to weight regain — much like obese individuals usually regain the weight they have lost. Indeed, evidence suggests that weight suppression predicts weight gain in individuals with … Continue reading →

Bingeing Because Food is Yummy: A Stepping Stone Toward Recovery from Anorexia and Bulimia?

Liz 8 Comments

This may sound counterintuitive at first, but I’m thankful for two aspects of my eating disorder, which I believe helped me make the choice to aim towards recovery: the development of binge eating after chronic food restriction and the physical inability to purge through self-induced vomiting. Like many individuals diagnosed with anorexia nervosa that go on to develop binge eating, I tended to choose high-fat foods and sweets as my “go-to” food items. I had always enjoyed such foods and was a notorious junk food aficionado as a young girl (way before any eating disorder symptoms developed). Once the bingeing behavior started, I couldn’t stop.

Sitting with the discomfort after a binge made me seriously consider whether this was something I could maintain for any lengthy period of time, and that’s when I started getting help. In a sense, I believe my affection for sweet foods, and propensity to binge … Continue reading →

Cognitive-Behavioural Therapy for Bulimia Nervosa in the “Real World”: What's the Evidence?

Tetyana

Cognitive-behavioural therapy (CBT) is commonly described as the evidence-based treatment for bulimia nervosa. But do the findings from nearly perfectly crafted trials, with stringently followed protocols and “ideal” participants apply to the “real world”? How generalizable are the findings from carefully selected participants to clinical populations where, for one, the prevalence of psychiatric comorbidities is relatively high?

In other words, CBT has been shown to be efficacious (i.e., it works in a controlled experimental research trial setting) but is it effective (i.e., does it work in a clinical setting where clients might have multiple diagnoses and complex needs)?

This is precisely the question that Glenn Waller and colleagues sought to answer. They wanted to see whether CBT would work in a “routine clinical setting, where none of the exclusion-and protocol-based constraints […] apply.”

PARTICIPANTS

Participants were recruited from a publicly-funded outpatient ED service in the UK. The only exclusion criteria … Continue reading →

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

… 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
… Continue reading →

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

… 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

… Continue reading →