Mitchell

Excessive Exercise in Eating Disorders

Tetyana 20 Comments

Excessive exercise (EE) is common among eating disorder patients. Indeed, in the study I’ll write about today, 39% of patients engaged in EE. Previous studies have tried to find psychopathological and personality correlates of EE but the results have been inconsistent. Some studies have suggested that impulsivity and addictiveness are highly correlated with EE whereas others found that anxious and depressive traits were more closely associated.

In a retrospective case series study involving outpatients with AN and BN, Penas-Lledo et al. found higher levels of anxiety and depression… among those who were identified as exercising excessively. The authors claimed that exercise might serve to reduce anxiety and stress in individuals with AN. In a similar study with adolescent inpatients with AN, Holtkamp et al. found that anxiety significantly predicted variance in exercise levels. These investigators proposed that anxiety symptoms in combination with food restriction contributed to increased levels of physical

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Think You Are Not “Sick Enough” Because You Didn’t Lose Your Period? Read This.

Tetyana 1 Comment

Anonymous asked, “I’ve never lost my period. Weight restored I am naturally thin, but even at a BMI of 15 or so I always got my period (although it wasn’t always regularly). This makes me feel like I’m not actually sick because I hear about everyone losing their period.”

eatruncats replied: “To the anon who asked about losing periods: For all the times she worries about not being sick enough because she never lost her period, there are people who lost their periods at BMIs of 18, 19, and 20 who worry about not being sick enough because they never got to a BMI of 15. If you have an eating disorder, you are “sick enough.” Period.“

As it stands now, amenorrhea–or the loss of three consecutive menstrual cycles–is a diagnostic criterion for anorexia nervosa. Individuals who have not lost their periods are diagnosed with eating disorder not … Continue reading →

Chronicity in Eating Disorders: How Do We Define It and What Do We Do About It?

Tetyana 5 Comments

It comes as no surprise that the earlier eating disordered individuals receive treatment, the higher the likelihood that they will make a full recovery. In other words, the duration of the illness is inversely proportional with the likelihood of full recovery.

The problem is that a lot of eating disorders are not caught early. That a lot of people don’t have access to the treatment they need. Insurance will not cover it, their doctors don’t think it is a problem or won’t treat it, or there is simply no space. And even if there is space, and insurance will  cover it, dropout rates are incredibly high and treatment success is meager. The end result? Sometimes it is a success story – a full or partial recovery. But other times, the stories make headlines across the world, and not for good reason.

So then, what can we do about … Continue reading →

Predictors of Diagnostic Crossover and Symptom Fluctuation in Eating Disorders

Tetyana 8 Comments

Symptom fluctuation and diagnostic crossover are common in eating disorder patients. A study by Eddy et al. (2008) – who followed patients over an average of 7 years – showed that crossover between subtypes and full-syndrome diagnoses is very common : of those initially diagnosed with anorexia nervosa, almost 73% crossed over to another diagnosis (between symptoms and to bulimia nervosa). More specifically, roughly 50% experienced fluctuation between subtypes (restricting, AN-R, and binge/purge type, AN-BP) and roughly 35% crossed over to bulimia nervosa (a subset experienced both). Of those initially diagnosed with bulimia, roughly 14% crossed over to AN-BP and of those, 3.91% crossed over to AN-R.

This finding (though, well-known to ED specialists and even more well-known to patients) has important implications for treatment. For example, CBT and anti-depressants seem to have positive results in bulimic patients, but not so much in anorexics. What then, about those that crossover … Continue reading →

EDNOS, Bulimia Nervosa: As Deadly as Anorexia in Outpatients

Tetyana

Eating disorder not otherwise specified (EDNOS), the catch-all diagnosis for eating disorder patients that don’t neatly fit into the DSM-IV anorexia nervosa (AN) or bulimia nervosa (BN) categories, is often thought to be less severe. Patients with sub-threshold AN or BN (missing one or two criteria) fall into the EDNOS (a large proportion, perhaps the majority, of patients). The inherent assumption in the word sub-threshold is that the patient is not as sick. Symptom frequency and behaviours are not that bad.

Increasingly, research is showing otherwise (which comes as no surprise for those of us who have struggled with eating disorders).

One study that has illustrated this quite nicely was published in 2009 by Dr. Scott Crow and colleagues in the American Journal of Psychiatry. Given that most ED mortality research has focused on anorexia nervosa, Crow et al wanted to compare mortality (from all-causes and suicide specifically) in patients … Continue reading →

A Meta-Analysis of Mortality in Eating Disorders

Tetyana

You often hear that anorexia nervosa has the highest mortality rate of any psychiatric illness, but you might struggle to find the rates for bulimia nervosa or EDNOS. Even for AN, the most common cause of death is rarely reported and the reported rates often vary a lot (depending on the study (and the media outlet).

I wanted to find out what are: (1) the mortality rates in BN and EDNOS and (2) the common causes of death in these disorders.  A relatively recent meta-analysis (click here for some background, pros and cons of meta-analyses) of 36 studies, which addressed some of my questions, was published by Arcelus and colleagues.

They excluded studies that had less than 15 patients and/or <1-year follow-up.

SO, WHAT DID THEY FIND?

Mortality in Anorexia Nervosa:

  • 35 studies, mean follow-up time: 12.8 years (maximum 36.2), mean sample size was 361 (maximum 6009).
  • Total
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