It’s no secret that I am not a fan of primarily psychoeducational interventions for people with eating disorders (EDs). It irks me that the overall theory in implementing this kind of intervention seems to be: if they only knew what they were doing to their bodies, people with EDs would take better care of themselves. Of course I take issue with this idea – if knowing that EDs were harmful to one’s health was enough to make the changes needed to not have an ED anymore, far fewer people would be struggling.
In case you don’t know what I’m talking about, a psychoeducational program is one that focuses on educating people about a mental illness, including what qualifies as pathology, what the behaviours look like, what the harms are, and what possible interventions exist. To be fair, there are not that many examples of purely psychoeducational interventions for … Continue reading →
Identifying risk factors for eating disorder symptoms may help us develop more evidence-based prevention mentions. Personally not convinced that prevention is really possible with the types of individual-focused programs we have today, I would argue that identifying risk factors may at least help us determine which individuals should be screened in subsequent years. If they do develop eating disorders, they will hopefully be more likely to receive early intervention and treatment.
To identify predictors of eating disorder symptoms, Elizabeth Evans and colleagues (2016) conducted a longitudinal study that measured various putative risk factors at ages 7, 9, and 12 in a group of boys and girls. The authors also wanted to identify correlates of eating disorder symptoms at 12 years of age. They measured eating attitudes and dietary restraint, BMI, body dissatisfaction, and depressive symptoms.
- 516 participants; 262 girls and 254 boys
- all individuals were residents of Gateshead, located
… Continue reading →
This is part II of posts on why I am highly skeptical of the argument that we need to understand the genetic basis of eating disorders in order to improve outcomes. If you would like to leave a comment, please read Part I as well.
I worry about the implications of focusing on genetics and neurobiology in identifying causes of and solutions to eating disorders in the context of a neoliberal society.
When I was an adolescent, finding out that eating disorders have a genetic component alleviated my guilt. Coming across Dr. Walter Kaye’s research into the neurobiology of eating disorders — the hypothesis that the drive to restrict may be linked to and reinforced by serotonin systems in the brain (here, here, and here) — provided me with a plausible biological explanation for why restricting made me feel calmer. It meant my eating disorder was … Continue reading →
I no longer support genetics research into eating disorders. Okay, that’s not quite right: I no longer support genetics research into eating disorders under the pretense that it will improve treatment outcomes or prevent eating disorders. I just don’t believe it. Moreover, I think emphasizing the need for a genetic understanding of eating disorders shifts focus away from research and, more importantly, from actions, that can yield much greater benefits much quicker.
It wasn’t always like this. In my third (junior) year of university, I wrote a mini-review on the genetic and neurobiological etiology (cause) of anorexia nervosa. In it, I argued that “in order to improve recovery outcomes, more specific treatments based on genetic and neurobiological evidence need to be developed.” I concluded by writing,
However, with the advent of large-scale genetic databases and worldwide collaboration among researchers resulting in larger sample sizes, the future of AN research
… Continue reading →
I can’t help but think I often write more about the issues surrounding the general lack of treatment options for eating disorders that I sometimes neglect to comment on what is available. A part of this is that I would refer to myself as somewhat of a treatment modality atheist – I have the luxury of being someone who does eating disorder research but is not involved in directly treating those with eating disorders, and so I don’t need to specialize in one type of treatment. My bottom line tends to be that no one-size-fits-all, and that the type of treatment that works for someone will depend on so many factors (like their gender, ethnicity, socioeconomic status, body size, ability, even their politics to a certain extent) that I wouldn’t want to proclaim one type of treatment as king.
In spite of this treatment modality atheism (or perhaps because of … Continue reading →
I write a lot about systems-level change for eating disorders, and about how the services that we have available for eating disorders are severely lacking. What I tend to struggle with – though it’s something I’m working on – is how to actually MAKE the changes I’m advocating for. I always fear the tendency to get caught up in saying “this is how things should be,” when I know that eating disorders are so complex and multifaceted and that one size does not fit all when it comes to support. I also fear my experience and my story becoming “the” story about eating disorders and recovery; just because something worked for me does not mean it will work for others.
Surprisingly, despite a general discontent in the ED field with the service continuum, there are few studies that explore what kinds of changes might be made to eating disorder services … Continue reading →
There’s a growing acknowledgment that women/feminine-presenting people are not the only people who get eating disorders. Increasingly, headlines proclaim that “men get eating disorders too!” and note that the stereotype that eating disorders are a “girl thing” is tired and problematic. This is great – anything that breaks down the well-entrenched notion that only young, rich, skinny, white, cis- and hetero girls are the only ones to get eating disorders is a welcome move in my opinion.
However, are we just reinscribing gender norms and the focus on body image and body ideals in the way we talk about eating disorders in boys and men? I just finished reading an article by Wright, Halse & Levy (2015) asking just this question. The article provides a compelling argument for re-visioning how we talk about eating disorders amongst boys and men.
Wright, Halse & Levy explore discourses around eating disorders in … Continue reading →
There’s been a fair bit of talk lately (ok, always) about evidence in eating disorders. In addition to the evidence for certain types of treatment, there’s talk about evidence for causes of eating disorders, evidence for whether recovery is possible, and more. The framing I generally see advanced is that we need to be using evidence-based practice only; presumably, this evidence comes from scientific research. I don’t disagree, but in this post I’ll be writing about how science is never wholly objective and is situated in social context.
Let the record show that I love science. I love all kinds of science: biological science, genetic science, neuroscience, social science, you name it, I think learning and research and scientific methods are interesting. I can’t do all kinds of science; as Tetyana says, this blog itself has moved away from “science” as she originally intended it as I continue to dominate … Continue reading →
A single in-lab assessment of caloric consumption, loss, and retention during binge-purge episodes in individuals with bulimia nervosa (BN) is frequently cited as evidence that purging via self-induced vomiting is an ineffective strategy for calorie disposal and weight control (Kaye, Weltzin, Hsu, McConaha, & Bolton, 1993). These findings have been widely interpreted to mean that, on average, purging rids the body of only about half of the calories consumed, regardless of total quantity.
However, a closer examination of the study does NOT support the notion that purging is an ineffective compensatory behavior. Indeed, the findings of Kaye et al. (1993) would appear to have been both misunderstood and overgeneralized in the subsequent decades. This has important implications for therapeutic alliance in clinical practice as well as for understanding the nature of symptoms, metabolic processes, and physiological alterations in EDs.
The study included 17 individuals, all of … Continue reading →
For those of you who follow me on Twitter, you may have noticed that I was at the International Conference on Eating Disorders (ICED), the major yearly conference put on by the Academy for Eating Disorders, over the past few days. As I write this post, I am sitting in the San Francisco Airport trying to synthesize my experiences into what may or may not turn into an epic blog post.
Despite my extreme extroversion on the Internet, I actually live in a funny place where I’m continually balancing my innate criticality and training as critical health psychology graduate student with the desire for folks to like me. I see this playing out at conferences like ICED, where people’s opinions of me and my fitness to do this work matter. I am unable to sit in a session and not voice my perspectives on Twitter, but I’m also continually filtering … Continue reading →