Disclosure and Pathways to Treatment in Eating Disorders

We hear a fair bit about the length of time it can take to access eating disorder treatment. Delays are particularly distressing as the evidence points to better outcomes for those who receive timely care for their eating disorders (e.g. Treasure & Russell, 2011). We know about some of the potential barriers to care for eating disorders, including the lack of specialized services, the stereotypes and stigma that can impede formal and informal help-seeking, and the financial costs of seeking care not always covered by insurance. However, we know less about when people with eating disorders disclose their struggles, who they disclose to, and how this impacts their path to care.

When I was searching for articles related to treatment access for eating disorders, I came across a preliminary study published in 2012 by Gilbert and colleagues investigating disclosure of eating disorders and subsequent pathways to care. Because it is a brief report, I was curious to see whether others had taken the work in the “future directions” the authors suggest. However, I could find very few studies …

Reflecting on the 2015 International Conference on Eating Disorders

When I get back from conferences I always have this odd mix of elation and overwhelmedness. This is never more acute than when I return home from an eating disorder conference. I get back to my apartment, flop down on my couch, and revel in the silence- while stewing in my mind about everything that happened, how to make sense of it, and where to go from here.

Sometimes it takes a bit of time to really digest (apparently I can’t write about eating disorders without inadvertently using food or bodily metaphors!) all that went on. So, I appreciate your patience in waiting for this post. In case you don’t follow my incessant Tweeting, last week I was at the International Conference on Eating Disorders (ICED). Last year, I had my Science of Eds partner in crime with me, and the year before that she went solo (recaps here and here).

I’d like to begin by saying how wonderful it is to hear people talk favorably about the blog. I love blogging here, and I am so grateful to …

Not So Fast: Is There a Connection Between Religious Fasting and Eating Disorders?

I’ve always wondered about how being encouraged to fast for religious reasons might impact those who are vulnerable to eating disorders and those who already have eating disorders. I can’t imagine it would be easy to be around others who were fasting in the name of religion while struggling with an eating disorder. Equally, I can certainly see the dangers of participating in fasting for those who are predisposed to eating disorders.

Despite not being religious myself, however, I understand that fasting is important to some people who subscribe to religions that encourage the practice. So, how might we balance the potential dangers of fasting with the freedom of religious observance? And, what is the impact of religious fasting on individuals with eating disorders, or those developing eating disorders?

In this post, I’ll highlight some of the main findings from 2 studies about religious fasting and eating disorders: one quantitative study exploring the experiences of women in Bulgaria and one case series about eating disorders and Ramadan.

Fasting: Uniformly Negative?

It would be easy for me to say that no …

Pride Before a Fall: The Intertwining of Pride and Shame in Eating Disorders

Is there a link between eating disorders and shame? What about pride? Can understanding these emotions help us to understand how eating disorders develop, and how they are maintained? In reviewing literature for my specialization paper, I stumbled upon a qualitative study by Skarderud (2007) about the role of shame in eating disorders. I found the article quite interesting, so I fired up the “where was this cited” tool on my university library database and uncovered a wealth of studies looking at shame, pride, and eating disorders.

For the purposes of this post, I’ll comment on Skarderud’s study, also bringing in a longitudinal study by Troop & Redshaw (2012) that looks at general and bodily shame.

Shame and Pride

Skarderud, who uses a phenomenological approach in his study (meaning that he is trying to unearth the particularities of shame for those who experience it) sees shame as made up of both positive and negative elements. He states that “shame is something we want, and something we do not want” (p. 82), referring to how we (socially) …

Teacher, Learn Thyself: Critical Issues in School-Based Eating Disorder Prevention

Prevention programs for eating disorders abound, though many people I’ve talked to (mostly on Twitter, because that’s where I have a lot of discussions of this type) have expressed the sentiment that limited resources might be better spent on early intervention or treatment in general. Still, it isn’t hard to understand why we still optimistically aim for eating disorder prevention; of course we would rather stop eating disorders in their tracks, before they wreak havoc on the lives of people and their loved ones. I’ve written about my own take on the “is prevention possible” debate elsewhere, highlighting some of my concerns, as well as some more optimistic sentiments about truly systemic prevention efforts.

One of the things I am most concerned about is the fact that prevention tends to take place in the school context, delivered by teachers who may or may not know much about eating disorders themselves and whose “healthy eating” messages may do more harm than good. In this post I will look at 3 studies focusing on the role of teachers in delivering …

Of Binge Eating, Age, and Distress: Child-Adolescent vs. Adult Onset Binge Eating

I’m embarrassed to say that my knowledge around binge eating disorder (BED) is sorely lacking compared to my understanding of the prevalence, correlates, treatments for, experiences of, and recovery from anorexia nervosa, bulimia nervosa, and OSFED (I still prefer “EDNOS,” but I’ll go with DSM 5 here). I don’t think this knowledge gap is uncommon; I’ve seen BED mentioned as a passing note in many an article, despite a general awareness that BED is relatively common. In order to begin to fill this knowledge gap (allow me a little self-indulgence as I fill this knowledge gap “out loud,” here), I thought I’d do a little reading and writing around BED. I also look forward to engaging in the comments, if you’re more savvy than I in this realm.

We know that BED is relatively common; general prevalence ranges from 0.7-4% (Latner & Clyne, 2008). In certain samples, for example people pursuing obesity treatment, this prevalence rate jumps to 15-50% (Johnson, Spitzer & Williams, 2001) (note, of course, that this large discrepancy might be partially due to the …

Beyond Thinness: Men, Muscularity and Eating Disorders

Eating disorder research tends to focus on girls and women. Which makes sense: eating disorders disproportionately affect women. However, it isn’t just the research on eating disorders that focuses on women: it’s the entire history of eating disorders as a diagnosis. The first descriptions of anorexia nervosa by William Gull and bulimia nervosa by Gerald Russell were both based primarily on observations of female patients (although Russell did include two men). Therefore, it’s possible that our basic construction of eating disorders is based on a specifically female experience.

One example of this is the focus on weight loss as a cardinal component of eating disorders (barring binge eating disorder). This is often attributed to the pursuit of a “thin ideal” created by our culture; however, this thin ideal doesn’t necessarily apply to men. Whilst women encounter pressure to be thin, evidence suggests that men encounter pressure to be more muscular—a drive that by its nature would not necessarily be associated with the pursuit of weight loss (Olivardia, 2001).

The point at which this pursuit of muscularity becomes a …

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 5

We’ve begun to scratch the surface of the vast and growing literature on cultural context and eating disorders in the previous 4 posts in this series. Of course, as I reflected the other day, there could (maybe should?) be a blog solely devoted to this topic- each time I read another study in this area, it pulls me down the rabbit hole into another related area.

In what will be the last part of this series for now, I’ll review a study by Bennett, Sharpe, Freeman, and Carson (2004) on the request of Lisa LaBorde (via Twitter). The authors wanted to learn more about the presence (or lack thereof) of eating disorders in Sub-Saharan Africa, a context that they describe as less driven by the thin-ideal. This was, they suggest, the first thorough exploration of anorexia in sub-Saharan Africa, and so might reveal more about whether and how anorexia nervosa is present in area of the world that is differently positioned on the world stage than Western societies.

THE STUDY

Bennett et al. selected 2 high schools located …

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 4

The more I write about culture and eating disorders, the more I want to know. I keep finding more articles to add to the mix; I know I’m far from the first to be interested in how culture and eating disorders intersect, and for that matter, what counts as “culture.” Still, this has been a fascinating exploration so far! In case you’re curious, this is to be the second last post in the series, for now at least. There will be one more after this, about eating disorders in Ghana (from a Twitter request). In this post, I will continue to explore the “culture boundness” of eating disorders by looking at a study relating to eating disorders in Africa. In this study, Le Grange, Louw, Breen & Katzman (2004) illustrate how eating disorders have emerged in Caucasian and non-Caucasian adolescents in South Africa.

THE STUDY

Le Grange and colleagues set out to complicate the package picture of the eating disorder/culture-of-thinness relationship by exploring the emergence of eating disorders in groups traditionally presumed to be “immune” to eating disorders …

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 3

The articles I’ve looked at so far in this series (Becker, in part 1, and Keel and Klump in part 2) give us some insight into the idea that the link between “Western” societies and eating disorders is more complex than a simple matter of media exposure. But, having read these studies, I was still left a bit wanting in terms of unpacking that black box of “culture” that gets tossed around in scholarly and popular literature. What, exactly, are we talking about when we talk culture in eating disorders?

Rebecca Lester, who is quite a prolific social anthropologist and who has written about eating disorder treatment systems in the USA and Mexico, makes the argument that “culture” is too often used as an umbrella term for semi-related but not-entirely-synonymous factors. This makes me wonder: is it possible that in latching on to the media side of Becker’s findings, for example, there has been too little attention paid to the other systemic factors that are indeed tied to culture- but not culture as it is generally attended to?…